GRADE Workshop 21st November 2018, Oslo (0900-1700)
GRADE-CERQual Workshop 22nd November 2018, Oslo (0900-1700)

Cochrane Norway and Cochrane Sweden welcome you to a one-day workshop in the use of GRADE, followed by a one-day workshop in the use of GRADE-CERQual. Participants are welcome to attend both workshops or only one.

Background: A systematic review identifies, appraises and synthesises individual studies about a particular question. GRADE is used to assess the certainty of (or confidence in) evidence from systematic reviews of effectiveness and the strength of recommendations in guidelines. Similarly, GRADE-CERQual is used to assess how much confidence to place in findings
from systematic reviews of qualitative research.

Workshop objectives:
To deepen understanding and gain practical experience in the GRADE approach, either for reviews of effectiveness evidence or for reviews of qualitative evidence.
Workshop on GRADE for reviews of effectiveness evidence:

Workshop on GRADE-CERQual for reviews of qualitative evidence:

Workshop format: Both workshops will use a combination of short lectures, small group learning based around worked examples and exercises, and plenary discussion. Participants will also be provided with a short reading list in advance of the workshops. The workshop will be run in English.

Participant criteria: The workshop is targeted at authors or users of systematic reviews. Participants do not have to be Cochrane contributors. Participants interested in the GRADE-CERQual workshop are expected to be familiar with primary qualitative research methods.

Workshop location: Both workshops will be held at the following venue: Norwegian Institute of Public Health in Oslo (www.fhi.no) Marcus Thranes gt. 6, 7th floor

Participant fees: Each workshop will cost 900 NOK (1500 NOK for both days). This fee will also cover lunch and coffee during the workshops.1

Registration deadline: October 31st, to be completed on: https://sweden.cochrane.org/courses-workshops/workshop-grade-and-grade-cerqual-oslo-november-21-22
Staff at the Norwegian Institute of Public Health participate for free but will not be prioritised. An additional workshop for staff at the Institute will be organised at a later date (Dec 3rd) if there is a lack of space. 

 
On June the 4th 2018 Lotte Groth Jensen and Kathrine Carstensen (DEFACTUM, Denmark) presented their experiences with using the GRADE-CERQual approach in systematic reviews of qualitative research in an oral presentation at the HTAi Conference in Vancouver.

 
The presentation aimed at giving examples of applying CERQual in reviews with different objectives and fields of research, presenting and discussing the strengths and limitations of the approach. The presentation drew on practical experiences with using CERQual in four qualitative systematic reviews, two of which are already published in international scientific journals. The two published articles can be accessed from the journals' webpages using the links at the end of this contribution.
 
The following summarizes the main experiences presented in the presentation:
 
The four qualitative systematic reviews presented were conducted with multiple and partly diverse purposes, indicating that such reviews can contribute relevant and important information in different situations. All four reviews are based on research projects conducted in collaboration with health care professionals and aim to uncover the existing research field and identify knowledge gaps in these fields. In this way, the reviews provided health care professionals with knowledge about relevant aspects of their clinical practice. One review was furthermore used to inform the design and focus of a research project and another review was conducted following a national health technology assessment, with the aim of disseminating important knowledge from the national project to an international audience.
 
On the basis of applying the CERQual approach to these four reviews, we have identified several strengths of using the approach, especially in relation to creating an overview and enhancing the usability of the findings. From our experiences, one main strength of the CERQual approach is its ability to facilitate the presentation of often both complex and large amounts of knowledge included in qualitative reviews in a clear and structured way. Besides creating a better overview of the review findings, the clear presentation makes the review findings more useful in decision making. Creating an overview and enhancing usability is, in our opinion, further strengthen by the idea of CERQual to pool knowledge from different studies into common findings across studies. Another key strength of the CERQual approach, in our opinion, is related to the core aim of the approach to facilitate an assessment of the quality and strength of the identified review findings. This provides decision-makers, clinicians and other readers of the review with valuable assessments of how much confidence they can place in the presented evidence. We suggest that this may help to increase the impact and usability of qualitative evidence in political decision-making and clinical practice. Finally, based on our experiences, CERQual contributes to a more uniform reporting of qualitative research. A reporting familiar to health care professionals and a reporting in accordance with the reporting of evidence from quantitative research.
 
Besides the many strengths of using the CERQual approach, we have also identified some limitations in the process of conducting the four reviews. Besides the fact that it can be a rather time consuming process to go through all the steps in the approach, we also identified the risk of simplifying results from qualitative research by missing out on some of the contextual features of qualitative research and its level of details. Another point to consider is the fact, that qualitative research can be conducted using various approaches, stressing different use of theory and methodology. In a review using the CERQual approach, results from these various approaches are compiled into common findings and it can be difficult for the reader to identify these different approaches and make judgment about the reasonableness of mixing their results in to one measure.
 
CERQual represents a tool to facilitate the use of qualitative evidence in clinical and political decision making. Although the CERQual approach can be time-consuming to learn, it is a useful tool to apply when learned. The CERQual approach may encourage a more uniform reporting of qualitative research that may increase the impact of systematic reviews of qualitative studies. The CERQual approach may lead to simplification of qualitative research by missing out on context and nuances if you do not pay attention to this issue in the writing and presentation of findings.
 
Written by and Lotte Groth Jensen and Kathrine Carstensen
Links to published qualitative systematic reviews using CERQual:
 
Carstensen, K., Lou, S., Jensen, L. G., Nissen, N. K., Ørtenblad, L., Pfau, M., Ankersen, P. V.. Psychiatric service users' experiences of emergency departments: a CERQual review of qualitative studies. Nordic Journal of Psychiatry, 2013. 71, 4: 315-23.
 
Lou, S., Jensen L. G., Petersen, O. B., Vogel, I., Hvidman L., Møller A., Nielsen C. P.. Parental response to severe or lethal prenatal diagnosis: a systematic review of qualitative studies.  Prenatal Diagnosis, 2017. 37, 8:731-43.  

Response to "Experiences with using GRADE-CERQual" 

The CERQual coordinating team welcomes this reflection on using the CERQual approach by Lotte Groth Jensen and Kathrine Carstensen. We note that some of the critiques and strengths mentioned could be said to relate to QES methodology generally. Indeed distinguishing the two can be difficult but as we move forward it will be increasingly useful and important for reviewers to reflect on the process of using CERQual and consider what benefits and drawbacks are specific to the CERQual approach to assessing confidence (and what aspect, e.g. the summary of qualitative findings table), and what might be a result of the particular QES method used. By Megan Wainwright and Claire Glenton (CERQual Coordinating Team)
 

In July 2018, Prof. Jane Noyes (Bangor University) was called to give evidence to the Public Committee on Evidence-Based Practices for Public Health Emergency preparedness and Response in Washington DC. 

She presented the CERQual approach and also was asked to briefly summarise the use of the iCAT_SR tool.    It was a fabulous occasion and Jane found herself giving evidence alongside such dignitaries as Dr James Polk, Chief Medical Officer at NASA who spoke on what could be shared about NASA’s work and evidence-base on disaster preparedness for the space missions and future MARS mission, and Dr Michael Woolcock the Lead Social Scientist at the World Bank.  Holger Schunnermann joined the meeting via skype to present the GRADE approach.
 

WHO Chapter on QES now available in PORTUGUESE
 

The following Chapter is now available in Portuguese. Get it HERE
Using evidence from qualitative research to develop WHO guidelines. In: WHO handbook for guideline development. 2nd ed. Geneva: World Health Organization; 2014
 

ESQUIRE is one of the only short courses in qualitative evidence synthesis available on a yearly basis and this year it celebrated its 10th anniversary! The course is led by Andrew Booth (ScHARR, University of Sheffield) and administered by the  Short Course Unit of the School of Health and Related Research, University of Sheffield. This year the course was held September 11-13 and included contributions by Fiona Campbell (ScHARR), Helen Buckley (ScHARR) and myself. I had the good fortune of not only providing a CERQual taster workshop, but attending the entire 3-day course. The energy in the room was fantastic (how could it not with all the delicious hot lunches, scrumptious cakes and bountiful amounts of tea and coffee!?). We had participants from all over the UK as well as Spain, Brazil and Australia, bringing to the course experience in primary qualitative research and systematic review methodology. The course follows the chronology of a qualitative evidence synthesis - beginning with question writing and searching and ending with CERQual and reporting. The chronological design really helps give a picture of the process to newbies as well as solidify and refine understanding for those with already some experience in QES (like myself!). With plenty of time for questions, participants were able to get review-specific feedback that really helped to ground the theory in actual practice. Next year's course will be held September 10-12 2019 and is already open for inquiries and registration. Find more info here: https://www.sheffield.ac.uk/scharr/shortcourseunit/esquire
By Megan Wainwright (CERQual Coordinating team)

First CERQual Workshop in Portuguese in Sao Paolo

On September 30th, the first CERQual Workshop in Portuguese was delivered by Sharmila Alina de Sousa (Fiocruz Brasilia) and Vicky Pileggi (University of Sao Paolo) in the the Nursing School of the University of São Paulo, Brazil.

Professor Cassia Soares was responsible for the event that brought together about 30 researchers and professors from the faculty and other national public institutions. Slides, worksheets and handouts were all provided in Portuguese. The vast majority of people were already familiar with qualitative methodologies for basic research and some of them were already familiar with systematic reviews of qualitative research. The workshop went very well, the change in the order of the components in the worksheet example (coherence, relevance, adequacy, methodological limitations) enabled better discussions on the subject with high expectations for the use of the approach. A final table was prepared to which each small groups' assessments were added. This greatly facilitated comparison of the judgments made in each group and helped guide discussion.
 

The Cochrane Colloquium held in Edinburgh this year offered another workshop of the CERQual approach bringing together people from different countries around the world.

The workshop was very interesting and allowed, once again, the dissemination of the approach as a good option for achieving transparency in the assessment of confidence in the evidence from reviews of qualitative research. I was very happy and grateful to receive a financial support from Wiley to attend the Cochrane Colloquium in Edinburgh this year. This support allowed me to deepen my knowledge in systematic reviews (both qualitative and quantitative) so that I could not only improve the reviews I am working on with colleagues (Pregnancy and Childbirth group), but also put it to use in my clinical practice and in the classes I teach. By: Vicky Pileggi
 

CERQual Workshop in Tehran
 

Arash Rashidian (WHO/CERQual Coordinating Team) delivered a two day workshop on strengthening the use of qualitative evidence in decision making and the CERQual approach in Tehran at the National Institute of Health Research, Ministry of Health and Medical Education, July 24-25.