Skip to content

Research at St Andrews

Applying GRADE-CERQual to qualitative evidence synthesis findings-paper 7: understanding the potential impacts of dissemination bias

Research output: Contribution to journalArticlepeer-review


Andrew Booth, Simon Lewin, Claire Glenton, Heather Munthe-Kaas, Ingrid Toews, Jane Noyes, Arash Rashidian, Rigmor C. Berg, Brenda Nyakang'o, Joerg J. Meerpohl, GRADE-CERQual Coordinating Team

School/Research organisations


Background: The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on a probable fifth component, dissemination bias. Given its exploratory nature, we are not yet able to provide guidance on applying this potential component of the CERQual approach. Instead, we focus on how dissemination bias might be conceptualised in the context of qualitative research and the potential impact dissemination bias might have on an overall assessment of confidence in a review finding. We also set out a proposed research agenda in this area.

Methods: We developed this paper by gathering feedback from relevant research communities, searching MEDLINE and Web of Science to identify and characterise the existing literature discussing or assessing dissemination bias in qualitative research and its wider implications, developing consensus through project group meetings, and conducting an online survey of the extent, awareness and perceptions of dissemination bias in qualitative research.

Results: We have defined dissemination bias in qualitative research as a systematic distortion of the phenomenon of interest due to selective dissemination of studies or individual study findings. Dissemination bias is important for qualitative evidence syntheses as the selective dissemination of qualitative studies and/or study findings may distort our understanding of the phenomena that these syntheses aim to explore and thereby undermine our confidence in these findings. Dissemination bias has been extensively examined in the context of randomised controlled trials and systematic reviews of such studies. The effects of potential dissemination bias are formally considered, as publication bias, within the GRADE approach. However, the issue has received almost no attention in the context of qualitative research. Because of very limited understanding of dissemination bias and its potential impact on review findings in the context of qualitative evidence syntheses, this component is currently not included in the GRADE-CERQual approach.

Conclusions: Further research is needed to establish the extent and impacts of dissemination bias in qualitative research and the extent to which dissemination bias needs to be taken into account when we assess how much confidence we have in findings from qualitative evidence syntheses.



Original languageEnglish
Article number12
JournalImplementation Science
Issue numberSupp 1
Publication statusPublished - 25 Jan 2018

    Research areas

  • Confidence, Dissemination bias, Evidence-based practice, GRADE, Methodology, Publication bias, Qualitative evidence synthesis, Qualitative research, Research design, Systematic review methodology

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. Qualitative evidence syntheses: Assessing the relative contributions of multi-context and single-context reviews

    Booth, A., Mshelia, S., Analo, C. V. & Nyakang'o, S. B., 1 Dec 2019, In: Journal of Advanced Nursing. 75, 12, p. 3812-3822 11 p.

    Research output: Contribution to journalArticlepeer-review

  2. Women's perceived barriers to giving birth in health facilities in rural Kenya: A qualitative evidence synthesis

    Nyakang'o, S. B. & Booth, A., 1 Dec 2018, In: Midwifery. 67, p. 1-11 11 p.

    Research output: Contribution to journalReview articlepeer-review

  3. Effectiveness of interventions aimed at improving physical and psychological outcomes of fall-related injuries in people with dementia: A narrative systematic review

    Robalino, S., Nyakang'o, S. B., Beyer, F. R., Fox, C. & Allan, L. M., 20 Feb 2018, In: Systematic Reviews. 7, 1, 31.

    Research output: Contribution to journalArticlepeer-review

Related by journal

  1. Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project)

    Prados-Torres, A., del Cura-González, I., Prados-Torres, D., López-Rodríguez, J. A., Leiva-Fernández, F., Calderón-Larrañaga, A., López-Verde, F., Gimeno-Feliu, L. A., Escortell-Mayor, E., Pico-Soler, V., Sanz-Cuesta, T., Bujalance-Zafra, M. J., Morey-Montalvo, M., Boxó-Cifuentes, J. R., Poblador-Plou, B., Fernández-Arquero, J. M., González-Rubio, F., Ramiro-González, M. D., Coscollar-Santaliestra, C., Martín-Fernández, J. & 7 others, Barnestein-Fonseca, M. P., Valderas-Martínez, J. M., Marengoni, A., Muth, C., Multi-PAP Group, Hernández-Santiago, V. & Azcoaga-Lorenzo, A., 27 Apr 2017, In: Implementation Science. 12, 10 p., 54.

    Research output: Contribution to journalArticlepeer-review

  2. Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project): A clinical trial by clusters

    del Cura-González, I., López-Rodríguez, J. A., Sanz-Cuesta, T., Rodríguez-Barrientos, R., Martín-Fernández, J., Ariza-Cardiel, G., Polentinos-Castro, E., Román-Crespo, B., Escortell-Mayor, E., Rico-Blázquez, M., Hernández-Santiago, V., Azcoaga-Lorenzo, A., Ojeda-Ruiz, E., González-González, A. I., Ávila-Tomas, J. F., Barrio-Cortés, J., Molero-García, J. M., Ferrer-Peña, R., Tello-Bernabé, M. E., Trujillo-Martín, M. & 31 others, Barral, A. G., Moreno, A. F., Pérez, P. C., Barba, E. C., Rodríguez Monje, M. T., Iturbe, A. G., Crespo, L. I. M., Mañeru, M. E. M., de Gómez Barragan, M. J. G., Elustondo, S. G., Fuertes, R. R., Cabello Ballesteros, L. M., Nido, R. Á., Moreno, C. B., Rojas, G. C., Rivas, J. L. L., Pikatza, A. Z., Celaya, C. S., Montalvo, M. M., Almeida, L. P. C., álamo Rodríguez, M. D., García-Franco, A. L., Weismann, E. C., álvarez, R. M., Bustillo, B. M., del Pozo, M. S. C., Perruca, L. S., Salinero Fort, M. Á., de Burgos Luna, C., SanJuan, A. M. & Educaguia Group, 17 May 2016, In: Implementation Science. 11, 10 p., 71.

    Research output: Contribution to journalArticlepeer-review

  3. Action to Support Practices Implement Research Evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting 'high impact' clinical practice recommendations in general practice

    Willis, T. A., Hartley, S., Glidewell, L., Farrin, A. J., Lawton, R., McEachan, R. R. C., Ingleson, E., Heudtlass, P., Collinson, M., Clamp, S., Hunter, C., Ward, V., Hulme, C., Meads, D., Bregantini, D., Carder, P., Foy, R. & ASPIRE programme, 29 Feb 2016, In: Implementation Science. 11, 11 p., 25.

    Research output: Contribution to journalArticlepeer-review

ID: 272683673