Practice guidelines on migrants' health: assessment of their quality and reporting

Abstract

Background: Migrants may carry with them communicable and non communicable diseases as they move to the host country. Screening migrants may help in improving their health status and in preventing the spread of infections to the host population.

Objective: To identify and assess the quality of published practice guidelines addressing migrants' health.

Methods: We included practice guidelines addressing migrants' health at the clinical, public health or health systems levels. We searched Medline, Embase, the National Guideline Clearinghouse and the Canadian Medical Association's Clinical Practice Guidelines Database. Two teams of two reviewers conducted in duplicate and independent manner study selection, data abstraction, assessment of the guideline quality (using the AGREE II instrument), and assessment of the quality of the reporting (using the RIGHT statement).

Results: Out of 2732 citations captured by the electronic search, we included 24 eligible practice guidelines, all addressing the level of post-arrival to the host country and published between 2011 and 2017. The majority of guidelines (57%) addressed non-communicable diseases, 95% addressed screening, while 52% addressed prevention and treatment respectively. The majority of the guidelines reported their funding sources. 86% used the GRADE approach as part of the development process. The included guidelines scored high on the majority of the items, and low on the following two domains of the AGREE II instrument: rigor of development and applicability. The mean number of the RIGHT checklist items met by the included guidelines was 27, out of a total of 35. Most of the guidelines were based on systematic reviews (95.6%). A minority of the included guidelines (26%) reported considering the values and preferences of the target populations or the costs and resource implications (30%) in the formulation of recommendations.

Conclusion: We identified 23 practice guidelines addressing migrants' health, the majority of which addressed screening services. The vast majority of the captured guidelines targeted screening because the population of interest is migrants, meaning that the intention of the guidelines is to deal with additional factors than usual ones, such as prevalence of disease in country of origin, endemic diseases and others. The guidelines suffered limitations on two quality domains (rigor of development and applicability), and have room for improvement of their reporting.

Keywords: Clinical practice guidelines; Health; Migrants; Quality; Refugees; Systematic.

Fig. 1

PRISMA Flow Diagram; Legend: This diagram shows the systematic process we followed to include papers captured by our search

Fig. 2

The Appraisal of Guidelines for REsearch and Evaluation (AGREE II) results per domain for each included guideline (N = 23); Legend: The X-axis: number referring to included guideline from Table B; Y-axis: percentage score on Agree II domain: Bule: Domain 1: Scope and purpose; Red: Domain 2: Stakeholder involvement; Green: Domain 3: Rigor of development; Purple: Domain 4: Clarity of presentation; Light blue: Domain 5: Applicability; Orange: Domain 6: Editorial Independence

Fig. 3

The Reporting Items for practice Guidelines in HealThcare (RIGHT) fulfilled by the eligible guidelines. Legend