Evaluating the effectiveness of an educational and feedback intervention aimed at improving consideration of sex differences in guideline development

Abstract

Objectives To investigate the effect of an educational and feedback intervention to enhance consideration of sex differences in clinical guideline development. Design Preintervention and postintervention questionnaires in intervention and control groups. Content analysis of intervention guidelines and former versions. Setting Guideline consultants, working-group members and guideline documents of two Dutch guidelinedeveloping organisations. Main outcome measures Attitudes of guideline developers concerning the importance of considering sex differences and the number of the sex-specific statements in the contents of guideline documents. Results The attitude of the intervention group did not change significantly relative to the control group. Consideration of sex-related factors within the guidelines increased relative to available previous versions. Conclusion Education and expert feedback may increase consideration of sex differences in guidelines. Further efforts are needed to implement and test these interventions.Clinical guidelines describe the best available evidence concerning the diagnosis and treatment of patients, and they play an important role in improving the quality of care.1 2 Since 1993, the National Institutes of Health and other researchfunding agencies have required the equitable inclusion of men and women in clinical research. This has generated more evidence on sex differences in health outcomes.6e8 Women and men may need different preventive, diagnostic or therapeutic strategies. 6 For example, the alcohol use disorders identification test (AUDIT) screening instrument for alcohol problems is less sensitive and more specific for women than it is for men, indicating different cut-off points. In a previous study, we showed that the two major Dutch guideline-developing organisations, the Dutch College of General Practitioners (NHG) and the Dutch Institute for Healthcare Improvement (CBO), paid no systematic attention to sexrelated factors in either the development or content of their guidelines.11 Other research showed little attention to ethnic background of patients in guidelines.12 Both organisations therefore agreed to participate in a follow-up project (the Diversity Consultation Project) to improve consideration of diversity issues in guideline development.Our previous study identified two barriers to considering gender issues in guideline development: lack of awareness that it might improve the quality of guidelines and lack of know-how for doing so. 11 We designed an intervention to remove these barriers using education and expert feedback. Evidence from other settings suggests that such intervention strategies can effect change among professionals. 13e17This article describes the intervention and evaluates the extent to which it influenced the awareness and know-how of guideline developers regarding the importance of considering sex differences when developing and writing guidelines. METHODS SettingThe CBO and the NHG have been developing clinical guidelines since the 1980s.18 1...

Sex and gender considerations in Canadian clinical practice guidelines: a systematic review

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“… What is the subject matter of sex‐specific health issues addressed in the discussion (reproductive health issues or other sex‐specific health issues) [29]? What is the group role of GDC members (staff member, chair or committee member) and the sex of the speakers who initiated the discussion [35]? What is the general approach (see ) taken by the participants in the discussion to the subject matter under discussion (sex‐specific health issues) [35]? What are the overarching categories and themes addressed in the episode [34]? To this end, episodes were broken up in strings of dialogue referring to the same theme and overarching categories [40]. …”

“…What is the subject matter of sex‐specific health issues addressed in the discussion (reproductive health issues or other sex‐specific health issues) [29]?…”

“…In an earlier study we found that the guidelines that were developed under the guidance of such trained staff members contained more sex‐specific statements than previous versions [29]. Most of these statements referred to reproductive health issues (such as fertility, pregnancy, and breastfeeding) and only a few referred to other sex‐specific health issues.…”

Challenges of Clinical Practice Guidelines Adaptation in Iran: Lesson Learned for Developing Countries

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