School of Allied Health, The University of Western Australia, Crawley, Western Australia, 6009, Australia.
PEB Consulting Pty Ltd, 69 Federation St, Mount Hawthorn, Western Australia, 6016, Australia.
BMC Pregnancy Childbirth. 2021 Apr 23;21(1):322. doi: 10.1186/s12884-021-03775-9.
Health professionals caring for women and infants experiencing difficulty with breastfeeding have reported deficiencies in evidence-based lactation knowledge. LactaMap is an online lactation care support system with more than 100 clinical practice guidelines to support breastfeeding care. Clinical practice guidelines support medical decision-making by summarising scientific evidence into systematically developed statements for specific clinical circumstances. Both common-sense and theory-based approaches have been used for guideline development and debate continues regarding which is superior. LactaMap clinical practice guidelines were created over the course of 5 years using a common-sense approach that was refined inductively. The aim of this study was to incorporate a theory-based framework approach into the methodology for ongoing update and review of LactaMap clinical practice guidelines.
The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was chosen as the framework-based approach to appraise LactaMap guideline quality. The study was conducted in two phases. The first phase appraised all 103 original LactaMap guidelines. The second phase appraised a subset of 15 updated LactaMap guidelines using improved methodology guided by phase 1, as well as 15 corresponding original (un-updated) guidelines.
Mean Domain scores for 103 LactaMap original guidelines were above 75% in 3 of the 6 AGREE II quality Domains and no mean Domain score rated poorly. Update of guideline methodology was guided by phase 1 appraisals. Improved documentation of methods relating to questions in the Rigour of Development Domain resulted in improvement in mean Domain score from 39 to 72%.
This study showed that a theory-based approach to guideline development methodology can be readily integrated with a common-sense approach. Factors identified by AGREE II theory-based framework provided practical guidance for changes in methodology that were integrated prior to LactaMap website publication. Demonstration of high quality in LactaMap clinical practice guideline methodology ensures clinicians and the public can have trust that the content founded on them is robust, scientific and of highest possible quality.
照顾母乳喂养有困难的妇女和婴儿的健康专业人员报告说，他们缺乏基于证据的哺乳知识。LactaMap 是一个拥有超过 100 条临床实践指南的在线哺乳护理支持系统，旨在支持母乳喂养护理。临床实践指南通过将科学证据总结为针对特定临床情况的系统制定的陈述来支持医疗决策。共识和基于理论的方法都被用于指南的制定，关于哪种方法更优越的争论仍在继续。LactaMap 临床实践指南是在过去 5 年中使用共识方法创建的，该方法通过归纳法不断完善。本研究旨在将基于理论的框架方法纳入 LactaMap 临床实践指南的持续更新和审查方法。
选择评估指南研究和评估（AGREE） II 工具作为基于框架的方法来评估 LactaMap 指南的质量。该研究分为两个阶段进行。第一阶段评估了所有 103 条原始 LactaMap 指南。第二阶段使用第一阶段改进的方法评估了 15 条更新的 LactaMap 指南和 15 条相应的原始（未更新）指南。
在 6 个 AGREE II 质量领域中的 3 个领域中，103 条原始 LactaMap 指南的平均领域得分均高于 75%，没有任何平均领域得分较差。指南方法的更新受到第一阶段评估的指导。与发展领域的问题相关的方法的记录得到改善，导致平均领域得分从 39 提高到 72%。
本研究表明，基于理论的指南开发方法可以很容易地与共识方法相结合。AGREE II 基于理论的框架确定的因素为方法的改变提供了实用的指导，这些改变在 LactaMap 网站发布之前进行了整合。LactaMap 临床实践指南方法学的高质量证明确保临床医生和公众可以相信基于这些指南的内容是稳健的、科学的和最高质量的。
