Zähringer Jasmin, Schwingshackl Lukas, Movsisyan Ani, Stratil Jan M, Capacci Sara, Steinacker Jürgen M, Forberger Sarah, Ahrens Wolfgang, Küllenberg de Gaudry Daniela, Schünemann Holger J, Meerpohl Joerg J
Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Pettenkofer School of Public Health, LMU Munich, Munich, Germany.
Implement Sci. 2020 May 24;15(1):37. doi: 10.1186/s13012-020-00984-2.
Nutrition and physical activity policies have the potential to influence lifestyle patterns and reduce the burden of non-communicable diseases. In the world of health-related guidelines, GRADE (Grading of Recommendations, Assessment, Development and Evaluation) is the most widely used approach for assessing the certainty of evidence and determining the strength of recommendations. Thus, it is relevant to explore its usefulness also in the process of nutrition and physical activity policymaking and evaluation. The purpose of this scoping review was (i) to generate an exemplary overview of documents using the GRADE approach in the process of nutrition and physical activity policymaking and evaluation, (ii) to find out how the GRADE approach has been applied, and (iii) to explore which facilitators of and barriers to the use of GRADE have been described on the basis of the identified documents. The overarching aim of this work is to work towards improving the process of evidence-informed policymaking in the areas of dietary behavior, physical activity, and sedentary behavior.
A scoping review was conducted according to current reporting standards. MEDLINE via Ovid, the Cochrane Library, and Web of Science were systematically searched up until 4 July 2019. Documents describing a body of evidence which was assessed for the development or evaluation of a policy, including documents labeled as "guidelines," or systematic reviews used to inform policymaking were included.
Thirty-six documents were included. Overall, 313 GRADE certainty of evidence ratings were identified in systematic reviews and guidelines; the strength of recommendations/policies was assessed in four documents, and six documents mentioned facilitators or barriers for the use of GRADE. The major reported barrier was the initial low starting level of a body of evidence from non-randomized studies when assessing the certainty of evidence.
This scoping review found that the GRADE approach has been used for policy evaluations, in the evaluation of the effectiveness of policy-relevant interventions (policymaking), as well as in the development of guidelines intended to guide policymaking. Several areas for future research were identified to explore the use of GRADE in health policymaking and evaluation.
营养与身体活动政策有可能影响生活方式模式并减轻非传染性疾病负担。在与健康相关的指南领域，GRADE（推荐分级、评估、制定与评价）是评估证据确定性及确定推荐强度时使用最广泛的方法。因此，探讨其在营养与身体活动政策制定及评估过程中的实用性也具有重要意义。本范围综述的目的是：（i）对在营养与身体活动政策制定及评估过程中使用GRADE方法的文献进行示例性概述；（ii）了解GRADE方法是如何应用的；（iii）根据所识别的文献，探讨已描述的使用GRADE方法的促进因素和障碍。这项工作的总体目标是努力改进饮食行为、身体活动和久坐行为领域基于证据的政策制定过程。
根据当前报告标准进行范围综述。截至2019年7月4日，通过Ovid检索MEDLINE、Cochrane图书馆和Web of Science。纳入描述为制定或评估政策而评估的一组证据的文献，包括标记为“指南”的文献或用于为政策制定提供信息的系统评价。
纳入3篇文献。总体而言，在系统评价和指南中确定了313个GRADE证据确定性评级；在4篇文献中评估了推荐/政策的强度，6篇文献提到了使用GRADE方法的促进因素或障碍。报告的主要障碍是在评估证据确定性时，来自非随机研究的一组证据最初的起始水平较低。
本范围综述发现，GRADE方法已用于政策评估、政策相关干预措施有效性的评估（政策制定）以及旨在指导政策制定的指南制定。确定了几个未来研究领域，以探讨GRADE方法在卫生政策制定和评估中的应用。
