Research On Key Problems And Countermeasures In The Grading Method Of Evidence Quality For Public Health Decision-Making

Objective: To systematically reviews the current status of research on evidence quality grading methods for public health decision-making,discusses the problems and countermeasures in the application of evidence quality grading methods for public health decision-making,provides reference and support for the development of scientific evidence quality grading methods for public health decision-making in the future,and helps modernize the realm of public health’s governance system and capability.Methods:(i)Bibliometric analysis: Search Chinese and foreign language databases to include relevant studies on grading method of evidence quality for public health decision-making,and the distribution of their publication years,journals,institutions and authors were visualized and analyzed,and clustering analysis of key words was conducted.(ii)Qualitative systematic review: Relevant studies on the application of grading method of evidence quality for public health decision-making were systematically searched,the CASP checklist was used to evaluate the quality of the included literature,and a three-level interpretive analysis of the application of evidence quality grading methods for public health decision-making was conducted using the thematic synthesis method to establish a pool of question entries.(iii)Delphi method: Based on the comprehensive results of the qualitative system evaluation,a Delphi expert consultation form was developed for the question entries.17 domestic and international experts were selected and two rounds of consultation.The key questions were selected by calculating the authority coefficient,the coordination coefficient,the mean score of each question,the coefficient of variation and the perfect score.(iv): Semi-structured interviews: Using semi-structured interviews,the Delphi correspondence experts were interviewed,and an interview outline was developed based on the selected key questions to propose countermeasures.Results:(i)Status analysis of the method for grading the quality of evidence for public health decision-making: A total of 155 relevant studies were included,with a fluctuating and slowly increasing trend in the number of publications.Included studies were published in 53 journals,with a total of 604 authors from 351 institutions in 48 countries participating.Developed countries such as the USA,Canada and the UK were at the center of the collaborative network.Keyword analysis revealed that current research on methods for grading the quality of evidence for public health decisionmaking focuses on GRADE,systematic reviews,guidelines,recommendations,and factors influencing the grading of evidence.(ii)Systematic review of methodological issues in grading evidence for public health decision-making: 14 qualitative studies were included,of which eight were of high quality,four were of moderate quality and two were of low quality.A thematic synthesis of questions on the application of evidence quality grading methods in public health from the included studies was conducted,summarizing 14 question entries in seven categories,including questions on sources of evidence,questions on evidence for different types of studies,questions on evidence grading for complex intervention studies,questions on consistency,complexity and validity of evidence quality grading methods,and questions on evidence grading results.(iii)Key problems and countermeasures in the grading method of evidence quality for public health decision-making: the first round of Delphi correspondence had an expert positivity coefficient of 100%,the coefficient of expert authority was Cr = 0.788,and the Kendall coordination coefficient was 0.147(P =0.002).The second round of Delphi correspondence had a positive expert coefficient of100%,the coefficient of expert authority was Cr = 0.794 and the Kendall coordination coefficient was 0.162(P = 0.018).Based on the scores of the two rounds and the experts’ opinions,the final selection was "observational studies lacked grading,and the starting evidence levels for different types of observational studies were low and identical,making it difficult to reflect the true quality of evidence in this area" and "complex intervention studies were frequently downgraded due to heterogeneity,indirectness,and study limitations,making it difficult to reflect the true quality of evidence in this area".Five Delphi experts participated in semi-structured interviews,and the data were qualitatively collated and analysed to develop two responses,namely to refine the starting level of evidence for observational studies of different designs and to develop and implement additional escalation criteria.Conclusions: Methods for grading the quality of evidence for public health decision-making continue to receive attention,focusing on GRADE,systematic reviews,guidelines,recommendations,and factors influencing the grading of evidence.However,key issues remain,such as the low quality of evidence for observational studies and complex intervention studies,for which future research should refine the distinction between the starting level of evidence for observational studies of different designs,develop and implement additional escalation criteria,and optimise or develop more appropriate methods for grading the quality of evidence for research in public health.