The GRADE framework can be applied across a variety of different fields, not the least of which is public health. Public health, as the authors of a new GRADE concept paper define it, is concerned with "preventing disease, prolonging life, and promoting health through the organized efforts of society" and comprises three key domains: health protection, health services, and health improvement. However, the field of public health also has unique challenges in the application of GRADE that require addressing.
To dig deeper into these challenges and design a plan of action for solutions and guidance, the GRADE Public Health group conducted a scoping review to better understand published accounts of the barriers, challenges, and facilitators to the adoption and application of GRADE in public health contexts, presenting the results of nine identified articles. Of these, five major challenges were identified:
- Incorporating diverse perspectives
- Selecting and prioritizing outcomes
- Interpreting outcomes and identifying a threshold for decision-making
- Assessing certainty of evidence from diverse sources (e.g., nonrandomized studies)
- Addressing implications for decision-makers, including concerns about conditional recommendations