Methods used to conceptualise dimensions of health equity impacts of public health interventions in systematic reviews

Gareth J Hollands, Emily South, Ian Shemilt, Sandy Oliver, James Thomas, Amanda J Sowden

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Our aims were to, first, identify and summarise the use of methods, frameworks, and tools as a conceptual basis for investigating dimensions of equity impacts of public health interventions in systematic reviews including an equity focus. These include PROGRESS-Plus, which identifies key sociodemographic characteristics that determine health outcomes. Second, we aimed to document challenges and opportunities encountered in the application of such methods, as reported in systematic reviews.

Study Design and Setting
We conducted a methodological study, comprising an overview of systematic reviews with a focus on, or that aimed to assess, the equity impacts of public health interventions. We used electronic searches of the Cochrane Database of Systematic Reviews, the Database of Promoting Health Effectiveness Reviews (DoPHER), and the Finding Accessible Inequalities Research in Public Health (FAIR) Database, supplemented with automated searches of the OpenAlex dataset. An active learning algorithm was used to prioritise title-abstract records for manual screening against eligibility criteria. We extracted and analysed a core dataset from a purposively selected sample of reviews, to summarise key characteristics and approaches to conceptualising investigations of equity.

We assessed 322 full-text reports for eligibility, from which we included 120 reports of systematic reviews. PROGRESS-Plus was the only formalised framework used to conceptualise dimensions of equity impacts. Most reviews were able to apply their intended methods to at least some degree. Where intended methods were unable to be applied fully, this was usually because primary research studies did not report the necessary information. A general rationale for focusing on equity impacts was often included, but few reviews explicitly justified their focus on (or exclusion of) specific dimensions. In addition to practical challenges such as data not being available, authors highlighted significant measurement and conceptual issues with applying these methods which may impair the ability to investigate and interpret differential impacts within and between studies. These issues included investigating constructs that lack standardised operationalisation and measurement, and the complex nature of differential impacts, with dimensions that may interact with one another, as well as with particular temporal, personal, social or geographic contexts.

PROGRESS-Plus is the predominant framework used in systematic reviews to conceptualise differential impacts of public health interventions by dimensions of equity. It appears sufficiently broad to encompass dimensions of equity examined in most investigations of this kind. However, PROGRESS-Plus does not necessarily ensure or guide critical thinking about more complex pathways or interactions between dimensions of equity, nor with wider contextual factors, and important practical, measurement and conceptual challenges remain. The findings from investigations of equity impacts in systematic reviews could be made more useful through more explicitly rationalised and considered approaches to the design, conduct and reporting of both primary research and the reviews themselves.

Registration: Registered on PROSPERO (CRD42022371805).
Original languageEnglish
Article number111312
Number of pages13
JournalJournal of Clinical Epidemiology
Publication statusPublished - 1 Mar 2024

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© 2024 The Author(s).

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