PROGRESS Framework: Applying an equity lens to interventions

A summary of

O'Neill (Petkovic), J., Tabish, H., Welch, V., Petticrew, M., Pottie, K., & Clarke, M. (2014). Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology, 67, 56-64.

How to cite this NCCMT summary:

National Collaborating Centre for Methods and Tools (2015). PROGRESS Framework: Applying an equity lens to interventions. Hamilton, ON: McMaster University. (Updated 20 July, 2015) Retrieved from http://www.nccmt.ca/resources/search/234.

Categories: Method, Define, Adapt

These summaries are written by the NCCMT to condense and to provide an overview of the resources listed in the Registry of Methods and Tools and to give suggestions for their use in a public health context. For more information on individual methods and tools included in the review, please consult the authors/developers of the original resources.

Relevance for Public Health

PROGRESS can be used in two ways. First, public health program planners or managers could use PROGRESS to guide the adaptation of an intervention plan. PROGRESS can help you adapt research evidence to your community by identifying factors that may affect how the disadvantaged groups in your population engage with the intervention being planned or the method of implementation. For example, suppose you are asked to design a program to increase rates of active transportation by cycling in your inner-city community. The research evidence indicates that placing self-serve bike rental stations encourages people to travel by bike. Before determining an implementation plan, you consider whether the PROGRESS factors may impact groups' or individuals’ access to and use of the intervention that renders the intervention less effective for disadvantaged priority populations. Inversely, you may want to consider whether your intervention may produce any negative or positive impacts on the PROGRESS factors.

Second, public health researchers could use the PROGRESS framework to ensure that their research question, analysis and reporting encompasses an equity lens. You can use the Equity Checklist for Systematic Review Authors to consider equity in the design and reporting of your research.

Description

The PROGRESS acronym is intended to ensure that there is explicit consideration for health equity, the unfair difference in disease burden, when conducting research and adapting research evidence to inform the design of new interventions. The PROGRESS acronym was created by Evans and Brown (2003) to describe factors that contribute to health inequity. PROGRESS stands for:

  • Place of residence
  • Race/ethnicity/culture/language
  • Occupation
  • Gender/sex
  • Religion
  • Education
  • Socioeconomic status
  • Social capital

PROGRESS serves as a reminder to consider the intersecting determinants of health when designing research or an implementation plan. The acronym is not meant to encompass all the factors involved with the distribution of health. Rather, it emphasizes that multiple factors affect health inequity. This acronym encourages public health researchers, program planners and managers to think about these intersecting determinants of health, and their consequences on equity. Explicit identification of these factors can create opportunities to redistribute resources to address health inequities.

In some contexts, additional factors may affect the impact an intervention can have on equity. PROGRESS has been expanded into PROGRESS-Plus (Oliver et al., 2008) to include other context-specific factors that facilitate disadvantage. These factors include: personal characteristics that are associated with discrimination (e.g., age, disability), features of a relationship (e.g., smoking parents, excluded from school), time-dependant relationships (e.g., leaving the hospital, respite care) and other circumstances that may indicate disadvantage.

Implementing the Method/Tool
Steps for Using Method/Tool

The PROGRESS acronym helps you to remember to consider the social determinants of health when adapting an evidence-informed recommendation to a community. PROGRESS stands for:

  • Place of residence
  • Race/ethnicity/culture/language
  • Occupation
  • Gender/sex
  • Religion
  • Education
  • Socioeconomic status
  • Social capital

You can use the PROGRESS factors after you have searched, appraised and synthesized the research evidence. To use PROGRESS:

  1. Compile the recommendation(s) for the interventions(s) you have formed with the research evidence.
  2. Independently or with stakeholders, consider the impact each potential recommendation can have on the PROGRESS factors.
  3. Consider the effect PROGRESS factors have on access and acceptability of each recommendation.
  4. Choose the most appropriate intervention for your community.
  5. Create an implementation plan for the intervention that addresses the relevant PROGRESS factors.
Who is involved

Program planners or managers will lead the administration of this method. If equity is not a priority, they may need to champion the use of the PROGRESS factors during planning and implementation. Representatives from your community can engage with this method, so they can share their experience with each PROGRESS factor.

Conditions for Use
Not specified
Evaluation and Measurement Characteristics
Evaluation
Has not been evaluated
Validity
Validity not tested
Reliability
Reliability not tested
Methodological Rating
Unknown/No evidence
Method/Tool Development
Developer(s)

Jennifer O'Neill

Coordinator, Campbell and Cochrane Equity Methods Group

Bruyere Research Institute, University of Ottawa

85 Primrose Avenue Office 302

Ottawa, ON K1R 6M1

613-562-5800 ext. 1963

jennifer.oneill@ottawa.ca

Method of Development

The acronym PROGRESS was developed by Evans and Browns (2003). This acronym was adopted by the Campbell and Cochrane Equity Methods Group to guide the analysis and reporting of equity focused research. The use of PROGRESS to apply an equity lens to interventions was developed through consultation with experts on the PROGRESS factors.

Release Date
2014
Contact Person/Source

Jennifer Petkovic (Formerly Jennifer O'Neill)

Coordinator, Campbell and Cochrane Equity Methods Group

Bruyere Research Institute, University of Ottawa

85 Primrose Avenue Office 302

Ottawa, ON K1R 6M1

613-562-5800 ext. 1963

jennifer.petkovic@ottawa.ca

Resources

Title of Primary Resource
Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health
File Attachment
None
Web-link
Reference
O'Neill (Petkovic), J., Tabish, H., Welch, V., Petticrew, M., Pottie, K., & Clarke, M. (2014). Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. Journal of Clinical Epidemiology, 67, 56-64.
Type of Material
Journal Article
Format
Periodical
Cost to Access
Not specified
Language
English
Conditions for Use
2014 Elsevier Inc.

Title of Supplementary Resource
Road traffic crashes: operationalizing equity in the context of health sector reform
File Attachment
None
Web-link
Reference
Evans, T., & Brown, H. (2003). Road traffic crashes: operationalizing equity in the context of health sector reform. Injury Control Safety Promotion, 10(1-2), 11-12.
Type of Material
Journal Article
Format
Periodical
Cost to Access
Not specified
Language
English
Conditions for Use
© Swets & Zeitlinger

Title of Supplementary Resource
Health promotion, inequalities, and young people's health. A systematic review of research.
File Attachment
None
Web-link
Reference
Oliver, S., Kavanagh, J., Caird, J., Lorene, T., Oliver, K., & Harden, A. (2008). Health promotion, inequalities, and young people's health. A systematic review of research. Retrieved from http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=2410.
Type of Material
Article
Format
On-line Access
Cost to Access
None.
Language
English
Conditions for Use
Copyright 2006-2009 Social Science Research Unit, Institute of Education

Title of Supplementary Resource
Equity Checklist for Systematic Review Authors
File Attachment
None
Web-link
Reference
Ueffing, E., Tugwell, P., Welch, V., Petticrew, M., & Kristjansson, E. for the Campbell and Cochrane Equity Methods Group. Equity Checklist for Systematic Review Authors. Version 2011-11-08. Accessed at http://equity.cochrane.org/sites/equity.cochrane.org/files/uploads/equitychecklist2011.pdf on August, 18th, 2014.
Type of Material
Checklist
Format
On-line Access
Cost to Access
None.
Language
English
Conditions for Use
Not specified

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