Applying GRADE-CERQual to Interpretive Review Findings: Reflections From a Cochrane meta-ethnography on Childhood Vaccination Acceptance

GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was developed to support the use of evidence from qualitative reviews within policy- and decision-making. To date, the approach has been applied predominantly to aggregative synthesis methodologies and descriptive review findings. GRADE-CERQual guidance recommends the approach be tested on more diverse review methodologies and outputs to support its evolution. This paper contributes to this evolution by reflecting on our experiences of applying GRADE-CERQual to findings that emerged from a recent Cochrane meta-ethnography on childhood vaccination. Specifically, we describe the similarities and differences, challenges and dilemmas we experienced applying the approach to more interpretive versus more descriptive review findings. We found that we were able to apply the core criteria and principles of GRADE-CERQual in ways that were congruent with the methodologies and epistemologies of a meta-ethnography and its findings. We also found that the practical application processes were similar across review finding types. The main differences related to the level of demand placed on the evidence and the level of complexity involved with the decisions. Compared to more descriptive findings, more interpretive findings required evidence that was richer, thicker, more contextually situated and methodologically stronger for us to have the same level of confidence in them. Making the assessments for these findings also involved more complicated forms of judgement. We provide practical examples to illustrate these complexities and how we approached them, which others applying GRADE-CERQual to more interpretive review findings could draw upon. We also highlight areas requiring further discussion, in the hope that this will offer a platform for engagement and the potential future refinement of the approach. Ultimately, this could enhance the usability of GRADE-CERQual for a larger range of qualitative review findings and in turn expand the kinds of knowledges that count within decision-making.