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Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 4: how to assess coherence

Colvin, Christopher J.; Garside, Ruth; Wainwright, Megan; Munthe-Kaas, Heather; Glenton, Claire; Bohren, Meghan A.; Carlsen, Benedicte; Tunçalp, Özge; Noyes, Jane; Booth, Andrew; Rashidian, Arash; Flottorp, Signe; Lewin, Simon

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Christopher J. Colvin

Ruth Garside

Heather Munthe-Kaas

Claire Glenton

Meghan A. Bohren

Benedicte Carlsen

Özge Tunçalp

Jane Noyes

Andrew Booth

Arash Rashidian

Signe Flottorp

Simon Lewin


Background: The GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE 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) relevance, (3) coherence and (4) adequacy of data. This paper is part of a series providing guidance on how to apply CERQual and focuses on CERQual’s coherence component. Methods: We developed the coherence component by searching the literature for definitions, gathering feedback from relevant research communities and developing consensus through project group meetings. We tested the CERQual coherence component within several qualitative evidence syntheses before agreeing on the current definition and principles for application. Results: When applying CERQual, we define coherence as how clear and cogent the fit is between the data from the primary studies and a review finding that synthesises that data. In this paper, we describe the coherence component and its rationale and offer guidance on how to assess coherence in the context of a review finding as part of the CERQual approach. This guidance outlines the information required to assess coherence, the steps that need to be taken to assess coherence and examples of coherence assessments. Conclusions: This paper provides guidance for review authors and others on undertaking an assessment of coherence in the context of the CERQual approach. We suggest that threats to coherence may arise when the data supporting a review finding are contradictory, ambiguous or incomplete or where competing theories exist that could be used to synthesise the data. We expect the CERQual approach, and its individual components, to develop further as our experiences with the practical implementation of the approach increase.


Colvin, C. J., Garside, R., Wainwright, M., Munthe-Kaas, H., Glenton, C., Bohren, M. A., …Lewin, S. (2018). Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 4: how to assess coherence. Implementation Science, 13(S1), Article 13.

Journal Article Type Article
Online Publication Date Jan 25, 2018
Publication Date Jan 25, 2018
Deposit Date May 8, 2018
Publicly Available Date May 9, 2018
Journal Implementation Science
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 13
Issue S1
Article Number 13


Published Journal Article (664 Kb)

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This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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