Background: It is expected that global guidelines are informed by rigorous evidence and procedures. Yet the process of guideline development itself rarely undergoes the same scrutiny. In particular, there is limited information on whether countries find guidelines easy to adopt and adapt. This study summarises an independent evaluation of guidelines produced by the Evidence and Programme Guidance Unit, at the Department of Nutrition for Health and Development at the World Health Organization (WHO).
Objectives: The study aimed to determine the adaptability of the nutrition guidelines and to gather recommendations to improve their future development. Adaptability was defined by methodological quality and implementation of guidelines.
Methods: We employed a mixed-methods approach. The qualitative data were collected through a desk review and two waves of semi-structured interviews (n=12), and were analysed through axial coding. The assessment also included the use of two standardised instruments completed by key stakeholders. The Appraisal Guideline for Research and Evaluation questionnaire, version II was used to assess guideline quality (n=6), while implementability was assessed with the electronic version of the Guideline Implementability Appraisal (n=7).
Results: Key strengths of the guideline-development process were: the appropriate management of conflicts of interest of guideline developers and the systematic use of high-quality evidence to inform the recommendations. However, guidelines lacked precise implementation advice, which decreased the overall guideline implementability. Challenges related to collaborative work within interdisciplinary groups were also identified.
Conclusions: The mixed-methods approach allowed a rigorous framework to assess guideline adaptability, which was responsive to leads emerging from the qualitative data. Nutrition evidence-informed guidelines are of good methodological quality, but implementability requires improvement. Ways of improving relate to guideline content, the dynamics shaping interdisciplinary work, and actions for implementation feasibility.
Financial support: Micronutrient Initiative, WHO.