Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Jul 13;182(10):E472-8.
doi: 10.1503/cmaj.091716. Epub 2010 May 31.

Development of the AGREE II, part 2: assessment of validity of items and tools to support application

Melissa C Brouwers  1 , Michelle E Kho, George P Browman, Jako S Burgers, Françoise Cluzeau, Gene Feder, Béatrice Fervers, Ian D Graham, Steven E Hanna, Julie Makarski; AGREE Next Steps Consortium
Collaborators, Affiliations

Development of the AGREE II, part 2: assessment of validity of items and tools to support application

Melissa C Brouwers et al. CMAJ. .

Abstract

Background: We established a program of research to improve the development, reporting and evaluation of practice guidelines. We assessed the construct validity of the items and user's manual in the beta version of the AGREE II.

Methods: We designed guideline excerpts reflecting high-and low-quality guideline content for 21 of the 23 items in the tool. We designed two study packages so that one low-quality and one high-quality version of each item were randomly assigned to each package. We randomly assigned 30 participants to one of the two packages. Participants reviewed and rated the guideline content according to the instructions of the user's manual and completed a survey assessing the manual.

Results: In all cases, content designed to be of high quality was rated higher than low-quality content; in 18 of 21 cases, the differences were significant (p < 0.05). The manual was rated by participants as appropriate, easy to use, and helpful in differentiating guidelines of varying quality, with all scores above the mid-point of the seven-point scale. Considerable feedback was offered on how the items and manual of the beta-AGREE II could be improved.

Interpretation: The validity of the items was established and the user's manual was rated as highly useful by users. We used these results and those of our study presented in part 1 to modify the items and user's manual. We recommend AGREE II (available at www.agreetrust.org) as the revised standard for guideline development, reporting and evaluation.

PubMed Disclaimer

References

    1. Field MJ, Lohr KN, editors. Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine. Clinical practice guidelines: directions for a new program. Washington (DC): National Academy Press; 1990.
    1. Whitworth JA. Best practices in use of research evidence to inform health decisions. Health Res Policy Syst. 2006;4:11. - PMC - PubMed
    1. Browman GP, Brouwers M, Fervers B, et al. Population-based cancer control and the role of guidelines-towards a “systems” approach. In: Elwood JM, Sutcliffe SB, editors. Cancer control. Oxford (UK): Oxford University Press; 2009.
    1. Woolf SH, Grol R, Hutchinson A, et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ. 1999;318:527–30. - PMC - PubMed
    1. The AGREE Collaboration. Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: the AGREE project. Qual Saf Health Care. 2003;12:18–23. - PMC - PubMed

MeSH terms