Table 2.
Views and experiences of CG adaptation
| Themes | No of participants |
| Reasons for adapting CGs | |
| Develop their CGs | |
| As part of de novo CG development process | 3 |
| To avoid duplicates and save efforts | 1 |
| To save resources and time | 3 |
| Implementing/endorsing for target settings | 5 |
| Updating existing CGs | 3 |
| Solving recommendations’ controversy | 1 |
| Challenges for adapting CGs | |
| Poor reporting or the limitations of source CG(s) | 2 |
| Limited skills in advanced CG development and adaptation | 3 |
| The intensity in terms of resources and time for adaptation | 2 |
| Specific steps of adaptation process: | |
| Addressing context differences between source CG(s) and adapted CG | 4 |
| Addressing inconsistency and integrate recommendations from different source CG(s) | 3 |
| Updating or supplementing with research evidence | 1 |
| Implementation barriers | 5 |
| Addressing context differences between source CG(s) and the adapted CG | |
| Through panel discussion | 7 |
| Adapting to the target context (at CG level) | |
| Prioritising the source CG(s) according to different factors | 2 |
| Discarding the source CG(s) | 1 |
| Adapting to the target context (at recommendation level) | |
| Evaluating the reason behind and reconsidering the strength of the recommendations | 1 |
| Contextualising by considering different factors | 3 |
| Formulating new recommendations for a specific population (eg, subgroups) | 1 |
| Adapting to the target context (at evidence level) | |
| Supplementing new evidence/other considerations | 2 |
| Reporting the differences when drafting the recommendation | 3 |
| Addressing inconsistencies between recommendations from different source CG(s) | |
| Through panel discussion | 2 |
| Selecting source CG(s) with different criteria (at CG level) | |
| Good quality/rigorous development of source CG(s) | 5 |
| Content relevance/suitability to the target context | 2 |
| Most up to date | 2 |
| Trustworthy source CG(s) | 1 |
| Assessing the reason for inconsistency | |
| At recommendation level | 4 |
| At evidence level | 3 |
| Not applicable when single CG was included | 4 |
| Updating source evidence | |
| Trigger for supplement/update search of source CG(s) | |
| Source CG(s) do not answer all the questions of interest | 3 |
| Source CG(s) are outdated | 1 |
| Source CG(s) are consensus-based | 2 |
| Experts’ suggestions | 2 |
| Way of including new evidence | |
| Literature search (eg, pragmatic search or a full de novo search) | 6 |
| Update the search from source CG(s) | 3 |
| Experts’ suggestions | 3 |
| If the source CG(s) are not evidence-based or do not answer the questions | |
| Start CG de novo development process | 3 |
| Discard the recommendation | 1 |
| Conduct the consensus process | 1 |
| Considering implementation barriers | |
| Way of obtaining information | |
| Experts’ opinion | 4 |
| Literature search | 5 |
| Group discussion | 5 |
| Decision making after consideration of implementation barriers | |
| Modifying the practice instead of change recommendations | 1 |
| Modifying the recommendations | 1 |
| Reporting the differences if needed | 4 |
CGs, clinical guidelines.