Applying GRADE-CERQual to interpretive review findings: Reflections from a Cochrane meta-ethnography on childhood vaccination acceptance

Date & Time
Monday, September 4, 2023, 12:05 PM - 12:15 PM
Location Name
Session Type
Oral presentation
Qualitative synthesis methods
Oral session
Assessing evidence certainty
Cooper S1, Leon N2, Schmidt B3, Swartz A4, Wiysonge CS1, Colvin C4
1Cochrane South Africa, South African Medical Research Council, South Africa
2Health Systems Research Unit, South African Medical Research Council, South Africa
3School of Public Health, Faculty of Community Health Sciences, University of the Western Cape, South Africa
4School of Public Health and Family Medicine, University of Cape Town, South Africa

Background: GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was developed to support the increasing use of review findings from qualitative evidence syntheses within policy and decision-making. To date, the approach has mainly been applied to aggregative synthesis methodologies and descriptive review findings. Current GRADE-CERQual guidance suggests there is a need for testing with more diverse review methods and outputs, which will provide important insights for the ongoing evolution of the approach.
Objectives: This presentation aims to contribute to the evolution of GRADE-CERQual by reflecting on our experiences of applying the approach to the findings that emerged from a Cochrane meta-ethnography on childhood vaccination acceptance. Specifically, we describe the similarities and differences, challenges, and dilemmas we experienced when applying the approach to the more interpretive versus more descriptive findings that emerged from our review.
Results: We found that we were able to apply the core criteria and principles of GRADE-CERQual in ways that were congruent with the methodologies and epistemologies of a meta-ethnographic approach and associated interpretive findings. We also found that the practical application processes were similar for the more descriptive versus interpretive findings. The main differences we experienced related to the level of demand placed on the evidence supporting the review finding and the level of complexity involved with the decisions. Compared with the more descriptive findings, the more interpretive findings required supporting data that were richer, thicker, more contextually situated, and methodologically stronger for us to have the same level of confidence in them. Making the assessments for the more interpretive findings also involved greater dilemmas and more complicated forms of judgement, particularly for the component of coherence. We provide practical examples to illustrate these complexities and how we approached them.
Conclusions: Our experiences of applying GRADE-CERQual to more interpretive review findings generated various challenges and quandaries which we highlight and hope will offer a platform for further engagement. This could enhance the usability of GRADE-CERQual and in turn the kinds of knowledge that count within health decision-making, with ultimate positive effect on patients and other evidence users. Patient, public, and/or healthcare consumer involvement: None.