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Table 1 CERQual assessments of coherence for different kinds of review findings—examples

From: Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 4: how to assess coherence

Review findings Concerns about coherence
Descriptive review findings
 Women are comfortable with the process of managing medical abortion at home Moderate concerns: though generally the case, the data were actually more varied and this finding is an over-simplified description of the underlying patterns of comfort/discomfort.
 The experience of women having a medical abortion at home varied. Some felt overwhelmed, some felt comfortable and empowered, and some reported that it was just like any other minor medical procedure Minor concerns: the data were indeed varied, and these were three broad types of discomfort expressed by women. The studies usually addressed this issue in passing, though, and did not often explore in detail what women meant when they said they expressed comfort, empowerment or feeling overwhelmed.
Conceptual review findings
 Most women who were counselled by trained medical providers had a good experience with medical abortion. When women who had been counselled by trained professionals had a bad experience, it was because of ‘disrupted expectations’, when the experience did not match what they were told to expect. No or very minor concerns: the finding reflects the complexity and variation of the data, and the association of bad experiences with ‘disrupted expectations’ is well supported by details in the underlying studies. We explored other possible explanations for bad experiences despite the provision of counselling (e.g. poor or inconsistent counselling by trained medical providers) but found no data supporting these alternatives.
Interpretive/explanatory review findings
 When women have a sense of self-efficacy and control, have access to information and emergency health services, trust their providers and have appropriately trained providers, their experience of medical abortion at home is positive. The sense of self-efficacy and control and their trust in providers are the most important factors in their experience but these cannot be introduced at the time of the abortion services (i.e. they have to already be in place) Serious concerns: the interpretation in this finding is somewhat supported by data from several studies. However, there were some contradictory cases that did not fit the model in the finding (e.g. one study where women met the model’s criteria but nonetheless reported a poor experience of medical abortion at home). In other studies, it was hard to tell if the data really supported this model because of vaguely defined measures or inconsistent definitions across studies.