Closing the gap: introducing the EQUALS MAP framework for equity-focused evidence synthesis

Abstract Background Equity-focused analysis is vital to understanding how interventions affect disadvantaged groups and prevent widening inequalities via intervention-generated inequalities. We reviewed PROGRESS-Plus usage - a commonly used framework in equity-focused reviews and proposed a novel framework. Methods First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis. Results From the 325 studies included, the PROGRESS-Plus dimensions most assessed were sex(52%), ethnicity/race(49%), and age(44%). The PROGRESS-Plus framework missed context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Our new framework EQUALS MAP includes: Ethnicity (and culture and race); Qualifications (and other socioeconomic factors of household or individual); Underprivileged areas; Age; Lesbian, gay and other sexual identities; Sex and gender; Multiple disadvantages; Additional groups experiencing significant disadvantage; and Physical and mental disability. Conclusions EQUALS MAP encapsulates the key dimensions of health inequities whilst for allowing context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions. Key messages • PROGRESS-Plus - a commonly used framework for equity-focuses evidence synthesis - misses context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. • EQUALS MAP is a novel framework which encapsulates the key dimensions of health inequalities whilst allowing for context-specific flexibility.