Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights

Abstract

IntroductionIn January 2019, the WHO reviewed evidence to develop global recommendations on self-care interventions for sexual and reproductive health and rights (SRHR). Identification of research gaps is part of the WHO guidelines development process, but reliable methods to do so are currently lacking with gender, equity and human rights (GER) infrequently prioritised.MethodsWe expanded a prior framework based on Grading of Evidence, Assessment, Development and Evaluation (GRADE) to include GER. The revised framework is applied systematically during the formulation of research questions and comprises: (1) assessment of the GRADE strength and quality rating of recommendations; (2) mandatory inclusion of research questions identified from a global stakeholder survey; and (3) selection of the GER standards and principles most relevant to the question through discussion and consensus. For each question, we articulated: (1) the most appropriate and robust study design; (2) an alternative pragmatic design if the ideal design was not feasible; and (3) the methodological challenges facing researchers through identifying potential biases.ResultsWe identified 39 research questions, 7 overarching research approaches and 13 discrete feasible study designs. Availability and accessibility were most frequently identified as the GER standards and principles to consider when planning studies, followed by privacy and confidentiality. Selection and detection bias were the primary methodological challenges across mixed methods, quantitative and qualitative studies. A lack of generalisability potentially limits the use of study results with non-participation in research potentially highest in more vulnerable populations.ConclusionA framework based on GRADE that includes stakeholders’ values and identification of core GER standards and principles provides a practical, systematic approach to identifying research questions from a WHO guideline. Clear guidance for future studies will contribute to an anticipated ‘living guidelines’ approach within WHO. Foregrounding GER as a separate component of the framework is innovative but further elaboration to operationalise appropriate indicators for SRHR self-care interventions is required.

Self-care interventions for preconception, antenatal, intrapartum and postpartum care: a scoping review

“… 36 While some studies have investigated diagnostic accuracy of self-sampling for reproductive tract infections in pregnancy, evidence on their benefits, harms and effective linkages with health systems is currently lacking. 37 Lastly, we identified self-care studies on insecticide-treated nets for malaria, mostly from the sub-Saharan Africa region. However there was little research on other low-cost strategies amenable to a self-care approach (indoor residual spraying and insect repellents), or from other malaria-endemic regions such as Asia and Latin America.…”

“…Similarly, self-collection of vaginal samples for reproductive tract infections is an emerging alternative to clinic-based sampling 36. While some studies have investigated diagnostic accuracy of self-sampling for reproductive tract infections in pregnancy, evidence on their benefits, harms and effective linkages with health systems is currently lacking 37. Lastly, we identified self-care studies on insecticide-treated nets for malaria, mostly from the sub-Saharan Africa region.…”

Development of a Mission-Driven Research Agenda to Support Efforts to End Epidemics

“…To our knowledge, this article is the first describing and evaluating the process to develop a mission-driven Research Agenda undertaken by a large center within a state public health department. We adapted processes utilized in the development of prior plans and research agendas to suit the needs and capacity of our organization 6,10–19. Research questions were requested from nearly 230 external stakeholders, including research and subject matter experts throughout the state, to ensure the agenda reflected research gaps identified by those actively conducting research or working in relevant areas; a long-standing advisory body; and internal staff.…”

“…The development process for this Research Agenda included components common to the development of previous NYSDOH plans 6,10 and other public health research agendas [11][12][13][14][15][16][17][18][19] but was adaptive and did not follow a specified predetermined framework. The process began in early 2021 with the formation of an internal Research Agenda Committee.…”

Changing national health policies for introduction, uptake and scale-up of self-care interventions for sexual and reproductive health and rights in the Eastern Mediterranean Region

“…It must come with better evidence on what strategies work to enhance the capacities of individuals and communities to access quality self-care interventions. A structure to support further research that includes stakeholder values and identification of core gender, equity and human rights standards and principles can strengthen the evidence base [ 7 ]. Strong partnerships, collaborative approaches and political will become increasingly important alongside evidence-based instruments and tools to assess the starting point and map the desired directions for policy change.…”