Migrant Healthcare Guidelines: A Systematic Quality Assessment

J Immigr Minor Health. 2019 Apr;21(2):401-413. doi: 10.1007/s10903-018-0759-9.


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.

Keywords: AGREE II tool; Migrant health; Practice guidelines; Quality assessment; Refugee health.

Publication types

  • Systematic Review

MeSH terms

  • Culturally Competent Care / standards*
  • Evidence-Based Medicine / standards
  • Health Services Accessibility / standards*
  • Humans
  • Minority Health / statistics & numerical data
  • Practice Guidelines as Topic / standards*
  • Transients and Migrants / statistics & numerical data