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GRADE equity guidelines 1: considering health equity in GRADE guideline development: introduction and rationale
Vivian A Welch1, Elie A Akl2, Gordon Guyatt3
1Bruyère Research Institute, Bruyère Continuing Care, University of Ottawa, 304b-85 Primrose Avenue, Ottawa, Ontario, Canada K1R 6M1; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Faculty of Medicine, Room 101, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G-5Z3.
This study outlines how to integrate health equity into the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Explicitly considering equity in guideline development promotes health equity.
Area of Science:
- Health Equity Research
- Clinical Guideline Development
- Public Health Policy
Background:
- Health equity is crucial for fair healthcare delivery.
- Existing guideline methodologies may not adequately address health equity.
- There is a need to integrate health equity considerations into established frameworks.
Purpose of the Study:
- To introduce the rationale for incorporating health equity into the GRADE methodology.
- To present methods for explicitly considering health equity in guideline development.
- To enhance the development of clinical, public health, and health system guidelines.
Main Methods:
- Systematic literature search for guideline methodology and health equity articles.
- Analysis of existing guidelines that explicitly addressed health equity.
- Consultation with GRADE Working Group members and broader stakeholder feedback.
Main Results:
- Development of three key articles focusing on equity integration.
- Guidance on incorporating equity into the overall guideline approach.
- Methods for rating certainty and evidence to decision (EtD) frameworks with an equity lens.
Conclusions:
- Clinical and public health guidelines can actively promote health equity.
- Explicitly considering equity within the GRADE methodology is essential for guideline development.
- This approach strengthens the impact of guidelines on health equity.
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