Guideline development handbooks outline the methodology that authoring organizations use to create public health and clinical practice guidelines (CPGs). We created an Equity Assessment Tool (EquAT) for guideline development handbooks to identify areas of improvement and foster conversations.

Sequential phases lead to tool development and face/content validation in this mixed-methods study. In phase 1, we reviewed the literature to generate a list of “essential elements” or tasks that are part of guideline development methodology, mapped “essential elements” with relevant equity concepts, and drafted our tool for use in reviewing guideline development handbooks. In phase 2, we surveyed experts for feedback on “essential elements” and explicit language for assessing equity within the tool and refined items. We piloted and finalized the tool based on feedback.

We identified 18 essential elements within five domains of guideline development and created a draft EquAT. Twenty of 25 invited experts responded to the online survey for feedback on the tool. Most experts provided limited feedback, and the most common suggestion was adding clarifying language to the existing tool criteria for assessing equity. Ten experts participated in pilot testing the revised tool. We found a diversity of scores, and potential reasons might be due to the complexity of the tool, differences in equity frameworks, and a variety of expertise. We incorporated their feedback and finalized the tool.

We developed and validated the EquAT, a tool to foster discussion among assessors about the extent of health equity considerations in guideline development handbooks.