Migrant Healthcare Guidelines: A Systematic Quality Assessment

Significant international and cross-border migration has led to a growing availability of migrant healthcare guidelines (MHGs), which we systematically reviewed for quality. PubMed, MEDLINE, CINHAL, PsychINFO and guideline developer/guideline databases were searched for MHGs published 2006-2016. Three independent reviewers assessed eligible MHGs using the Appraisal of Guidelines, Research and Evaluation II instrument (AGREE II). MHGs were identified as high quality if they had a score of 60% in at least three of the six domains, including rigour of development, and overall quality was assessed on a seven-point Likert scale. We included 32 MHGs. Overall agreement between reviewers was very good. Mean scores for each AGREE II domain were as follows: 85 +/- 19.0% for scope and purpose; 51 +/- 30.5% for stakeholder involvement; 34 +/- 31.9% for rigour of development; 86 +/- 7.3% for clarity of presentation; 40 +/- 23.6% for applicability; and 27 +/- 38.5% for editorial independence. Nine and six MHGs were deemed recommended or recommended with modifications, respectively, and 17 were not recommended. Our review of MHGs has highlighted critical deficiencies in rigour of development, applicability, editorial independence and stakeholder involvement that point to the need for improvements in future MHGs.