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Abstract：
BACKGROUND: This is the third in a series of three papers describing the use of qualitative evidence syntheses (QES) to inform the development of clinical and health systems guidelines. WHO has recognised the need to improve its guideline methodology to ensure that decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable to end users. In addition to the standard data on effectiveness, WHO guidelines increasingly use evidence derived from QES to provide information on acceptability and feasibility and to develop important implementation considerations.
METHODS: WHO convened a group drawn from the technical teams involved in formulating recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. As members of WHO guideline technical teams, our aim in this paper is to explore how we have used findings from QES to develop implementation considerations for these guidelines.
RESULTS: For each guideline, in addition to using systematic reviews of effectiveness, the technical teams used QES to gather evidence of the acceptability and feasibility of interventions and, in some cases, equity issues and the value people place on different outcomes. This evidence was synthesised using standardised processes. The teams then used the QES to identify implementation considerations combined with other sources of information and input from experts.
CONCLUSIONS: QES were useful sources of information for implementation considerations. However, several issues for further development remain, including whether researchers should use existing health systems frameworks when developing implementation considerations; whether researchers should take confidence in the evidence into account when developing implementation considerations; whether qualitative evidence that reveals implementation challenges should lead guideline panels to make conditional recommendations or only point to implementation considerations; and whether guideline users find it helpful to have challenges pointed out to them or whether they also need solutions. Finally, we need to explore how QES findings can be incorporated into derivative products to aid implementation.
METHODS: WHO convened a group drawn from the technical teams involved in formulating recent (2010-2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. As members of WHO guideline technical teams, our aim in this paper is to explore how we have used findings from QES to develop implementation considerations for these guidelines.
RESULTS: For each guideline, in addition to using systematic reviews of effectiveness, the technical teams used QES to gather evidence of the acceptability and feasibility of interventions and, in some cases, equity issues and the value people place on different outcomes. This evidence was synthesised using standardised processes. The teams then used the QES to identify implementation considerations combined with other sources of information and input from experts.
CONCLUSIONS: QES were useful sources of information for implementation considerations. However, several issues for further development remain, including whether researchers should use existing health systems frameworks when developing implementation considerations; whether researchers should take confidence in the evidence into account when developing implementation considerations; whether qualitative evidence that reveals implementation challenges should lead guideline panels to make conditional recommendations or only point to implementation considerations; and whether guideline users find it helpful to have challenges pointed out to them or whether they also need solutions. Finally, we need to explore how QES findings can be incorporated into derivative products to aid implementation.
摘要：
背景：这是描述使用定性证据综合（QES）为临床和卫生系统指南的制定提供信息的三篇论文中的第三篇。世卫组织认识到有必要改进其指导方法，以确保决策过程透明且以证据为基础，并且所产生的建议是相关的并适用于最终用户。除了有效性的标准数据外，世卫组织指南越来越多地使用从质量和健康水平获得的证据来提供关于可接受性和可行性的信息，并制定重要的实施考虑因素。
方法：世卫组织召集了一个来自技术团队的小组，参与制定近期（2010-2018年）的QES指南。采用务实和反复的方法，包括世卫组织工作人员和其他利益攸关方的反馈意见，小组反思，讨论并确定了设计QES并在指南开发中使用所得结果的关键方法和研究意义。作为世卫组织指导技术小组的成员，我们在本文中的目的是探讨我们如何使用QES的结果来制定这些指南的实施注意事项。
结果：对于每个指南，除了使用有效性的系统评价，技术团队使用QES来收集干预措施的可接受性和可行性的证据，在某些情况下,公平问题和人们对不同结果的价值。该证据是使用标准化过程合成的。然后，团队使用QES结合其他信息来源和专家的输入来确定实施考虑因素。
结论：QES是实施考虑的有用信息来源。然而,还有几个需要进一步发展的问题，包括研究人员在制定实施考虑时是否应使用现有的卫生系统框架；研究人员在制定实施考虑时是否应考虑对证据的信心；揭示实施挑战的定性证据是否应引导指南小组提出有条件的建议或只指出实施考虑；以及指南用户是否认为向他们指出挑战有帮助或他们是否也需要解决方案。最后,我们需要探索如何将QES发现纳入衍生产品以帮助实施。
方法：世卫组织召集了一个来自技术团队的小组，参与制定近期（2010-2018年）的QES指南。采用务实和反复的方法，包括世卫组织工作人员和其他利益攸关方的反馈意见，小组反思，讨论并确定了设计QES并在指南开发中使用所得结果的关键方法和研究意义。作为世卫组织指导技术小组的成员，我们在本文中的目的是探讨我们如何使用QES的结果来制定这些指南的实施注意事项。
结果：对于每个指南，除了使用有效性的系统评价，技术团队使用QES来收集干预措施的可接受性和可行性的证据，在某些情况下,公平问题和人们对不同结果的价值。该证据是使用标准化过程合成的。然后，团队使用QES结合其他信息来源和专家的输入来确定实施考虑因素。
结论：QES是实施考虑的有用信息来源。然而,还有几个需要进一步发展的问题，包括研究人员在制定实施考虑时是否应使用现有的卫生系统框架；研究人员在制定实施考虑时是否应考虑对证据的信心；揭示实施挑战的定性证据是否应引导指南小组提出有条件的建议或只指出实施考虑；以及指南用户是否认为向他们指出挑战有帮助或他们是否也需要解决方案。最后,我们需要探索如何将QES发现纳入衍生产品以帮助实施。
