DECIDE frameworks for policy makers

DECIDE is a is a 5-year project started in 2011, co-funded by the European Commission under the Seventh Framework Programme. The project’s objective is "To improve the dissemination of evidence-based recommendations by building on the work of the GRADE Working Group to develop and evaluate methods that address the targeted dissemination of guidelines."

One of the outputs from DECIDE is a set of frameworks. These are tools that can help people make a transparent recommendation or decision about a health intervention. Our team is developing frameworks for decisions or recommendations regardinghealth systems and public healthinterventions:

  • Evidence to Recommendation Framework
  • Evidence to Decision Framework
  • Recommendation to Decision Framework.

These frameworks provide a shared informational starting point for dialogues underpinning decisions or recommendations. Based on set of important generic criterion for health systems and public health decisions, they bring evidence and structure to complex discussions. They also help highlight where important information is lacking. Additionally, because the frameworks clearly separate evidence from judgments about this evidence, disagreements are easier to untangle. The frameworks can also help local policy makers implement national or global guidelines, by making explicit what evidence and which judgments underlie a guideline panel’s conclusions. This makes it easier for policy makers in different contexts to adapt recommendations to their own setting, by bringing in evidence from their own setting or make different judgments for any of the criterion.

(More information about DECIDE frameworks)

How are DECIDE frameworks for health systems currently being used?

The frameworks can be used in different ways, including as a tool for a guideline panel to move from evidence to recommendations, and as a way to present to the end users of the guidelines the different factors and associated judgments that influenced the panel’s decision.

Early versions of the framework have been used by two World Health Organisation panels making global recommendations. Feedback from these groups has led to improved versions of the framework.

Example - The DECIDE Evidence to Recommendations Framework in use:

In 2011 the World Health Organisation established a guideline panel to answer the following health systems question: “Which mother and newborn healthcare interventions can safely and effectively be moved to health workers with lower levels of training?” A technical team of researchers broke this down into 128 individual questions and searched for global evidence on relevant issues. Frameworks were filled in for each question. The panel then worked together to arrive at a recommendation for each question, using the frameworks to structure and inform their discussions. (See also Collaboration with the WHO) Text from the last page of each framework served as a summary for publication, with a link to the rest of the underlying framework and the supporting evidence. 

We are currently carrying out rounds of stakeholder feedback and user testing. Later we will be testing the framework in randomised trials.


Templates and instructions for use

Since the frameworks are currently under development, templates are not yet available for external use. Examples and more explanation can be found here.

Relevant publications from staff at Cochrane Norway

Shaun Treweek et al. Developing and evaluating communication strategies to support informed decisions and practice based on evidence (DECIDE): protocol and preliminary results. Implementation Science 2013, 8:6.


DECIDE is a 5-year project (running from January 2011 to 2015) co-funded by the European Commission under the Seventh Framework Programme.

More information about DECIDE: