Background:
Sex and gender matter to health outcomes. However, their consideration in systematic reviews (SRs) is challenging and infrequent. In 2017, Cochrane Madrid used the Sex and Gender Appraisal Tool for Systematic Reviews (SGAT-SR) to assess the consideration of sex and gender in 113 Cochrane Reviews of interventions to prevent healthcare-associated infections.

Objectives:
To describe our experience with the SGAT-SR and, if necessary, to make consensus-based recommendations for improvement.

Methods:
Five people with heterogeneous experience in SRs (from no experience to 15 years) used the SGAT-SR to assess the sex and gender content of 113 Cochrane Reviews. At least two people independently used the tool for each review. We used a predefined form in EPPI-reviewer 4 to collect our general and item-specific comments about the tool. Finally, we tabulated our team’s feedback on the tool and our recommendations for improvement.

Results:
We found the SGAT-SR to be helpful in assessing the consideration of sex and gender in Cochrane Reviews. However, we encountered some challenges, on the basis of which we developed the following recommendations for improvement (among others):
1) to provide specific guidance for each item of the tool, for example, how to assess the sex and gender-based analysis performed, or how to judge if the tables of Characteristics of included studies reported information on sex and gender correctly;
2) to provide a glossary;
3) to allow the assessment of sex and gender separately;
4) to assess key Cochrane Review sections not yet considered, such as the Plain language summary, or the evaluation of the quality of the evidence;
6) to link the tool with the Cochrane Handbook and the Methodological Expectations of Cochrane Intervention Reviews (MECIR) standards.

Conclusions:
The tool helped us to assess the sex and gender content of 113 Cochrane Reviews, however, it still has some room for improvement. We propose the Campbell and Cochrane Equity Methods Group updates the SGAT-SR whilst involving key stakeholders, such as systematic reviewers, trialists, members of the Cochrane Editorial Unit, and citizens.

Patient or healthcare consumer involvement:
This study involved people with no experience in systematic reviews, which allowed us to reflect the views of healthcare consumers.