A Reporting Tool for Adapted Guidelines in Health Care: The RIGHT-Ad@pt Checklist

To maximize the efficiency of resources and reduce redundancy, organizations and countries may decide to adapt an existing practice guideline rather than developing a new one. The RIGHT (Reporting Items for practice Guidelines in HealThcare) statement currently informs the reporting of the guideline development; however, it does not cover reporting of steps that are specific to guideline adaptation.

A scientific workgroup, filled this gap and developed a new reporting tool designed to improve standardization and transparency of adapted health care guidelines. Called the RIGHT-Ad@pt Checklist, the tool focuses on improving the clarity and explicitness of recommendations that have been adapted for use in different health care systems, and of the guideline development process.

The RIGHT-Ad@pt Checklist was developed as an extension of the RIGHT statement through a multi-step process involving literature reviews and consensus building involving a range of stakeholders including guideline adaptation experts, users, journal editors, and policy makers. The checklist was designed to be used to guide the reporting of adapted guidelines, including adaptation process and the adapted recommendations. It can also be applied to assess the completeness of reporting and, in combination with available adaptation frameworks, to inform adaptation processes. Different audiences may use the RIGHT-Ad@pt checklist for different purposes:

  • Guideline developers could use the checklist to report their adapted guidelines;
  • Journal editors and reviewers could use the checklist to ensure the completeness and transparency of the reporting in the publication of adapted guidelines;
  • Clinicians could accurately identify and apply adapted recommendations to their clinical practice based on detailed and clear reporting; and
  • Policymakers could evaluate the feasibility of adapted recommendations for local implementation based on the reporting contents suggested by the checklist.

The checklist was published in Annals of Internal Medicine and is available here

Photo by Mikael Blomkvist on Pexels.com

Maternal Mortality in Afghanistan: a critical review to understand strategic priorities

Afghanistan, a landlocked mountainous nation, situated strategically between Central and South Asia, has been in conflict since the Saur Revolution in 1978 when  the socialist People’s Democratic Party (PDP) of Afghanistan seized  power from the then secular government (Gascoigne, 2015; BBC, 2015) . This led to a civil war between PDP, supported by the Soviet Union, and the Mujahidin, supported by the United States vide Pakistan. The vicious cycle of conflicts continued till November 2001 when the Taliban (a radical offshoot of Mujahidin) was routed out, ironically by military action of United States(BBC, 2015) .

In 2001, as multi-pronged reconstruction efforts started, it brought hopes that conflict, social upheaval, and food shortages would end(Castillo, 2013), and Afghanistan would march towards the Millennium Development Goals (MDG), along with the 191 other countries that had adopted it .  Among the eight ambitious MDG’s , adopted was the goal to “reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio (MMR)”(United Nations, 2015)  . Afghanistan however was accorded the unfortunate title of being the “riskiest place on earth for health of mothers” a few years back (Save The Children, 2010) .

The report aims to critically analyse maternal mortality in Afghanistan from the year 2000 to 2015. –  a period roughly corresponding to the era of US-led reconstruction action (Castillo, 2013).  

The report written for an academic purpose to analyze a post-conflict state is being released publicly on 31st August 2021 as Afghanistan potentially faces conflict again. The report, it is hoped, serves as a reminder to democratic nations that : Peace is the most important determinant of health. There is no health without human rights.

Reporting guideline for priority setting of health research (REPRISE)

Historically, the health research agenda has been largely investigator-driven with limited input from other stakeholders including patients, caregivers and the community . Given the evident mismatch between the research interests of patients and researchers, investment into health research may be misdirected to areas of low priority or fail to address important needs of relevant stakeholders. For example, an analysis of 14 research priority setting partnerships involving patients with different medical conditions found that pharmacological interventions were prioritized only in 18% of the total priorities but 58% of the clinical trials in those fields evaluated pharmacological interventions .

Globally, there have been calls for research priority setting with stakeholders to be done at all levels of health systems, jurisdictions, and health areas . There is no consensus on the definition of research priority setting but most definitions refer to a range of activities that involve identifying, prioritizing, and achieving consensus on the research areas or questions of importance to stakeholders . The past two decades have seen increasing efforts to develop better ways to engage all relevant stakeholders, particularly patients, in setting priorities for research across different health disciplines and populations [15,16,17]. Involving stakeholders in an explicit manner in research priority setting can help to: 1) ensure that funding decisions and research meet critical evidence gaps to inform decision making; 2) facilitate shared responsibility and accountability in implementing the research agenda; 3) improve the relevance and legitimacy of research; and 4) ultimately achieve better health outcomes .

A diverse range of methods are used to prioritize research given the different healthcare contexts, populations, environments and resources available in which the priority setting is undertaken [14]. The process of research priority setting can be complex, political and value-laden. It can also be challenging to identify, address and integrate the different perspectives and values held by diverse stakeholders. While there is no consensus on what constitutes “successful” research priority setting, it has been advocated that processes must be fair, legitimate, informed by credible evidence, involve a broad spectrum of stakeholders, and be transparent

However, reviews of published research priority setting exercises have consistently demonstrated a lack of transparency because of suboptimal reporting . A systematic review of research priority setting in childhood chronic disease, in which most studies were conducted in the UK, US, and Australia, found that methods for collecting and prioritizing research topics were reported in only 50 (60%) of the 84 studies included. Another review of research priority setting exercises in Zambia reported that details about the process and the stakeholders involved were omitted in the majority of studies , and similarly, a review of studies in the Islamic Republic of Iran revealed that 22 (61%) of the 36 priority setting studies did not report methods and only listed the research priorities . Inadequate description of the stakeholders and the methods makes it difficult to assess the validity of research priorities identified, and limits the ability to aggregate, analyze or compare research priorities that have been established .

Frameworks and guidelines are available for conducting and evaluating research priority setting, which mainly focus on criteria related to the process rather than the outcomes and impact of priority setting. There are no published guidelines for reporting priority setting for health research . Ensuring the transparency of the process for research priority setting can strengthen legitimacy and credibility to support implementation and maximise impact. A reporting checklist for research priority setting may facilitate more consistent and comprehensive reporting and enable researchers and end-users to better understand the processes taken in developing research priorities.

The paper presents the reporting guideline for priority setting of health research (REPRISE), describes its development and provide a rationale for the items included.

Read the full paper in BMC Medical Research Methodology here (Open Access)