Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods

Noyes, Jane; Booth, Andrew; Moore, Graham; Flemming, Kate; Tunçalp, Özge; Shakibazadeh, Elham

doi:10.1136/bmjgh-2018-000893

Cited by 497Meta-analysis and systematic reviewsHealth Policy Implementation ScienceClinical practice guidelines implementation

Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods

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Noyes, Jane, Booth, Andrew, Moore, Graham, Flemming, Kate, Tunçalp, Özge, Shakibazadeh, Elham·2019·BMJ Global Health

DOI 10.1136/bmjgh-2018-000893PMC PMC6350750

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Abstract

Guideline developers are increasingly dealing with more difficult decisions concerning whether to recommend complex interventions in complex and highly variable health systems. There is greater recognition that both quantitative and qualitative evidence can be combined in a mixed-method synthesis and that this can be helpful in understanding how complexity impacts on interventions in specific contexts. This paper aims to clarify the different purposes, review designs, questions, synthesis methods and opportunities to combine quantitative and qualitative evidence to explore the complexity of complex interventions and health systems. Three case studies of guidelines developed by WHO, which incorporated quantitative and qualitative evidence, are used to illustrate possible uses of mixed-method reviews and evidence. Additional examples of methods that can be used or may have potential for use in a guideline process are outlined. Consideration is given to the opportunities for potential integration of quantitative and qualitative evidence at different stages of the review and guideline process. Encouragement is given to guideline commissioners and developers and review authors to consider including quantitative and qualitative evidence. Recommendations are made concerning the future development of methods to better address questions in systematic reviews and guidelines that adopt a complexity perspective.

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The first author read all charted data before coding each study's findings to preserve its original context and ensure that its findings could be fully understood without misinterpretation.
“the first author read all the charted data (including study aims, methods, and samples) before coding each study’s findings to preserve its original context and ensure that its findings could be fully understood without misinterpretation [39].”
From Experiences of Using Digital Mindfulness-Based Interventions: Rapid Scoping Review and Thematic Synthesis (2023) · cites this paper as [39]
The ‘Types of findings produced by specific methods’ section says that third-order interpretations preserve studies’ original context, and ‘Data extraction’ notes that a synthesis framework may arise from reading included studies early in a review. Neither passage specifies that a first author should read all charted data before coding, nor says that doing so ensures findings are understood without misinterpretation. No page numbers were available in our copy. (LLM, conf=0.82)
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Nursing students' professional identity development: An integrative review
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Application of IoT in Healthcare: Keys to Implementation of the Sustainable Development Goals
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A systematic review and framework for digital leadership research maturity in higher education
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A mixed‐studies systematic review of the experiences of body image, disordered eating, and eating disorders during the COVID ‐19 pandemic
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A review of the relationship between poverty and child abuse and neglect: Insights from scoping reviews, systematic reviews and meta‐analyses
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Psychological and interpersonal factors associated with sexualized drug use among men who have sex with men: a mixed-methods systematic review
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Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis
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Lessons from countries implementing find, test, trace, isolation and support policies in the rapid response of the COVID-19 pandemic: a systematic review
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A systematic scoping review and textual narrative synthesis of physical and mixed‐reality simulation in pre‐service teacher training
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Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review
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Promoting Physical Activity Through Conversational Agents: Mixed Methods Systematic Review
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Decolonising research approaches towards non-extractive research
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Social-ecological factors influencing loneliness and social isolation in older people: a scoping review
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A comprehensive guide to conduct a systematic review and meta-analysis in medical research
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Multi‐family therapy for eating disorders: A systematic scoping review of the quantitative and qualitative findings
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A systematic review of the educational experiences and needs of children with cancer returning to school
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Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice
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Reflections on project ECHO: qualitative findings from five different ECHO programs
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Dance for Chronic Pain Conditions: A Systematic Review
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Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study
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Effect of Pelvic Floor Symptoms on Women's Participation in Exercise: A Mixed-Methods Systematic Review With Meta-analysis
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Conducting and Writing Quantitative and Qualitative Research
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A Systematic Review of Augmented Reality in Health Sciences: A Guide to Decision-Making in Higher Education
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Complex health interventions in complex systems: improving the process and methods for evidence-informed health decisions
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Powered mobility interventions for very young children with mobility limitations to aid participation and positive development: the EMPoWER evidence synthesis
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A review of methods for addressing components of interventions in meta-analysis
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Towards remote leadership in health care: Lessons learned from an integrative review
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Registered nurses' perceptions of having a calling to nursing: A mixed‐method study
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Promoting women’s and children’s health through community groups in low-income and middle-income countries: a mixed-methods systematic review of mechanisms, enablers and barriers
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Understanding How the Design and Implementation of Online Consultations Affect Primary Care Quality: Systematic Review of Evidence With Recommendations for Designers, Providers, and Researchers
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Obstacles and opportunities to using research evidence in local public health decision-making in England
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Trust Amongst Refugees in Resettlement Settings: a Systematic Scoping Review and Thematic Analysis of the Literature
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The perspectives of patients with chronic diseases and their caregivers on self-management interventions: A scoping review of reviews.
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Hospital surge capacity preparedness in disasters and emergencies: a systematic review
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Facilitators and barriers of using digital technology for the management of diabetic foot ulcers: A qualitative systematic review
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Health service use among adults with cerebral palsy: a mixed‐methods systematic review
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End-of-Life Care Preferences of Older Patients with Multimorbidity: A Mixed Methods Systematic Review
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A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life
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A rollercoaster of emotions: An integrative review of emotions and its impact on health professional students' learning in simulation‐based education
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How does ethnicity affect presence of advance care planning in care records for individuals with advanced disease? A mixed-methods systematic review
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The Design, Content and Delivery of Relationship and Sexuality Education Programmes for People with Intellectual Disabilities: A Systematic Review of the International Evidence
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The global impact of the COVID-19 pandemic on clinical radiography practice: A systematic literature review and recommendations for future services planning
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Integrated malaria prevention in low- and middle-income countries: a systematic review
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An integrative review of the factors influencing older nurses’ timing of retirement
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The use of GRADE-CERQual in qualitative evidence synthesis: an evaluation of fidelity and reporting
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A meta-ethnography of autistic people’s experiences of social camouflaging and its relationship with mental health
Field, S. L., Williams, M. O., Jones, C. R. G., & Fox, J. R. E. (2024) · Autism · doi:10.1177/13623613231223036 · Cited by 45 · see citing works
Social Needs Resource Connections: A Systematic Review of Barriers, Facilitators, and Evaluation
Steeves-Reece, A. L., Totten, A. M., Broadwell, K. D., Richardson, D. M., Nicolaidis, C., & Davis, M. M. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2021.12.002 · Cited by 47 · see citing works
Five common pitfalls in mixed methods systematic reviews: lessons learned
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Facilitators of and Barriers to Accessing Hospital Medical Specialty Telemedicine Consultations During the COVID-19 Pandemic: Systematic Review
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Disrespect and abuse as a predictor of postnatal care utilisation and maternal-newborn well-being: a mixed-methods systematic review
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Prosocial Interventions and Health Outcomes
Byrne, M., Tan, R. K. J., Wu, D., Marley, G., Hlatshwako, T. G., Tao, Y., Bissram, J., Nachman, S., Tang, W., Ramaswamy, R., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.46789 · Cited by 43 · see citing works
Methods for data extraction and data transformation in convergent integrated mixed methods systematic reviews
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A systematic review, umbrella review, and quality assessment on clinical translation of stem cell therapy for knee osteoarthritis: Are we there yet?
Shang, Z., Wanyan, P., Zhang, B., Wang, M., & Wang, X. (2023) · Stem cell research & therapeutics · doi:10.1186/s13287-023-03332-5 · Cited by 34 · see citing works
Psychosocial support interventions to improve treatment outcomes for people living with tuberculosis: A mixed methods systematic review and meta-analysis
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Adaptation and continuous learning: integrative review of coping strategies of palliative care professionals
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The Influence of Patient–Provider Communication on Self‐Management Among Patients With Chronic Illness: A Systematic Mixed Studies Review
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Knowledge, attitudes and practices concerning catheter‐associated urinary tract infection amongst healthcare workers: a mixed methods systematic review
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Non‐restrictive interventions to reduce self‐harm amongst children in mental health inpatient settings: Systematic review and narrative synthesis
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Interventions to Prevent Potentially Avoidable Hospitalizations: A Mixed Methods Systematic Review
Lyhne, C. N., Bjerrum, M. B., Riis, A. H., & Jørgensen, M. J. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.898359 · Cited by 42 · see citing works
Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review
Darlington, C. K., Clark, R. R. S., Jacoby, S. F., Terplan, M., Alexander, K., & Compton, P. A. (2023) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2023.110944 · Cited by 37 · see citing works
‘A certain magic’ – autistic adults’ experiences of interacting with other autistic people and its relation to Quality of Life: A systematic review and thematic meta-synthesis
Watts, G., Crompton, C. J., Grainger, C., Long, J., Botha, M., Somerville, M., & Cage, E. (2024) · Autism · doi:10.1177/13623613241255811 · Cited by 36 · see citing works
Peer support for people living with rare or young onset dementia: An integrative review
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Policy gaps and opportunities: A systematic review of autism spectrum disorder and criminal justice intersections
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Research and evidence-based practice in clinical radiography: A systematic review of barriers and recommendations for a new direction
Balushi, H. A., Watts, H., & Akudjedu, T. N. (2024) · Radiography · doi:10.1016/j.radi.2024.01.012 · Cited by 36 · see citing works
Experiences of Using Digital Mindfulness-Based Interventions: Rapid Scoping Review and Thematic Synthesis
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A systematic review of mindset interventions in mathematics classrooms: What works and what does not?
Bui, P., Pongsakdi, N., McMullen, J. A., Lehtinen, E., & Hannula‐Sormunen, M. M. (2023) · Educational Research Review · doi:10.1016/j.edurev.2023.100554 · Cited by 44 · see citing works
The language of behaviour changes in dementia: A mixed methods survey exploring the perspectives of people with dementia
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Use, adoption, and effectiveness of tippy-tap handwashing station in promoting hand hygiene practices in resource-limited settings: a systematic review
Mbakaya, B. C., Kalembo, F. W., & Zgambo, M. (2020) · BMC Public Health · doi:10.1186/s12889-020-09101-w · Cited by 32 · see citing works
Knowledge, perceptions and experiences of nurses in antimicrobial optimization or stewardship in the intensive care unit
Padigos, J., Reid, S. A., Kirby, E. R., & Broom, J. K. (2020) · Journal of Hospital Infection · doi:10.1016/j.jhin.2020.12.003 · Cited by 33 · see citing works
Non-pharmacological interventions for sleep disturbances in people with dementia
Wilfling, D., Calo, S., Dichter, M. N., Meyer, G., Möhler, R., & Köpke, S. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011881.pub2 · Cited by 59 · see citing works
Maintaining cultural identity: A systematic mixed studies review of cultural influences on the self‐care of African immigrants living with non‐communicable disease
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The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review
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The impact of strike action on healthcare delivery: A scoping review
Essex, R., Ahmed, S., Elliott, H., Lakika, D. M., Mackenzie, L., & Weldon, S. M. (2022) · The International Journal of Health Planning and Management · doi:10.1002/hpm.3610 · Cited by 29 · see citing works
Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review
Evans, R., MacDonald, S., Trubey, R., Noyes, J., Robling, M., Willis, S., Boffey, M., Wooders, C., Vinnicombe, S., & Melendez-Torres, G. J. (2023) · Systematic Reviews · doi:10.1186/s13643-023-02260-y · Cited by 29 · see citing works
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Recommendations for culturally safe clinical kidney care for First Nations Australians: a guideline summary
Tunnicliffe, D. J., Bateman, S. M., Arnold‐Chamney, M., Dwyer, K. M., Howell, M., Gebadi, A., Jesudason, S., Kelly, J., Lambert, K., Majoni, S. W., et al. (2023) · The Medical Journal of Australia · doi:10.5694/mja2.52114 · Cited by 29 · see citing works
Challenges in heart failure care in four European countries: a comparative study
Steiner, B., Neumann, A., Pelz, Y., Ski, C. F., Hill, L., Thompson, D. R., Fitzsimons, D., Dixon, L., Brandts, J., Verket, M., et al. (2023) · European Journal of Public Health · doi:10.1093/eurpub/ckad059 · Cited by 28 · see citing works
A systematic review of the impact of chronic pain on adolescents' school functioning and school personnel responses to managing pain in the schools
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Characterizing social-ecological context and success factors of antimicrobial resistance interventions across the One Health spectrum: analysis of 42 interventions targeting E. coli
Léger, A., Lambraki, I. A., Graells, T., Cousins, M., Henriksson, P. J. G., Harbarth, S., Carson, C. A., Majowicz, S. E., Troell, M. F., Parmley, E. J., et al. (2021) · BMC Infectious Diseases · doi:10.1186/s12879-021-06483-z · Cited by 27 · see citing works
Training and expertise in undertaking assisted vaginal delivery (AVD): a mixed methods systematic review of practitioners views and experiences
Feeley, C., Crossland, N., Betrán, A. P., Weeks, A. D., Downe, S. M., & Kingdon, C. (2021) · Reproductive Health · doi:10.1186/s12978-021-01146-3 · Cited by 27 · see citing works
The impact of strike action on patient morbidity: A systematic literature review
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The Commercial Determinants of Health and Evidence Synthesis (CODES): methodological guidance for systematic reviews and other evidence syntheses
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Qualitative evidence synthesis for complex interventions and guideline development: clarification of the purpose, designs and relevant methods
Flemming, K., Booth, A., Garside, R., Tunçalp, Ö., & Noyes, J. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2018-000882 · Cited by 389 · see citing works
Self-citation
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Higgins, J. P. T., López-López, J. A., Becker, B. J., Davies, S. R., Dawson, S., Grimshaw, J. M., McGuinness, L. A., Moore, T. H. M., Rehfuess, E. A., Thomas, J., et al. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2018-000858 · Cited by 322 · see citing works
Implications of a complexity perspective for systematic reviews and guideline development in health decision making
Petticrew, M. P., Knai, C., Thomas, J., Rehfuess, E. A., Noyes, J., Gerhardus, A., Grimshaw, J., Rutter, H., & McGill, E. (2019) · BMJ Global Health · doi:10.1136/bmjgh-2018-000899 · Cited by 201 · see citing works
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Synthesizing evidence on complex interventions: how meta-analytical, qualitative, and mixed-method approaches can contribute
Petticrew, M. P., Rehfuess, E. A., Noyes, J., Higgins, J. P. T., Mayhew, A., Tomás Pantoja, C., Shemilt, I., & Sowden, A. J. (2013) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2013.06.005 · Cited by 292 · see citing works
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Reviewing and synthesising quantitative data on complex interventions
Möhler, R., & Hirt, J. (2026) · Routledge eBooks · doi:10.4324/9781003495642-7

Authors: Noyes, J., Booth, A., Moore, G., Flemming, K., Tunçalp, Ö., & Shakibazadeh, E.
Affiliations: Bangor University (GB)
University of Sheffield (GB)
Cardiff University (GB)
University of York (GB)
World Health Organization (CH)
Tehran University of Medical Sciences (IR)
Corresponding author: Noyes, Jane
ORCID: Noyes, Jane
Booth, Andrew
Moore, Graham
Flemming, Kate
Tunçalp, Özge
Shakibazadeh, Elham
Venue: BMJ Global Health
Publisher: BMJ
Published: 2019-01
Volume: 4
Issue: Suppl 1
Pages: e000893
ISSN: 2059-7908 (ISSN-L)
DOI: 10.1136/bmjgh-2018-000893
PMC: PMC6350750
OpenAlex: W2906715785
Cited by: 497
References: 63
Citations by year: 2026: 70 · 2025: 80 · 2024: 83 · 2023: 66 · 2022: 51 · 2021: 83 · 2020: 49 · 2019: 13 · 2015: 1 · 2012: 1
Type: conference abstract
Language: en
Open access: gold
doi.org
Licence: cc-by-nc
creativecommons.org/licenses/by-nc/3.0/igo/ (unspecified, 24 d)
Locations: BMJ Global Health (publishedVersion, cc-by-nc)
Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders: Funding provided by the World Health Organization Department of Maternal, Newborn, Child and Adolescent Health through a grant received from the United States Agency for International Development.
Topics: Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords: complex interventions, evidence synthesis, clinical guideline development, WHO guidelines, complexity perspective

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Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods

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