Exploring perspectives of knowledge users about reporting on health equity in observational studies: A qualitative study informing the development of the STROBE-Equity reporting guideline

Background Health inequities arising from systemic factors and contextual conditions result in avoidable and unjust differences in health outcomes, with profound social and economic implications. Health inequities can frequently go unreported in observational studies. Observational studies can uniquely inform how we understand and address persisting health inequities through collecting, reporting and analyzing health equity factors using ‘inclusive’ methodological considerations. While the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) reporting guideline aims to improve observational study reporting quality, existing extensions lack a specific focus on health equity. Engaging those who will use or be impacted by research (“knowledge users”), including participant/research collaborators, is central to bridging the gap between knowledge production and real-world application. Therefore, the purpose of this study was to gather a range of perspectives from these knowledge users to inform the development of the STROBE-Equity guideline extension, which aims to improve the reporting of equity-relevant considerations in observational studies. Methods This study used a qualitative description approach, employing semi-structured key informant interviews and framework analysis to collect and analyze the views of researchers, policymakers, decision-makers, funders, journal editors, and participant-research collaborators. Participants were purposefully sampled to reflect diverse perspectives from knowledge users with relevant experience on health equity reporting. Results Eleven key informants participated in the interviews. Information from interviews was categorized into seven themes: “Clarifying equity”, “Equity is dynamic”, “The challenges of making equity claims”, “Making reporting on equity feasible”, “Using reporting guidelines to manage tension”, “Potential for better outcomes”, and “Nobody’s perspective is neutral”. Participants emphasized the need for standardized equity-relevant reporting practices and offered insight into challenges, opportunities, and strategies for integrating equity-relevant considerations into observational study reporting. Conclusions Findings show that participants viewed equity as a complex concept and stressed the need for practical guidance to support equity reporting in observational studies. They highlighted barriers such as limited time, resources, and publication word limits, but saw the STROBE-Equity extension as a valuable tool for structuring reporting, raising awareness, and encouraging reflection, with the potential to improve the quality and impact of equity-relevant research.