Background: Tuberculosis (TB) is the number one infectious disease killer in the world. TB is both preventable, and curable. Since 1997, the World Health Organization’s (WHO) Global TB (GTB) Programme has released evidence-informed publications to guide member states. In their EndTB strategy, the WHO set a mandate to eradicate TB by 2035, in part by intensifying TB research and innovation. As an effort towards this goal, this project applies evidence mapping methodologies to published WHO TB recommendations, in an innovative process called “recommendation mapping” (RM).
Objectives: The prime objective of RM is to allow guideline developers and key stakeholders to
identify gaps and clusters of recommendations across publications, serve as an instrumental tool
in the sequence of guideline development (from intelligent priority setting, to the assembly of
final recommendations) and increase the accessibility of key guideline components. The
secondary objective of this work is to poise guideline components for live update and refinement
in a rapidly learning health system.
Methods: In this mixed methods study, a methodological framework for mapping guideline
components is proposed, with both a quantitative and narrative assessment of raw data and final map outputs. A qualitative analysis from the perspective of key stakeholders, policy-makers, researchers and WHO-GTB liaisons working in guideline development is also included. For the methodological piece, all publications containing WHO TB recommendations were eligible for the mapping exercise. Each recommendation was extracted according to all subdomains of their PICO backbone. Subsections of recommendations are coded using existing ontologies (SNOMED-CT, ATC, ICD-11). A centralized database containing extracted and coded recommendations was then presented in an online and interactive schematic. For the qualitative assessment of palatability of this approach within the organization, semi-structured interviews and a survey was delivered to eligible participants at two Guideline Development Group meetings for WHO tuberculosis treatment and screening guidelines.
Results: The notable result of this work is the development, refinement and application of
recommendation mapping methodologies. 20 WHO-GTB guidelines underwent an application of
the novel recommendation methodologies proposed in this thesis to create an interactive map,
and a searchable database. In-depth interviews and survey results with 21 participants (WHO GTB staff, WHO TB- guideline development group members and technical experts) pointed to
concerns in the current accessibility and organization of WHO-GTB guidelines.
Conclusions: Recommendation mapping may have utility in charting the terrain of
recommendations, inform priority setting, and provide a scaffold for the future transition to living guidelines. / Thesis / Master of Public Health (MPH) / The World Health Organization (WHO) issues guidelines to help clinicians, policy-makers,
and researchers make informed decisions in their work. Guidelines contain recommendations
that can be thought of as bottom-line answers to the questions we ask the scientific literature
(based on the evidence available to us today). The WHO’s Tuberculosis (TB) Department is
partaking in a novel digital reorganization of their guideline recommendations using the
evidence-mapping methods proposed in this thesis. This thesis uses the principles of evidence
mapping to create recommendation maps that, like any map, chart the landscape in a given
domain (in this case, TB recommendations). The recommendation map will help guide the WHO
in setting priorities for future research and guideline development.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/25436 |
| Date | January 2020 |
| Creators | Hajizadeh, Anisa |
| Contributors | Schünemann, Holger, Health Research Methodology |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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