Background: Equity-focused systematic reviews of effectiveness provide decision makers with the best available evidence on interventions for disadvantaged populations. Current guidance for conducting equity-focused systematic reviews acknowledges that the context in which one lives contributes to inequities. Unfortunately, there is a lack of guidance on when and how to report contextual details in these circumstances. It remains unknown how current review authors of equity-focused reviews identify and use contextual data in their reviews and what impact this has on their findings and conclusions.

Objectives: To describe the extent to which contextual factors are considered in equity-focused systematic reviews, describe the methods used, and assess the implications of their context-related findings on conclusions (implications, practice and research).

Methods: A methodology study examining the evidence on methodological aspects of equity-focused systematic reviews. Equity-focused systematic reviews are systematically identified through database searching and reference searching. The synthesis of results is guided by a mixed methods synthesis approach that incorporates quantitative and qualitative elements as appropriate.

Results: Context includes geographical, epidemiological, socio-cultural, socio-economic, ethical, political and legal domains. The inclusion of contextual information may impact the conclusions of equity-focused reviews and is dependent on the author’s decision to apply a multiple-context versus single-context approach. Stakeholder engagement represents one strategy to determine whether a narrow or broad approach should be used to ensure that systematic review findings are useful for their intended audience.

Conclusions: This study has implications for systematic review authors, clinical guideline developers and policy-makers. It may catalyze a discussion on improved reporting of contextual domains both in equity-focused systematic reviews and primary studies to improve their credibility, transferability, and implications for decision makers. Such improved understanding of methodological challenges may lead to improved reporting, analyses and conclusions for topics and populations with concerns of equity, and downstream may lead to better guidelines and improved professional practice to improve health equity of disadvantaged populations.

Patient or healthcare consumer involvement: Not applicable