Step 6. Grading recommendations
All questions were transformed into recommendations prior to anonymous voting. Post deliberation, the recommendation associated with the intervention was presented to the GDG members followed by a discussion focusing on the framing of the recommendation. For consistency, all recommendations were initially framed as “recommend” and based on voting results by the GDG members were changed to “recommend” or “suggest” and in favor or against the intervention. The GDG members initially voted for or against each recommendation, followed by a vote on the strength of the recommendation (strong or weak). A simple majority of >50% was used as the threshold to determine the direction and strength of the recommendations.