Chair of Public Health and Health Services Research, Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.
Health Res Policy Syst. 2024 Jul 5;22(1):79. doi: 10.1186/s12961-024-01165-z.
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.
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.
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.
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.
制定公共卫生、卫生系统和卫生政策干预措施的指南需要复杂的系统思维，以便在动态系统中理解干预措施的直接和间接影响。世卫组织整合框架是一个根植于世界卫生组织（世卫组织）规范和价值观的循证决策框架，它为系统地评估指南中的复杂性提供了一种结构化的方法，例如干预措施的健康效益和危害及其人权和社会文化可接受性之间的平衡。本文提供了一个工作实例，说明了世卫组织整合框架在世卫组织预防儿童虐待养育干预措施指南制定中的应用，并分享了有关增值、遇到的挑战和经验教训的反思性见解。
该方法包括描述世卫组织整合框架的预期逐步应用，并从指导世卫组织养育干预措施指南制定的核心团队的内部反思会议和方法学研讨会上获得反思性见解。
世卫组织整合框架在整个指南制定过程中得到了应用。它在以下步骤中促进了广泛的决策标准和系统层面方面的反思性审议：（1）界定指南范围并确定利益攸关方参与；（2）确定世卫组织整合框架的优先次准则和指南结果；（3）利用研究证据为世卫组织整合框架准则提供信息；（4）根据世卫组织整合框架准则制定和提出建议。尽管有增值作用，但也遇到了一些挑战，例如需要大量时间投入、优先次准则的广泛范围、跨多种准则的整合以及证据来源和将见解转化为简明格式等。
世卫组织整合框架的应用对于将有效性证据与养育干预措施的实施和更广泛影响方面的见解结合起来至关重要，超出了健康效益和危害考虑的范围，并促进了全社会的视角。针对优先次准则的世卫组织整合框架证据审查对于指导指南制定小组讨论、提供建议和澄清不确定性具有重要作用。这一经验为未来使用世卫组织整合框架的指南小组和指南方法学家提供了重要的经验教训。
