PRISMA reporting guideline and standards for qualitative evidence synthesis

Health and care services need high quality information (‘evidence’) from research to help make decisions to benefit patients and the public. Qualitative evidence from studies using, for example, interviews or focus groups can explore and explain people’s behaviours, experiences and perceptions of health. Bringing together evidence from many individual qualitative studies (called ‘qualitative evidence synthesis’) is a good way of making sense of research information, for example, to explore and explain why patients, the public or health professionals behave in certain ways; what it is like to experience an illness, service or treatment; and how and why health services or policies work or not.

Qualitative evidence syntheses are seen as increasingly important and are produced ever more frequently. Major healthcare guideline developers, including the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO), now commission qualitative evidence syntheses to inform their guidelines. From 2015 to 2019, qualitative evidence syntheses contributed to 28% of NICE guidelines. Published qualitative evidence syntheses increased dramatically in number from only 31 in 2007 to 1,695 in 2020, but reporting quality varies and is often poor. For example, 84% of qualitative evidence syntheses published by Cochrane, a respected publisher, did not report their research question.

Low-quality reporting means that patients, guideline developers, and health and care managers, may feel less able to trust qualitative evidence synthesis findings. Consequently, they will be less likely to use potentially valuable information about people’s experiences and preferences to improve treatments and services. Researchers need to carry out high-quality syntheses reported to a high standard. Reporting guidelines such as PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for quantitative evidence e.g. drug trials, are proven to improve research reporting quality. However, researchers do not have an up-to-date guideline to help them report qualitative evidence syntheses.

The ENTREQ (enhancing transparency in reporting the synthesis of qualitative research) guideline for qualitative evidence syntheses is widely used but outdated. Many important innovations in qualitative evidence synthesis methods have occurred since ENTREQ was published in 2012. Furthermore, ENTREQ did not follow good practice in reporting guideline development, e.g. researcher agreement was not sought on guideline content. The eMERGe reporting guideline that we developed more recently is only for one specific type of complex qualitative evidence synthesis; most content is not relevant to the wide variety of other QES methods. The widely-used, high-quality PRISMA reporting guideline is not suitable for qualitative evidence syntheses. Over 60% of PRISMA reporting items require adaptation or are inapplicable and several important reporting aspects are missing. An up-to-date reporting guideline for qualitative evidence syntheses is needed urgently to raise reporting quality to increase trust in and use of their findings for improving health and care.

We propose to develop a new version of the PRISMA reporting guideline, for qualitative evidence syntheses. We will identify reporting recommendations and guidance from the literature, academic experts, and other stakeholders including patients and the public; define good practice principles and standards; agree guideline content with all stakeholders; test how user-friendly the guideline is with researchers; and disseminate the guideline.

One guideline is excellent value for money: it can raise the reporting quality of all subsequent qualitative evidence syntheses, and so better inform development of policy and practice and, ultimately, improve outcomes for patients and the public.