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Marshall J, Papavasiliou E, Fox C, Hawkes M, Irvine A, Moniz-Cook E, Pick A, Polley MJ, Reeve J, Robinson L, Rook G, Sadler E, Wolverson E, Walker S, Cross JL. Social prescribing for people living with dementia (PLWD) and their carers: what works, for whom, under what circumstances and why - protocol for a complex intervention systematic review. BMJ Open 2024; 14:e080551. [PMID: 38589260 PMCID: PMC11015224 DOI: 10.1136/bmjopen-2023-080551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Dementia is a complex medical condition that poses significant challenges to healthcare systems and support services. People living with dementia (PLWD) and their carers experience complex needs often exacerbated by social isolation and challenges in accessing support. Social prescribing (SP) seeks to enable PLWD and their carers to access community and voluntary sector resources to support them address such needs. Existing research, however, does not describe what SP interventions are currently in place in dementia care. Little is known about the needs these interventions are designed to address, the reasons that lead PLWD and their carers to participate in them, their effectiveness and the extent to which they could increase positive health outcomes if adopted and how. METHODS AND ANALYSIS A complex intervention systematic review of SP for PLWD and/or their carers will be conducted using an iterative logic model approach. Six electronic (MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and Cochrane/CENTRAL) and two grey literature databases (EThOS and CORE) were searched for publications between 1 January 2003 and June 2023, supplemented by handsearching of reference lists of included studies. Study selection, data extraction and risk of bias assessment, using Gough's Weight of Evidence Framework, will be independently performed by two reviewers. A narrative approach will be employed to synthesise and report quantitative and qualitative data. Reporting will be informed by the Preferred Reporting Items for Systematic Review and Meta-Analysis Complex Interventions extension statement and checklist. ETHICS AND DISSEMINATION No ethical approval is required due to this systematic review operating only with secondary sources. Findings will be disseminated through peer-reviewed publications, conference presentations and meetings with key stakeholders including healthcare professionals, patient and carer groups, community organisations (eg, the Social Prescribing Network and the Evidence Collaborative at the National Academy for Social Prescribing), policymakers and funding bodies. PROSPERO REGISTRATION NUMBER CRD42023428625.
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Affiliation(s)
- Jessica Marshall
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | | | | | | | | | - Aimee Pick
- University of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | | | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle, UK
| | - George Rook
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Euan Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Emma Wolverson
- Faculty of Health Sciences, University of Hull, Hull, UK
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O’Grady M, Connolly D, Kennedy M, Mockler D, Broderick J, Barrett E. The Role of Intermediaries in Connecting Community-Dwelling Adults to Local Physical Activity and Exercise: A Scoping Review. Int J Integr Care 2024; 24:12. [PMID: 38706537 PMCID: PMC11067969 DOI: 10.5334/ijic.7731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction Connecting inactive individuals to local physical activity (PA) and exercise, via intermediaries (professionals who can facilitate and support connections to non-medical services) may be an effective method to tackle physical inactivity. Evidence regarding the processes of intermediaries, the profile of people referred, how connections to local PA and exercise are made and outcomes of these connections is lacking. Methods This scoping review followed guidelines from the Joanna Briggs Institute. Searches of four electronic databases (Embase, Medline, Web of Science, CINAHL) and an extensive grey literature search were conducted from inception to June 2022. Full-text studies which reported on community-dwelling adults (population), and the processes of intermediaries (concept) when connecting to local PA and exercise (context) were considered for inclusion. A logic model was created to map processes to outcomes. Evidence advances and gaps were identified. Results N = 28 studies were identified. Participants referred to an intermediary were older, female, and with poorer health. Where possible, the processes of referral, assessment, follow-up and discharge by intermediaries were described, as well as the local PA and exercise services used. Short-term PA outcomes appeared positive after working with intermediaries, but many studies were poorly described, and the review was not designed to examine effectiveness of this intervention. Discussion/Conclusion Many aspects of the processes were poorly described. More robust studies evaluating the processes of intermediaries are needed, as well as further exploration of the optimum processes in improving PA outcomes.
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Affiliation(s)
- Megan O’Grady
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Megan Kennedy
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - David Mockler
- The Library of Trinity College, The University of Dublin, College Green, Dublin 2, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Emer Barrett
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
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Lin JS, Webber EM, Bean SI, Evans CV. Development of a Health Equity Framework for the US Preventive Services Task Force. JAMA Netw Open 2024; 7:e241875. [PMID: 38466305 DOI: 10.1001/jamanetworkopen.2024.1875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Importance Clinical practice guidelines can play an important role in mitigating health inequities. The US Preventive Services Task Force (USPSTF) has prioritized addressing health equity and racism in its recommendations. Objective To develop a framework that would allow the USPSTF to incorporate a health equity lens that spans the entirety of its recommendation-making process. Evidence Review Key guidance, policy, and explanatory frameworks related to health equity were identified, and their recommendations and findings were mapped to current USPSTF methods. USPSTF members as well as staff from multiple entities supporting the USPSTF portfolio were consulted. Based on all the gathered information, a draft health equity framework and checklist were developed; they were then circulated to the USPSTF's key partners for input and review. Findings An equity framework was developed that could be applied to all phases of the recommendation process: (1) topic nomination, selection, and prioritization; (2) development of the work plan; (3) evidence review; (4) evidence deliberation; (5) development of the recommendation statement; and (6) dissemination of recommendations. For each phase, several considerations and checklist items to address are presented. These items include using health equity as a prioritization criterion and engaging a diverse group of stakeholders at the earliest phases in identifying topics for recommendations; developing necessary equity-relevant questions (eg, beyond effectiveness and harms) to address during the protocol phase; using methods in synthesizing the evidence and contextual issues in the evidence review related to specific populations experiencing a disproportionate burden of disease; and examining the magnitude and certainty of net benefit, implementation considerations, risk assessment, and evidence gaps through an equity lens when developing evidence-based recommendations. Conclusions and Relevance Executing this entire framework and checklist as described will be challenging and will take additional time and resources. Nonetheless, whether adopted in its entirety or in parts, this framework offers guidance to the USPSTF, as well as other evidence-based guideline entities, in its mission to develop a more transparent, consistent, and intentional approach to addressing health equity in its recommendations.
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Affiliation(s)
- Jennifer S Lin
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Elizabeth M Webber
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Sarah I Bean
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Corinne V Evans
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Solomon-Rakiep T, Olivier J, Amponsah-Dacosta E. Weak Adoption and Performance of Hepatitis B Birth-Dose Vaccination Programs in Africa: Time to Consider Systems Complexity?-A Scoping Review. Trop Med Infect Dis 2023; 8:474. [PMID: 37888602 PMCID: PMC10611266 DOI: 10.3390/tropicalmed8100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/01/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
The persistent burden of chronic hepatitis B among ≤5-year-old children in Africa suggests missed opportunities for controlling mother-to-child transmission (MTCT) of the hepatitis B virus (HBV). This scoping review maps the evidence base on the risk of HBV MTCT, the status of HBV MTCT mitigation strategies including hepatitis B birth-dose vaccination, and the role of systems complexity on the suboptimal adoption and performance of hepatitis B birth-dose vaccination programs in Africa. Overall, 88 peer-reviewed and grey literature sources published between 2000-2022 were included in this review. The growing evidence base consistently argues for a heightened risk of HBV MTCT amidst the HIV co-epidemic in the region. Without universal HBV screening programs integrated within broader antenatal care services, current selective hepatitis B birth-dose vaccination is unlikely to effectively interrupt HBV MTCT. We underscore critical health systems-related barriers to universal adoption and optimal performance of hepatitis B birth-dose vaccination programs in the region. To better conceptualize the role of complexity and system-wide effects on the observed performance of the program, we propose an adapted systems-based logic model. Ultimately, exploring contextualized complex systems approaches to scaling-up universal hepatitis B birth-dose vaccination programs should form an integral part of the regional research agenda.
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Affiliation(s)
- Tasneem Solomon-Rakiep
- Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Jill Olivier
- Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Ammous O, Andreas S, Friede T, Kampo R, Schwarz S, Wollsching-Strobel M, Salem S, Windisch W, Mathes T. Adherence enhancing interventions for pharmacological and oxygen therapy in patients with COPD: protocol for a systematic review and component network meta-analyses. Syst Rev 2023; 12:159. [PMID: 37684691 PMCID: PMC10486002 DOI: 10.1186/s13643-023-02326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is characterised by hyperinflation and expiratory airflow limitation due to long-term exposure to irritants. The variety and complexity of COPD treatment and the possible added comorbidities may make the patients find it difficult to cope with the required medications. That is why supporting patients' adherence is critical because not taking medications correctly increases the risk of complications and creates an additional financial burden. A range of interventions aiming to improve patient adherence were used, and most of them are complex since they involve a mix of elements. Furthermore, despite the variety of available tools, assessing adherence is challenging because clinicians usually do not get a concrete judgement if their patients followed their treatment plan reliably. We aim to evaluate the effectiveness of adherence-enhancing interventions for COPD patients, explore which intervention (component) works for which patients and check the factors influencing the implementation and participant responses. METHODS We will perform a comprehensive literature search (Medline, Embase, Cochrane Library, trial registries) without restrictions on language and publication status, and we will include all controlled studies investigating the effect of adherence-enhancing intervention on patients with COPD. We plan to involve COPD patients in the systematic review development through two patient interviews (one before and one after the systematic review). Two reviewers will perform the screening, data extraction and risk of bias (ROB) assessment. For ROB, we will use ROB 2.0 to assess randomised controlled trials, and ROBINS-I to assess non-randomised studies. We will perform pair-wise random-effects meta-analyses and component network meta-analyses to identify the most effective components and combinations of components. We will use the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence. To determine the degree of complexity, we will use the iCAT_SR checklist, and then, following a logical model, we will group the interventions according to prespecified criteria. DISCUSSION This systematic review aims to point out the most effective and implementable adherence-enhancing interventions by using methods for synthesising evidence on complex interventions and involving COPD patients all along with the review process. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022353977.
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Affiliation(s)
- Omar Ammous
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.
| | - Stefan Andreas
- Clinic for Pneumology/Krs. Kassel, Immenhausen, Germany
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Regina Kampo
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Sarah Schwarz
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
- Witten/Herdecke University, Witten, Germany
| | - Maximilian Wollsching-Strobel
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
- Witten/Herdecke University, Witten, Germany
| | - Susanna Salem
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfram Windisch
- Cologne Merheim Hospital, Department of Pneumology, Kliniken der Stadt Köln gGmbH, Cologne, Germany
- Witten/Herdecke University, Witten, Germany
| | - Tim Mathes
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- Department of Evidence-Based Health Services Research (Institute for Research in Operative Medicine), Witten/Herdecke University, Witten, Germany
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Dube KR, Powis KM, McCaul M, de Beer ST, Slogrove AL. Adverse birth outcome case definitions associated with maternal HIV and antiretroviral drug use in pregnancy: a scoping review protocol. BMJ Open 2023; 13:e072417. [PMID: 37369411 PMCID: PMC10410838 DOI: 10.1136/bmjopen-2023-072417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The global antiretroviral therapy era has led to a decline in the number of children newly acquiring HIV and an increase in the number of children who are HIV-exposed and uninfected (HEU). This shift has prompted extensive research focussing on health and survival outcomes of children who are HEU. Study findings, particularly in relation to adverse birth outcomes, have been disparate, inconclusive and have not always been generalisable. Thus, the objectives of this scoping review are (1) to identify and extract definitions used for the adverse birth outcome terms 'low birth weight', 'small for gestational age', 'stillbirth' and 'preterm birth'; (2) to compare the characteristics of studies from which birth outcome definitions were extracted by (a) temporal periods and (b) study country setting (high-income vs low-income and middle-income countries); (3) to use content analysis to map and describe the temporal and geographic distribution of the definitions used and construct a logical model of their evolution. METHODS AND ANALYSIS The online databases of PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library and CINHAL/EBSCOhost will be used to identify published and grey literature from 2011 to 2022 to identify definitions for the adverse birth outcome terms 'low birth weight', 'small for gestational age', 'stillbirth' and 'preterm birth'. A three-step process of (1) duplicate removal, (2) title and abstract screening and (3) full text screening will be used to select included studies. The extracted data will be used to conduct a comparative analysis, content analysis and construct a logic model. ETHICS AND DISSEMINATION This review will be used to inform a consensus process around the development of harmonised definitions for the specified adverse birth outcomes. Our dissemination plan includes presentations, publications as well as the development infographics and a resource hub. The study is approved by the Human Research Ethics Committee of Stellenbosch University.
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Affiliation(s)
- Kopano Rebaona Dube
- Deparmtment of Paediatrics & Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Kathleen M Powis
- Deparment of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Departments of Internal Medicine and Paediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael McCaul
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
| | - Shani Tamlyn de Beer
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences University of Cape Town, Cape Town, Western Cape, South Africa
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Amy L Slogrove
- Deparmtment of Paediatrics & Child Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
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Long J, Ohlsen S, Senek M, Booth A, Weich S, Wood E. Realist synthesis of factors affecting retention of staff in UK adult mental health services. BMJ Open 2023; 13:e070953. [PMID: 37208136 DOI: 10.1136/bmjopen-2022-070953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVES The shortage of healthcare staff is a global problem. UK mental health services have, on average, a higher turnover of staff than the NHS. Factors affecting retention of this staff group need to be explored in more depth to understand what is working for whom, for what reasons and in what circumstances. This review aims to conduct a realist synthesis to explore evidence from published studies, together with stakeholder involvement to develop programme theories that hypothesise how and why retention occurs in the mental health workforce and identify additional evidence to explore and test these theories thereby highlighting any persistent gaps in understanding. This paper develops programme theories that hypothesise why retention occurs and in what context and tests these theories thereby highlighting any persistent gaps in understanding. METHODS Realist synthesis was used to develop programme theories for factors affecting retention of UK mental health staff. This involved: (1) stakeholder consultation and literature scoping to develop initial programme theories; (2) structured searches across six databases to identify 85 included relevant literature relating to the programme theories; and (3) analysis and synthesis to build and refine a final programme theory and logic model. RESULTS Phase I combined findings from 32 stakeholders and 24 publications to develop six initial programme theories. Phases II and III identified and synthesised evidence from 88 publications into three overarching programme theories stemming from organisational culture: interconnectedness of workload and quality of care, investment in staff support and development and involvement of staff and service users in policies and practice. CONCLUSIONS Organisational culture was found to have a key underpinning effect on retention of mental health staff. This can be modified but staff need to be well supported and feel involved to derive satisfaction from their roles. Manageable workloads and being able to deliver good quality care were also key.
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Affiliation(s)
- Jaqui Long
- School of Health and Related Research, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Sally Ohlsen
- School of Health and Related Research, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Michaela Senek
- School of Health and Related Research, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Andrew Booth
- School of Health and Related Research, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Scott Weich
- School of Health and Related Research, The University of Sheffield, Sheffield, South Yorkshire, UK
| | - Emily Wood
- School of Health and Related Research, The University of Sheffield, Sheffield, South Yorkshire, UK
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Rehfuess EA, Movsisyan A, Pfadenhauer LM, Burns J, Ludolph R, Michie S, Strahwald B. Public health and social measures during health emergencies such as the COVID-19 pandemic: An initial framework to conceptualize and classify measures. Influenza Other Respir Viruses 2023; 17:e13110. [PMID: 36909296 PMCID: PMC9996427 DOI: 10.1111/irv.13110] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/11/2023] Open
Abstract
Background Public health and social measures (PHSM) intend to reduce the transmission of infectious diseases and to reduce the burden on health systems, economies and societies. During the COVID-19 pandemic, PHSM have been selected, combined and implemented in a variable manner and inconsistently categorized in policy trackers. This paper presents an initial conceptual framework depicting how PHSM operate in a complex system, enabling a wide-reaching description of these measures and their intended and unintended outcomes. Methods In a multi-stage development process, we combined (i) a complexity perspective and systems thinking; (ii) literature on existing COVID-19 PHSM frameworks, taxonomies and policy trackers; (iii) expert input and (iv) application to school and international travel measures. Results The initial framework reflects our current understanding of how PHSM are intended to achieve transmission-related outcomes in a complex system, offering visualizations, definitions and worked examples. First, PHSM operate through two basic mechanisms, that is, reducing contacts and/or making contacts safer. Second, PHSM are defined not only by the measures themselves but by their stringency and application to specific populations and settings. Third, PHSM are critically influenced by contextual factors. The framework provides a tool for structured thinking and further development, rather than a ready-to-use tool for practice. Conclusions This conceptual framework seeks to facilitate coordinated, interdisciplinary research on PHSM effectiveness, impact and implementation; enable consistent, coherent PHSM monitoring and evaluation; and contribute to evidence-informed decision-making on PHSM implementation, adaptation and de-implementation. We expect this framework to be modified and refined over time.
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Affiliation(s)
- Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology LMU Munich Munich Germany.,Pettenkofer School of Public Health Munich Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology LMU Munich Munich Germany.,Pettenkofer School of Public Health Munich Germany
| | - Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology LMU Munich Munich Germany.,Pettenkofer School of Public Health Munich Germany
| | - Jacob Burns
- Institute for Medical Information Processing, Biometry and Epidemiology LMU Munich Munich Germany.,Pettenkofer School of Public Health Munich Germany
| | - Ramona Ludolph
- Department of Epidemic and Pandemic Preparedness and Prevention WHO Health Emergencies Programme, World Health Organization Geneva Switzerland
| | - Susan Michie
- UCL Centre for Behaviour Change University College London London UK
| | - Brigitte Strahwald
- Institute for Medical Information Processing, Biometry and Epidemiology LMU Munich Munich Germany.,Pettenkofer School of Public Health Munich Germany
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Wood L, Foster NE, Lewis M, Bronfort G, Groessl EJ, Hewitt C, Miyamoto GC, Reme SE, Bishop A. Matching the Outcomes to Treatment Targets of Exercise for Low Back Pain: Does it Make a Difference? Results of Secondary Analyses From Individual Patient Data of Randomised Controlled Trials and Pooling of Results Across Trials in Comparative Meta-analysis. Arch Phys Med Rehabil 2023; 104:218-228. [PMID: 35934047 DOI: 10.1016/j.apmr.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore whether using a single matched or composite outcome might affect the results of previous randomized controlled trials (RCTs) testing exercise for non-specific low back pain (NSLBP). The first objective was to explore whether a single matched outcome generated greater standardized mean differences (SMDs) when compared with the original unmatched primary outcome SMD. The second objective was to explore whether a composite measure, composed of matched outcomes, generated a greater SMD when compared with the original primary outcome SMD. DESIGN We conducted exploratory secondary analyses of data. SETTING Seven RCTs were included, of which 2 were based in the USA (University research clinic, Veterans Affairs medical center) and the UK (primary care clinics, nonmedical centers). One each were based in Norway (clinics), Brazil (primary care), and Japan (outpatient clinics). PARTICIPANTS The first analysis comprised 1) 5 RCTs (n=1033) that used an unmatched primary outcome but included (some) matched outcomes as secondary outcomes, and the second analysis comprised 2) 4 RCTs (n=864) that included multiple matched outcomes by developing composite outcomes (N=1897). INTERVENTION Exercise compared with no exercise. MAIN OUTCOME MEASURES The composite consisted of standardized averaged matched outcomes. All analyses replicated the RCTs' primary outcome analyses. RESULTS Of 5 RCTs, 3 had greater SMDs with matched outcomes (pooled effect SMD 0.30 [95% confidence interval {CI} 0.04, 0.56], P=.02) compared with an unmatched primary outcome (pooled effect SMD 0.19 [95% CI -0.03, 0.40] P=.09). Of 4 composite outcome analyses, 3 RCTs had greater SMDs in the composite outcome (pooled effect SMD 0.28 [95% CI 0.05, 0.51] P=.02) compared with the primary outcome (pooled effect SMD 0.24 [95% CI -0.04, 0.53] P=.10). CONCLUSIONS These exploratory analyses suggest that using an outcome matched to exercise treatment targets in NSLBP RCTs may produce greater SMDs than an unmatched primary outcome. Composite outcomes could offer a meaningful way of investigating superiority of exercise than single domain outcomes.
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Affiliation(s)
- Lianne Wood
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham, UK.
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK
| | - Gert Bronfort
- Earl E Bakken Centre for Spirituality and Healing, University of Minnesota, Minneapolis, MN, USA
| | - Erik J Groessl
- University of California San Diego, Herbert Wertheim School of Public Health and UCSD Health Services Research Centre, La Jolla, CA, USA
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, UK
| | - Gisela C Miyamoto
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
| | - Silje E Reme
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Annette Bishop
- Primary Care Centre Versus Arthritis, School of Medicine, Faculty of Medicine, Keele University, Newcastle-under-Lyme, UK
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Doustmohammadian A, Mohammadi-Nasrabadi F, Keshavarz-Mohammadi N, Hajjar M, Alibeyk S, Hajigholam-Saryazdi M. Community-based participatory interventions to improve food security: A systematic review. Front Nutr 2022; 9:1028394. [PMID: 36601081 PMCID: PMC9807164 DOI: 10.3389/fnut.2022.1028394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction This systematic review aimed to evaluate community-based participatory (CBP) interventions to improve food security and/or its dimensions to highlight the scope and characteristics of interventions and extract the characteristics of effective interventions. Methods The electronic databases, including PubMed/MEDLINE, SCOPUS, EMBASE, Web of Science, and Google Scholar, were searched from 1980 to 30 August 2022 for relevant studies. We included randomized controlled trials (RCTs), cluster randomized controlled trials (cRCTs), controlled before and after studies (CBAs), non-randomized controlled trials (nRCT), and interrupted time series (ITS) studies to identify the community-based participatory interventions. The indicators of food and nutrition security into four dimensions, as well as food insecurity measured as score and/or prevalence of food insecurity based on validated perception-based measures were considered outcome. Two reviewers independently evaluated the studies for eligibility, extracted data, and evaluated the risk of bias in the included studies using the Effective Public Health Practice Project (EPHPP). The quality of included reports was categorized as strong (when there were no weak ratings), moderate (when one factor was rated as weak), or weak (when two or more factors were rated as weak). A descriptive analysis of the findings was performed. Results A total of twelve studies were included. The quality of all eligible studies (n = 12) was rated as moderate/weak. Most CBP interventions were guided by formative research (n = 9, 75%). Two main groups for utilized strategies were identified: agricultural and nutrition strategies. Agricultural strategies included agricultural education, preparing and improving soil and seeds, promoting and supporting gardening/harvesting utilizing traditional skills based on the local culture, and agroecological practices. Nutrition strategies included store and shopping programs, farmers' markets, fresh fruit and vegetable programs, nutrition education programs for mothers, and food vouchers. The main outcomes improved in the CBP interventions were food security (n = 2) and its dimensions, including availability (n = 3), access (n = 5), and utilization (n = 2). All agroecological practices achieved statistically significant outcomes in the intended food security target(s). However, nutritional interventions were not effective for some access components such as mean adequacy ratio, fruit and vegetable intake, and nutrition environment of the stores. No studies evaluated stability outcome components of food security. Discussion CBP interventions guided by formative research data and agroecological practices were promising strategies to improve food security and its dimensions. Insufficient data on the stability components of food security and weak design studies were the considerable gaps in the research evidence reviewed. More research employing randomized experimental designs with adequate sample size and high retention rates is required. Systematic review registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020189477].
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Affiliation(s)
- Azam Doustmohammadian
- Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Mohammadi-Nasrabadi
- Research Department of Food and Nutrition Policy and Planning, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran,*Correspondence: Fatemeh Mohammadi-Nasrabadi, ,
| | - Nastaran Keshavarz-Mohammadi
- School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Nastaran Keshavarz-Mohammadi,
| | - Melika Hajjar
- Department of Community Nutrition, School of Nutrition Sciences and Food Technology, Student Research Committee, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sepideh Alibeyk
- Faculty of Nutrition Sciences and Food Technology, Library, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Hajigholam-Saryazdi
- Faculty of Nutrition Sciences and Food Technology, Library, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kamphuis CBM, Forberger S, Lien N, Rehfuess E, Luszczynska A. Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: the system-based Policy Evaluation Network (PEN) framework. Eur J Public Health 2022; 32:iv3-iv9. [PMID: 36444110 PMCID: PMC9706121 DOI: 10.1093/eurpub/ckac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Policy Evaluation Network (PEN) is a multidisciplinary Pan-European research consortium focussing on policies affecting dietary intake, physical activity and sedentary behaviour. At the start, the PEN consortium expressed the need for an overarching, system-based framework covering the complexities between the different domains of the policy process (design, implementation and outcomes) in order to execute all research activities in a coherent way. This article describes the PEN framework itself and its development process. METHODS A staged approach to the development of a system-based framework was executed between February 2019 and February 2022. We started with a point-of-departure framework, made use of existing models, collected PEN outputs at different project stages (through online meetings, e-mail exchanges and workshops with PEN researchers) and drew updated versions of the framework, which resulted in the system-based PEN framework. RESULTS The system-based PEN framework depicts the policy process as a complex system, visualizing the dynamic interrelations between and within policy domains (i.e. policy design, policy implementation and policy outcomes), the ways they interact with the context, and how to assure a focus on equity in each domain. CONCLUSIONS The system-based PEN framework may guide researchers and professionals involved in the evaluation of health- or sustainability-related policies to consider their evaluation in a comprehensive picture, including domain interactions, contextual influences and equity considerations, as these can have important implications for the scope of their research. The stage-based process as applied for the development of the PEN framework can serve as a template for other research projects wishing to develop their own framework.
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Affiliation(s)
- Carlijn B M Kamphuis
- Correspondence: Carlijn B.M. Kamphuis, Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands, Tel: +31 (0) 30 253 3489, e-mail:
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences & Humanities, Wroclaw, Poland
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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12
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Kelly L, Twohig C, Woods CB, Luszczynska A, Murrin C, Lien N, Meshkovska B, Kamphuis CBM, Poelman MP, Terragani L, Forberger S, Hebestreit A, Ahrens W, Harrington JM. Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network. Eur J Public Health 2022; 32:iv10-iv20. [PMID: 36444104 PMCID: PMC9706120 DOI: 10.1093/eurpub/ckac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the 'Policy Evaluation Network' (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. METHODS A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. RESULTS Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. 'Outcome' and 'Impact'). A conceptual 'Inter-relations in policy-related concepts' diagram was developed to enable navigation through an online database with key terms. CONCLUSIONS The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages.
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Affiliation(s)
- Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cliona Twohig
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, CARE-BEH Center for Applied Research on Health Behaviour and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Celine Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Laura Terragani
- Department of Nutrition, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
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Mendes CDSS, Souza PRD, Rabelo A, Silva AMD, Silva MRD, Santos DVD, Soárez PCD. Logical model of telenursing program of a high complexity oncology care center. Rev Esc Enferm USP 2022; 56:e20220067. [PMID: 35880959 PMCID: PMC10116880 DOI: 10.1590/1980-220x-reeusp-2022-0067en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/22/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To develop the logical model of the Alô Enfermeiro program aiming at elucidating the existing structure, activities carried out, and expected results, allowing the program implementation systematic evaluation. METHOD This is an evaluative study with a qualitative approach. The development of the logical model was based on systematic methodologies, constituted from the analysis of institutional documents, literature review, search for essential elements that supported the implementation of the program, and the participation of stakeholders for discussion and validation of the data obtained. RESULTS It was possible to define the macro problem that gave rise to the program, establish the definition of the Program Alô Enfermeiro, target audience, general and specific objectives, as well as to structure the necessary components, such as inputs and activities, indicating the expected results in the short, medium, and long term. The logical model allowed the identification of the Alô Enfermeiro Program evaluation question, directed to the evaluation of results. CONCLUSION The logical model developed allowed the comprehension of the program structure, the interaction among the activities carried out and the expected results of the "Alô Enfermeiro".
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Affiliation(s)
| | | | - Andrea Rabelo
- Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Patrícia Coelho de Soárez
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Preventiva, São Paulo, SP, Brazil
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Koebe P, Bohnet-Joschko S. The Impact of Digital Transformation on Inpatient Care: A Mixed Design Study (Preprint). JMIR Public Health Surveill 2022; 9:e40622. [PMID: 37083473 PMCID: PMC10163407 DOI: 10.2196/40622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 01/13/2023] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND In the context of the digital transformation of all areas of society, health care providers are also under pressure to change. New technologies and a change in patients' self-perception and health awareness require rethinking the provision of health care services. New technologies and the extensive use of data can change provision processes, optimize them, or replace them with new services. The inpatient sector, which accounts for a particularly large share of health care spending, plays a major role in this regard. OBJECTIVE This study examined the influences of current trends in digitization on inpatient service delivery. METHODS We conducted a scoping review. This was applied to identify the international trends in digital transformation as they relate to hospitals. Future trends were considered from different perspectives. Using the defined inclusion criteria, international peer-reviewed articles published between 2016 and 2021 were selected. The extracted core trends were then contextualized for the German hospital sector with 12 experts. RESULTS We included 44 articles in the literature analysis. From these, 8 core trends could be deduced. A heuristic impact model of the trends was derived from the data obtained and the experts' assessments. This model provides a development corridor for the interaction of the trends with regard to technological intensity and supply quality. Trend accelerators and barriers were identified. CONCLUSIONS The impact analysis showed the dependencies of a successful digital transformation in the hospital sector. Although data interoperability is of particular importance for technological intensity, the changed self-image of patients was shown to be decisive with regard to the quality of care. We show that hospitals must find their role in new digitally driven ecosystems, adapt their business models to customer expectations, and use up-to-date information and communications technologies.
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Affiliation(s)
- Philipp Koebe
- Faculty of Management, Economics and Society, Witten/Herdecke University, Witten, Germany
| | - Sabine Bohnet-Joschko
- Faculty of Management, Economics and Society, Witten/Herdecke University, Witten, Germany
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15
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Huiberts I, Singh A, van Lenthe FJ, Chinapaw M, Collard D. Evaluation proposal of a national community-based obesity prevention programme: a novel approach considering the complexity perspective. Int J Behav Nutr Phys Act 2022; 19:31. [PMID: 35331266 PMCID: PMC8943931 DOI: 10.1186/s12966-022-01271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Community-based obesity prevention programmes are considered an important strategy to curb the obesity epidemic. The JOGG (Youth At a Healthy Weight) approach is a large-scale community-based programme for childhood obesity prevention in the Netherlands that has been implemented over the past ten years. Practice-based development of the programme, both at the national and local level, increasingly poses challenges for its evaluation. One considerable challenge is the increasing acknowledgement of the complexity in the JOGG-approach, characterized by (a) objectives that vary locally, (b) adaptions to the programme over time in response to a community's shifting needs, challenges and opportunities, and (c) emergent outcomes and non-linear causality.We propose an evaluation framework that highlights elements of the complex local practice, including the local programme theory, implementation, adaption, the influence of context and feedback loops and intended as well as emergent and unintended outcomes. By studying each of these elements in practice, we hope to learn about principles that guide effective obesity prevention across contexts. The results of the proposed evaluation will inform both practice and research.Considering complexity in evaluation is a relatively new challenge in public health and therefore an emergent research area. The proposed framework for complex evaluations allows to retrospectively evaluate a programme that was implemented and developed in practice, and enables us to learn from practice-based experiences. Following the ISBNPA Dare2Share initiative, we kindly invite other researchers in the field to share their ideas and experiences regarding integration of complexity in evaluation.
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Affiliation(s)
- Irma Huiberts
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands. .,Mulier Instituut, Utrecht, The Netherlands.
| | - Amika Singh
- Mulier Instituut, Utrecht, The Netherlands.,Center for Physically Active Learning, Faculty of Education, Arts and Sports. Western, Norway University of Applied Sciences, Sogndal, Norway
| | - Frank J van Lenthe
- Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands.,Faculty of Geosciences, Utrecht University, Utrecht, The Netherlands
| | - Mai Chinapaw
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
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Lewis NV, Munas M, Colombini M, d'Oliveira AF, Pereira S, Shrestha S, Rajapakse T, Shaheen A, Rishal P, Alkaiyat A, Richards A, Garcia-Moreno CM, Feder GS, Bacchus LJ. Interventions in sexual and reproductive health services addressing violence against women in low-income and middle-income countries: a mixed-methods systematic review. BMJ Open 2022; 12:e051924. [PMID: 35193906 PMCID: PMC8867339 DOI: 10.1136/bmjopen-2021-051924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To synthesise evidence on the effectiveness, cost-effectiveness and barriers to responding to violence against women (VAW) in sexual and reproductive health (SRH) services in low/middle-income countries (LMICs). DESIGN Mixed-methods systematic review. DATA SOURCES Medline, Embase, Psycinfo, Cochrane, Cinahl, IMEMR, Web of Science, Popline, Lilacs, WHO RHL, ClinicalTrials.gov, Google, Google Scholar, websites of key organisations through December 2019. ELIGIBILITY CRITERIA Studies of any design that evaluated VAW interventions in SRH services in LMICs. DATA EXTRACTION AND SYNTHESIS Concurrent narrative quantitative and thematic qualitative syntheses, integration through line of argument and mapping onto a logic model. Two reviewers extracted data and appraised quality. RESULTS 26 studies of varied interventions using heterogeneous outcomes. Of ten interventions that strengthened health systems capacity to respond to VAW during routine SRH consultation, three reported no harm and reduction in some types of violence. Of nine interventions that strengthened health systems and communities' capacity to respond to VAW, three reported conflicting effects on re-exposure to some types of VAW and mixed effect on SRH. The interventions increased identification of VAW but had no effect on the provision (75%-100%) and uptake (0.6%-53%) of referrals to VAW services. Of seven psychosocial interventions in addition to SRH consultation that strengthened women's readiness to address VAW, four reduced re-exposure to some types of VAW and improved health. Factors that disrupted the pathway to better outcomes included accepting attitudes towards VAW, fear of consequences and limited readiness of the society, health systems and individuals. No study evaluated cost-effectiveness. CONCLUSIONS Some VAW interventions in SRH services reduced re-exposure to some types of VAW and improved some health outcomes in single studies. Future interventions should strengthen capacity to address VAW across health systems, communities and individual women. First-line support should be better tailored to women's needs and expectations. PROSPERO REGISTRATION NUMBER CRD42019137167.
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Affiliation(s)
- Natalia V Lewis
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Muzrif Munas
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Manuela Colombini
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - A F d'Oliveira
- Faculty of Medicine, University of São Paulo Institute of Biomedical Sciences, Sao Paulo, Brazil
| | - Stephanie Pereira
- Faculty of Medicine, University of São Paulo Institute of Biomedical Sciences, Sao Paulo, Brazil
| | - Satya Shrestha
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
- School of Medical Sciences, Kathmandu University, Kathmandu, Nepal
| | - Thilini Rajapakse
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Amira Shaheen
- Faculty of Medicine and Health Sciences, An-najah National University, Nablus, State of Palestine
| | - Poonam Rishal
- School of Medical Sciences, Kathmandu University, Kathmandu, Nepal
| | - Abdulsalam Alkaiyat
- Faculty of Medicine and Health Sciences, An-najah National University, Nablus, State of Palestine
| | - Alison Richards
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
- NIHR ARC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Claudia M Garcia-Moreno
- Department of Reproductive Health and Research, Organisation mondiale de la Sante, Geneve, Switzerland
| | - Gene S Feder
- Bristol Medical School (PHS), University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Loraine J Bacchus
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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17
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Lobczowska K, Banik A, Romaniuk P, Forberger S, Kubiak T, Meshkovska B, Neumann-Podczaska A, Kaczmarek K, Scheidmeir M, Wendt J, Scheller DA, Wieczorowska-Tobis K, Steinacker JM, Zeeb H, Luszczynska A. Frameworks for implementation of policies promoting healthy nutrition and physically active lifestyle: systematic review. Int J Behav Nutr Phys Act 2022; 19:16. [PMID: 35151330 PMCID: PMC8841124 DOI: 10.1186/s12966-021-01242-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/23/2021] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Policy frameworks focusing on policy implementation may vary in terms of their scope, included constructs, relationships between the constructs, and context factors. Although multiple policy implementation frameworks exist, the overarching synthesis characterizing differences between the frameworks is missing. This study investigated frameworks guiding implementation of policies aiming at healthy nutrition, physical activity promotion, and a reduction of sedentary behavior. In particular, we aimed at examining the scope of the frameworks and the content of included constructs (e.g., referring to implementation processes, determinants, or implementation evaluation), the level at which these constructs operate (e.g., the individual level, the organizational/community level), relationships between the constructs, and the inclusion of equity factors.
Methods
A systematic review (the PROSPERO registration no. CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analyzed.
Results
Across the frameworks, 47.4% (18 in 38) addressed three aims: description of the process, determinants, and the evaluation of implementation. The majority of frameworks (65.8%; 25 in 38) accounted for constructs from three levels: individual, organizational/community, and the system level. System-level constructs were included less often (76.3%; 29 in 38) than individual-level or organizational/community-level constructs (86.8% [33 in 38 frameworks] and 94.7% [36 in 38 frameworks] respectively). The majority of frameworks (84.2%, 32 in 38) included at least some sections that were solely of descriptive character (a list of unassociated constructs); 50.0% (19 in 38) included sections of prescriptive character (general steps of implementation); 60.5% (23 in 38) accounted for explanatory sections (assuming bi- or uni-directorial associations). The complex system approach was accounted for only in 21.1% (8 in 38) of frameworks. More than half (55.3%; 21 in 38) of frameworks did not account for any equity constructs (e.g., socioeconomic status, culture).
Conclusions
The majority of policy implementation frameworks have two or three aims (combining processes, determinants and/or the evaluation of implementation), include multi-level constructs (although the system-level determinants are less frequently included than those from the individual- or organizational/community-level), combine sections of purely descriptive character with sections accounting for prescriptive and/or explanatory associations, and are likely to include a little or no equity constructs.
Registration
PROSPERO, #CRD42019133251.
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Dichter MN. Logische Modelle und der Theory of Change-Ansatz zur theoretischen Fundierung pflegewissenschaftlicher Interventionen. Pflege 2022; 35:1-3. [PMID: 35068182 DOI: 10.1024/1012-5302/a000855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Martin N Dichter
- Institut für Pflegewissenschat, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln
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19
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Lobczowska K, Banik A, Brukalo K, Forberger S, Kubiak T, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Wieczorowska-Tobis K, Bekker MPM, Zeeb H, Luszczynska A. Meta-review of implementation determinants for policies promoting healthy diet and physically active lifestyle: application of the Consolidated Framework for Implementation Research. Implement Sci 2022; 17:2. [PMID: 34991624 PMCID: PMC8734337 DOI: 10.1186/s13012-021-01176-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although multiple systematic reviews indicate that various determinants (barriers and facilitators) occur in the implementation processes of policies promoting healthy diet, physical activity (PA), and sedentary behavior (SB) reduction, the overarching synthesis of such reviews is missing. Applying the Consolidated Framework for Implementation Research (CFIR), this meta-review aims to (1) identify determinants that were systematically indicated as occurring during the implementation processes and (2) identify differences in the presence of determinants across reviews versus stakeholder documents on healthy diet/PA/SB policies, reviews/stakeholder documents addressing healthy diet policies versus PA/SB policies targeting any population/setting, and healthy diet/PA/SB policies focusing on school settings. METHODS A meta-review of published systematic scoping or realist reviews (k = 25) and stakeholder documents (k = 17) was conducted. Data from nine bibliographic databases and documentation of nine major stakeholders were systematically searched. Included reviews (72%) and stakeholder documents (100%) provided qualitative synthesis of original research on implementation determinants of policies promoting healthy diet or PA or SB reduction, and 28% of reviews provided some quantitative synthesis. Determinants were considered strongly supported if they were indicated by ≥ 60.0% of included reviews/stakeholder documents. RESULTS Across the 26 CFIR-based implementation determinants, seven were supported by 66.7-76.2% of reviews/stakeholder documents. These determinants were cost, networking with other organizations/communities, external policies, structural characteristics of the setting, implementation climate, readiness for implementation, and knowledge/beliefs of involved individuals. Most frequently, published reviews provided support for inner setting and individual determinants, whereas stakeholder documents supported outer and inner setting implementation determinants. Comparisons between policies promoting healthy diet with PA/SB policies revealed shared support for only three implementation determinants: cost, implementation climate, and knowledge/beliefs. In the case of healthy diet/PA/SB policies targeting school settings, 14 out of 26 implementation determinants were strongly supported. CONCLUSIONS The strongly supported (i.e., systematically indicated) determinants may guide policymakers and researchers who need to prioritize potential implementation determinants when planning and monitoring the implementation of respective policies. Future research should quantitatively assess the importance or role of determinants and test investigate associations between determinants and progress of implementation processes. TRIAL REGISTRATION PROSPERO, # CRD42019133341.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Katarzyna Brukalo
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, Bode 60, 6700 EW, Wageningen, the Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland.
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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Mendes CDSS, Souza PRD, Rabelo A, Silva AMD, Silva MRD, Santos DVD, Soárez PCD. Modelo lógico do programa de telenfermagem de um centro de assistência de alta complexidade em oncologia. Rev Esc Enferm USP 2022. [DOI: 10.1590/1980-220x-reeusp-2022-0067pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
RESUMO Objetivo: Desenvolver o modelo lógico do programa Alô Enfermeiro com o intuito de elucidar a estrutura existente, atividades realizadas e resultados esperados, possibilitando a avaliação sistemática da implementação do programa. Método: Trata-se de uma pesquisa avaliativa de abordagem qualitativa. O desenvolvimento do modelo lógico foi embasado em metodologias sistemáticas, constituídas a partir da análise dos documentos institucionais, revisão da literatura, busca por elementos essenciais que fundamentaram a implementação do programa, e a participação dos stakeholders para discussão e validação dos dados obtidos. Resultados: Foi possível definir o macroproblema que deu origem ao programa, estabelecer a definição do Programa Alô Enfermeiro, público-alvo, objetivos geral e específicos, além de estruturar os componentes necessários, como insumos e atividades, indicando os resultados esperados em curto, médio e longo prazo. O modelo lógico permitiu a identificação da pergunta avaliativa do Programa Alô Enfermeiro, direcionada à avaliação de resultados. Conclusão O modelo lógico desenvolvido possibilitou a compreensão da estrutura do programa, da interação entre as atividades realizadas e os resultados esperados do “Alô Enfermeiro”.
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Palm R, Fahsold A, Roes M, Holle B. Context, mechanisms and outcomes of dementia special care units: An initial programme theory based on realist methodology. PLoS One 2021; 16:e0259496. [PMID: 34784375 PMCID: PMC8594822 DOI: 10.1371/journal.pone.0259496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia. Methods The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described. Results We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management. Discussion As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.
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Affiliation(s)
- Rebecca Palm
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- * E-mail:
| | - Anne Fahsold
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
| | - Martina Roes
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
| | - Bernhard Holle
- Faculty of Health, Witten/Herdecke University, School of Nursing Science, Witten, Germany
- German Center for Neurodegenerative Diseases, Witten, Germany
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22
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Schunk M, Berger U, Le L, Rehfuess E, Schwarzkopf L, Streitwieser S, Müller T, Hofmann M, Holle R, Huber RM, Mansmann U, Bausewein C. BreathEase: rationale, design and recruitment of a randomised trial and embedded mixed-methods study of a multiprofessional breathlessness service in early palliative care. ERJ Open Res 2021; 7:00228-2020. [PMID: 34671668 PMCID: PMC8521025 DOI: 10.1183/23120541.00228-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background The Munich Breathlessness Service has adapted novel support services to the German context, to reduce burden in patients and carers from breathlessness in advanced disease. It has been evaluated in a pragmatic fast-track randomised controlled trial (BreathEase; NCT02622412) with embedded qualitative interviews and postal survey. The aim of this article is to describe the intervention model and study design, analyse recruitment to the trial and compare sample characteristics with other studies in the field. Methods Analysis of recruitment pathways and enrolment, sociodemographic and clinical characteristics of participants and carers. Results Out of 439 people screened, 253 (58%) were offered enrolment and 183 (42%) participated. n=97 (70%) carers participated. 186 (42%) people did not qualify for inclusion, mostly because breathlessness could not be attributed to an underlying disease. All participants were self-referring; 60% through media sources. Eligibility and willingness to participate were associated to social networks and illness-related activities as recruitment routes. Mean age of participants was 71 years (51% women), with COPD (63%), chronic heart failure (8%), interstitial lung disease (9%), pulmonary hypertension (6%) and cancer (7%) as underlying conditions. Postal survey response rate was 89%. Qualitative interviews were conducted with 16 patients and nine carers. Conclusion The BreathEase study has a larger and more heterogeneous sample compared to other trials. The self-referral-based and prolonged recruitment drawing on media sources approximates real-world conditions of early palliative care. Integrating qualitative and quantitative components will allow a better understanding and interpretation of the results of the main effectiveness study. The BreathEase study, a mixed-methods pragmatic RCT evaluating the Munich Breathlessness Service, included a heterogeneous sample that approximates real-world conditions of early palliative care, and ran qualitative and quantitative trial siblingshttps://bit.ly/375nCMO
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Affiliation(s)
- Michaela Schunk
- Dept of Palliative Medicine, LMU Hospital, LMU Munich, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Ursula Berger
- Pettenkofer School of Public Health, Munich, Germany.,Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Lien Le
- Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Eva Rehfuess
- Pettenkofer School of Public Health, Munich, Germany.,Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Larissa Schwarzkopf
- Health Economics and Health Care Management (IGM), Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Munich, Germany.,Institut für Therapieforschung, Munich, Germany
| | | | - Thomas Müller
- Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Miriam Hofmann
- Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Rolf Holle
- Pettenkofer School of Public Health, Munich, Germany.,Health Economics and Health Care Management (IGM), Helmholtz Zentrum München GmbH, German Research Center for Environmental Health, Munich, Germany
| | - Rudolf Maria Huber
- Dept of Medicine V, LMU Hospital, LMU Munich, Munich, Germany.,Member of the German Center of Lung Research (DZL, CPC-M), Munich, Germany
| | - Ulrich Mansmann
- Pettenkofer School of Public Health, Munich, Germany.,Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Dept of Palliative Medicine, LMU Hospital, LMU Munich, Munich, Germany
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23
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Klinger C, Burns J, Movsisyan A, Biallas R, Norris SL, Rabe JE, Stratil JM, Voss S, Wabnitz K, Rehfuess EA, Verboom B. Unintended health and societal consequences of international travel measures during the COVID-19 pandemic: a scoping review. J Travel Med 2021; 28:taab123. [PMID: 34369562 PMCID: PMC8436381 DOI: 10.1093/jtm/taab123] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/18/2021] [Accepted: 07/27/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND/OBJECTIVE International travel measures to contain the coronavirus disease of 2019 (COVID-19) pandemic represent a relatively intrusive form of non-pharmaceutical intervention. To inform decision-making on the (re)implementation, adaptation, relaxation or suspension of such measures, it is essential to not only assess their effectiveness but also their unintended effects. METHODS This scoping review maps existing empirical studies on the unintended consequences, both predicted and unforeseen, and beneficial or harmful, of international travel measures. We searched multiple health, non-health and COVID-19-specific databases. The evidence was charted in a map in relation to the study design, intervention and outcome categories identified and discussed narratively. RESULTS Twenty-three studies met our inclusion criteria-nine quasi-experimental, two observational, two mathematical modelling, six qualitative and four mixed-methods studies. Studies addressed different population groups across various countries worldwide. Seven studies provided information on unintended consequences of the closure of national borders, six looked at international travel restrictions and three investigated mandatory quarantine of international travellers. No studies looked at entry and/or exit screening at national borders exclusively, however six studies considered this intervention in combination with other international travel measures. In total, 11 studies assessed various combinations of the aforementioned interventions. The outcomes were mostly referred to by the authors as harmful. Fifteen studies identified a variety of economic consequences, six reported on aspects related to quality of life, well-being, and mental health and five on social consequences. One study each provided information on equity, equality, and the fair distribution of benefits and burdens, environmental consequences and health system consequences. CONCLUSION This scoping review represents the first step towards a systematic assessment of the unintended benefits and harms of international travel measures during COVID-19. The key research gaps identified might be filled with targeted primary research, as well as the additional consideration of gray literature and non-empirical studies.
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Affiliation(s)
- Carmen Klinger
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Jacob Burns
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Ani Movsisyan
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Renke Biallas
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Susan L Norris
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Julia E Rabe
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Jan M Stratil
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Stephan Voss
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Katharina Wabnitz
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Eva A Rehfuess
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Ben Verboom
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square Oxford OX1 2ER
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Teodorowski P, Jones E, Tahir N, Ahmed S, Frith L. Public involvement and engagement in big data research: protocol for a scoping review and a systematic review of delivery and effectiveness of strategies for involvement and engagement. BMJ Open 2021; 11:e050167. [PMID: 34413107 PMCID: PMC8378392 DOI: 10.1136/bmjopen-2021-050167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/27/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Big data research has grown considerably over the last two decades. This presents new ethical challenges around consent, data storage and anonymisation. Big data research projects require public support to succeed and it has been argued that one way to achieve this is through public involvement and engagement. To better understand the role public involvement and engagement can play in big data research, we will review the current literature. This protocol describes the planned review methods. METHODS AND ANALYSIS Our review will be conducted in two stages. In the first stage, we will conduct a scoping review using Arksey and O'Malley methodology to comprehensively map current evidence on public involvement and engagement in big data research. Databases (CINAHL, Health Research Premium Collection, PubMed, Scopus, Web of Science) and grey literature will be searched for eligible papers. We provide a narrative description of the results based on a thematic analysis. In the second stage, out of papers found in the scoping review which discuss involvement and engagement strategies, we will conduct a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, exploring the delivery and effectiveness of these strategies. We will conduct a qualitative synthesis. Relevant results from the quantitative studies will be extracted and placed under qualitative themes. Individual studies will be appraised through Mixed Methods Appraisal Tool (MMAT), we will then assess the overall confidence in each finding through Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Results will be reported in a thematic and narrative way. ETHICS AND DISSEMINATION This protocol sets out how the review will be conducted to ensure rigour and transparency. Public advisors were involved in its development. Ethics approval is not required. Review findings will be presented at conferences and published in peer-reviewed journals.
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Affiliation(s)
- Piotr Teodorowski
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Elisa Jones
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | | | - Lucy Frith
- Departments of Law and Philosophy, University of Liverpool, Liverpool, UK
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25
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Crowley T, Rohwer A. Self-management interventions for adolescents living with HIV: a systematic review. BMC Infect Dis 2021; 21:431. [PMID: 33962558 PMCID: PMC8105944 DOI: 10.1186/s12879-021-06072-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden. METHODS We considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non-RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form. RESULTS We included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of self-management domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes. CONCLUSION Existing evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019126313.
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Affiliation(s)
- Talitha Crowley
- Department of Nursing and Midwifery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anke Rohwer
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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26
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[Evidence-based public health: perspectives and specific implementation factors]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:514-523. [PMID: 33851222 PMCID: PMC8087605 DOI: 10.1007/s00103-021-03308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Evidenzbasierung stellt auch im öffentlichen Gesundheitswesen eine zentrale Anforderung dar. 5 allgemeine Prinzipien gelten in der evidenzbasierten Medizin wie in der evidenzbasierten Public Health (EBPH). Sie umfassen Systematik, Transparenz im Umgang mit Unsicherheit, Integration und Partizipation, Umgang mit Interessenkonflikten sowie einen strukturierten, reflektierten Prozess. Dieser Artikel hat das Ziel, ein gemeinsames Verständnis von evidenzbasierter Public Health zu fördern. Mit einer systematischen Literaturrecherche zu Perspektiven der Evidenzbasierung in Public Health wurde das internationale Verständnis von EBPH beleuchtet. So wurden 20 englischsprachige und eine deutschsprachige Quelle identifiziert und einer Inhaltsanalyse unterzogen. Über die allgemeinen Prinzipien hinausgehende Charakteristika dieser Perspektiven befassen sich mit Aspekten der Bevölkerungsorientierung, dem zugrunde liegenden Verständnis von Evidenz, zu beteiligenden Disziplinen und Interessengruppen sowie relevanten Kriterien und notwendigen Kompetenzen für eine Umsetzung von Evidenzbasierung. Darauf aufbauend und unter Berücksichtigung methodischer Entwicklungen im Umgang mit Komplexität lassen sich 4 spezifische Umsetzungsfaktoren der EBPH ableiten. Sie umfassen Theorie, Interdisziplinarität, Kontextabhängigkeit und Komplexität sowie allgemeine gesellschaftliche Aspekte. Die praktische Umsetzung von EBPH erfordert personelle und finanzielle Ressourcen sowie Kompetenzen – unter anderem für die Durchführung systematischer Übersichtsarbeiten zur Wirksamkeit von Maßnahmen unter Alltagsbedingungen, für die wissenschaftliche Betrachtung weiterer relevanter Fragestellungen sowie für die Etablierung transparenter Prozesse zur Formulierung von Empfehlungen.
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Greenwood K, Webb R, Gu J, Fowler D, de Visser R, Bremner S, Abramowicz I, Perry N, Clark S, O'Donnell A, Charlton D, Jarvis R, Garety P, Nandha S, Lennox B, Johns L, Rathod S, Phiri P, French P, Law H, Hodgekins J, Painter M, Treise C, Plaistow J, Irwin F, Thompson R, Mackay T, May CR, Healey A, Hooper R, Peters E. The Early Youth Engagement in first episode psychosis (EYE-2) study: pragmatic cluster randomised controlled trial of implementation, effectiveness and cost-effectiveness of a team-based motivational engagement intervention to improve engagement. Trials 2021; 22:272. [PMID: 33845856 PMCID: PMC8042707 DOI: 10.1186/s13063-021-05105-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Early Intervention in Psychosis (EIP) services improve health outcomes for young people with psychosis in the medium-long term, but 25% of young people disengage in the first 12 months with costs to their mental health, families, society and the NHS. This study will evaluate the effectiveness, cost-effectiveness and implementation of a team-based motivational Early Youth Engagement (EYE-2) intervention. METHOD The study design is a cluster randomised controlled trial (RCT) with economic evaluation, comparing the EYE-2 intervention + standardised EIP service to standardised EIP service alone, with randomisation at the team level. A process evaluation will evaluate the delivery of the intervention qualitatively and quantitatively across contexts. The setting is 20 EIP teams in 5 sites: Manchester, South London, East Anglia, Thames Valley and Hampshire. Participants are young people (14-35 years) with first episode psychosis, and EIP staff. The intervention is the team-based motivational engagement (EYE-2) intervention, delivered alongside standardised EIP services, and supported by additional training, website, booklets and social groups. The comparator is the standardised EIP service. Both interventions are delivered by EIP clinicians. The primary outcome is time to disengagement (time in days from date of allocation to care coordinator to date of last contact following refusal to engage with EIP service, or lack of response to EIP contact for a consecutive 3-month period). Secondary outcomes include mental and physical health, deaths, social and occupational function, recovery, satisfaction and service use at 6, 12, 18 and 24 months. A 12-month within-trial economic evaluation will investigate cost-effectiveness from a societal perspective and from an NHS perspective. DISCUSSION The trial will provide the first test of an engagement intervention in standardised care, with the potential for significant impact on the mental health and wellbeing of young people and their families, and economic benefits for services. The intervention will be highly scalable, supported by the toolkit including manuals, commissioning guide, training and resources, adapted to meet the needs of the diverse EIP population, and based on an in-depth process evaluation. TRIAL REGISTRATION ISRCTN 51629746 prospectively registered 7th May 2019. Date assigned 10th May 2019.
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Affiliation(s)
- Kathryn Greenwood
- R&D, Sussex Partnership NHS Foundation Trust, Hove, UK. .,School of Psychology, University of Sussex, Falmer, UK.
| | - Rebecca Webb
- School of Psychology, University of Sussex, Falmer, UK
| | - Jenny Gu
- School of Psychology, University of Sussex, Falmer, UK
| | - David Fowler
- R&D, Sussex Partnership NHS Foundation Trust, Hove, UK.,School of Psychology, University of Sussex, Falmer, UK.,University of East Anglia, Norwich, UK
| | | | - Stephen Bremner
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Iga Abramowicz
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Nicky Perry
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Stuart Clark
- Sussex Partnership NHS Foundation Trust, Hove, UK
| | | | - Dan Charlton
- Sussex Partnership NHS Foundation Trust, Hove, UK
| | | | - Philippa Garety
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sunil Nandha
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Belinda Lennox
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Johns
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Peter Phiri
- Southern Health NHS Foundation Trust, Southampton, UK
| | - Paul French
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK.,Manchester Metropolitan University, Manchester, UK
| | - Heather Law
- Greater Manchester Mental Health NHS Foundation Trust, Greater Manchester, UK
| | | | | | - Cate Treise
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Francis Irwin
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | | | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Andy Healey
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Richard Hooper
- Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Emmanuelle Peters
- King's College London, Institute of Psychiatry Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Wood L, Bishop A, Lewis M, Smeets RJEM, Bronfort G, Hayden JA, Foster NE. Treatment targets of exercise for persistent non-specific low back pain: a consensus study. Physiotherapy 2021; 112:78-86. [PMID: 34029781 DOI: 10.1016/j.physio.2021.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Despite several hundred previous randomised controlled trials (RCTs), the key treatment targets of exercise for persistent non-specific low back pain (NSLBP) remain unclear. This study aimed to generate consensus about the key treatment targets of exercise interventions for patients with NSLBP. DESIGN Consensus was generated using modified nominal group technique in two, sequential, workshops. The results of a previous systematic review informed the first, national, workshop idea generation and the results of this workshop informed the second, international, workshop. The authors generated a starting list of 30 treatment targets from the systematic review. A pre-specified consensus threshold of 75% was used in the voting stage. PARTICIPANTS Workshop participants included people with experience of using exercise to manage their persistent NSLBP, clinicians who prescribe exercise for persistent NSLBP, and researchers who design and evaluate exercise interventions in RCTs. All participants generated, voted and ranked the treatment targets in each workshop using an online platform. RESULTS A total of 39 participants contributed to the consensus (15 in the national workshop and 24 in the international workshop), comprising two people with NSLBP, six clinicians and 31 researchers/clinicians. A total of 40 exercise treatment targets were generated, and 25 were retained after voting and ranking. The prioritised targets of exercise for persistent NSLBP were: improving function, improving quality of life, reducing pain, meeting patient-specific goals and reducing fear of movement. CONCLUSIONS Future RCTs of exercise should specify the targets of their exercise intervention and consider assessing these treatment targets as well as including mediation analyses.
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Affiliation(s)
- Lianne Wood
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK; Nottingham University Hospitals NHS Trust, Queens Medical Centre, Derby Road, Nottingham NG 2UH, UK.
| | - Annette Bishop
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK
| | - Martyn Lewis
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK
| | - Rob J E M Smeets
- Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University Maastricht, The Netherlands; CIR Revalidatie, Eindhoven, The Netherlands
| | - Gert Bronfort
- Earl E Bakken Centre for Spirituality and Healing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Faculty of Medicine and Health Sciences, Keele University, Newcastle-under-Lyme ST5 5BG, UK
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Wolfenden L, Movsisyan A, McCrabb S, Stratil JM, Yoong SL. Selecting Review Outcomes for Systematic Reviews of Public Health Interventions. Am J Public Health 2021; 111:465-470. [PMID: 33476230 PMCID: PMC7893343 DOI: 10.2105/ajph.2020.306061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/04/2022]
Abstract
For systematic reviews to have an impact on public health, they must report outcomes that are important for decision-making. Systematic reviews of public health interventions, however, have a range of potential end users, and identifying and prioritizing the most important and relevant outcomes represents a considerable challenge.In this commentary, we describe potentially useful approaches that systematic review teams can use to identify review outcomes to best inform public health decision-making. Specifically, we discuss the importance of stakeholder engagement, the use of logic models, consideration of core outcome sets, reviews of the literature on end users' needs and preferences, and the use of decision-making frameworks in the selection and prioritization of outcomes included in reviews.The selection of review outcomes is a critical step in the production of public health reviews that are relevant to those who use them. Utilizing the suggested strategies may help the review teams better achieve this.
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Affiliation(s)
- Luke Wolfenden
- Luke Wolfenden and Sam McCrabb are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia. Ani Movsisyan and Jan M. Stratil are with the Institute for Medical Information Processing, Biometry and Epidemiology and the Pettenkofer School of Public Health, Ludwig Maximilian University of Munich, Munich, Germany. Sze Lin Yoong is with the Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Ani Movsisyan
- Luke Wolfenden and Sam McCrabb are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia. Ani Movsisyan and Jan M. Stratil are with the Institute for Medical Information Processing, Biometry and Epidemiology and the Pettenkofer School of Public Health, Ludwig Maximilian University of Munich, Munich, Germany. Sze Lin Yoong is with the Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Sam McCrabb
- Luke Wolfenden and Sam McCrabb are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia. Ani Movsisyan and Jan M. Stratil are with the Institute for Medical Information Processing, Biometry and Epidemiology and the Pettenkofer School of Public Health, Ludwig Maximilian University of Munich, Munich, Germany. Sze Lin Yoong is with the Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Jan M Stratil
- Luke Wolfenden and Sam McCrabb are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia. Ani Movsisyan and Jan M. Stratil are with the Institute for Medical Information Processing, Biometry and Epidemiology and the Pettenkofer School of Public Health, Ludwig Maximilian University of Munich, Munich, Germany. Sze Lin Yoong is with the Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Sze Lin Yoong
- Luke Wolfenden and Sam McCrabb are with the School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia. Ani Movsisyan and Jan M. Stratil are with the Institute for Medical Information Processing, Biometry and Epidemiology and the Pettenkofer School of Public Health, Ludwig Maximilian University of Munich, Munich, Germany. Sze Lin Yoong is with the Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
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Dawson S, Bierce A, Feder G, Macleod J, Turner KM, Zammit S, Lewis NV. Trauma-informed approaches to primary and community mental health care: protocol for a mixed-methods systematic review. BMJ Open 2021; 11:e042112. [PMID: 33602707 PMCID: PMC7896604 DOI: 10.1136/bmjopen-2020-042112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Exposure to different types of psychological trauma may lead to a range of adverse effects on trauma survivors, including poor mental and physical health, economic, social and cognitive functioning outcomes. Trauma-informed (TI) approaches to care are defined as a service system grounded in and directed by an understanding of how trauma affects the survivors' neurological, biological, physiological and social development. TI service system involves training of all staff, service improvements and sometimes screening for trauma experiences. The UK started incorporating TI approaches into the National Health Service. While policies recommend it, the evidence base for TI approaches to healthcare is not well established. We aim to conduct a systematic review to synthesise evidence on TI approaches in primary and community mental healthcare globally. METHODS AND ANALYSIS We will undertake a systematic search for primary studies in Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, websites of organisations involved in the development and implementation of TI approaches in healthcare, and databases of thesis and dissertation. Included studies will be in English published between 1990 and February 2020. Two reviewers will independently perform study selection with data extraction and quality appraisal undertaken by one reviewer and checked for accuracy by a second reviewer. A results-based convergent synthesis will be conducted where quantitative (narratively) and qualitative (thematically) evidence will be analysed separately and then integrated using another method of synthesis. We set up a trauma survivor group and a professional group to consult throughout this review. ETHICS AND DISSEMINATION There is no requirement for ethical approval for this systematic review as no empirical data will be collected. The findings will be disseminated through a peer-reviewed publication, scientific and practitioner conferences, and policy briefings targeted at local and national policy makers. PROSPERO REGISTRATION NUMBER CRD42020164752.
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Affiliation(s)
- Shoba Dawson
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
| | - Angel Bierce
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
| | - Gene Feder
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
| | - John Macleod
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, National Institute for Health Research Applied Research Collaboration West (ARC West), Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Katrina M Turner
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, National Institute for Health Research Applied Research Collaboration West (ARC West), Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Stan Zammit
- Centre for Academic Primary Care, Population Health Sciences, National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Natalia V Lewis
- Centre for Academic Primary Care, Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, National Institute for Health Research Applied Research Collaboration West (ARC West), Bristol, UK
- Centre for Academic Primary Care, Population Health Sciences, National Institute for Health Research (NIHR) Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
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Interrupted time series study found mixed effects of the impact of the Bavarian smoke-free legislation on pregnancy outcomes. Sci Rep 2021; 11:4209. [PMID: 33603103 PMCID: PMC7892567 DOI: 10.1038/s41598-021-83774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 02/01/2021] [Indexed: 11/20/2022] Open
Abstract
In 2007 the German government passed smoke-free legislation, leaving the details of implementation to the individual federal states. In January 2008 Bavaria implemented one of the strictest laws in Germany. We investigated its impact on pregnancy outcomes and applied an interrupted time series (ITS) study design to assess any changes in preterm birth, small for gestational age (primary outcomes), and low birth weight, stillbirth and very preterm birth. We included 1,236,992 singleton births, comprising 83,691 preterm births and 112,143 small for gestational age newborns. For most outcomes we observed unclear effects. For very preterm births, we found an immediate drop of 10.4% (95%CI − 15.8, − 4.6%; p = 0.0006) and a gradual decrease of 0.5% (95%CI − 0.7, − 0.2%, p = 0.0010) after implementation of the legislation. The majority of subgroup and sensitivity analyses confirm these results. Although we found no statistically significant effect of the Bavarian smoke-free legislation on most pregnancy outcomes, a substantial decrease in very preterm births was observed. We cannot rule out that despite our rigorous methods and robustness checks, design-inherent limitations of the ITS study as well as country-specific factors, such as the ambivalent German policy context have influenced our estimation of the effects of the legislation.
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Fortune N, Madden R, Riley T, Short S. The International Classification of Health Interventions: an 'epistemic hub' for use in public health. Health Promot Int 2021; 36:1753-1764. [PMID: 33585880 DOI: 10.1093/heapro/daab011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The current lack of a common basis for collecting data on population-level prevention and health promotion interventions causes public health to be relatively invisible within broader health systems, making it vulnerable to funding cuts when there is pressure to reduce spending. Further, the inconsistent use of terms for describing interventions hinders knowledge translation and building an evidence base for public health practice and policy. The International Classification of Health Interventions (ICHI), being developed by the World Health Organization, is a standard statistical classification for interventions across the full scope of health systems. ICHI has potential to meet the need for a common language and structure for describing and capturing information about prevention and health promotion interventions. We report on a developmental appraisal conducted to examine the strengths and limitations of ICHI for coding interventions delivered for public health purposes. Our findings highlight classification challenges in relation to: consistently identifying separate components within multi-component interventions; operationalizing the ICHI concept of intervention target when there are intermediary targets as well as an ultimate target; coding an intervention component that involves more than one ICHI target or action; and standardising what is being counted. We propose that, alongside its purpose as a statistical classification, ICHI can play a valuable role as an 'epistemic hub', to be used flexibly by public health actors to meet a range of information needs, and as a basis for improved communication and exchange.
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Affiliation(s)
- Nicola Fortune
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
| | - Richard Madden
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
| | - Therese Riley
- Therese Riley Consulting, Sandringham, VIC, 3191, Australia
| | - Stephanie Short
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
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Stratil JM, Voss M, Arnold L. WICID framework version 1.0: criteria and considerations to guide evidence-informed decision-making on non-pharmacological interventions targeting COVID-19. BMJ Glob Health 2020; 5:bmjgh-2020-003699. [PMID: 33234529 PMCID: PMC7688443 DOI: 10.1136/bmjgh-2020-003699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction Public health decision-making requires the balancing of numerous, often conflicting factors. However, participatory, evidence-informed decision-making processes to identify and weigh these factors are often not possible- especially, in the context of the SARS-CoV-2 pandemic. While evidence-to-decision frameworks are not able or intended to replace stakeholder participation, they can serve as a tool to approach relevancy and comprehensiveness of the criteria considered. Objective To develop a decision-making framework adapted to the challenges of decision-making on non-pharmacological interventions to contain the global SARS-CoV-2 pandemic. Methods We employed the ‘best fit’ framework synthesis technique and used the WHO-INTEGRATE framework as a starting point. First, we adapted the framework through brainstorming exercises and application to case studies. Next, we conducted a content analysis of comprehensive strategy documents intended to guide policymakers on the phasing out of applied lockdown measures in Germany. Based on factors and criteria identified in this process, we developed the WICID (WHO-INTEGRATE COVID-19) framework version 1.0. Results Twelve comprehensive strategy documents were analysed. The revised framework consists of 11+1 criteria, supported by 48 aspects, and embraces a complex systems perspective. The criteria cover implications for the health of individuals and populations due to and beyond COVID-19, infringement on liberties and fundamental human rights, acceptability and equity considerations, societal, environmental and economic implications, as well as implementation, resource and feasibility considerations. Discussion The proposed framework will be expanded through a comprehensive document analysis focusing on key stakeholder groups across the society. The WICID framework can be a tool to support comprehensive evidence-informed decision-making processes.
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Affiliation(s)
- Jan M Stratil
- Institute for Medical Informatics, Biometry and Epidemiology - IBE and Pettenkofer School of Public Health, LMU Munich, Munich, Bavaria, Germany
| | - Maike Voss
- Global Issues Division, German Institute for International and Security Affairs, Berlin, Germany
| | - Laura Arnold
- Epidemiology and Health Reporting, Academy of Public Health Services, Duesseldorf, North Rhine-Westphalia, Germany
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Reed H, Couturiaux D, Davis M, Edwards A, Janes E, Kim HS, Melendez-Torres GJ, Murphy S, Rotevatn TA, Smith J, Evans R. Co-production as an Emerging Methodology for Developing School-Based Health Interventions with Students Aged 11-16: Systematic Review of Intervention Types, Theories and Processes and Thematic Synthesis of Stakeholders' Experiences. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:475-491. [PMID: 33237552 PMCID: PMC8060205 DOI: 10.1007/s11121-020-01182-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 01/04/2023]
Abstract
Co-production affords an intervention’s target population the opportunity to participate in intervention theory decision-making during the development process. This addresses the over-reliance on developing interventions through academic theories which can be devoid of contextual understanding and result in challenges to implementing school-based health programmes. There is an emergent empirical literature on co-producing school-based health interventions, but an understanding of appropriate theoretical types and processes and stakeholders’ experiences is lacking. Through the conduct of a systematic review, this study seeks to understand the types and underlying theories and processes for co-production in school-based health interventions with students aged 11–16. A thematic synthesis explored stakeholders’ experiences of the different types of co-production. A systematic search of five electronic bibliographic databases, citation tracking of included studies, and consultation with an expert international panel were employed. Of 27,433 unique papers, 30 papers representing 22 studies were retained to describe types, and 23 papers of 18 studies used to synthesise stakeholders’ experiences. Three types were identified: external, individual-level, and system-level capacity-building. Whilst this review showed variability in co-production types, stakeholders involved and processes, shared functions were identified. Students’, school staff, facilitators’ and researchers’ experiences in terms of acceptability, feasibility and undertaking decision-making are discussed. Recommendations for conceptualising and reporting co-production and process evaluations of co-produced school-based health interventions are highlighted.
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Affiliation(s)
- Hayley Reed
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK.
| | - Danielle Couturiaux
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Marianne Davis
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Amy Edwards
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Edward Janes
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Hyun Sue Kim
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - G J Melendez-Torres
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Simon Murphy
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Torill Alise Rotevatn
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220, Aalborg East, Denmark
| | - Jesse Smith
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Rhiannon Evans
- DECIPHer, UKCRC Centre of Excellence, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
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Durao S, Visser ME, Ramokolo V, Oliveira JM, Schmidt BM, Balakrishna Y, Brand A, Kristjansson E, Schoonees A. Community-level interventions for improving access to food in low- and middle-income countries. Cochrane Database Syst Rev 2020; 8:CD011504. [PMID: 32761615 PMCID: PMC8890130 DOI: 10.1002/14651858.cd011504.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND After decades of decline since 2005, the global prevalence of undernourishment reverted and since 2015 has increased to levels seen in 2010 to 2011. The prevalence is highest in low- and middle-income countries (LMICs), especially Africa and Asia. Food insecurity and associated undernutrition detrimentally affect health and socioeconomic development in the short and long term, for individuals, including children, and societies. Physical and economic access to food is crucial to ensure food security. Community-level interventions could be important to increase access to food in LMICs. OBJECTIVES To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants, children and women; elderly, poor or unemployed people; or minority groups. SEARCH METHODS We searched for relevant studies in 16 electronic databases, including trial registries, from 1980 to September 2019, and updated the searches in six key databases in February 2020. We applied no language or publication status limits. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster randomised controlled trials (cRCTs) and prospective controlled studies (PCS). All population groups, adults and children, living in communities in LMICs exposed to community-level interventions aiming to improve food access were eligible for inclusion. We excluded studies that only included participants with specific diseases or conditions (e.g. severely malnourished children). Eligible interventions were broadly categorised into those that improved buying power (e.g. create income-generation opportunities, cash transfer schemes); addressed food prices (e.g. vouchers and subsidies); addressed infrastructure and transport that affected physical access to food outlets; addressed the social environment and provided social support (e.g. social support from family, neighbours or government). DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts, and full texts of potentially eligible records, against the inclusion criteria. Disagreements were resolved through discussion or arbitration by a third author, if necessary. For each included study, two authors independently extracted data and a third author arbitrated disagreements. However, the outcome data were extracted by one author and checked by a biostatistician. We assessed risk of bias for all studies using the Effective Practice and Organization of Care (EPOC) risk of bias tool for studies with a separate control group. We conducted meta-analyses if there was a minimum of two studies for interventions within the same category, reporting the same outcome measure and these were sufficiently homogeneous. Where we were able to meta-analyse, we used the random-effects model to incorporate any existing heterogeneity. Where we were unable to conduct meta-analyses, we synthesised using vote counting based on effect direction. MAIN RESULTS We included 59 studies, including 214 to 169,485 participants, and 300 to 124, 644 households, mostly from Africa and Latin America, addressing the following six intervention types (three studies assessed two different types of interventions). Interventions that improved buying power: Unconditional cash transfers (UCTs) (16 cRCTs, two RCTs, three PCSs): we found high-certainty evidence that UCTs improve food security and make little or no difference to cognitive function and development and low-certainty evidence that UCTs may increase dietary diversity and may reduce stunting. The evidence was very uncertain about the effects of UCTs on the proportion of household expenditure on food, and on wasting. Regarding adverse outcomes, evidence from one trial indicates that UCTs reduce the proportion of infants who are overweight. Conditional cash transfers (CCTs) (nine cRCTs, five PCSs): we found high-certainty evidence that CCTs result in little to no difference in the proportion of household expenditure on food and that they slightly improve cognitive function in children; moderate-certainty evidence that CCTs probably slightly improve dietary diversity and low-certainty evidence that they may make little to no difference to stunting or wasting. Evidence on adverse outcomes (two PCSs) shows that CCTs make no difference to the proportion of overweight children. Income generation interventions (six cRCTs, 11 PCSs): we found moderate-certainty evidence that income generation interventions probably make little or no difference to stunting or wasting; and low-certainty evidence that they may result in little to no difference to food security or that they may improve dietary diversity in children, but not for households. Interventions that addressed food prices: Food vouchers (three cRCTs, one RCT): we found moderate-certainty evidence that food vouchers probably reduce stunting; and low-certainty evidence that that they may improve dietary diversity slightly, and may result in little to no difference in wasting. Food and nutrition subsidies (one cRCT, three PCSs): we found low-certainty evidence that food and nutrition subsidies may improve dietary diversity among school children. The evidence is very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low-certainty evidence). Interventions that addressed the social environment: Social support interventions (one cRCT, one PCS): we found moderate-certainty evidence that community grants probably make little or no difference to wasting; low-certainty evidence that they may make little or no difference to stunting. The evidence is very uncertain about the effects of village savings and loans on food security and dietary diversity. None of the included studies addressed the intervention category of infrastructure changes. In addition, none of the studies reported on one of the primary outcomes of this review, namely prevalence of undernourishment. AUTHORS' CONCLUSIONS The body of evidence indicates that UCTs can improve food security. Income generation interventions do not seem to make a difference for food security, but the evidence is unclear for the other interventions. CCTs, UCTs, interventions that help generate income, interventions that help minimise impact of food prices through food vouchers and subsidies can potentially improve dietary diversity. UCTs and food vouchers may have a potential impact on reducing stunting, but CCTs, income generation interventions or social environment interventions do not seem to make a difference on wasting or stunting. CCTs seem to positively impact cognitive function and development, but not UCTs, which may be due to school attendance, healthcare visits and other conditionalities associated with CCTs.
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Affiliation(s)
- Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Marianne E Visser
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Amanda Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Durao S, Visser ME, Ramokolo V, Oliveira JM, Schmidt BM, Balakrishna Y, Brand A, Kristjansson E, Schoonees A. Community-level interventions for improving access to food in low- and middle-income countries. Cochrane Database Syst Rev 2020; 7:CD011504. [PMID: 32722849 PMCID: PMC7390433 DOI: 10.1002/14651858.cd011504.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND After decades of decline since 2005, the global prevalence of undernourishment reverted and since 2015 has increased to levels seen in 2010 to 2011. The prevalence is highest in low- and middle-income countries (LMICs), especially Africa and Asia. Food insecurity and associated undernutrition detrimentally affect health and socioeconomic development in the short and long term, for individuals, including children, and societies. Physical and economic access to food is crucial to ensure food security. Community-level interventions could be important to increase access to food in LMICs. OBJECTIVES To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants, children and women; elderly, poor or unemployed people; or minority groups. SEARCH METHODS We searched for relevant studies in 16 electronic databases, including trial registries, from 1980 to September 2019, and updated the searches in six key databases in February 2020. We applied no language or publication status limits. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster randomised controlled trials (cRCTs) and prospective controlled studies (PCS). All population groups, adults and children, living in communities in LMICs exposed to community-level interventions aiming to improve food access were eligible for inclusion. We excluded studies that only included participants with specific diseases or conditions (e.g. severely malnourished children). Eligible interventions were broadly categorised into those that improved buying power (e.g. create income-generation opportunities, cash transfer schemes); addressed food prices (e.g. vouchers and subsidies); addressed infrastructure and transport that affected physical access to food outlets; addressed the social environment and provided social support (e.g. social support from family, neighbours or government). DATA COLLECTION AND ANALYSIS Two authors independently screened titles and abstracts, and full texts of potentially eligible records, against the inclusion criteria. Disagreements were resolved through discussion or arbitration by a third author, if necessary. For each included study, two authors independently extracted data and a third author arbitrated disagreements. However, the outcome data were extracted by one author and checked by a biostatistician. We assessed risk of bias for all studies using the Effective Practice and Organization of Care (EPOC) risk of bias tool for studies with a separate control group. We conducted meta-analyses if there was a minimum of two studies for interventions within the same category, reporting the same outcome measure and these were sufficiently homogeneous. Where we were able to meta-analyse, we used the random-effects model to incorporate any existing heterogeneity. Where we were unable to conduct meta-analyses, we synthesised using vote counting based on effect direction. MAIN RESULTS We included 59 studies, including 214 to 169,485 participants, and 300 to 124, 644 households, mostly from Africa and Latin America, addressing the following six intervention types (three studies assessed two different types of interventions). Interventions that improved buying power: Unconditional cash transfers (UCTs) (16 cRCTs, two RCTs, three PCSs): we found high-certainty evidence that UCTs improve food security and make little or no difference to cognitive function and development and low-certainty evidence that UCTs may increase dietary diversity and may reduce stunting. The evidence was very uncertain about the effects of UCTs on the proportion of household expenditure on food, and on wasting. Regarding adverse outcomes, evidence from one trial indicates that UCTs reduce the proportion of infants who are overweight. Conditional cash transfers (CCTs) (nine cRCTs, five PCSs): we found high-certainty evidence that CCTs result in little to no difference in the proportion of household expenditure on food and that they slightly improve cognitive function in children; moderate-certainty evidence that CCTs probably slightly improve dietary diversity and low-certainty evidence that they may make little to no difference to stunting or wasting. Evidence on adverse outcomes (two PCSs) shows that CCTs make no difference to the proportion of overweight children. Income generation interventions (six cRCTs, 11 PCSs): we found moderate-certainty evidence that income generation interventions probably make little or no difference to stunting or wasting; and low-certainty evidence that they may result in little to no difference to food security or that they may improve dietary diversity in children, but not for households. Interventions that addressed food prices: Food vouchers (three cRCTs, one RCT): we found moderate-certainty evidence that food vouchers probably reduce stunting; and low-certainty evidence that that they may improve dietary diversity slightly, and may result in little to no difference in wasting. Food and nutrition subsidies (one cRCT, three PCSs): we found low-certainty evidence that food and nutrition subsidies may improve dietary diversity among school children. The evidence is very uncertain about the effects on household expenditure on healthy foods as a proportion of total expenditure on food (very low-certainty evidence). Interventions that addressed the social environment: Social support interventions (one cRCT, one PCS): we found moderate-certainty evidence that community grants probably make little or no difference to wasting; low-certainty evidence that they may make little or no difference to stunting. The evidence is very uncertain about the effects of village savings and loans on food security and dietary diversity. None of the included studies addressed the intervention category of infrastructure changes. In addition, none of the studies reported on one of the primary outcomes of this review, namely prevalence of undernourishment. AUTHORS' CONCLUSIONS The body of evidence indicates that UCTs can improve food security. Income generation interventions do not seem to make a difference for food security, but the evidence is unclear for the other interventions. CCTs, UCTs, interventions that help generate income, interventions that help minimise impact of food prices through food vouchers and subsidies can potentially improve dietary diversity. UCTs and food vouchers may have a potential impact on reducing stunting, but CCTs, income generation interventions or social environment interventions do not seem to make a difference on wasting or stunting. CCTs seem to positively impact cognitive function and development, but not UCTs, which may be due to school attendance, healthcare visits and other conditionalities associated with CCTs.
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Affiliation(s)
- Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Marianne E Visser
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vundli Ramokolo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Yusentha Balakrishna
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Amanda Brand
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Anel Schoonees
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Development and Validation of a Logic Model for Utilization of Nutrition Support among Patients with Cancer. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4513719. [PMID: 32685485 PMCID: PMC7334779 DOI: 10.1155/2020/4513719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/22/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
Cancer is the leading cause of morbidity and mortality, and about one in six people die from cancer globally. Approximately 20% to 70% of cancer patients are accompanied with malnutrition, and nutrition support plays an important role among cancer patients. However, the utilization of nutrition support is generally irrational in clinical practices and it is affected by multiple factors. Logic models not only present a framework to improve intervention of health care setting but also identify all the elements, pathways, outcomes, and their relationships between systems. This study developed a logic model of nutrition support for cancer patients based on current literature and conducted interview with medical staff in Macao to validate the logic model. In addition, suggestions were given as references to improve the utilization of nutrition support among cancer patients.
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Howarth M, Brettle A, Hardman M, Maden M. What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription. BMJ Open 2020; 10:e036923. [PMID: 32690529 PMCID: PMC7371129 DOI: 10.1136/bmjopen-2020-036923] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription. DESIGN Scoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations. DATA SOURCES A range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019. ELIGIBILITY CRITERIA We included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition. DATA EXTRACTION AND SYNTHESIS Three reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion. RESULTS From the 8896 papers located, a total of 77* studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models. CONCLUSIONS Gardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a 'social prescription' globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.
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Affiliation(s)
- Michelle Howarth
- School of Health and Society, University of Salford, Salford, Manchester, UK
| | - Alison Brettle
- School of Health and Society, University of Salford, Salford, Manchester, UK
| | - Michael Hardman
- School of Science, Engineering and Environment, University of Salford, Salford, Manchester, UK
| | - Michelle Maden
- Department of Health Services Research, University of Liverpool, Liverpool, UK
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Mearns H, Otiku PK, Shelton M, Kredo T, Kagina BM, Schmidt BM. Screening strategies for adults with type 2 diabetes mellitus: a systematic review protocol. Syst Rev 2020; 9:156. [PMID: 32660625 PMCID: PMC7359237 DOI: 10.1186/s13643-020-01417-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is limited evidence on whether screening for type 2 diabetes mellitus affects health outcomes. A recent systematic review of randomised clinical trials found only one trial that met their inclusion criteria; therefore, current guidelines for screening interventions for type 2 diabetes mellitus are based on expert opinions and best practice rather than synthesised evidence. This systematic review seeks to collate evidence from non-randomised studies to investigate the effect of screening for adults with type 2 diabetes on outcomes including diabetes-related morbidity, mortality (all-cause and diabetes-related) and harms. METHODS This systematic review will follow Effective Practice and Organisation of Care (EPOC) guidelines for the synthesis of non-randomised studies. We will search PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Academic Search Premier and Health Source Nursing Academic (from inception onwards). We will include non-randomised trials, controlled before-after studies, interrupted time-series studies, repeated measures studies and concurrently controlled prospective cohort studies. The primary outcome will be diabetes-related morbidity (microvascular complications of diabetic retinopathy, nephropathy or neuropathy or macrovascular complications of non-fatal myocardial infarction, peripheral arterial disease or non-fatal stroke). The secondary outcomes will be mortality (all-cause and diabetes-related) and harms of screening strategies to patients (including psychological harms or adverse events following treatments) or to health care system (including resource allocation for false-positives or overdiagnosis). Two reviewers will independently screen all citations and full-text articles. Data will be abstracted by one reviewer and checked by a second. The risk of bias of individual studies will be appraised using the ROBINS-I tool. GRADE will be used to determine the quality of the scientific evidence. If feasible, we will conduct random effects meta-analysis where appropriate. If necessary, analyses will be conducted to explore the potential sources of heterogeneity (e.g. age, sex, socio-economic status, rural versus urban or low-middle income versus high-income country). We will disseminate the findings via publications and through relevant networks. DISCUSSION The protocol outlines the methods for systematically reviewing and synthesising evidence of screening strategies for type 2 diabetes mellitus and their effect on health outcomes associated with the disease. The potential impact of this systematic review is improved evidence-informed decision-making for policies and practice for screening of type-2 diabetes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020147439.
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Affiliation(s)
- Helen Mearns
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa.
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Paul Kuodi Otiku
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary Shelton
- Health Sciences Library, University of Cape Town, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, University of Cape Town, Cape Town, South Africa
- School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Chang F, Eriksson A, Östlund B. Discrepancies between Expected and Actual Implementation: The Process Evaluation of PERS Integration in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4245. [PMID: 32545871 PMCID: PMC7344572 DOI: 10.3390/ijerph17124245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Abstract
Recent studies prove that when implementing new technology technology-driven and one-size-fits-all approaches are problematic. This study focuses on the process of implementing personal emergency response system (PERS) at nursing homes. The aim is to understand why the implementation of PERS has not met initial expectations. Multiple methods were used in two Swedish nursing homes, including document analysis, questionnaires (n = 42), participant observation (67 h), and individual interviews (n = 12). A logic model was used to ascertain the discrepancies that emerged between expected and actual implementation, and the domestication theory was used to discuss the underlying meanings of the discrepancies. The discrepancies primarily focused on staff competence, system readiness, work routines, and implementation duration. Corresponding reasons were largely relevant to management issues regarding training, the procurement systems, individual and collective responsibilities as well as invisible work. The uptake of technology in daily practice is far more nuanced than a technology implementation plan might imply. We point out the importance of preparing for implementation, adjusting to new practices, and leaving space and time for facilitating implementation. The findings will be of use to implementers, service providers, and organizational managers to evaluate various measures in the implementation process, enabling them to perform technology implementation faster and more efficiently.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, SE-142 58 Stockholm, Sweden; (A.E.); (B.Ö.)
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Schmidt BM, Durao S, Toews I, Bavuma CM, Hohlfeld A, Nury E, Meerpohl JJ, Kredo T. Screening strategies for hypertension. Cochrane Database Syst Rev 2020; 5:CD013212. [PMID: 32378196 PMCID: PMC7203601 DOI: 10.1002/14651858.cd013212.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hypertension is a major public health challenge affecting more than one billion people worldwide; it disproportionately affects populations in low- and middle-income countries (LMICs), where health systems are generally weak. The increasing prevalence of hypertension is associated with population growth, ageing, genetic factors, and behavioural risk factors, such as excessive salt and fat consumption, physical inactivity, being overweight and obese, harmful alcohol consumption, and poor management of stress. Over the long term, hypertension leads to risk for cardiovascular events, such as heart disease, stroke, kidney failure, disability, and premature mortality. Cardiovascular events can be preventable when high-risk populations are targeted, for example, through population-wide screening strategies. When available resources are limited, taking a total risk approach whereby several risk factors of hypertension are taken into consideration (e.g. age, gender, lifestyle factors, diabetes, blood cholesterol) can enable more accurate targeting of high-risk groups. Targeting of high-risk groups can help reduce costs in that resources are not spent on the entire population. Early detection in the form of screening for hypertension (and associated risk factors) can help identify high-risk groups, which can result in timely treatment and management of risk factors. Ultimately, early detection can help reduce morbidity and mortality linked to it and can help contain health-related costs, for example, those associated with hospitalisation due to severe illness and poorly managed risk factors and comorbidities. OBJECTIVES To assess the effectiveness of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce morbidity and mortality associated with hypertension. SEARCH METHODS An Information Specialist searched the Cochrane Register of Studies (CRS-Web), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Latin American Caribbean Health Sciences Literature (LILACS) Bireme, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) without language, publication year, or publication status restrictions. The searches were conducted from inception until 9 April 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) and non-RCTs (NRCTs), that is, controlled before and after (CBA), interrupted time series (ITS), and prospective analytic cohort studies of healthy adolescents, adults, and elderly people participating in mass, targeted, or opportunistic screening of hypertension. DATA COLLECTION AND ANALYSIS Screening of all retrieved studies was done in Covidence. A team of reviewers, in pairs, independently assessed titles and abstracts of identified studies and acquired full texts for studies that were potentially eligible. Studies were deemed to be eligible for full-text screening if two review authors agreed, or if consensus was reached through discussion with a third review author. It was planned that at least two review authors would independently extract data from included studies, assess risk of bias using pre-specified Cochrane criteria, and conduct a meta-analysis of sufficiently similar studies or present a narrative synthesis of the results. MAIN RESULTS We screened 9335 titles and abstracts. We identified 54 potentially eligible studies for full-text screening. However, no studies met the eligibility criteria. AUTHORS' CONCLUSIONS There is an implicit assumption that early detection of hypertension through screening can reduce the burden of morbidity and mortality, but this assumption has not been tested in rigorous research studies. High-quality evidence from RCTs or programmatic evidence from NRCTs on the effectiveness and costs or harms of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce hypertension-related morbidity and mortality is lacking.
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Affiliation(s)
- Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ingrid Toews
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Charlotte M Bavuma
- College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
| | - Ameer Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Edris Nury
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Burns J, Boogaard H, Polus S, Pfadenhauer LM, Rohwer AC, van Erp AM, Turley R, Rehfuess EA. Interventions to reduce ambient air pollution and their effects on health: An abridged Cochrane systematic review. ENVIRONMENT INTERNATIONAL 2020; 135:105400. [PMID: 31855800 DOI: 10.1016/j.envint.2019.105400] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/11/2019] [Accepted: 12/06/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND A broad range of interventions have been implemented to improve ambient air quality, and many of these have been evaluated. Yet to date no systematic review has been conducted to identify and synthesize these studies. In this systematic review, we assess the effectiveness of interventions in reducing ambient particulate matter air pollution and improving adverse health outcomes. METHODS We searched a range of electronic databases across multiple disciplines, as well as grey literature databases, trial registries, reference lists of included studies and the contents of relevant journals, through August 2016. Eligible for inclusion were randomized and cluster randomized controlled trials, as well as several non-randomized study designs often used for evaluating air quality interventions. We included studies that evaluated interventions targeting industrial, residential, vehicular and multiple sources, with respect to their effect on mortality, morbidity and the concentrations of particulate matter (PM - including PM10, PM2.5, coarse particulate matter and combustion-related PM), as well as several criteria pollutants, including ozone, carbon monoxide, nitrogen oxides, nitrogen dioxide, nitric oxide and sulphur dioxide. We did not restrict studies based on the population, setting or comparison. Two authors independently assessed studies for inclusion, extracted data and assessed risk of bias. We assessed risk of bias using the Graphic Appraisal Tool for Epidemiological studies (GATE) for correlation studies, as modified and employed by the UK National Institute for Health and Care Excellence. We synthesized evidence narratively, as well as graphically using harvest plots. We assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS We included 42 studies assessing 38 unique interventions. These comprised a heterogeneous mix of interventions, including those aiming to address industrial sources (n = 5; e.g. the closure of a factory), residential sources (n = 7; e.g. coal ban), vehicular sources (n = 22; e.g. low emission zones), and multiple sources (n = 4; e.g. tailored measures that target both local traffic and industrial polluters). Evidence for effectiveness was mixed. Most included studies observed either no significant association or an association favoring the intervention, with little evidence that the assessed interventions might be harmful. CONCLUSIONS Given the heterogeneity across interventions, outcomes, and methods, it was difficult to derive overall conclusions regarding the effectiveness of interventions in terms of improved air quality or health. Some evidence suggests that interventions are associated with improvements in air quality and human health, with very little evidence suggesting interventions were harmful. The evidence base highlights the challenges related to establishing the effectiveness of specific air pollution interventions on outcomes. It also points to the need for improved study design and analysis methods, as well as more uniform evaluations. The prospective planning of evaluations and an evaluation component built into the design and implementation of interventions may also be particularly beneficial.
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Affiliation(s)
- J Burns
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany.
| | - H Boogaard
- Health Effects Institute, Boston, MA, USA
| | - S Polus
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany
| | - L M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany
| | - A C Rohwer
- Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - R Turley
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - E A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Germany; Pettenkofer School of Public Health, LMU Munich, Germany
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Muirhead K, Macaden L, Clarke C, Smyth K, Polson R, O'Malley C. The characteristics of effective technology-enabled dementia education for health and social care practitioners: protocol for a mixed studies systematic review. Syst Rev 2019; 8:316. [PMID: 31810480 PMCID: PMC6896733 DOI: 10.1186/s13643-019-1212-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The global prevalence of people living with dementia is expected to increase exponentially and yet evidence suggests gaps in dementia-specific knowledge amongst practitioners. Evidence-based learning approaches can support educators and learners who are transitioning into new educational paradigms resulting from technological advances. Technology-enabled learning is increasingly being used in health care education and may be a feasible approach to dementia education. METHODS This protocol aims to describe the methodological and analytical approaches for undertaking a systematic review of the current evidence based on technology-enabled approaches to dementia education for health and social care practitioners. The design and methodology were informed by guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. DISCUSSION The evidence generated from a systematic review of the current evidence is intended to inform the design and implementation of technology-enabled dementia education programmes and to advance the current academic literature at a time of unprecedented demographic and technological transition. TRIAL REGISTRATION PROSPERO, CRD42018115378.
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Affiliation(s)
- Kevin Muirhead
- Department of Nursing and Midwifery, School of Health, Social Care & Life Sciences, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK.
| | - Leah Macaden
- Department of Nursing and Midwifery, School of Health, Social Care & Life Sciences, University of the Highlands and Islands, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK
| | - Charlotte Clarke
- School of Health in Social Science, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Keith Smyth
- Learning and Teaching Academy, University of the Highlands and Islands, Ness Walk, Inverness, IV3 5SQ, UK
| | - Rob Polson
- Highland Health Sciences Library, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK
| | - Chris O'Malley
- Highland Health Sciences Library, Centre for Health Science, Old Perth Road, Inverness, IV2 3JH, UK
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MacEntee MI. A typology of systematic reviews for synthesising evidence on health care. Gerodontology 2019; 36:303-312. [PMID: 31691365 DOI: 10.1111/ger.12439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/28/2019] [Accepted: 09/24/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The objectives of this paper are to (a) Review published references to systematic reviews; (b) offer a typology of systematic reviews for synthesising evidence on health care; and (c) summarise the guides for designing, reporting and appraising the reviews. BACKGROUND Systematic reviews play a role in finding, synthesising, transferring and implementing evidence for healthcare policy, practice guidelines and allocation of health resources. They have been particularly successful in confirming or synthesising evidence for health care by meta-analysing aggregated data from multiple randomised controlled trials. However, concerns about the limitations of evidence from controlled trials have prompted interest in other review methods capable of locating and appraising evidence from more diverse, and possibly more realistic, healthcare situations. METHODS An iterative citation-tracking process with Google Search and grey literature identified 204 papers on previous typologies and methods of systematic reviews. RESULTS AND CONCLUSIONS There are six types of systematic reviews: narrative; meta-analysis; scoping; qualitative; umbrella; and realist. Each type has distinct objectives, characteristics and attributes, but with much overlapping of methods and guides. Sensitivity to the need for qualitative evidence on complex human responses to ill-health and health care has broadened the objectives and methods of health-related systematic reviews to find, appraise and synthesis useful evidence for practice guidelines, healthcare policy and allocation of health resources.
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Affiliation(s)
- Michael I MacEntee
- Professor Emeritus of Prosthodontics & Dental Geriatrics, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Abbott R, Orr N, McGill P, Whear R, Bethel A, Garside R, Stein K, Thompson‐Coon J. How do "robopets" impact the health and well-being of residents in care homes? A systematic review of qualitative and quantitative evidence. Int J Older People Nurs 2019; 14:e12239. [PMID: 31070870 PMCID: PMC6766882 DOI: 10.1111/opn.12239] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Robopets are small animal-like robots which have the appearance and behavioural characteristics of pets. OBJECTIVE To bring together the evidence of the experiences of staff, residents and family members of interacting with robopets and the effects of robopets on the health and well-being of older people living in care homes. DESIGN Systematic review of qualitative and quantitative research. DATA SOURCES We searched 13 electronic databases from inception to July 2018 and undertook forward and backward citation chasing. METHODS Eligible studies reported the views and experiences of robopets from residents, family members and staff (qualitative studies using recognised methods of qualitative data collection and analysis) and the effects of robopets on the health and well-being of care home residents (randomised controlled trials, randomised crossover trials and cluster randomised trials). Study selection was undertaken independently by two reviewers. We used the Wallace criteria and the Cochrane Risk of Bias tool to assess the quality of the evidence. We developed a logic model with stakeholders and used this as a framework to guide data extraction and synthesis. Where appropriate, we used meta-analysis to combine effect estimates from quantitative studies. RESULTS Nineteen studies (10 qualitative, 2 mixed methods and 7 randomised trials) met the inclusion criteria. Interactions with robopets were described as having a positive impact on aspects of well-being including loneliness, depression and quality of life by residents and staff, although there was no corresponding statistically significant evidence from meta-analysis for these outcomes. Meta-analysis showed evidence of a reduction in agitation with the robopet "Paro" compared to control (-0.32 [95% CI -0.61 to -0.04, p = 0.03]). Not everyone had a positive experience of robopets. CONCLUSIONS Engagement with robopets appears to have beneficial effects on the health and well-being of older adults living in care homes, but not all chose to engage. Whether the benefits can be sustained are yet to be investigated. IMPLICATIONS FOR PRACTICE Robopets have the potential to benefit people living in care homes, through increasing engagement and interaction. With the robopet acting as a catalyst, this engagement and interaction may afford comfort and help reduce agitation and loneliness.
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Affiliation(s)
- Rebecca Abbott
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Noreen Orr
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Paige McGill
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Rebecca Whear
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Alison Bethel
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Ruth Garside
- European Centre for Environment and Human HealthUniversity of Exeter Medical School, University of ExeterExeterUK
| | - Ken Stein
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
| | - Jo Thompson‐Coon
- Evidence Synthesis Team, NIHR CLAHRC South West Peninsula (PenCLAHRC), College of Medicine and HealthUniversity of ExeterExeterUK
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Schildmann J, Nadolny S, Haltaufderheide J, Gysels M, Vollmann J, Bausewein C. Do we understand the intervention? What complex intervention research can teach us for the evaluation of clinical ethics support services (CESS). BMC Med Ethics 2019; 20:48. [PMID: 31307458 PMCID: PMC6633613 DOI: 10.1186/s12910-019-0381-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluating clinical ethics support services (CESS) has been hailed as important research task. At the same time, there is considerable debate about how to evaluate CESS appropriately. The criticism, which has been aired, refers to normative as well as empirical aspects of evaluating CESS. MAIN BODY In this paper, we argue that a first necessary step for progress is to better understand the intervention(s) in CESS. Tools of complex intervention research methodology may provide relevant means in this respect. In a first step, we introduce principles of "complex intervention research" and show how CESS fulfil the criteria of "complex interventions". In a second step, we develop a generic "conceptual framework" for "ethics consultation on request" as standard for many forms of ethics consultation in clinical ethics practice. We apply this conceptual framework to the model of "bioethics mediation" to make explicit the specific structural and procedural elements of this form of ethics consultation on request. In a final step we conduct a comparative analysis of two different types of CESS, which have been subject to evaluation research: "proactive ethics consultation" and "moral case deliberation" and discuss implications for evaluating both types of CESS. CONCLUSION To make explicit different premises of implemented CESS interventions by means of conceptual frameworks can inform the search for sound empirical evaluation of CESS. In addition, such work provides a starting point for further reflection about what it means to offer "good" CESS.
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Affiliation(s)
- Jan Schildmann
- Institute for History and Ethics of Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany.
| | - Stephan Nadolny
- Institute for History and Ethics of Medicine, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle, Germany
- Institute for educational and health-care research in the health sector (InBVG), Bielefeld University of Applied Sciences, Interaktion 1, 33619, Bielefeld, Germany
- University of Applied Sciences for Diakonia, Bethelweg 8, 33617, Bielefeld, Germany
| | - Joschka Haltaufderheide
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, 44779, Bochum, Germany
| | - Marjolein Gysels
- Centre for Social Science and Global Health, University of Amsterdam, AHTC, Tower C4, Paasheuvelweg 25, 1105, BP Amsterdam, Netherlands
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Markstr. 258a, 44779, Bochum, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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Burns J, Boogaard H, Polus S, Pfadenhauer LM, Rohwer AC, van Erp AM, Turley R, Rehfuess E. Interventions to reduce ambient particulate matter air pollution and their effect on health. Cochrane Database Syst Rev 2019; 5:CD010919. [PMID: 31106396 PMCID: PMC6526394 DOI: 10.1002/14651858.cd010919.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ambient air pollution is associated with a large burden of disease in both high-income countries (HICs) and low- and middle-income countries (LMICs). To date, no systematic review has assessed the effectiveness of interventions aiming to reduce ambient air pollution. OBJECTIVES To assess the effectiveness of interventions to reduce ambient particulate matter air pollution in reducing pollutant concentrations and improving associated health outcomes. SEARCH METHODS We searched a range of electronic databases with diverse focuses, including health and biomedical research (CENTRAL, Cochrane Public Health Group Specialised Register, MEDLINE, Embase, PsycINFO), multidisciplinary research (Scopus, Science Citation Index), social sciences (Social Science Citation Index), urban planning and environment (Greenfile), and LMICs (Global Health Library regional indexes, WHOLIS). Additionally, we searched grey literature databases, multiple online trial registries, references of included studies and the contents of relevant journals in an attempt to identify unpublished and ongoing studies, and studies not identified by our search strategy. The final search date for all databases was 31 August 2016. SELECTION CRITERIA Eligible for inclusion were randomized and cluster randomized controlled trials, as well as several non-randomized study designs, including controlled interrupted time-series studies (cITS-EPOC), interrupted time-series studies adhering to EPOC standards (ITS-EPOC), interrupted time-series studies not adhering to EPOC standards (ITS), controlled before-after studies adhering to EPOC standards (CBA-EPOC), and controlled before-after studies not adhering to EPOC standards (CBA); these were classified as main studies. Additionally, we included uncontrolled before-after studies (UBA) as supporting studies. We included studies that evaluated interventions to reduce ambient air pollution from industrial, residential, vehicular and multiple sources, with respect to their effect on mortality, morbidity and several air pollutant concentrations. We did not restrict studies based on the population, setting or comparison. DATA COLLECTION AND ANALYSIS After a calibration exercise among the author team, two authors independently assessed studies for inclusion, extracted data and assessed risk of bias. We conducted data extraction, risk of bias assessment and evidence synthesis only for main studies; we mapped supporting studies with regard to the types of intervention and setting. To assess risk of bias, we used the Graphic Appraisal Tool for Epidemiological studies (GATE) for correlation studies, as modified and employed by the Centre for Public Health Excellence at the UK National Institute for Health and Care Excellence (NICE). For each intervention category, i.e. those targeting industrial, residential, vehicular and multiple sources, we synthesized evidence narratively, as well as graphically using harvest plots. MAIN RESULTS We included 42 main studies assessing 38 unique interventions. These were heterogeneous with respect to setting; interventions were implemented in countries across the world, but most (79%) were implemented in HICs, with the remaining scattered across LMICs. Most interventions (76%) were implemented in urban or community settings.We identified a heterogeneous mix of interventions, including those aiming to address industrial (n = 5), residential (n = 7), vehicular (n = 22), and multiple sources (n = 4). Some specific interventions, such as low emission zones and stove exchanges, were assessed by several studies, whereas others, such as a wood burning ban, were only assessed by a single study.Most studies assessing health and air quality outcomes used routine monitoring data. Studies assessing health outcomes mostly investigated effects in the general population, while few studies assessed specific subgroups such as infants, children and the elderly. No identified studies assessed unintended or adverse effects.The judgements regarding the risk of bias of studies were mixed. Regarding health outcomes, we appraised eight studies (47%) as having no substantial risk of bias concerns, five studies (29%) as having some risk of bias concerns, and four studies (24%) as having serious risk of bias concerns. Regarding air quality outcomes, we judged 11 studies (31%) as having no substantial risk of bias concerns, 16 studies (46%) as having some risk of bias concerns, and eight studies (23%) as having serious risk of bias concerns.The evidence base, comprising non-randomized studies only, was of low or very low certainty for all intervention categories and primary outcomes. The narrative and graphical synthesis showed that evidence for effectiveness was mixed across the four intervention categories. For interventions targeting industrial, residential and multiple sources, a similar pattern emerged for both health and air quality outcomes, with essentially all studies observing either no clear association in either direction or a significant association favouring the intervention. The evidence base for interventions targeting vehicular sources was more heterogeneous, as a small number of studies did observe a significant association favouring the control. Overall, however, the evidence suggests that the assessed interventions do not worsen air quality or health. AUTHORS' CONCLUSIONS Given the heterogeneity across interventions, outcomes, and methods, it was difficult to derive overall conclusions regarding the effectiveness of interventions in terms of improved air quality or health. Most included studies observed either no significant association in either direction or an association favouring the intervention, with little evidence that the assessed interventions might be harmful. The evidence base highlights the challenges related to establishing a causal relationship between specific air pollution interventions and outcomes. In light of these challenges, the results on effectiveness should be interpreted with caution; it is important to emphasize that lack of evidence of an association is not equivalent to evidence of no association.We identified limited evidence for several world regions, notably Africa, the Middle East, Eastern Europe, Central Asia and Southeast Asia; decision-makers should prioritize the development and implementation of interventions in these settings. In the future, as new policies are introduced, decision-makers should consider a built-in evaluation component, which could facilitate more systematic and comprehensive evaluations. These could assess effectiveness, but also aspects of feasibility, fidelity and acceptability.The production of higher quality and more uniform evidence would be helpful in informing decisions. Researchers should strive to sufficiently account for confounding, assess the impact of methodological decisions through the conduct and communication of sensitivity analyses, and improve the reporting of methods, and other aspects of the study, most importantly the description of the intervention and the context in which it is implemented.
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Affiliation(s)
- Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
| | | | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
| | - Anke C Rohwer
- Stellenbosch UniversityCentre for Evidence‐based Health Care, Faculty of Medicine and Health SciencesFrancie van Zijl DriveCape TownSouth Africa7505
| | | | - Ruth Turley
- Cardiff UniversityCentre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)1 Museum PlaceCardiffUKCF10 3BD
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichGermany
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Eshun-Wilson I, Jaffer S, Smith R, Johnson S, Hine P, Mateo A, Stephani AM, Garner P. Maintaining relevance in HIV systematic reviews: an evaluation of Cochrane reviews. Syst Rev 2019; 8:46. [PMID: 30732644 PMCID: PMC6366015 DOI: 10.1186/s13643-019-0960-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/22/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Research turnover in the HIV field is rapid, and as a result, maintaining high-quality, up-to-date, and relevant systematic reviews is a challenge. One approach is to frequently update published reviews. METHODS We evaluated the methods and relevance of all HIV systematic reviews and protocols published in the Cochrane Library over a 16-year period (2000-2016) to determine the need to update published reviews or complete of reviews in progress. RESULTS Of 148 published reviews and protocols, 129 (87%) were identified as not for updating or progression to publication, mostly due to research questions which were either entirely outdated or addressed questions in an outdated manner (N = 89; 60%); this was anticipated for older reviews, but was found also to be the case for recent publications. Some research questions were also inadequately conceptualized, particularly when complex pragmatic trials or behavioral interventions were included. CONCLUSIONS We suggest that authors clearly characterize interventions and synthesis approaches in their review protocols. In research fields, such as HIV, where questions change frequently, systematic reviews and protocols should be regularly re-evaluated to ensure relevance to current questions. This process of re-evaluation should be incorporated into the methods of living systematic reviews.
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Affiliation(s)
- Ingrid Eshun-Wilson
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Francie Van Zyl drive, Cape Town, 7505, South Africa. .,University of California, San Francisco, USA.
| | - Shahista Jaffer
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Francie Van Zyl drive, Cape Town, 7505, South Africa
| | - Rhodine Smith
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Francie Van Zyl drive, Cape Town, 7505, South Africa
| | - Samuel Johnson
- Cochrane Infectious Diseases Group, Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Hine
- Cochrane Infectious Diseases Group, Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Alberto Mateo
- Cochrane Infectious Diseases Group, Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anne-Marie Stephani
- Cochrane Infectious Diseases Group, Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK.,University of Central Lancashire, Lancashire, UK
| | - Paul Garner
- Cochrane Infectious Diseases Group, Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Lehne G, Voelcker-Rehage C, Meyer J, Bammann K, Gansefort D, Brüchert T, Bolte G. Equity Impact Assessment of Interventions to Promote Physical Activity among Older Adults: A Logic Model Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E420. [PMID: 30717136 PMCID: PMC6388141 DOI: 10.3390/ijerph16030420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 11/16/2022]
Abstract
Reducing social inequalities in health and health determinants, including physical activity (PA), is a major challenge for public health. PA-promoting interventions are increasingly implemented. Little is known, however, about the impact of these interventions on social inequalities. For prioritizing interventions most likely to be effective in reducing inequalities, studies of PA interventions need to conduct equity impact assessments. The aim of this article is to describe the development of a logic model framework for equity impact assessments of interventions to promote PA. The framework was developed within the prevention research network AEQUIPA-Physical activity and health equity: primary prevention for healthy ageing, informed by an equity-focused systematic review, expert interviews, exploratory literature searches, and joint discussions within the network. The framework comprises a general equity-focused logic model to be adapted to specific interventions. The intervention-specific equity-focused logic models illustrate the key elements relevant for assessing social inequalities in study participation, compliance with and acceptance of interventions, as well as the efficacy of interventions. Future work within AEQUIPA will reveal which key elements are most critical for the interventions' equity impacts. Equity impact assessments are beneficial for prioritizing interventions most likely to be effective in reducing health inequalities.
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Affiliation(s)
- Gesa Lehne
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
| | - Claudia Voelcker-Rehage
- Institute of Human Movement Science and Health, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, 09126 Chemnitz, Germany.
| | - Jochen Meyer
- OFFIS-Institute for Information Technology, 26121 Oldenburg, Germany.
| | - Karin Bammann
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
- Working Group Epidemiology of Demographic Change, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
| | - Dirk Gansefort
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, 28359 Bremen, Germany.
| | - Tanja Brüchert
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany.
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany.
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Montgomery P, Movsisyan A, Grant SP, Macdonald G, Rehfuess EA. Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health. BMJ Glob Health 2019; 4:e000848. [PMID: 30775013 PMCID: PMC6350753 DOI: 10.1136/bmjgh-2018-000848] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022] Open
Abstract
Public health interventions and health technologies are commonly described as 'complex', as they involve multiple interacting components and outcomes, and their effects are largely influenced by contextual interactions and system-level processes. Systematic reviewers and guideline developers evaluating the effects of these complex interventions and technologies report difficulties in using existing methods and frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE). As part of a special series of papers on implications of complexity in the WHO guideline development, this paper serves as a primer on how to consider sources of complexity when using the GRADE approach to rate certainty of evidence. Relevant sources of complexity in systematic reviews, health technology assessments and guidelines of public health are outlined and mapped onto the reported difficulties in rating the estimates of the effect of these interventions. Recommendations on how to address these difficulties are further outlined, and the need for an integrated use of GRADE from the beginning of the review or guideline development is emphasised. The content of this paper is informed by the existing GRADE guidance, an ongoing research project on considering sources of complexity when applying the GRADE approach to rate certainty of evidence in systematic reviews and the review authors' own experiences with using GRADE.
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Affiliation(s)
- Paul Montgomery
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Ani Movsisyan
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sean P Grant
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | | | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University, Munich, Germany
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