Seven principles for integrating health equity considerations in the practice guideline enterprise

BACKGROUND AND OBJECTIVES: Health equity aims to provide all individuals with equal and fair opportunities to achieve optimal health. Practice guidelines can play a pivotal role in advancing health equity; yet, few organizations use tools to systematically integrate health equity considerations. Thus, it is important to establish a foundation for practical tools to support the systematic integration of health equity considerations. This manuscript proposes principles for the integration of health equity considerations in the practice guideline enterprise. METHODS: In the process of developing an equity extension for the GIN-McMaster guideline development checklist, we established a diverse advisory group of guideline developers, patients, members of the public experiencing inequities, health equity researchers, and guideline developers. We formulated the principles informed by a methodological review of guideline handbooks and iterative discussions between working group members. RESULTS: We identified the following seven principles for integrating health equity considerations into the practice guideline enterprise: (1) articulating health equity, (2) a priori planning for considering health equity, (3) selection and engagement of individuals with lived experiences of inequities, (4) equity in evidence synthesis, (5) developing equity-informed recommendations, (6) inclusive knowledge mobilization, and (7) evaluating the impact of health equity considerations. We elaborated on the importance of the principles using published examples and mapped them to the different phases of the guideline development process. CONCLUSION: Guideline developers should adhere to these principles in the development of guidelines and health equity guideline development and appraisal tools. These principles are the foundational concepts for developing health equity extension items for the GIN-McMaster guideline development checklist.