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Limbu YB, Huhmann BA. What influences consumers' online medication purchase intentions and behavior? A scoping review. Front Pharmacol 2024; 15:1356059. [PMID: 38414739 PMCID: PMC10896895 DOI: 10.3389/fphar.2024.1356059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
Objective: Consumers increasingly buy pharmaceuticals online. No scoping review has been carried out to summarize and synthesize the studies that have identified drivers of consumers' purchase intention and behavior from online pharmacies. Thus, we conducted a scoping review to explore the extent to which prior research has studied consumer purchase intentions and behavior related to online pharmacies, the drivers previously identified to explain consumers' online pharmacy purchase intentions and behavior, and how these antecedents differ between OTC and prescription medications. Then, we identified gaps in the published literature to form a comprehensive theory-based agenda for future research. Methods: We searched PubMed, Web of Science, and Scopus to retrieve relevant studies published in English in peer-reviewed journals. The search strategy identified forty-eight eligible studies. Results: We identified twelve types of factors influencing purchase intentions and behaviors from online pharmacies: demographics, convenience, availability, price, evaluations of the purchase environment, information sources, internet usage, prior experience, perceived risk, health insurance, privacy, and product. Our analysis also revealed differences between OTC and prescription medications in drivers of purchase intentions and behaviors. Conclusion: While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. However, other factors (e.g., convenience, availability, lower prices, and favorable evaluations toward the purchase environment) more consistently enhanced online medication purchase intentions and behavior. An extensive agenda for future research is advanced.
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Affiliation(s)
- Yam B Limbu
- Department of Marketing, Montclair State University, Montclair, NJ, United States
| | - Bruce A Huhmann
- Department of Marketing, Virginia Commonwealth University, Richmond, VA, United States
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Dewidar O, Bondok M, Abdelrazeq L, Aliyeva K, Solo K, Welch V, Brignardello-Petersen R, Mathew JL, Hazlewood G, Pottie K, Hartling L, Khalifa DS, Duda S, Falavigna M, Khabsa J, Lotfi T, Petkovic J, Elliot S, Chi Y, Parker R, Kristjansson E, Riddle A, Darzi AJ, Magwood O, Saad A, Rada G, Neumann I, Loeb M, Reveiz L, Mertz D, Piggott T, Turgeon AF, Schünemann H, Tugwell P. Equity issues rarely addressed in the development of COVID-19 formal recommendations and good practice statements: a cross-sectional study. J Clin Epidemiol 2023; 161:116-126. [PMID: 37562727 DOI: 10.1016/j.jclinepi.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/21/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND AND OBJECTIVE To identify COVID-19 actionable statements (e.g., recommendations) focused on specific disadvantaged populations in the living map of COVID-19 recommendations (eCOVIDRecMap) and describe how health equity was assessed in the development of the formal recommendations. METHODS We employed the place of residence, race or ethnicity or culture, occupation, gender or sex, religion, education, socio-economic status, and social capital-Plus framework to identify statements focused on specific disadvantaged populations. We assessed health equity considerations in the evidence to decision frameworks (EtD) of formal recommendations for certainty of evidence and impact on health equity criteria according to the Grading of Recommendations, Assessment, Development, and Evaluations criteria. RESULTS We identified 16% (124/758) formal recommendations and 24% (186/819) good practice statements (GPS) that were focused on specific disadvantaged populations. Formal recommendations (40%, 50/124) and GPS (25%, 47/186) most frequently focused on children. Seventy-six percent (94/124) of the recommendations were accompanied with EtDs. Over half (55%, 52/94) of those considered indirectness of the evidence for disadvantaged populations. Considerations in impact on health equity criterion most frequently involved implementation of the recommendation for disadvantaged populations (17%, 16/94). CONCLUSION Equity issues were rarely explicitly considered in the development COVID-19 formal recommendations focused on specific disadvantaged populations. Guidance is needed to support the consideration of health equity in guideline development during health emergencies.
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Affiliation(s)
- Omar Dewidar
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Mostafa Bondok
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leenah Abdelrazeq
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Health Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Khadija Aliyeva
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Karla Solo
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Romina Brignardello-Petersen
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Joseph L Mathew
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Glen Hazlewood
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Kevin Pottie
- Department of Family Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence and Cochrane Child Health, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Dina Sami Khalifa
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Duda
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maicon Falavigna
- National Institute for Health Technology Assessment, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tamara Lotfi
- Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Elliot
- Alberta Research Centre for Health Evidence, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Cochrane Child Health, Department of Pediatrics, University of Alberta, Alberta, Canada
| | - Yuan Chi
- Beijing Yealth Technology Co., Ltd, Beijing, China; Cochrane Campbell Global Ageing Partnership, London, UK
| | | | - Elizabeth Kristjansson
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Riddle
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence, and Impact and Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, Ontario, Canada; Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | - Ammar Saad
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Chile; UC Evidence Centre, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Neumann
- School of Medicine, Universidad San Sebastián, Santiago, Chile
| | - Mark Loeb
- Departments of Pathology and Molecular Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ludovic Reveiz
- Department of Evidence and Intelligence for Action in Health and Incident Management System for COVID-19, WHO Regional Office for the Americas/Pan American Health Organization, Washington, DC, USA
| | - Dominik Mertz
- Department of Medicine and Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Family Medicine, Queens University, Kingston, Ontario, Canada; Peterborough Public Health, Peterborough, Ontario, Canada
| | - Alexis F Turgeon
- CHU de Québec - Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, Quebec, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Quebec, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G DeGroote Cochrane Canada and McMaster GRADE Centres, McMaster University, Hamilton, Ontario, Canada; WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences Humanitas University, Humanitas University, Milan, Italy; Cochrane Canada, Hamilton, Ontario, Canada
| | - Peter Tugwell
- Department of Medicine, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Basirat R, Soleimani S, Shakiba B, Maghsoudi R. Assessment of health equity consideration in Cochrane systematic reviews and primary studies on urolithiasis. Health Sci Rep 2023; 6:e1133. [PMID: 36846534 PMCID: PMC9953072 DOI: 10.1002/hsr2.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
Background and Aims Health injustice is defined as "unnecessary, preventable, unjustified and unfair health differences." One of the most important scientific sources on the prevention and management of urolithiasis are Cochrane reviews in this field. Given that the first step in eliminating health injustice is to identify the causes, the aim of the present study was to evaluate equity considerations in Cochrane reviews and the included primary studies on urinary stones. Methods Cochrane reviews on kidney stones and ureteral stones were searched through the Cochrane Library. The included clinical trials in each of the reviews published after 2000 were also collected. Two different researchers reviewed all the included Cochrane reviews and primary studies. The researchers reviewed each PROGRESS criteria independently (P: place of residence, R: race/ethnicity/culture, O: occupation, G: gender, R: religion, E: education, S: socioeconomic status, S: social capital and networks). The geographical location of the included studies was categorized as low-income, middle-income and high-income countries, based on the World Bank income criteria. Each PROGRESS dimension was reported for both the Cochrane reviews and the primary studies. Results In total, 12 Cochrane reviews and 140 primary studies were included in this study. None of the included Cochrane reviews had specifically mentioned the PROGRESS framework in the Method section whereas gender distribution and place of residence were reported in two and one reviews, respectively. In 134 primary studies at least one item of PROGRESS was reported. The most frequent item was gender distribution, followed by place of residence. Conclusion According to the results of this study, the authors of Cochrane systematic reviews on urolithiasis, and researchers who have conducted such trials, have rarely considered health equity dimensions when designing and performing their studies. Therefore, researchers worldwide should be motivated to study populations from low-income countries with low socioeconomic status in addition to different cultures, ethnicities, and so forth. Furthermore, RCT reporting guidelines such as CONSORT should include health equity dimensions and the editors and reviewers of scientific journals should encourage researchers to further emphasize on health equity in their studies.
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Affiliation(s)
- Reyhane Basirat
- School of MedicineIran University of Medical SciencesTehranIran
| | - Sevim Soleimani
- Student Research Committee, Faculty of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Behnam Shakiba
- Department of Urology, Firoozgar Hospital, School of MedicineIran University of Medical SciencesTehranIran
- Firoozgar Clinical Research Development CenterIran University of Medical SciencesTehranIran
| | - Robab Maghsoudi
- Department of Urology, Firoozgar Hospital, School of MedicineIran University of Medical SciencesTehranIran
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Russell O, Lester S, Black RJ, Hill CL. Socioeconomic Status and Medication Use in Rheumatoid Arthritis: A Scoping Review. Arthritis Care Res (Hoboken) 2023; 75:92-100. [PMID: 36106932 PMCID: PMC10100498 DOI: 10.1002/acr.25024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Socioeconomic status (SES) influences disease outcomes in rheumatoid arthritis (RA) patients. Differences in medication use may partly explain this association. A scoping review was used to identify research conducted on this topic and determine what knowledge gaps remain. METHODS Medline, Embase, and PsychInfo were searched from their inception until February 2022 for studies that assessed SES and medication use as an outcome variable. Data was extracted on the use of specific SES measures, medication use, and whether differences in SES variables were associated with differences in medication use. RESULTS We identified 2,103 studies, of which 81 were selected for inclusion. Included studies originated most frequently from the US (42%); the mean ± SD age of participants was 55.9 ± 6.8 years, and most were female (75%). Studies measured a median of 4 SES variables (interquartile range 3-6), with educational, area-level SES, and income being the most frequent measurements used. Patients' race and/or ethnicity were documented by 34 studies. Studies primarily assessed the likelihood of prescription of disease-modifying antirheumatic drugs or dispensation, medication adherence, or treatment delays. A majority of studies documented at least 1 SES measure associated with a difference in medication use. CONCLUSION There is some evidence that SES affects use of medications in patients with RA; however, multiple definitions of SES have been utilized, making comparisons between studies difficult. Prospective studies with consistently defined SES will be needed to determine whether differences in medication use accounts for the poorer outcomes experienced by patients of lower SES.
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Affiliation(s)
- Oscar Russell
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Lester
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rachel J Black
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine L Hill
- The Queen Elizabeth Hospital, Woodville, South Australia, Australia, and Adelaide Medical School, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Peat G, Jordan KP, Wilkie R, Corp N, van der Windt DA, Yu D, Narle G, Ali N. Do recommended interventions widen or narrow inequalities in musculoskeletal health? An equity-focussed systematic review of differential effectiveness. J Public Health (Oxf) 2022; 44:e376-e387. [PMID: 35257184 PMCID: PMC9424108 DOI: 10.1093/pubmed/fdac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background It is unclear whether seven interventions recommended by Public Health England for preventing and managing common musculoskeletal conditions reduce or widen health inequalities in adults with musculoskeletal conditions. Methods We used citation searches of Web of Science (date of ‘parent publication’ for each intervention to April 2021) to identify original research articles reporting subgroup or moderator analyses of intervention effects by social stratifiers defined using the PROGRESS-Plus frameworks. Randomized controlled trials, controlled before-after studies, interrupted time series, systematic reviews presenting subgroup/stratified analyses or meta-regressions, individual participant data meta-analyses and modelling studies were eligible. Two reviewers independently assessed the credibility of effect moderation claims using Instrument to assess the Credibility of Effect Moderation Analyses. A narrative approach to synthesis was used (PROSPERO registration number: CRD42019140018). Results Of 1480 potentially relevant studies, seven eligible analyses of single trials and five meta-analyses were included. Among these, we found eight claims of potential differential effectiveness according to social characteristics, but none that were judged to have high credibility. Conclusions In the absence of highly credible evidence of differential effectiveness in different social groups, and given ongoing national implementation, equity concerns may be best served by investing in monitoring and action aimed at ensuring fair access to these interventions.
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Affiliation(s)
- G Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - K P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - R Wilkie
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - N Corp
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D A van der Windt
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - D Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - G Narle
- Public Health England, London, SE1 8UG, UK.,Versus Arthritis, Chesterfield, S41 7TD, UK
| | - N Ali
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, SW1H 0EU, UK
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Welch V, Dewidar O, Tanjong Ghogomu E, Abdisalam S, Al Ameer A, Barbeau VI, Brand K, Kebedom K, Benkhalti M, Kristjansson E, Madani MT, Antequera Martín AM, Mathew CM, McGowan J, McLeod W, Park HA, Petkovic J, Riddle A, Tugwell P, Petticrew M, Trawin J, Wells GA. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev 2022; 1:MR000028. [PMID: 35040487 PMCID: PMC8764740 DOI: 10.1002/14651858.mr000028.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness. SEARCH METHODS We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies. SELECTION CRITERIA We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility. AUTHORS' CONCLUSIONS There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.
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Affiliation(s)
- Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | | | | | - Kevin Brand
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | | | - Jessie McGowan
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Marmora, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Petticrew
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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[GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 153-154:119-125. [PMID: 32727700 DOI: 10.1016/j.zefq.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. STUDY DESIGN AND SETTING Consensus-based guidance developed by the GRADE working group members and other methodologists. This is a German translation of the original paper published in English. RESULTS We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. CONCLUSION The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.
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Nielsen SM, Storgaard H, Ellingsen T, Shea BJ, Wells GA, Welch VA, Furst DE, de Wit M, Voshaar M, Juhl CB, Boers M, Escorpizo R, Woodworth TG, Boonen A, Bliddal H, March LM, Tugwell P, Christensen R. Population characteristics as important contextual factors in rheumatological trials: an exploratory meta-epidemiological study from an OMERACT Working Group. Ann Rheum Dis 2020; 79:1269-1276. [PMID: 32606042 DOI: 10.1136/annrheumdis-2020-217237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/24/2020] [Accepted: 06/02/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To explore whether trial population characteristics modify treatment responses across various interventions, comparators and rheumatic conditions. METHODS In this meta-epidemiological study, we included trials from systematic reviews available from the Cochrane Musculoskeletal Group published up to 23 April 2019 in Cochrane Library with meta-analyses of five or more randomised controlled trials (RCTs) published from year 2000. From trial reports, we extracted data on 20 population characteristics. For characteristics with sufficient data (ie, available for ≥2/3 of the trials), we performed multilevel meta-epidemiological analyses. RESULTS We identified 19 eligible systematic reviews contributing 187 RCTs (212 comparisons). Only age and sex were explicitly reported in ≥2/3 of the trials. Using information about the country of the trials led to sufficient data for five further characteristics, that is, 7 out of 20 (35%) protocolised characteristics were analysed. The meta-regressions showed effect modification by economic status, place of residence, and, nearly, from healthcare system (explaining 4.8%, 0.9% and 1.5% of the between-trial variation, respectively). No effect modification was demonstrated from age, sex, patient education/health literacy or predominant religion. CONCLUSIONS This study demonstrates the scarce reporting of most population characteristics, hampering investigation of their impact with meta-research. Our sparse results suggest that place of residence (ie, continent of the trial), economic status (based on World Bank classifications) and healthcare system (based on WHO index for health system performance) may be important in explaining the variation in treatment response across trials. There is an urgent need for consistent reporting of important population characteristics in trials. PROSPERO REGISTRATION NUMBER CRD42019127642.
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Affiliation(s)
- Sabrina Mai Nielsen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark .,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Helene Storgaard
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Beverley J Shea
- Ottawa Hospital Research Institute, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - George A Wells
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Vivian Andrea Welch
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Research Institute, Ottawa, Ontario, Canada
| | - Daniel E Furst
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA.,University of Washington, Seattle, Washington, USA.,University of Florence, Florence, Italy
| | - Maarten de Wit
- OMERACT Patient Research Partner, Zaltbommel, The Netherlands
| | - Marieke Voshaar
- Department Psychology, Health and Technology, University of Twente, Twente, The Netherlands
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev & Gentofte, Denmark
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Reuben Escorpizo
- Department of Rehabilitation and Movement Science, College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Thasia G Woodworth
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, California, USA
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), 6229 ER Maastricht University, Maastricht, The Netherlands
| | - Henning Bliddal
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Lyn M March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Peter Tugwell
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
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9
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Evans J, Mwangi N, Burn H, Ramke J. Equity was rarely considered in Cochrane Eyes and Vision systematic reviews and primary studies on cataract. J Clin Epidemiol 2020; 125:57-63. [PMID: 32389807 DOI: 10.1016/j.jclinepi.2020.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/18/2020] [Accepted: 04/30/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We sought to understand the extent to which Cochrane Eyes and Vision systematic reviews of interventions for cataract, and primary studies, consider equity. STUDY DESIGN AND SETTING This is a review of Cochrane Eyes and Vision systematic reviews (CSRs) on cataract published on the Cochrane Library (end of March 2019) (n = 23), and recently published primary studies included in those reviews (n = 62), using the PROGRESSPlus framework. RESULTS One CSR considered equity as a topic. Four (17%) CSRs included a low- and middle-income country (LMIC) author; one of them was a first author. The CSR with equity as a main topic restricted primary studies to those conducted in LMICs; otherwise none of the systematic reviews used PROGRESS factors as inclusion or exclusion criteria. None of the CSRs reported subgroup analyses by any PROGRESS factor, although these were planned in two. Two of the primary studies were led by an LMIC author; 42% involved LMIC authors; 37% were conducted in LMICs; 73% of studies reported on gender/sex of participants, but other PROGRESS factors were less frequently reported. Three studies reported subgroup analyses by sex; one reported subgroup analyses by race/ethnicity. CONCLUSION PROGRESS factors and equity are rarely considered in studies of interventions for cataract, and this is reflected in the associated Cochrane reviews.
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Affiliation(s)
- Jennifer Evans
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nyawira Mwangi
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; Department of Clinical Medicine, Kenya Medical Training College, Nairobi, Kenya
| | - Helen Burn
- Department of Ophthalmology, Stoke Mandeville Hospital, Aylesbury, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; School of Optometry and Vision Science, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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10
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Petkovic J, Jull J, Yoganathan M, Dewidar O, Baird S, Grimshaw JM, Johansson KA, Kristjansson E, McGowan J, Moher D, Petticrew M, Robberstad B, Shea B, Tugwell P, Volmink J, Wells GA, Whitehead M, Cuervo LG, White H, Taljaard M, Welch V. Reporting of health equity considerations in cluster and individually randomized trials. Trials 2020; 21:308. [PMID: 32245522 PMCID: PMC7118943 DOI: 10.1186/s13063-020-4223-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/02/2020] [Indexed: 01/12/2023] Open
Abstract
Background The randomized controlled trial (RCT) is considered the gold standard study design to inform decisions about the effectiveness of interventions. However, a common limitation is inadequate reporting of the applicability of the intervention and trial results for people who are “socially disadvantaged” and this can affect policy-makers’ decisions. We previously developed a framework for identifying health-equity-relevant trials, along with a reporting guideline for transparent reporting. In this study, we provide a descriptive assessment of health-equity considerations in 200 randomly sampled equity-relevant trials. Methods We developed a search strategy to identify health-equity-relevant trials published between 2013 and 2015. We randomly sorted the 4316 records identified by the search and screened studies until 100 individually randomized (RCTs) and 100 cluster randomized controlled trials (CRTs) were identified. We developed and pilot-tested a data extraction form based on our initial work, to inform the development of our reporting guideline for equity-relevant randomized trials. Results In total, 39 trials (20%) were conducted in a low- and middle-income country and 157 trials (79%) in a high-income country focused on socially disadvantaged populations (78% CRTs, 79% RCTs). Seventy-four trials (37%) reported a subgroup analysis across a population characteristic associated with disadvantage (25% CRT, 49% RCTs), with 19% of included studies reporting subgroup analyses across sex, 9% across race/ethnicity/culture, and 4% across socioeconomic status. No subgroup analyses were reported for place of residence, occupation, religion, education, or social capital. One hundred and forty-one trials (71%) discussed the applicability of their results to one or more socially disadvantaged populations (68% of CRT, 73% of RCT). Discussion In this set of trials, selected for their relevance to health equity, data that were disaggregated for socially disadvantaged populations were rarely reported. We found that even when the data are available, opportunities to analyze health-equity considerations are frequently missed. The recently published equity extension of the Consolidated Reporting Standards for Randomized Trials (CONSORT-Equity) may help improve delineation of hypotheses related to socially disadvantaged populations, and transparency and completeness of reporting of health-equity considerations in RCTs. This study can serve as a baseline assessment of the reporting of equity considerations.
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Affiliation(s)
- Jennifer Petkovic
- Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | - Janet Jull
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Manosila Yoganathan
- Infectious Diseases and Prevention Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Omar Dewidar
- Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Baird
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kjell Arne Johansson
- Bergen Centre for Ethics and Priority Setting (BCEPS) Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Elizabeth Kristjansson
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jessie McGowan
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mark Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Bjarne Robberstad
- Section for Ethics and Health Economics, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Beverley Shea
- Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tugwell
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON, Canada
| | - Jimmy Volmink
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Luis Gabriel Cuervo
- Department of Health Systems and Services, Pan American Health Organization, Washington, DC, USA
| | | | - Monica Taljaard
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - Vivian Welch
- Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada
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11
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Hardman R, Begg S, Spelten E. What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review. BMC Health Serv Res 2020; 20:150. [PMID: 32106889 PMCID: PMC7045733 DOI: 10.1186/s12913-020-5010-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background The social gradient in chronic disease (CD) is well-documented, and the ability to effectively self-manage is crucial to reducing morbidity and mortality from CD. This systematic review aimed to assess the moderating effect of socioeconomic status on self-management support (SMS) interventions in relation to participation, retention and post-intervention outcomes. Methods Six databases were searched for studies of any design published until December 2018. Eligible studies reported on outcomes from SMS interventions for adults with chronic disease, where socioeconomic status was recorded and a between-groups comparison on SES was made. Possible outcomes were participation rates, retention rates and clinical or behavioural post-intervention results. Results Nineteen studies were retrieved, including five studies on participation, five on attrition and nine studies reporting on outcomes following SMS intervention. All participation studies reported reduced engagement in low SES cohorts. Studies assessing retention and post-intervention outcomes had variable results, related to the diversity of interventions. A reduction in health disparity was seen in longer interventions that were individually tailored. Most studies did not provide a theoretical justification for the intervention being investigated, although four studies referred to Bandura’s concept of self-efficacy. Conclusions The limited research suggests that socioeconomic status does moderate the efficacy of SMS interventions, such that without careful tailoring and direct targeting of barriers to self-management, SMS may exacerbate the social gradient in chronic disease outcomes. Screening for patient disadvantage or workload, rather than simply recording SES, may increase the chances of tailored interventions being directed to those most likely to benefit from them. Future interventions for low SES populations should consider focussing more on treatment burden and patient capacity. Trial registration PROSPERO registration CRD42019124760. Registration date 17/4/19.
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Affiliation(s)
- Ruth Hardman
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, Victoria, 3500, Australia. .,Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, Victoria, 3500, Australia.
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Evelien Spelten
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, Victoria, 3500, Australia
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12
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López-Alcalde J, Stallings E, Cabir Nunes S, Fernández Chávez A, Daheron M, Bonfill Cosp X, Zamora J. Consideration of sex and gender in Cochrane reviews of interventions for preventing healthcare-associated infections: a methodology study. BMC Health Serv Res 2019; 19:169. [PMID: 30876452 PMCID: PMC6419810 DOI: 10.1186/s12913-019-4001-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 03/07/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are common and increase morbidity, mortality, and healthcare costs. Their control continues to be an unresolved issue worldwide. HAIs epidemiology shows sex/gender differences. Thus the lack of consideration of sex/gender in Cochrane reviews will limit their applicability and capacity to support informed decisions. This study aims to describe the extent to which Cochrane reviews of interventions for preventing HAIs consider sex and gender. METHODS Methodology study appraising Cochrane reviews of interventions to prevent HAIs. SEARCH METHODS Cochrane Database of Systematic Reviews from 1995 (launch of the journal) to 31 December 2016. Two authors independently extracted data with EPPI-Reviewer 4 software, and independently appraised the sex/gender content of the reviews with the Sex and Gender Appraisal Tool for Systematic Reviews (SGAT-SR). RESULTS This study included 113 reviews assessing the effects of interventions for preventing HAIs. 100 reviews (88%) used at least one sex or gender-related term. The terminology used was heterogeneous, being "sex" the term used in more reviews (51%). No review defined neither sex nor gender. Thus we could not assess the definitions provided. Consideration of sex and gender was practically absent in the included reviews; in fact, no review met all the applicable items of the SGAT-SR, and 51 reviews (50%) fulfilled no item. No review provided a complete description of the sex and the gender of the samples of the included studies. Only ten reviews (10%) planned to perform sex- and gender-based analysis and only three (3%) could complete the analysis. The method chosen was always the subgroup analysis based on sex (one review) or gender (two reviews). Three reviews (3%) considered sex or gender-related findings in the conclusions. CONCLUSION Consideration of sex and gender in Cochrane reviews of interventions for preventing HAIs was practically absent. This lack of attention to sex and gender reduces the quality of Cochrane reviews, and their applicability for all people: women and men, boys and girls, and people of diverse gender identities. Cochrane should attempt to address the shortfalls detected.
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Affiliation(s)
- Jesús López-Alcalde
- Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Faculty of Health Sciences, Universidad Francisco de Vitoria (UFV)-Madrid, Madrid, Spain
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- Cochrane Associate Centre of Madrid, Madrid, Spain
| | - Elena Stallings
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
| | | | | | | | - Xavier Bonfill Cosp
- Iberoamerican Cochrane Centre, IIB Sant Pau, Universitat Autònoma de Barcelona, Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Javier Zamora
- Clinical Biostatistics Unit, Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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13
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Petkovic J, Welch V, Jull J, Petticrew M, Kristjansson E, Rader T, Yoganathan M, McGowan J, Lyddiatt A, Grimshaw JM, Volmink J, Moher D, Shea B, Pottie K, Pantoja T, Wells GA, Tugwell P. How health equity is reported and analyzed in randomized trials. Hippokratia 2017. [DOI: 10.1002/14651858.mr000046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jennifer Petkovic
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 312 Ottawa ON Canada K1N 5C8
| | - Vivian Welch
- Bruyère Research Institute; Methods Centre; 85 Primrose Avenue Ottawa ON Canada
| | - Janet Jull
- University of Ottawa; Bruyère Research Institute; 43 Bruyère St Annex E, room 312 Ottawa ON Canada K1N 5C8
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine; Department of Social & Environmental Health Research, Faculty of Public Health & Policy; 15-17 Tavistock Place London UK WC1H 9SH
| | - Elizabeth Kristjansson
- University of Ottawa; School of Psychology, Faculty of Social Sciences; Room 407C, Montpetit Hall 125 University Ottawa ON Canada K1N 6N5
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH); 600-865 Carling Avenue Ottawa ON Canada
| | | | - Jessie McGowan
- Faculty of Medicine, University of Ottawa; Department of Medicine; Ottawa ON Canada K1N 6N5
| | - Anne Lyddiatt
- No affiliation; 28 Greenwood Road Ingersoll ON Canada N5C 3N1
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute; Clinical Epidemiology Program; The Ottawa Hospital - General Campus 501 Smyth Road, Box 711 Ottawa ON Canada K1H 8L6
| | - Jimmy Volmink
- Stellenbosch University; Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences; PO Box 241 Cape Town South Africa 8000
| | - David Moher
- Ottawa Hospital Research Institute; Box 208, 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Beverley Shea
- University of Ottawa; Department of Epidemiology and Community Medicine; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Kevin Pottie
- University of Ottawa; Family Medicine; 75 Bruyere St Ottawa ON Canada K1N 5C8
| | - Tomas Pantoja
- Pontificia Universidad Católica de Chile; Department of Family Medicine, Faculty of Medicine; Centro Medico San Joaquin, Vicuña Mackenna 4686 Macul Santiago Chile
| | - George A Wells
- University of Ottawa; Department of Epidemiology and Community Medicine; 501 Smyth Road Ottawa ON Canada K1H 8L6
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa; Department of Medicine; Ottawa ON Canada K1N 6N5
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14
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Welch VA, Akl EA, Pottie K, Ansari MT, Briel M, Christensen R, Dans A, Dans L, Eslava-Schmalbach J, Guyatt G, Hultcrantz M, Jull J, Katikireddi SV, Lang E, Matovinovic E, Meerpohl JJ, Morton RL, Mosdol A, Murad MH, Petkovic J, Schünemann H, Sharaf R, Shea B, Singh JA, Solà I, Stanev R, Stein A, Thabaneii L, Tonia T, Tristan M, Vitols S, Watine J, Tugwell P. GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence. J Clin Epidemiol 2017; 90:76-83. [PMID: 28389397 PMCID: PMC5680526 DOI: 10.1016/j.jclinepi.2017.01.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 01/11/2017] [Accepted: 01/26/2017] [Indexed: 01/13/2023]
Abstract
Objectives The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. Study Design and Setting Consensus-based guidance developed by the GRADE working group members and other methodologists. Results We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. Conclusion The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society.
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Affiliation(s)
- Vivian A Welch
- Bruyère Research Institute, University of Ottawa and Bruyère Continuing Care, 85 Primrose Ave, Ottawa K1R 7G5, Canada.
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, P.O. Box: 11-0236, Riad-El-Solh Beirut, 1107 2020 Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Kevin Pottie
- Bruyère Research Institute, University of Ottawa and Bruyère Continuing Care, 85 Primrose Ave, Ottawa K1R 7G5, Canada; Departments of Family Medicine and Epidemiology and Community Medicine, Bruyère Research Institute, University of Ottawa, WHO and EU ECDC Consultant
| | - Mohammed T Ansari
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Room 101, 600 Peter Morand Crescent, Ottawa ON K1G 5Z3 Canada
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel, Spitalstrasse 12, Basel 4031, Switzerland; Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Antonio Dans
- Department of Medicine, University of the Philippines-Manila, Manila 1000, Philippines
| | - Leonila Dans
- Department of Pediatrics, University of the Philippines-Manila, Taft Ave, Manila 1000, Philippines
| | - Javier Eslava-Schmalbach
- Group of Equity in Health, Hospital Universitario Nacional de Colombia, Faculty of Medicine, Universidad Nacional de Colombia; Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion -S.C.A.R.E. Cra 30 45-03, Bogota 111321, Colombia
| | - Gordon Guyatt
- Department of Clinical Epidemiology & Biostatistics and Department of Medicine, McMaster University Health Sciences Centre, McMaster University, 1280 Main Street West, Room HSC-2C12, Hamilton, Ontario L8S 4K1, Canada
| | - Monica Hultcrantz
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), S:t Eriksgatan 117, Stockholm SE-102 33, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm SE-171 77, Sweden
| | - Janet Jull
- Bruyère Research Institute, University of Ottawa, 85 Primrose Avenue, Room 312, Ottawa, Ontario K1R 7G5
| | | | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | | | - Joerg J Meerpohl
- Cochrane Germany, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Strasse 153, Freiburg 79110, Germany; Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité - U1153, Inserm / Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, 1, place du Parvis Notre-Dame, Paris 75004, France
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Medical Foundation Building Level 6, 92-94 Parramatta Road, Camperdown, NSW 2050, Australia
| | - Annhild Mosdol
- Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Jennifer Petkovic
- Bruyère Research Institute & University of Ottawa, 85 Primrose Avenue, Ottawa, Ontario K1R 7G5
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ravi Sharaf
- Division of Gastroenterology, Northwell Health/Hofstra University School of Medicine, Long Island Jewish Medical Center, Research Building B202, 270-05 76th Avenue, New Hyde Park, NY 11040, USA
| | - Bev Shea
- Bruyère Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Jasvinder A Singh
- Medicine Service, Birmingham Veterans Affairs Medical Center, 700, 19th Street South, Birmingham, AL 35233, USA; Department of Medicine at School of Medicine and the Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0022, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 200 1st Street SW, Rochester, MN 55905, USA
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau, CIBER of Epidemiology and Public Health (CIBERESP-IIB Sant Pau), Barcelona, Spain
| | - Roger Stanev
- Institute of Technology, University of Washington, 1900 Commerce St., Tacoma, WA 98402, USA
| | - Airton Stein
- Public Health Department - Universidade Federal de Ciencias da Saude de Porto Alegre (Ufcspa), Rua Sarmento Leite, 245, CEP - CEP 90050-170 and HTA of Conceicao Hospital, Porto Alegre, Brazil
| | - Lehana Thabaneii
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Niesenweg 6, Bern 3012, Switzerland
| | - Mario Tristan
- IHCAI Foundation & Cochrane Central America & Spanish speaking Caribbean, Av 7. calles 35 y 37, No 35 30, Codigo Postal 10106, San Jose, Costa Rica
| | - Sigurd Vitols
- Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Joseph Watine
- Laboratory Medicine, Hôpital La Chartreuse, avenue Caylet, F-12200, Villefranche-de-Rouergue, France
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, K1H 8M5, Ottawa, Canada
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15
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McFadden B, Jones McGrath K, Lowe T, Thiessen C, Irinici S, Shah T, Milosavljevic S, Bath B. Examining the Supply of and Demand for Physiotherapy in Saskatchewan: The Relationship between Where Physiotherapists Work and Population Health Need. Physiother Can 2016; 68:335-345. [PMID: 27904233 DOI: 10.3138/ptc.2015-70] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This research examined the association between the distribution of physiotherapists in Saskatchewan relative to population health characteristics and self-reported physiotherapy use. Methods: Using a cross-sectional design, de-identified data were collected from the 2013 Saskatchewan College of Physical Therapy membership renewals (n=643), and Saskatchewan population health characteristics data were obtained from the 2009-2012 Canadian Community Health Surveys (CCHSs). Age- and sex-adjusted proportions of selected population health characteristics were calculated and stratified by health region and rural-urban location; both were determined, for physiotherapists and CCHS participants, using postal codes. The association between physiotherapy distribution and physiotherapy use was calculated, and geospatial mapping techniques were used to display physiotherapist distribution across the province relative to population health characteristics. Results: Across health regions, a positive correlation (r=0.655, p<0.029) was found between physiotherapist distribution and self-reported physiotherapy use. Mapping population health characteristics according to physiotherapist distribution demonstrated an imbalance between supply and distribution of physiotherapists and population health needs and demands. Conclusion: There is a discrepancy in Saskatchewan among the distribution of physiotherapists, self-reported physiotherapy use, and population health characteristics, especially in rural settings. These findings provide insight into which areas are in need of increased physiotherapy services.
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Affiliation(s)
| | | | | | | | | | - Tayyab Shah
- School of Physical Therapy, University of Saskatchewan
| | | | - Brenna Bath
- School of Physical Therapy, University of Saskatchewan
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16
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Putrik P, Ramiro S, Lie E, Keszei AP, Kvien TK, van der Heijde D, Landewé R, Uhlig T, Boonen A. Less educated and older patients have reduced access to biologic DMARDs even in a country with highly developed social welfare (Norway): results from Norwegian cohort study NOR-DMARD. Rheumatology (Oxford) 2016; 55:1217-24. [PMID: 27012686 DOI: 10.1093/rheumatology/kew048] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To explore whether age, gender or education influence the time until initiation of the first bDMARD in patients with RA. METHODS Data from the Norwegian Register of DMARDs collected between 2000 and 2012 were used. Only DMARD-naïve patients with RA starting their first conventional synthetic DMARD were included in the analyses. The start of the first bDMARD was the main outcome of interest. Cox regression analyses were used to explore the impact of education, age and gender on the start of a first bDMARD, adjusting for confounders, either at baseline or varying over time (time-varying model). RESULTS Of 1946 eligible patients [mean (s.d.) age: 55 (14) years, 68% females], 368 (19%) received a bDMARD during follow-up (mean 2.6 years). In the baseline prediction model, older age [Hazard Ratio (HR) 0.97, 95% CI: 0.96, 0.98], lower education [HR = 0.76 and 0.68 for low and intermediate education levels vs college/university education, respectively (P = 0.01)] and female gender [only in the period 2000-03, HR = 0.61 (95% CI: 0.41, 0.91)] were associated with a lower hazard ratio to start a bDMARD. The time-varying model provided overall consistent results, but the effect of education was only relevant for older patients (>57 years) and became more pronounced by the end of the decade. CONCLUSIONS Less educated and older patients have disadvantages with regard to access to costly treatments, even in a country with highly developed welfare like Norway. Females had lower access in the beginning of the 2000s, but access had improved by the end of the decade.
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Affiliation(s)
- Polina Putrik
- Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University Health Promotion and Education, Maastricht University, Maastricht
| | - Sofia Ramiro
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Andras P Keszei
- Medical Informatics, Uniklinik RWTH Aachen University, Aachen, Germany
| | - Tore K Kvien
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Désirée van der Heijde
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Robert Landewé
- Amsterdam Rheumatology & Immunology Center, Amsterdam, Amsterdam Rheumatology, Atrium Medical Center, Heerlen, the Netherlands and
| | - Till Uhlig
- Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University Rheumatology, Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway
| | - Annelies Boonen
- Rheumatology, Maastricht University Medical Center and CAPHRI Research Institute Maastricht University
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Welch V, Petticrew M, Petkovic J, Moher D, Waters E, White H, Tugwell P, Atun R, Awasthi S, Barbour V, Bhutta ZA, Cuervo LG, Groves T, Koehlmoos-Perez T, Kristjansson E, Moher D, Oxman A, Pantoja T, Petticrew M, Petkovic J, Pigott T, Ranson K, TanTorres T, Tharyan P, Tovey D, Tugwell P, Volmink J, Wager E, Waters E, Welch V, Wells G, White H. Extending the PRISMA statement to equity-focused systematic reviews (PRISMA-E 2012): explanation and elaboration. J Clin Epidemiol 2016; 70:68-89. [DOI: 10.1016/j.jclinepi.2015.09.001] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2015] [Indexed: 01/08/2023]
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CONSIDERING EQUITY IN HEALTH TECHNOLOGY ASSESSMENT: AN EXPLORATORY ANALYSIS OF AGENCY PRACTICES. Int J Technol Assess Health Care 2015; 31:314-23. [DOI: 10.1017/s0266462315000549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: Equity is one of the founding principles in most healthcare systems. Financial constraints entail an increased risk of exacerbating inequities and a greater need for evidence-based decisions. It is, therefore, both important and timely to enquire how equity can be addressed in health technology assessment (HTA) practice. We aimed to explore related practices from a broad range of HTA agencies, identify exemplary approaches and common concerns, and offer insights for future considerations.Methods: HTA agencies for which both methodological guides and HTA reports were publicly available were selected from an initial comprehensive pool. Information was extracted on issues ranging from a general commitment to fairness to specific measures targeting both methodological and process-related elements.Results: Methodological documents and ninety-eight reports from nineteen agencies were analyzed. Our findings indicate that equity was not a standard consideration in HTA report production. The nature of specific approaches and the amount of resources invested into including an equity perspective varied considerably. Specific measures (e.g., appropriate information sources, analytical tools, and schemes) were mentioned by almost half of the agencies analyzed. Albeit sporadic, both horizontal and vertical equity considerations were identified in included HTA reports.Conclusions: While varying legal contexts and institutional principles can lead to different interpretations of equity at the decision point, a combination of methodological and process-related practices could contribute to more equity-sensitive evaluations, especially in conjunction with enhanced dissemination of existing methodological tools. Networking initiatives on behalf of existing collaborating platforms could play an important role in this direction.
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Welch V, Jull J, Petkovic J, Armstrong R, Boyer Y, Cuervo LG, Edwards S, Lydiatt A, Gough D, Grimshaw J, Kristjansson E, Mbuagbaw L, McGowan J, Moher D, Pantoja T, Petticrew M, Pottie K, Rader T, Shea B, Taljaard M, Waters E, Weijer C, Wells GA, White H, Whitehead M, Tugwell P. Protocol for the development of a CONSORT-equity guideline to improve reporting of health equity in randomized trials. Implement Sci 2015; 10:146. [PMID: 26490367 PMCID: PMC4618136 DOI: 10.1186/s13012-015-0332-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health equity concerns the absence of avoidable and unfair differences in health. Randomized controlled trials (RCTs) can provide evidence about the impact of an intervention on health equity for specific disadvantaged populations or in general populations; this is important for equity-focused decision-making. Previous work has identified a lack of adequate reporting guidelines for assessing health equity in RCTs. The objective of this study is to develop guidelines to improve the reporting of health equity considerations in RCTs, as an extension of the Consolidated Standards of Reporting Trials (CONSORT). METHODS/DESIGN A six-phase study using integrated knowledge translation governed by a study executive and advisory board will assemble empirical evidence to inform the CONSORT-equity extension. To create the guideline, the following steps are proposed: (1) develop a conceptual framework for identifying "equity-relevant trials," (2) assess empirical evidence regarding reporting of equity-relevant trials, (3) consult with global methods and content experts on how to improve reporting of health equity in RCTs, (4) collect broad feedback and prioritize items needed to improve reporting of health equity in RCTs, (5) establish consensus on the CONSORT-equity extension: the guideline for equity-relevant trials, and (6) broadly disseminate and implement the CONSORT-equity extension. DISCUSSION This work will be relevant to a broad range of RCTs addressing questions of effectiveness for strategies to improve practice and policy in the areas of social determinants of health, clinical care, health systems, public health, and international development, where health and/or access to health care is a primary outcome. The outcomes include a reporting guideline (CONSORT-equity extension) for equity-relevant RCTs and a knowledge translation strategy to broadly encourage its uptake and use by journal editors, authors, and funding agencies.
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Affiliation(s)
- Vivian Welch
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - J Jull
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - J Petkovic
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - R Armstrong
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, 5/207 Bouverie St Carlton 3010, Victoria, Australia.
| | - Y Boyer
- Canada Research Chair in Aboriginal Health and Wellness, Brandon University, Manitoba, Canada.
| | - L G Cuervo
- Research Promotion and Development Office of Knowledge Management, Bioethics and Research Pan American Health Organization, World Health Organization, Washington, DC, USA.
| | - Sjl Edwards
- Research Ethics and Governance, University College London, London, England.
| | - A Lydiatt
- Cochrane Musculoskeletal Group, London, Ontario, Canada.
| | - D Gough
- Department of Social Science, University College London, London, UK.
| | - J Grimshaw
- Ottawa Hospital Research Institute, Medicine University of Ottawa, Ottawa, Canada.
| | - E Kristjansson
- School of Psychology, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - L Mbuagbaw
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. .,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada. .,Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Avenue Henri Dunant, Messa, Yaoundé, Cameroon.
| | - J McGowan
- Department of Medicine, University of Ottawa, Ontario, Canada.
| | - D Moher
- Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - T Pantoja
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Centro Médico San Joaquín Vicuña Mackenna 4686, Macul, Santiago, Chile.
| | - M Petticrew
- Department of Social and Environmental Health Research, Public Health Evaluation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England.
| | - K Pottie
- Departments of Family Medicine and Epidemiology and Community Medicine Primary Care Research Group and Equity Methods Group, Bruyere Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada.
| | - T Rader
- Canadian Agency for Drugs and Technology in Health, 865 Carling Ave Ottawa, Ontario, Canada.
| | - B Shea
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
| | - M Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ontario, Canada.
| | - E Waters
- Public Health Insight, Melbourne School of Population and Global Health, University of Melbourne, 5/207 Bouverie St Carlton 3010, Victoria, Australia.
| | - C Weijer
- Rotman Institute of Philosophy, Western University, 1151 Richmond Street, London, Ontario, Canada.
| | - G A Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | - H White
- Alfred Deakin University, Geelong, Victoria, Australia.
| | - M Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - P Tugwell
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose, Ottawa, Ontario, Canada.
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Welch V, Petticrew M, Petkovic J, Moher D, Waters E, White H, Tugwell P. Extending the PRISMA statement to equity-focused systematic reviews (PRISMA-E 2012): explanation and elaboration. Int J Equity Health 2015; 14:92. [PMID: 26450828 PMCID: PMC4599721 DOI: 10.1186/s12939-015-0219-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/21/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The promotion of health equity, the absence of avoidable and unfair differences in health outcomes, is a global imperative. Systematic reviews are an important source of evidence for health decision-makers, but have been found to lack assessments of the intervention effects on health equity. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) is a 27 item checklist intended to improve transparency and reporting of systematic reviews. We developed an equity extension for PRISMA (PRISMA-E 2012) to help systematic reviewers identify, extract, and synthesise evidence on equity in systematic reviews. METHODS AND FINDINGS In this explanation and elaboration paper we provide the rationale for each extension item. These items are additions or modifications to the existing PRISMA Statement items, in order to incorporate a focus on equity. An example of good reporting is provided for each item as well as the original PRISMA item. CONCLUSIONS This explanation and elaboration document is intended to accompany the PRISMA-E 2012 Statement and the PRISMA Statement to improve understanding of the reporting guideline for users. The PRISMA-E 2012 reporting guideline is intended to improve transparency and completeness of reporting of equity-focused systematic reviews. Improved reporting can lead to better judgement of applicability by policy makers which may result in more appropriate policies and programs and may contribute to reductions in health inequities. To encourage wide dissemination of this article it is accessible on the International Journal for Equity in Health, Journal of Clinical Epidemiology, and Journal of Development Effectiveness web sites.
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Affiliation(s)
- Vivian Welch
- Bruyere Research Institute, 43 Bruyère St, Annex E, room 304, Ottawa, K1N 5C8, Ontario, Canada.
| | | | - Jennifer Petkovic
- Research Associate, 43 Bruyère St, Annex E, room 304, Ottawa, K1N 5C8, Ontario, Canada
| | - David Moher
- Ottawa Hospital Research Institute, The Ottawa Hospital, General Campus, Centre for Practice Changing Research Building 501 Smyth Road, PO BOX 201B, Ottawa, Ontario, K1H 8L6, Canada
| | - Elizabeth Waters
- School of Population and Global Health, University of Melbourne, Level 5, 207 Bouverie Street, Victoria, 3010, Australia
| | - Howard White
- International Initiative for Impact Evaluation (3ie), Global Development Network, Post Box No. 7510, Vasant Kunj PO, New Delhi, India
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, 43 Bruyère St, Annex E, room 304, Ottawa, K1N 5C8, Ontario, Canada
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Guillemin F, Carruthers E, Li LC. Determinants of MSK health and disability – Social determinants of inequities in MSK health. Best Pract Res Clin Rheumatol 2014; 28:411-33. [DOI: 10.1016/j.berh.2014.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Malmivaara A. On decreasing inequality in health care in a cost-effective way. BMC Health Serv Res 2014; 14:79. [PMID: 24552288 PMCID: PMC3943459 DOI: 10.1186/1472-6963-14-79] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 02/13/2014] [Indexed: 11/10/2022] Open
Abstract
Background Scientific evidence indicates that access to health care services shown effective is often poorer among the disadvantaged people than among the non-disadvantaged. Advancing cost-effectiveness and equality in obtaining services shown effective are often stated as the two main objectives for health care. Discussion The important question is how to decrease inequality in a most cost-effective way. Some evidence indicates that effectiveness and cost-effectiveness of interventions may be high among the disadvantaged patient groups. However, the relationship between decreasing inequality and cost-effectiveness is complex and depend e.g. on clinical and health care system factors. Summary To expand the knowledge base for advancing equality in a cost-effective way, scientific efforts on four levels are suggested: research into ways how practitioners can provide efficient services for the disadvantaged patients, widening of scope at all levels of evidence based medicine to account also for the disadvantaged, research on quality improvement and evidence implementation, as well as benchmarking research including documentation of services among the disadvantaged.
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Affiliation(s)
- Antti Malmivaara
- Centre for Health and Social Economics, National Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland.
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O'Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, Evans T, Pardo Pardo J, Waters E, White H, Tugwell P. 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. [DOI: 10.1016/j.jclinepi.2013.08.005] [Citation(s) in RCA: 513] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/12/2013] [Accepted: 08/14/2013] [Indexed: 12/16/2022]
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Nasser M, Ueffing E, Welch V, Tugwell P. An equity lens can ensure an equity-oriented approach to agenda setting and priority setting of Cochrane Reviews. J Clin Epidemiol 2013; 66:511-21. [DOI: 10.1016/j.jclinepi.2012.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 11/22/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
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Impact of socioeconomic gradients within and between countries on health of patients with rheumatoid arthritis (RA): Lessons from QUEST RA. Best Pract Res Clin Rheumatol 2012; 26:705-20. [DOI: 10.1016/j.berh.2012.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2012] [Indexed: 12/29/2022]
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Mizen LAM, Macfie ML, Findlay L, Cooper SA, Melville CA. Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities. Implement Sci 2012; 7:42. [PMID: 22578137 PMCID: PMC3479008 DOI: 10.1186/1748-5908-7-42] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 04/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical practice guidelines are developed to improve the quality of healthcare. However, clinical guidelines may contribute to health inequities experienced by disadvantaged groups. This study uses an equity lens developed by the International Clinical Epidemiology Network (INCLEN) to examine how well clinical guidelines address inequities experienced by individuals with intellectual disabilities. METHODS Nine health problems relevant to the health inequities experienced by persons with intellectual disabilities were selected. Clinical guidelines on these disorders were identified from across the world. The INCLEN equity lens was used as the basis for a purpose-designed, semistructured data collection tool. Two raters independently examined each guideline and completed the data collection tool. The data extracted by each rater were discussed at a research group consensus conference and agreement was reached on a final equity lens rating for each guideline. RESULTS Thirty-six guidelines were identified, one of which (2.8%) explicitly excluded persons with intellectual disabilities. Of the remaining 35, six (17.1%) met the first criterion of the equity lens, identifying persons with intellectual disabilities at high risk for the specific health problem. Eight guidelines (22.9%) contained any content on intellectual disabilities. Six guidelines addressed the fourth equity lens criterion, by giving specific consideration to the barriers to implementation of the guideline in disadvantaged populations. There were no guidelines that addressed the second, third, and fifth equity lens criteria. CONCLUSIONS The equity lens is a useful tool to systematically examine whether clinical guidelines address the health needs and inequities experienced by disadvantaged groups. Clinical guidelines are likely to further widen the health inequities experienced by persons with intellectual disabilities, and other disadvantaged groups, by being preferentially advantageous to the general population. There is a need to systematically incorporate methods to consider disadvantaged population groups into the processes used to develop clinical guidelines.
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Affiliation(s)
- Lindsay AM Mizen
- Psychiatry Training Scheme, South East Scotland Deanery, Edinburgh, Scotland, UK
| | - Marjorie L Macfie
- Learning Disabilities Psychiatry Higher Training Scheme, West of Scotland Deanery, Glasgow, Scotland, UK
| | - Linda Findlay
- Department of Learning Disabilities Psychiatry, NHS Lanarkshire, Longdales, Kirklands, Bothwell, Scotland, UK
| | - Sally-Ann Cooper
- Mental Health and Wellbeing, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Craig A Melville
- Mental Health and Wellbeing, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK
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Welch V, Petticrew M, Ueffing E, Benkhalti Jandu M, Brand K, Dhaliwal B, Kristjansson E, Smylie J, Wells GA, Tugwell P. Does consideration and assessment of effects on health equity affect the conclusions of systematic reviews? A methodology study. PLoS One 2012; 7:e31360. [PMID: 22427804 PMCID: PMC3302723 DOI: 10.1371/journal.pone.0031360] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 01/06/2012] [Indexed: 11/19/2022] Open
Abstract
Introduction Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local, regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research. Methods We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pre-tested data collection form. Any differences in data extraction were resolved by discussion. Results Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity. Conclusion The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is currently lacking in systematic reviews.
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Affiliation(s)
- Vivian Welch
- Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada.
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Welch V, Tugwell P, Petticrew M, de Montigny J, Ueffing E, Kristjansson B, McGowan J, Benkhalti Jandu M, Wells GA, Brand K, Smylie J. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev 2010; 2010:MR000028. [PMID: 21154402 PMCID: PMC7391240 DOI: 10.1002/14651858.mr000028.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES To systematically review methods to assess effects on health equity in systematic reviews of effectiveness. SEARCH STRATEGY We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010. SELECTION CRITERIA We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. DATA COLLECTION AND ANALYSIS Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS Thirty-four methodological studies were included. The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1). Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility. AUTHORS' CONCLUSIONS There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.
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Affiliation(s)
- Vivian Welch
- University of OttawaCentre for Global Health, Institute of Population Health1 Stewart Street, Room 206OttawaOntarioCanadaK1N 6N5
| | - Peter Tugwell
- Ottawa HospitalCentre for Global Health, Institute of Population Health, Department of Medicine1 Stewart StreetOttawaOntarioCanadaK1N 6N5
| | - Mark Petticrew
- London School of Hygiene and Tropical MedicineDepartment of Social & Environmental Health Research, Faculty of Public Health & Policy15‐17 Tavistock PlaceLondonUKWC1H 9SH
| | | | - Erin Ueffing
- University of OttawaCentre for Global Health, Institute of Population Health1 Stewart Street, Room 206OttawaOntarioCanadaK1N 6N5
| | - Betsy Kristjansson
- University of OttawaSchool of Psychology, Faculty of Social SciencesRoom 407C, Montpetit Hall125 UniversityOttawaOntarioCanadaK1N 6N5
| | - Jessie McGowan
- University of OttawaInstitute of Population Health/Ottawa Health Research Institute1 Stewart St. room 206OttawaOntarioCanadaK1N 6N5
| | - Maria Benkhalti Jandu
- University of OttawaCenter for Global Health, Institute of Population Health1 Stewart StreetOttawaONCanadaK1N 6N5
| | - George A Wells
- University of Ottawa Heart InstituteCardiovascular Research Reference CentreRoom H1‐140 Ruskin StreetOttawaOntarioCanadaK1Y 4W7
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Petticrew M, Tugwell P, Welch V, Ueffing E, Kristjansson E, Armstrong R, Doyle J, Waters E. Better evidence about wicked issues in tackling health inequities. J Public Health (Oxf) 2009; 31:453-6. [DOI: 10.1093/pubmed/fdp076] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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