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McMaster GRADE Centre

Checklist Extension for Health Equity

Equity Extension of the GIN-McMaster Guideline Development Checklist

See the publication here: 

Akl EA, Welch V, Pottie K, Eslava-Schmalbach J, Darzi A, Sola I, et al. GRADE equity guidelines 2: considering health equity in GRADE guideline development: equity extension of the guideline development checklist. J Clin Epidemiol. 2017 Oct;90:68-75. https://www.jclinepi.com/article/S0895-4356(17)30470-5/fulltext

 

The authors of the equity extension note, “The checklist includes 18 stages of the guideline development process, from the organizational aspects, to the development of recommendations, to their implementation, evaluation, and update. Although equity could potentially be taken into consideration at each of these stages, we provide specific suggestions on how to consider equity for the following most relevant stages.” Please refer to the publication for the complete guidance and suggestions:

 

Step

Specific Suggestions

2. Setting priorities

· Consider dedicating part of or a whole guideline (as opposed to no part) to the care of disadvantaged populations

3. Guideline group membership

· Include representatives of the disadvantaged populations in the different guideline groups, particularly the voting panel;

 

· Ensure the method for recruitment of group members considers representatives of all relevant disadvantaged populations;

 

· Recruit a methodologist who is familiar with and mindful of equity issues

 

· Ensure the chair of the voting panel is familiar with equity issues.

5. Identifying the target audience(s)

· Specify relevant disadvantaged populations when identifying the target audience(s);

 

· Involve representatives of disadvantaged populations when identifying the target audience(s).

8. Generating the guideline questions

· Consider equity when specifying elements of the PICO questions;

 

· Consider “good-practice statements” that could help address equity issues.

9. Considering the importance of outcomes and interventions

· Involve representatives of disadvantaged populations in rating the importance of interventions and outcomes;

 

· Search selected databases (e.g., UK DUETs, COMET) for outcomes rated as important by disadvantaged populations;

 

· Consider separate recommendations for disadvantaged populations if their values and preferences are thought to differ substantively to the point of affecting the strength and/or direction of recommendation.

10. Deciding what evidence to include and searching for evidence

· Seek evidence specific to disadvantaged populations, for example, baseline risks specific to those groups;

 

· Consider including evidence derived from fields other than health (e.g., social science) that address disadvantaged populations.

 

· Search literature published in the language relevant to the disadvantaged population

11. Summarizing the evidence and considering additional information

· Consider the PROGRESS-plus elements when synthesizing the evidence;

 

· Follow the PRISMA-equity statement when reporting the systematic reviews;

 

· Consider information on resource use, cost, effect on equity, feasibility, and acceptability from the perspective of disadvantaged populations.

14. Wording of recommendations

· Be as specific as possible in defining the population to maximize the understanding that it applies to a disadvantaged populations (when applicable);

 

· Include the necessary remarks following the recommendation to ensure its appropriate implementation in disadvantaged populations;

 

· Ensure that language is used carefully so that the recommendation does not stigmatize already disadvantaged populations.

17. Evaluation and use

· Produce tools to facilitate implementation and use among disadvantaged populations;

 

· Monitor and audit implementation and use among disadvantaged populations.