Research
Open Access

Health equity considerations in guideline development: a rapid scoping review

Nicole Shaver, Alexandria Bennett, Andrew Beck, Becky Skidmore, Gregory Traversy, Melissa Brouwers, Julian Little, David Moher, Ainsley Moore and Navindra Persaud
April 25, 2023 11 (2) E357-E371; DOI: https://doi.org/10.9778/cmajo.20220130

Abstract

Background: Systematic guidance for considering health equity in guidelines is lacking. This scoping review aims to synthesize current best practices for integrating health equity into guideline development and the benefits or drawbacks of these practices.

Methods: We searched Ovid MEDLINE ALL and Embase Classic+Embase on the Ovid platform, CINAHL on EBSCO, and Web of Science (Core Collection) from 2010 to 2022. We searched grey literature from 2015 to 2022, using the Canadian Agency for Drugs and Technologies in Health Grey Matters checklist and searches of potentially relevant websites. Articles were screened independently by 1 reviewer. Proposed best practices, advantages and disadvantages, and tools were extracted independently by 1 reviewer and qualitatively synthesized based on the relevant steps of a comprehensive checklist covering the stages of guideline development.

Results: We included 26 articles that proposed best practices for incorporating health equity within the guideline development process. These practices were organized under different stages of the development process, including guideline planning, evidence review, guideline development and dissemination. Included studies provided best practices from guideline producers, articles discussing health equity in current guidelines, articles addressing strategies to increase equity in the guideline implementation process, and literature reviews of promising health equity practices.

Interpretation: Our scoping review identified best practices to incorporate health equity considerations at each phase of guideline development. Identified practices may be used to inform equity-promoting strategies with the guideline development process; however, guideline producers should carefully consider the advantages and disadvantages of best practices when integrating health equity.

The attainment of the highest possible standard of health for all is a fundamental human right.1 Over the past 2 decades, many countries and global organizations have undertaken measures to reduce health inequities, 2–4 which are defined as avoidable differences in health that are considered unfair and unjust but modifiable.5,6 Factors that contribute to unfair and avoidable differences in health are diverse, complex and interdependent.7 Populations that are marginalized owing to social, economic or environmental factors may face a higher burden of disease or poorer health outcomes due to structural inequities that result in an unequal allocation of power and resources.7,8 These issues may be further compounded because of a differential ability (or opportunity) to access or use the full spectrum of health care.9 For these reasons, health equity has been increasingly recognized as a vital consideration in clinical practice, public health and policy-making.2,10–13 These issues have been thrown into prominence by the COVID-19 pandemic.14

Evidence-based clinical practice guidelines have the potential to reduce health inequities and improve care among disadvantaged populations.15–17 Guidelines can also unintentionally create or exacerbate existing health inequities between populations.15,17–20 For example, guidelines may recommend a treatment that is inaccessible to the socioeconomically disadvantaged. This could increase the health of those who are more socioeconomically advantaged more readily than those who are disadvantaged, thus widening health disparities.21 Indeed, guidelines that solely consider evidence of effectiveness of clinical options as a foundation for the recommendations without consideration of the evidence related to their implementation, acceptability, feasibility and capacity to mitigate disparities do not meet international standards of quality.22 Incorporating health equity into clinical practice guidelines remains a challenge because there is no widely accepted guidance or standard for reporting quality and the few available tools or checklists for evaluating guideline quality do not include health equity.16,23 The impact of the pandemic on health care systems is likely to create an urgent demand for guidelines to address the accumulated need for health care decisions, and a need for these decisions to consider health equity.24–26

In 2014, a content analysis was performed to outline methodological themes and processes on how to address health equity in guideline development.27 Since 2014, several guideline developers (e.g., the National Institute for Health and Care Excellence in the United Kingdom, the National Health and Medical Research Council in Australia28 and the World Health Organization29) have updated their guidance for considering health equity in guidelines. Notably, in 2017 the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group released a series of papers providing guidance on how to explicitly address health equity in the GRADE guideline development process.17 Whereas evidence has accumulated over recent years, no reviews, to our knowledge, have synthesized contemporary strategies to incorporate health equity into guideline development or compared differences across proposed strategies. Therefore, the objective of this scoping review is to identify current best practices to integrate health equity into guideline development and the benefits or drawbacks of these practices.

Methods

The protocol for this scoping review was made available on the Open Science Framework before the start of the project (https://osf.io/skvnx/). The complete report is also available on the Open Science Framework. Levac and colleagues’ update of the Arksey and O’Malley methodological framework for scoping reviews guided this review.30,31 We also followed the methodology manual published by the Joanna Briggs Institute for scoping reviews,32,33 where applicable. Given budgetary and timeline restraints, we selected a rapid review methodology whereby components of the scoping review are simplified or omitted (e.g., 1 reviewer) to produce results in a timely manner.34,35

Literature search

An experienced medical information specialist (B.S.) developed and tested the search strategies through an iterative process in consultation with the review team. Another senior information specialist peer reviewed the strategies before execution using the Peer Review of Electronic Search Strategies checklist (Appendix 1, available at www.cmajopen.ca/content/11/2/E357/suppl/DC1).36 Using the multifile option in Ovid, we searched Ovid MEDLINE ALL and Embase Classic+Embase. We also searched CINAHL (EBSCO) and the Web of Science (Core Collection). All searches were conducted on Nov. 23, 2020, and updated on July 30, 2022. Strategies used a combination of controlled vocabulary (e.g., “Guidelines as Topic”) and guideline-related keywords in proximity to terms representing either processes (e.g., develop, framework, process) or disadvantaged populations (e.g., disparity, inequity, underserved). Vocabulary and syntax were adjusted across databases. Where possible, animal-only and opinion pieces were removed from our searches using filters. There were no language restrictions applied to our search strategy, but search results were limited to publication dates from 2010 onwards for feasibility purposes (e.g., time and budget constraints). An initial scan of the published literature showed that sources of interest were published after 2010. Results were downloaded and deduplicated using EndNote version 9.3.3 (Clarivate Analytics). The full strategies can be found in Appendix 2, available at www.cmajopen.ca/content/11/2/E357/suppl/DC1.

We conducted a targeted search of the grey literature to identify relevant nonindexed and unpublished literature using the Canadian Agency for Drugs and Technologies in Health Grey Matters checklist37 and thorough searches of potentially relevant websites (Appendix 3, available at www.cmajopen.ca/content/11/2/E357/suppl/DC1). Grey literature searches were limited to English language documents published from 2015 to 2022. A more recent cut-off (2015) was selected for grey literature to limit the amount of grey literature to be screened and conduct a more comprehensive search of materials issued in recent years.

Study eligibility criteria

Table 1 outlines the study inclusion and exclusion criteria. Relevant studies were included if they described procedures or processes that address health equity in the guideline development process. Articles that described equity promotion practices in primary research studies (e.g., promoting health equity when conducting randomized clinical trials) or systematic reviews (only) were excluded. Only studies published in English or French were included. Eligible study designs included primary research designs, reviews or guidelines. Commentaries, editorials, responses, opinion pieces, protocol registrations and animal-only studies were excluded.

View this table:
Table 1:

Eligibility criteria

Study selection

The article selection process consisted of 2 phases of screening: title and abstract review and full-text review. After the removal of duplicates, the titles and abstracts of all references identified in our search were uploaded into Covidence software (Covidence) for screening.38 A pilot screening exercise occurred before each phase of screening to ensure interrater reliability and determine the adequacy of the screening criteria. For both phases, articles were screened by a single reviewer (N.S. or A. Bennett) using the eligibility criteria described above. An additional second reviewer (N.S., A. Bennett or A. Beck) verified included references and performed a secondary review of any references that the first reviewer was unsure met the inclusion criteria.

Charting the data

All included full-text articles were reviewed and charted by 1 reviewer using a pilot-tested data extraction form. Data extraction was completed using NVivo Software released in March 2020 (QSR International).39 The data extraction template is available in Appendix 4 (www.cmajopen.ca/content/11/2/E357/suppl/DC1). We captured data items related to study characteristics, including author and organization, study design, the article’s aim, and a description of the population and setting. When articles provided equity recommendations specifically for guidelines, we extracted best practices and mapped them to the stages of the guideline development process, as outlined by a comprehensive guideline development checklist.40 The benefits and drawbacks of these approaches, as described by the authors, were also extracted if available. We did not formally appraise the methodological quality of included articles, as our primary goal was to map any available evidence, either from the peer-reviewed or grey literature, rather than identify the highest-quality evidence to answer a specific key question related to policy or practice.32

Data analysis

Identified best practices are mapped against a comprehensive guideline development checklist that outlines 18 topics for guideline development.40 Tables are included to summarize included study characteristics, practices for incorporating equity in guideline development, advantages or disadvantages of these practices, and relevant frameworks and tools.

Ethics approval

We did not require ethics approval for this study.

Results

A total of 26 articles proposed best practices for incorporating health equity within guideline development. Study characteristics are presented in Table 2. Full texts were excluded because they did not address the guideline development process (n = 114) or describe practices for the promotion of health equity (n = 19); other reasons were ineligible study designs (n = 19), ineligible language of publication (n = 8), unavailable full texts (n = 10) or duplicate articles (n = 6). The screening process is summarized in our PRISMA flowchart (Figure 1), and the list of excluded studies at full-text screening can be found in Appendix 5 (available at www.cmajopen.ca/content/11/2/E357/suppl/DC1).

View this table:
Table 2:

Characteristics and summary of included articles, grouped by organization

Figure 1:
Figure 1:

PRISMA flow diagram and list of excluded full-text studies with reasons.

Five articles focused on a specific population or subgroup including indigenous populations,50 individuals with intellectual disabilities,20 minority ethnic groups,48 individuals with lived experience of homelessness,58 and gender groups.57 Key sources included the GRADE equity guideline series published in 2017, which provided guidance and examples on considering equity at key stages of the guideline development process.17,41–43 Shi and colleagues conducted a review (published in 2014) synthesizing methods for incorporating equity in clinical practice guidelines.27 Other articles included sources that provided best practices from guideline producers, 28,29,46,48,50,51 articles discussing health equity in current guidelines,2,20,52,53,56 articles addressing strategies to increase equity in the guideline implementation process,15,44,58 and literature reviews of health equity practices.47,57

Table 3 provides a detailed summary of best practices, their advantages and disadvantages, and any relevant tools for health equity promotion. We structured the results using the relevant topics of a comprehensive checklist covering the stages of guideline development40 and further organized topics under 4 phases: guideline planning, evidence review, guideline development and dissemination. Of the 18 topics outlined in the comprehensive checklist for guideline development, we identified 12 topics where proposed best practices for incorporating health equity can be considered. “Assessing equity within guidelines” was an additional topic under guideline development we identified through our synthesis.

View this table:
Table 3:

Summary of proposed best practices within each of the 4 stages of guideline development

In some cases, similar strategies and tools for health equity promotion were identified by several different included sources. For example, 4 unique articles noted that PROGRESS-Plus60 may help guideline developers systematically consider and prioritize populations for whom the health care topic is relevant. 27,28,41,56 Six sources suggested including representatives and stakeholders from disadvantaged groups who are involved throughout the entire guideline development process.20,28,41,44,50,51

We detected no incompatibility among the identified unique strategies for each guideline topic. However, for some guideline topics where multiple strategies were suggested, only 1 strategy was recommended to be selected for implementation. For example, the New Zealand Guideline Group’s framework50 presented 2 alternative approaches to promoting indigenous (Māori) representation in guideline group membership. One approach was to include representatives of disadvantaged population groups in the guideline group and the other was to create an independent subgroup of representatives within the larger guideline group. Either of these approaches were suggested to promote indigenous representation, and each had associated advantages and disadvantages (Table 3).

Interpretation

Our scoping review found substantive recommendations on best practices to incorporate health equity during the 4 phases of guideline development (Table 3). Of the 18 topics outlined by the comprehensive checklist for guideline development, we identified 12 topics where incorporating health equity can be considered. We identified an additional topic under guideline development for “assessing equity within guidelines.” We included 26 articles from peer-reviewed and grey literature sources, including reports from federal and provincial agencies, community health centres and international guideline producers.

Since the systematic review by Shi and colleagues published in 2014,27 several articles have been published, including the GRADE equity series, which provided comprehensive guidance and real-world examples regarding equity promotion. Our review captured new articles and additional sources related to health equity promotion, including health equity toolkits, interventions to increase equity in primary care delivery and organizational health equity plans. One article, published in 2020, highlighted the importance of increasing awareness of gender-specific medicine in tailored guidelines to properly address characteristics and needs of certain populations within each gender.57 Gender differences of diseases is a neglected dimension of medicine and not included in most guidelines.57,70 Additionally, improving the care for marginalized populations, including individuals experiencing homelessness, can be achieved through identifying determinants of guideline implementation.58 One study identified a number of specific knowledge translation strategies in the context of individuals experiencing homelessness, through a qualitative survey, that may affect the implementation of guidelines, including homeless-specific training for health professionals, feasibility of permanent supportive housing and discrimination faced by those with lived experience of homelessness.58 These practical examples illustrate considerations guideline developers can acknowledge when looking to promote health equity in guideline development.

Although equity-related guidance was captured for most stages of guideline development,40 some gaps in the knowledge base remain. No equity-related guidance was captured to identify or report on conflicts of interest, an important consideration for clinical guideline producers because of potential vulnerability from industry influence.71 We identified few strategies and tools relating to equity promotion in guideline reporting, peer review, monitoring guideline uptake and updating. Additionally, there was no discussion on the advantages or disadvantages of best practices for the final stages, dissemination and uptake of recommendations. Future research may need to explore whether special considerations related to equity are required for these steps in the guideline process.

Some of the identified strategies have become more commonplace in evidence reviews and the guideline process, in general. For example, some of the guidance we found related to “searching for relevant evidence” were applied in our own scoping review search strategy. This included not adding language filters to our search strategy, considering evidence from qualitative and observational studies, and screening evidence outside of traditional health sources in our grey literature search strategy. However, despite the evidence base on health equity in guideline development existing since 2011,72 the uptake of health-equity promoting practices is slow. A review of WHO guidelines published between 2014 and 2019 found that only 54% of guidelines used the Evidence to Decision framework to consider health equity and that only 28% of recommendations from these guidelines related to health equity were supported by research evidence.73

Guideline producers should consider the use of guideline checklists and tools to implement health-equity promoting practices throughout guideline development. The strategies synthesized in this scoping review may help in supporting guideline organizations to develop their own health equity framework or plan. However, the selection of equity-promoting strategies must be tailored to the goals of a particular guideline organization. For example, some equity practices targeted toward WHO clinical guidelines may be less relevant for clinical practice guidelines for primary care practitioners. Additionally, we limited our discussion of advantages and disadvantages to those that had been identified in the original articles. There may be additional benefits or limitations to practices when considering implementation. For example, one strategy when identifying a guideline’s target audience was to involve representatives of disadvantaged groups.41 Whereas no drawbacks were discussed in the article, implementing such a practice would likely have cost and resource implications for the guideline organization, from additional time needed to contact and secure appropriate representatives and to compensate representatives for their time. Finally, developers should remain conscious of important systemic health and social inequities in our health care system when implementing practices. Clinical and epidemiologic research has highlighted the dangers of “othering” certain patient groups. The provision of separate medical care or recommendations for population subgroups, such as in race-based medicine, may further exacerbate health disparities rather than mitigate them.74,75 Any equity framework or plan should be developed in partnership with experts in the field of health equity, as well as health system stakeholders and community organizations.

Limitations

Given the urgency of the need for a map of equity considerations in guideline development and resource restraints, a rapid scoping review methodology was selected as the best available approach to answer our research question; however, limitations to our methodology should be acknowledged. Although our search strategy was comprehensive, we may have failed to capture articles on equity-promoting strategies using a single reviewer, especially if these studies did not explicitly define these strategies (e.g., tools to facilitate patient engagement). To mitigate this concern and validate our search strategy, we consulted an external content expert in health equity to review our excluded studies list. Although this is a limitation and may have resulted in relevant practices being missed, it is unlikely to bias our results, as our goal was to provide a summary of best practices. Finally, a narrative synthesis was used to analyze and summarize our results. Efforts were made to be systematic in our use of qualitative data synthesis methods; however, we did not follow a formal thematic content analysis process, which may reduce our review’s reproducibility.

Conclusion

Overall, our scoping review found considerable evidence on proposed best practices to promote health equity. Identified practices may be used to inform equity-promoting strategies within the guideline development process and within the guideline organization itself. Whereas health equity is a complex issue and guideline organizations must carefully balance the pros and cons of best practices, our review provides an overview of available strategies and resources to aid guideline producers in creating a plan to integrate health equity in a timely way.

Footnotes

  • ↵* Dr. Ainsley Moore died June 25, 2021.

  • Competing interests: Navindra Persaud reports grants from the Canadian Institutes of Health Research, Canada Research Chairs Program and the Ontario SPOR Support Unit. He is a member of the Canadian Task Force on Preventive Health Care (travel expenses paid for by the Public Health Agency of Canada), advisor to the pan-Canadian Advisory Panel on a Framework for a Prescription Drug List (no payment or compensation) and an associate editor for CMAJ. No other competing interests were declared.

  • Contributors: Nicole Shaver and Alexandria Bennett contributed to conceptualization, project administration, methodology, writing the original draft and revisions. Andrew Beck contributed to the methodology, writing the original draft and revisions. Becky Skidmore reviewed and edited the manuscript and performed the search strategy. Melissa Brouwers, Julian Little and David Moher acquired funding, contributed to the methodology, and reviewed and edited the manuscript. Gregory Traversy, Ainsley Moore and Navindra Persaud conceived, reviewed and edited the manuscript. Nicole Shaver and Alexandria Bennett contributed equally to this work. All authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

  • Funding: Funding for this evidence review is provided by the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

  • Data sharing: All data presented are available in the published record, and the protocol and full report are available on the Open Science Framework (https://osf.io/skvnx/).

  • Supplemental information: For reviewer comments and the original submission of this manuscript, please see www.cmajopen.ca/content/11/2/E357/suppl/DC1.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    (2006) Constitution of the World Health Organization (World Health Organization, Geneva) Availablehttps://www.who.int/publications/m/item/constitution-of-the-world-health-organization. accessed 2021 Feb. 3.
  2. ↵
    1. Dewidar O,
    2. Tsang P,
    3. León-García M,
    4. et al.
    (2020) Over half of the WHO guidelines published from 2014 to 2019 explicitly considered health equity issues: a cross-sectional survey. J Clin Epidemiol 127:125–33.
    OpenUrl
    1. Graham H
    (2004) Social determinants and their unequal distribution: clarifying policy understandings. Milbank Q 82:101–24.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Working Group for Monitoring Action on the Social Determinants of Health
    (2018) Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity. Int J Equity Health 17:136.
    OpenUrl
  5. ↵
    1. Whitehead M
    (1992) The concepts and principles of equity and health. Int J Health Serv 22:429–45.
    OpenUrlCrossRefPubMed
  6. ↵
    (2014) WHO handbook for guideline development (World Health Organization, Geneva).
  7. ↵
    1. Baciu A
    (2017) in Communities in action: pathways to health equity, The root causes of health inequity, eds Negussie Y, Geller A, Weinstein JN (National Academies Press, Washington (DC)) Availablehttps://www.ncbi.nlm.nih.gov/books/NBK425845/. accessed 2020 Nov. 2.
  8. ↵
    1. Braveman P,
    2. Gottlieb L
    (2014) The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep 129(Suppl 2):19–31.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Riley WJ
    (2012) Health disparities: gaps in access, quality and affordability of medical care. Trans Am Clin Climatol Assoc 123:167–72.
    OpenUrlPubMed
  10. ↵
    1. Andermann A
    (2016) Taking action on the social determinants of health in clinical practice: a framework for health professionals. CMAJ 188:E474–E483.
    OpenUrlFREE Full Text
    1. Braveman PA,
    2. Kumanyika S,
    3. Fielding J,
    4. et al.
    (2011) Health disparities and health equity: the issue is justice. Am J Public Health 101(Suppl 1):S149–55.
    OpenUrlCrossRefPubMed
    1. Daghofer D,
    2. Edwards P
    (2009) Toward health equity: a comparative analysis and framework for action (Public Health Agency of Canada, Strategic Initiatives and Innovations Directorate, Ottawa).
  13. ↵
    Health Quality Ontario’s health equity plan (Health Quality Ontario, Toronto) Available: https://www.hqontario.ca/What-is-Health-Quality/Health-Equity-and-Quality/Our-Health-Equity-Plan. accessed 2020 Dec. 1.
  14. ↵
    1. Antequera A,
    2. Lawson DO,
    3. Noorduyn SG,
    4. et al.
    (2021) Improving social justice in COVID-19 health research: interim guidelines for reporting health equity in observational studies. Int J Environ Res Public Health 18:9357.
    OpenUrlPubMed
  15. ↵
    1. Eslava-Schmalbach J,
    2. Sandoval-Vargas G,
    3. Mosquera P
    (2011) Incorporating equity into developing and implementing for evidence-based clinical practice guidelines. Rev Salud Publica (Bogota) 13:339–51.
    OpenUrlPubMed
  16. ↵
    1. Oxman AD,
    2. Schünemann HJ,
    3. Fretheim A
    (2006) Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity. Health Res Policy Syst 4:24.
    OpenUrlCrossRefPubMed
  17. ↵
    1. Welch VA,
    2. Akl EA,
    3. Guyatt G,
    4. et al.
    (2017) GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale. J Clin Epidemiol 90:59–67.
    OpenUrlPubMed
    1. Dans AM,
    2. Dans L,
    3. Oxman AD,
    4. et al.
    (2007) Assessing equity in clinical practice guidelines. J Clin Epidemiol 60:540–6.
    OpenUrlCrossRefPubMed
    1. Lorenc T,
    2. Petticrew M,
    3. Welch V,
    4. et al.
    (2013) What types of interventions generate inequalities? Evidence from systematic reviews: Table 1. J Epidemiol Community Health 67:190–3.
    OpenUrlAbstract/FREE Full Text
  20. ↵
    1. Mizen LA,
    2. Macfie ML,
    3. Findlay L,
    4. et al.
    (2012) Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities. Implement Sci 7:42.
    OpenUrlCrossRefPubMed
  21. ↵
    1. Aldrich R,
    2. Kemp L,
    3. Stewart Williams J,
    4. et al.
    (2003) Using socioeconomic evidence in clinical practice guidelines. BMJ 327:1283–5.
    OpenUrlFREE Full Text
  22. ↵
    1. Florez ID,
    2. Brouwers MC,
    3. Kerkvliet K,
    4. et al.
    (2020) Assessment of the quality of recommendations from 161 clinical practice guidelines using the Appraisal of Guidelines for Research and Evaluation–Recommendations Excellence (AGREE-REX) instrument shows there is room for improvement. Implement Sci 15:79.
    OpenUrl
  23. ↵
    1. Eikermann M,
    2. Holzmann N,
    3. Siering U,
    4. et al.
    (2014) Tools for assessing the content of guidelines are needed to enable their effective use — a systematic comparison. BMC Res Notes 7:853.
    OpenUrlCrossRefPubMed
  24. ↵
    (2021) Overview: COVID-19’s impact on health care systems (Canadian Institute for Health Information, Ottawa) Available: https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-systems/the-big-picture. accessed 2022 Sept. 9.
    1. Moynihan R,
    2. Sanders S,
    3. Michaleff ZA,
    4. et al.
    (2021) Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open 11:e045343.
    OpenUrlAbstract/FREE Full Text
  26. ↵
    The impact of COVID-19 on health and health systems (Organisation for Economic Co-operation and Development, Paris) Available: https://www.oecd.org/health/covid-19.htm. accessed 2022 Sept. 9.
  27. ↵
    1. Shi C,
    2. Tian J,
    3. Wang Q,
    4. et al.
    (2014) How equity is addressed in clinical practice guidelines: a content analysis. BMJ Open 4:e005660.
    OpenUrlAbstract/FREE Full Text
  28. ↵
    (2018) Guidelines for guidelines: equity (National Health and Medical Research Council (NHMRC), Canberra (AU)) Availablehttps://www.nhmrc.gov.au/guidelinesforguidelines/plan/equity. accessed 2021 Feb. 3.
  29. ↵
    1. Rehfuess EA,
    2. Stratil JM,
    3. Scheel IB,
    4. et al.
    (2019) The WHO-INTEGRATE evidence to decision framework version 1.0: integrating WHO norms and values and a complexity perspective. BMJ Glob Health 4(Suppl 1):e000844.
    OpenUrlAbstract/FREE Full Text
  30. ↵
    1. Levac D,
    2. Colquhoun H,
    3. O’Brien KK
    (2010) Scoping studies: advancing the methodology. Implement Sci 5:69.
    OpenUrlCrossRefPubMed
  31. ↵
    1. Arksey H,
    2. O’Malley L
    (2005) Scoping studies: towards a methodological framework. Int J Soc Res Methodol 8:19–32.
    OpenUrlCrossRef
  32. ↵
    1. Peters M,
    2. Godfrey C,
    3. McInerney P,
    4. et al.
    (2015) The Joanna Briggs Institute reviewers’ manual 2015 methodology for JBI scoping reviews (The Joanna Briggs Institute, The University of Adelaide South Australia, Adelaide (AU)).
  33. ↵
    1. Peters MD,
    2. Marnie C,
    3. Tricco AC,
    4. et al.
    (2020) Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth 18:2119–26.
    OpenUrlCrossRefPubMed
  34. ↵
    1. Khangura S,
    2. Konnyu K,
    3. Cushman R,
    4. et al.
    (2012) Evidence summaries: the evolution of a rapid review approach. Syst Rev 1:10.
    OpenUrlCrossRefPubMed
  35. ↵
    1. Tricco AC,
    2. Langlois E,
    3. Straus SE,
    4. et al.
    (2017) Rapid reviews to strengthen health policy and systems: a practical guide (World Health Organization, Geneva).
  36. ↵
    1. McGowan J,
    2. Sampson M,
    3. Salzwedel DM,
    4. et al.
    (2016) PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol 75:40–6.
    OpenUrlCrossRefPubMed
  37. ↵
    (2015) Grey Matters: a practical tool for searching health-related grey literature (Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa) Available: https://www.cadth.ca/sites/default/files/is/Grey%20Matters_EN-2019.doc. accessed 2022 Oct. 3.
  38. ↵
    Covidence systematic review software (Veritas Health Innovation, Melbourne (AU)) Available: www.covidence.org.
  39. ↵
    (2020) NVivo (QSR International, Burlington (MA)) Available: https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home.
  40. ↵
    1. Schunemann HJ,
    2. Wiercioch W,
    3. Etxeandia I,
    4. et al.
    (2014) Guidelines 2.0: systematic development of a comprehensive checklist for a successful guideline enterprise. CMAJ 186:E123–42.
    OpenUrlAbstract/FREE Full Text
  41. ↵
    1. Akl EA,
    2. Welch V,
    3. Pottie K,
    4. et al.
    (2017) GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist. J Clin Epidemiol 90:68–75.
    OpenUrlPubMed
    1. Welch VA,
    2. Akl EA,
    3. Pottie K,
    4. et al.
    (2017) GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. J Clin Epidemiol 90:76–83.
    OpenUrlPubMed
  43. ↵
    1. Pottie K,
    2. Welch V,
    3. Morton R,
    4. et al.
    (2017) GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process. J Clin Epidemiol 90:84–91.
    OpenUrlPubMed
  44. ↵
    1. Eslava-Schmalbach J,
    2. Mosquera P,
    3. Alzate JP,
    4. et al.
    (2017) Considering health equity when moving from evidence-based guideline recommendations to implementation: a case study from an uppermiddle income country on the GRADE approach. Health Policy Plan 32:1492.
    OpenUrl
    1. Pottie K,
    2. Magwood O,
    3. Rahman P,
    4. et al.
    (2021) GRADE concept paper 1: validating the “F.A.C.E” instrument using stakeholder perceptions of feasibility, acceptability, cost, and equity in guideline implement. J Clin Epidemiol 131:133–40.
    OpenUrl
  46. ↵
    (2014) Handbook for guideline development: chapter 5 incorporating equity, gender, human rights and social determinants into guidelines (World Health Organization, Geneva) Availablehttps://apps.who.int/iris/handle/10665/145714. accessed 2022 Mar. 18.
  47. ↵
    1. Liburd LC,
    2. Hall JE,
    3. Mpofu JJ,
    4. et al.
    (2020) Addressing health equity in public health practice: frameworks, promising strategies, and measurement considerations. Annu Rev Public Health 41:417–32.
    OpenUrl
  48. ↵
    (2018) Promoting health and preventing premature mortality in black, Asian and other minority ethnic groups (National Institute for Health and Care Excellence (NICE), London (UK)) Available: www.nice.org.uk/guidance/qs167. accessed 2020 Dec. 16.
  49. (2021) NICE ’S equality objectives and equality programme 2020–2024 (National Institute for Health and Care Excellence (NICE), London (UK)) Availablehttps://www.nice.org.uk/Media/Default/About/Who-we-are/Policies-and-procedures/Equality%20objectives%20and%20equality%20programme%202020%20-%202024.docx. accessed 2020 Dec. 16.
  50. ↵
    1. Berentson-Shaw J
    (2012) Reducing inequality in health through evidence-based clinical guidance: Is it feasible? The New Zealand experience. Int J Evid-Based Healthc 10:146–53.
    OpenUrl
  51. ↵
    (2019) Scottish Intercollegiate Guidelines Network (SIGN). Sign 50: a guideline developer’s handbook (NHS Scotland, Edinburgh) Available: http://www.sign.ac.uk. accessed 2021 Feb. 18.
  52. ↵
    1. Prescott C,
    2. Shahram SZ,
    3. Ogilvie G,
    4. et al.
    (2020) Applying a health equity tool to assess a public health nursing guideline for practice in sexually transmitted infection assessment in British Columbia. Can J Public Health 111:610–6.
    OpenUrl
  53. ↵
    1. Razon N,
    2. Hessler-Jones D,
    3. Bibbins-Domingo K,
    4. et al.
    (2020) Research Gate, Clinical hypertension guidelines and social determinants of health: a systematic scoping review. Available: https://www.researchsquare.com/article/rs-59491/v1, doi:10.21203/rs.3.rs-59491/v1, accessed 2020 Dec. 1.
    OpenUrlCrossRef
    1. Barnabe C,
    2. Pianarosa E,
    3. Hazlewood G
    (2021) Informing the GRADE evidence to decision process with health equity considerations: demonstration from the Canadian rheumatoid arthritis care context. J Clin Epidemiol 138:147–55.
    OpenUrl
    1. Engl M,
    2. Binns P,
    3. Trehan I,
    4. et al.
    (2022) Children living with disabilities are neglected in severe malnutrition protocols: a guideline review. Arch Dis Child 107:637–43.
    OpenUrlAbstract/FREE Full Text
  56. ↵
    1. Eslava-Schmalbach JH,
    2. Welch VA,
    3. Tugwell P,
    4. et al.
    (2016) Incorporating equity issues into the development of Colombian clinical practice guidelines: suggestions for the GRADE approach. Rev Salud Publica (Bogota) 18:72–81.
    OpenUrl
  57. ↵
    1. Machluf Y,
    2. Chaiter Y,
    3. Tal O
    (2020) Gender medicine: lessons from COVID-19 and other medical conditions for designing health policy. World J Clin Cases 8:3645–68.
    OpenUrl
  58. ↵
    1. Magwood O,
    2. Hanemaayer A,
    3. Saad A,
    4. et al.
    (2020) Determinants of implementation of a clinical practice guideline for homeless health. Int J Environ Res Public Health 17:7938.
    OpenUrl
    1. Rai D,
    2. Kumar A,
    3. Waheed SH,
    4. et al.
    (2022) Gender differences in international cardiology guideline authorship: a comparison of the US, Canadian, and European cardiology guidelines from 2006 to 2020. J Am Heart Assoc 11:e024249.
    OpenUrl
  60. ↵
    1. O’Neill J,
    2. Tabish H,
    3. Welch V,
    4. et al.
    (2014) Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol 67:56–64.
    OpenUrlCrossRefPubMed
    1. Kunst AE,
    2. Mackenbach JP
    (1994) Measuring socio-economic Inequalities in Health (World Health Organization, Copenhagen).
  62. Guidelines for guidelines handbook (National Health and Medical Research Council, Canberra (AU)) Availablehttps://www.nhmrc.gov.au/guidelinesforguidelines. accessed 2021 Feb. 3.
  63. (2021) Indigenous collection (Informit, Melbourne (AU)) Available: https://search.informit.org/topic/rmit-products/IELIND. accessed 2021 Feb. 3.
  64. Promote and practice — publications (Australian Indigenous HealthInfoNet, Mt. Lawley (AU)) Available: https://healthinfonet.ecu.edu.au/key-resources/publications/. accessed 2021 Feb. 3.
    1. Tugwell P,
    2. Petticrew M,
    3. Kristjansson E,
    4. et al.
    (2010) Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health. BMJ 341:c4739.
    OpenUrlFREE Full Text
    1. Sun X,
    2. Briel M,
    3. Walter SD,
    4. et al.
    (2010) Is a subgroup effect believable? Updating criteria to evaluate the credibility of subgroup analyses. BMJ 340:c117.
    OpenUrlFREE Full Text
    1. Welch V,
    2. Petticrew M,
    3. Petkovic J,
    4. et al.
    (2016) Extending the PRISMA statement to equity-focused systematic reviews (PRISMA-E 2012): explanation and elaboration. J Clin Epidemiol 70:68–89.
    OpenUrlCrossRefPubMed
    1. Guyatt GH,
    2. Oxman AD,
    3. Kunz R,
    4. et al.
    (2011) GRADE guidelines: 8. rating the quality of evidence — indirectness. J Clin Epidemiol 64:1303–10.
    OpenUrlCrossRefPubMed
    1. Ismail SJ,
    2. Hardy K,
    3. Tunis MC,
    4. et al.
    (2020) A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations. Vaccine 38:5861–76.
    OpenUrlPubMed
  70. ↵
    1. Baggio G,
    2. Corsini A,
    3. Floreani A,
    4. et al.
    (2013) Gender medicine: a task for the third millennium. Clin Chem Lab Med 51:713–27.
    OpenUrlCrossRefPubMed
  71. ↵
    1. Elder K,
    2. Turner KA,
    3. Cosgrove L,
    4. et al.
    (2020) Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study, 192:E617–25.
  72. ↵
    1. Acosta N,
    2. Pollard J,
    3. Mosquera P,
    4. et al.
    (2011) The concept of equity when developing clinical practice guidelines. Rev Salud Publica (Bogota) 13:327–38.
    OpenUrlPubMed
  73. ↵
    1. Dewidar O,
    2. Tsang P,
    3. Leon-Garcia M,
    4. et al.
    (2020) Over half of the WHO guidelines published from 2014 to 2019 explicitly considered health equity issues: a cross-sectional survey. J Clin Epidemiol 127:125–33.
    OpenUrl
  74. ↵
    1. Cerdeña JP,
    2. Plaisime MV,
    3. Tsai J
    (2020) From race-based to race-conscious medicine: how anti-racist uprisings call us to act. Lancet 396:1125–8.
    OpenUrlCrossRefPubMed
  75. ↵
    1. Vyas DA,
    2. Eisenstein LG,
    3. Jones DS
    (2020) Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. N Engl J Med 383:874–82.
    OpenUrlCrossRefPubMed
Back to top

In this issue

CMAJ Open: 11 (2)
Vol. 11, Issue 2
1 Mar 2023

Article tools

Respond to this article
Print
Download PDF
Article Alerts
Email Article
Citation Tools
Health equity considerations in guideline development: a rapid scoping review
Nicole Shaver, Alexandria Bennett, Andrew Beck, Becky Skidmore, Gregory Traversy, Melissa Brouwers, Julian Little, David Moher, Ainsley Moore, Navindra Persaud
Mar 2023, 11 (2) E357-E371; DOI: 10.9778/cmajo.20220130
Twitter logo Facebook logo Mendeley logo

Collections