Equity in clinical practice guidelines: a systematic review

Clinical practice guidelines (CPGs) are essential tools that help clinicians make evidence-based decisions. However, guidelines often fail to address how recommendations apply across diverse populations, including people who are socially or economically disadvantaged, culturally diverse communities, rural and remote populations, and groups experiencing discrimination. This project examines how well sexual and reproductive health clinical practice guidelines incorporate equity considerations for culturally diverse populations and whether guidelines consider differences in access, acceptability, relevance, and outcomes. Students will learn how to critically appraise guidelines, identify gaps, synthesise findings, and contribute to improving how guidelines support equitable healthcare. This project is suitable for undergraduate and postgraduate students interested in public health, health equity, clinical research, evidence synthesis, or policy. What the Student Will Do 1. Identify and select clinical practice guidelines Students will: • Conduct structured searches of: o guideline repositories (e.g., NHMRC, GIN, TRIP) o professional organisations o grey literature sources o peer-reviewed guideline publications • Screen guidelines using predefined inclusion/exclusion criteria. • Extract metadata (e.g., country, condition, target audience, year, organisation). Skills developed: • Database searching • Grey literature searching • Understanding guideline development processes • Eligibility screening and record management 2. Extract data on equity and cultural considerations Students will extract information such as: • Whether guidelines discuss cultural diversity, cultural safety, or migrant health • How recommendations consider language needs, health literacy, or cultural practices • Use of equity frameworks (e.g., PROGRESS-Plus, GRADE equity extensions) • Involvement of diverse communities in guideline development • Whether evidence sources include culturally diverse populations Skills gained: • Designing and using data extraction templates • Critical reading and appraisal of guideline content • Understanding equity and cultural safety concepts • Working with predefined coding frameworks 3. Data synthesis and analysis Depending on the level of study, students may undertake: Qualitative synthesis • Thematic analysis of how equity related to culturally diversity is described or omitted. • Identifying patterns across guideline developers or health topics. Quantitative synthesis • Frequency counts and descriptive statistics (e.g., % guidelines considering equity). • Exploring associations (e.g., country, year, organisation type). Mixed-methods synthesis • Integrating quantitative and qualitative findings into a cohesive narrative. Skills developed: • Qualitative coding • Evidence synthesis methods • Use of software (e.g., Excel, NVivo, Covidence) 4. Further skill development - assess quality using established appraisal tools Depending on scope, students may assess guidelines using tools such as: • AGREE II or AGREE-REX • GRADE Equity extension • Health equity assessment tools Skills developed: • Critical appraisal • Understanding of guideline quality domains • Application of validated methodological tools 5. Contribute to manuscripts for peer-reviewed publication Students will participate in: • Structuring the introduction and background • Drafting methods and results sections • Creating tables, figures, and PRISMA flow diagrams • Responding to peer-review feedback (if the project progresses to submission) Skills developed: • Academic writing • Manuscript formatting • Understanding authorship conventions • Data visualisation