Applying GRADE-CERQual to qualitative evidence synthesis findings - A new series of papers

A series of papers published in Implementation Science this week provides guidance on how to apply the GRADE-CERQual approach. CERQual helps assess how much confidence to place in findings from qualitative evidence syntheses.

Why is GRADE-CERQual important?

Findings from syntheses of qualitative research can help provide evidence on people’s views of health and social care issues, about whether interventions are acceptable to the people affected by them, about the feasibility of interventions, and about a range of other factors that are likely to influence implementation. Such syntheses are being used increasingly to inform decisions about health and social policies. The GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) approach helps decision makers use these syntheses by indicating how much confidence they should place in each finding.

The GRADE-CERQual approach is already being used in guidelines published by the World Health Organization (WHO), the National Institute for Health and Care Excellence in the UK, the Swedish Council on Health Technology Assessment and the European Commission Initiative on Breast Cancer. Susan L Norris, Secretary of the WHO Guidelines Review Committee, says: “The importance of qualitative data is increasingly recognized when producing recommendations in public health, as these recommendations must reflect far more than the balance of benefits and harms of an intervention as measured quantitatively. Data on acceptability and feasibility, for example, are invaluable when formulating recommendations and when adapting them to the local context.  The CERQual approach has been vital in helping us to use qualitative evidence appropriately.”   

Series of seven papers

This series provides detailed guidance on how to apply the GRADE-CERQual approach. Paper 1 gives an overview of CERQual’s rationale and conceptual basis, how the approach was developed, its aims, and its main components. Papers 3, 4, 5, 6 and 7 discuss each CERQual component, including how the component is conceptualized and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table.

The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes, but is also relevant to guideline development agencies, primary qualitative researchers and implementation scientists and practitioners.

Co-author Professor Jane Noyes, from the School of Social Sciences, Bangor University, United Kingdom, noted that “The uptake of CERQual by global guideline organisations has been rapid.  CERQual has already had a major impact on the way leading guideline organisations make evidence-based recommendations that are informed by additional qualitative evidence syntheses.”

Co-author Simon Lewin, from the Norwegian Institute of Public Health and the South African Medical Research Council adds  that “This series provides CERQual users with detailed information on how to apply the approach. CERQual is already helping decision makers across the world understand how much confidence to place in findings from qualitative evidence syntheses. This will help them use qualitative evidence more widely and appropriately.”

Part of the international GRADE Working Group

CERQual has been developed by an international team of qualitative researchers, as a subgroup of the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Working Group (, with funding from the Alliance for Health Policy and Systems Research, Cochrane, Norad, the Research Council of Norway and WHO. Co-author Claire Glenton notes: “We encourage those keen to support the further development of CERQual to join our subgroup via our website (”

The GRADE-CERQual papers are freely available on the Implementation Science website at

Publication date: 25 January 2018