Journal Article

Applying the WHO-INTEGRATE evidence-to-decision framework in the development of WHO guidelines on parenting interventions: step-by-step process and lessons learnt

Backhaus, Sophia, Gardner, Frances, Butchart, Alexander, Rehfuess, Eva, Strahwald, Brigitte, Movsisyan, Ani

2024

Overview

Background Development of guidelines for public health, health system, and health policy interventions demands complex systems thinking to understand direct and indirect effects of interventions within dynamic systems. The WHO-INTEGRATE framework, an evidence-to-decision framework rooted in the norms and values of the World Health Organization (WHO), provides a structured method to assess complexities in guidelines systematically, such as the balance of an intervention’s health benefits and harms and their human rights and socio-cultural acceptability. This paper provides a worked example of the application of the WHO-INTEGRATE framework in developing the WHO guidelines on parenting interventions to prevent child maltreatment, and shares reflective insights regarding the value added, challenges encountered, and lessons learnt. Methods The methodological approach comprised describing the intended step-by-step application of the WHO-INTEGRATE framework and gaining reflective insights from introspective sessions within the core team guiding the development of the WHO guidelines on parenting interventions and a methodological workshop. Results The WHO-INTEGRATE framework was used throughout the guideline development process. It facilitated reflective deliberation across a broad range of decision criteria and system-level aspects in the following steps: (1) scoping the guideline and defining stakeholder engagement, (2) prioritising WHO-INTEGRATE sub-criteria and guideline outcomes, (3) using research evidence to inform WHO-INTEGRATE criteria, and (4) developing and presenting recommendations informed by WHO-INTEGRATE criteria. Despite the value added, challenges, such as substantial time investment required, broad scope of prioritised sub-criteria, integration across diverse criteria, and sources of evidence and translation of insights into concise formats, were encountered. Conclusions Application of the WHO-INTEGRATE framework was crucial in the integration of effectiveness evidence with insights into implementation and broader implications of parenting interventions, extending beyond health benefits and harms considerations and fostering a whole-of-society-perspective. The evidence reviews for prioritised WHO-INTEGRATE sub-criteria were instrumental in guiding guideline development group discussions, informing recommendations and clarifying uncertainties. This experience offers important lessons for future guideline panels and guideline methodologists using the WHO-INTEGRATE framework.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abused children / Acceptability / Analysis / Application / Child / Child abuse & neglect / Child Abuse - prevention & control / Complex systems / Complex systems thinking / Criteria / Decision Making / Decisions / Dynamical systems / Evidence-to-decision framework / Frame analysis / Guideline development / Guidelines / Guidelines as Topic / Health Administration / Health care policy / Health education / Health Policy / Health services / Health Services Research / Human rights / Humans / Indirect effects / Intervention / Medical policy / Medicine / Medicine & Public Health / Mental health / Methodological approaches / Objectives / Organizational effectiveness / Parenting / Parenting interventions / Parents & parenting / Practice Guidelines as Topic / Public Health / R & D/Technology Policy / Social aspects / Sociocultural factors / Stakeholder Participation / Value added / World Health Organization