Senior GRADE methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis

BACKGROUND: The World Health Organization (WHO) classifies a substantial proportion of their recommendations as strong despite low or very low confidence (certainty) in estimates of effect. Such discordant recommendations are often inconsistent with Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. OBJECTIVE: To gain the perspective of senior WHO methodology chairs regarding panels' use of GRADE, particularly …