Table 3

Integrate evidence to decision framework criteria, example questions and types of studies to potentially address these questions (derived from Rehfeuss et al 16)

Domains of the WHO-INTEGRATE EtD frameworkExamples of potential research question(s) that a synthesis of qualitative and/or quantitative evidence could addressTypes of studies that could contribute to a review of qualitative and quantitative evidence
Balance of benefits and harmsTo what extent do patients/beneficiaries value different health outcomes?Qualitative: studies of views and experiences
Quantitative: Questionnaire surveys
Human rights and sociocultural acceptabilityIs the intervention  socioculturally acceptable to patients/beneficiaries as well as to those implementing it?
To what extent do patients/beneficiaries value different non-health outcomes?
How does the intervention affect an individual’s, population group’s or organisation’s autonomy, that is, their ability to make a competent, informed and voluntary decision?
Qualitative: discourse analysis, qualitative studies (ideally longitudinal to examine changes over time)
Quantitative: pro et contra analysis, discrete choice experiments, longitudinal quantitative studies (to examine changes over time), cross-sectional studies
Mixed-method studies; case studies
Health equity, equality and non-discriminationHow affordable is the intervention for individuals, households or communities?
How accessible—in terms of physical as well as informational access—is the intervention across different population groups?
Qualitative: studies of views and experiences
Quantitative: cross-sectional or longitudinal observational studies, discrete choice experiments, health expenditure studies; health system barrier studies, cross-sectional or longitudinal observational studies, discrete choice experiments, ethical analysis, GIS-based studies
Societal implicationsWhat is the  social impact of the intervention: are there features of the intervention that increase or reduce stigma and that lead to social consequences? Does the intervention enhance or limit social goals, such as education, social cohesion and the attainment of various human rights beyond health? Does it change social norms at individual or population level?
What is the environmental impact of the intervention? Does it contribute to or limit the achievement of goals to protect the environment and efforts to mitigate or adapt to climate change?
Qualitative: studies of views and experiences
Quantitative: RCTs, quasi-experimental studies, comparative observational studies, longitudinal implementation studies, case studies, power analyses, environmental impact assessments, modelling studies
Feasibility and health system considerationsAre there any legal factors that impact on implementation of the intervention?
How might governance aspects, such as past decisions and strategic considerations, positively or negatively impact the implementation of the intervention?
How does the intervention interact with the existing health system? Is it likely to fit well or not, is it likely to impact on it in positive or negative ways?
How does the intervention interact with the need for and usage of the existing health workforce and broader human resources, at national and subnational levels?
How does the intervention interact with the need for and usage of the existing health system infrastructure as well as other relevant infrastructure, at national and subnational levels?
Non-research: policy and regulatory frameworks
Qualitative: studies of views and experiences
Mixed-method: health systems research, situation analysis, case studies
Quantitative: cross-sectional studies
  • GIS, Geographical Information System; RCT, randomised controlled trial.