Development of the Kunonga Framework for Extending Approaches in Health Inequality and Inequity Evidence Syntheses

BackgroundHealth inequalities and inequities are shaped by intersecting social determinants and cumulative life-course experiences. However, conventional evidence synthesis methods often lack the conceptual and analytical tools to capture this complexity. This limits their ability to inform inequality and/or inequity-sensitive policy and practice. In response, we developed a methodological framework to support the systematic integration of intersectionality and life-course perspectives into evidence synthesis. MethodsFramework development followed a three-phase process. First, a systematic review identified conceptual and operational limitations in existing synthesis methods that seek to address health inequality and/or inequity. Second, semi-structured discussions were conducted with eight experts in health inequalities and evidence synthesis to elicit practice-relevant insights aimed at addressing these gaps. Third, findings from both phases were synthesised using a modified framework analysis to construct a structured thematic model aligned with key stages of evidence syntheses (protocol development, data extraction and analysis), informing the design of the methodological framework. ResultsThe Kunonga Framework offers practical tools and methodological guidance for integrating inequality and/or inequity considerations throughout the evidence synthesis lifecycle. It is underpinned by three core principles: (1) distinguishing between health inequality and health inequity to improve conceptual clarity; (2) applying intersectionality to examine how overlapping social disadvantages shape health outcomes; and (3) adopting a life-course perspective to assess how inequalities and inequities emerge, accumulate and evolve over time. The framework provides practical tools, including logic models, intersectionality matrices and life-stage mapping, to support implementation. A case study on ethnic inequalities in palliative care prescribing illustrated the frameworks feasibility and highlighted its potential to enhance analytical depth and policy relevance. ConclusionsThe Kunonga Framework advances evidence synthesis methodology by operationalising established theoretical constructs into actionable guidance. It supports reviewers in considering social complexity and changes across the life-course, helping to explain for whom, how, and in what contexts interventions may work. While developed to support inequality and/or inequity-focused reviews, it can also improve the relevance and depth of broader evidence syntheses. Future research should explore its use across different types of reviews and assess how it can be applied using both qualitative and quantitative methods.