Evidence map›Paper›PMID 35501069›Full record

SynthesisBMJ global health2022

Developing an integrated multilevel model of uncertainty in health care: a qualitative systematic review and thematic synthesis.

Prashanti Eachempati, Roland Brian Büchter, Kiran Kumar Ks, Sally Hanks, John Martin, Mona Nasser

Open access · goldAbstract readSystematic Review
In one paragraph

Synthesis in BMJ global health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.8field-weighted citation impact, top 10% of its field
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

8 citing papers in PubMed, 12 citations in OpenAlex.

  1. Review
  2. What is new in the early health technology assessment's new definition?International journal of technology assessment in health care · 2026
    Article
  3. Article
  4. Article
  5. Complexity and Barriers to Vision Care: A Narrative Review Informed by a Mobile Eye Program.International journal of environmental research and public health · 2025
    Review
  6. Article
  7. Article
  8. Article
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

6 authors at 3 institutions in 3 countries.

Prashanti EachempatiDepartment of Prosthodontics, Faculty of Dentistry, Manipal University College Malaysia, Bukit Baru, Malaysia prashanti.eachempati@manipal.edu.my.ORCID 0000-0003-1263-7423
Roland Brian BüchterInstitute for Research in Operative Medicine (IFOM), Faculty of Health-School of Medicine, Witten/Herdecke University, Cologne, Nordrhein-Westfalen, Germany.
Kiran Kumar KsDepartment of Prosthodontics, Faculty of Dentistry, Manipal University College Malaysia, Bukit Baru, Malaysia.
Sally HanksPeninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, UK.
John MartinSustainable Earth Institute, University of Plymouth, Plymouth, UK.
Mona NasserPeninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, UK.
University of Plymouth · GBManipal University College Malaysia · MYWitten/Herdecke University · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionUncertainty is an inevitable part of healthcare and a source of confusion and challenge to decision-making. Several taxonomies of uncertainty have been developed, but mainly focus on decisions in clinical settings. Our goal was to develop a holistic model of uncertainty that can be applied to both clinical as well as public and global health scenarios.

methodsWe searched Medline, Embase, CINAHL, Scopus and Google scholar in March 2021 for literature reviews, qualitative studies and case studies related to classifications or models of uncertainty in healthcare. Empirical articles were assessed for study limitations using the Critical Appraisal Skills Programme (CASP) checklist. We synthesised the literature using a thematic analysis and developed a dynamic multilevel model of uncertainty. We sought patient input to assess relatability of the model and applied it to two case examples.

resultsWe screened 4125 studies and included 15 empirical studies, 13 literature reviews and 5 case studies. We identified 77 codes and organised these into 26 descriptive and 11 analytical themes of uncertainty. The themes identified are global, public health, healthcare system, clinical, ethical, relational, personal, knowledge exchange, epistemic, aleatoric and parameter uncertainty. The themes were included in a model, which captures the macro, meso and microlevels and the inter-relatedness of uncertainty. We successfully piloted the model on one public health example and an environmental topic. The main limitations are that the research input into our model predominantly came from North America and Europe, and that we have not yet tested the model in a real-life setting.

conclusionWe developed a model that can comprehensively capture uncertainty in public and global health scenarios. It builds on models that focus solely on clinical settings by including social and political contexts and emphasising the dynamic interplay between different areas of uncertainty.

Indexed as

Delivery of Health CarePublic HealthGlobal HealthHumansQualitative ResearchUncertaintySystematic review

Identifiers

PMID35501069
PMCPMC9062775
OpenAlexW4225263200

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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.