25
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Improving the use of research evidence in guideline development: 12. Incorporating considerations of equity

      review-article
      1 , , 2 , 1
      Health Research Policy and Systems
      BioMed Central

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the 12 th of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this.

          Objectives

          We reviewed the literature on incorporating considerations of equity in guidelines and recommendations.

          Methods

          We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments.

          Key questions and answers

          We found few directly relevant empirical methodological studies. These answers are based largely on logical arguments.

          When and how should inequities be addressed in systematic reviews that are used as background documents for recommendations?

          • The following question should routinely be considered: Are there plausible reasons for anticipating differential relative effects across disadvantaged and advantaged populations?

          • If there are plausible reasons for anticipating differential effects, additional evidence should be included in a review to inform judgments about the likelihood of differential effects.

          What questions about equity should routinely be addressed by those making recommendations on behalf of WHO?

          • The following additional questions should routinely be considered:

          • How likely is it that the results of available research are applicable to disadvantaged populations and settings?

          • How likely are differences in baseline risk that would result in differential absolute effects across disadvantaged and advantaged populations?

          • How likely is it that there are important differences in trade-offs between the expected benefits and harms across disadvantaged and advantaged populations?

          • Are there different implications for disadvantaged and advantaged populations, or implications for addressing inequities?

          What context specific information is needed to inform adaptation and decision making in a specific setting with regard to impacts on equity?

          • Those making recommendations on behalf of WHO should routinely consider and offer advice about the importance of the following types of context specific data that might be needed to inform adaptation and decision making in a specific setting:

          • Effect modifiers for disadvantaged populations and for the likelihood of differential effects

          • Baseline risk in relationship to social and economic status

          • Utilization and access to care in relationship to social and economic status

          • Costs in relationship to social and economic status

          • Ethics and laws that may impact on strategies for addressing inequities

          • Availability of resources to address inequities

          What implementation strategies are likely be needed to ensure that recommendations are implemented equitably?

          • Organisational changes are likely to be important to address inequities. While it may only be possible to consider these in relationship to specific settings, consideration should be given to how best to provide support for identifying and addressing needs for organisational changes. In countries with pervasive inequities institutional, cultural and political changes may first be needed.

          • Appropriate indicators of social and economic status should be used to monitor the effects of implementing recommendations on disadvantaged populations and on changes in social and economic status.

          Related collections

          Most cited references37

          • Record: found
          • Abstract: found
          • Article: not found

          The concepts and principles of equity and health.

          In 1984, the 32 member states of the World Health Organization European Region took a remarkable step forward in agreeing unanimously on 38 targets for a common health policy for the Region. Not only was equity the subject of the first of these targets, but it was also seen as a fundamental theme running right through the policy as a whole. However, equity can mean different things to different people. This article looks at the concepts and principles of equity as understood in the context of the World Health Organization's Health for All policy. After considering the possible causes of the differences in health observed in populations--some of them inevitable and some unnecessary and unfair--the author discusses equity in relation to health care, concentrating on issues of access to care, utilization, and quality. Lastly, seven principles for action are outlined, stemming from these concepts, to be borne in mind when designing or implementing policies, so that greater equity in health and health care can be promoted.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Defining equity in health.

            To propose a definition of health equity to guide operationalisation and measurement, and to discuss the practical importance of clarity in defining this concept. Conceptual discussion. Setting, Patients/Participants, and Main results: not applicable. For the purposes of measurement and operationalisation, equity in health is the absence of systematic disparities in health (or in the major social determinants of health) between groups with different levels of underlying social advantage/disadvantage-that is, wealth, power, or prestige. Inequities in health systematically put groups of people who are already socially disadvantaged (for example, by virtue of being poor, female, and/or members of a disenfranchised racial, ethnic, or religious group) at further disadvantage with respect to their health; health is essential to wellbeing and to overcoming other effects of social disadvantage. Equity is an ethical principle; it also is consonant with and closely related to human rights principles. The proposed definition of equity supports operationalisation of the right to the highest attainable standard of health as indicated by the health status of the most socially advantaged group. Assessing health equity requires comparing health and its social determinants between more and less advantaged social groups. These comparisons are essential to assess whether national and international policies are leading toward or away from greater social justice in health.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              A consumer's guide to subgroup analyses.

              The extent to which a clinician should believe and act on the results of subgroup analyses of data from randomized trials or meta-analyses is controversial. Guidelines are provided in this paper for making these decisions. The strength of inference regarding a proposed difference in treatment effect among subgroups is dependent on the magnitude of the difference, the statistical significance of the difference, whether the hypothesis preceded or followed the analysis, whether the subgroup analysis was one of a small number of hypotheses tested, whether the difference was suggested by comparisons within or between studies, the consistency of the difference, and the existence of indirect evidence that supports the difference. Application of these guidelines will assist clinicians in making decisions regarding whether to base a treatment decision on overall results or on the results of a subgroup analysis.
                Bookmark

                Author and article information

                Journal
                Health Res Policy Syst
                Health Research Policy and Systems
                BioMed Central (London )
                1478-4505
                2006
                5 December 2006
                : 4
                : 24
                Affiliations
                [1 ]Norwegian Knowledge Centre for the Health Services, P.O. Box 7004, St. Olavs plass, N-0130 Oslo, Norway
                [2 ]INFORMA, S.C. Epidemiologia, Istitituto Regina Elena, Via Elio Chianesi 53, 00144 Rome, Italy
                Article
                1478-4505-4-24
                10.1186/1478-4505-4-24
                1702352
                17147814
                0e2f0ef7-91aa-4e07-9ea3-7b9817b989a3
                Copyright © 2006 Oxman et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 7 April 2006
                : 5 December 2006
                Categories
                Review

                Health & Social care
                Health & Social care

                Comments

                Comment on this article