User experiences of qualitative evidence in the GRADE evidence-to-decision framework: findings from Malawi, Nigeria, and South Africa

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OBJECTIVES: Qualitative evidence can provide valuable insights to guideline development groups (GDGs) on the acceptability, feasibility, equity and implementation considerations of an intervention. However, there is inadequate guidance on how to present qualitative evidence that informs these questions. In the Global Evidence, Local Adaptation (GELA) project, we explored GDG members' experiences of the qualitative evidence that informed the acceptability, feasibility, and equity criteria of the GRADE Evidence-to-Decision framework (EtD-F), in the context of guideline development in three sub-Saharan African countries. STUDY DESIGN AND SETTING: We carried out user tests of the GRADE EtD-F developed during GELA. We conducted a total of 12 interviews with GDG members in Malawi, Nigeria, and South Africa. We reviewed the interview transcripts to identify and prioritize problems, positive feedback, and suggestions. We also carried out a thematic analysis informed by Rosenbaum's adaptation of the Honeycomb Model, which defines seven domains of user experience (accessibility, findability, usability, understandability, credibility, desirability, and affiliation). RESULTS: Overall, users experienced the GRADE Evidence-to-Decision document as credible and understandable and identified with the content related to the acceptability, feasibility, and equity criteria. Users disagreed on how summarized information presenting qualitative evidence should be. Given the text-heavy nature of qualitative evidence, the design and layout of this information in the document helped make the qualitative evidence more desirable, understandable, and relatable to users. However, some GDG members had difficulties in navigating the document, understanding certain framework components, or defining its purpose; highlighting their need for orientation and further guidance to efficiently make use of the acceptability, feasibility, and equity information presented. CONCLUSION: How qualitative evidence is presented contributes to guideline panels' ability to understand, identify with, and use this evidence when making decisions. However, further research is needed on how to optimize user experiences of different types of evidence in the GRADE EtD-F.

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