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Using Qualitative Evidence in Decision Making for Health and Social Interventions: An Approach to Assess Confidence in Findings from Qualitative Evidence Syntheses (GRADE-CERQual)
Open accessAbstract
Simon Lewin and colleagues present a methodology for increasing transparency and confidence in qualitative research synthesis.
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“Downgrades were primarily driven by methodological limitations related to limited reporting of researcher positioning and reflexivity across contributing studies, and depending on the finding, by context-dependence (relevance) or uneven richness of supporting data (adequacy) (Lewin et al., 2015).”
From Relational and Institutional Disenfranchisement in Suicide Bereavement: A Qualitative Meta-Synthesis of Family Members' Experiences (2026) · cites this paper as Lewin et al., 2015
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“The Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach [37] was used to assess the confidence that can be attributed to the evidence informing each individual review finding, with ratings of high, moderate, or low confidence being attributed to each finding.”
From Older Adults’ Experiences and Perceptions of Immersive Virtual Reality: Systematic Review and Thematic Synthesis (2022) · cites this paper as [37]
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“Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach.”
From Older Adults’ Experiences and Perceptions of Immersive Virtual Reality: Systematic Review and Thematic Synthesis (2022) · cites this paper as [37]
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“Confidence in the evidence was assessed using the GRADE-CERQual [37] tool and ranged from high to moderate (Multimedia Appendix 7 [9,14-16,44-52]).”
From Older Adults’ Experiences and Perceptions of Immersive Virtual Reality: Systematic Review and Thematic Synthesis (2022) · cites this paper as [37]
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Citations
Cites
Tong, A., Sainsbury, P., & Craig, J. (2007) · International Journal for Quality in Health Care · doi:10.1093/intqhc/mzm042 · Cited by 42,509
Dermyshi, E., Wang, Y., Yan, C., Hong, W., Qiu, G., Gong, X., & Zhang, T. (2017) · Neonatology · doi:10.1159/000454668 · Cited by 24,586
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
Guyatt, G. H., Oxman, A. D., Vist, G. E., Kunz, R., Falck-Ytter, Y., Alonso-Coello, P., & Schünemann, H. J. (2008) · BMJ · doi:10.1136/bmj.39489.470347.ad · Cited by 23,305
How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability
Guest, G., Bunce, A., & Johnson, L. (2006) · Field Methods · doi:10.1177/1525822x05279903 · Cited by 20,808
GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables
Guyatt, G., Oxman, A. D., Akl, E. A., Kunz, R., Vist, G., Brozek, J., Norris, S., Falck-Ytter, Y., Glasziou, P., & deBeer, H. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.04.026 · Cited by 10,681
Gibbs, G. (2007) · doi:10.4135/9781849208574 · Cited by 4,299
Enhancing the quality and credibility of qualitative analysis.
(1999) · PubMed Central · Cited by 4,133
Systematic reviews in the social sciences: a practical guide
(2006) · Choice Reviews Online · doi:10.5860/choice.43-5664 · Cited by 4,083
Systematic Reviews in the Social Sciences: A Practical Guide
Petticrew, M., & Roberts, H. (2006) · doi:10.1002/9780470754887 · Cited by 3,586
Norderyd, O. M., Koch, G., Papias, A., Köhler, A. A., Helkimo, A. N., Brahm, C., Lindmark, U., Lindfors, N., Mattsson, A., Rolander, B., et al. (2015) · PubMed · Cited by 3,584
Cited by
Sorted by citations
Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series
Lewin, S., Booth, A., Glenton, C., Munthe-Kaas, H., Rashidian, A., Wainwright, M., Bohren, M. A., Tunçalp, Ö., Colvin, C. J., Garside, R., et al. (2018) · Implementation Science · doi:10.1186/s13012-017-0688-3 · Cited by 1,231
Self-citationImproving the content validity of the mixed methods appraisal tool: a modified e-Delphi study
Hong, Q. N., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., et al. (2019) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2019.03.008 · Cited by 1,082
“Several approaches for rating the overall quality of evidence have been developed, such as Grading of Recommendations, Assessment, Development and Evaluations (GRADE) [38] and GRADE-Confidence in the Evidence from Reviews of Qualitative research (CERQual) [39].”
MethodRating the certainty in evidence in the absence of a single estimate of effect
Murad, M. H., Mustafa, R. A., Schünemann, H. J., Sultan, S., & Santesso, N. (2017) · Evidence Based Medicine · doi:10.1136/ebmed-2017-110668 · Cited by 717
Ames, H., Glenton, C., & Lewin, S. A. (2019) · BMC Medical Research Methodology · doi:10.1186/s12874-019-0665-4 · Cited by 612
Self-citationLewin, S. A., Bohren, M. A., Rashidian, A., Munthe‐Kaas, H. M., Glenton, C., Colvin, C. J., Garside, R., Noyes, J., Booth, A., Tunçalp, Ö., et al. (2018) · Implementation Science · doi:10.1186/s13012-017-0689-2 · Cited by 606
Self-citation
Metadata
- Authors
- Lewin, S., Glenton, C., Munthe-Kaas, H., Carlsen, B., Colvin, C. J., Gülmezoglu, M., Noyes, J., Booth, A., Garside, R., & Rashidian, A.
- Affiliations
- South African Medical Research Council (ZA)
- Nasjonalt Kunnskapssenter for Helsetjenesten (NO)
- Uni Research (Norway) (NO)
- University of Cape Town (ZA)
- World Bank (US)
- Bangor University (GB)
- University of Sheffield (GB)
- University of Exeter (GB)
- World Health Organization Regional Office for the Eastern Mediterranean (EG)
- Corresponding author
- Lewin, Simon
- ORCID
- Venue
- PLOS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2015-10-27
- Volume
- 12
- Issue
- 10
- Pages
- e1001895
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC4624425
- OpenAlex
- W2107819237
- Cited by
- 866
- References
- 48
- Citations by year
- 2026: 68 · 2025: 60 · 2024: 84 · 2023: 66 · 2022: 77 · 2021: 120 · 2020: 86 · 2019: 95 · 2018: 75 · 2017: 77 · 2016: 54 · 2015: 2
- FWCI
- 63.46
- Type
- journal article
- Language
- en
- Update notices
- correction (2016-06-10)
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Bangor University Research Portal (Bangor University) (acceptedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Bergen Open Research Archive (BORA) (University of Bergen) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion)
- Open University of Cape Town (University of Cape Town) (submittedVersion, cc-by)
- Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
- Bangor University Research Portal (Bangor University) (submittedVersion, other-oa)
- Funders
- World Health Organization
- South African Medical Research Council
- Alliance for Health Policy and Systems Research
- Medical Research Council
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Social Sciences › Education › Qualitative Research Methods and Applications
- Social Sciences › Sociology and Political Science › Delphi Technique in Research
- Keywords
- qualitative evidence synthesis, GRADE-CERQual, decision-making, transparency, research evidence appraisal
- MeSH terms
- Decision Making, Humans, Public Policy, Research Design, Qualitative Research, Evidence-Based Practice
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