ProjectsNIHR Policy Reviews FacilityGuidance on considering and reporting health equity issues in reviews
Guidance on considering and reporting methods for investigating health equity issues in systematic reviews and other evidence syntheses

Contact: Ian Shemilt

Start Date: 2023-

End Date: N/A (Ongoing) 
 

Background

Health inequities are unfair, systematic disparities in health outcomes between population subgroups, arising from the social conditions in which people live, and they are therefore associated with people’s social, economic or personal characteristics. Health inequities are closely related to (and reflect) issues of equality, diversity and inclusion, as they are most often experienced by marginalised, at-risk and/or socially excluded people, members of inclusion health groups and/or those with protected characteristics. People in equity-related subgroups may be identified in terms of a range of personal characteristics, reflecting multiple dimensions of health inequity, including (but not limited to): age; sex; gender; sexual identity; race, ethnicity and ancestry, socio-economic status; level of education; disability; and/or location (country).


 

About this guidance

We have primarily developed this guidance and suite of tools to provide a flexible template for promoting routine consideration and reporting of methods and processes for incorporating health equity perspectives and/or investigating health equity issues in protocols and full reviews or maps conducted by the UK National Institute of Health Research (NIHR) Policy Research Programme (PRP) Reviews Facility ('NIHR PRP Reviews Facility'). It aims to draw together several relevant strands of methods guidance and tools for systematic reviews (see 'Signposted wider sources of guidance and tools', below). 

The guidance is intended for users with advanced expertise in systematic review and evidence synthesis methods. To apply this guidance, users will need to be closely familiar with details of the wider sources of methods guidance and tools it draws together and signposts, and their implications for conducting reviews (see 'Signposted wider sources of guidance and tools', below). 

The current version of this guidance and tools is Version 1.0 (October 2024). This version is currently undergoing its first phase of piloting (see below for details).

These materials will evolve as we continue to develop them, and updated versions will be made available on this webpage. The next steps are that we plan: (1) to iteratively develop and (pilot) test this guidance and suite of tools using selected NIHR PRP Reviews Facility (and other) evidence synthesis projects; and (2) to (continue to) collaborate with other interested researchers, groups and networks, to formally develop the methods guidance and tools to make them broadly applicable for wider use by the international systematic reviews and evidence synthesis communities. 
 

Guidance and tools

The 'main guidance document' should be used as the main source. This contains various figures and tables, which are also provided separately for ease of reference and re-sizing.

Main guidance document (.docx)

Overview of signalling questions (.png)

Checklist (x3): Table A | Table B | Table C (.docx)

Flowcharts (x3): Figure 1 | Figure 2 | Figure 3 (.png)
 

Signposted wider sources of guidance and tools


PRISMA Reporting Guidelines and Checklists  

PRISMA (2012): PRISMA-E Explanation and Elaboration
PRISMA (2015): PRISMA-P Elaboration and Explanation 
PRISMA (2020): PRISMA Explanation and Elaboration

PRO-EDI Tools and Guidance on Equity, Diversity and Inclusion in Evidence Synthesis

PRO-EDI (2024): Improving how equity, diversity and inclusion is handled in evidence synthesis
PRO-EDI (2024): Characteristics of included participants table template (short)
PRO-EDI (2024): Characteristics of included participants table template and detailed guidance
PRO-EDI (2024): Characteristics of included participants table template interpretation / examples

GRADE Guidance on Assessing Certainty of Evidence

GRADE (2023): Assessing certainty of evidence: Inconsistency
GRADE (2011): Assessing certainty of evidence: Indirectness

EPPI Centre Guidance on Analysis / Synthesis Methods

EPPI Centre (2017): Chapter 9: Synthesis Methods for Combining and Configuring Quantitative Data
EPPI Centre (2017): Chapter 8: Chapter Synthesis Methods for Combining and Configuring Textual or Mixed Methods Data
EPPI Centre (2014): Qualitative Comparative Analysis (QCA)
 

Enquiries and support

For enquiries, or to access support for piloting this guidance, please contact Ian Shemilt.
 

How to cite this guidance

Shemilt I, Hollands GJ, D'Souza P, Macdowall W, Sutcliffe K. (2024). Considering and reporting methods for investigating health equity issues in systematic reviews and other evidence syntheses. (Version 1.0. October 2024). London: EPPI Centre, Social Science Research Unit, UCL Institute of Education, University College London. 
 

Acknowledgements

We thank Shaun Treweek (Health Services Research Unit, University of Aberdeen) for the valued informal mentorship and advice he has provided to us during this project. We also thank our colleague Carol Rivas (Social Science Research Unit, UCL) who has also provided valued advice and has recently joined the core team of developers of the materials posted on this web page (guidance and suite of tools). We also thank our NIHR PRP Reviews Facility colleagues Dylan Kneale (EPPI Centre) and Amanda Sowden (Centre for Reviews and Dissemination (CRD)) for providing their feedback and comments on an earlier draft of these materials. 
 

Further information

This work is being conducted under the auspices of the NIHR PRP Reviews Facility. The NIHR PRP Reviews Facility is a collaboration between the EPPI Centre (UCL), the CRD (University of York), and the Department of Public Health, Environments and Society (PHES, London School of Hygiene and Tropical Medicine). The views expressed in this publication are those of the authors and not necessarily those of the UK National Health Service (NHS), the UK National Institute for Health Research (NIHR) or the UK Department for Health and Social Care (DHSC).

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