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Formulating questions to explore complex interventions within qualitative evidence synthesis
  1. Andrew Booth1,
  2. Jane Noyes2,
  3. Kate Flemming3,
  4. Graham Moore4,
  5. Özge Tunçalp5,
  6. Elham Shakibazadeh6
  1. 1School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2School of Social Sciences, Bangor University, Wales, UK
  3. 3Department of Health Sciences, The University of York, York, UK
  4. 4School of Social Sciences, Cardiff University, Cardiff, UK
  5. 5Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Genève, Switzerland
  6. 6Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  1. Correspondence to Dr Andrew Booth; A.Booth{at}


When making decisions about complex interventions, guideline development groups need to factor in the sociocultural acceptability of an intervention, as well as contextual factors that impact on the feasibility of that intervention. Qualitative evidence synthesis offers one method of exploring these issues. This paper considers the extent to which current methods of question formulation are meeting this challenge. It builds on a rapid review of 38 different frameworks for formulating questions. To be useful, a question framework should recognise context (as setting, environment or context); acknowledge the criticality of different stakeholder perspectives (differentiated from the target population); accommodate elements of time/timing and place; be sensitive to qualitative data (eg, eliciting themes or findings). None of the identified frameworks satisfied all four of these criteria. An innovative question framework, PerSPEcTiF, is proposed and retrospectively applied to a published WHO guideline for a complex intervention. Further testing and evaluation of the PerSPEcTiF framework is required.

  • systematic review
  • qualitative study

This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (CC BY NC 3.0 IGO), which permits use, distribution,and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.Disclaimer: The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

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  • Handling editor Soumyadeep Bhaumik

  • Contributors AB, JN, KF and GM conceptualised the paper. ÖT and ES interpreted the paper in the context of guideline and decision-making processes. AB conducted the rapid review and devised the original PerSPEcTiF framework. JN, KF, GM and ÖT helped to revise the framework. AB wrote all drafts of the paper. All authors revised the drafts critically and approved the final version for publication.

  • Funding Funding provided by the World Health Organization Department of Maternal, Newborn, Child and Adolescent Health through grants received from the United States Agency for International Development and the Norwegian Agency for Development Cooperation.

  • Disclaimer ÖT is a staff member of WHO. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of WHO.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data supporting this article is available in the text, supporting tables within the text or the online supporting tables.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.