Strengths and limitations
Our findings are strengthened by the comprehensive search strategy. We
used the same tried and tested search strategy employed in several
previous reviews relevant to maternal and newborn
health.2,5,13-16 Building on past reviews we further
included COS specific to clinical practice. We believe this is the first
application of the COS-STAD criteria to evaluate the COS development
process relevant to maternal and neonatal health, making the findings
pertinent to the CROWN Initiative. For consistency, we applied identical
COS-STAD assessment criteria to that of Gargon et a., in their
assessment of cancer-related COS;9 the first report
using COS-STAD criteria. Despite our efforts, our findings do have some
limitations. Due to resource limitations, the search and screening
process was conducted primarily by one person (VS). Although ten percent
of papers were evaluated by a second person (DC), it is possible that
some COS papers may have been missed. Assessing each standard against
COS-STAD criteria was challenging. Some assumptions were made,
particularly in terms of stakeholder involvement. For example, we
assumed those who would use the COS in research were involved when
participants were conference delegates or expert working groups. It is
possible that this may have not been the case. In contrast to Duffy et
al.,6 we have not reported COS in development. A quick
search of the COMET database identified 44 COS in development related to
maternal and neonatal health. Future COS developers and users are
encouraged to review the COMET database of ongoing and completed
COS.