Improving the use of research evidence in guideline development: 13. Applicability, transferability and adaptation

Schünemann, Holger J; Fretheim, Atle; Oxman, Andrew D

The GWG also recognizes that "WHO takes a global perspective in addressing the needs of (192) member states. Differences in outcome will not only be due to transferring results from a research to a field setting, but also from the different cultural, economic, socio-demographic contexts present in the member-states," and that for "WHO guidelines, the traditional approach of reviewing and reporting evidence on efficacy and safety is certainly crucial but not sufficient. It can be regarded as the first step, but it is also necessary to examine the implications of applying each possible set of recommendations on a population basis. The initial body of evidence to be considered in WHO guidelines will be identical to that of traditional guidelines, but WHO guidelines will need to go further, to take the second step of spelling out the implications of adopting recommendations on costs and on population health. If done adequately, this will allow decision makers in different settings to take the third step of "localizing" the guidelines to their settings, and deciding where the trade-off between additional benefit and additional costs should be set. It will also be useful in determining what is acceptable for the end-users." However, one of the limitations of the GWG is that they have not been operationalized or implemented consistently. Only few WHO guideline processes have followed the GWG [8] .