Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health.

OBJECTIVES To assess the utility of an acronym, place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital ("PROGRESS"), in identifying factors that stratify health opportunities and outcomes. We explored the value of PROGRESS as an equity lens to assess effects of interventions on health equity. STUDY DESIGN AND SETTING We assessed the utility of PROGRESS by using it in 11 systematic reviews and methodological studies published between 2008 and 2013. To develop the justification for each of the PROGRESS elements, we consulted experts to identify examples of unfair differences in disease burden and an intervention that can effectively address these health inequities. RESULTS Each PROGRESS factor can be justified on the basis of unfair differences in disease burden and the potential for interventions to reduce these differential effects. We have not provided a rationale for why the difference exists but have attempted to explain why these differences may contribute to disadvantage and argue for their consideration in new evaluations, systematic reviews, and intervention implementation. CONCLUSION The acronym PROGRESS is a framework and aide-memoire that is useful in ensuring that an equity lens is applied in the conduct, reporting, and use of research.

[1]  Robert H. Fletcher,et al.  Deworming and adjuvant interventions for improving the developmental health and well‐being of children in low‐ and middle‐income countries: a systematic review and network meta‐analysis , 2013 .

[2]  R. Priya.  Gender, women and primary health care renewal: A discussion paper , 2012 .

[3]  G. Guyatt,et al.  Male circumcision for the prevention of heterosexually acquired HIV infection: a meta‐analysis of randomized trials involving 11 050 men * , 2008, HIV medicine.

[4]  M. Marmot,et al.  Challenging health inequalities--implications for the workplace. , 2010, Occupational medicine.

[5]  James Thomas,et al.  Inequalities and the mental health of young people: a systematic review of secondary school-based cognitive behavioural interventions [IOE Research Briefing N°46] , 2009 .

[6]  Melissa Fuster,et al.  Barriers in access to insecticide-treated bednets for malaria prevention: an analysis of Cambodian DHS data. , 2012, Journal of vector borne diseases.

[7]  M. Lindström,et al.  Ethnic Differences in Self-reported Lack of Access to a Regular Doctor: A Population-based Study , 2002, Ethnicity & health.

[8]  Gower Street,et al.  Health inequalities among British civil servants: the Whitehall II study , 1991, The Lancet.

[9]  M. Whitehead,et al.  The Social Basis of Disparities in Health , 2001 .

[10]  P. Tugwell,et al.  Does Consideration and Assessment of Effects on Health Equity Affect the Conclusions of Systematic Reviews? A Methodology Study , 2012, PloS one.

[11]  E. Baumer,et al.  Social Capital and Homicide , 2001 .

[12]  E. Jacoby,et al.  Acute childhood diarrhoea and maternal time allocation in the northern central Sierra of Peru. , 1995, Health policy and planning.

[13]  Peter Tugwell,et al.  What types of interventions generate inequalities? Evidence from systematic reviews , 2012, Journal of Epidemiology & Community Health.

[14]  N. Binkin,et al.  Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition , 2012, The Lancet.

[15]  Timothy D Baker,et al.  The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India. , 2003, Social science & medicine.

[16]  B. Vuylsteke,et al.  Evidence of Declining STD Prevalence in a South African Mining Community Following a Core‐Group Intervention , 2000, Sexually transmitted diseases.

[17]  T A Sheldon,et al.  Race and ethnicity in health research. , 1992, Journal of public health medicine.

[18]  S. Moses.  Male circumcision: a new approach to reducing HIV transmission , 2009, Canadian Medical Association Journal.

[19]  J. Rex,et al.  The Ethnicity Reader: Nationalism, Multiculturalism and Migration , 2010 .

[20]  M. Whitehead,et al.  The concepts and principles of equity and health. , 1992, International journal of health services : planning, administration, evaluation.

[21]  J. Awoonor-Williams,et al.  The Ghana community-based health planning and services initiative for scaling up service delivery innovation. , 2005, Health policy and planning.

[22]  David Ogilvie,et al.  Bmc Medical Research Methodology Open Access the Harvest Plot: a Method for Synthesising Evidence about the Differential Effects of Interventions , 2022 .

[23]  D. Gwatkin.  10 best resources on... health equity. , 2007, Health policy and planning.

[24]  P. Braveman.  Challenging inequities in health: from ethics to action , 2002 .

[25]  M. Petticrew,et al.  Population tobacco control interventions and their effects on social inequalities in smoking: systematic review , 2008, Tobacco Control.

[26]  C. Watts,et al.  Effect of a structural intervention for the prevention of intimate-partner violence and HIV in rural South Africa: a cluster randomised trial , 2006, The Lancet.

[27]  J. Bower,et al.  Underimmunization in Ohio's Amish: Parental Fears Are a Greater Obstacle Than Access to Care , 2011, Pediatrics.

[28]  David Moher,et al.  PRISMA-Equity 2012 Extension: Reporting Guidelines for Systematic Reviews with a Focus on Health Equity , 2012, PLoS medicine.

[29]  B. Smedley,et al.  Unequal Treatment: Con-fronting Racial and Ethnic Disparities in Health Care , 2002 .

[30]  P. Braveman,et al.  Socioeconomic Status and Breastfeeding Initiation among California Mothers , 2006, Public health reports.

[31]  P Adam Kelly,et al.  Conceptualizing and categorizing race and ethnicity in health services research. , 2005, Health services research.

[32]  I. Kawachi,et al.  Social capital, income inequality, and mortality. , 1997, American journal of public health.

[33]  M. Suarez‐Almazor,et al.  Is health equity considered in systematic reviews of the Cochrane Musculoskeletal Group? , 2008, Arthritis and rheumatism.

[34]  C. Victora,et al.  Explaining trends in inequities: evidence from Brazilian child health studies , 2000, The Lancet.

[35]  I. Kawachi,et al.  Socioeconomic determinants of health : Health and social cohesion: why care about income inequality? , 1997 .

[36]  T. Hesketh,et al.  Son preference and sex-selective abortion in China: informing policy options , 2012, International Journal of Public Health.

[37]  Social Funds: Assessing Effectiveness , 2002 .

[38]  Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people. , 2013, The Cochrane database of systematic reviews.

[39]  M. Sheth,et al.  Diarrhea prevention through food safety education , 2004, Indian journal of pediatrics.

[40]  Catherine E. Ross,et al.  The links between education and health. , 1995 .

[41]  T. Evans,et al.  Ethical dimensions of health equity , 2001 .

[42]  J. Katz,et al.  The impact of vitamin A supplementation on mortality inequalities among children in Nepal. , 2005, Health policy and planning.

[43]  Linda C. Li,et al.  Reaching those most in need: A scoping review of interventions to improve health care quality for disadvantaged populations with osteoarthritis , 2011, Arthritis care & research.

[44]  S. Moses,et al.  Human immunodeficiency virus infection in long-distance truck drivers in east Africa. , 1994, Archives of internal medicine.

[45]  Martin Ravallion,et al.  Does Piped Water Reduce Diarrhea for Children in Rural India? , 1999 .

[46]  R. Hayes,et al.  Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis , 2000, AIDS.

[47]  Robert Fletcher,et al.  Deworming and adjuvant interventions for improving the developmental health and well-being of children in low-and middle-income countries : a systematic review and network meta-analysis , 2015 .

[48]  Tim Evans,et al.  Road traffic crashes: operationalizing equity in the context of health sector reform , 2003, Injury control and safety promotion.

[49]  J. Habicht,et al.  Effect of economic reforms on child growth in urban and rural areas of China. , 1996, The New England journal of medicine.

[50]  Joel D. Selanikio,et al.  Integrating insecticide‐treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher‐based methods , 2005, Tropical medicine & international health : TM & IH.

[51]  P. Tugwell,et al.  Evidence-based clinical guidelines for immigrants and refugees , 2011, Canadian Medical Association Journal.

[52]  P. Tugwell,et al.  How effects on health equity are assessed in systematic reviews of interventions. , 2010, The Cochrane database of systematic reviews.

[53]  Mario Lucchini,et al.  Socioeconomic Determinants of Health , 2021, Encyclopedia of Quality of Life and Well-Being Research.

[54]  N. Crowcroft,et al.  Race, ethnicity, culture, and science , 1994, BMJ.

[55]  A. Shields,et al.  Racial Categories in Medical Practice: How Useful Are They? , 2007, PLoS medicine.

[56]  S. Oliver,et al.  Health promotion, inequalities and young people’s health: a systematic review of research , 2008 .

[57]  R. Wilchins,et al.  Gender Violence , 2002, Journal of homosexuality.

[58]  Andrew D Oxman,et al.  SUPPORT Tools for evidence-informed health Policymaking (STP) 10: Taking equity into consideration when assessing the findings of a systematic review , 2009, Health research policy and systems.

[59]  J. Yoder,et al.  EFFICACY AND SAFETY OF CASPOFUNGIN THERAPY IN CHILDREN WITH INVASIVE FUNGAL INFECTIONS , 2006, The Pediatric infectious disease journal.

[60]  P. Tugwell,et al.  Strategies to increase the ownership and use of insecticide-treated bednets to prevent malaria. , 2015, The Cochrane database of systematic reviews.

[61]  Sharon Friel,et al.  Closing the gap in a generation: health equity through action on the social determinants of health , 2008, The Lancet.

[62]  R. Bhopal,et al.  White, European, Western, Caucasian, or what? Inappropriate labeling in research on race, ethnicity, and health. , 1998, American journal of public health.

[63]  I. Sempowski.  Effectiveness of financial incentives in exchange for rural and underserviced area return-of-service commitments: systematic review of the literature. , 2004, Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la medecine rurale : le journal officiel de la Societe de medecine rurale du Canada.

[64]  N. Mutrie,et al.  Nowhere to play? The relationship between the location of outdoor play areas and deprivation in Glasgow. , 2007, Health & place.

[65]  Sandy Oliver,et al.  Damned if you do, damned if you don't: subgroup analysis and equity , 2011, Journal of Epidemiology & Community Health.

[66]  Mandy K. Green,et al.  Findings from a Community-based Participatory Prevention Research Intervention Designed to Increase Social Capital in Latino and African American Communities , 2008, Journal of Immigrant and Minority Health.

[67]  Ronny Bell.  The Socioeconomic Determinants of Health , 2010 .

[68]  Karthik Muralidharan,et al.  Missing in action: teacher and health worker absence in developing countries. , 2006, The journal of economic perspectives : a journal of the American Economic Association.

[69]  Rebecca Cannings-John,et al.  Culturally appropriate health education for type 2 diabetes mellitus in ethnic minority groups. , 2008, The Cochrane database of systematic reviews.

[70]  R. Bhopal,et al.  Ethnicity as a variable in epidemiological research , 1994, BMJ.

[71]  Peter J. Aspinall,et al.  Approaches to Developing an Improved Cross-National Understanding of Concepts and Terms Relating to Ethnicity and Race , 2007 .

[72]  C. Melville,et al.  Clinical guidelines contribute to the health inequities experienced by individuals with intellectual disabilities , 2012, Implementation Science.

[73]  K. Pottie,et al.  Official language proficiency and self-reported health among immigrants to Canada. , 2011, Health reports.

[74]  S. Oliver,et al.  Childhood obesity and educational attainment: a systematic review , 2011 .

[75]  Sandy Oliver,et al.  Getting started with a review , 2012 .

[76]  Frank H. Galvan,et al.  Perceived discrimination and depression among low-income Latina male-to-female transgender women , 2012, BMC Public Health.

[77]  Underground coal mining disasters and fatalities--United States, 1900-2006. , 2009, MMWR. Morbidity and mortality weekly report.