Table 7.

Results of thematic analysis and barriers and facilitators to the use of Cochrane reviews in the development of guidance

Themes and subthemes	Barriers and facilitators
Theme 1. The process of using Cochrane reviews (CRs) in the development of guidance
• CRs used early in process/used in development phase	Barriers
• Systematic reviews top of evidence hierarchy/priority over other forms of evidence	• CRs may not be available, may not fit with guideline scope
• Guideline developers (GD) will use CR if available, but not always possible—CR may not be available/may not ‘fit’	• CR may be out of date
• GD may use whole CR or parts of CR (e.g. using evidence tables)/parts used vary	Facilitators
• CRs can save GD time (e.g. using existing searches/data)	• Similar evidence hierarchy
• GD may build on work of Cochrane reviewers/existing reviews	• Cochrane processes for searching/ identifying studies seen as reliable and thorough
• GD may redo the review (depending on resources)	• Similar processes for critical appraisal
	• Structure of CR means that GD can use all or part of it
Theme 2. Quality of Cochrane reviews
• Cochrane is a respected/trustworthy brand	Barriers
• Transparent/easy to replicate	• Quality not always good
• Robust methods	• Quality may be poorer in older reviews
• Variable quality (not all good)	Facilitators
• Perception that quality may be poorer in older reviews	• Generally respected/trustworthy brand
	• Robust methods that can be replicated
Theme 3. Culture and approaches
• Cochrane and GD have similar attitudes towards evaluating and appraising evidence	Barriers
• Cochrane reviews routinely used to inform guideline development process	• Different time frames and resources
• Some differences in methods (e.g. CR double data extraction but some GD not)	• Different priorities of Cochrane and GD
• Role of judgement (part of guideline development process but not CR)	• Different needs and perspectives
• Cochrane and GDs may have different scopes/focus/drivers behind review questions	Facilitators
• Tensions between different perspectives and interests (e.g. academic/clinical/policy)	• Similar attitudes towards evaluating and synthesising evidence
• Resources—different time frames and sources of funding	• Cochrane embedded in culture of guidelines
Theme 4. Up-to-date evidence
• CRs can be out of date (become out of data quickly)	Barriers
• Some confusion around dates of updates	• Cochrane too slow to update
• Some GD (e.g. WHO) work with CRGs to update reviews (they fund this)	• Lack of resources to fund reviews/updates
• Delay in publication/updating	• Slow editorial processes
	Facilitators
	• Guideline developers fund CRG to update review
Theme 5. Methodological issues
• Newer is better (newer CRs seen as methodologically better)	Barriers
• May be statistical issues (wrong data/statistical methods—barrier to use)	• Statistical issues (e.g. CR not used outcome measures, statistics GD want)
• Lack of clarity on which follow-up data used from papers	• Need for network meta-analysis and comparative analysis reviews
• Network meta-analysis, comparative analysis reviews	• Lack of facilities for sharing data
• GRADE (NICE have to use it, Cochrane do not)
• Cochrane focus on RCTs—not always appropriate, particularly for public health
• GD want better facilities for sharing and reanalysing data from CRs
Theme 6. Collaboration/communication
• Good communication improves use of review	Barriers
• Timing of communication is important	• Problems communicating with review authors and CRGs
• Dialogue/clear communication/negotiation important with appropriate persons	• Issues of ownership and authorship
• Collaboration and positive engagement might help speed things up	Facilitators
• Close collaboration between WHO and certain Cochrane groups	• Good communication between GD and authors or CRGs improves use of CR (timing important)
• Formal links between CRG and guideline developers to promote use of CR	• Financial support
• GD experience problems communicating with CRGs
• Issues of ownership/authorship—recognition and reward