PRO EDI-A Tool to Help Systematic Reviewers Make Equity, Diversity, and Inclusion Assessments.

Abstract

Introduction: Decisions need evidence, and for healthcare decisions, the evidence decision-makers often want is a systematic review. However, reviews often lack clarity about who is represented within the evidence they synthesize, which limits understanding of how findings apply to diverse populations. PRO EDI was developed to help systematic review authors extract and report equity-related participant data to support greater transparency and more informed judgments about applicability.

Methods: PRO EDI was developed iteratively between August 2022 and March 2024 and was conceptualized as a way of making it easier to use PROGRESS-Plus, a framework to assess equity in reviews. An initial draft was created and then discussed and revised in collaboration with an international advisory group. A relatively mature version of the tool was then presented to a meeting of the Cochrane Health Equity Thematic Group. The modified version that emerged from that meeting was considered v1 of PRO EDI.

Results: PRO EDI has two main components: a participant characteristics table and guidance on how to use the extracted characteristics data within reviews. PRO EDI recommends that six participant characteristics should be extracted for all included studies in a review: age, sex, gender, ethnicity, race and ancestry, socioeconomic status, and location. Other characteristics (e.g., disability) may be important for some reviews. PRO EDI is relevant for all systematic reviews, not just those with an equity focus. The tool has been piloted in several reviews and is publicly available via Trial Forge.

Conclusion: PRO EDI gives systematic review authors a consistent way of deciding which participant characteristics to extract from included studies to support equity-related judgments in their results and discussion. It also suggests ways in which those judgments can be presented.