Background: GRADE is an approach to grading the quality (or certainty) of evidence and strength of recommendations (www.gradeworkinggroup.org). It was developed for assessing evidence on the effectiveness of clinical interventions. However, it is increasingly being used in areas beyond clinical practice (often in areas where randomised-controlled trials are lacking), where systematic reviewers, guideline developers and guideline committees may not be aware of, or familiar with GRADE.

Objectives: To present:
• An interactive GRADE ‘walked through’ example.
• Our experience of using this to explain GRADE to systematic reviewers and committees working in areas other than medicine and who are new to GRADE.

Methods: We have recently started to use GRADE assessment in a national guideline programme of public health and social care; this includes systematic reviewers and committee members who are not aware of, or are familiar with GRADE. We developed a slide set and ‘walked through’ example to explain the core principles of GRADE and how it would work for evidence of effectiveness in areas beyond clinical practice.

Results:Initial approaches to explaining GRADE focused on the technical aspects of assessment – limitations, inconsistency, indirectness, and imprecision. More recently, we have focused on the principle of using GRADE, along with a worked example – can pets improve our health? This is a fictitious example and developed to be easy to understand, whilst showing how GRADE works and particularly, how judgments influence the final assessment.
This approach aims to ensure people understand how GRADE works, and to explore how the evidence in their particular context might be assessed – rather than to understand the underlying mechanics of GRADE.

Conclusion: GRADE can be challenging to explain to new audiences, and especially in contexts where randomised-controlled trials are sparse. This approach uses a simple example to explore the use of GRADE in areas beyond that of clinical practice, and supports new users of GRADE – systematic reviewers, guideline developers, and committees – to understand and explore its use in their own specific context.