Evaluation of the development process and impact of the S3-guideline for the prevention and control of SARS-CoV-2 transmission in schools

Wabnitz, Katharina-Jaqueline Pascale (2025): Evaluation of the development process and impact of the S3-guideline for the prevention and control of SARS-CoV-2 transmission in schools. Dissertation, LMU München: Medizinische Fakultät

Abstract

Background In Germany, public health and social measures (PHSM) for infection prevention and control have been implemented in a range of settings during the COVID-19 pandemic, including in schools. While PHSM in schools such as cohorting, mask mandates and surveillance measures can contribute to reducing SARS-CoV-2 transmission, their im-plementation can also have unintended and negative consequences beyond intended health outcomes. Therefore, a multi-disciplinary and multi-stakeholder panel was brought together to develop an evidence- and consensus-based guideline for PHSM in schools, aiming to provide policymakers and practitioners with a scientific foundation for their decisions. This specifically included consideration of unintended consequences, facilitated by the use of the WHO-INTEGRATE Evidence-to-Decision framework. We sought to understand strengths and weaknesses of the guideline development process as well as the impact of this guideline as a tool for evidence-informed policymaking dur-ing a public health emergency. We aimed to not only contribute to the knowledge base around the evidence-to-policy interface but also to identify good practices for future pub-lic health emergencies. Methods We took a multi-pronged approach to evaluating the S3-guideline for the prevention and control of SARS-CoV-2 transmission in schools (ff. S3-guideline) in terms of strengths and weaknesses of its development process (sub-study I) and its impact on political and practical decision-making processes (sub-study II). We defined impact as knowledge about and use of the S3-guideline by political and practical decision-makers. We chose a qualitative, retrospective design for both sub-studies. In sub-study I, we carried out semi-structured interviews with guideline panel members who we recruited purposively, aiming to include all disciplinary perspectives and stakeholder groups represented in the panel plus the guideline secretariat. In sub-study II, we sent Freedom of Information Act (FoIA) inquiries to ministries of education, family, and health in all 16 Federal States. Additionally, we conducted semi-structured interviews with individuals involved in deci-sion-making regarding PSHM in schools in two Federal States and with members of the guideline panel. To analyse the interview data, we applied deductive-inductive thematic qualitative content analysis according to Kuckartz in both sub-studies. Results The guideline development process was characterised by heterogeneity in terms of the quality and scope of the available evidence as well as the types of expertise that partici-pants represented, notably scientific expertise and expertise grounded in lived experi-ences. The full potential of the WHO-INTEGRATE framework might not have been har-nessed and certain methods-related decisions taken in light of the considerable time pressure were reflected upon critically by participants. Overall, participants’ perceptions regarding the impact of the guideline were heterogeneous. Its evidence- and consensus-based development process was perceived to render the guideline a valuable source of information but limitations in its usability were noted such as lack of context-specificity. Analysis of responses to the FoIA inquiries showed that the guideline was known in nine out of 16 Federal State ministries of education and considered to check existing direc-tives for school measures in five Federal States; two of which instigated changes in their directives according to the guideline. Conclusions The guideline development process was subject to a range of challenges, yet its output was relatively well recognised by decision-makers in Federal States’ ministries for edu-cation and considered alongside other sources of evidence. To have an impact on deci-sion-making during public health emergencies while meeting ambitious objectives such as effective stakeholder engagement, further reflection on methods for rapid guidelines and their integration into political and practical decision-making is warranted. More re-search on the usability and usefulness of public health guidelines for decision-making in the German Federal State system is needed.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: guideline, COVID-19, public health and social measures, evaluation, impact, process
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 10. Januar 2025
• 1. Bericht­erstatter:in: Rehfuess, Eva