Background:
The interactive Evidence to Decision (iEtD) tool, developed in the context of the DECIDE project, is a stand-alone version of the GRADEpro GDT Evidence to Decision (EtD) framework. The iEtD is freely available online but little is known about how organisations have been using it or their user experience.

Objectives:
To evaluate users' experiences with the iEtD and identify the main barriers to and facilitators for its use.

Methods:
We contacted 856 users registered in the iEtD via email and invited the 20 users who referred to a real use of the software to a semi-structured interview. Audio recordings were transcribed and one researcher carried out a content analysis of the interviews, supported with the honeycomb framework. Two researchers independently checked the content for accuracy.

Results:
We interviewed seven users from six countries in four continents. The most common scenario they described was using iEtD in the context of guideline development. Participants reported having an overall positive experience, without any major difficulties navigating or using the different sections of the framework. They also reported having used most of the framework criteria satisfactorily. Some reported tailoring the framework, for instance adding or deleting criteria, translating to another language or rewording headings. Several preferred to produce a Word version rather than working online, due to practical constraints and lack of flexibility. Some reported serious concerns with the exportable formats, especially in terms of understandability.

Conclusions:
A very limited number of users have used the iEtD tool since its development. Although the experience is in general positive, our work has identified some important limitations of this resource. Our findings could be of use in improving this resource, for the further development of GRADEpro GDT or other similar software.

Patient or healthcare consumer involvement:
Our findings are based on users' experiences.