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The Relevance of Health Equity to the Evidence Synthesis Process:
Results From a Quantitative Survey of Health Information Professionals

Stacy Torian, MLIS, MAa, Stephen Maher, MSIS, LMSWb

aAssistant Curator: Librarian for Health Sciences, Bobst Library, New York University, New
York, New York,https://www.orcid.org/0009-0002-9859-5075 , stacy.torian@nyu.edu

bAssistant Curator: Librarian for Social Work & Psychology, Bobst Library, New York
University, New York, New York,http://orcid.org/0000-0002-6628-6756 ,
stephen.maher@nyu.edu

Cite as: Torian S and Maher S. The Relevance of Health Equity to the Evidence Synthesis
Process: Results From a Quantitative Survey of Health Information Professionals.
Hypothesis. 2025;37(2). doi:10.18060/28655

Torian, Maher. All works in Hypothesis are licensed under a CC BY-NC 4.0
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1

https://www.orcid.org/0009-0002-9859-5075
https://orcid.org/
mailto:stacy.torian@nyu.edu
https://www.orcid.org/0000-0002-6628-6756
https://orcid.org/
mailto:stephen.maher@nyu.edu
https://creativecommons.org/licenses/by-nc/4.0/
https://creativecommons.org/licenses/by-nc/4.0/


Peer Reviewed Article Hypothesis, Vol. 37, No. 2, 2025

Abstract
Background: In their work as research collaborators, health information professionals often
contribute both extensive knowledge of evidence synthesis methods and an engaged
awareness of the sociopolitical context in which evidence synthesis takes place. Within this
context, researchers are increasingly being encouraged to demonstrate how their work will
advance health equity. Our study sought to determine how confident health information
professionals feel discussing health equity in an evidence synthesis context and how relevant
they think it is to the process.

Methods: Using the email lists of U.S.-based and international library organizations, the
authors conducted a quantitative survey of health information professionals with experience
working on evidence synthesis projects (e.g., systematic or scoping reviews) within the past
10 years. The authors used the survey software Qualtrics to calculate descriptive statistics for
each of the survey questions and analyze correlations between responses to different
questions.

Results: While a majority of health information professionals surveyed exhibited both
familiarity with health equity as a concept and a belief in its relevance to evidence synthesis,
far fewer were highly comfortable discussing health equity with researchers. Only 6% of
participants had used the PRISMA-Equity Extension (a health equity-centered evidence
synthesis tool) in a systematic review.

Discussion: The study results suggest that a number of health information professionals
would benefit from training on health equity-centered evidence synthesis tools and more
experience having health equity-related research discussions.

Introduction
“Evidence synthesis” is a term that describes different methods of identifying, evaluating, and
analyzing research literature on a topic1. One of the most common types of evidence
synthesis is the systematic review. Recognized as the “best known type of review”2, the
systematic review presents a synthesis and evaluation of all the available literature on a
research topic, along with a suggested course of action in the realm of policy or practice3,4.
Systematic reviews require a well-defined research question or topic, a research protocol, a
comprehensive literature search strategy, explicit criteria regarding what literature will or will
not be included, careful literature appraisal and synthesis, and a detailed reporting of the
reviewers’ methods and findings5. Systematic reviews are a critical component of
evidence-based practice (EBP), an approach to healthcare that emphasizes “the integration of
best available evidence, clinical expertise, and patient values and circumstances”6 in the
context of clinical practice.

For over a decade, the National Academy of Medicine (formerly the Institute of Medicine),
the Cochrane Handbook for Systematic Reviews of Interventions, and the Agency for
Healthcare Research and Quality have recommended that research teams conducting
systematic reviews seek the support of librarians, information specialists, or other expert
searchers when crafting literature searches5,7,8. While researchers often consult health
information professionals for assistance with literature searching, health information

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professionals contribute more than search strategies to the evidence synthesis process. Those
additional contributions include educating research teams on how evidence syntheses are
conducted and facilitating the planning of the study methodology9.

Although systematic reviews are recognized as an important source of synthesized research,
researchers and policymakers have expressed concerns about the absence of an equity
perspective in the reporting of systematic review results and recommendations10-13. The
World Health Organization (WHO) has defined equity as “the absence of unfair, avoidable or
remediable differences among groups of people, whether those groups are defined socially,
economically, demographically, or geographically or by other dimensions of inequality (e.g.
sex, gender, ethnicity, disability, or sexual orientation).14” An equity perspective examines
how the interventions recommended in the review could address unfair inequalities in health
outcomes15. Such a perspective also requires researchers to think critically about the review
topics they choose, the types of literature they review, the details they report in their findings,
and the environmental context within which any interventions they recommend might take
place16-18. The study that follows is an attempt to determine what views health information
professionals hold on the subject of health equity in evidence synthesis, to what extent they
engage in discussions about this subject with researchers, and their level of comfort with these
types of discussions. It begins with a literature review on the role of health information
professionals and health equity considerations in evidence synthesis, followed by the
presentation of the study results, discussion of the study findings, and suggestions for further
research and reflection.

Literature Review

The role of health information professionals in evidence synthesis

Some of the earliest examples of librarians’ involvement in evidence syntheses occurred in the
1990s, with an increase in the use of systematic reviews in medicine to combine the results of
clinical trials19. These instances correlated with the beginning of electronic publishing, and
the emergence of the Internet as a medium for disseminating information20,21. Specifically
with respect to biomedical literature, the launch of PubMed in 1997 provided researchers, via
the Internet, the ability to leverage the National Library of Medicine’s online database,
MEDLINE, to search its comprehensive bibliographic index of medical articles (Index
Medicus)22. Librarians were the early adopters of these online databases, and clinicians and
researchers recognized their expertise with indexing practices and familiarity with controlled
vocabularies. They valued the librarian’s skills for facilitating their approaches to
meta-analyses and other evidence synthesis projects20.

As the electronic publishing of articles proliferated, so too did the coverage of online
databases to index and aid researchers in the searching and retrieval of this material. This
would contribute to an increase in the number of systematic reviews23. With this increase
came the need for guidelines for researchers to follow in conducting a systematic review and
other evidence syntheses. These guidelines, including those from the Cochrane Collaboration,
the National Academy of Medicine, and the Joanna Briggs Institute, identified librarians as
collaborators either for assisting in the development of search strategies for retrieving relevant
materials or in managing the methods process5,24,25. Arksey and O’Malley - the authors of the

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original methodological framework for scoping reviews - made a similar recommendation,
suggesting that non-librarians may not be able to design a sufficient search strategy for
evidence syntheses26.

In the mid-2010s, researchers started to test the merits of these recommendations within their
respective disciplines. In general internal medicine, librarian co-authorship in systematic
reviews correlated with higher quality search strategies27. In pediatrics, researchers
considered search strategies conducted by librarians to be more reproducible28,29. There have
also been studies advocating for the involvement of librarians in evidence syntheses in
education30 and dentistry31.

As their reputations for being “natural advisors and partners”32 on evidence syntheses have
spread, librarians have investigated their roles and the challenges that come from these
collaborations. One of the challenges librarians and information professionals have identified
is that as they accumulate experience working on evidence syntheses, they find themselves
educating researchers on these methodologies in addition to collaborating with them on their
search strategies33. Another challenge centers on authorship and acknowledgement of the
contribution librarians and information professionals provide in evidence syntheses. Despite
the recommendations and evidence of the benefit of their contributions, librarians have found
that their efforts in the search process can be perceived as invisible labor34 and can go
unrecognized35,36.

As a result of these challenges, many librarians have developed service models for managing
demand and researcher expectations37–42.

Health equity and evidence synthesis

Over the years, scholarship on health equity and evidence synthesis has evolved in parallel
with the broader discourse on health equity in the field of public health. In their 2007 paper,
Cochrane’s Elizabeth Waters and Rebecca Armstrong announced the beginning of a Cochrane
Review Group for Public Health and Health Promotion, asserting that the group would “help
ensure that reviews will be oriented towards building evidence for equity and reducing
inequalities and best meet the needs of decision-makers, practitioners and consumers.43”
During roughly the same time period, in 2003, public health researchers Timothy Evans and
Hilary Brown introduced PROGRESS, an acronym that stands for multiple “socially
stratifying forces” that have consequences for health equity, namely “place of residence,
religion, occupation, gender, race/ethnicity, education, socioeconomic status, and social
networks and capital.44” PROGRESS can assist researchers in highlighting demographic
characteristics and socioeconomic circumstances that can impact the effectiveness of
interventions45. Recognizing both the potential and the limitations of this tool, a group of
researchers mapping studies on the health of young people developed an enhancement of
PROGRESS in 2008 called PROGRESS Plus to encompass personal factors that can lead to
inequitable health outcomes46. Though not used consistently in systematic reviews, both
PROGRESS and PROGRESS Plus continue to be recognized as helpful tools for presenting
and assessing systematic review results from a health equity standpoint45,47–49.

Another public health development that greatly influenced scholars promoting health equity in
evidence synthesis was a 2008 report by the World Health Organization’s Commission on

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Social Determinants of Health (CSDH) urging governmental stakeholders and international
organizations to take substantive steps to ensure that under-resourced communities have
equitable access to the resources that will help them maintain good health50. In a 2010 paper
acknowledging the CSDH’s call, Tugwell et al. provided guidance to public health researchers
seeking to incorporate a health equity perspective into their systematic reviews. Their
recommendations included creating a logic model to envision how particular interventions
might impact specific groups, taking into account the environmental context within which the
interventions might be implemented, using PROGRESS Plus to decide which outcomes are
most important to assess for people experiencing health inequities, and considering the
inclusion of study types beyond the randomized control trial51.

In the decade following the formation of the CSDH and the publication of the 2010 paper,
guidance on how to incorporate health equity considerations into the evidence synthesis
process became more detailed and formalized. In 2012 (a year after the acceptance of the Rio
Political Declaration on Social Determinants of Health at the World Conference on Social
Determinants of Health)52, Welch et al. published the PRISMA-Equity Extension
(PRISMA-E), a protocol to guide researchers doing equity focused-systematic reviews on
how to report their evidence synthesis results in a way that centers health equity concerns53,54.
PRISMA-E is based on the Preferred Reporting Items for Systematic Reviews and
Meta-Analysis (PRISMA) checklist, one of many protocols and tools researchers use to
structure and transparently report the methods and results of their systematic reviews. In
subsequent years, the 2013 paper "Health equity: evidence synthesis and knowledge
translation methods”16 and the Cochrane Handbook’s chapter on health equity published in
202047 provided further guidance. The Cochrane chapter is referenced in the Joanna Briggs
Institute (JBI) Manual for Evidence Synthesis, alongside a statement urging authors to
“consider Equity, Diversity and Inclusion in the planning and conduct of systematic and
scoping reviews.55”

Despite this guidance, some researchers still struggle to bring an equity perspective to their
systematic reviews. Analyses conducted within the past several years have revealed
inconsistent reporting of intervention effects by demographic or socio-economic factors in
groups of systematic reviews on cataract13, COVID-1949, and loneliness and social isolation48.
One issue is that the individual studies included in reviews do not always include population
data related to most of the PROGRESS or PROGRESS Plus factors13. Secondly, even when
such data are included, systematic reviewers do not always consider these factors in their
analyses48. As public health researchers have noted, not acknowledging how an intervention’s
impact might differ across demographic and socio-economic groups could lead systematic
reviewers to recommend public health interventions that actually amplify existing inequities
without benefiting the populations who are already experiencing disproportionately negative
health outcomes49,56.

In recognition of the importance of health equity in evidence synthesis, the Cochrane Equity
Methods Group authored a 2023 position statement stating, “We are committed to ensuring
that all Cochrane authors consider health equity in their reviews.17” A November 2024
Cochrane webinar titled “Equity in all Cochrane reviews,” further emphasized this objective.
There the presenters recommended that researchers consider an equity perspective not only
for “equity-focused reviews” but also for reviews “aimed at the general population.57”

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As health information professionals are more sought after in the production of evidence
syntheses, they are well-positioned to introduce or encourage researchers to bring an equity
perspective to their systematic reviews, particularly where it concerns research question
development, literature searching, and the use of tools such as PROGRESS Plus or
PRISMA-E. The purpose of this study was to determine how familiar librarians are with
health equity in evidence synthesis and how confident they feel introducing or discussing an
equity perspective during meetings with researchers. Our primary goal is to promote dialogue
about health equity in evidence synthesis and related methodological considerations among
health information professionals in the health sciences.

Methods
The authors arranged the survey into three sections. The first section of the survey, which
included a statement from the authors’ Institutional Review Board (IRB), sought to identify
how experienced the participant was in collaborating in evidence synthesis projects. If they
had been involved with one within the past 10 years, they advanced to the subsequent
sections. In the second section, the authors asked participants to share which supporting
documents they used or knew of in these projects. In the third section the authors inquired
about the participants’ familiarity with the concept of health equity. The authors provided the
definition of health equity offered by Burford et al. in 2013: “the absence of avoidable and
unfair inequalities in health, and social determinants of health.15” This definition cites
contributions from Whitehead (1992)58, Bosch-Capblanch et al. (2012)59, and the World
Health Organization (2011)52. It was in this third section that the authors assessed the
participants’ familiarity with the PRISMA-Equity Extension.

The authors developed their survey questions (see Supplemental Materials) in Qualtrics60 and
opened the survey for completion from February to March 2024. After the completion period,
the authors exported the data from Qualtrics to Google Sheets for initial tabulation and
calculations and, finally, the construction of the tables and graphs in this study.

The authors recruited participants anonymously through various U.S.-based professional
associations, including the Medical Library Association (via the MLA Connect newsletter and
the Systematic Review Caucus, Nursing and Allied Health Caucus, New Members Caucus,
Latinx Caucus, African American Medical Librarians Alliance Caucus, and Social Justice
Caucus email lists) and the Association of College and Research Libraries (ACRL). The
authors also included international groups like the International Federation of Library
Associations and Institutions (IFLA) and the non-profit organizations The Cochrane
Collaboration and The Campbell Collaboration, whose missions focus on the promotion and
dissemination of evidence-based research. Health information professionals who subscribe to
the newsletters and email lists of these organizations received the authors’ solicitation to
participate in the survey. Three hundred twenty participants completed the survey. Out of
these, 97% (310) of the participants acknowledged having been involved in an evidence
synthesis (systematic review, scoping review, meta-analysis) within the past 10 years, an
indication that the authors recruited participants through appropriate professional
organizations.

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Results
The authors used Qualtrics to calculate descriptive statistics for the answers from the 310
survey participants. The statistics include four cross tabulations, each comparing survey
participants’ answers to one question with their answers to another question. Because of
rounding, there are situations where the total percentage breakdown does not equal 100%
(e.g., Figure 2). The data is presented in summary form below and through the graphs and
tables that follow the summary.

The authors, informed by their own experience as health sciences librarians, approached this
study with the belief that a research consultation for an evidence synthesis project is often the
best opportunity a health information professional has to offer their methodological expertise
and to talk with researchers about the role of health equity in the evidence synthesis process.
To gain perspective on the survey participants’ methodological expertise, the authors provided
a list of well-known evidence synthesis methodology documents to measure their familiarity
with said documents. As noted in Figure 1, a significant portion of survey participants have
used the evidence synthesis supporting documents listed in the survey (i.e., Campbell,
Cochrane, Joanna Briggs Institute, and PRISMA). Forty-seven participants mentioned 49
additional resources (Table 1; See Supplemental Materials ). As noted in Figure 2, roughly
84% of the 310 participants indicated that they had taken the initiative to suggest these
supporting documents or that both they and the research team had suggested them, as opposed
to 12% who indicated that the research team alone had suggested the documents (the
remaining 5% did not answer the question).

Figure 1. Which supporting documents did you refer to for these evidence syntheses?

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Figure 2. How were the supporting documents introduced and or suggested?

Considered in aggregate, these responses indicate a wide range of evidence synthesis
methodological knowledge among the survey participants. Notably, three of the four
supporting documents mentioned in the survey contain chapters on equity (Cochrane, JBI)47,55

or offer supplemental documentation related to equity (PRISMA)53.

In order to take advantage of the opportunity that an evidence synthesis research consultation
provides for discussing health equity with researchers, health information professionals must
be conversant with the concept of health equity. After being provided with a definition of
health equity, 60% of the survey participants indicated that they were moderately familiar or
very familiar with the concept of health equity, while 26% were slightly familiar, 7% were not
familiar at all, and 7% did not answer (Figure 3). Additionally, 42% of participants have
discussed health equity with researchers during evidence synthesis collaborations (Figure 4).
In most cases (75%), the research team initiated the discussions, but in 21% of cases the
health information professionals initiated the discussions (Figure 5). As noted in Correlation
Chart 1, health information professionals who were very or moderately familiar with the
concept of health equity were more likely to have had discussions about the topic during
research collaborations on evidence synthesis than were those who were only slightly familiar
or unfamiliar with the concept.

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Figure 3. How familiar are you with the concept of health equity?

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Figure 4. In your work collaborating with researchers on evidence syntheses, have you ever
had discussions about health equity?

Correlation Chart 1.

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Figure 5. Who initiated the discussion about health equity?

Regarding the relevance of health equity to the evidence synthesis process, nearly
three-quarters (64%) of the survey participants believe that health equity discussions are
moderately or very relevant to the evidence synthesis process, while 24% believe they are
only slightly relevant or not relevant at all (12% did not respond to the question) (Figure 6).
As shown in Correlation Chart 2, participants who were moderately or very familiar with the
concept of health equity were more likely to indicate that discussions about health equity
were very relevant to the evidence synthesis process. Additionally, participants who thought
health equity was very relevant to the evidence synthesis process were more likely to have had
discussions about health equity with researchers (Correlation Chart 3).

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Figure 6. How relevant do you think discussions about health equity are in the evidence
synthesis process?

Correlation Chart 2.

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Correlation Chart 3.

Despite the relatively high percentage of participants indicating familiarity with the concept
of health equity and affirming the relevancy of health equity to the evidence synthesis process,
only about half of the participants surveyed (46%) feel very or somewhat comfortable
discussing health equity with researchers (Figure 7). About 28% are neither comfortable or
uncomfortable, while 14% are somewhat or very uncomfortable. Furthermore, even though
79% of the participants have used the PRISMA reporting guideline, 52% were not at all
familiar with the PRISMA-Equity Extension and only 6% had used it in a systematic review
(Figure 8). As expected, those who were moderately or very familiar with the concept of
health equity were more likely to be somewhat comfortable or very comfortable discussing
the concept with researchers (Correlation Chart 4).

Figure 7. How comfortable are you discussing health equity with researchers?

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Figure 8. How familiar are you with the PRISMA-Equity Extension?

Correlation Chart 4.

Discussion
The survey participants who were involved in an evidence synthesis project within the past 10
years (310) exemplified the knowledge and experience reflected in the aforementioned
guidelines that identify librarians as collaborators. Less than 3% of the participants reported

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not using any of the examples of supporting documents provided in the survey. Seventy-nine
percent of participants referred to PRISMA in their collaboration on evidence syntheses, the
most frequently used supporting document. In addition to demonstrating their familiarity with
the supporting documents provided in the survey, the participants provided a substantive list
of “Other” examples (see Supplemental Materials, Table 1). These “Other” examples, created
or authored by organizations or individuals in North America and Europe, underscore the
global nature of evidence synthesis work.

Prior studies have shown how the role of librarians and information professionals has evolved
from designing search strategies to educating researchers in evidence synthesis
methodologies33. The participants verified this observation, indicating that in 55% of their
experiences, they alone introduced or suggested the supporting documents to the research
team (as shown in Figure 2). This is consistent with the findings of Logan (2023) who found
that, among a group of 42 researchers who had co-authored reviews with librarians, 64.3%
were motivated by librarians’ methodological expertise32.

The participants’ responses to these questions confirmed the authors’ hypothesis, that because
health information professionals are more sought after in the production of evidence
syntheses, they could be well-positioned to introduce or encourage researchers to bring an
equity perspective to this work. When asked about health equity, 86% of the participants had
some familiarity with the concept (as shown in Figure 3) and when asked whether they had
had discussions about health equity with researchers, 42% said yes (as shown in Figure 4). In
those discussions about health equity, the participants said the researchers mostly initiated the
topic. While this finding could reflect the fact that health information professionals are often
not the lead researchers on evidence synthesis projects, it could also suggest that there is more
to be done to increase their understanding of the concept of health equity and its role in
evidence synthesis.

It is notable that 42% of participants provided a neutral response to the comfortability
question (28%) or expressed some level of discomfort with discussing health equity with
researchers (14%) (as shown in Figure 7). The level of comfort with discussing the concept
could play a role in the willingness to initiate health equity discussions with researchers.
While the level of comfort could be related to knowledge or understanding, it could also be
due to factors indiscernible from the survey questions.

Overall the results suggest possible connections between a health information professional’s
thinking about the relevance of health equity to evidence synthesis and their experience
discussing health equity with researchers. The participants who thought health equity was
very relevant to evidence synthesis were more likely to have had discussions about health
equity with researchers (Correlation Chart 3). Similarly, participants unfamiliar with the
meaning of health equity were more likely to feel uncomfortable discussing health equity with
researchers (Correlation Chart 4).

The fact that 52% of participants described themselves as “not at all familiar” with the
PRISMA-Equity Extension presents an opportunity for health information professionals.
Given their role in methodology discussions, it is possible that their mentioning PRISMA-E
during these discussions could have a meaningful impact on incorporating health equity into
this research. This is not to suggest that PRISMA-E is the only supporting document that

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considers health equity. Other tools, like PROGRESS Plus, could be considered. Health
information professionals may also take the initiative, in collaboration with their research
teams, to develop their own supporting documents.

Limitations

Although the authors solicited participants from international professional organizations, the
survey was not designed to identify the geographic location of the participants. The
quantitative nature of the survey also restricted any possibility for nuance, particularly around
the questions about discussions with research teams. While asking who initiated the health
equity discussion is important, missing from this survey are details about the quality and
dynamics of these discussions with research teams. A possible direction for future research
would be to conduct qualitative interviews with health information professionals about
experiences collaborating on evidence synthesis and the subject of health equity. This
approach may address the limitation of human memory our participants may have had in
recalling their experiences collaborating in evidence syntheses.

Conclusion
Health information professionals have a history of making meaningful contributions to
evidence synthesis, and this study illustrates that they understand the potential of bringing a
health equity perspective to this work. Their experiences as methodological advisors provide
a solid foundation for developing or deepening expertise in equity-centered evidence
synthesis methods and tools such as PRISMA-E. While 36% of the participants in this study
had some level of familiarity with the health equity-focused evidence synthesis tool
PRISMA-E, slightly over half (52%) did not, which suggests that librarian training related to
this tool would be beneficial. A critical action moving forward will be staying up to date on
discussions about tools like PRISMA-E, as well as other tools for incorporating health equity
considerations into the evidence synthesis process, such as PROGRESS and PROGRESS
Plus. Staying up to date could involve active participation in meetings where equity-centered
evidence synthesis tools and methods are being discussed and debated, such as public
webinars sponsored by medical research organizations or library organizations.

The finding that 42% of the study participants have had health equity discussions with
research teams suggests that a substantial number of researchers would be open to health
equity-related evidence synthesis guidance conveyed by health information professionals.
Health information professionals could offer this guidance through research consultations and
during library instruction sessions. With their knowledge of information sources, health
information professionals are particularly well positioned to convey the guidance that pertains
to literature searching (such as encouraging researchers to take an expansive view of what
constitutes legitimate research evidence).

As health information professionals continue to collaborate on evidence synthesis projects, it
is important that they be comfortable communicating about health equity with evidence
synthesis researchers. The finding that 72% of study participants are less than “very
comfortable” with discussing health equity with researchers is concerning and suggests that
health information professionals might benefit from training on how to approach the topic of
health equity during research discussions.

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The literature supports incorporating health equity considerations and values into every stage
of the evidence synthesis process. By obtaining training on equity-centered evidence
synthesis methods and bringing a health equity perspective to their collaborations with
researchers, health information professionals can strengthen their knowledge base and support
the public good.

Corresponding Author
Stacy Torian, Librarian for Health Sciences (Allied Health), New York University Libraries,
stacy.torian@nyu.edu

Ethical Declarations
Because it involved minimal risk of harm to the survey participants, our study received an
exemption from U.S. federal policy on human subjects research via our Institutional Review
Board. To ensure the privacy of participants, the authors did not collect personal identifiers or
geographic location data. The Institutional Review Board of New York University approved
the study on December 18, 2023 (Study IRB-FY2024-7965).

Data Availability Statement
Data are summarized in the tables and figures.

CRediT Statement
Stacy Torian: Conceptualization, methodology, analysis, data collection, writing, manuscript
revision

Stephen Maher: Conceptualization, methodology, analysis, data visualization, writing,
manuscript revision

Both Torian and Maher are lead authors of the manuscript.

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