Grading the quality of evidence in complex interventions: a guide for evidence-based practitioners
Open accessAbstract
Evidence-based practitioners who want to apply evidence from complex interventions to the care of their patients are often challenged by the difficulty of grading the quality of this evidence. Using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and an illustrative example, we propose a framework for evaluating the quality of evidence that depends on obtaining feedback from the evidence user (eg, guideline panel) to inform: (1) proper framing of the question, (2) judgements about directness and consistency of evidence and (3) the need for additional contextual and qualitative evidence. Using this framework, different evidence users and based on their needs would consider the same evidence as high, moderate, low or very low.
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Public health interventions, such as WASH, are often complex, contain several interacting components, require multiple behaviours and target groups, and are often inherently difficult to randomise or mask, which makes them more likely to be rated as low or very low certainty evidence compared with interventions that can be better controlled, such as clinical interventions.
“Public health interventions, such as WASH, are often complex and contain several interacting components, require multiple behaviours and target groups, and are often inherently difficult to randomise or mask, which makes them more likely to be rated as low or very low certainty evidence compared with interventions that can be better controlled, such as clinical interventions.104, 105”
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Wolf, J., Hubbard, S., Brauer, M., Ambelu, A., Arnold, B. F., Bain, R., Bauza, V., Brown, J., Caruso, B. A., Clasen, T., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00937-0 · Cited by 377 · see citing works
- Authors
- Murad, M. H., Almasri, J., Alsawas, M., & Farah, W.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Murad, M Hassan
- Venue
- Evidence Based Medicine
- Publisher
- BMJ
- Published
- 2016-12-08
- Volume
- 22
- Issue
- 1
- Pages
- 20-22
- ISSN
- 1356-5524 (ISSN-L)
- 1473-6810
- OpenAlex
- W2559798449
- Cited by
- 22
- References
- 0
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 3 · 2021: 1 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 3
- FWCI
- 2.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ Evidence-Based Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- quality of evidence grading, complex interventions, GRADE, evidence-based practice, contextual evidence, qualitative evidence
- MeSH terms
- Humans, Evidence-Based Medicine
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