Article type
Abstract
Background: Internationally accepted standards for trustworthy guidelines include the necessity to ground recommendations in values and preferences—defined as people’s perspectives, beliefs, and goals for health and life. Considering values and preferences respects the rights of citizens to participate in health decision-making and ensures that guidelines align with the needs of the communities they intend to serve.
Objective: We performed a systematic review of COVID-19 public health guidelines to capture and characterize whether and how they considered values and preferences.
Methods: We searched the eCOVID19 RecMap platform—an international catalog of COVID-19 guidelines—up to July 2023. We included COVID-19 public health guidelines that made recommendations about vaccination, masking, isolation, lockdowns, travel restrictions, contact tracing, infection surveillance, and school closures. Reviewers worked independently and in duplicate to review guidelines for consideration of values and preferences.
Results: Our search yielded 129 eligible guidelines, of which 73 (56.6%) were published by international organizations, 43 (33.3%) by national organizations, and 14 (10.9%) by professional societies and associations. Few guidelines (26; 20.2%) considered values and preferences.
Among guidelines that considered values and preferences, most did so by referencing published research (24; 92.3%) and used values and preferences to inform the weighing of benefits and harms of alternative recommendations (24; 92.3%). None of the guidelines performed systematic reviews addressing values and preferences. Instead, guidelines referenced select published research on values and preferences without a description of how publications were identified, which may lead to cherry picking of the evidence. Guidelines only occasionally engaged laypersons as part of the guideline development group (6; 23.1%).
Conclusions: Most COVID-19 public health guidelines did not consider values and preferences. When values and preferences were considered, the approach was often suboptimal. Disregard for values and preferences in guidelines may have contributed to unpopular COVID-19 policies and an erosion of trust in public health.
As the pandemic evolves from an acute threat to a long-term public health issue, now is a critical time to learn from our response. We recommend future research identify efficient methods for considering values and preferences in guidelines developed during health emergencies.
Objective: We performed a systematic review of COVID-19 public health guidelines to capture and characterize whether and how they considered values and preferences.
Methods: We searched the eCOVID19 RecMap platform—an international catalog of COVID-19 guidelines—up to July 2023. We included COVID-19 public health guidelines that made recommendations about vaccination, masking, isolation, lockdowns, travel restrictions, contact tracing, infection surveillance, and school closures. Reviewers worked independently and in duplicate to review guidelines for consideration of values and preferences.
Results: Our search yielded 129 eligible guidelines, of which 73 (56.6%) were published by international organizations, 43 (33.3%) by national organizations, and 14 (10.9%) by professional societies and associations. Few guidelines (26; 20.2%) considered values and preferences.
Among guidelines that considered values and preferences, most did so by referencing published research (24; 92.3%) and used values and preferences to inform the weighing of benefits and harms of alternative recommendations (24; 92.3%). None of the guidelines performed systematic reviews addressing values and preferences. Instead, guidelines referenced select published research on values and preferences without a description of how publications were identified, which may lead to cherry picking of the evidence. Guidelines only occasionally engaged laypersons as part of the guideline development group (6; 23.1%).
Conclusions: Most COVID-19 public health guidelines did not consider values and preferences. When values and preferences were considered, the approach was often suboptimal. Disregard for values and preferences in guidelines may have contributed to unpopular COVID-19 policies and an erosion of trust in public health.
As the pandemic evolves from an acute threat to a long-term public health issue, now is a critical time to learn from our response. We recommend future research identify efficient methods for considering values and preferences in guidelines developed during health emergencies.