A protocol serves as road map for the conduct of a review and the rigour with which it is applied determines the quality of the review. However, there are often components in a protocol that are not detailed, which allow a degree of discretion to the review authors in how they are executed. Qualitative evidence syntheses using GRADE-CERQual may be even more open to such discretions, given that the methodology is less well established than for effectiveness reviews. It may also be more true for contemporary and emerging topics such as mobile health (mHealth).
To describe the process of 1) refining the eligibility criteria during screening, and 2) deciding on a more focused screening of the updated search records, for a GRADE-CERQual qualitative evidence synthesis review.
Methods and results:
The review is about health workers' perceptions and experiences of using mHealth technologies.
Refining the eligibility criteria: Despite a detailed and comprehensive definition of mHealth, there were many instances during the screening where the co-screeners disagreed on whether the technology used was mHealth. All the team members 'voted' on unresolved cases with the reason for their decision. This was recorded and resulted in a refined criteria document that was used to resolve future disagreements.
More focused screening: A second search was mandated given the time lapse from the first search. From the 23 included studies from the first search, 38 findings were drafted. For screening of the records from the second search, the review team drafted a list of topics that were not represented or were under-represented in the findings, for example high-income settings. They also identified findings graded as low confidence findings because of inadequate reporting in the literature, and screened with the purpose of looking for studies that added evidence to these findings. The eligibility document and focused screening of the second search contributed towards a more nuanced implementation of the review protocol.
Protocol components may often not be detailed and comprehensive enough to account for unexpected issues arising during the review. Transparent and appropriate measures to deal with these instances may enhance the methodological rigour and quality of the review.
Patient or healthcare consumer involvement: