Table 2.

GRADE guidelines and health equity: four examples

When to think about health equity in guideline development	Consideration of health equity	Community water fluoridation, community guide, 2014 [51]	Canadian migrant health guidelines, 2010 [28]	WHO guidelines on HIV and STI prevention for MSM and transgender people, 2011 [52]	Colombia guidelines on preventing complications in pregnancy and childbirth, 2013 [53]
Question formulation and priorities, scope definition & group membership	What are the priorities of disadvantaged groups or populations, and how does this affect the key questions?	Logic models were developed to include health disparities as an outcome of interest. The panel included experts with experience in socioeconomically disadvantaged regions	Priorities were set by Delphi surveys of practitioners working with migrants. Panel included primary care and specialist practitioners working with immigrant and refugee populations, and the methods included assessment of health equity considerations of baseline risk; genetic and cultural factors; and adherence variation [50]	Panel included content experts from community-based organizations; key outcomes included quality of life and stigma/discrimination because of their perceived relevance to the population of interest	Panel included specialists in health equity, including practitioners working in disadvantaged low-income settings
Evidence assessment (i.e., in systematic review of the evidence)	1.Analysis of differences of effect (baseline risk and effectiveness) 2.Targeted interventions 3.Quality assessment of directness	Assessed evidence from studies about effects of fluoridation in low socioeconomic status areas	The panel rated the directness of evidence for immigrant and refugee populations explicitly. Evidence was considered direct (transferable) because although no studies focused on immigrants or refugees, the panel felt that there was no good reason why the results would not apply	Panel searched for studies targeted toward or focused on transgender and MSM but did not find any. Panel decided that evidence was direct, although most studies were not in MSM or transgender people	Evidence was assessed for specific disadvantaged populations in terms of baseline risk, e.g., risk of malnutrition for low-income mothers
Evidence to recommendation	Balance of likely impact on health equity with other factors	Evidence on health disparities was considered in formulating the recommendation by including a row in their summary table on effect on disparities	Evidence on immigrant-specific baseline risk and outcomes were considered in developing recommendations	Values of MSM and transgender people incorporated by community representatives on the panel and a survey of MSM and transgender people. Resource use in resource-constrained setting was influential in recommending against male circumcision	Equity was considered in developing recommendations by adding a separate recommendation for socioeconomically disadvantaged women at high risk of malnutrition

Abbreviations: GRADE, Grading of Recommendations Assessment, Development and Evaluation; WHO, World Health Organization; HIV, human immunodeficiency virus; STI, sexually transmitted infection; MSM, men who have sex with men.

Community water fluoridation: (http://www.thecommunityguide.org/oral/supportingmaterials/RRfluoridation.html).