Evidence map›Paper›PMID 33476768›Full record

ArticleJournal of clinical epidemiology2021

Challenges in applying the GRADE approach in public health guidelines and systematic reviews: a concept article from the GRADE Public Health Group.

Michele Hilton Boon, Hilary Thomson, Beth Shaw, Elie A Akl, Stefan K Lhachimi, Jesús López-Alcalde, Miloslav Klugar, Leslie Choi, Zuleika Saz-Parkinson, Reem A Mustafa and 10 more

Abstract readConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of clinical epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
39citing papers in PubMed, 12 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

39 citing papers in PubMed, 12 syntheses or guidelines pooled it.

  1. Pooled it
  2. Global prevalence of post-COVID-19 condition: a systematic review and meta-analysis of prospective evidence.Health promotion and chronic disease prevention in Canada : research, policy and practice · 2025
    Pooled it
  3. CYP2D6 genotype and associated 5-HTClinical and translational science · 2025
    Pooled it
  4. Guideline
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  11. Suicide among transport industry workers: A systematic review and meta-analysis.Scandinavian journal of work, environment & health · 2022
    Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors.

Michele Hilton BoonMRC/CSO Social and Public Health Sciences Unit, Berkeley Square, 99 Berkeley Street, University of Glasgow, Glasgow G3 7HR, UK. Electronic address: michele.hiltonboon@glasgow.ac.uk.
Hilary ThomsonMRC/CSO Social and Public Health Sciences Unit, Berkeley Square, 99 Berkeley Street, University of Glasgow, Glasgow G3 7HR, UK.
Beth ShawCenter for Evidence-based Policy, Oregon Health & Science University, Portland, OR 97201 USA.
Elie A AklDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
Stefan K LhachimiDepartment for Health Services Research, Institute of Public Health and Nursing Research, University of Bremen, Grazer Straße 4, 28359 Bremen, Germany; Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
Jesús López-AlcaldeDepartment of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona; Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV)-Madrid; Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS); CIBER Epidemiology and Public Health; Cochrane Associate Centre of Madrid, Madrid, Spain.
Miloslav KlugarFaculty of Medicine, Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, The Czech Republic Centre for Evidence-Based Healthcare; JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Masaryk University, 625 00 Brno, Czechia.
Leslie ChoiThe Department of Vector Biology, Partnership for Increasing the Impact of Vector Control, Liverpool School of Tropical Medicine, Liverpool, UK.
Zuleika Saz-ParkinsonEuropean Commission, Joint Research Centre, Ispra, Italy.
Reem A MustafaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada; Departments of Medicine and Biomedical & Health Informatics, University of Missouri-Kansas City, Kansas City, MO 66160 USA.
Miranda W LangendamDepartment of Clinical Epidemiology, Amsterdam University Medical Centres, University of Amsterdam, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
Olivia CraneNational Institute for Health and Care Excellence (NICE), Level 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT, UK.
Rebecca L MorganDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada.
Eva RehfuessInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.
Bradley C JohnstonDepartment of Nutrition, Texas A&M University, College Station, TX, USA.
Lee Yee ChongCochrane Public Health and Health Systems Network, University of Oxford, Oxford, UK.
Gordon H GuyattDepartment of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4K1, Canada.
Holger J SchünemannDepartment of Health Research Methods, Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, and WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Srinivasa Vittal KatikireddiMRC/CSO Social and Public Health Sciences Unit, Berkeley Square, 99 Berkeley Street, University of Glasgow, Glasgow G3 7HR, UK.
GRADE Working Group

Funding

Chief Scientist Office SCAF/15/02Chief Scientist Office SPHSU13Chief Scientist Office SPHSU15Chief Scientist Office SPHSU17Medical Research Council MC_UU_00022/2Medical Research Council MC_UU_12017/13Medical Research Council MC_UU_12017/15Medical Research Council MR/P027873/1
6 · The paper itself

Abstract

BACKGROUND AND

objectiveThis article explores the need for conceptual advances and practical guidance in the application of the GRADE approach within public health contexts.

methodsWe convened an expert workshop and conducted a scoping review to identify challenges experienced by GRADE users in public health contexts. We developed this concept article through thematic analysis and an iterative process of consultation and discussion conducted with members electronically and at three GRADE Working Group meetings.

resultsFive priority issues can pose challenges for public health guideline developers and systematic reviewers when applying GRADE: (1) incorporating the perspectives of diverse stakeholders; (2) selecting and prioritizing health and "nonhealth" outcomes; (3) interpreting outcomes and identifying a threshold for decision-making; (4) assessing certainty of evidence from diverse sources, including nonrandomized studies; and (5) addressing implications for decision makers, including concerns about conditional recommendations. We illustrate these challenges with examples from public health guidelines and systematic reviews, identifying gaps where conceptual advances may facilitate the consistent application or further development of the methodology and provide solutions.

conclusionThe GRADE Public Health Group will respond to these challenges with solutions that are coherent with existing guidance and can be consistently implemented across public health decision-making contexts.

Indexed as

Guidelines as TopicSystematic Reviews as TopicEvidence-Based MedicineGRADE ApproachHumansPublic HealthGRADEGuidelinesHealth policyNonrandomized studiesPublic healthSocial determinants

Identifiers

PMID33476768
PMCPMC8352629

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.