ArticleBMJ global health2019
Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health.
Article in BMJ global health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 6 syntheses or guidelines pooled it.
- Infectious complications following transperineal prostate biopsy with or without periprocedural antibiotic prophylaxis-a systematic review including meta-analysis of all comparative studies.Prostate cancer and prostatic diseases · 2026Pooled it
- Approaches to early intervention for common mental health problems in young people: a systematic review.BMC medicine · 2025Pooled it
- The effects of dietary patterns and food groups on symptomatic osteoarthritis: A systematic review.Nutrition & dietetics : the journal of the Dietitians Association of Australia · 2023Pooled it
- Is movement variability altered in people with chronic non-specific low back pain? A systematic review.PloS one · 2023Pooled it
- Effects of goal-oriented care for adults with multimorbidity: A systematic review and meta-analysis.Journal of evaluation in clinical practice · 2022Pooled it
- Interventions to reduce ambient particulate matter air pollution and their effect on health.The Cochrane database of systematic reviews · 2019Pooled it
- Clinical research on homeopathic preparations: protocol template for a series of systematic reviews.Systematic reviews · 2026Article
- Framework for evidence synthesis of traditional, complementary and integrative medicine systems incorporating context and complexity, illustrated by the example of homeopathy.Frontiers in public health · 2026Article
- '4 Ss' for successful blood pressure control.Journal of hypertension · 2025Article
- A methodology for determining dosing recommendations for anticancer drugs in patients with reduced kidney function.EClinicalMedicine · 2025Review
- Effectiveness of different de-implementation strategies in primary care: systematic review and meta-analysis.BMJ medicine · 2025Article
- Review
- Systems for rating bodies of evidence used in systematic reviews of air pollution exposure and reproductive and children's health: a methodological survey.Environmental health : a global access science source · 2024Review
- Characteristics of the sources, evaluation, and grading of the certainty of evidence in systematic reviews in public health: A methodological study.Frontiers in public health · 2023Article
- A framework for synthesizing intervention evidence from multiple sources into a single certainty of evidence rating: Methodological developments from a US National Academies of Sciences, Engineering, and Medicine Committee.Research synthesis methods · 2023Review
- Using GRADE Evidence to Decision frameworks to support the process of health policy-making: an example application regarding taxation of sugar-sweetened beverages.European journal of public health · 2022Article
- Research and implementation interactions in a social accountability study: utilizing guidance for conducting process evaluations of complex interventions.International journal for equity in health · 2022Article
- Randomized controlled trials in de-implementation research: a systematic scoping review.Implementation science : IS · 2022Article
- Guideline development in harm reduction: Considerations around the meaningful involvement of people who access services.Drug and alcohol dependence reports · 2022Review
- Clearinghouse Standards of Evidence on the Transparency, Openness, and Reproducibility of Intervention Evaluations.Prevention science : the official journal of the Society for Prevention Research · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Public health interventions and health technologies are commonly described as 'complex', as they involve multiple interacting components and outcomes, and their effects are largely influenced by contextual interactions and system-level processes. Systematic reviewers and guideline developers evaluating the effects of these complex interventions and technologies report difficulties in using existing methods and frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE). As part of a special series of papers on implications of complexity in the WHO guideline development, this paper serves as a primer on how to consider sources of complexity when using the GRADE approach to rate certainty of evidence. Relevant sources of complexity in systematic reviews, health technology assessments and guidelines of public health are outlined and mapped onto the reported difficulties in rating the estimates of the effect of these interventions. Recommendations on how to address these difficulties are further outlined, and the need for an integrated use of GRADE from the beginning of the review or guideline development is emphasised. The content of this paper is informed by the existing GRADE guidance, an ongoing research project on considering sources of complexity when applying the GRADE approach to rate certainty of evidence in systematic reviews and the review authors' own experiences with using GRADE.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.