Guideline name and type: WHO guidelines on parenting interventions to prevent maltreatment and enhance parent–child relationships with children aged 0–17 years, 2022 | Standard guideline (1st version) https://www.who.int/publications/i/item/9789240065505 Organisation: World Health Organization Lead contact: Violence Prevention Unit, Social Determinants of Health Department | violenceprevention@who.int Guideline purpose: The guideline seeks to address child maltreatment and harsh parenting, enhance the parent–child relationship, and prevent poor mental health among parents and emotional and behavioural problems among children. The evidence-based recommendations are intended to support government personnel, donors, project developers, programme managers, nongovernmental organisations (NGOs), faith-based organisations , and development assistance agencies to implement parenting interventions. Type of health condition: Injuries · Psychosocial Health · Other Intervention type: Behavioural/ Psychosocial/ Educational Intervention and health condition (based on keywords): Prevention · Child maltreatment · Parent–Child Relationships · Mental Health · Violence Against Women and Girls · Parenting Interventions · Psychosocial Interventions Rationale for choice of WHO-INTEGRATE: not described Use of WHO-INTEGRATE in guideline development: not described Publications describing/evaluating the use of WHO-INTEGRATE in the guideline: The WHO-INTEGRATE reviews and systematic reviews with meta-analyses are available at https://www.who.int/teams/social-determinants-of-health/violence-prevention/parenting-guidelines

Guideline name and type: WHO Abortion care guideline 2022 | Standard guideline (update of three previous WHO guidelines) https://apps.who.int/iris/handle/10665/349316 Organisation: WHO, Human Reproduction Programme Lead contact : World Health Organization, WHO, Department of Sexual and Reproductive Health | srhhrp@who.int Guideline purpose: Abortion Care Guideline (2022) is an updated consolidated guideline, which replaces all the previous WHO guidelines on abortion care. Aim: to enable evidence-based decision-making with respect to quality abortion care. Type of health condition: Other  Intervention type: Clinical Health policy · Health system · Pharmaceutical Intervention and health condition (based on keywords): Sexual and reproductive health Rationale for choice of WHO-INTEGRATE: "This framework brings in the criteria that are critical to comprehensive abortion care (especially the humans rights and sociocultural acceptability considerations). Given that this topic area does not have a vast array of randomized trials and that we have to rely on observational studies" Use of WHO-INTEGRATE in guideline development: During scoping · During the formulation of questions · During decisions concerning evidence retrieval and synthesis · During the formulation of recommendations Publications describing/evaluating the use of WHO-INTEGRATE in the guideline: de Londras F, Cleeve A, Rodriguez MI, Lavelanet A. Integrating rights and evidence: a technical advance in abortion guideline development. BMJ Glob Health. 2021 Feb;6(2):e004141. doi: 10.1136/bmjgh-2020-004141

Guideline name and type: Wheelchair provision guidelines, 2023 | Standard guideline (1st version) https://www.who.int/publications/i/item/9789240074521 Organisation: World Health Organization, International Society for Prosthetics and Orthotics, International Society of Wheelchair Professionals Lead contact : WHO, Assistive Technology Team, Guidelines Review Committee Guideline purpose: Ultimately, the purpose of these guidelines is to [help WHO member states to] ensure that wheelchair users have timely access through wheelchair services that are people-centred and responsive to their needs.'; target audience: policy-makers, wheelchair service personnel, and wheelchair user representative organizations. Type of health condition: Infectious diseases · Non-communicable diseases · Injuries · Psychosocial health · Other  Intervention type: Clinical · Health policy · Health system Intervention and health condition (based on keywords): Access to assistive technology · Participation · Wheel chair use Rationale for choice of WHO-INTEGRATE: "[The WHO Integrate framework] seemed like a natural choice given the essential human rights considerations related to the subject and the target population and caregiver". Guideline: "For each recommendation, explicit consideration was made with regards to the overall balance of benefits and harms, human rights, sociocultural acceptability, health equity, equality and non-discrimination, societal implications, financial and economic considerations, feasibility and health system considerations, as well as quality of evidence." Use of WHO-INTEGRATE in guideline development: During scoping · During the formulation of questions · During decisions concerning evidence retrieval and synthesis · During the formulation of recommendations Publications describing/evaluating the use of WHO-INTEGRATE in the guideline: Appendices: https://www.who.int/publications/i/item/9789240074521

Guideline name and type: S3-Guideline: Measures for the prevention and control of SARS-CoV-2 transmission in schools | Living Guideline (V1) | Short version | [German: S3-Leitlinie Maßnahmen zur Prävention und Kontrolle der SARS-CoV-2-Übertragung in Schulen | Lebende Leitlinie | Kurzfassung] Reg-number: 027-076 | First version no longer available online, latest version available here: https://register.awmf.org/de/leitlinien/detail/027-076 Organisation: AWMF (Germany) Lead contact: Prof. Dr. Eva Rehfuess | rehfuess@ibe.med.uni-muenchen.de Guideline purpose: The guideline is intended to provide stakeholders in the school setting with evidence-based and consensus-based recommendations to prevent and control SARS-CoV-2 transmission in schools. Type of health condition: Infectious diseases · Psychosocial health Intervention type: Behavioural/ Psychosocial/ Educational · Environmental · Occupational · Screening Intervention and health condition (based on keywords): COVID-19 prevention · Intervention bundles · School-based interventions · Cohorting · Masking · Ventilation Rationale for choice of WHO-INTEGRATE: not described Use of WHO-INTEGRATE in guideline development: not described Publications describing/evaluating the use of WHO-INTEGRATE in the guideline: Wabnitz K, Rueb M, Pfadenhauer LM, Strahwald B, Rehfuess EA. Rapid development of an evidence- and consensus-based guideline for controlling transmission of SARS-CoV-2 in schools during a public health emergency - A process evaluation. Front Public Health. 2023 Mar 30;11:1075210. doi: 10.3389/fpubh.2023.1075210 Wabnitz, K., Rueb, M., Rehfuess, E.A. et al. Assessing the impact of an evidence- and consensus-based guideline for controlling SARS-CoV-2 transmission in German schools on decision-making processes: a multi-component qualitative analysis. Health Res Policy Sys 21, 138 (2023). doi.org/10.1186/s12961-023-01072-9

Guideline name and type: Guidelines on Sanitation and Health, 2018 | Standard guideline (1st version) | https://www.who.int/publications/i/item/9789241514705 Organisation: World Health Organization Lead contact: WHO, Department of Public Health, Environmental and Social Determinants of Health | medlicottk@who.int Guideline purpose: The purpose of these guidelines is to promote safe sanitation systems and practices in order to improve wellbeing and prevent sanitation related disease. They summarize the evidence on the links between sanitation and health, provide evidence-informed recommendations, and offer guidance for encouraging international, national and local sanitation policies and actions to maximize the health benefits on sanitation investments. The guidelines also seek to articulate and support the role of health and other actors in sanitation policy and programming to help ensure that health risks are identified and managed effectively. Target audience: national and local authorities responsible for the safety of sanitation systems and services, including policy makers, planners, implementers and those responsible for the development, implementation and monitoring of standards and regulations. This includes health authorities and, since sanitation is often managed outside the health sector, other agencies with responsibilities for sanitation. Type of health condition: Infectious diseases · Injuries · Psychosocial health · Other  Intervention type: Behavioural / Psychosocial / Educational · Environmental · Health policy · Health system · Occupational Intervention and health condition (based on keywords): Safe sanitation (human excreta) · Prevention of infectious diseases · Well-being (dignity, privacy, safety, access to education and economic opportunity) Rationale for choice of WHO-INTEGRATE: Since sanitation is a complex intervention and the guideline covers both "what" and "how" questions guideline developers were struggling with applying the EtD framework proposed in WHO guideline development handbook - therefore they worked with the WHO-INTEGRATE framework as an alternative. Use of WHO-INTEGRATE in guideline development: During the formulation of recommendations (page 148) Publications describing/evaluating the use of WHO-INTEGRATE in the guideline: no

Guideline name and type: WHO recommendations on induction of labour, at or beyond term, 2022 | Standard guideline (update) https://www.who.int/publications/i/item/9789240052796 Organisation: World Health Organization Lead contact : Maternal and Perinatal Health Unit, Department of Sexual and Reproductive Health and Research | srhmph@who.int Guideline purpose: The guideline is intended to update existing evidence-based recommendations for health professionals regarding the timing of induction of labour, the use of mechanical methods for the induction of labour, and induction of labour in outpatient settings. Type of health condition: Other Intervention type: Clinical · Environmental · Health Policy · Health System · Nutrition · Occupational · Pharmaceutical · Screening · Vaccination Intervention and health condition (based on keywords): Maternal Health · Perinatal Health · Induction of Labour Rationale for choice of WHO-INTEGRATE: Framework dimensions related to equity and equality were perceived useful for systematic application in the guideline Use of WHO-INTEGRATE in guideline development: During decisions concerning evidence retrieval and synthesis // During the formulation of recommendations Publications describing/evaluating the use of WHO-INTEGRATE in the guideline: Murano, M. et al. Using the WHO-INTEGRATE evidence-to-decision framework to develop recommendations for induction of labour. Health Res Policy Sys 20, 125 (2022). doi.org/10.1186/s12961-022-00901-7

ABSTRACT Background: Decision-making on matters of public health and health policy is a deeply value-laden process. The World Health Organization (WHO)-INTEGRATE framework was proposed as a new evidence-to-decision (EtD) framework to support guideline development from a complexity perspective, notably in relation to public health and health system interventions, and with a foundation in WHO norms and values. This study was conducted as part of the development of the framework to assess its comprehensiveness and usefulness for public health and health policy decision-making. Methods: We conducted a qualitative study comprising nine key informant interviews (KIIs) with experts involved in WHO guideline development and four focus group discussions (FGDs) with a total of forty health decision-makers from Brazil, Germany, Nepal and Uganda. Transcripts were analyzed using MAXQDA12 and qualitative content analysis. Results: Most key informants and participants in the FGDs appreciated the framework for its relevance to real-world decision-making on four widely differing health topics. They praised its broad perspective and comprehensiveness with respect to new or expanded criteria, notably regarding societal implications, equity considerations, and acceptability. Some guideline developers questioned the value of the framework beyond current practice and were concerned with the complexity of applying such a broad range of criteria in guideline development processes. Participants made concrete suggestions for improving the wording and definitions of criteria as well as their grouping, for covering missing aspects, and for addressing overlap between criteria. Conclusion: The framework was well-received by health decision-makers as well as the developers of WHO guidelines and appears to capture all relevant considerations discussed in four distinct real-world decision processes that took place on four different continents. Guidance is needed on how to apply the framework in guideline processes that are both transparent and participatory. A set of suggestions for improvement provides a valuable starting point for advancing the framework towards version 2.0. Keywords: Decision-Making; Framework; Guideline Development; Priority Setting; Resource Allocation; World Health Organization. Stratil JM, Paudel D, Setty KE, Menezes de Rezende CE, Monroe AA, Osuret J, Scheel IB, Wildner M, Rehfuess EA. Advancing the WHO-INTEGRATE Framework as a Tool for Evidence-Informed, Deliberative Decision-Making Processes: Exploring the Views of Developers and Users of WHO Guidelines. Int J Health Policy Manag. 2022 May 1;11(5):629-641. doi: 10.34172/ijhpm.2020.193. PMID: 33131223; PMCID: PMC9309924.

ABSTRACT Introduction: Evidence-to-decision (EtD) frameworks intend to ensure that all criteria of relevance to a health decision are systematically considered. This paper, part of a series commissioned by the WHO, reports on the development of an EtD framework that is rooted in WHO norms and values, reflective of the changing global health landscape, and suitable for a range of interventions and complexity features. We also sought to assess the value of this framework to decision-makers at global and national levels, and to facilitate uptake through suggestions on how to prioritise criteria and methods to collect evidence. Methods: In an iterative, principles-based approach, we developed the framework structure from WHO norms and values. Preliminary criteria were derived from key documents and supplemented with comprehensive subcriteria obtained through an overview of systematic reviews of criteria employed in health decision-making. We assessed to what extent the framework can accommodate features of complexity, and conducted key informant interviews among WHO guideline developers. Suggestions on methods were drawn from the literature and expert consultation. Results: The new WHO-INTEGRATE (INTEGRATe Evidence) framework comprises six substantive criteria-balance of health benefits and harms, human rights and sociocultural acceptability, health equity, equality and non-discrimination, societal implications, financial and economic considerations, and feasibility and health system considerations-and the meta-criterion quality of evidence. It is intended to facilitate a structured process of reflection and discussion in a problem-specific and context-specific manner from the start of a guideline development or other health decision-making process. For each criterion, the framework offers a definition, subcriteria and example questions; it also suggests relevant primary research and evidence synthesis methods and approaches to assessing quality of evidence. Conclusion: The framework is deliberately labelled version 1.0. We expect further modifications based on focus group discussions in four countries, example applications and input across concerned disciplines. Keywords: health policy; health systems; public health. Supplementary files with definitions, sub-criteria and guiding questions: https://gh.bmj.com/content/bmjgh/4/Suppl_1/e000844/DC1/embed/inline-supplementary-material-1.docx Rehfuess EA, Stratil JM, Scheel IB, Portela A, Norris SL, Baltussen R. The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Health. 2019 Jan 25;4(Suppl 1):e000844. doi: 10.1136/bmjgh-2018-000844. PMID: 30775012; PMCID: PMC6350705.

ABSTRACT Background: Decision-making in public health and health policy is complex and requires careful deliberation of many and sometimes conflicting normative and technical criteria. Several approaches and tools, such as multi-criteria decision analysis, health technology assessments and evidence-to-decision (EtD) frameworks, have been proposed to guide decision-makers in selecting the criteria most relevant and appropriate for a transparent decision-making process. This study forms part of the development of the WHO-INTEGRATE EtD framework, a framework rooted in global health norms and values as reflected in key documents of the World Health Organization and the United Nations system. The objective of this study was to provide a comprehensive overview of criteria used in or proposed for real-world decision-making processes, including guideline development, health technology assessment, resource allocation and others. Methods: We conducted an overview of systematic reviews through a combination of systematic literature searches and extensive reference searches. Systematic reviews reporting criteria used for real-world health decision-making by governmental or non-governmental organization on a supranational, national, or programme level were included and their quality assessed through a bespoke critical appraisal tool. The criteria reported in the reviews were extracted, de-duplicated and sorted into first-level (i.e. criteria), second-level (i.e. sub-criteria) and third-level (i.e. decision aspects) categories. First-level categories were developed a priori using a normative approach; second- and third-level categories were developed inductively. Results: We included 36 systematic reviews providing criteria, of which one met all and another eleven met at least five of the items of our critical appraisal tool. The criteria were subsumed into 8 criteria, 45 sub-criteria and 200 decision aspects. The first-level of the category system comprised the following seven substantive criteria: "Health-related balance of benefits and harms"; "Human and individual rights"; "Acceptability considerations"; "Societal considerations"; "Considerations of equity, equality and fairness"; "Cost and financial considerations"; and "Feasibility and health system considerations". In addition, we identified an eight criterion "Evidence". Conclusion: This overview of systematic reviews provides a comprehensive overview of criteria used or suggested for real-world health decision-making. It also discusses key challenges in the selection of the most appropriate criteria and in seeking to implement a fair decision-making process. Keywords: Criteria; Decision-making; Decisionmaking; HTA; Health technology assessment; Priority-setting; Resource allocation; WHO; WHO-INTEGRATE. Stratil JM, Baltussen R, Scheel I, Nacken A, Rehfuess EA. Development of the WHO-INTEGRATE evidence-to-decision framework: an overview of systematic reviews of decision criteria for health decision-making. Cost Eff Resour Alloc. 2020 Feb 11;18:8. doi: 10.1186/s12962-020-0203-6. PMID: 32071560; PMCID: PMC7014604.

Background: In 2019, WHO prioritized updating recommendations relating to three labour induction topics: labour induction at or beyond term, mechanical methods for labour induction, and outpatient labour induction. As part of this process, we aimed to review the evidence addressing factors beyond clinical effectiveness (values, human rights and sociocultural acceptability, health equity, and economic and feasibility considerations) to inform WHO Guideline Development Group decision-making using the WHO-INTEGRATE evidence-to-decision framework, and to reflect on how methods for identifying, synthesizing and integrating this evidence could be improved. Methods: We adapted the framework to consider the key criteria and sub-criteria relevant to our intervention. We searched for qualitative and other evidence across a variety of sources and mapped the eligible evidence to country income setting and perspective. Eligibility assessment and quality appraisal of qualitative evidence syntheses was undertaken using a two-step process informed by the ENTREQ statement. We adopted an iterative approach to interpret the evidence and provided both summary and detailed findings to the decision-makers. We also undertook a review to reflect on opportunities to improve the process of applying the framework and identifying the evidence. Results: Using the WHO-INTEGRATE framework allowed us to explore health rights and equity in a systematic and transparent way. We identified a lack of qualitative and other evidence from low- and middle-income settings and in populations that are most impacted by structural inequities or traditionally excluded from research. Our process review highlighted opportunities for future improvement, including adopting more systematic evidence mapping methods and working with social science researchers to strengthen theoretical understanding, methods and interpretation of the evidence. Conclusions: Using the WHO-INTEGRATE evidence-to-decision framework to inform decision-making in a global guideline for induction of labour, we identified both challenges and opportunities relating to the lack of evidence in populations and settings of need and interest; the theoretical approach informing the development and application of WHO-INTEGRATE; and interpretation of the evidence. We hope these insights will be useful for primary researchers as well as the evidence synthesis and health decision-making communities, and ultimately contribute to a reduction in health inequities. Keywords: Decision-making; Evidence-to-decision framework; Guideline development; Guidelines; Health equity; Induction of labour; WHO; WHO-INTEGRATE; World Health Organization. Murano M, Chou D, Costa ML, Turner T. Using the WHO-INTEGRATE evidence-to-decision framework to develop recommendations for induction of labour. Health Res Policy Syst. 2022 Nov 7;20(1):125. doi: 10.1186/s12961-022-00901-7. PMID: 36344986; PMCID: PMC9641799.

Problem: At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reliable, globally applicable recommendations for safe and continuous school operations were lacking. Approach: In October 2020, the German Association of Scientific Medical Societies' task force for COVID-19 guidelines and public health researchers at Ludwig-Maximilians-Universität München initiated the rapid development of a living evidence- and consensus-based guideline to reduce severe acute respiratory syndrome coronavirus 2 transmission in schools. To facilitate transparent, structured and comprehensive decision-making with a whole-of-society perspective, they applied the WHO-INTEGRATE evidence-to-decision framework. This framework supported a broad, multisectoral composition of the guideline panel. The panel used newly synthesized evidence on nine school measures. Participating medical societies or the guideline secretariat completed evidence-to-decision tables. They also drafted recommendations for the guideline panel, who discussed and revised them during moderated consensus conferences. Local setting: In Germany, each state is responsible for organizing schooling. The German Association of Scientific Medical Societies coordinates development of evidence- and consensus-based guidelines. Relevant changes: The first version of the guideline was published in February 2021, and the guideline dissemination created much media attention. Of the 16 state education ministries, almost all knew about the guideline, nine recognized it as a relevant source of information and five used it to check existing directives. Lessons learnt: The WHO-INTEGRATE framework facilitated a comprehensive assessment of school measures from the start of guideline development, considering the broad societal impact of the measures. Using the framework in rapid mode was feasible, but it fell short of its potential. Rehfuess EA, Pfadenhauer L, Nothacker M, Strahwald B. Using the WHO-INTEGRATE framework to develop a COVID-19 guideline for schools, Germany. Bull World Health Organ. 2024 Oct 1;102(10):742-748. doi: 10.2471/BLT.24.291550. Epub 2024 Aug 27. PMID: 39318890; PMCID: PMC11418849.

ABSTRACT Background: Development of guidelines for public health, health system, and health policy interventions demands complex systems thinking to understand direct and indirect effects of interventions within dynamic systems. The WHO-INTEGRATE framework, an evidence-to-decision framework rooted in the norms and values of the World Health Organization (WHO), provides a structured method to assess complexities in guidelines systematically, such as the balance of an intervention's health benefits and harms and their human rights and socio-cultural acceptability. This paper provides a worked example of the application of the WHO-INTEGRATE framework in developing the WHO guidelines on parenting interventions to prevent child maltreatment, and shares reflective insights regarding the value added, challenges encountered, and lessons learnt. Methods: The methodological approach comprised describing the intended step-by-step application of the WHO-INTEGRATE framework and gaining reflective insights from introspective sessions within the core team guiding the development of the WHO guidelines on parenting interventions and a methodological workshop. Results: The WHO-INTEGRATE framework was used throughout the guideline development process. It facilitated reflective deliberation across a broad range of decision criteria and system-level aspects in the following steps: (1) scoping the guideline and defining stakeholder engagement, (2) prioritising WHO-INTEGRATE sub-criteria and guideline outcomes, (3) using research evidence to inform WHO-INTEGRATE criteria, and (4) developing and presenting recommendations informed by WHO-INTEGRATE criteria. Despite the value added, challenges, such as substantial time investment required, broad scope of prioritised sub-criteria, integration across diverse criteria, and sources of evidence and translation of insights into concise formats, were encountered. Conclusions: Application of the WHO-INTEGRATE framework was crucial in the integration of effectiveness evidence with insights into implementation and broader implications of parenting interventions, extending beyond health benefits and harms considerations and fostering a whole-of-society-perspective. The evidence reviews for prioritised WHO-INTEGRATE sub-criteria were instrumental in guiding guideline development group discussions, informing recommendations and clarifying uncertainties. This experience offers important lessons for future guideline panels and guideline methodologists using the WHO-INTEGRATE framework. Keywords: Complex systems thinking; Evidence-to-decision framework; Guideline development; Health policy; Parenting interventions.; Public health. Movsisyan A, Backhaus S, Butchart A, Gardner F, Strahwald B, Rehfuess E. Applying the WHO-INTEGRATE evidence-to-decision framework in the development of WHO guidelines on parenting interventions: step-by-step process and lessons learnt. Health Res Policy Syst. 2024 Jul 5;22(1):79. doi: 10.1186/s12961-024-01165-z. PMID: 38970125; PMCID: PMC11227174.