Implementation of the GRADE adolopment framework was perceived as appropriate, acceptable, and feasible in a national guideline program in the Philippines: a mixed-methods study

Authors

• Ian Theodore Cabaluna, National Institutes of Health, University of the Philippines Manila
• Katrice Biños, De La Salle Medical and Health Sciences Institute
• Rosally Zamora, University of the Philippines College of Medicine
• Angela Castrillo, De La Salle Medical and Health Sciences Institute
• Cynthia Cordero, University of the Philippines College of Medicine
• Marissa Alejandria, National Institutes of Health, University of the Philippines Manila
• Lia Palileo-Villanueva, University of the Philippines College of Medicine
• Leonila Dans, University of the Philippines College of Medicine

Publication Date

8-1-2026

Document Type

Article

Publication Title

Journal of Clinical Epidemiology

Abstract

Background The Grading of Recommendations Assessment Development and Evaluation (GRADE) Adolopment framework provides a structured approach for adapting and developing clinical practice guidelines; however, evidence on its implementation in low- and middle-income countries (LMICs) is limited. This study evaluated the implementation of the GRADE Adolopment framework in the development of the Philippine Periodic Health Examination (PHEX) screening guidelines and identified perceived barriers, enablers, and areas for improvement. Study Design and Setting We conducted a sequential exploratory mixed-methods study involving a document review, key informant interviews ( n = 14), and a survey ( n = 109) among members of the PHEX guideline task force in the Philippines. Thematic analysis and integration of quantitative and qualitative findings were used to assess implementation outcomes: appropriateness, acceptability, and feasibility. Results Implementation required contextual modifications to the GRADE Adolopment process, including de novo development of evidence-to-decision tables and use of rapid reviews. Most survey respondents found the framework appropriate (93.6%), acceptable (99.1%), and feasible (96.3%). Qualitative findings indicated that structured methods and alignment with local policy needs contributed to perceived appropriateness, while transparency supported acceptability. Enablers included technical guidance, prior experience, and high-quality evidence access. Key barriers included limited familiarity with the framework, lack of standardized processes, and insufficient resources and capacity. Conclusion The GRADE Adolopment framework can be effectively implemented in LMIC settings with appropriate adaptations. Investments in capacity-building, interest holder engagement, and resource allocation are essential to sustain its use and improve the development of evidence-based clinical practice guidelines in the Philippines and similar contexts. Plain Language Summary Clinical practice guidelines help doctors and health systems make decisions about screening, treatment, and disease prevention. Developing these guidelines from scratch requires substantial time, expertise, and resources. One approach to make guideline development more efficient is the GRADE Adolopment framework. This study evaluated how the GRADE Adolopment framework was implemented in the Philippines during the development of national guidelines for preventive health screening through the PHEX project. Using interviews, document review, and a survey of guideline developers, the study examined whether the framework was appropriate, acceptable, and feasible in this setting. Most participants reported that the framework improved transparency, structure, and collaboration in guideline development. However, implementation required significant technical expertise, training, and coordination. Limited familiarity with the framework and gaps in local evidence were identified as important challenges. These findings suggest that the GRADE Adolopment framework can be used successfully in LMICs, but sustained implementation requires investments in training, methodological support, and stronger interest holder engagement.

APA Citation

Cabaluna, I., Biños, K., Zamora, R., Castrillo, A., Cordero, C., Alejandria, M., Palileo-Villanueva, L., & Dans, L. (8-1-2026). Implementation of the GRADE adolopment framework was perceived as appropriate, acceptable, and feasible in a national guideline program in the Philippines: a mixed-methods study. Faculty Research and Scholarly Works.
DOI:10.1016/j.jclinepi.2026.112319