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How equity is addressed in clinical practice guidelines: a content analysis
  1. Chunhu Shi1,2,
  2. Jinhui Tian1,2,
  3. Quan Wang1,2,3,
  4. Jennifer Petkovic4,
  5. Dan Ren3,
  6. Kehu Yang1,2,
  7. Yang Yang5
  1. 1Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
  2. 2Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
  3. 3The First Clinical Medicine School, Lanzhou University, Lanzhou, China
  4. 4Centre for Global Health, University of Ottawa, Ottawa, Canada
  5. 5School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
  1. Correspondence to Professor Kehu Yang; kehuyangebm2006{at}126.com

Abstract

Objectives Considering equity into guidelines presents methodological challenges. This study aims to qualitatively synthesise the methods for incorporating equity in clinical practice guidelines (CPGs).

Setting Content analysis of methodological publications.

Eligibility criteria for selecting studies Methodological publications were included if they provided checklists/frameworks on when, how and to what extent equity should be incorporated in CPGs.

Data sources We electronically searched MEDLINE, retrieved references, and browsed guideline development organisation websites from inception to January 2013. After study selection by two authors, general characteristics and checklists items/framework components from included studies were extracted. Based on the questions or items from checklists/frameworks (unit of analysis), content analysis was conducted to identify themes and questions/items were grouped into these themes.

Primary outcomes The primary outcomes were methodological themes and processes on how to address equity issues in guideline development.

Results 8 studies with 10 publications were included from 3405 citations. In total, a list of 87 questions/items was generated from 17 checklists/frameworks. After content analysis, questions were grouped into eight themes (‘scoping questions’, ‘searching relevant evidence’, ‘appraising evidence and recommendations’, ‘formulating recommendations’, ‘monitoring implementation’, ‘providing a flow chart to include equity in CPGs’, and ‘others: reporting of guidelines and comments from stakeholders’ for CPG developers and ‘assessing the quality of CPGs’ for CPG users). Four included studies covered more than five of these themes. We also summarised the process of guideline development based on the themes mentioned above.

Conclusions For disadvantaged population-specific CPGs, eight important methodological issues identified in this review should be considered when including equity in CPGs under the guidance of a scientific guideline development manual.

  • QUALITATIVE RESEARCH
  • PUBLIC HEALTH

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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