Qualitative Evidence Synthesis in health and social care guidelines: what is its role and how might it be optimised?

Purpose and scope: The body of research reported in this thesis aims to better understand the role of qualitative evidence syntheses (QES) in the development of health (including public health) and social care guideline development, and how its role might be optimised.

Methods: Three studies were undertaken:
• A systematic review of methods and processes used for incorporating QES into health and social care guideline development.
• A quantitative content analysis to understand how frequently QES was undertaken by a leading health and social care guideline producer in the United Kingdom (the National Institute for Health and Care Excellence), and how closely the reports of those syntheses adhere to established reporting standards.
• A qualitative interview study to explore in-depth the views and perceptions of key committee participants regarding QES in health and social care, and how evidence from QES currently informs the process of developing recommendations.

Results: Key results indicate that, although there is some guidance internationally about how to undertake and integrate QES in guidelines, committee participants in this study struggle with QES, primarily in terms of understanding the purpose, role, and value of the qualitative paradigm, especially in situating it in relation to quantitative approaches. However, QES are perceived as a genuinely valuable tool for increasing stakeholder and lay-member visibility and inclusion.

Conclusions: Methods for using QES in the development of guidelines are underdeveloped and this study of one organisation in the UK indicates that further training for both committee members and staff, alongside methodological development, will enhance the usefulness of this important source of evidence. Further research is suggested alongside practical recommendations for guideline producers.