Equity, Diversity, and Inclusion (EDI) thinking in systematic reviews: the comparison of two tools for increasing the awareness and consideration of EDI in a systematic review of physical activity and heart failure.

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

3D.4

Presenter:

Alyson Huntley

Twitter:

@capcbristol

Co-authors:

Lorna Duncan, Shoba Dawson, Rachel Johnson, Rosie Essery, Yasmin Ismail, Justine Baird, Karen Butcher, Emily Whight

Author institutions:

University of Bristol, University of Southampton, University Hospitals Bristol, North Bristol NHS Trust, Sirona Care

Problem

It is important when we carry out health research to think about everyone who will benefit from the project, considering things like age, gender, race, where people live, what types of lives they lead. We call this equity, diversity, and inclusivity (EDI) thinking. Historically, researchers have not always been very good at this, and the participants involved in research have often been the easiest people to involve, rather than an appropriate range of people for whom the research is useful. This project is about EDI thinking in systematic reviews (SR) in health care.

Approach

We used two tools that have been developed to help researchers consider EDI issues: the PROGRESS-Plus tool (PPT) and the Equality Impact Assessment tool (EqIAT). We compared these tools within our current SR ‘Experiences of participation in physical activity by people with heart failure: a systematic review and meta-aggregation of qualitative studies’. (PROSPERO 2022 CRD42022342883). We followed the individual guidance on using the tools and documented our progress, the experience of the research team and the final impact on the completed review.

Findings

The PPT identified gaps in EDI thinking within the papers in the SR, with a lack of information around such items as occupation and social capita. Known inequities in heart failure research such as a low percentage of female participants and unrepresentative age groups were confirmed by the process. No papers explicitly outlined EDI thinking in their methods although age, sex and ethnic group representation issues are reported in some of the papers’ discussions. In some papers we can see digital exclusion borne out by restrictive inclusion criteria for tele/remote/digital approaches.The EqIAT facilitated relevant EDI discussions around our topic area prior to and after the conduct of the SR which included the researchers, clinicians and our heart failure public and patient involvement group. This enhanced awareness of EDI issues on our topic area prior to data extraction, some of which were relevant to the SR and some that were more generally relevant to people with heart failure. There were no discrepancies between our EqIAT discussions and the PPT items.

Consequences

Considering EDI issues in SRs is essential so that the evidence produced is relevant to patients and the public. Both the PPT and the EqIAT acted as a checklist to facilitate this process and support EDI thinking in health care research. The two tools differed in that PPT ensures that all relevant data is extracted from the included papers in a SR and identifies EDI issues for discussion and future research. The EqIAT is designed to ensure EDI thinking occurs before a SR is conducted, potentially at the protocol stage, and overlaps with the PPT in facilitating the output of a review.

Submitted by:

Alyson Huntley

Funding acknowledgement:

This work was supported by the Elizabeth Blackwell Institute, University of Bristol and the Wellcome Trust Institutional Strategic Support Fund.' The WT ISSF3 grant number is 204813/Z/16/Z. using data from a funded Research for Patient Benefit (RfPB) grant: NIHR203155 – Heart failure And Participation in Physical activitY (the HAPPY study).