Development, inter-rater reliability and feasibility of a checklist to assess implementation (Ch-IMP) in systematic reviews: the case of provider-based prevention and treatment programs targeting children and youth

The CONSENSYS approach: An instrument to support CONtextual SENsitivity in SYStematic reviews

Contextual factors such as cultural values and traditions impact on implementation processes of healthcare interventions. It is one of the reasons why local stakeholders may decide to role out a programme differently from how it has originally been developed or described in scientific literature. This can result in different but most likely more context-specific outcomes. Systematic reviews are considered important in answering what works, for whom and in which circumstances. They often include a section on implications for policymakers and practitioners, in which they discuss relevant options to engage with. Implementation sections are coloured by the cultural background, theoretical and disciplinary perspective of the reviewers formulating them. They do not necessarily consider local contexts in which the evidence needs to be applied, hence the recommendations may be too general to be useful. When policy makers and practitioners implement systematic review findings the evidence presented needs to be translated to their local context. We propose CONSENSYS, an instrument that facilitates the transfer from review evidence into practice. CONSENSYS contains 52 contextual factors categorised as either of ecological and socio-cultural relevance or pitched as influencing actor. CONSENSYS is relevant for reviewers because it supports them in structuring and formulating context-sensitive implications sections. It may also guide end-users of systematic reviews in translating review evidence for use in local policies and practices. CONSENSYS is the first rigorously developed instrument that focusses on implications for policy and practice sections in systematic reviews.

Factors that influence women's engagement with breastfeeding support: A qualitative evidence synthesis

Breastfeeding is an integral part of early childhood interventions as it can prevent serious childhood and maternal illnesses. For breastfeeding support programmes to be effective, a better understanding of contextual factors that influence women's engagement and satisfaction with these programmes is needed. The aim of this synthesis is to suggest strategies to increase the level of satisfaction with support programmes and to better match the expectations and needs of women. We systematically searched for studies that used qualitative methods for data collection and analysis and that focused on women's experiences and perceptions regarding breastfeeding support programmes. We applied a maximum variation purposive sampling strategy and used thematic analysis. We assessed the methodological quality of the studies using a modified version of the CASP tool and assessed our confidence in the findings using the GRADE-CERQual approach. We included 51 studies of which we sampled 22 for in-depth analysis. Our sampled studies described the experiences of women with formal breastfeeding support by health care professionals in a hospital setting and informal support as for instance from community support groups. Our findings illustrate that the current models of breastfeeding support are dependent on a variety of contextual factors encouraging and supporting women to initiate and continue breastfeeding. They further highlight the relevance of providing different forms of support based on socio-cultural norms and personal backgrounds of women, especially if the support is one-on-one. Feeding decisions of women are situated within a woman's personal situation and may require diverse forms of support.

Executive functioning as a predictor of physiological and subjective acute stress responses in non-clinical adult populations: A systematic literature review and meta-analysis

The goal of this systematic review and meta-analysis was to evaluate whether executive functioning predicts subsequent acute stress responses. A systematic search (conducted between May 22nd and 30th, 2019; updated on April 4th, 2020) on Cochrane, OpenGray, Proquest Dissertations and Thesis Global, PsycInfo, Pubmed, Scopus, and Web of Science revealed 27 correlational and five interventional studies. For quality appraisal, we used the BIOCROSS Tool, the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the Revised Cochrane Risk-of-bias Tool for Randomized Trials. Attentional control was most consistently associated with acute stress. A robust variation estimation meta-analysis, conducted when sufficient data was available, revealed a small, significant, and negative correlation between higher working memory and subsequent lower cortisol reactivity (r = .09, p = .025, 95 % CI [0.15, 0.02]). These results highlight the role of executive functioning for acute stress responses, the scarcity of relevant data, and the need for both interventional designs and the consideration of mediators and moderators to understand underlying mechanisms.

Risk of skin tears and its predictors among hospitalized older adults in Singapore

AIM

To identify the characteristics that may be predictive of development of risk of skin tears among hospitalized older adults in Singapore.

BACKGROUND

Skin tears are wounds that are partial or full-thickness separation of skin layers, which are common in older adults. Skin tears can result from shearing, friction, and/or blunt force. Skin tears have correlated with prolonged hospitalization, raised health-care costs and poorer quality of life.

METHODS

This cross-sectional descriptive correlational study recruited a convenience sample of 140 patients aged 65 years or above from a Singapore acute hospital. A modified International Skin Tear Advisory Panel (ISTAP) Skin Tear Risk Assessment Pathway was used for data collection; this is a validated instrument to assess patients for risks of skin tears in clinical settings.

RESULTS

The results of the multiple linear regression analysis indicated that increasing age, being underweight, caregiver-dependence and dementia predicted higher levels of risk of skin tears among hospitalized older adults in Singapore. These factors accounted for 33.6% of the variance.

CONCLUSION

This study can aid health-care professionals assess patients' risk of skin tears and implement appropriate interventions to minimize risks of skin tears.

The RIMES Statement: A Checklist to Assess the Quality of Studies Evaluating Risk Minimization Programs for Medicinal Products

INTRODUCTION

Pharmaceutical risk minimization programs involve interventions designed to support safe and appropriate use of medicines. Currently, information regarding the evaluation of these programs is not publicly reported in a standardized and transparent manner. To address this gap, we developed and piloted a quality reporting checklist entitled the Reporting recommendations Intended for pharmaceutical risk Minimization Evaluation Studies (RIMES).

METHODS

Checklist development was guided by three sources: (1) a theoretical framework derived from program theory and process evaluation; (2) public health intervention design and evaluation principles; and (3) a review of existing quality reporting checklists. Two raters independently reviewed 10 recently published (2012-2016) risk minimization program evaluation studies using the proposed checklist. Inter-rater reliability of the checklist was assessed using Cohen's Kappa and Gwet's AC1.

RESULTS

A 43-item checklist was generated. Results indicated substantial inter-rater reliability overall (κ = 0.65, AC1 = 0.65) and for three (key information, design and evaluation) of the four subscales (κ ≥ 0.64, AC1 ≥ 0.64). The fourth subscale (implementation) showed low reliability based on Cohen's Kappa, but substantial reliability based on the AC1 (κ = 0.17, AC1 = 0.61).

CONCLUSIONS

The RIMES statement augments relevant elements from existing quality reporting guidelines with items that address aspects of intervention design, implementation and evaluation specific to pharmaceutical risk minimization programs. Our results show that the RIMES statement reliably measures key dimensions of reporting quality. This tailored checklist is an important first step in improving the reporting quality of risk minimization evaluation studies and may ultimately help to improve the quality of these interventions themselves.

Opportunities for Enhanced Strategic Use of Surveys, Medical Records, and Program Data for HIV Surveillance of Key Populations: Scoping Review

BACKGROUND

Normative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately.

OBJECTIVE

The aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs.

METHODS

To provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched.

RESULTS

There remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and medical record data continue to be insufficiently robust to provide estimates of the 90-90-90 targets for key populations.

CONCLUSIONS

Current reliance on more active data collection processes, including key population-specific surveys, remains warranted until the quality and validity of passively collected routine program and medical record data for key populations is optimized.

Searching for the Impact of Participation in Health and Health Research: Challenges and Methods

Internationally, the interest in involving patients and the public in designing and delivering health interventions and researching their effectiveness is increasing. Several systematic reviews of participation in health research have recently been completed, which note a number of challenges in documenting the impact of participation. Challenges include working across stakeholders with different understandings of participation and levels of experience in reviewing; comparing heterogeneous populations and contexts; configuring findings from often thin descriptions of participation in academic papers; and dealing with different definitions of impact. This paper aims to advance methods for systematically reviewing the impact of participation in health research, drawing on recent systematic review guidance. Practical examples for dealing with issues at each stage of a review are provided based on recent experience. Recommendations for improving primary research on participation in health are offered and key points to consider during the review are summarised.

Engagement of stakeholders in the development of a Theory of Change for handwashing and sanitation behaviour change

A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice.

Cochrane Qualitative and Implementation Methods Group guidance series-paper 2: methods for question formulation, searching, and protocol development for qualitative evidence synthesis

This paper updates previous Cochrane guidance on question formulation, searching, and protocol development, reflecting recent developments in methods for conducting qualitative evidence syntheses to inform Cochrane intervention reviews. Examples are used to illustrate how decisions about boundaries for a review are formed via an iterative process of constructing lines of inquiry and mapping the available information to ascertain whether evidence exists to answer questions related to effectiveness, implementation, feasibility, appropriateness, economic evidence, and equity. The process of question formulation allows reviewers to situate the topic in relation to how it informs and explains effectiveness, using the criterion of meaningfulness, appropriateness, feasibility, and implementation. Questions related to complex questions and interventions can be structured by drawing on an increasingly wide range of question frameworks. Logic models and theoretical frameworks are useful tools for conceptually mapping the literature to illustrate the complexity of the phenomenon of interest. Furthermore, protocol development may require iterative question formulation and searching. Consequently, the final protocol may function as a guide rather than a prescriptive route map, particularly in qualitative reviews that ask more exploratory and open-ended questions.

Cochrane Qualitative and Implementation Methods Group guidance series-paper 4: methods for assessing evidence on intervention implementation

OBJECTIVES

This article provides reviewers with guidance on methods for identifying and processing evidence to understand intervention implementation.

STUDY DESIGN AND SETTING

Strategies, tools, and methods are applied to the systematic review process to illustrate how process and implementation can be addressed using quantitative, qualitative, and other sources of evidence (i.e., descriptive textual and nonempirical).

RESULTS

Reviewers can take steps to navigate the heterogeneity and level of uncertainty present in the concepts, measures, and methods used to assess implementation. Activities can be undertaken in advance of a Cochrane quantitative review to develop program theory and logic models that situate implementation in the causal chain. Four search strategies are offered to retrieve process and implementation evidence. Recommendations are made for addressing rigor or risk of bias in process evaluation or implementation evidence. Strategies are recommended for locating and extracting data from primary studies. The basic logic is presented to assist reviewers to make initial review-level judgments about implementation failure and theory failure.

CONCLUSION

Although strategies, tools, and methods can assist reviewers to address process and implementation using quantitative, qualitative, and other forms of evidence, few exemplar reviews exist. There is a need for further methodological development and trialing of proposed approaches.