Factors Associated with the Quality and Transparency of National Guidelines: A Mixed-Methods Study

Tanja Kovačević, Davorka Vrdoljak, Slavica Jurić Petričević, Ivan Buljan, Dario Sambunjak, Željko Krznarić, Ana Marušić and Ana Jerončić
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Tanja Kovačević: Department of Pediatrics, University Hospital of Split, 21000 Split, Croatia
Davorka Vrdoljak: Cochrane Croatia, University of Split School of Medicine, 21000 Split, Croatia
Slavica Jurić Petričević: Department of Pulmology, University Hospital of Split, 21000 Split, Croatia
Ivan Buljan: Cochrane Croatia, University of Split School of Medicine, 21000 Split, Croatia
Dario Sambunjak: Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia
Željko Krznarić: Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
Ana Marušić: Cochrane Croatia, University of Split School of Medicine, 21000 Split, Croatia
Ana Jerončić: Cochrane Croatia, University of Split School of Medicine, 21000 Split, Croatia

IJERPH, 2022, vol. 19, issue 15, 1-22

Abstract: We assessed the methodological quality and transparency of all the national clinical practice guidelines that were published in Croatia up until 2017 and explored the factors associated with their quality rating. An in-depth quantitative and qualitative analysis was performed using rigorous methodology. We evaluated the guidelines using a validated AGREE II instrument with four raters; we used multiple linear regressions to identify the predictors of quality; and two focus groups, including guideline developers, to further explore the guideline development process. The majority of the guidelines (N = 74) were developed by medical societies. The guidelines’ quality was rated low: the median standardized AGREE II score was low, 36% (IQR 28–42), and so were the overall-assessments. The aspects of the guidelines that were rated best were the “clarity of presentation” and the “scope and purpose” (median ≥ 59%); however, the other four domains received very low scores (15–33%). Overall, the guideline quality did not improve over time. The guidelines that were developed by medical societies scored significantly worse than those developed by governmental, or unofficial working groups (12–43% per domain). In focus group discussions, inadequate methodology, a lack of implementation systems in place, a lack of awareness about editorial independence, and broader expertise/perspectives in working groups were identified as factors behind the low scores. The factors identified as affecting the quality of the national guidelines may help stakeholders who are developing interventions and education programs aimed at improving guideline quality worldwide.

Keywords: knowledge; education; public health; national guidelines; guideline development; clinical practice guidelines; methodological quality; focus group (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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