Maden Michelle
Department of Health Services Research, University of Liverpool, Liverpool Reviews and Implementation Group (LRIG), Second Floor, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
Syst Rev. 2016 Nov 28;5(1):202. doi: 10.1186/s13643-016-0379-1.
Given that we know that interventions shown to be effective in improving the health of a population may actually widen the health inequalities gap while others reduce it, it is imperative that all systematic reviewers consider how the findings of their reviews may impact (reduce or increase) on the health inequality gap. This study reviewed existing guidance on incorporating considerations of health inequalities in systematic reviews in order to examine the extent to which they can help reviewers to incorporate such issues.
A mapping review was undertaken to identify guidance documents that purported to inform reviewers on whether and how to incorporate considerations of health inequalities. Searches were undertaken in Medline, CINAHL and The Cochrane Library Methodology Register. Review guidance manuals prepared by international organisations engaged in undertaking systematic reviews, and their associated websites were scanned. Studies were included if they provided an overview or discussed the development and testing of guidance for dealing with the incorporation of considerations of health inequalities in evidence synthesis. Results are summarised in narrative and tabular forms.
Twenty guidance documents published between 2009 and 2016 were included. Guidance has been produced to inform considerations of health inequalities at different stages of the systematic review process. The Campbell and Cochrane Equity Group have been instrumental in developing and promoting such guidance. Definitions of health inequalities and guidance differed across the included studies. All but one guidance document were transparent in their method of production. Formal methods of evaluation were reported for six guidance documents. Most of the guidance was operationalised in the form of examples taken from published systematic reviews. The number of guidance items to operationalise ranges from 3 up to 26 with a considerable overlap noted.
Adhering to the guidance will require more work for the reviewers. It requires a deeper understanding of how reviewers can operationalise the guidance taking into consideration the barriers and facilitators involved. This has implications not only for understanding the usefulness and burden of the guidance but also for the uptake of guidance and its ultimate goal of improving health inequalities considerations in systematic reviews.
鉴于我们知道，一些被证明对改善人群健康有效的干预措施实际上可能会扩大健康不平等差距，而其他措施则会缩小这一差距，因此所有系统评价者都必须考虑其评价结果可能如何影响（缩小或扩大）健康不平等差距。本研究回顾了关于在系统评价中纳入健康不平等考量的现有指南，以考察它们在多大程度上能够帮助评价者纳入此类问题。
进行了一项映射综述，以识别旨在告知评价者是否以及如何纳入健康不平等考量的指南文件。检索了Medline、CINAHL和Cochrane图书馆方法学注册库。扫描了从事系统评价的国际组织编写的评价指南手册及其相关网站。纳入的研究需提供概述或讨论处理在证据综合中纳入健康不平等考量的指南的制定和测试情况。结果以叙述和表格形式进行总结。
纳入了2009年至2016年期间发表的20份指南文件。已制定指南以指导在系统评价过程的不同阶段对健康不平等进行考量。坎贝尔协作网和Cochrane公平小组在制定和推广此类指南方面发挥了重要作用。纳入研究中关于健康不平等的定义和指南各不相同。除一份指南文件外，所有文件在制定方法上都是透明的。有六份指南文件报告了正式的评估方法。大多数指南以已发表系统评价中的实例形式实施。实施的指南项目数量从3项到26项不等，存在相当大的重叠。
评价者遵循这些指南需要做更多工作。这需要更深入地了解评价者如何在考虑到相关障碍和促进因素的情况下实施这些指南。这不仅对理解指南的有用性和负担有影响，而且对指南的采用及其在系统评价中改善健康不平等考量的最终目标也有影响。
