Synthesizing the Current Methodology Landscape
Open Access DepositedHealth Equity Considerations in Guideline Development Handbooks
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We developed the Equity Assessment Tool (EquAT) for guideline development handbooks. To create our tool, we first scoped published literature to identify “essential elements,” or tasks that experts agree are part of guideline creation. Next, we mapped these essential elements with related health equity considerations from published literature. We drafted our tool to include criteria, or explicit language an assessor should look for when assessing a guideline development handbook. To establish face and content validity we first conducted an online survey and asked experts for their feedback on the criteria in the draft tool. We use qualitative coding to categorize feedback and revised the tool accordingly. We piloted the revised tool using the World Health Organization Handbook for Guideline Development, 2nd edition (2014) and finalized our tool. We systematically searched for national-level guideline development handbooks and then applied the final tool to each handbook. One assessor applied the EquAT tool to each guideline development handbook and documented missing criteria. To further understand the usefulness of this tool, two assessors separately rated two guideline development handbooks and compared their assessments. Results
Clinical practice guidelines (CPGs) are statements intended to optimize patient health. Since the 1990s, evidence-based CPG publication rapidly accelerated, and forced their audiences to question their quality and variability. In response, several authoring organizations created guideline development handbooks, which provide guideline development teams with instructions on how to create clinical practice/public health guidelines. Referenced widely, guideline development handbooks are one upstream way to influence health equity considerations in CPGs. Previous literature has highlighted the importance of health equity in the clinical practice guideline development process. The purpose of this dissertation is to develop and test a tool focused solely on guideline development handbooks and the extent to which they support health equity. Methods
We successfully developed and tested the EquAT, a novel tool for assessing health equity in guideline development handbooks. The focus of our tool should not be the specific scores, but rather the discussions that this tool fosters. Groups might use this tool to review their handbooks and to prompt discussions about opportunities for improvement. The EquAT tool can enable informed conversations about helpful ways to better address health equity in guideline development.
Background
We identified 18 essential elements, or commonly agreed upon tasks, of guideline development. Results from our survey showed that 20 experts generally agreed on health equity focused tasks of guideline development. These experts offered feedback on how to improve existing criteria with additional language. During our pilot test with the WHO guideline development handbook, experts expressed a diversity of opinions on the relevance of the tool to health equity focused content. Reasons include differences in health equity frameworks, and expertise. We identified 10 guideline development handbooks and assessed them using our final EquAT tool. We found variation in the degree to which guideline development handbook content considered health equity. In our sample of two assessors, the two disagreed about a third of the time. Reasons for differences between the two reviewers includes variation in understanding of health systems context. Conclusions
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