Methods for the development of NICE public health guidance (third edition)

2.2.1 Using the conceptual framework to construct a logic model

After holding the internal topic selection meeting and identifying a potential topic area, the CPHE, assisted by NICE information services, will prepare the briefing paper for the TAW.

The first step is to use the NICE public health conceptual framework (section 1.4) to construct a topic-specific conceptual framework (see below and appendix A). This framework may incorporate the assumed relationships between action and outcomes and, if possible, any relevant programme theory or theory of change (Pawson 2006; Weiss 1995).

The framework is used to:

Topics are mapped onto the vectors of causation outlined in the framework (population, environment, society and organisations) and cross-classified according to the potential level of intervention (population, community, organisation, family, domestic or individual).

The framework may also be used to construct a logic model. This model should incorporate the assumed relationships between action and outcomes described in the conceptual framework. Both the conceptual framework and the logic model are set out below (see figures 2.1–3).

Figure 2.1 Conceptual framework for public health guidance

Figure 2.2 A conceptual framework for promoting mental wellbeing at work

Figure 2.3 A logic model for promoting mental wellbeing at work

2.2.2 Preliminary information exercise

Before the NICE information services team starts the preliminary search for information, it consults the logic model to determine which literature (including which type of literature) will be most relevant to the topic.

It then carries out the preliminary information gathering exercise. In some cases, this will be related to a broad topic area; in others it will be more specific. It should bring together different sources of information to provide an overview of the topic (including key issues). This is not a comprehensive search of the evidence base at this stage but rather aims to provide a background for development of the subsequent scope.

Databases and websites may be searched to identify key epidemiological reviews, policy documents and existing reviews of effectiveness. It is particularly important to identify any related NICE guidance (existing or in development) and other related guidance published in the UK (and abroad, if relevant). Key sources of relevant health inequalities information are also important.

Useful generic resources might include:

The precise details of the search will be governed by the logic model and the topic. For a list of databases and websites that the search might include, see appendix B.

2.2.3 Preparing the briefing paper for the TAWs

The briefing paper aims to:

On completion, briefing papers are presented to the TAWs.

2.2.4 TAWs

TAWs are held on regular basis and attendees are drawn from a range of key stakeholder and practitioner groups including:

Representation is also sought from a range of public, private and third sector organisations including relevant patient, carer and service user groups. At the TAW, NICE will discuss with the DH which potential topic areas align with government policy.

Discussions are informed by the briefing papers and, where appropriate, by the conceptual framework discussed in section 2.2.1 (see appendix A for more detail).

The TAW also considers the extent of inequalities in health in relation to the topic area under consideration and whether or not the potential guidance would address these issues.

2.2.5 Preparing referrals

Draft referrals from the topic advisory group are refined by CPHE and an internal consistency check is carried out to ensure topics do not overlap and are properly integrated with other public health or clinical guidance. The draft referrals are discussed with policy leads at the DH, who then prepare a submission to ministers for formal consideration. Once ministers have considered the submission, 1 or more formal ministerial referrals may be made to NICE to develop public health guidance in the topic area. Final responsibility for public health guidance referrals remains with the Secretary of State for Health. If ministers make a referral CPHE then determine where the guidance development fits in the CPHE's forward programme. Once determined, work begins on developing the scope of the topic, which is a formal document that sets out what the guidance will and will not cover (see sections 2.3, 2.4, 2.5).

2.4.1 Developing key questions

The CPHE project team should refine the outline logic model constructed for the briefing paper (see figure 2.3) to draft a set of key questions that the guidance will aim to address. (These key questions, in turn, will be the starting point for developing research questions for the reviews.) The number of questions will depend on the topic and the breadth of the scope. However, it is important to ensure the total number:

Key questions should be clear, realistic and focused. They should cover all areas of the guidance remit and should not introduce new aspects. They should be concerned with effectiveness, cost effectiveness, the relationship between interventions and outcomes, feasibility and acceptability and inequalities (also see section 2.4.2). They may cover the determinants of health, including risk and protective factors (and the relationships between them). Most important, the key questions should clearly relate to the interventions being considered and the outcomes that will be used to assess their effectiveness and cost effectiveness. Therefore, in addition to the logic model, the CPHE project team should use the population, intervention, comparison and outcome (PICO) framework to specify interventions, where appropriate, as follows.

2.4.2 Considerations

The list of considerations should set out the factors that the PHAC are likely to consider when developing recommendations. They may become sub-questions for the reviews and may indicate where expert testimony will be required. They may include the various confounding factors that could influence the outcome, effectiveness and cost effectiveness of each type of activity, along with any other relevant information. The programme theory or theories of change approach and the logic model adopted may be helpful when compiling this list.

Typically, some of the following issues may be considered:

The considerations, key questions and other parameters (for example, populations, activities and outcomes) outlined in the scope should be used to develop specific research questions for the reviews (see chapter 3). The programme theory or theories of change approach that has been adopted may also help.

The extent of inequalities in health in relation to the topic under consideration should have been considered at the briefing paper stage, during the TAWs and should be considered again as the scope is being written. Any issues identified should be used to find interested groups to invite to become stakeholders (these issues may also need to be raised with them).