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Zhu Y, Song T, Zhang Z, Yu P. Developing an Instrument to Evaluate the Quality of Dementia Websites. Healthcare (Basel) 2023; 11:3163. [PMID: 38132053 PMCID: PMC10742665 DOI: 10.3390/healthcare11243163] [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: 11/09/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023] Open
Abstract
In today's digital era, health information, especially for conditions like dementia, is crucial. This study aims to develop an instrument, demenTia wEbsite measSurement insTrument (TEST), through four steps: identifying existing instruments, determining criteria, selecting and revising measurement statements, and validating the instrument from March to August 2020. Five health informatics experts used the content validity ratio (CVR) test for validation. Thirteen evaluators compared Fleiss Kappa and intraclass correlation coefficient (ICC) values across four dementia websites using TEST and another tool, DISCERN. TEST consists of seven criteria and 25 measurement statements focusing on content quality (relevance, credibility, currency) and user experience (accessibility, interactivity, attractiveness, privacy). CVR = 1 confirmed all statements as essential. The TEST demonstrated stronger consistency and assessor agreement compared to DISCERN, measured by Fleiss Kappa and ICC. Overall, it is a robust tool for reliable and user-friendly dementia resources, ensuring health holistic information accessibility.
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Affiliation(s)
| | | | | | - Ping Yu
- School of Computing and Information Technology, University of Wollongong, Wollongong, NSW 2522, Australia; (Y.Z.); (T.S.); (Z.Z.)
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2
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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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3
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Malmivaara A. The human risks of bias in medical and rehabilitation research and practice: the eight Is. Eur J Phys Rehabil Med 2019; 55:372-377. [PMID: 30990003 DOI: 10.23736/s1973-9087.19.05807-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The human mind is liable to make biased interpretations. The biomedical paradigm supposes that an objective truth can be reached with rigorous scientific methods. Human risk of bias is defined in this paper as threats to validity of study results that cannot be controlled even by rigorous scientific methods. AIM To identify categories of potential human risks of biases in quantitative medical and rehabilitation practice and research; and to review the available evidence of human risks of biases in each of these categories. DESIGN A narrative review. RESULTS Eight potential categories of human risk of bias (HRoB) in clinical and rehabilitation practice and research were identified: identity, integrity, independence, intelligence, ideology, interest, incentive and inequity. There is evidence that conflict of interest, deficient integrity and inequity contribute to biased scientific interpretations; and that due to inequity the evidence of effectiveness of interventions for disadvantaged patient groups is scarce. There is also evidence that biased decisions can occur in health care practice due to the state of inequity. DISCUSSION As all categories of HRoB's start with the letter 'I', these are named the eight Is. The categories overlap with each other. Studies assessing the impacts of biases related to conflict of interests, deficient integrity and inequity were identified. However, other potential human risks of biases have been studied very little or not at all. CONCLUSIONS The human beings' liability to biased thinking and all categories of HRoB should be recognized in clinical and rehabilitation practice and research, and use the best verified means to reduce the HRoB. More research is needed, particularly on how to reduce HRoB in medical practice and quantitative clinical research. These actions should be considered congruent to those aiming to increase the validity of the scientific method. CLINICAL REHABILITATION IMPACT The human risk of bias should be considered in assessment of evidence from clinical epidemiology as well as in clinical praxis.
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Affiliation(s)
- Antti Malmivaara
- Center for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland -
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4
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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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Garza C, Stover PJ, Ohlhorst SD, Field MS, Steinbrook R, Rowe S, Woteki C, Campbell E. Best practices in nutrition science to earn and keep the public's trust. Am J Clin Nutr 2019; 109:225-243. [PMID: 30657846 PMCID: PMC6900562 DOI: 10.1093/ajcn/nqy337] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022] Open
Abstract
Public trust in nutrition science is the foundation on which nutrition and health progress is based, including sound public health. An ASN-commissioned, independent Advisory Committee comprehensively reviewed the literature and available public surveys about the public's trust in nutrition science and the factors that influence it and conducted stakeholder outreach regarding publicly available information. The Committee selected 7 overlapping domains projected to significantly influence public trust: 1) conflict of interest and objectivity; 2) public benefit; 3) standards of scientific rigor and reproducibility; 4) transparency; 5) equity; 6) information dissemination (education, communication, and marketing); and 7) accountability. The literature review comprehensively explored current practices and threats to public trust in nutrition science, including gaps that erode trust. Unfortunately, there is a paucity of peer-reviewed material specifically focused on nutrition science. Available material was examined, and its analysis informed the development of priority best practices. The Committee proposed best practices to support public trust, appropriate to ASN and other food and nutrition organizations motivated by the conviction that public trust remains key to the realization of the benefits of past, present, and future scientific advances. The adoption of the best practices by food and nutrition organizations, such as ASN, other stakeholder organizations, researchers, food and nutrition professionals, companies, government officials, and individuals working in the food and nutrition space would strengthen and help ensure earning and keeping the public's continued trust in nutrition science.
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Affiliation(s)
- Cutberto Garza
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Patrick J Stover
- College of Agriculture and Life Sciences, Texas A&M University, College Station, TX
| | | | - Martha S Field
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Robert Steinbrook
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | | | - Catherine Woteki
- Department of Food Science and Human Nutrition, Iowa State University, Ames, IA
| | - Eric Campbell
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Denver, CO
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Toward a theory-led metaframework for considering socioeconomic health inequalities within systematic reviews. J Clin Epidemiol 2018; 104:84-94. [PMID: 30125710 DOI: 10.1016/j.jclinepi.2018.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 07/08/2018] [Accepted: 08/12/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To develop a theory-led framework to inform reviewers' understanding of what, how, and why health care interventions may lead to differential effects across socioeconomic groups. STUDY DESIGN AND SETTING A metaframework approach combined two theoretical perspectives (socioeconomic health inequalities and complex interventions) into a single framework to inform socioeconomic health inequality considerations in systematic reviews. RESULTS Four theories relating to complexity within systematic reviews and 16 health inequalities intervention theories informed the development of a metaframework. Factors relating to the type of intervention, implementation, context, participant response, and mechanisms associated with differential effects across socioeconomic groups were identified. The metaframework can inform; reviewer discussions around how socioeconomic status (SES) can moderate intervention effectiveness during question formulation, approaches to data extraction and help identify a priori analysis considerations. CONCLUSION The metaframework offers a transparent, practical, theory-led approach to inform a program theory for what, how, and why interventions work for different SES groups in systematic reviews. It can enhance existing guidance on conducting systematic reviews that consider health inequalities, increase awareness of how SES can moderate intervention effectiveness, and encourage a greater engagement with theory throughout the review process.
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Maden M, Cunliffe A, McMahon N, Booth A, Carey GM, Paisley S, Dickson R, Gabbay M. Use of programme theory to understand the differential effects of interventions across socio-economic groups in systematic reviews-a systematic methodology review. Syst Rev 2017; 6:266. [PMID: 29284538 PMCID: PMC5747153 DOI: 10.1186/s13643-017-0638-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/23/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Systematic review guidance recommends the use of programme theory to inform considerations of if and how healthcare interventions may work differently across socio-economic status (SES) groups. This study aimed to address the lack of detail on how reviewers operationalise this in practice. METHODS A methodological systematic review was undertaken to assess if, how and the extent to which systematic reviewers operationalise the guidance on the use of programme theory in considerations of socio-economic inequalities in health. Multiple databases were searched from January 2013 to May 2016. Studies were included if they were systematic reviews assessing the effectiveness of an intervention and included data on SES. Two reviewers independently screened all studies, undertook quality assessment and extracted data. A narrative approach to synthesis was adopted. RESULTS A total of 37 systematic reviews were included, 10 of which were explicit in the use of terminology for 'programme theory'. Twenty-nine studies used programme theory to inform both their a priori assumptions and explain their review findings. Of these, 22 incorporated considerations of both what and how interventions do/do not work in SES groups to both predict and explain their review findings. Thirteen studies acknowledged 24 unique theoretical references to support their assumptions of what or how interventions may have different effects in SES groups. Most reviewers used supplementary evidence to support their considerations of differential effectiveness. The majority of authors outlined a programme theory in the "Introduction" and "Discussion" sections of the review to inform their assumptions or provide explanations of what or how interventions may result in differential effects within or across SES groups. About a third of reviews used programme theory to inform the review analysis and/or synthesis. Few authors used programme theory to inform their inclusion criteria, data extraction or quality assessment. Twenty-one studies tested their a priori programme theory. CONCLUSIONS The use of programme theory to inform considerations of if, what and how interventions lead to differential effects on health in different SES groups in the systematic review process is not yet widely adopted, is used implicitly, is often fragmented and is not implemented in a systematic way.
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Affiliation(s)
- Michelle Maden
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Alex Cunliffe
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Naoimh McMahon
- Faculty of Health and Wellbeing, University of Central Lancashire, Brook Building, Preston, PR1 2HE UK
| | - Andrew Booth
- Evidence Based Information Practice, School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | | | - Suzy Paisley
- Innovation and Knowledge Transfer (IKT), ScHARR, University of Sheffield, Sheffield, UK
| | - Rumona Dickson
- Liverpool Reviews and Implementation Group (LRIG), Department of Health Services Research, University of Liverpool, Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
| | - Mark Gabbay
- Department of Health Services Research, University of Liverpool, Block B Waterhouse Building, 1–5 Brownlow St., Liverpool, L69 3GL UK
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8
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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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9
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HEALTH TECHNOLOGY ASSESSMENT OF PUBLIC HEALTH INTERVENTIONS: A SYNTHESIS OF METHODOLOGICAL GUIDANCE. Int J Technol Assess Health Care 2017; 33:135-146. [DOI: 10.1017/s0266462317000228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: The evaluation of public health interventions poses some challenges. As a consequence, health technology assessment (HTA) methods for public health interventions (PHI) have to be adapted. This study aimed to summarize the available guidance on methods for HTA of PHI.Methods: We systematically searched for methodological guidance on HTA of PHIs. Our focus was on research synthesis methods to evaluate effectiveness. Relevant information was synthesized narratively in a standardized way.Results: Only four guidance documents were identified specifically for HTAs of PHI. The approaches used for HTAs of PHIs are broader and more flexible than those for medical interventions. For this reason, there is a tendency to identify the intervention components and context factors that influence the effectiveness and transferability of an intervention rather than to assess its effectiveness in general. The details in the guidance vary without justification. Unjustified heterogeneity between the different guidance approaches is most pronounced for quality assessment, assessment of applicability, and methods to integrate qualitative and quantitative evidence. Descriptions for the assessment of integrity, heterogeneity, sustainability, context factors, and applicability are often vague.Conclusions: The heterogeneity in approaches indicates that there is currently no consensus on methods to deal with the challenges of the PHI evaluations. A possible explanation for this may be that the methods are not sufficiently developed, and advantages and disadvantages of a certain method in relation to the research question (e.g., broad/focused) have not yet been sufficiently evaluated.
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10
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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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11
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Maden M. Consideration of health inequalities in systematic reviews: a mapping review of guidance. Syst Rev 2016; 5:202. [PMID: 27894332 PMCID: PMC5127052 DOI: 10.1186/s13643-016-0379-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 11/10/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Given that we know that interventions shown to be effective in improving the health of a population may actually widen the health inequalities gap while others reduce it, it is imperative that all systematic reviewers consider how the findings of their reviews may impact (reduce or increase) on the health inequality gap. This study reviewed existing guidance on incorporating considerations of health inequalities in systematic reviews in order to examine the extent to which they can help reviewers to incorporate such issues. METHODS A mapping review was undertaken to identify guidance documents that purported to inform reviewers on whether and how to incorporate considerations of health inequalities. Searches were undertaken in Medline, CINAHL and The Cochrane Library Methodology Register. Review guidance manuals prepared by international organisations engaged in undertaking systematic reviews, and their associated websites were scanned. Studies were included if they provided an overview or discussed the development and testing of guidance for dealing with the incorporation of considerations of health inequalities in evidence synthesis. Results are summarised in narrative and tabular forms. RESULTS Twenty guidance documents published between 2009 and 2016 were included. Guidance has been produced to inform considerations of health inequalities at different stages of the systematic review process. The Campbell and Cochrane Equity Group have been instrumental in developing and promoting such guidance. Definitions of health inequalities and guidance differed across the included studies. All but one guidance document were transparent in their method of production. Formal methods of evaluation were reported for six guidance documents. Most of the guidance was operationalised in the form of examples taken from published systematic reviews. The number of guidance items to operationalise ranges from 3 up to 26 with a considerable overlap noted. CONCLUSIONS Adhering to the guidance will require more work for the reviewers. It requires a deeper understanding of how reviewers can operationalise the guidance taking into consideration the barriers and facilitators involved. This has implications not only for understanding the usefulness and burden of the guidance but also for the uptake of guidance and its ultimate goal of improving health inequalities considerations in systematic reviews.
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Affiliation(s)
- Michelle Maden
- Department of Health Services Research, University of Liverpool, Liverpool Reviews and Implementation Group (LRIG), Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
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Welch V, Petkovic J, Pardo Pardo J, Rader T, Tugwell P. Interactive social media interventions to promote health equity: an overview of reviews. Health Promot Chronic Dis Prev Can 2016; 36:63-75. [PMID: 27077792 PMCID: PMC4964231 DOI: 10.24095/hpcdp.36.4.01] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Social media use has been increasing in public health and health promotion because it can remove geographic and physical access barriers. However, these interventions also have the potential to increase health inequities for people who do not have access to or do not use social media. In this paper, we aim to assess the effects of interactive social media interventions on health outcomes, behaviour change and health equity. METHODS We conducted a rapid response overview of systematic reviews. We used a sensitive search strategy to identify systematic reviews and included those that focussed on interventions allowing two-way interaction such as discussion forums, social networks (e.g. Facebook and Twitter), blogging, applications linked to online communities and media sharing. RESULTS Eleven systematic reviews met our inclusion criteria. Most interventions addressed by the reviews included online discussion boards or similar strategies, either as stand-alone interventions or in combination with other interventions. Seven reviews reported mixed effects on health outcomes and healthy behaviours. We did not find disaggregated analyses across characteristics associated with disadvantage, such as lower socioeconomic status or age. However, some targeted studies reported that social media interventions were effective in specific populations in terms of age, socioeconomic status, ethnicities and place of residence. Four reviews reported qualitative benefits such as satisfaction, finding information and improved social support. CONCLUSION Social media interventions were effective in certain populations at risk for disadvantage (youth, older adults, low socioeconomic status, rural), which indicates that these interventions may be effective for promoting health equity. However, confirmation of effectiveness would require further study. Several reviews raised the issue of acceptability of social media interventions. Only four studies reported on the level of intervention use and all of these reported low use. More research on established social media platforms with existing social networks is needed, particularly in populations at risk for disadvantage, to assess effects on health outcomes and health equity.
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Affiliation(s)
- V Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - J Petkovic
- Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada
| | - J Pardo Pardo
- Centre for Global Health, University of Ottawa, Ottawa, Ontario, Canada
| | - T Rader
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - P Tugwell
- Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ontario, Ottawa, Canada
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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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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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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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Assessing the applicability of findings in systematic reviews of complex interventions can enhance the utility of reviews for decision making. J Clin Epidemiol 2013; 66:1251-61. [DOI: 10.1016/j.jclinepi.2013.06.017] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 06/25/2013] [Accepted: 06/27/2013] [Indexed: 11/18/2022]
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