Seven Principles for Integrating Health Equity Considerations in the Practice Guideline Enterprise

Abstract

BackgroundHealth equity aims to provide all individuals with equal and fair opportunities to achieve optimal health. Practice guidelines can play a pivotal role in advancing health equity, yet, few organizations utilize tools to systematically integrate health equity considerations. Thus, it is important to establish a foundation for practical tools to support the systematic integration of health equity considerations. This manuscript proposes principles for the integration of health equity considerations in the practice guideline enterprise.MethodsIn the process of developing an equity extension for the GIN-McMaster guideline development checklist, we established a diverse advisory group of guideline developers, patients, members of the public experiencing inequities, health equity researchers and guideline developers. We formulated the principles informed by a methodological review of guideline handbooks, and iterative discussions between working group members.ResultsWe identified seven principles for considering integrating health equity considerations in the practice guideline enterprise. 1) Articulating health equity, 2) a priori planning for considering health equity, 3) Selection and engagement with individuals with lived experiences of inequities, 4) Equity in evidence synthesis, 5) Developing equity-informed recommendations, 6) Inclusive knowledge mobilization, and 7) Evaluating the impact of health equity considerations. We elaborated on the importance of the principles using published examples and mapped them to the different phases of the guideline development process.ConclusionsGuideline developers should adhere to these principles in the development of guidelines and health equity guideline development and appraisal tools. These principles are the foundational concepts for developing health equity extension items for the GIN-McMaster guideline development checklist.

Note:
Funding declaration: This work was partially funded by Public Health Agency of Canada. The funder was not involved in the conceptualization or design of the project.

Conflict of Interests: Omar Dewidar, Vivian Welch, Elie A. Akl, Kevin Pottie and Peter Tugwell are the co-leads of the GRADE-Equity Project Group. The previously mentioned authors and Jordi Pardo Pardo have authored some of the guidance cited in this manuscript. Andrea J. Darzi and Jordi Pardo Pardo are the co-leads of the Equity in implementation tools category of the Cochrane Equity Thematic group.

Ethical Approval: This study was approved by the University of Ottawa Ethics Board (H-03-24-10188) and conducted in accordance with their policies and procedures.

Keywords: Guidelines, equity, diversity and inclusion, contextualization, principles