Abstract
Objective
To provide guidance for guideline developers on how to consider health equity at key
stages of the guideline development process.
Study Design and Setting
Literature review followed by group discussions and consensus building.
Results
The key stages at which guideline developers could consider equity include setting
priorities, guideline group membership, identifying the target audience(s), generating
the guideline questions, considering the importance of outcomes and interventions,
deciding what evidence to include and searching for evidence, summarizing the evidence
and considering additional information, wording of recommendations, and evaluation
and use. We provide examples of how guidelines have actually considered equity at
each of these stages.
Conclusion
Guideline projects should consider the aforementioned suggestions for recommendations
that are equity sensitive.
Keywords
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References
- Incorporating equity into developing and implementing for evidence-based clinical practice guidelines.Revista de Salud Pública. 2011; 13: 339-351
- Out of context: clinical practice guidelines and patients with multiple chronic conditions: a systematic review.Med Care. 2014; 52: S92-S100
- How equity is addressed in clinical practice guidelines: a content analysis.BMJ Open. 2014; 4: e005660
- Health equity: evidence synthesis and knowledge translation methods.Syst Rev. 2013; 2: 43
- GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables.J Clin Epidemiol. 2011; 64: 383-394
- Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity.Health Res Policy Syst. 2006; 4: 24
- Assessing equity in clinical practice guidelines.J Clin Epidemiol. 2007; 60: 540-546
- Positively equal. A guide to addressing equality issues in developing NICE clinical guidelines.2nd ed. 2012
- The concepts and principles of equity and health.Int J Health Serv. 1992; 22: 429-445
- WHO handbook for guideline development.2nd ed. 2014
- Using socioeconomic evidence in clinical practice guidelines.Br Med J. 2003; 327: 1283-1285
- Attention to sex-related factors in the development of clinical practice guidelines.J women's Health. 2007; 16: 82-92
- Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise.Can Med Assoc J. 2014; 186: E123-E142
- Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health.J Clin Epidemiol. 2014; 67: 56-64
- The James Lind Alliance Guidebook.5th ed. 2013
- Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities.Implement Sci. 2012; 7: 42
- Evidence-based methods to address disparities in global cancer control: the development of guidelines in Asia.Lancet Oncol. 2013; 14: 1154-1155
- Coupled ethical-epistemic analysis of public health research and practice: categorizing variables to improve population health and equity.Am J Public Health. 2015; 105: e36-e42
- A new typology of policies to tackle health inequalities and scenarios of impact based on Rose's population approach.J Epidemiol Community Health. 2013; 67: 286-291
- Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis.Public Health Research 1.4, Southampton (UK)2013
- Patient and public involvement in clinical practice guidelines: a knowledge synthesis of existing programs.Med Decis making. 2011; 31: E45-E74
- Prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people.2011
- Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection.2013
- The HIV-1 Epidemic: Low- to Middle-Income Countries.Cold Spring Harbor Pespectives in Medicine, 2012: 2
- Prevention and treatment of HIV and other sexually transmitted infections for sex workers in low- and middle-income countries.2012 (Recommendations for a public health approach)
- GRADE guidelines: 2. Framing the question and deciding on important outcomes.J Clin Epidemiol. 2010; 64: 395-400
- Guideline panels should not GRADE good practice statements.J Clin Epidemiol. 2015; 68: 597-600
NICE. UK Database of Uncertainties about the Effects of Treatments (UK DUETs): a resource to make uncertainties explicit and to help prioritise new research.
Initiative C. Core outcome measures in effectiveness trials.
- End-of-life treatment preferences: a key to reducing ethnic/racial disparities in advance care planning?.Cancer. 2014; 120: 3981-3986
- GRADE guidelines: 3. Rating the quality of evidence.J Clin Epidemiol. 2011; 64: 401-406
- Exclusion and inclusion of nonwhite ethnic minority groups in 72 North American and European cardiovascular cohort studies.PLoS Med. 2006; 3: e44
- HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis.BMJ Public Health. 2010; 10: 317
- How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 European populations.PLoS One. 2014; 9: e110952
- Systematic reviews of health effects of social interventions: 1. Finding the evidence: how far should you go?.J Epidemiol Community Health. 2005; 59: 804-808
- PRISMA-equity 2012 extension: reporting guidelines for systematic reviews with a focus on health equity.PLoS Med. 2012; 9: e1001333
- A population search filter for hard-to-reach populations increased search efficiency for a systematic review.J Clin Epidemiol. 2014; 67: 554-559
- Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health.BMJ. 2010; 341: c4739
- GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations.J Clin Epidemiol. 2013; 66: 719-725
Organization WH. The use of bedaquiline in the treatment of multidrug-resistant tuberculosis - Interim policy guidance.
- Patient engagement in research: a systematic review.BMC Health Serv Res. 2014; 14: 89
Article info
Publication history
Published online: May 09, 2017
Accepted:
January 19,
2017
Footnotes
Funding: S.V.K. is funded by an NRS Scottish Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_12017/13 and MC_UU_12017/15), and Chief Scientist's Office (SPHSU13 and SPHSU15).
Conflict of interest: All members are authors of the GRADE working group. Also EAA, GG, RBP, HJS were involved in the “Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise”.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
