Open Access Research article

Evidence-based decision-making in infectious diseases epidemiology, prevention and control: matching research questions to study designs and quality appraisal tools

Thomas Harder113*, Anja Takla1, Eva Rehfuess2, Alex Sánchez-Vivar3, Dorothea Matysiak-Klose1, Tim Eckmanns1, Gérard Krause14, Helena de Carvalho Gomes5, Andreas Jansen5, Simon Ellis6, Frode Forland78, Roberta James9, Joerg J Meerpohl10, Antony Morgan6, Holger Schünemann11, Teun Zuiderent-Jerak12 and Ole Wichmann1

Author Affiliations

1 Robert Koch Institute, Berlin, Germany

2 Institute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany

3 Health Protection Scotland (HPS) and the Scottish Health Protection Network (HPN), Glasgow, UK

4 Helmholtz Centre for Infection Research, Braunschweig, Germany

5 European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

6 National Institute for Health and Care Excellence (NICE), London, UK

7 Royal Tropical Institute, Amsterdam, The Netherlands

8 Norwegian Institute of Public Health, Oslo, Norway

9 Scottish Intercollegiate Guidelines Network (SIGN), Edinburgh, UK

10 German Cochrane Center, University Medical Center Freiburg, Freiburg, Germany

11 Departments of Clinical Epidemiology, Biostatistics & Medicine, McMaster University Health Sciences Centre, Hamilton, ON, Canada

12 Department of Technology and Social Change, Linköping University, Linköping, Sweden

13 Immunization Unit, Department for Infectious Disease Epidemiology, Robert Koch Institute, Seestrasse 10, Berlin 13353, Germany

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BMC Medical Research Methodology 2014, 14:69  doi:10.1186/1471-2288-14-69

Published: 21 May 2014



The Project on a Framework for Rating Evidence in Public Health (PRECEPT) was initiated and is being funded by the European Centre for Disease Prevention and Control (ECDC) to define a methodology for evaluating and grading evidence and strength of recommendations in the field of public health, with emphasis on infectious disease epidemiology, prevention and control. One of the first steps was to review existing quality appraisal tools (QATs) for individual research studies of various designs relevant to this area, using a question-based approach.


Through team discussions and expert consultations, we identified 20 relevant types of public health questions, which were grouped into six domains, i.e. characteristics of the pathogen, burden of disease, diagnosis, risk factors, intervention, and implementation of intervention. Previously published systematic reviews were used and supplemented by expert consultation to identify suitable QATs. Finally, a matrix was constructed for matching questions to study designs suitable to address them and respective QATs. Key features of each of the included QATs were then analyzed, in particular in respect to its intended use, types of questions and answers, presence/absence of a quality score, and if a validation was performed.


In total we identified 21 QATs and 26 study designs, and matched them. Four QATs were suitable for experimental quantitative study designs, eleven for observational quantitative studies, two for qualitative studies, three for economic studies, one for diagnostic test accuracy studies, and one for animal studies. Included QATs consisted of six to 28 items. Six of the QATs had a summary quality score. Fourteen QATs had undergone at least one validation procedure.


The results of this methodological study can be used as an inventory of potentially relevant questions, appropriate study designs and QATs for researchers and authorities engaged with evidence-based decision-making in infectious disease epidemiology, prevention and control.

Evidence-based public health; Quality appraisal tools; Risk of bias; Study designs; Infectious disease prevention and control