Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Ludwig-Maximilians-Universität München, Munich, Germany.
Pettenkofer School of Public Health, Munich, Germany.
Front Public Health. 2023 Mar 30;11:1075210. doi: 10.3389/fpubh.2023.1075210. eCollection 2023.
Different measures to prevent and control the spread of SARS-CoV-2 have been implemented in German schools. Decisions regarding such measures should be informed by evidence regarding their effectiveness, and their unintended consequences for health and society. A multi-stakeholder panel was convened to develop an evidence- and consensus-based guideline for school measures, using the novel WHO-INTEGRATE framework. Developing a guideline to inform decision-making outside of the clinical realm during a public health emergency was unprecedented in Germany. This study aims to identify lessons learnt for similar endeavours by addressing the following research question: What were the strengths and weaknesses of the guideline development process as perceived by the different groups involved?
Fifteen semi-structured interviews were conducted virtually. We recruited participants aiming to include the perspectives of all groups contributing to the guideline development, including both panel members (scientists, practitioners, school family and observers) and the guideline secretariat. For analysis, we carried out deductive-inductive thematic qualitative text analysis according to Kuckartz, structuring findings using a category system.
Due to time pressure, the guideline secretariat was heavily involved not only in synthesising the evidence but also in developing and drafting recommendations. Participants critically reflected on certain methods-related decisions, including the development of draft recommendations and application of the WHO-INTEGRATE framework by scientists only. The full potential of the framework might not have been harnessed. Participants' understanding of relevant and valid evidence varied, and the available evidence base was limited. Participants represented different types of expertise, notably expertise informed by scientific evidence and expertise grounded in lived experience, influencing their involvement in the guideline development process and discussions during meetings.
Developing an evidence- and consensus-based public health guideline in only three months was challenging, notably because of the involvement of a broad range of stakeholders and the use of a novel Evidence-to-Decision framework, both unprecedented in Germany. Learning from this process with a view to "institutionalising" the development of public health guidelines and refining methods can contribute to more evidence-informed public health decision-making in Germany and beyond, in general and during a public health emergency.
德国的学校已经采取了不同的措施来预防和控制 SARS-CoV-2 的传播。关于这些措施的决策应该基于其有效性的证据，以及它们对健康和社会的意外后果。一个多利益攸关方小组被召集起来，使用世界卫生组织新的 INTEGRATE 框架制定了一份基于证据和共识的学校措施指南。在德国，以前从未在公共卫生紧急情况下在临床领域之外制定指导方针以做出决策。本研究旨在通过回答以下研究问题来确定类似努力的经验教训：不同利益相关者小组认为指南制定过程的优缺点是什么？
进行了 15 次虚拟半结构式访谈。我们招募了参与者，旨在纳入参与指南制定的所有小组的观点，包括小组的成员（科学家、从业者、学校家庭和观察员）和指南的秘书处。为了进行分析，我们根据 Kuckartz 进行了演绎-归纳式主题定性文本分析，使用分类系统构建发现。
由于时间压力，指南秘书处不仅参与了证据的综合，还参与了建议的制定和起草。参与者对某些与方法相关的决策进行了批判性反思，包括起草建议的发展和仅由科学家应用世界卫生组织 INTEGRATE 框架。该框架的全部潜力可能尚未得到充分利用。参与者对相关和有效证据的理解存在差异，并且可用的证据基础有限。参与者代表了不同类型的专业知识，特别是基于科学证据的专业知识和基于经验的专业知识，这影响了他们在指南制定过程中的参与和会议期间的讨论。
在短短三个月内制定基于证据和共识的公共卫生指南具有挑战性，尤其是因为涉及广泛的利益相关者以及使用新的证据转化为决策框架，这在德国都是前所未有的。从这个过程中吸取教训，以期“制度化”公共卫生指南的制定并改进方法，可以促进德国乃至更广泛的国家在一般情况下和公共卫生紧急情况下更具循证的公共卫生决策。
