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. 2018 Jan 25;13(Suppl 1):13.
doi: 10.1186/s13012-017-0691-8.

Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 4: how to assess coherence

Christopher J Colvin  1 , Ruth Garside  2 , Megan Wainwright  1 , Heather Munthe-Kaas  3 , Claire Glenton  4 , Meghan A Bohren  5 , Benedicte Carlsen  6 , Özge Tunçalp  5 , Jane Noyes  7 , Andrew Booth  8 , Arash Rashidian  9   10 , Signe Flottorp  4 , Simon Lewin  4   11
Affiliations

Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 4: how to assess coherence

Christopher J Colvin et al. Implement Sci. .

Abstract

Background: The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE working group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) relevance, (3) coherence and (4) adequacy of data. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual's coherence component.

Methods: We developed the coherence component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual coherence component within several qualitative evidence syntheses before agreeing on the current definition and principles for application.

Results: When applying CERQual, we define coherence as how clear and cogent the fit is between the data from the primary studies and a review finding that synthesises that data. In this paper, we describe the coherence component and its rationale and offer guidance on how to assess coherence in the context of a review finding as part of the CERQual approach. This guidance outlines the information required to assess coherence, the steps that need to be taken to assess coherence and examples of coherence assessments.

Conclusions: This paper provides guidance for review authors and others on undertaking an assessment of coherence in the context of the CERQual approach. We suggest that threats to coherence may arise when the data supporting a review finding are contradictory, ambiguous or incomplete or where competing theories exist that could be used to synthesise the data. We expect the CERQual approach, and its individual components, to develop further as our experiences with the practical implementation of the approach increase.

Keywords: Coherence; Confidence; Evidence-based practice; GRADE; Guidance; Methodology; Qualitative evidence synthesis; Qualitative research; Research design; Systematic review methodology.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable. This study did not undertake any formal data collection involving humans or animals.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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Figures

Fig. 1
Fig. 1
Overview of the GRADE-CERQual series of papers
Fig. 2
Fig. 2
Spectrum representing the degree of transformation of data in qualitative evidence syntheses
Fig. 3
Fig. 3
Steps in assessing the coherence of a review finding
See this image and copyright information in PMC

References

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    1. Glenton C, Carlsen B, Lewin S, Munthe-Kaas HM, Colvin CJ, Tuncalp Ö, Bohren M, Noyes J, Booth A, Garside R, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 5: how to assess adequacy of data. Implement Sci. 2018;13(Suppl 1): 10.1186/s13012-017-0692-7. - PMC - PubMed
    1. Munthe-Kaas HM, Bohren M, Carlsen B, Glenton C, Lewin S, Colvin CJ, Tuncalp Ö, Noyes J, Booth A, Garside R, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 3: how to assess methodological limitations. Implement Sci. 2018;13(Suppl 1): 10.1186/s13012-017-0690-9. - PMC - PubMed
    1. Noyes J, Booth A, Lewin S, Carlsen B, Glenton C, Munthe-Kaas HM, Colvin CJ, Garside R, Bohren M, Rashidian A, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 6: how to assess relevance of the data. Implement Sci. 2018;13(Suppl 1): 10.1186/s13012-017-0693-6. - PMC - PubMed
    1. Lewin S, Bohren M, Rashidian A, Glenton C, Munthe-Kaas HM, Carlsen B, Colvin CJ, Tuncalp Ö, Noyes J, Booth A, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 2: how to make an overall CERQual assessment of confidence and create a Summary of Qualitative Findings table. Implement Sci. 2018;13(Suppl 1): 10.1186/s13012-017-0689-2. - PMC - PubMed

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