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Agénor M, Noh M, Eiduson R, LeBlanc M, Line EC, Goldman RE, Potter J, Austin SB. Barriers to and opportunities for advancing racial equity in cervical cancer screening in the United States. BMC Womens Health 2024; 24:362. [PMID: 38907205 PMCID: PMC11191319 DOI: 10.1186/s12905-024-03151-7] [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: 10/27/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND In the United States (U.S.), racially minoritized people have higher rates of cervical cancer morbidity and mortality compared to white individuals as a result of racialized structural, social, economic, and health care inequities. However, cervical cancer screening guidelines are based on studies of predominately white individuals and do not substantially discuss or address racialized cervical cancer inequities and their social determinants, including racism. METHODS We conducted in-depth interviews with health care providers (N = 30) and key informants with expertise in health equity (N = 18). We utilized semi-structured interview guides that addressed providers' views and experiences delivering cervical cancer screening to racially minoritized individuals and key informants' recommendations for advancing racial equity in the development and implementation of cervical cancer screening guidelines. Interviews were analyzed using a template style thematic analysis approach involving deductive and inductive coding, memo writing, and matrix analysis for theme development. RESULTS Most health care providers adopted a universal, one-size-fits-all approach to cervical cancer screening with the stated goal of ensuring racial equality. Despite frequently acknowledging the existence of racialized cervical cancer inequities, few providers recognized the role of social inequities in influencing them, and none discussed the impact of racism. In contrast, key informants overwhelmingly recommended that providers adopt an approach to cervical cancer screening and follow-up care that recognizes the role of racism in shaping racialized cervical cancer and related social inequities, is developed in partnership with racially minoritized communities, and involves person-centered, structurally-competent, and trauma-informed practices that address racially minoritized peoples' unique lived experiences in historical and social context. This racism-conscious approach is not to be confused with race-based medicine, which is an essentialist and racist approach to health care that treats race as a biological variable rather than as a social and political construct. CONCLUSIONS Developers and implementers of cervical cancer screening guidelines should explicitly recognize and address the impact of racism on cervical cancer screening, follow-up care, and outcomes, meaningfully incorporate racially minoritized communities' perspectives and experiences, and facilitate provider- and institutional-level practices that foster racial equity in cervical cancer.
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Affiliation(s)
- Madina Agénor
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, MPH Box G-S121-4, Providence, RI, 02912, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Madeline Noh
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Rose Eiduson
- Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Merrily LeBlanc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Sociology, Northeastern University, Boston, MA, USA
| | - Emmett C Line
- Teachers College, Columbia University, New York, NY, USA
| | - Roberta E Goldman
- Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - S Bryn Austin
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Hunter B, Dawes L, Wadsworth M, Sadler L, Edmonds L, McAra-Couper J, Allen-Mokaraka T, Groom KM. An evaluation of the quality, suitability and impact on equity of clinical practice guidelines relevant to preterm birth for use in Aotearoa New Zealand. BMC Pregnancy Childbirth 2024; 24:234. [PMID: 38570754 PMCID: PMC10993582 DOI: 10.1186/s12884-024-06415-0] [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: 07/24/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Preterm birth is a leading cause of perinatal morbidity and mortality and a defining event for pregnant people, infants, and whānau (extended families). Recommendations have been made for a national preterm birth prevention initiative focusing on equity in Aotearoa New Zealand, including the development of a national best practice guide. An understanding of the number and quality of guidelines, and consideration of their suitability and impact on equity is required. METHODS Guidelines were identified through a systematic literature search, search of professional bodies websites, and invitation to regional health services in Aotearoa New Zealand. Obstetric and midwifery clinical directors were invited to report on guideline use. Identified guidelines were appraised by a 23-member trans-disciplinary Review Panel; quantitatively using the AGREE-II instrument and qualitatively using modified ADAPTE questions. The quality of guidelines available but not in use was compared against those in current use, and by health services by level of maternity and neonatal care. Major themes affecting implementation and impact on equity were identified using Braun and Clarke methodology. RESULTS A total of 235 guidelines were included for appraisal. Guidelines available but not in use by regional health services scored higher in quality than guidelines in current use (median domain score Rigour and Development 47.5 versus 18.8, p < 0.001, median domain score Overall Assessment 62.5 versus 44.4, p < 0.001). Guidelines in use by regional health services with tertiary maternity and neonatal services had higher median AGREE II scores in several domains, than those with secondary level services (median domain score Overall Assessment 50.0 versus 37.5, p < 0.001). Groups identified by the Review Panel as experiencing the greatest constraints and limitations to guideline implementation were rural, provincial, low socioeconomic, Māori, and Pacific populations. Identified themes to improve equity included a targeted approach to groups experiencing the least advantage; a culturally considered approach; nationally consistent guidance; and improved funding to support implementation of guideline recommendations. CONCLUSIONS We have systematically identified and assessed guidelines on preterm birth. High-quality guidelines will inform a national best practice guide for use in Taonga Tuku Iho, a knowledge translation project for equity in preterm birth care and outcomes in Aotearoa.
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Affiliation(s)
- Briar Hunter
- Liggins Institute, University of Auckland, Auckland, Aotearoa New Zealand.
| | - Lisa Dawes
- Liggins Institute, University of Auckland, Auckland, Aotearoa New Zealand
- Taonga Tuku Iho Principal Investigator Group, Auckland, Aotearoa New Zealand
- National Women's Health, Te Whatu Ora Te Toka Tumai, Auckland, Aotearoa New Zealand
| | - Makayla Wadsworth
- Liggins Institute, University of Auckland, Auckland, Aotearoa New Zealand
| | - Lynn Sadler
- Taonga Tuku Iho Principal Investigator Group, Auckland, Aotearoa New Zealand
- National Women's Health, Te Whatu Ora Te Toka Tumai, Auckland, Aotearoa New Zealand
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, Aotearoa New Zealand
| | - Liza Edmonds
- Taonga Tuku Iho Principal Investigator Group, Auckland, Aotearoa New Zealand
- Department of Women's and Children's Health, Te Whatu Ora Southern, Dunedin, Aotearoa New Zealand
- Kõhatu Center for Hauora Māori, University of Otago, Dunedin, Aotearoa New Zealand
| | - Judith McAra-Couper
- Taonga Tuku Iho Principal Investigator Group, Auckland, Aotearoa New Zealand
- Department of Midwifery, Auckland University of Technology, Auckland, Aotearoa New Zealand
| | - Tina Allen-Mokaraka
- Taonga Tuku Iho Principal Investigator Group, Auckland, Aotearoa New Zealand
| | - Katie M Groom
- Liggins Institute, University of Auckland, Auckland, Aotearoa New Zealand
- Taonga Tuku Iho Principal Investigator Group, Auckland, Aotearoa New Zealand
- National Women's Health, Te Whatu Ora Te Toka Tumai, Auckland, Aotearoa New Zealand
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Mescouto K, Olson RE, Costa N, Evans K, Dillon M, Walsh K, Jensen N, Hodges PW, Lonergan K, Weier M, Setchell J. Fostering equitable change in health services: Using critical reflexivity to challenge dominant discourses in low back pain care in Australia. J Health Serv Res Policy 2024; 29:12-21. [PMID: 37553877 DOI: 10.1177/13558196231193862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
OBJECTIVES Justice and equity-focused practices in health services play a critical but overlooked role in low back pain (LBP) care. Critical reflexivity - the ability to examine and challenge power relations, and broader social issues embedded in everyday life - can be a useful tool to foster practices that are more socially just. No research has yet explored this approach in back pain health services. This study sought to understand how clinicians construct LBP in relation to broader socio-cultural-political aspects of care and explore if those constructions changed when clinicians engaged with critically reflexive dialogues with researchers. METHODS Using critical discourse analysis methods, this qualitative study explored institutionalised patterns of knowledge in the construction of LBP care. We conducted 22 critically reflexive dialogues with 29 clinicians from two health services in Australia - a private physiotherapy clinic and a public multidisciplinary pain clinic. RESULTS Our analyses suggested that clinicians and services often constructed LBP care at an individual level. This dominant individualistic discourse constrained consideration of justice-oriented practices in the care of people with LBP. Through dialogues, discursive constructions of LBP care expanded to incorporate systems and health service workplace practices. This expansion fostered more equitable clinical and service practices - such as assisting patients to navigate health care systems, considering patients' socioeconomic circumstances when developing treatment plans, encouraging staff discussion of possible systemic changes to enhance justice, and fostering a more inclusive workplace culture. Although such expansions faced challenges, incorporating broader discourses enabled recommendations to address LBP care inequities. CONCLUSIONS Critical reflexivity can be a tool to foster greater social justice within health services. By expanding constructions of LBP care beyond individuals, critical reflexive dialogues can foster discussion and actions towards more equitable workplace cultures, services and systems.
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Affiliation(s)
- Karime Mescouto
- Postdoctoral Research Fellow, RECOVER Injury Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Rebecca E Olson
- Associate Professor, School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Nathalia Costa
- Lecturer in Physiotherapy, Sydney School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Adjunct Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Kerrie Evans
- Group Chief Education and Research Officer, Healthia Limited, Brisbane, QLD, Australia
- Senior Research Fellow, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Miriam Dillon
- PhD Candidate, School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Kelly Walsh
- Senior Physiotherapist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia
| | - Niamh Jensen
- Clinical Psychologist, Metro South Health Pain Rehabilitation Centre, Brisbane, QLD, Australia
| | - Paul W Hodges
- Professor & NHMRC Leadership Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | - Megan Weier
- Senior Lecturer, Centre for Social Impact, University of New South Wales, Sydney, NSW, Australia
| | - Jenny Setchell
- Senior Research Fellow, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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Dewidar O, Pardo JP, Welch V, Hazlewood GS, Darzi AJ, Barnabe C, Pottie K, Petkovic J, Kuria S, Sha Z, Allam S, Busse JW, Schünemann HJ, Tugwell P. Operationalizing the GRADE-equity criterion to inform guideline recommendations: application to a medical cannabis guideline. J Clin Epidemiol 2024; 165:111185. [PMID: 37952701 DOI: 10.1016/j.jclinepi.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Incorporating health equity considerations into guideline development often requires information beyond that gathered through traditional evidence synthesis methodology. This article outlines an operationalization plan for the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-equity criterion to gather and assess evidence from primary studies within systematic reviews, enhancing guideline recommendations to promote equity. We demonstrate its use in a clinical guideline on medical cannabis for chronic pain. STUDY DESIGN AND SETTING We reviewed GRADE guidance and resources recommended by team members regarding the use of evidence for equity considerations, drafted an operationalization plan, and iteratively refined it through team discussion and feedback and piloted it on a medicinal cannabis guideline. RESULTS We propose a seven-step approach: 1) identify disadvantaged populations, 2) examine available data for specific populations, 3) evaluate population baseline risk for primary outcomes, 4) assess representation of these populations in primary studies, 5) appraise analyses, 6) note barriers to implementation of effective interventions for these populations, and 7) suggest supportive strategies to facilitate implementation of effective interventions. CONCLUSION Our approach assists guideline developers in recognizing equity considerations, particularly in resource-constrained settings. Its application across various guideline topics can verify its feasibility and necessary adjustments.
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Affiliation(s)
- Omar Dewidar
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Jordi Pardo Pardo
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, 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
| | - Glen S Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Pottie
- CT Lamont Centre for Primary Care, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, Western University, London, Ontario, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Shawn Kuria
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zhiming Sha
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Allam
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Cochrane Canada, MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Cochrane Canada, McMaster University, Hamilton, Ontario, Canada
| | - Peter Tugwell
- Ottawa Centre for Health Equity, Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Shaver N, Bennett A, Beck A, Skidmore B, Traversy G, Brouwers M, Little J, Moher D, Moore A, Persaud N. Health equity considerations in guideline development: a rapid scoping review. CMAJ Open 2023; 11:E357-E371. [PMID: 37171906 PMCID: PMC10139082 DOI: 10.9778/cmajo.20220130] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
BACKGROUND Systematic guidance for considering health equity in guidelines is lacking. This scoping review aims to synthesize current best practices for integrating health equity into guideline development and the benefits or drawbacks of these practices. METHODS We searched Ovid MEDLINE ALL and Embase Classic+Embase on the Ovid platform, CINAHL on EBSCO, and Web of Science (Core Collection) from 2010 to 2022. We searched grey literature from 2015 to 2022, using the Canadian Agency for Drugs and Technologies in Health Grey Matters checklist and searches of potentially relevant websites. Articles were screened independently by 1 reviewer. Proposed best practices, advantages and disadvantages, and tools were extracted independently by 1 reviewer and qualitatively synthesized based on the relevant steps of a comprehensive checklist covering the stages of guideline development. RESULTS We included 26 articles that proposed best practices for incorporating health equity within the guideline development process. These practices were organized under different stages of the development process, including guideline planning, evidence review, guideline development and dissemination. Included studies provided best practices from guideline producers, articles discussing health equity in current guidelines, articles addressing strategies to increase equity in the guideline implementation process, and literature reviews of promising health equity practices. INTERPRETATION Our scoping review identified best practices to incorporate health equity considerations at each phase of guideline development. Identified practices may be used to inform equity-promoting strategies with the guideline development process; however, guideline producers should carefully consider the advantages and disadvantages of best practices when integrating health equity.
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Affiliation(s)
- Nicole Shaver
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Alexandria Bennett
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont.
| | - Andrew Beck
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Becky Skidmore
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Gregory Traversy
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Melissa Brouwers
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Julian Little
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - David Moher
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Ainsley Moore
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
| | - Navindra Persaud
- School of Epidemiology and Public Health, Faculty of Medicine (Shaver, Bennett, Beck, Brouwers, Little, Moher), University of Ottawa; Skidmore Research & Information Consulting (Skidmore); Centre for Chronic Disease Prevention and Health Equity (Traversy), Public Health Agency of Canada; Clinical Epidemiology Program (Moher), Ottawa Hospital Research Institute, Ottawa, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Persaud), St. Michael's Hospital, Toronto, Ont
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Synnot A, Hill S, Jauré A, Merner B, Hill K, Bates P, Liacos A, Turner T. Broadening the diversity of consumers engaged in guidelines: a scoping review. BMJ Open 2022; 12:e058326. [PMID: 35710237 PMCID: PMC9204430 DOI: 10.1136/bmjopen-2021-058326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Guideline developers are encouraged to engage patients, carers and their representatives ('consumers') from diverse backgrounds in guideline development to produce more widely applicable guidelines. However, consumers from diverse backgrounds are infrequently included in guidelines and there is scant research to support guideline developers to do this. OBJECTIVES To identify principles and approaches to broaden the diversity of consumers engaged in guideline development. DESIGN Scoping review and semi-structured interviews. METHODS We conducted comprehensive searches to March 2020 for studies, reports and guidance documents. Inclusion criteria included the terms 'consumer' (patients, carers and their representatives), 'diversity' (defined using the PROGRESS-PLUS mnemonic) and 'consumer engagement' (the active involvement of consumers at any stage of guideline development). We also conducted four interviews with consumers and guideline developers. We used descriptive synthesis to identify themes, and summarised information about implemented approaches used to broaden diversity of consumers in guidelines. RESULTS From 10 included documents, we identified eight themes. Themes covered general engagement concepts (Respectful partnerships; Recruitment; Expectations, process and review); specific concepts about guideline development group (GDG) engagement (Characteristics of guideline personnel; Consumers' role, characteristics and prominence; Preparing and supporting consumers); and other (non-GDG) approaches (Online methods; Consultations and research-based approaches). The most commonly included PROGRESS-PLUS categories were Disability, Race/culture/ethnicity/language, Place of residence and Other vulnerable (eg, 'disadvantaged groups'). Each theme included the views of both consumers and guideline developers. We found descriptions of 12 implemented engagement approaches to broaden diversity of consumers in guidelines. CONCLUSIONS Relationship-building, mitigating power imbalances and meeting consumers where they are at underpin our findings. Engaging with diverse groups may require greater attention to building formal, respectful partnerships and employing inclusive engagement methods.
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Affiliation(s)
- Anneliese Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Allison Jauré
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, Victoria, Australia
| | - Peta Bates
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Tari Turner
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Petkovic J, Riddle A, Lytvyn L, Khabsa J, Akl EA, Welch V, Magwood O, Atwere P, Graham ID, Grant S, John D, Katikireddi SV, Langlois E, Mustafa RA, Todhunter‐Brown A, Schünemann H, Smith M, Stein AT, Concannon T, Tugwell P. PROTOCOL: Guidance for stakeholder engagement in guideline development: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1242. [PMID: 36911343 PMCID: PMC9096120 DOI: 10.1002/cl2.1242] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: to identify, describe, and summarize existing guidance and methods for multistakeholder engagement throughout the health guideline development process.
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Affiliation(s)
- Jennifer Petkovic
- Ottawa Centre for Health EquityBruyère Research InstituteOttawaCanada
| | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Lyubov Lytvyn
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
| | - Joanne Khabsa
- Clinical Research InstituteAmerican University of Beirut Medical CenterBeirutLebanon
| | - Elie A. Akl
- Department of Internal MedicineAmerican University of Beirut Medical CenterBeirutLebanon
| | - Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | - Olivia Magwood
- C.T. Lamont Primary Health Care Research CentreBruyère Research InstituteOttawaCanada
| | - Pearl Atwere
- Ottawa Centre for Health EquityBruyère Research InstituteOttawaCanada
| | - Ian D. Graham
- School of Epidemiology and Public Health, Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Sean Grant
- Department of Social and Behavioral Sciences, Richard M. Fairbanks School of Public HealthIndiana UniversityIndianapolisIndianaUSA
| | | | | | - Etienne Langlois
- Alliance for Health Policy and Systems ResearchWorld Health OrganizationGenevaSwitzerland
| | - Reem A. Mustafa
- Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
| | - Alex Todhunter‐Brown
- Nursing, Midwifery and Allied Health Professions Research UnitGlasgow Caledonian UniversityGlasgowUK
| | - Holger Schünemann
- Departments of Health Research MethodsEvidence, and Impact and of Medicine, McMaster UniversityHamiltonCanada
| | - Maureen Smith
- Canadian Organization for Rare DisordersOttawaCanada
| | - Airton T. Stein
- Department of Public HealthUniversidade Federal de Ciências da SaúdePorto AlegreBrazil
| | | | - Peter Tugwell
- Clinical Epidemiology ProgramOttawa Hospital Research InstituteOttawaCanada
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KOÇAK E, ALKAYA B. Evaluation of the oral dental health status of the Romani community in Turkey. CUKUROVA MEDICAL JOURNAL 2021. [DOI: 10.17826/cumj.952343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Porroche-Escudero A, Popay J. The Health Inequalities Assessment Toolkit: supporting integration of equity into applied health research. J Public Health (Oxf) 2020; 43:567-572. [PMID: 32323722 PMCID: PMC8458018 DOI: 10.1093/pubmed/fdaa047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite insistent calls for more and better evidence to inform action to reduce health inequities, applied health research sensitive to these inequalities is rare. Recognising this problem, the Collaboration for Leadership in Applied Research and Care in the North West Coast (England) developed the Health Inequalities Assessment Toolkit (HIAT) to support those involved in health research to integrate equity into their work. OBJECTIVE This paper reports on an evaluation of the extent to which HIAT enhances the equity focus of the work of users. METHODS The evaluation used semi-structured interviews, focus groups and workshops (n = 131 respondents including Public Advisers, university, NHS and local government partners). Routine data included HIAT feedback forms. FINDINGS HIAT can help to strengthen the equity focus of applied health research by: increasing understanding of how socioeconomic inequities impact on health; building capacity for integrating equity into all aspects of research, implementation and capacity building; stimulating thinking on action to address local structural drivers of health inequalities; and increasing understanding of the positive contribution public involvement can make to research. CONCLUSION If we are to advance health equity goals delivering research and training needs to be combined with political commitment to create more equal societies.
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Affiliation(s)
- Ana Porroche-Escudero
- Division of Health Research, Furness College, Lancaster University, Lancaster, LA1YW.,National Institute for Health Research Applied Research Collaboration, North West Coast
| | - Jennie Popay
- Division of Health Research, Furness College, Lancaster University, Lancaster, LA1YW
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10
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Petkovic J, Riddle A, Akl EA, Khabsa J, Lytvyn L, Atwere P, Campbell P, Chalkidou K, Chang SM, Crowe S, Dans L, Jardali FE, Ghersi D, Graham ID, Grant S, Greer-Smith R, Guise JM, Hazlewood G, Jull J, Katikireddi SV, Langlois EV, Lyddiatt A, Maxwell L, Morley R, Mustafa RA, Nonino F, Pardo JP, Pollock A, Pottie K, Riva J, Schünemann H, Simeon R, Smith M, Stein AT, Synnot A, Tufte J, White H, Welch V, Concannon TW, Tugwell P. Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation. Syst Rev 2020; 9:21. [PMID: 32007104 PMCID: PMC6995157 DOI: 10.1186/s13643-020-1272-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 01/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. Further, there is a lack of guidance on how to equitably and meaningfully engage multiple stakeholders. We aim to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation. METHODS This will be a multi-stage project. The first stage is to conduct a series of four systematic reviews. These will (1) describe existing guidance and methods for stakeholder engagement in guideline development and implementation, (2) characterize barriers and facilitators to stakeholder engagement in guideline development and implementation, (3) explore the impact of stakeholder engagement on guideline development and implementation, and (4) identify issues related to conflicts of interest when engaging multiple stakeholders in guideline development and implementation. DISCUSSION We will collaborate with our multiple and diverse stakeholders to develop guidance for multi-stakeholder engagement in guideline development and implementation. We will use the results of the systematic reviews to develop a candidate list of draft guidance recommendations and will seek broad feedback on the draft guidance via an online survey of guideline developers and external stakeholders. An invited group of representatives from all stakeholder groups will discuss the results of the survey at a consensus meeting which will inform the development of the final guidance papers. Our overall goal is to improve the development of guidelines through meaningful and equitable multi-stakeholder engagement, and subsequently to improve health outcomes and reduce inequities in health.
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Affiliation(s)
- Jennifer Petkovic
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada.
| | - Alison Riddle
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Joanne Khabsa
- Clinical Research Institute, American University of Beirut, Beirut, Lebanon
| | | | - Pearl Atwere
- Bruyère Research Institute, 85 Primrose Ave East, Ottawa, Ontario, Canada
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health Imperial College, London, UK
| | | | | | - Leonila Dans
- Department of Clinical Epidemiology, University of the Philippines-Manila, Taft Ave, 1000, Manila, Philippines
| | | | - Davina Ghersi
- National Health and Medical Research Council, Canberra, Australia
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sean Grant
- Department of Social & Behavioral Sciences, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, RG 6046, Indianapolis, IN, 46202, USA
| | | | - Jeanne-Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics & Clinical Epidemiology, Emergency Medicine Oregon Health & Science, University School of Medicine and the OHSU-PSU School of Public Health, Portland, USA
| | | | - Janet Jull
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - S Vittal Katikireddi
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, UK
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Anne Lyddiatt
- Cochrane Musculoskeletal Group, London, Ontario, Canada
| | | | - Richard Morley
- The Cochrane Collaboration, Cochrane Consumer Network, London, UK
| | - Reem A Mustafa
- Department of Internal Medicine/Division of Nephrology and Hypertension, University of Kansas Medical Center, Kansas, USA
| | - Francesco Nonino
- Unit of Epidemiology and Statistics, IRCCS - Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada
| | - Alex Pollock
- Nursing Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Kevin Pottie
- Departments of Family Medicine and Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Primary Care Research Group and Equity Methods Group, Bruyère Research Institute, Ottawa, Canada
| | - John Riva
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, Cochrane Canada and McMaster GRADE Centre, Hamilton, Canada
| | - Rosiane Simeon
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada
| | - Maureen Smith
- Cochrane Consumer Executive, Ottawa, Ontario, Canada
| | - Airton T Stein
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Rua Sarmento Leite 245, Porto Alegre, RS, 90050-170, Brazil
| | - Anneliese Synnot
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Howard White
- Alfred Deakin University, Geelong, Australia.,Journal of Development Studies and Journal of Development Effectiveness, Geelong, Victoria, Australia
| | - Vivian Welch
- Bruyère Research Institute, Bruyère Continuing Care and University of Ottawa, 85 Primrose Ave East, Ottawa, Ontario, Canada.,The Campbell Collaboration, Oslo, Norway
| | - Thomas W Concannon
- The RAND Corporation, Boston, MA, USA.,Tufts Clinical & Translational Science Institute, Tufts University School of Medicine, Boston, MA, USA
| | - Peter Tugwell
- University of Ottawa, Department of Medicine, Faculty of Medicine, Ottawa, Canada.,Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Canada
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11
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Nußbaumer-Streit B, Teufer B, Langer G, Meerpohl JJ, Ebenberger A, Gartlehner G. [GRADE equity guidelines 2: Considering health equity in GRADE guideline development - equity extension of the guideline development checklist]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 147-148:120-126. [PMID: 31757658 DOI: 10.1016/j.zefq.2019.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. STUDY DESIGN AND SETTING Literature review followed by group discussions and consensus building. RESULTS The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. CONCLUSION Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.
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Affiliation(s)
- Barbara Nußbaumer-Streit
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich.
| | - Birgit Teufer
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Gero Langer
- Institut für Gesundheits- und Pflegewissenschaft, German Center for Evidence-based Nursing »sapere aude«, Halle (Saale), Deutschland
| | - Joerg J Meerpohl
- Cochrane Deutschland / Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Agnes Ebenberger
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Gerald Gartlehner
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich; RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
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12
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Teufer B, Nußbaumer-Streit B, Ebenberger A, Titscher V, Conrad S, Langer G, Töws I, Gartlehner G. [GRADE equity guidelines 1: Considering health equity in GRADE guideline development - introduction and rationale]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2019; 146:53-59. [PMID: 31537503 DOI: 10.1016/j.zefq.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for developing clinical, public health, and health system guidelines. This article is a German translation of the original version published in English. STUDY DESIGN AND SETTING We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. RESULTS We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. CONCLUSION Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development.
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Affiliation(s)
- Birgit Teufer
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich.
| | - Barbara Nußbaumer-Streit
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Agnes Ebenberger
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Viktoria Titscher
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich
| | - Susann Conrad
- Abteilung Fachberatung Medizin, Gemeinsamer Bundesausschuss, Berlin, Deutschland
| | - Gero Langer
- Institut für Gesundheits- und Pflegewissenschaft, German Center for Evidence-based Nursing »sapere aude«, Halle (Saale), Deutschland
| | - Ingrid Töws
- Institut für Evidenz in der Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Gerald Gartlehner
- Department für Evidenzbasierte Medizin und Evaluation, Donau-Universität Krems, Krems, Österreich; RTI International, 3040 Cornwallis Drive, Research Triangle Park, NC, USA
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13
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Miguel RTD, Silvestre MAA, Imperial MLS, Ho BLC, Dans LF. Appraisal of the methodological quality of clinical practice guidelines in the Philippines. Int J Health Plann Manage 2019; 34:e1723-e1735. [PMID: 31433544 DOI: 10.1002/hpm.2886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The Republic of the Philippines has recently enacted the Universal Health Care Law, which mandates the Philippines Department of Health (DOH) to operationalize evidence-based clinical practice guideline (CPG) development. As a baseline to the foregoing task, the aim of this study was to appraise the methodological quality of CPGs previously developed and currently being disseminated in the Philippines. A multimethod search for CPGs was implemented. CPGs were independently evaluated using a modified version of the Knowledge Management Plus CPG appraisal tool. FINDINGS Eighty-seven CPGs were included in the appraisal. Majority implemented processes to ensure validity, ie, consideration for patient groups, management options, benefits, and harms (99%), and indicated strength of their recommendations (89%). Seventy-seven CPGs (89%) evaluated the evidence for local applicability. Of the 87 CPGs, 20 CPGs (23%) considered equity in the development process. The development process differed among CPGs with varying degrees of utilization of GRADE methodology (52%), disclosure of funding sources (72%), and engagement of technical support external to the development body (3%). Mean duration of CPG development was 1 year (SD 5.9 months), and mean interval between updates was 6 years and 1 month (SD 37.8 months). CONCLUSION Although most of the CPGs fulfilled essential criteria for quality recommendations (validity and applicability), equity considerations were limited. Furthermore, only half used the GRADE approach and development and dissemination practices differed substantially between CPGs. Thus, it is recommended that a standard CPG development process be made available by the DOH to be utilized by CPG developers in the Philippines.
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Affiliation(s)
| | - Maria Asuncion A Silvestre
- Asia-Pacific Center for Evidence-Based Healthcare, Manila, Philippines.,Kalusugan ng Mag-Ina (Health of Mother and Child), Inc., Quezon City, Philippines
| | - Ma Lourdes S Imperial
- Kalusugan ng Mag-Ina (Health of Mother and Child), Inc., Quezon City, Philippines.,Dr. Jose Fabella Memorial Hospital, Manila, Philippines
| | - Beverly Lorraine C Ho
- Health Policy Development and Planning Bureau, Department of Health, Manila, Philippines
| | - Leonila F Dans
- Asia-Pacific Center for Evidence-Based Healthcare, Manila, Philippines.,College of Medicine, University of the Philippines, Manila, Philippines
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14
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Akl EA, Welch V, Pottie K, Eslava-Schmalbach J, Darzi A, Sola I, Katikireddi SV, Singh J, Murad MH, Meerpohl J, Stanev R, Lang E, Matovinovic E, Shea B, Agoritsas T, Alexander PE, Snellman A, Brignardello-Petersen R, Gloss D, Thabane L, Shi C, Stein AT, Sharaf R, Briel M, Guyatt G, Schünemann H, Tugwell P. GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist. J Clin Epidemiol 2017; 90:68-75. [PMID: 28499847 DOI: 10.1016/j.jclinepi.2017.01.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide guidance for guideline developers on how to consider health equity at key stages of the guideline development process. STUDY DESIGN AND SETTING Literature review followed by group discussions and consensus building. RESULTS The key stages at which guideline developers could consider equity include setting priorities, guideline group membership, identifying the target audience(s), generating the guideline questions, considering the importance of outcomes and interventions, deciding what evidence to include and searching for evidence, summarizing the evidence and considering additional information, wording of recommendations, and evaluation and use. We provide examples of how guidelines have actually considered equity at each of these stages. CONCLUSION Guideline projects should consider the aforementioned suggestions for recommendations that are equity sensitive.
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Affiliation(s)
- Elie A Akl
- Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; Department of Medicine, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon.
| | - Vivian Welch
- Bruyére Research Institute, Bruyére Continuing Care and University of Ottawa, Bruyère St., Ottawa, Ontario, K1N 5C8, Canada
| | - Kevin Pottie
- Centre for Global Health, Institute of Population Health, University of Ottawa, 43 Bruyère St, Ottawa, Ontario, K1N 5C8, Canada
| | - Javier Eslava-Schmalbach
- Group of Equity in Health, Faculty of Medicine, Universidad Nacional de Colombia, Edif. Uriel Gutiérrez, Bogotá D.C., Colombia; Technology Development Center, Sociedad Colombiana de Anestesiologia y Reanimacion, Sociedad Colombiana de Anestesiología y ReanimaciónCra, 15 A No 120-74, Piso 4y5, Edif. Concord Center, Santa Fe de Bogotá, Colombia
| | - Andrea Darzi
- Clinical Research Institute, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon; AUB GRADE Center, American University of Beirut, PO Box 11-0236, Riad El Solh, Beirut, 1107 2020, Lebanon
| | - Ivan Sola
- Clinical Epidemiology and Public Health Department, Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/Sant Antoni Maria Claret, 167, Pavelló 18, planta 0, 08025 Barcelona, Spain
| | - Srinivasa Vittal Katikireddi
- Public Health MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200, Renfield Street, Glasgow G2 3QB, Scotland
| | - Jasvinder Singh
- Department of Medicine, School of Medicine, Birmingham VA Medical Center, 700 19th St S, Birmingham, AL 35233, USA; Division of Epidemiology, School of Public Health, University of Alabama at Birmingham (UAB), 1720 2nd Ave S, Birmingham, AL 35294, USA; Department of Orthopedic Surgery, Mayo Clinic College of Medicine, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Preventive Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Joerg Meerpohl
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité-U1153, Inserm/Université Paris Descartes, 1 place du Parvis Notre-Dame, 75004 Paris, France; Cochrane France, Hôpital Hôtel-Dieu, 1 place du Parvis Notre Dame, 75181 Paris, Cedex 04, France; Cochrane Germany, Medical Center-University of Freiburg, Breisacher Strasse 153, 79110 Freiburg, Germany
| | - Roger Stanev
- Institute of Technology, University of Washington, Tacoma, Washington, USA
| | - Eddy Lang
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW Calgary, Alberta, T2N 4N1, Canada
| | - Elizabeth Matovinovic
- Faculty of Medicine, Chiang Mai University, Su Thep, Mueang Chiang Mai District, Chiang Mai 50200, Thailand
| | - Beverley Shea
- Ottawa Hospital Research Institute, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Paul E Alexander
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | | | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada; Evidence Based Dentistry Unit, Faculty of Dentistry, University of Chile, Av. Libertador Bernardo O'Higgins, Santiago 1058, Chile
| | - David Gloss
- Department of Neurology, Charleston Area Medical Center, 1201 Washington Street East, Suite 100, Charleston, WV 25301, USA
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Chunhu Shi
- Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Airton T Stein
- Public Health Ufcspa, Ulbra and Conceicao Hospital, Av. Farroupilha, 8001, Bairro São José, Canoas (RS), Brasil
| | - Ravi Sharaf
- Long Island Jewish Medical Center North Shore University Hospital, 270-05 76th Ave, Queens, NY 11040, USA
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 21, 4056 Basel, Switzerland
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada
| | - Holger Schünemann
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, Hamilton, 1280 Main St., W.Hamilton, Ontario, L8S 4K1, Canada; Department of Medicine, Faculty of Health Sciences, Hamilton, 1280 Main St., W. Hamilton, Ontario, L8S 4K1, Canada; McMaster GRADE Center, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada
| | - Peter Tugwell
- The Centre for Global Health, Institute of Population Health, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario, K1N 6N5, Canada
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15
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GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale. J Clin Epidemiol 2017; 90:59-67. [PMID: 28412464 PMCID: PMC5675012 DOI: 10.1016/j.jclinepi.2017.01.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 01/11/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
Objectives This article introduces the rationale and methods for explicitly considering health equity in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology for development of clinical, public health, and health system guidelines. Study Design and Setting We searched for guideline methodology articles, conceptual articles about health equity, and examples of guidelines that considered health equity explicitly. We held three meetings with GRADE Working Group members and invited comments from the GRADE Working Group listserve. Results We developed three articles on incorporating equity considerations into the overall approach to guideline development, rating certainty, and assembling the evidence base and evidence to decision and/or recommendation. Conclusion Clinical and public health guidelines have a role to play in promoting health equity by explicitly considering equity in the process of guideline development.
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16
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Senior GRADE methodologists encounter challenges as part of WHO guideline development panels: an inductive content analysis. J Clin Epidemiol 2016; 70:123-8. [DOI: 10.1016/j.jclinepi.2015.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 09/06/2015] [Indexed: 11/21/2022]
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