Open Access

Die Klimakrise, das Artensterben sowie weitere anthropogene Umweltveränderungen wie Luft- und Wasserverschmutzung, sind auch Gesundheitskrisen. Wissenschaftliche Erkenntnisse darüber, wie problematisch und vielfältig die mit diesen Veränderungen einhergehenden Auswirkungen auf die menschliche Gesundheit sind, werden seit Jahren immer zahlreicher und eindeutiger [1, 2, 3].

Introduction During the COVID-19 pandemic, decision-making on measures to reduce or prevent transmission of SARS-CoV-2 in schools was rendered difficult by a rapidly evolving and uncertain evidence base regarding their effectiveness and unintended consequences. To support decision-makers, an interdisciplinary panel of scientific experts, public health and school authorities as well as those directly affected by school measures, was convened in an unprecedented effort to develop an evidence- and consensus-based public health guideline for German schools. This study sought to assess whether and how this guideline impacted decision-making processes. Methods This study comprised three components: (1) we sent inquiries according to the Freedom of Information Acts of each Federal State to ministries of education, family, and health. (2) We conducted semi-structured interviews with individuals involved in decision-making regarding school measures in two Federal States, and (3) we undertook semi-structured interviews with members of the guideline panel. The content of response letters in component 1 was analysed descriptively; data for components 2 and 3 were analysed using deductive-inductive thematic qualitative content analysis according to Kuckartz. Results Responses to the Freedom of Information Act inquiries showed that the guideline was recognised as a relevant source of information by ministries of education in nine out of 16 Federal States and used as a reference to check existing directives for school measures in five Federal States. All participants (20 interviews) emphasised the value of the guideline given its evidence- and consensus-based development process but also noted limitations in its usability and usefulness, e.g., lack of context-specificity. It was consulted by participants who advised policy-makers (5 interviews) alongside other sources of evidence. Overall, perceptions regarding the guideline’s impact were mixed. Conclusions Our findings suggest that the guideline was relatively well-known in Federal States’ decision-making bodies and that it was considered alongside other forms of evidence in some of these. We suggest that further research to evaluate the impact of public health guidelines on (political) decision-making is warranted. Guideline development processes may need to be adapted to account for the realities of decision-making during public health emergencies and beyond.

Die gesundheitlichen Folgen der Klima-, Biodiversitäts- und Verschmutzungskrisen sind bereits heute schwerwiegend und perspektivisch droht ein Multisystemversagen. Um die Folgen zu adressieren, ist ein tiefgreifender gesellschaftlicher Wandel unabdingbar. Um diesen anzustoßen, kommt professionell Pflegenden eine bedeutsame Rolle als Schlüsselpersonen des Wandels zu, denn ihnen wird besonderes Vertrauen entgegengebracht. Sie können sich sowohl in der individuellen Pflegenden-Patienten-Beziehung, als auch auf institutioneller und (berufs-)politischer Ebene für transformative Veränderungen einsetzen. Das Anbahnen hierfür benötigter transformativer Gestaltungskompetenzen in der pflegerischen Aus-, Fort- und Weiterbildung sollte daher zeitnah und flächendeckend sichergestellt werden.

Introduction: Different measures to prevent and control the spread of SARS-CoV-2 have been implemented in German schools. Decisions regarding such measures should be informed by evidence regarding their effectiveness, and their unintended consequences for health and society. A multi-stakeholder panel was convened to develop an evidence- and consensus-based guideline for school measures, using the novel WHO-INTEGRATE framework. Developing a guideline to inform decision-making outside of the clinical realm during a public health emergency was unprecedented in Germany. This study aims to identify lessons learnt for similar endeavours by addressing the following research question: What were the strengths and weaknesses of the guideline development process as perceived by the different groups involved? Methods: Fifteen semi-structured interviews were conducted virtually. We recruited participants aiming to include the perspectives of all groups contributing to the guideline development, including both panel members (scientists, practitioners, school family and observers) and the guideline secretariat. For analysis, we carried out deductive-inductive thematic qualitative text analysis according to Kuckartz, structuring findings using a category system. Results: Due to time pressure, the guideline secretariat was heavily involved not only in synthesising the evidence but also in developing and drafting recommendations. Participants critically reflected on certain methods-related decisions, including the development of draft recommendations and application of the WHO-INTEGRATE framework by scientists only. The full potential of the framework might not have been harnessed. Participants’ understanding of relevant and valid evidence varied, and the available evidence base was limited. Participants represented different types of expertise, notably expertise informed by scientific evidence and expertise grounded in lived experience, influencing their involvement in the guideline development process and discussions during meetings. Conclusion: Developing an evidence- and consensus-based public health guideline in only three months was challenging, notably because of the involvement of a broad range of stakeholders and the use of a novel Evidence-to-Decision framework, both unprecedented in Germany. Learning from this process with a view to “institutionalising” the development of public health guidelines and refining methods can contribute to more evidence-informed public health decision-making in Germany and beyond, in general and during a public health emergency.