Background: Evidence gap maps (EGMs) are a novel approach to establishing the breadth and depth of evidence on health. Their visual nature promotes knowledge translation to key stakeholders, including patients, practitioners and policymakers. The methods used to produce EGMs are systematic and rigorous but are open to challenges owing to their emerging nature in the canon of evidence synthesis. These challenges resulted in novel methods used within the production of an EGM surrounding interventions for obstetric fistula.
Objectives: To describe two novel methods used in conducting an EGM of interventions for treating obstetric fistula.
Methods: Although development of a framework is mandatory for EGMs, how stakeholders should be involved in establishing the framework is currently unclear. As such, a survey of key stakeholders (including patients and practitioners) was produced using Qualtrics to establish their perspectives on the most important interventions and outcomes to prioritise within the framework. The EGM was then produced in line with recommendations from the Campbell Collaboration and followed a prepublished protocol. Data synthesis was conducted in EPPI-Mapper. Sensitivity analyses using filters applied to the EGM were performed to determine where sufficient homogeneity to perform future evidence syntheses may be possible; this is not currently part of EGM guidance.
Results: Involving key stakeholders in the development of the EGM formed the structure of the evidence map by arranging the framework by what was considered most important to them. However, only 39 responses were received; focus groups or individual interviews may have garnered further insight, particularly if carried out in areas of high fistula prevalence. The reporting of the sensitivity analyses highlighted deficiencies in the evidence base; only 7 of 28 included studies [a combination of randomised controlled trials (RCTs) and non-RCTs] remained in the EGM and further illuminated the type of new primary data needed.
Conclusions: Further guidance on stakeholder involvement in EGMs, as well as development in the technology and methodologies supporting the production of EGMs, may help to address some of the current challenges faced in their production.
Patient, public and/or healthcare consumer involvement: Patients and the public were involved in answering the survey that determined the framework.