WHO/HIV/2014.23 ©World Health Organization 2014 Health system and public health evidence to recommendations framework
[Question]? Problem: [Problem] Option: [Option] Comparison: [Comparison] Setting: [Setting] CRITERIA Is the problem a priority? Are a large number of people affected? JUDGEMENTS No Probably No Uncertain Probably Yes Yes Varies
Background: [Background]
RESEARCH EVIDENCE
ADDITIONAL INFORMATION
[Evidence]
[Additional information]
P RO B LE M
No
Probably No
Uncertain
Probably Yes
Yes
Varies
[Evidence]
[Additional information]
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Problem: [Problem]
Option: [Option]
Comparison: [Comparison]
Setting: [Setting]
CRITERIA Are the desirable anticipated effects large?
JUDGEMENTS
RESEARCH EVIDENCE
ADDITIONAL INFORMATION
No
Probably No
Uncertain
Probably Yes
Yes
Varies
Summary of findings: [Comparison] Outcome Without [intervention] (per [#####] With [intervention] (per [#####]) Difference (per [#####] (95%CI) Relative effect (RR) (95%CI) RR [#.##] ([#.##] to [#.##]) RR [#.##] ([#.##] to [#.##] RR [#.##] ([#.##] to [#.##]
B E NE F IT S & HA RM S O F T HE O P T IO NS
Are the undesirable anticipated effects small?
Certainty of the evidence (GRADE) [Rating] [Rating] [Rating]
No
Probably No
Uncertain
Probably Yes
Yes
Varies
[Outcome] [Outcome] [Outcome]
[#####] [#####] [#####]
[#####] [#####] [#####]
[#####] more/less [#####] more/less [#####] more/less
[Additional information]
What is the overall certainty of this evidence?
No included studies
Very low
Low
Moderate
High
Link to detailed evidence profile
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Problem: [Problem]
Option: [Option]
Comparison: [Comparison]
Setting: [Setting]
CRITERIA
JUDGEMENTS
RESEARCH EVIDENCE The relative importance or values of the main outcomes of interest:
ADDITIONAL INFORMATION
How certain is the relative importance of the desirable and undesirable outcomes? V A LUE S
Possibly Important important uncertainty uncertainty or variability or variability
Probably no No important important No known uncertainty uncertainty undesirable or variability or variability outcomes
Outcome
Relative importance
Certainty of the evidence
[Outcome] [Outcome] [Outcome] [Outcome]
No evidence No evidence No evidence No evidence
-
[Additional information]
Are the desirable effects large relative to undesirable effects?
No
Probably No
Uncertain
Probably Yes
Yes
Varies
[Evidence]
[Additional information]
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Problem: [Problem]
Option: [Option]
Comparison: [Comparison]
Setting: [Setting]
CRITERIA Are the resources required small? Is the incremental cost small relative to the net benefits? What would be the impact on health inequities?
JUDGEMENTS No Probably No Uncertain Probably Yes Yes Varies
RESEARCH EVIDENCE
ADDITIONAL INFORMATION
RE S O URCE US E
[Evidence]
[Additional information]
No
Probably No
Uncertain
Probably Yes
Yes
Varies
[Evidence]
[Additional information]
E Q UIT Y
Increased Probably Uncertain Probably Reduced Varies increased reduced
[Evidence]
[Additional information]
A CCE P T A B ILIT Y
Is the option acceptable to key stakeholders?
No
Probably No
Uncertain
Probably Yes
Yes
Varies
[Evidence]
[Additional information]
F E A S IB ILIT Y
Is the option feasible to implement?
No
Probably No
Uncertain
Probably Yes
Yes
Varies
[Evidence]
[Additional information]
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Problem: [Problem]
Option: [Option]
Comparison: [Comparison]
Setting: [Setting]
Balance of consequences
Undesirable consequences clearly outweigh desirable consequences in most settings
Undesirable consequences probably outweigh desirable consequences in most settings
The balance between desirable and undesirable consequences is closely balanced or uncertain
Desirable consequences probably outweigh undesirable consequences in most settings
Desirable consequences clearly outweigh undesirable consequences in most settings
Type of recommendation
We recommend against the option
We suggest considering the option Only in the context of rigorous research Only with targeted monitoring and evaluation Only in specific contexts
We recommend the option
Recommendation (text)
[Recommendation]
Justification Implementation
[Justification] [Implementation considerations]
considerations
Monitoring and evaluation [Monitoring and evaluation] Research priorities [Research priorities]
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Problem: [Problem]
Option: [Option]
Comparison: [Comparison]
Setting: [Setting]
Evidence profile [title] Author(s): [Authors] Date: [YYYY-MM-DD] Question: [Question] Settings: [Setting] Bibliography: [Citation text] [Insert GRADE evidence profile] (Return)
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Problem: [Problem]
Option: [Option]
Comparison: [Comparison]
Setting: [Setting]
References (To make references appear here, place cursor in any text above this page and choose: Insert > Footnote…> Endnote > End of section)
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Explanations
Definitions for ratings of the certainty of the evidence (GRADE)** Ratings Definitions This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different* is low. This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different4 is moderate. This research provides some indication of the likely effect. However, the likelihood that it will be substantially different4 is high. This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different4 is very high. Implications This evidence provides a very good basis for making a decision about whether to implement the intervention. Impact evaluation and monitoring of the impact are unlikely to be needed if it is implemented. This evidence provides a good basis for making a decision about whether to implement the intervention. Monitoring of the impact is likely to be needed and impact evaluation may be warranted if it is implemented. This evidence provides some basis for making a decision about whether to implement the intervention. Impact evaluation is likely to be warranted if it is implemented. This evidence does not provide a good basis for making a decision about whether to implement the intervention. Impact evaluation is very likely to be warranted if it is implemented.
High
Moderate Low Very low
*Substantially different: large enough difference that it might have an effect on a decision **The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group began in the year 2000 as an informal collaboration of people with an interest in addressing the shortcomings of present grading systems in health care. The working group has developed a common, sensible and transparent approach to grading quality of evidence and strength of recommendations. Many international organizations have provided input into the development of the approach and have started using it.
(Return)
For most recent version of this framework (and additional frameworks): www.decide-collaboration.eu/WP5/Strategies/Framework
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