Enhancing health equity considerations in guidelines: health equity extension of the GIN-McMaster Guideline Development Checklist

Omar Dewidar^{1

2}, Shahab Sayfi³, Jordi Pardo Pardo⁴, Vivian Welch^{2

5}, Grace C Wright^{6

7}, Elie A Akl^{3

8}, Joanne Khabsa⁹, Jennifer S Lin¹⁰, Xiaoqin Wang^{11

12}, Andrea J Darzi^{3

13

14}, Tamara Lotfi¹⁵, Kevin Pottie^{16

17}, Jana Khawandi¹⁸, Rebecca L Morgan^{3

19}, Ana Carolina Pereira Nunes Pinto²⁰, Janice Tufte²¹, Sue E Brennan²², Ashley Motilall^{3

23}, Oyekola Oloyede²⁴, Reem A Mustafa^{25

3}, Jennifer Petkovic², Robby Nieuwlaat^{3

23}, Jun Xia^{26

27}, Xiaomei Yao^{3

28}, Yuan Chi²⁹, Holger J Schünemann^{30

31}, Peter Tugwell^{32

33

34}

Affiliations

¹ Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Bruyère Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁴ Ottawa Centre for Health Equity, University of Ottawa, Ottawa, Ontario, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Association of Women in Rheumatology, USA.
⁷ Grace C Wright MD PC Inc, New York, NY, USA.
⁸ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁹ Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
¹⁰ Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, OR, USA.
¹¹ Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
¹² University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
¹³ Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
¹⁴ Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada.
¹⁵ Cochrane Canada & GRADE McMaster, Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
¹⁶ CT Lamont Centre for Primary Care, Bruyère Health Research Institute, Ottawa, Ontario, Canada.
¹⁷ Department of Family Medicine, Western University, London, Ontario, Canada.
¹⁸ Evidence-Based Practice and Impact Center, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
¹⁹ School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
²⁰ Iberoamerican Cochrane Center, Barcelona, Spain.
²¹ Cochrane Consumer, COVID-END Equity group, Seattle, WA, USA.
²² School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
²³ Michael G. DeGroote Cochrane Canada, MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada.
²⁴ Sefako Makgatho Health Sciences University, South Africa.
²⁵ Department of Internal Medicine, University of Kansas Health System, Kansas City, KS, USA.
²⁶ Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China.
²⁷ School of Economics, University of Nottingham Ningbo, China.
²⁸ Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
²⁹ Yealth Network, Beijing Yealth Technology Co., Ltd, China.
³⁰ Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Milan, Italy.
³¹ WHO Collaborating Center for Evidence-Based Decision-Making in Health, Humanitas University, Milan, Italy.
³² Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³⁴ WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Health Research Institute, Ottawa, Ontario, Canada.

PMID: 40224676
PMCID: PMC11992520
DOI: 10.1016/j.eclinm.2025.103135

Enhancing health equity considerations in guidelines: health equity extension of the GIN-McMaster Guideline Development Checklist

Omar Dewidar et al. EClinicalMedicine. 2025.

. 2025 Mar 28:82:103135.

doi: 10.1016/j.eclinm.2025.103135. eCollection 2025 Apr.

Authors

Affiliations

¹ Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Bruyère Health Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
³ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
⁴ Ottawa Centre for Health Equity, University of Ottawa, Ottawa, Ontario, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Association of Women in Rheumatology, USA.
⁷ Grace C Wright MD PC Inc, New York, NY, USA.
⁸ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁹ Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon.
¹⁰ Kaiser Permanente Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, OR, USA.
¹¹ Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.
¹² University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
¹³ Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.
¹⁴ Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, Ontario, Canada.
¹⁵ Cochrane Canada & GRADE McMaster, Health Research Methods, Evidence & Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
¹⁶ CT Lamont Centre for Primary Care, Bruyère Health Research Institute, Ottawa, Ontario, Canada.
¹⁷ Department of Family Medicine, Western University, London, Ontario, Canada.
¹⁸ Evidence-Based Practice and Impact Center, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
¹⁹ School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
²⁰ Iberoamerican Cochrane Center, Barcelona, Spain.
²¹ Cochrane Consumer, COVID-END Equity group, Seattle, WA, USA.
²² School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
²³ Michael G. DeGroote Cochrane Canada, MacGRADE Centres, McMaster University, Hamilton, Ontario, Canada.
²⁴ Sefako Makgatho Health Sciences University, South Africa.
²⁵ Department of Internal Medicine, University of Kansas Health System, Kansas City, KS, USA.
²⁶ Nottingham Ningbo GRADE Centre, University of Nottingham Ningbo, China.
²⁷ School of Economics, University of Nottingham Ningbo, China.
²⁸ Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
²⁹ Yealth Network, Beijing Yealth Technology Co., Ltd, China.
³⁰ Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Milan, Italy.
³¹ WHO Collaborating Center for Evidence-Based Decision-Making in Health, Humanitas University, Milan, Italy.
³² Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
³³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³⁴ WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Health Research Institute, Ottawa, Ontario, Canada.

PMID: 40224676
PMCID: PMC11992520
DOI: 10.1016/j.eclinm.2025.103135

Abstract

Background: Practice guidelines may reduce health inequities by addressing preventable and unjust differences in health. However, health equity considerations are often inadequately integrated into the guideline planning and development process. This article describes a pragmatic approach to enhancing health equity considerations within guidelines by introducing an extension to the GIN-McMaster Guideline Development Checklist (GDC).

Methods: We reviewed the latest guidance on enhancing health equity considerations in guideline development to draft the checklist and deployed a global online survey from March 27th, 2024, to May 13th, 2024 to gather consensus. We conducted a methodological review of guideline development handbooks to identify best practices in health equity considerations. An advisory board comprised of diverse interest-holders informed the development of the checklist. We made revisions based on the survey feedback and review findings.

Findings: We present 21 extension items spanning 16 of the 18 guideline development topics from the GIN-McMaster GDC. Key additions include planning for engagement with individuals experiencing inequities in guideline development activities, applying an equity lens, and considering health equity in recommendation formulation, dissemination and implementation strategies. This checklist gives value to lived experiences to enrich health equity assessments, complementing empirical evidence to inform guideline recommendations. Guideline developers should assess guideline sensitivity to health equity to determine resource prioritization for optimal implementation of the extension items.

Interpretation: The GIN-McMaster health equity extension provides guidance for the streamlined integration of health equity considerations throughout the guideline development process. Using this tool alongside the original GIN-McMaster GDC may lead to more equitable and impactful guidelines.

Funding: This project was partially funded by Public Health Agency of Canada. The funder was not involved in the conceptualization or design or the conduct of the project.

Keywords: Diversity and inclusion; GIN-McMaster guideline checklist; Guidelines; Health equity.

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Conflict of interest statement

Omar Dewidar, Vivian Welch, Elie Akl, Kevin Pottie and Peter Tugwell are the leads of the GRADE-Equity Project Group and have authored some of the health equity guidance cited in this manuscript. Jordi Pardo Pardo has authored some of the guidance cited in this manuscript. All remaining authors have no other conflicts of interest. Holger J. Schünemann is chair of the GRADE Working Group and lead author and initiator of the original Guideline Development Checklist. Jennifer S. Lin has received AHRQ contracts for funded work for health equity related work to support the US Preventive Services Task Force and the EPC Program, and nonpaid consultant work and lectures on health equity and racial health equity in systematic reviews and clinical practice guidelines. Robby Nieuwlaat and Holger J. Schünemann have received financial contribution for CAN-PCC project from Public Health Agency of Canada from Jan-2023 to Mar-2025; payments made to institution. Vivian Welch holds an applied public health chair award from CIHR and PHAC (2024–2029). Kevin Pottie has a patent pending for patient engagement and a patient for an education system. Reem A. Mustafa has received a contract from AAP to conduct a review of existing frameworks to consider equity in developing guidance documents.

Figures

**Fig. 1**
**Process for developing the health equity extension of the GIN-McMaster Guideline Development Checklist**. CAN-PCC stands for Canadian Guidelines for Post COVID-19 Condition.

See this image and copyright information in PMC

References

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Enhancing health equity considerations in guidelines: health equity extension of the GIN-McMaster Guideline Development Checklist

Affiliations

Enhancing health equity considerations in guidelines: health equity extension of the GIN-McMaster Guideline Development Checklist

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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