The REP EQUITY Toolkit

The REP-EQUITY toolkit is an evidence-based, seven step guide to help research teams plan, facilitate, and report representative and equitable participation in their research.

What is the REP-EQUITY Toolkit?

The REP-EQUITY toolkit was developed by researchers at the University of Birmingham and funded by the National Institute for Health and Care Research (NIHR), Birmingham BRC, and the former West Midlands Applied Research Collaboration. The toolkit addresses the historical issue of systemic exclusion of particular groups in clinical trials such as minorities, older adults, or lower-income communities. When trials lack representative participation, the findings may not accurately reflect how an intervention impacts different populations. This can lead to medical bias and worsening health inequalities.

What are the seven steps?

The toolkit takes you through a checklist of seven sequential steps to follow from the start to the end of their study. Thinking about your own specific research area, the toolkit guides your research team to:

1. Use the available data and expertise to understand the characteristics of people experiencing the condition of interest.
2. Define the research team’s aims in terms of fairness and representativeness in their research.
3. Plan how the participant sample will be defined in terms of generalisability to the population of interest, how the risks and benefits of the research will be distributed, and the feasibility of the overall approach.
4. Set recruitment goals in terms of methodological requirements (e.g. for statistical power, exploratory analyses).
5. Consider how external factors that influence participation and sampling will be managed.
6. Plan how representation will be evaluated (e.g. comparison with the recruitment targets or with available data).
7. Consider and plan for the legacy of the research in terms of lasting outputs (e.g. advisory groups, participant registries, relationships with communities) and reporting the use of the toolkit and findings relating to underserved groups. 

Who should use the REP-EQUITY toolkit?

The toolkit was designed to be used by research teams to support representative research that is considerate of health inequalities.

We aim for the toolkit to be used throughout the research community. It is best used by in partnership with people with lived experience of the conditions under study.

How can the REP-EQUITY toolkit be used?

The toolkit can be used flexibly. This could include during:

1. The planning of a research study to ensure that all steps are considered and accounted for during planning and costing.
2. The course of a research study to refer to the steps and stay on track.
3. The reporting of a study to demonstrate the study’s adherence to and use of the toolkit.

How can I access the REP-EQUITY toolkit?

Complete the online form below to download the REP-EQUITY toolkit checklist. When downloading the toolkit checklist, you will be asked for some basic information to help us understand how the toolkit is being used and by whom.

Complete online form and download REP-EQUITY

How can I learn more about the REP-EQUITY toolkit?

Read the REP-EQUITY research paper Read the REP-EQUITY research briefing

How can the REP-EQUITY toolkit be cited?

You can cite the toolkit as follows:

Retzer, A., Ciytak, B., Khatsuria, F. et al. A toolkit for capturing a representative and equitable sample in health research. Nat Med 29, 3259–3267 (2023). https://doi.org/10.1038/s41591-023-02665-1

What are the terms of use?

This REP-EQUITY toolkit is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in the toolkit are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

How is the REP-EQUITY toolkit being used?

We are using the REP-EQUITY toolkit in a range of research studies, including early phase trials, applied health research, and data science. We are collecting case studies of its use, so watch this space.

Get in touch

If you would like to discuss use of the toolkit, contact Ameeta Retzer ([email protected]).