Skip to main content
Top
Published in: Implementation Science 1/2018

Open Access 01-01-2018 | Method

Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 5: how to assess adequacy of data

Authors: Claire Glenton, Benedicte Carlsen, Simon Lewin, Heather Munthe-Kaas, Christopher J. Colvin, Özge Tunçalp, Meghan A. Bohren, Jane Noyes, Andrew Booth, Ruth Garside, Arash Rashidian, Signe Flottorp, Megan Wainwright

Published in: Implementation Science | Special Issue 1/2018

Login to get access

Abstract

Background

The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation.
CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations; (2) coherence; (3) adequacy of data; and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual’s adequacy of data component.

Methods

We developed the adequacy of data component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual adequacy of data component within several qualitative evidence syntheses before agreeing on the current definition and principles for application.

Results

When applying CERQual, we define adequacy of data as an overall determination of the degree of richness and the quantity of data supporting a review finding. In this paper, we describe the adequacy component and its rationale and offer guidance on how to assess data adequacy in the context of a review finding as part of the CERQual approach. This guidance outlines the information required to assess data adequacy, the steps that need to be taken to assess data adequacy, and examples of adequacy assessments.

Conclusions

This paper provides guidance for review authors and others on undertaking an assessment of adequacy in the context of the CERQual approach. We approach assessments of data adequacy in terms of the richness and quantity of the data supporting each review finding, but do not offer fixed rules regarding what constitutes sufficiently rich data or an adequate quantity of data. Instead, we recommend that this assessment is made in relation to the nature of the finding. We expect the CERQual approach, and its individual components, to develop further as our experiences with the practical implementation of the approach increase.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gulmezoglu M, Noyes J, Booth A, Garside R, Rashidian A. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med. 2015;12(10):e1001895.CrossRefPubMedPubMedCentral Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gulmezoglu M, Noyes J, Booth A, Garside R, Rashidian A. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med. 2015;12(10):e1001895.CrossRefPubMedPubMedCentral
2.
go back to reference Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, Devereaux PJ, Montori VM, Freyschuss B, Vist G, et al. GRADE guidelines 6. Rating the quality of evidence--imprecision. J Clin Epidemiol. 2011;64(12):1283–93.CrossRefPubMed Guyatt GH, Oxman AD, Kunz R, Brozek J, Alonso-Coello P, Rind D, Devereaux PJ, Montori VM, Freyschuss B, Vist G, et al. GRADE guidelines 6. Rating the quality of evidence--imprecision. J Clin Epidemiol. 2011;64(12):1283–93.CrossRefPubMed
3.
go back to reference Colvin CJ, Garside R, Wainwright M, Lewin S, Bohren M, Glenton C, Munthe-Kaas HM, Carlsen B, Tuncalp Ö, Noyes J, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 4: how to assess coherence. Implement Sci. 2018;13(Suppl 1): https://doi.org/10.1186/s13012-017-0691-8. Colvin CJ, Garside R, Wainwright M, Lewin S, Bohren M, Glenton C, Munthe-Kaas HM, Carlsen B, Tuncalp Ö, Noyes J, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 4: how to assess coherence. Implement Sci. 2018;13(Suppl 1): https://​doi.​org/​10.​1186/​s13012-017-0691-8.
4.
go back to reference Munthe-Kaas HM, Bohren M, Carlsen B, Glenton C, Lewin S, Colvin CJ, Tuncalp Ö, Noyes J, Booth A, Garside R, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 3: how to assess methodological limitations. Implement Sci. 2018;13(Suppl 1): https://doi.org/10.1186/s13012-017-0690-9. Munthe-Kaas HM, Bohren M, Carlsen B, Glenton C, Lewin S, Colvin CJ, Tuncalp Ö, Noyes J, Booth A, Garside R, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 3: how to assess methodological limitations. Implement Sci. 2018;13(Suppl 1): https://​doi.​org/​10.​1186/​s13012-017-0690-9.
5.
go back to reference Noyes J, Booth A, Lewin S, Carlsen B, Glenton C, Munthe-Kaas HM, Colvin CJ, Garside R, Bohren M, Rashidian A, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 6: how to assess relevance of the data. Implement Sci. 2018;13(Suppl 1): https://doi.org/10.1186/s13012-017-0693-6. Noyes J, Booth A, Lewin S, Carlsen B, Glenton C, Munthe-Kaas HM, Colvin CJ, Garside R, Bohren M, Rashidian A, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 6: how to assess relevance of the data. Implement Sci. 2018;13(Suppl 1): https://​doi.​org/​10.​1186/​s13012-017-0693-6.
6.
go back to reference Lewin S, Bohren M, Rashidian A, Glenton C, Munthe-Kaas HM, Carlsen B, Colvin CJ, Tuncalp Ö, Noyes J, Booth A, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 2: how to make an overall CERQual assessment of confidence and create a summary of qualitative findings table. Implement Sci. 2018;13(Suppl 1): https://doi.org/10.1186/s13012-017-0689-2. Lewin S, Bohren M, Rashidian A, Glenton C, Munthe-Kaas HM, Carlsen B, Colvin CJ, Tuncalp Ö, Noyes J, Booth A, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 2: how to make an overall CERQual assessment of confidence and create a summary of qualitative findings table. Implement Sci. 2018;13(Suppl 1): https://​doi.​org/​10.​1186/​s13012-017-0689-2.
7.
go back to reference Ames HMR, Glenton C, Lewin S. Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev. 2017;2:CD011787.PubMed Ames HMR, Glenton C, Lewin S. Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev. 2017;2:CD011787.PubMed
8.
go back to reference Aslam RW, Hendry M, Carter B, Noyes J, Rycroft Malone J, Booth A, Pasterfield D, Charles JM, Craine N, Tudor Edwards R, et al. Interventions for preventing unintended repeat pregnancies among adolescents (protocol). Cochrane Database Syst Rev. 2015;(1):CD011477. Aslam RW, Hendry M, Carter B, Noyes J, Rycroft Malone J, Booth A, Pasterfield D, Charles JM, Craine N, Tudor Edwards R, et al. Interventions for preventing unintended repeat pregnancies among adolescents (protocol). Cochrane Database Syst Rev. 2015;(1):CD011477.
9.
go back to reference Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gulmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;11(1):71.CrossRefPubMedPubMedCentral Bohren MA, Hunter EC, Munthe-Kaas HM, Souza JP, Vogel JP, Gulmezoglu AM. Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis. Reprod Health. 2014;11(1):71.CrossRefPubMedPubMedCentral
10.
go back to reference Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, Aguiar C, Saraiva Coneglian F, Diniz AL, Tuncalp O, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12(6):e1001847. discussion e1001847CrossRefPubMedPubMedCentral Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, Aguiar C, Saraiva Coneglian F, Diniz AL, Tuncalp O, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12(6):e1001847. discussion e1001847CrossRefPubMedPubMedCentral
11.
go back to reference Colvin CJ, de Heer J, Winterton L, Mellenkamp M, Glenton C, Noyes J, Lewin S, Rashidian A. A systematic review of qualitative evidence on barriers and facilitators to the implementation of task-shifting in midwifery services. Midwifery. 2013;29(10):1211–21.CrossRefPubMed Colvin CJ, de Heer J, Winterton L, Mellenkamp M, Glenton C, Noyes J, Lewin S, Rashidian A. A systematic review of qualitative evidence on barriers and facilitators to the implementation of task-shifting in midwifery services. Midwifery. 2013;29(10):1211–21.CrossRefPubMed
12.
go back to reference Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, Rashidian A. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;10:CD010414. Glenton C, Colvin CJ, Carlsen B, Swartz A, Lewin S, Noyes J, Rashidian A. Barriers and facilitators to the implementation of lay health worker programmes to improve access to maternal and child health: qualitative evidence synthesis. Cochrane Database Syst Rev. 2013;10:CD010414.
13.
go back to reference Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2017;(11):Art. No.: CD011558. Munabi-Babigumira S, Glenton C, Lewin S, Fretheim A, Nabudere H. Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis. Cochrane Database Syst Rev. 2017;(11):Art. No.: CD011558.
14.
go back to reference Munthe-Kaas HM, Hammerstrøm KT, et al. Effekt av og erfaringer med kontinuitetsfremmende tiltak i barnevernsinstitusjoner. Oslo: Norwegian Knowledge Centre for the Health Services; 2013. Munthe-Kaas HM, Hammerstrøm KT, et al. Effekt av og erfaringer med kontinuitetsfremmende tiltak i barnevernsinstitusjoner. Oslo: Norwegian Knowledge Centre for the Health Services; 2013.
15.
go back to reference O’Brien TD, Noyes J, Spencer LH, Kubis HP, Hastings RP, Edwards RT, Bray N, Whitaker R. ‘Keep fit’ exercise interventions to improve health, fitness and well-being of children and young people who use wheelchairs: mixed-method systematic review protocol. J Adv Nurs. 2014;70(12):2942–51.CrossRefPubMed O’Brien TD, Noyes J, Spencer LH, Kubis HP, Hastings RP, Edwards RT, Bray N, Whitaker R. ‘Keep fit’ exercise interventions to improve health, fitness and well-being of children and young people who use wheelchairs: mixed-method systematic review protocol. J Adv Nurs. 2014;70(12):2942–51.CrossRefPubMed
16.
go back to reference Rashidian A, Shakibazadeh E, Karimi-Shahanjarini A, Glenton C, Noyes J, Lewin S, Colvin C, Laurant M. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: qualitative evidence synthesis (protocol). Cochrane Database Syst Rev. 2013;2:CD010412. Rashidian A, Shakibazadeh E, Karimi-Shahanjarini A, Glenton C, Noyes J, Lewin S, Colvin C, Laurant M. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: qualitative evidence synthesis (protocol). Cochrane Database Syst Rev. 2013;2:CD010412.
17.
go back to reference Whitaker R, Hendry M, Booth A, Carter B, Charles J, Craine N, Edwards RT, Lyons M, Noyes J, Pasterfield D, et al. Intervention now to eliminate repeat unintended pregnancy in teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, qualitative and realist synthesis of implementation factors and user engagement. BMJ Open. 2014;4(4):e004733.CrossRefPubMedPubMedCentral Whitaker R, Hendry M, Booth A, Carter B, Charles J, Craine N, Edwards RT, Lyons M, Noyes J, Pasterfield D, et al. Intervention now to eliminate repeat unintended pregnancy in teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, qualitative and realist synthesis of implementation factors and user engagement. BMJ Open. 2014;4(4):e004733.CrossRefPubMedPubMedCentral
18.
go back to reference Downe S, Finlayson K, Tuncalp Ӧ, Metin Gulmezoglu A. What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women. BJOG. 2016;123(4):529–39.CrossRefPubMed Downe S, Finlayson K, Tuncalp Ӧ, Metin Gulmezoglu A. What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women. BJOG. 2016;123(4):529–39.CrossRefPubMed
19.
go back to reference Odendaal WA, Goudge J, Griffiths F, Tomlinson M, Leon N, Daniels K. Healthcare workers’ perceptions and experience on using mHealth technologies to deliver primary healthcare services: qualitative evidence synthesis (protocol). Cochrane Database Syst Rev. 2015;(11):CD011942. Odendaal WA, Goudge J, Griffiths F, Tomlinson M, Leon N, Daniels K. Healthcare workers’ perceptions and experience on using mHealth technologies to deliver primary healthcare services: qualitative evidence synthesis (protocol). Cochrane Database Syst Rev. 2015;(11):CD011942.
20.
go back to reference Lewin S, Booth A, Glenton C, Munthe-Kaas HM, Rashidian A, Wainwright M, Bohren MA, Tuncalp Ö, Colvin CJ, Garside R, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci. 2018;13(Suppl 1): https://doi.org/10.1186/s13012-017-0688-3. Lewin S, Booth A, Glenton C, Munthe-Kaas HM, Rashidian A, Wainwright M, Bohren MA, Tuncalp Ö, Colvin CJ, Garside R, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci. 2018;13(Suppl 1): https://​doi.​org/​10.​1186/​s13012-017-0688-3.
21.
go back to reference Baker S, Edwards R. How many qualitative interviews is enough? Expert voices and early career reflections on sampling and cases in qualitative research. Southampton: National Centre for Research Methods; 2012. p. 1–42. Baker S, Edwards R. How many qualitative interviews is enough? Expert voices and early career reflections on sampling and cases in qualitative research. Southampton: National Centre for Research Methods; 2012. p. 1–42.
22.
go back to reference Popay J, Rogers A, Williams G. Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res. 1998;8(3):341–51.CrossRefPubMed Popay J, Rogers A, Williams G. Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res. 1998;8(3):341–51.CrossRefPubMed
23.
24.
go back to reference Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60.
25.
go back to reference Green J, Thorogood N. Qualitative methods for Health Research. London: Sage; 2005. Green J, Thorogood N. Qualitative methods for Health Research. London: Sage; 2005.
26.
27.
go back to reference Charmaz K. In: Baker S, Edwards R, editors. How many qualitative interviews is enough? Expert voices and early career reflections on sampling and cases in qualitative research. Southampton: National Centre for Research Methods; 2012. p. 21–2. Charmaz K. In: Baker S, Edwards R, editors. How many qualitative interviews is enough? Expert voices and early career reflections on sampling and cases in qualitative research. Southampton: National Centre for Research Methods; 2012. p. 21–2.
28.
go back to reference Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18(1):59–82.CrossRef
29.
go back to reference Francis J, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45.CrossRefPubMed Francis J, Johnston M, Robertson C, Glidewell L, Entwistle V, Eccles MP, Grimshaw JM. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychol Health. 2010;25(10):1229–45.CrossRefPubMed
Metadata
Title
Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 5: how to assess adequacy of data
Authors
Claire Glenton
Benedicte Carlsen
Simon Lewin
Heather Munthe-Kaas
Christopher J. Colvin
Özge Tunçalp
Meghan A. Bohren
Jane Noyes
Andrew Booth
Ruth Garside
Arash Rashidian
Signe Flottorp
Megan Wainwright
Publication date
01-01-2018
Publisher
BioMed Central
Published in
Implementation Science / Issue Special Issue 1/2018
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0692-7

Other articles of this Special Issue 1/2018

Implementation Science 1/2018 Go to the issue