Highlights
What is already known?
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• Methods guidance for evidence synthesis and evidence-based advice has been predominantly developed for clinical medicine, focusing on intervention effectiveness and structured decision-making processes.
What is new?
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• This scoping review systematically maps existing methods guidance across a range of research questions and types of scientific enquiry and identifies key gaps in the applicability of methods guidance to public health, particularly in rapid response, integration of diverse evidence types, and real-world decision-making contexts.
Potential impact for RSM readers
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• The findings offer both a repository for those conducting evidence synthesis and developing evidence-based advice and a roadmap for those seeking to advance methodological approaches that better align with public health needs. They support the development of adaptable and broader approaches to evidence synthesis and evidence-based advice in public health. The interactive evidence map is available here: https://ew6.ibe.med.uni-muenchen.de/mediate/evidence-gap-map/.
1 Introduction
Effective public health decision-making depends on timely and trustworthy evidence. Evidence synthesis plays a critical role in developing evidence-informed recommendations by systematically collecting, appraising, and synthesising available research on a range of different questions. To support this process, methods guidance on how to conduct evidence synthesis and formulate evidence-based advice—defined broadly as public health recommendations or guidance derived from a systematic consideration of the available evidence—is crucial in ensuring quality, consistency, and transparency across public health recommendations.1 However, most existing methods guidance has been developed in clinical medicine under the evidence-based medicine paradigm, primarily focusing on questions of intervention effectiveness and safety (i.e., benefit-harm balance) and selected methodologies (e.g., randomised controlled trials).Reference Guyatt, Oxman, Schünemann, Tugwell and Knottnerus2
Over time, the principles of evidence-based decision-making have expanded beyond clinical medicine to other fields, including public health, where demands tend to be more complex. While key principles still apply, public health decision-making addresses population-level health impacts with equity being a core value. It often concerns sectors beyond the health sector, where various consequences beyond those intended, as well as acceptability, feasibility, and other implementation considerations, play a critical role.Reference Rehfuess, Stratil Jan, Scheel Inger, Portela, Norris Susan and Baltussen3– Reference Moberg, Oxman and Rosenbaum5 Public health measures tackle multiple health determinants (e.g., social, environmental, and behavioural),Reference Remais and Jackson6 interact with diverse socio-economic and political factors, and require integration of multiple streams of evidence to address a wide range of questions.4 These complexities call for tailored methods guidance to ensure appropriate and actionable evidence-based advice for public health.
The need for reliable, transparent, and systematic approaches becomes even more acute during public health emergencies.Reference Khalil, Tamara, Rada and Akl7, Reference Jamie, Paul and Leesa8 In such situations, decision-makers must act swiftly under dynamically evolving conditions and in a climate of much uncertainty, relying on incomplete and rapidly evolving evidence. The COVID-19 pandemic highlighted critical gaps in existing methods guidance, which often proved inadequate, notably with regards to rapid approaches in the face of pressing decision-making needs.Reference Rehfuess, Burns and Pfadenhauer9 Public health agencies, both nationally and internationally, faced the dual challenge of having to inform decisions with far-reaching societal implications and of having to build on a rapidly changing and often very limited evidence base.Reference Tweed, Selbie, Tegnell, Viso, Ahmed and Mastkov10
In response to these challenges and informed by lessons from the COVID-19 pandemic,4 the European Centre for Disease Prevention and Control (ECDC)—the European Union (EU)‘s public health agency—has expanded its mandate to include the provision of evidence-based recommendations to guide infectious disease prevention and control.11, 12 Previously, ECDC’s primary role was to collect and analyse data on infectious diseases, such as COVID-19, influenza, and tuberculosis, as well as public health issues, such as antimicrobial resistance and vaccination. While it has long played a critical role in assessing health risks for countries in the EU and the European Economic Area, its post-pandemic role now also explicitly includes evidence-based advice.12 To support these responsibilities, ECDC launched an initiative that aims to develop practical, fit-for-purpose methods guidance for evidence synthesis and evidence-based public health advice, focusing on infectious disease epidemiology, prevention, and control.
In the context of this initiative, the MEthoDs guidance for public heAlTh Evidence synthesis and evidence-based advice (MEDIATE) consortium was commissioned to take stock of existing methods guidance.13 The present scoping review systematically identifies and maps existing methods guidance on evidence synthesis and evidence-based advice, with the aim to chart the existing landscape and highlight areas where further development could be beneficial. The dual framing of this work—as a scoping review and an evidence map—served two complementary functions. The scoping review methodology enabled a comprehensive and systematic identification of relevant guidance, while the evidence mapping approach provided a structured framework for organising and visualising key characteristics of the guidance and the existing gaps. By focusing on both routine and emergency contexts, the review provides an important resource for everyone producing evidence synthesis and evidence-based advice in the health field and for methodologists seeking to advance methods for evidence-based public health decision-making.
2 Methods
The protocol for this review was registered a priori with the Open Science Framework and can be found at https://doi.org/10.17605/OSF.IO/WMXCN. Key methodological decisions are summarised in the following sections and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews.Reference Tricco, Lillie and Zarin14
2.1 Criteria for including methods guidance
We defined methods guidance as documents that provide a set of principles, structured processes, recommendations, or the like regarding the conduct of evidence synthesis or the development of evidence-based advice. Importantly, such guidance had to address the overall process of developing evidence synthesis or evidence-based advice rather than address specific steps only (e.g., methods guidance focusing only on critical appraisal of studies). We did not apply restrictions based on publication type. The methods guidance could have been developed and published by researchers, such as in peer-reviewed journals, or developed and/or used by key institutions in health care. Key institutions were defined as entities that develop and disseminate methods guidance for evidence synthesis or guideline development, promoting research transparency and quality (e.g., Cochrane Collaboration, Joanna Briggs Institute [JBI]), or as global, national, and regional health organisations that commission or conduct evidence synthesis and evidence-based advice (e.g., WHO, national public health institutes). The MEDIATE consortium collaboratively identified 26 key institutions (see File S1 of the Supplementary Material).
To be included, methods guidance had to focus on any type of evidence synthesis (e.g., systematic reviews, scoping reviews, overviews of reviews) and/or any type of evidence-based advice (e.g., evidence-based guidelines or recommendations and health technology assessments (HTAs)) directed at populations/groups rather than individuals/patients. Given the lack of a classification of types of evidence-based advice, our approach was inclusive, considering methods guidance for any type of advice that is the result of a structured and transparent development approach using the best available evidence and expert assessment to varying extents. We excluded methods guidance solely concerned with knowledge dissemination, knowledge translation, or science communication, as well as guidance focusing on reporting standards. While we recognise that EtD frameworks may be viewed as a tool to facilitate knowledge translation, EtD frameworks are not primarily designed or exclusively used for this purpose. They therefore fit this review’s focus on guidance that informs the full process of evidence synthesis or structured formulation of advice, rather than guidance on dissemination or implementation.
We included guidance published from 2000 onwards. This cut-off choice is rooted in the historical progression of evidence-based methodologies. While the term ‘evidence-based medicine’ was introduced in the 1990s, marking the start of a period of foundational growth and development in relevant methods, it was the early 2000s that saw the publication of key standards and methodological benchmarks, such as PRISMAReference Page, McKenzie and Bossuyt15 and AGREE (Appraisal of Guidelines for Research & Evaluation).Reference Brouwers, Kho and Browman16 By focusing on literature published during the last 20+ years, our intention was to capture the refinement and expansion of evidence-based methodologies that followed these important advancements and ensure our focus remains on the most relevant and contemporary methodological approaches. In line with our review protocol, we included guidance applicable across any health discipline (e.g., clinical medicine, public health) and concerning any health issue (e.g., infectious diseases, non-communicable diseases). While our primary interest in this map was public health, we adopted broader inclusion criteria encompassing multiple disciplines to allow capturing evidence-based principles that are foundational across disciplines and hence also applicable to public health. Public health often intersects with the social sciences—particularly in areas such as health systems, policy, and community interventions—so we included guidance from organisations, such as the Campbell Collaboration, when it was concerned with methods directly applicable to evidence synthesis or advice generation in health/wellbeing-related contexts. However, we did not include guidance focused solely on non-health disciplines such as education or criminal justice.
2.2 Search methods
We used a multi-pronged approach to searching that combines: (i) systematic searches in scientific databases, (ii) searches on the websites of key institutions, and (iii) citation searches based on identified relevant documents (i.e., network searches of related articles). We conducted searches in English but included methods guidance published in all other languages.
2.2.1 Systematic searches in scientific databases
The searches were designed by an experienced information specialist (IK). They were developed using both free text and relevant controlled vocabulary terms, if available. The following databases were searched on 24 April 2024: Ovid Medline ALL, Web of Science Core Collection (Science Citation Index Expanded (SCI-EXPANDED), Social Sciences Citation Index (SSCI), Arts & Humanities Citation Index (AHCI), Emerging Sources Citation Index (ESCI))00), and the Library of Guidance for Health Scientists (LIGHTS) (https://lights.science/). The Medline search strategy was assessed by a second information specialist using the Peer Review of Electronic Search Strategies (PRESS) guideline.Reference McGowan, Sampson, Salzwedel, Cogo, Foerster and Lefebvre17 The search blocks focused on (i) types of evidence synthesis and evidence-based advice (e.g., systematic reviews, scoping reviews, HTAs), (ii) conduct (e.g., development, reporting), and (iii) guidance (e.g., manual, guidance, guideline). We searched LIGHTS using the filters for systematic reviews, HTAs, meta-analyses, and clinical practice guidelines to identify relevant guidance. Because the database currently has no export function, the LIGHTS team provided us with a list of PMIDs and DOIs to enable the downloading of references via citationchaser (https://estech.shinyapps.io/citationchaser/). The full search strategy is available in File S2 of the Supplementary Material.
All search results were deduplicated using EPPI Reviewer 6.
2.2.2 Searches on the websites of key institutions
An information specialist advised on the comprehensive search strategy for key institutions’ websites. For a systematic, transparent, and reproducible approach, we used the following search approaches on the websites of the key institutions:
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1. Manual website navigation: Websites were explored using their built-in structure, navigating sections, such as publications, resources, and libraries.
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2. Keyword searches: Search terms like ‘handbook’ ‘manual’ ‘guidance’ ‘systematic review’ and ‘evidence synthesis’ and their combinations were systematically applied using each website’s search function.
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3. Google-limited searches: For websites without functional search tools, we conducted Google site-limited searches using predefined combinations of keywords (e.g., site:cochrane.org handbook OR guidance ‘systematic reviews’).
The first 20 results from each query were screened for relevance. All search activities were documented, including the search date, source, method, and number of retrieved documents. This approach was tailored to the structure and functionality of each institution’s website.
2.2.3 Network searches
We ran a network search on 2 June 2024 on 247 guidance documents identified during full text screening in OpenAlex (https://openalex.org/)Reference Priem, Piwowar and Orr18 using EPPI Reviewer 6Reference Thomas, Graziosi, Brunton, Ghouze, O'Driscoll and Bond19 based on high relevance guidance (see further details under Results below) identified from our database searches and full text screening (applying ‘bibliography’ and ‘recommended by’ functions).
2.3 Selection of methods guidance
We first screened the titles and abstracts of the identified records using EPPI Reviewer.Reference Thomas, Graziosi, Brunton, Ghouze, O'Driscoll and Bond19 All reviewers involved with this stage of screening piloted the screening guidance by screening the same 50 records. Based on this, we revised and standardised the screening guidance. Eight reviewers (AD, AG, AM, BNS, CK, GB, JH, KAI) independently screened the titles and abstracts using a conservative approach, meaning if there were any uncertainties regarding the inclusion of a record, that record was moved to full-text screening without a second review. We used priority screening for this stage, a method that ranks studies based on a machine learning (ML) model to prioritise the studies that are most likely to be relevant, ensuring that the records most likely to be included are screened first. As we approached the threshold beyond which no further relevant records were expected, we screened an additional 300 lower-ranked records to validate this. Since none met the inclusion criteria, we concluded screening and relied on the ML model’s prioritisation.
The same process was used for full text screening. Seven reviewers (AD, AM, BNS, CK, GB, JH, and KAI) independently screened the full texts. If there were uncertainties regarding the inclusion of a record, a second reviewer reviewed the record before a final decision on inclusion or exclusion was made.
2.4 Data extraction and development of the initial map of methods guidance
We developed an a priori mapping framework for categorising identified methods guidance. This was drafted by AM and ER, refined through iterative discussions within the team and tested on selected methods guidance documents (e.g., Cochrane Handbook) to ensure the framework’s depth and practicality. While according to our protocol (https://doi.org/10.17605/OSF.IO/WMXCN), we had initially planned to conduct more detailed data mapping, extracting and summarising textual data on reported experiences with the methods guidance and their limitations/gaps, we did not proceed for feasibility reasons, given the very large number of methods guidance identified. The domains of the final mapping framework are presented in Table 1.
Domains of the mapping framework
Additionally, we coded the specific health area covered (i.e., infectious diseases, non-communicable diseases, and injuries), the focus area (i.e., clinical, public health, and service delivery), and marked any cross-cutting themes that emerged (e.g., how to incorporate equity considerations, complexity, stakeholder engagement, and automation/ML).
The map was developed using the EPPI mapper, a web-based tool designed to create interactive visualisations for organising and exploring evidence.20 This interactive map allows users to navigate the methods guidance by applying the pre-defined categories in a dynamic format. One reviewer first mapped 50 methods guidance documents based on the a priori framework, validating the application of the mapping framework in consultation with the other reviewers. Seven reviewers (AD, AM, BNS, CK, GB, JH, and KAI) then coded the remaining methods guidance documents using the pre-defined mapping categories. Senior researchers in the team provided feedback on the mapping process and presentation of the findings in the initial map (ER, FF, SAF, and JM).
2.5 External consultations and map refinement
To refine the initial map of methods guidance, we conducted a brief survey with 53 methodologists from across the world identified through the project partners’ network, receiving 13 responses (25% response rate). Participants reviewed the map and provided general feedback. They were also specifically asked to suggest additional guidance, particularly for rapid (i.e., production within a few weeks) and ultra-rapid approaches (i.e., production within a few days), as well as provide information on ongoing projects to develop methods guidance. The survey, conducted via LimeSurvey21 from July 27 to August 30, 2024, included a link to the initial map for review.
Additionally, the initial map was shared with 18 members of ECDC’s Methodological Advisory Group (MAG), convened by the ECDC Chief Scientist to advise the agency on how to strengthen evidence-based approaches. This is composed of methodologists and representatives of European national public health institutes. Four MAG members (22% response rate) provided feedback.
All input from methodologists and MAG members was synthesised to refine and update the map. Respondents consenting to be named are listed in File S3 of the Supplementary Material.
3 Results
3.1 Results of the search
Figure 1 provides a graphical representation of our search and guidance selection results. In total, we identified 17,386 unique records through systematic searches in databases, key institutions’ websites, and network searches, as well as through consultations with methodologists and MAG members. These consultations yielded a total of 65 records, of which 58 were unique and not found through literature searches.
PRISMA flow diagram. *Although we conducted deduplication in EPPI Reviewer prior to the title and abstract screening, a few duplicates were still identified during the screening process. These duplicates were due to inconsistencies in the reporting of titles, issues, and volumes, which were not detected by EPPI Reviewer.
Out of the 17,386 unique records, we manually screened 6,797 (including the 58 records suggested by methodologists and MAG members) and excluded 10,589 based on a low likelihood of relevance, as indicated by the ML model. This model was trained to differentiate between manually identified included records and excluded records. As we reached the threshold where we did not expect further relevant includes, we continued to screen an additional 300 records to ensure the validity of the threshold. As none of these 300 records were found to be eligible, we felt safe to stop screening and rely on the ML model. The 30% likely relevance threshold, which was chosen based on evaluations and experience at the Norwegian Institute of Public Health,Reference Muller, Ames and Himmels22 was found appropriate as no further relevant methods guidance was identified.
In total, we screened 1,184 full texts, of which 391 met our inclusion criteria. Among these, 247 records were classified as guidance products. The remaining 144 records were classified as guidance-like products; while not explicitly labelled as guidance, these documents provided broader literature reviews and often overviews of existing guidance detailing a step-by-step approach to evidence synthesis or evidence-based advice. We decided to include them in the map, adding an additional code to differentiate between guidance and guidance-like products. Filtering on this code allows users to decide for themselves whether they consider them relevant or not. However, for the network searches, we used only the guidance products.
3.2 Development of the map
As described above, we created an initial map using only records identified through literature searches. We refined the initial map based on feedback from external methodologists and MAG members. Following the consultations, we made the following adaptations:
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• We added 18 additional guidance documents to the map from the 58 unique records suggested by methodologists and MAG members. Of these, 13 were classified as guidance products, and five as guidance-like products.
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• We reclassified selected guidance products based on specific suggestions. For instance, with regards to ‘type of question’, methods guidance on qualitative evidence synthesis was reassigned from the category ‘intervention’ to ‘other’, as it was found to address multiple broader questions related to experiences, values, and preferences.
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• For guidance products concerned with evidence-based advice, we omitted the specification of ‘type of question’. These products primarily address management (i.e., advice on how to intervene), rendering many of the predefined question types (e.g., prevalence/incidence, disease burden) irrelevant.
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• We updated the references for some guidance products with the latest versions available. In cases where the previous versions of the guidance were available online (e.g., on the websites of the key institution), these were included and counted as distinct guidance products.
These consultations also revealed 13 ongoing projects on the development of methods guidance; however, none had a completed guidance product at the time of the map’s finalisation.
3.3 Characteristics of included guidance products
Table 2 provides an overview of the characteristics of the 247 included guidance products.
Characteristics of included methods guidance products
1Some guidance products fall into more than one sub-category, therefore the percentages in each category do not add up to 100%.
Most of the included methods guidance products were published from 2011 onwards (216 guidance products, 87%), with the highest concentration between 2021 and 2024 (79 products, 32%).
The included methods guidance more often addressed the development of evidence synthesis (155 products, 63%) than evidence-based advice (98 products, 40%), with some guidance covering both areas. In evidence synthesis, most focused on systematic reviews of quantitative data (116 products, 75%); in evidence-based advice, most focused on guidelines/recommendations (77 products, 79%).
In terms of specific health areas, most guidance was classified to be generic, meaning they did not specify a health area (212 products, 86%); we found only 12 guidance products Reference Moberg, Oxman and Rosenbaum5% addressing infectious diseases.23– Reference Arnold, Bimczok, Lehner and Stratil34 Similarly, while most guidance products did not specify a focus area, a large proportion had a clinical focus (80 products, 32%) with only 41 products (17%) classified as addressing public health.
Sixty of the included methods guidance products (24%) addressed cross-cutting themes: equity (19 products, 8%),Reference Rehfuess, Stratil Jan, Scheel Inger, Portela, Norris Susan and Baltussen3, Reference Dewidar, Kawala and Antequera27, Reference McCaul, Tovey and Young31, Reference Arnold, Bimczok, Lehner and Stratil34– Reference Movsisyan, Rehfuess and Norris49 complexity (17 products, 7%),Reference Rehfuess, Stratil Jan, Scheel Inger, Portela, Norris Susan and Baltussen3, Reference Arnold, Bimczok, Lehner and Stratil34, 38, Reference Cumpston, McKenzie, Welch and Brennan45, Reference Movsisyan, Rehfuess and Norris49– Reference Wilson, Oliver, Melendez-Torres, Lavis, Waddell and Dickson61 context and implementation (16 products, 6%),Reference Moberg, Oxman and Rosenbaum47, Reference Movsisyan, Rehfuess and Norris49, Reference Lin, Murad and Leas62– 75 stakeholder engagement (13 products, 5%),Reference Akl, Cuker, Mustafa, Nieuwlaat, Stevens and Schunemann29, Reference McCaul, Tovey and Young31, 37, 38, Reference Petticrew, Glover and Volmink46, Reference Movsisyan, Rehfuess and Norris49, Reference Diaz Del Campo, Gracia, Blasco and Andradas76– Reference Munthe-Kaas Heather, Nøkleby, Lewin and Glenton82 ethics (8 products, 3%),Reference Arnold, Bimczok, Lehner and Stratil34, 44, Reference Movsisyan, Rehfuess and Norris49, Reference Rehfuess, Stratil, Scheel, Portela, Norris and Baltussen69, Reference Assasi, Tarride, O’Reilly and Schwartz83– Reference Mertz and Strech86 adaptation (5 products, 2%),75, 87– Reference Kristiansen, Brandt and Agoritsas90 and automation/ML (4 products, 2%).Reference Lichtner, Alper and Jurth91– Reference van Haastrecht, Sarhan, Yigit, Brinkhuis and Spruit94 Finally, most of the methods guidance focused on producing evidence synthesis and evidence-based advice in routine circumstances (215 products, 87%) and only 19 (Reference Jamie, Paul and Leesa8%) addressed rapid approaches. Four of the included methods guidance were published in languages other than English (i.e., German, Spanish, and Portuguese).
In the following, we describe the 247 methods guidance products included in the map. We describe the guidance products addressing evidence synthesis and evidence-based advice separately. For the guidance products on evidence synthesis, we further specify the type of question they address, as well as the specific product type and mode of production they describe (see Figure 2). This is further visually presented in an interactive map, which can be found at: https://ew6.ibe.med.uni-muenchen.de/mediate/evidence-gap-map/. In this map and data presentation, we use the term systematic review—as commonly understood—to refer to systematic reviews of quantitative data (with or without meta-analysis), distinguishing it from other forms of evidence synthesis such as qualitative evidence synthesis and mixed-methods syntheses. However, all of these represent systematic and structured approaches to synthesising evidence. For guidance products on evidence-based advice, we provide a summary of specific product type and production mode addressed; but do not specify the type of question as we omitted this specification for these guidance products.
Map of evidence synthesis methods guidance. The interactive evidence map is available here: https://ew6.ibe.med.uni-muenchen.de/mediate/evidence-gap-map/.
Note: Note: In this evidence map, the term “systematic review” is used to refer to systematic reviews of quantitative data (with or without meta-analysis), consistent with common usage. Qualitative and mixed-methods syntheses are presented as separate categories.
3.4 Description of methods guidance on evidence synthesis
Our review identified significant variability in the availability and focus of methods guidance across different types of evidence synthesis questions. Below, we summarise the findings for each question type.
3.4.1 Prevalence and incidence
We identified only three methods guidance products applicable to the questions of prevalence/incidence in evidence synthesis.Reference Harder, Takla and Eckmanns28, Reference Munn, Moola, Lisy, Riitano and Tufanaru95, Reference Aromataris and Munn96 Specifically, one offered methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and incidence data,Reference Munn, Moola, Lisy, Riitano and Tufanaru95 the second described a broader framework (the PRECEPT framework) for evaluating and grading evidence in infectious disease epidemiology, prevention and control,Reference Harder, Takla and Eckmanns28 and the third comprises the specific chapter on prevalence/incidence in the JBI Manual for Evidence Synthesis.Reference Aromataris and Munn96 All of these guidance products focused on conducting evidence synthesis in normal circumstances.
3.4.2 Disease burden
The only identified methods guidance relevant to disease burden assessment was the PRECEPT framework.Reference Harder, Takla and Eckmanns28
3.4.3 Clinical manifestation
We did not identify any methods guidance specifically addressing evidence synthesis for clinical manifestation questions, such as symptomatology or disease progression.
3.4.4 Aetiology and risk factors
We identified six methods guidance products applicable to the question of aetiology and risk factors in evidence synthesis.Reference Petticrew, Glover and Volmink46, Reference Aromataris and Munn96– Reference Denison, Dodds and Ntani100 Examples include the COSMOS-E guidanceReference Dekkers Olaf, Vandenbroucke Jan, Cevallos, Renehan Andrew, Altman Douglas and COSMOS-E97 and the specific chapter on aetiology/risk factors in the JBI Manual for Evidence Synthesis.Reference Aromataris and Munn96 All of these offered guidance on the conduct of systematic reviews of observational studies of aetiology in normal circumstances.
3.4.5 Prognosis
Six methods guidance products addressed questions of prognosis.Reference Damen, Moons, van Smeden and Hooft25, Reference Liu, Yao, Li, Liu, Chen and Gao101– Reference Debray Thomas, Damen Johanna and Snell Kym105 For example, the guidance by Riley et al. describes how various systematic review tools could be adapted for use across the steps of reviewing the prognostic factor studies.Reference Riley, Moons and Snell103 All of these offered guidance for conducting systematic reviews of prognostic studies in normal circumstances.
3.4.6 Diagnosis
We found 13 methods guidance products applicable to the question of diagnosis.Reference Harder, Takla and Eckmanns28, Reference Liu, Yao, Li, Liu, Chen and Gao101, Reference Sousa and Ribeiro104, 106– Reference Smetana, Umscheid, Chang and Matchar115 Examples include the Cochrane handbook for systematic reviews of diagnostic test accuracy (DTA)109 and the Template of Multiplicity and Analysis in Systematic Reviews proposed to be used in conjunction with the Cochrane DTA guidance.Reference Mallett, Dinnes, Takwoingi and de Ruffano114 All of these focused on systematic reviews of diagnostic studies in normal circumstances.
3.4.7 Laboratory-based aspects
We did not identify any methods guidance specifically addressing evidence synthesis for laboratory-based aspects, such as laboratory procedures.
3.4.8 Interventions
We identified 30 methods guidance products applicable to interventions.Reference Harder, Takla and Eckmanns28, 37, 38, Reference Cumpston, McKenzie, Welch and Brennan45, Reference Guise Jeanne, Chang, Butler, Viswanathan and Tugwell53, Reference Petticrew, Anderson and Elder57, Reference Wilson, Oliver, Melendez-Torres, Lavis, Waddell and Dickson61, Reference Nasser, van Weel, van Binsbergen and van de Laar66, Reference Duddy and Wong67, Reference Aromataris and Munn96, Reference Furlan, Malmivaara and Chou116– Reference Wong, Greenhalgh, Westhorp, Buckingham and Pawson135 Of these, 26 focused on systematic reviews of intervention effects,Reference Harder, Takla and Eckmanns28, 37, 38, Reference Cumpston, McKenzie, Welch and Brennan45, Reference Guise Jeanne, Chang, Butler, Viswanathan and Tugwell53, Reference Petticrew, Anderson and Elder57, Reference Wilson, Oliver, Melendez-Torres, Lavis, Waddell and Dickson61, Reference Nasser, van Weel, van Binsbergen and van de Laar66, Reference Aromataris and Munn96, Reference Furlan, Malmivaara and Chou116– Reference Higgins123, 125– Reference Neumann and Schünemann133 including the Cochrane,38 Campbell,121 and JBI guidance,Reference Aromataris and Munn96 one guidance from Campbell addressed evidence (gap) maps,Reference White, Albers and Gaarder134 one focused on reviews of reviews of interventions,Reference Smith, Devane, Begley and Clarke124 and two were concerned with other types of evidence synthesis. Reference Duddy and Wong67, Reference Wong, Greenhalgh, Westhorp, Buckingham and Pawson135 These included realist approaches, such as the RAMESES guidance for meta-narrative reviews.Reference Wong, Greenhalgh, Westhorp, Buckingham and Pawson135 Most of these guidance products focused on normal circumstances, three addressed rapid reviews. Reference Wilson, Oliver, Melendez-Torres, Lavis, Waddell and Dickson61, Reference Garritty, Gartlehner and Nussbaumer-Streit122, Reference Garritty, Hamel and Trivella130 These included the original and updated guidance from the Cochrane Rapid Review Methods GroupReference Garritty, Gartlehner and Nussbaumer-Streit122, Reference Garritty, Hamel and Trivella130 and one guidance focusing on rapid reviews for health policy and system questions.Reference Wilson, Oliver, Melendez-Torres, Lavis, Waddell and Dickson61
3.4.9 Implementation
Ten methods guidance products were found applicable to implementation considera tions.Reference Noyes, Booth and Cargo56, Reference Pfadenhauer, Gerhardus and Mozygemba59, Reference Cargo, Harris and Pantoja63, Reference Harden, Thomas, Cargo, Harris, Pantoja and Flemming64, Reference Duddy and Wong67, Reference Munthe-Kaas Heather, Nøkleby, Lewin and Glenton82, Reference Wong, Greenhalgh, Westhorp, Buckingham and Pawson135– Reference Harris, Booth and Cargo138 Of these, two guidance products focused integrating implementation issues in systematic reviews Reference Pfadenhauer, Gerhardus and Mozygemba59, Reference Munthe-Kaas Heather, Nøkleby, Lewin and Glenton82 (here and throughout used to refer to reviews of quantitative data, unless otherwise specified), six guidance products from the Cochrane Qualitative and Implementation Methods Group addressed qualitative evidence synthesis,Reference Noyes, Booth and Cargo56, Reference Cargo, Harris and Pantoja63, Reference Harden, Thomas, Cargo, Harris, Pantoja and Flemming64, Reference Glenton, Lewin and Downe136– Reference Harris, Booth and Cargo138 and one from the same group was concerned with mixed-methods evidence synthesis. Reference Noyes, Booth and Cargo56 We also classified the two guidance products on realist approaches described under Interventions as applicable to implementation.Reference Duddy and Wong67, Reference Wong, Greenhalgh, Westhorp, Buckingham and Pawson135 All guidance products addressed evidence synthesis in normal circumstances.Reference Noyes, Booth and Cargo56, Reference Pfadenhauer, Gerhardus and Mozygemba59, Reference Cargo, Harris and Pantoja63, Reference Harden, Thomas, Cargo, Harris, Pantoja and Flemming64, Reference Duddy and Wong67, Reference Munthe-Kaas Heather, Nøkleby, Lewin and Glenton82, Reference Wong, Greenhalgh, Westhorp, Buckingham and Pawson135– Reference Harris, Booth and Cargo138
3.4.10 Economic considerations
Six methods guidance products addressed economic considerations in evidence synthesis.24, Reference Aromataris and Munn96, Reference Chattopadhyay, Jacob and Hopkins139– Reference Carande-Kulis, Maciosek Michael and Briss Peter142 Examples include the guidance on systematic reviews of economic evidence from the Community Preventive Services Task Force143 and the dedicated chapter from the JBI Manual for Evidence Synthesis.Reference Aromataris and Munn96 All focused on systematic reviews in normal circumstances.
3.4.11 Generic
We classified 68 methods guidance products as generic, meaning they did not specify a type of question and/or covered many different questions.Reference Heron, Buitrago-Garcia and Ipekci26, Reference Tricco, Garritty and Boulos30, Reference McCaul, Tovey and Young31, Reference Tugwell, Petticrew and Kristjansson36, Reference Welch, Petticrew and O'Neill43, Reference Maden, McMahon, Booth, Dickson, Paisley and Gabbay48, Reference Langlois É, Daniels and Akl60, Reference Lin, Murad and Leas62, Reference Pollock, Alexander and Munn79, Reference Marshall and Wallace92, Reference van Haastrecht, Sarhan, Yigit, Brinkhuis and Spruit94, 143– Reference Sen198 An example of such guidance is the methods guide on evidence synthesis for health policy and systems from WHO, highlighting various questions and synthesis methods.Reference Langlois É, Daniels and Akl60 Of all the guidance products in this category, 52 were found to focus on systematic reviews,Reference Heron, Buitrago-Garcia and Ipekci26, Reference Tricco, Garritty and Boulos30, Reference McCaul, Tovey and Young31, Reference Tugwell, Petticrew and Kristjansson36, Reference Welch, Petticrew and O'Neill43, Reference Maden, McMahon, Booth, Dickson, Paisley and Gabbay48, Reference Langlois É, Daniels and Akl60, Reference Lin, Murad and Leas62, Reference Marshall and Wallace92, Reference van Haastrecht, Sarhan, Yigit, Brinkhuis and Spruit94, 143– Reference Wafford and O'Dwyer148, Reference Lichtenstein, Yetley and Lau150, Reference Hammick, Dornan and Steinert152– 154, Reference du, Ryan and de156, Reference Levitt157, Reference Robinson Karen, Whitlock Evelyn and O’Neil159, Reference Knoll, Omar and Maclennan160, Reference Simmonds, Elliott, Synnot and Turner162, Reference Elliott, Synnot and Turner163, Reference Butler, Hartmann-Boyce, Livingstone-Banks, Turner and Lindson165, Reference Eiring, Brurberg, Nytroen and Nylenna167– Reference Tricco Andrea, Langlois Etienne and Straus Sharon169, Reference Aromataris, Fernandez, Godfrey, Holly, Khalil and Tungpunkom172– Reference Robinson, Chou and Berkman178, Reference Howard, Piacentino, MacMahon and Schulte Paul180– Reference Zhang, Cheng and Zhang182, Reference Bendersky, Auladell-Rispau, Urrútia and Rojas-Reyes María184– Reference Perestelo-Pérez186, Reference Cooper, Hedges and Valentine188– Reference Kisely and Siskind191, Reference Lipp194– Reference Sen198 nine on scoping reviews,Reference Pollock, Alexander and Munn79, Reference Anderson, Howarth, Vainre, Humphrey, Jones and Ford149, Reference Peters, Godfrey, Khalil, McInerney, Parker and Soares155, Reference Alexander, Cooper and Peters161, Reference Khalil, McInerney and Pollock166, Reference Sarrami-Foroushani, Travaglia, Debono, Clay-Williams and Braithwaite170, Reference Colquhoun, Levac and O'Brien171, Reference Peters, Marnie and Tricco192, Reference Pollock, Davies and Peters193 seven on umbrella reviews,Reference Hennessy, Johnson and Keenan151, Reference Bonczar, Ostrowski and D'Antoni158, Reference Robinson Karen, Whitlock Evelyn and O’Neil159, Reference Aromataris, Fernandez, Godfrey, Holly, Khalil and Tungpunkom172, Reference Robinson, Chou and Berkman178, 179, Reference Belbasis, Bellou and Ioannidis John183 and two on other types of evidence synthesis. Reference Wong, Greenhalgh, Westhorp and Pawson164, Reference Barry, Merkebu and Varpio187 In the other category, one methods guidance product addressed realist meta-reviews,Reference Wong, Greenhalgh, Westhorp and Pawson164 and one state-of-the-art literature review.Reference Barry, Merkebu and Varpio187 Most methods guidance products in the generic category focused on evidence synthesis in normal circumstances, eight on rapid approaches,Reference Tricco, Garritty and Boulos30, Reference McCaul, Tovey and Young31, Reference van Haastrecht, Sarhan, Yigit, Brinkhuis and Spruit94, Reference du, Ryan and de156, Reference Eiring, Brurberg, Nytroen and Nylenna167– Reference Tricco Andrea, Langlois Etienne and Straus Sharon169, Reference Crawford, Boyd, Jain, Khorsan and Jonas185 and seven on living approaches to evidence synthesis, including updating of evidence synthesis.Reference Heron, Buitrago-Garcia and Ipekci26, Reference Takwoingi, Hopewell, Tovey and Sutton Alex146, Reference Simmonds, Elliott, Synnot and Turner162, Reference Elliott, Synnot and Turner163, Reference Butler, Hartmann-Boyce, Livingstone-Banks, Turner and Lindson165, Reference Bendersky, Auladell-Rispau, Urrútia and Rojas-Reyes María184, Reference France, Wells, Lang and Williams199
3.4.12 Other types of questions
We classified 29 methods guidance products as addressing other types of questions than those described above.Reference Flemming, Booth, Garside, Tunçalp and Noyes51, Reference Noyes, Booth, Moore, Flemming, Tuncalp and Shakibazadeh52, Reference Noyes, Booth and Cargo56, Reference Petticrew, Rehfuess and Noyes58, Reference Cargo, Harris and Pantoja63, Reference Harden, Thomas, Cargo, Harris, Pantoja and Flemming64, Reference Stern, Lizarondo and Carrier68, 132, Reference Glenton, Lewin and Downe136– Reference Harris, Booth and Cargo138, Reference France, Wells, Lang and Williams199– Reference Booth, Sommer, Noyes, Houghton, Campbell and Na216 Ten of these focused on systematic reviews and addressed issues, such as health state utility values, patient-reported outcome measures, toxicity factors, health communication, and human biomonitoring data.Reference Petticrew, Rehfuess and Noyes58, 132, Reference Petrou, Kwon and Madan200– Reference Sharma, Kalina, Whaley and Scheringer205, Reference Siddaway Andy, Wood Alex and Hedges Larry210, Reference Patterson, Thorne, Canam and Jillings212 All of these focused on evidence synthesis in normal circumstances. Nineteen products focused on qualitative evidence synthesis Reference Flemming, Booth, Garside, Tunçalp and Noyes51, Reference Noyes, Booth and Cargo56, Reference Petticrew, Rehfuess and Noyes58, Reference Cargo, Harris and Pantoja63, Reference Harden, Thomas, Cargo, Harris, Pantoja and Flemming64, Reference Glenton, Lewin and Downe136– Reference Harris, Booth and Cargo138, Reference France, Wells, Lang and Williams199, Reference Finfgeld-Connett206, Reference Causer, Spiers and Riley207, 209– Reference Booth, Sommer, Noyes, Houghton, Campbell and Na216 and five on mixed-methods synthesis. Reference Noyes, Booth, Moore, Flemming, Tuncalp and Shakibazadeh52, Reference Noyes, Booth and Cargo56, Reference Petticrew, Rehfuess and Noyes58, Reference Stern, Lizarondo and Carrier68, Reference Lizarondo, Stern and Carrier208 Some of these were also relevant for implementation and therefore were also coded for that type of question (see above). We classified these as concerned with ‘other’ questions based on the suggestion from the MAG because most of these approaches address questions related to preferences and experiences and hence do not fit into any of the above categories. Most of these focused on synthesis in normal circumstances, one methods guidance was found on rapid qualitative evidence synthesis,Reference Booth, Sommer, Noyes, Houghton, Campbell and Na216 and one on how to update qualitative synthesis (classified together with the guidance focusing on living approaches).Reference France, Wells, Lang and Williams199
3.5 Description of methods guidance on evidence-based advice
Of the 98 guidance products on evidence-based advice, 11 offered guidance on how to develop HTAs,Reference Culyer and Bombard35, Reference Lysdahl, Mozygemba, Burns, Chilcott, Brönneke and Hofmann55, Reference Hunter, Facey and Thomas77, Reference Assasi, Tarride, O’Reilly and Schwartz83– Reference Heintz, Lintamo and Hultcrantz85, 217– 221 such as the National Institute for Health and Care Excellence (NICE) manual for health technology evaluations.221 Only one of these, the HTA Core Model from the European Network for Health Technology Assessment (EUnetHTA), discussed a rapid development approach.218
Most of the guidance in this category (77 guidance products, 79%) focused on guideline/recommendation development for evidence-based practice,23, Reference Dewidar, Kawala and Antequera27, Reference Akl, Cuker, Mustafa, Nieuwlaat, Stevens and Schunemann29, Reference McCaul, Tovey and Young31– Reference Arnold, Bimczok, Lehner and Stratil34, Reference Akl Elie, Welch and Pottie39– Reference Welch, Akl and Pottie42, 44, Reference Movsisyan, Rehfuess and Norris49, Reference Lima João, Tangamornsuksan and Guyatt Gordon54, Reference Brouwers, Makarski, Kastner, Hayden and Bhattacharyya70– Reference Diaz Del Campo, Gracia, Blasco and Andradas76, Reference Armstrong, Rueda, Gronseth and Mullins78, Reference Bjorkqvist, Giles and Cornford80, Reference Cluzeau, Wedzicha and Kelson81, Reference Mertz and Strech86– Reference Lichtner, Alper and Jurth91, Reference McDonald, Sharp, Morgan, Murad and Fraile Navarro93, Reference Neumann and Schünemann133, 154, Reference Eiring, Brurberg, Nytroen and Nylenna167, Reference Mancin, Sguanci and Andreoli176, Reference Causer, Spiers and Riley207, Reference Akl, Meerpohl, Elliott, Kahale and Schunemann222– 262 such as the GRADE guidanceReference Neumann and Schünemann133 and the ADAPTE methodology,87 and 10 specifically focused on EtD considerations,Reference Rehfuess, Stratil Jan, Scheel Inger, Portela, Norris Susan and Baltussen3, Reference Arnold, Bimczok, Lehner and Stratil34, Reference Pottie, Welch and Morton40, Reference Moberg, Oxman and Rosenbaum47, Reference Downe, Finlayson and Lawrie71, Reference Rosenbaum, Moberg and Glenton73, Reference Lewin, Glenton and Lawrie243, Reference Alonso-Coello, Oxman Andrew and Moberg263– Reference Morche, Conrad and Passon265 including the GRADE EtDReference Moberg, Oxman and Rosenbaum47 and the WHO-INTEGRATE frameworks.Reference Rehfuess, Stratil Jan, Scheel Inger, Portela, Norris Susan and Baltussen3 Most of these included products from key institutions and entities, such as the GRADE Working Group, WHO, NICE, the Guidelines International Network (GIN), and the US Prevention Services Task Force. Only eight of these guidance products addressed rapid approaches to guideline/recommendation development,Reference Dewidar, Kawala and Antequera27, Reference Akl, Cuker, Mustafa, Nieuwlaat, Stevens and Schunemann29, Reference McCaul, Tovey and Young31, Reference Alper, Tristan, Ramirez-Morera, Vreugdenhil, Van Zuuren and Fedorowicz88, Reference Eiring, Brurberg, Nytroen and Nylenna167, Reference Akl, Morgan and Rooney223, Reference Morgan, Florez and Falavigna245, 260 such as the extension of the GIN-McMaster guideline development checklist for rapid recommendations,Reference Morgan, Florez and Falavigna245 and seven offered guidance on living guidelines,Reference Kristiansen, Brandt and Agoritsas90, Reference McDonald, Sharp, Morgan, Murad and Fraile Navarro93, Reference Akl, Meerpohl, Elliott, Kahale and Schunemann222, Reference Cheyne, Fraile Navarro and Hill236, Reference El Mikati, Khabsa and Harb238, Reference Fraile Navarro, Cheyne and Hill239, Reference Navarro, Cheyne and Hill249 including the guidance produced by the Australian Living Evidence Consortium in partnership with NICE and the US GRADE network.Reference McDonald, Sharp, Morgan, Murad and Fraile Navarro93, Reference Cheyne, Fraile Navarro and Hill236, Reference Fraile Navarro, Cheyne and Hill239, Reference Navarro, Cheyne and Hill249 Six further products offered guidance on other types of evidence-based advice,225, 227, 228, Reference Lotfi, Hajizadeh, Moja, Akl Elie, Piggott and Kredo244, Reference Carrion-Camacho, Martinez-Brocca and Paneque-Sanchez-Toscano266, Reference Chambers and Wilson267 including how to develop briefings to support evidence-informed decision-making and actionable statements.
4 Discussion
4.1 Summary of the main findings
This scoping review provides a comprehensive overview of existing methods guidance for evidence synthesis and evidence-based advice employed in public health, as well as in clinical medicine and health care. Through a systematic and comprehensive search and consultations with methodologists and public health professionals, the map identified 391 guidance documents. Among these, 247 were classified as guidance products, while the remainder were categorised as guidance-like products. Most of the guidance products addressed evidence synthesis (155 products), with relatively fewer focusing on evidence-based advice (98 products). Additionally, the identified methods guidance often lacked specificity for public health contexts and infectious diseases. While we identified many areas lacking guidance, this does not necessarily indicate a need to produce new guidance. In some areas it might be reasonable to have limited guidance. For example, knowledge regarding the aetiology of well-known diseases does not need to be constantly updated, and one would therefore not expect any methods guidance for conducting living reviews on aetiology questions. Below we summarise and discuss the gaps that we think might benefit from further method development.
4.1.1 Evidence synthesis
The map demonstrates that the most comprehensive methods guidance exists for evidence synthesis related to interventions (30 products) and diagnostics (13 products). Some guidance is also available for prognosis (6 products) and aetiology/risk factors (6 products). However, gaps were identified in areas such as clinical manifestation and laboratory-based aspects, for which no guidance was found. Guidance for prevalence/incidence and disease burden is rare, suggesting a potential area for further guidance development to support a broader range of public health questions.
Additionally, most methods guidance focuses on systematic reviews of quantitative data, with limited attention to other types of evidence synthesis, such as qualitative evidence synthesis, scoping reviews, umbrella reviews, and mixed-methods synthesis. Expanding the scope of guidance to encompass these methodologies may be useful to address the diverse and complex needs of public health decision-making.
Finally, while most guidance products are designed for routine circumstances, there is limited attention to urgent or resource-constrained contexts. Although some guidance for rapid synthesis exists, there is a notable gap in ultra-rapid synthesis approaches (e.g., within 48 hours), which may better align with the pace required by many public health institutions during emergency responses.Reference Affengruber, Wagner and Gartlehner268 This need has been explicitly raised by ECDC in the context of commissioning this work, based on internal communications and expressed institutional priorities. This highlights the importance of developing further resources to support evidence synthesis in emergency scenarios.
4.1.2 Evidence-based advice
For evidence-based advice, most guidance products focus on the development of guidelines, evidence-based recommendations, and evidence-to-decision frameworks. There is relatively limited guidance on other types of evidence-based advice, such as HTAs. There may thus be an opportunity to broaden the range of guidance products available for decision-makers.
Similar to evidence synthesis, most guidance for evidence-based advice is intended for routine, non-urgent circumstances. While some resources are emerging for rapid guideline development and living guidelines, there is a complete lack of ultra-rapid approaches. Diversifying methods guidance to include these formats may help address the dynamic and time-sensitive nature of public health emergencies.
4.2 Strengths and limitations of the map
By systematically charting existing guidance, this interactive map serves as the first and most up-to-date repository of methods guidance on evidence synthesis and evidence-based advice for methodologists and decision-makers in public health, as well as clinical medicine and health care in general. It also provides a solid foundation for identifying priorities and supporting further methodological development by highlighting critical gaps. Despite the comprehensive approach undertaken in developing this map, several limitations may impact the completeness of the findings. The inclusion criteria for methods guidance were intentionally broad to capture a wide range of documents across different types of evidence synthesis and evidence-based advice. However, by focusing on guidance that addresses the overall process rather than specific steps (e.g., critical appraisal of studies, approaches to evidence synthesis), more innovative methodological developments related to individual steps, including those making use of artificial intelligence, might have been excluded. Our searches were conducted in April 2024, and it is possible that more recent tools and frameworks were not yet widely disseminated or indexed at the time. This could result in underrepresentation of methodological nuances that are critical for certain types of evidence synthesis or advice. However, focusing on guidance regarding the overall process was necessary to maintain this scoping review feasible.
Furthermore, the searches were conducted in English, focusing on scientific databases and the websites of key institutions, which may have led to the exclusion of relevant guidance published in other languages or formats less likely to be indexed or hosted on institutional platforms (e.g., textbooks). However, all identified non-English documents were examined and included in the map when relevant. The development of the map involved subjective decisions during the mapping and categorisation of the guidance documents. Although these decisions were made using a predefined framework, validated through pilot testing, discussed within the research team where necessary and performed by an experienced team of methodologists, there is an inherent risk of misclassification or oversimplification, especially given the diverse nature of the documents included. We also did not involve any stakeholders in developing the coding framework for the map. Moreover, given the large volume of methods guidance identified, certain planned aspects of the mapping process, such as detailed data extraction on reported experiences and limitations, were not feasible.
Finally, we did not initially plan for this map to be a living resource. However, its straightforward design allows for efficient updates. The team is currently exploring mechanisms and collaborations to transition it into a living format to ensure its ongoing relevance and utility.
4.3 Insights for further methods development
This scoping review was undertaken to systematically identify and map existing methods guidance for evidence synthesis and evidence-based advice, with the overarching aim of informing areas for methods development in public health. The review findings align with the concerns raised by many public health institutions, highlighting the need for methods guidance that recognises the complexities of synthesising evidence from public health policy and systems research.Reference Langlois É, Daniels and Akl60 The need has also been underscored for guidance that supports decision-making under uncertainties and within constrained timeframes, as is often required in public health emergencies.1, 269 Our findings reaffirm these by showing that existing guidance is predominantly designed for clinical medicine and routine decision-making contexts, rather than the dynamic and multifaceted landscape of public health.
The findings present a solid basis for further steps. One focus could be exploring how systematic and transparent approaches for evidence synthesis and evidence-based advice development can be effectively adapted to rapid and ultra-rapid timeframes. While methods guidance for rapid evidence synthesis on studies of interventions has been recently published,Reference Garritty, Hamel and Trivella130 a significant challenge remains in ensuring methodological rigour while reducing the timeframe, particularly for ultra-rapid decision-making (i.e., within 48 hours in emergencies) and for rapidly synthesising other types of primary studies (e.g., diagnostic test accuracy, complex public health interventions, qualitative evidence). Future efforts within ECDC could examine pragmatic approaches, such as streamlined data screening and extraction, as well as integration of structured expert judgement in time-sensitive situations. Collaborative models for evidence-informed practice that enhance efficiency and reduce redundancies are currently being supported by institutions, such as the National Collaborating Centre for Public Health in Canada270 and the Global Evidence Commission at the international level.271 Exploring similar models in the European context could help strengthen the methodological infrastructure for evidence-based public health decision-making in the region.
More broadly, the field of evidence-based public health would benefit from expanding synthesis methodologies beyond traditional intervention (effectiveness) studies. While many guidance products in our map were classified as addressing generic questions, we observed during the screening and coding process that much of this guidance implicitly reflects assumptions and frameworks derived from the intervention-effectiveness paradigm—for example, through the use of the PICO format for formulating questions based on population, intervention, comparison and outcomes, and emphasis on randomised controlled trials. Public health decisions frequently depend on diverse types of evidence, including data on disease burden, implementation feasibility, contextual acceptability, and real-world adaptability.Reference Rehfuess, Stratil Jan, Scheel Inger, Portela, Norris Susan and Baltussen3 Future methodological work could explore how these multiple streams of evidence can be efficiently synthesised in a time-sensitive manner. Additionally, emerging technologies such as artificial intelligence-assisted synthesis offer promising avenues for accelerating evidence synthesis while also maintaining transparency and rigour.Reference James Thomas, Noel-Storr and Moy272 A dialogue among methodologists, public health institutions, practitioners, and policymakers will be essential to refining approaches that are both robust and responsive to the complexities of real-world public health decision-making.
Acknowledgements
This work was carried out under contract with the European Centre for Disease Prevention and Control (ECDC) as part of its broader initiative to develop practical methodological guidance for evidence synthesis and evidence-based public health advice with a focus on infectious diseases, to support the use of the best available evidence in public health decision-making. We acknowledge the intellectual contributions of Dr. Helena de Carvalho Gomes at ECDC to the development of the initiative and the here presented evidence map. We are also grateful to the members of the ECDC Methodological Advisory Group for their valuable feedback, notably Dr. Zachary Munn, Dr. H.B.M. (Henk) Hilderink, Prof. Rens van de Schoot, and Dr. Keith Ian Quintyne.
Special thanks go to Marit Johansen at the Norwegian Institute of Public Health for peer-reviewing the search strategy and providing insightful feedback. We sincerely appreciate the contributions of methodologists around the world who participated in consultations and provided critical feedback on the initial version of the map (see File S3 of the Supplementary Material). Finally, we thank Stefan Schandelmaier for facilitating access to search results from the Library of Guidance for Health Scientists (LIGHTS), which greatly supported our review process.
Author contributions
All authors were involved in conceiving the idea for this research and manuscript. A.M. prepared the first draft with support from E.R. and K.A.I. All authors reviewed different versions of the manuscript and approved the final version.
Competing interest statement
The authors declare that no competing interests exist.
Data availability statement
All data contributing to this manuscript are derived from published sources identified through systematic searches of scientific databases and institutional websites. The full list of included references and corresponding extracted data can be explored via the interactive evidence map, accessible at https://ew6.ibe.med.uni-muenchen.de/mediate/evidence-gap-map/. References for included publications are also provided in the manuscript.
Funding statement
This work was funded by the European Centre for Disease Prevention and Control (ECDC). The work was undertaken within dedicated funding.
Supplementary material
To view supplementary material for this article, please visit http://doi.org/10.1017/rsm.2025.10051.
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