Background: Decolonisation of research methods refers to the undoing of colonial ideologies within academic thinking and broadening critical and theoretical positions within methodological approaches to address power imbalances and inherent biases. Trust in systematic reviews is underpinned by transparency, rigour, and objectivity at all stages of the review process. Frameworks, such as GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) and GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research), aim to improve transparency surrounding certainty or confidence in the evidence. A key element of these tools is to assess the overall directness or relevance of the synthesis findings to examine whether they offer a ‘restricted’ answer to the review question because of the populations, interventions, comparators, or outcomes studied. Application of GRADE and CerQual could therefore be used to identify underrepresentation of important ethnic groups or marginalised populations in research.
Objectives: To explore how GRADE and GRADE-CERQual could be employed to support decolonisation of systematic reviews.
Methods: An exploration of how systematic reviews on issues known to disproportionately affect certain ethnic groups could use GRADE and CERQual to support interpretation of the evidence and decolonisation of research. We use case examples of reviews on conditions known to disproportionately affect people of African, African-Caribbean, and South-Asian descent, such as diabetes, to illustrate how reviewers might consider the directness of the evidence to those groups.
Conclusions: Systematic review teams should routinely consider the potential for underrepresentation of important or marginalised ethnic groups as a restricting factor when applying the ‘directness’ dimension of GRADE or the ‘relevance’ dimension of CERQual. Review teams should consider providing equity statements in their summary of findings table to mitigate issues of colonial bias in research and to reduce the risk of perpetuating underrepresentation of marginalised populations. Patient, public, and/or healthcare consumer involvement: No specific patient or healthcare consumer involvement was sought for this abstract because of the theoretical nature of the work. However, the authors both value and advocate for diverse stakeholder involvement in the systematic review process.