CERQual: A new approach for supporting the use of qualitative evidence in decision making

A paper published in PLOS Medicine describes an innovative and transparent approach for assessing how much confidence to place in findings from qualitative evidence syntheses.

The new approach, known as CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’), is designed to help decision makers use qualitative evidence for decisions and policies about healthcare and social welfare.

Why is CERQual important?

Findings from syntheses of qualitative research can help to provide evidence on the feasibility and acceptability of interventions. They can also offer better insights into the factors influencing intervention implementation. Such syntheses are used more and more frequently in decision-making related to health and social policies. However, the paper shows that until recently the methods for assessing how much confidence to place in findings from qualitative evidence syntheses have been poorly developed.

Four components

There are four key components to the CERQual approach, namely assessments of: (1) the methodological limitations of the qualitative studies contributing to a review finding, (2) the relevance to the review question of the studies contributing to a review finding, (3) the coherence of the review finding, and (4) the adequacy of data supporting a review finding.

Co-convenors Jane Noyes, Ruth Garside and Andrew Booth, from the Cochrane Qualitative and Implementation Methods Group (CQIMG), welcome the appearance of this innovative approach stating that “as champions for the use of qualitative evidence synthesis in decision-making we have been delighted to be involved in the core CERQual team and in crafting this first publication. CERQual can help decision makers and other users understand how much confidence to place in findings from qualitative evidence syntheses. Providing CQIMG members and the constituencies they serve with this useful and practical approach will assist them in judging how much emphasis to give to findings when making their decisions. As such this will advance our Group’s remit as well as the science of qualitative evidence synthesis”

The CERQual approach has already been used in two guidelines published by the World Health Organization (WHO). Metin Gülmezoglu, from WHO’s Department of Reproductive Health and Research* and responsible for one of the guidelines, says: “The CERQual approach was very valuable in helping us to use qualitative evidence appropriately in developing the guideline recommendations. We anticipate wide use of the approach in the future within WHO and other organizations involved in guideline development.”

New opportunities

CERQual is being developed by a subgroup of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Working Group (www.gradeworkinggroup.org). Claire Glenton, one of the co-authors of the new PLOS Medicine paper, notes: “To support the further development of CERQual and to facilitate the wide involvement of stakeholders in this process, we’ve established a GRADE-CERQual Project Group. This is an informal collaboration of those who have an interest in how to assess the confidence in evidence from qualitative evidence syntheses. We’re encouraging those keen to work in this area to join the group via our website (www.cerqual.org) and to contribute to the development of the CERQual approach.”

The CERQual paper is now freely available on the PLOS Medicine website at http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001895

* The WHO Department of Reproductive Health and Research includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special programme of research, development and research training in human reproduction (HRP).