WHO-INTEGRATE framework version 1.0: criteria with abbreviated definitions, subcriteria and implications for a recommendation. All criteria are relevant for all interventions in health decision or guideline development processes. For subcriteria there should be a discussion as to which are most relevant and if or how evidence should be collected to inform these. Online supplementary table S2 provides detailed definitions of the criteria and example questions for each of the subcriteria.
| Criteria and abbreviated definitions | Subcriteria | Implications for a recommendation |
| Balance of health benefits and harms The balance of health benefits and harms reflects the magnitude and types of health impact of an intervention on individuals or populations, taking into account how those affected value different health outcomes. |
| The greater the net health benefit associated with an intervention, the greater the likelihood of a general recommendation in favour of this intervention. |
| Human rights and sociocultural acceptability This criterion encompasses two distinct constructs: The first refers to an intervention’s compliance with universal human rights standards and other considerations laid out in international human rights law beyond the right to health (as the right to health provides the basis of other criteria and subcriteria in this framework). The second, sociocultural acceptability, is highly time-specific and context-specific and reflects the extent to which those implementing or benefiting from an intervention as well as other relevant stakeholder groups consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. |
| All recommendations should be in accordance with universal human rights standards and principles. The greater the sociocultural acceptability of an intervention to all or most relevant stakeholders, the greater the likelihood of a general recommendation in favour of this intervention. |
| Health equity, equality and non-discrimination Health equity and equality reflect a concerted and sustained effort to improve health for individuals across all populations, and to reduce avoidable systematic differences in how health and its determinants are distributed. Equality is linked to the legal principle of non-discrimination, which is designed to ensure that individuals or population groups do not experience discrimination on the basis of their sex, age, ethnicity, culture or language, sexual orientation or gender identity, disability status, education, socioeconomic status, place of residence, or any other characteristics. |
| The greater the likelihood that the intervention increases health equity and/or equality and that it reduces discrimination against any particular group, the greater the likelihood of a general recommendation in favour of this intervention. |
| Societal implications Societal implications recognise that health interventions do not take place in isolation and may enhance or inhibit broader social, environmental or economic goals in the short or long term. It also reflects the fact that many regulatory, environmental or other population-level health interventions are directly aimed at system-level rather than individual-level changes. |
| The greater the net societal benefit associated with an intervention, the greater the likelihood of a general recommendation in favour of this intervention. |
| Financial and economic considerations Financial and economic considerations acknowledge that available financial (budgetary) resources are constrained and take into account the economic impact of an intervention on the health system, government or society as a whole. |
| The more advantageous the financial and economic implications of an intervention, the greater the likelihood of a general recommendation in favour of this intervention. |
| Feasibility and health system considerations Feasibility and health system considerations recognise that the most appropriate and feasible interventions may vary significantly across different contexts, both across countries and across jurisdictions within countries. Legislation and governance, the structure of the health system and existing programmes, as well as human resources and infrastructure, should be taken into account. |
| The greater the feasibility of an option from the perspective of all or most stakeholders, the greater the likelihood of a general recommendation in favour of the intervention. The more advantageous the implications for the health system as a whole, the greater the likelihood of a general recommendation in favour of the intervention. |
| Quality of evidence Quality of evidence, also referred to as certainty of evidence or strength of evidence, reflects the confidence that the available evidence is adequate to support a recommendation. In principle, quality of evidence can be applied across all criteria in the WHO-INTEGRATE framework. As a large number of criteria are integrated in the decision-making process, evidence is interpreted in the broadest sense and allows for relevant contributions from a variety of disciplinary approaches. Moreover, decision-making under uncertainty often involves stakeholder experience and judgement, when stronger evidence is unavailable. | – | The greater the quality of the evidence across different criteria in the WHO-INTEGRATE framework, the greater the likelihood of a general recommendation. |
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