A scoping review of systematic reviews on reducing lifestyle risk behaviours in disadvantaged groups

Background

Lifestyle risk behaviours are key risk factors for non-communicable diseases. Some disadvantaged groups face particularly poor health outcomes, which may be exacerbated by high prevalence of risk behaviours. The aim of this scoping review was to identify and bring together evidence from systematic reviews on reducing risk behaviours in these groups and highlight where there is insufficient evidence to inform policy.

Methods

MEDLINE and Embase were searched up to October 2020 for English language reviews, with supplementary searching in Epistemonikos and Health Systems Evidence. Systematic reviews reporting behavioural outcomes of interventions targeting smoking, alcohol use, diet or physical inactivity in nine disadvantaged groups were eligible. Reviews of population-level policies reporting differential effects for these groups and qualitative reviews of barriers or facilitators to change were included. Literature was mapped based on the group and behaviour targeted.

Results

Ninety-two systematic reviews were included. The majority (n = 68) focused on low income or socio-economic status. Fewer reviews were identified that included prisoners (n = 14), deprived areas (n = 12), homeless people (n = 10), people with learning disabilities (n = 9), unemployed people (n = 3) and refugees or asylum seekers (n = 2). We identified no reviews on care leavers or Gypsies, Travellers or Roma. In total only 11 reviews targeted alcohol use. There were some gaps for specific group and behaviour combinations and no intervention reviews on refugees.

Conclusions

A number of gaps were identified, highlighting where new syntheses or primary studies could add value. For example, reviews on interventions in refugees, Gypsies, Travellers and Roma, and care leavers could be useful for policy-making. Other useful contributions might include an overview of the perceptions of disadvantaged groups allowing common barriers to behaviour change to be identified as well as factors unique to specific groups.

Key messages

Nearly 100 systematic reviews focused on reducing risk behaviours in disadvantaged groups; they addressed different combinations of behaviours and groups. Gaps in the literature were identified where new syntheses could make a useful contribution to developing programmes and policies.

Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews

Background

There is increasing pressure to tackle the wider social determinants of health through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development.

Methods

Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport.

Results

Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, particularly interventions in the fields of housing and the work environment.

Conclusion

Intervention studies that address inequalities in health are a priority area for future public health research.

A systematic review of presumed consent systems for deceased organ donation

OBJECTIVES

To examine the impact of presumed consent legislation on organ donation and to review data on attitudes to presumed consent among the public, professionals and any other stakeholders.

DATA SOURCES

Eight electronic databases (MEDLINE, MEDLINE In-Process, EMBASE, CINAHL, PsycINFO, HMIC, PAIS International and OpenSIGLE) were searched from inception to January 2008. Supplementary internet searches were also performed.

REVIEW METHODS

A systematic review of studies comparing donation rates in a single country before and after the introduction of a presumed consent law or in countries with and without presumed consent systems. The methodological quality of these studies was assessed and a narrative synthesis of results undertaken. Surveys of attitudes towards presumed consent legislation were also included.

RESULTS

Over 2000 potentially relevant citations were identified, of which 13 studies met the inclusion criteria for the primary objective and 13 for the secondary objective. For the primary objective, eight studies were between-country comparisons and five were before-and-after studies. Four of the between-country comparisons were of sufficient methodological quality to provide reliable results. In all four studies presumed consent law or practice was associated with increased rates of organ donation, ranging from an increase of 2.7 donors per million population (pmp) in one study to 6.14 donors per million in another, and an increase of between 20% and 30% in two other studies. Factors other than presumed consent that had an impact on organ donation rates were mortality from road traffic accidents and cerebrovascular accident, the transplant capacity of a country, gross domestic product per capita and health expenditure per capita, religion, education, public access to information and a common law legal system. The five before-and-after studies represented three countries, all of which reported an increase in donation rates following the introduction of a presumed consent system (Austria, from 4.6 to 27.2 donors pmp over a 5-year period; Belgium, increase in kidney donation from 10.9 to 41.3 pmp during a 3-year period; Singapore, increase in kidney procurement from 4.7 to 31.3 per year in the 3 years after the change in legislation). There was very limited investigation of any other changes taking place concurrently with the changes in legislation across this set of studies. Of the 13 studies addressing the secondary objective, eight were surveys of the UK public, four were from other countries and one was an international survey of health professionals. There was variation among the UK surveys in the level of support for presumed consent, with surveys conducted before 2000 reporting the lowest levels of support (28-57%). The most recent survey by YouGov in 2007 reported that 64% of respondents supported a change to presumed consent.

CONCLUSIONS

Presumed consent alone is unlikely to explain the variation in organ donation rates between different countries. A combination of legislation, availability of donors, transplantation system organisation and infrastructure, wealth and investment in health care, as well as underlying public attitudes to and awareness of organ donation and transplantation, may all play a role, although the relative importance of each is not clear. Further reviews could investigate the factors likely to modify donor rates, such as procedures for family involvement. The way in which families of any potential donor are approached is likely to be an important factor and a review of qualitative research examining the experience of relatives in this context would be useful.

"A hard day's night?" The effects of Compressed Working Week interventions on the health and work-life balance of shift workers: a systematic review

OBJECTIVE

To systematically review studies of the effects of the Compressed Working Week on the health and work-life balance of shift workers, and to identify any differential impacts by socio-economic group.

METHODS

Systematic review. Following QUORUM guidelines, published or unpublished experimental and quasi-experimental studies were identified. Data were sourced from 27 electronic databases, websites, bibliographies, and expert contacts.

RESULTS

Fourty observational studies were found. The majority of studies only measured self-reported outcomes and the methodological quality of the included studies was not very high. Interventions did not always improve the health of shift workers, but in the five prospective studies with a control group, there were no detrimental effects on self-reported health. However, work-life balance was generally improved. No studies reported differential impacts by socio-economic group; however, most of the studies were conducted on homogeneous populations.

CONCLUSION

This review suggests that the Compressed Working Week can improve work-life balance, and that it may do so with a low risk of adverse health or organisational effects. However, better designed studies that measure objective health outcomes are needed.

Population tobacco control interventions and their effects on social inequalities in smoking: systematic review

OBJECTIVE

To assess the effects of population tobacco control interventions on social inequalities in smoking.

DATA SOURCES

Medical, nursing, psychological, social science and grey literature databases, bibliographies, hand-searches and contact with authors.

STUDY SELECTION

Studies were included (n = 84) if they reported the effects of any population-level tobacco control intervention on smoking behaviour or attitudes in individuals or groups with different demographic or socioeconomic characteristics.

DATA EXTRACTION

Data extraction and quality assessment for each study were conducted by one reviewer and checked by a second.

DATA SYNTHESIS

Data were synthesised using graphical ("harvest plot") and narrative methods. No strong evidence of differential effects was found for smoking restrictions in workplaces and public places, although those in higher occupational groups may be more likely to change their attitudes or behaviour. Smoking restrictions in schools may be more effective in girls. Restrictions on sales to minors may be more effective in girls and younger children. Increasing the price of tobacco products may be more effective in reducing smoking among lower-income adults and those in manual occupations, although there was also some evidence to suggest that adults with higher levels of education may be more price-sensitive. Young people aged under 25 are also affected by price increases, with some evidence that boys and non-white young people may be more sensitive to price.

CONCLUSIONS

Population-level tobacco control interventions have the potential to benefit more disadvantaged groups and thereby contribute to reducing health inequalities.

Systematic review of interventions to reduce delay in patients with suspected heart attack

OBJECTIVES

To evaluate the effectiveness of interventions aiming to reduce time from onset of signs and symptoms of an acute myocardial infarction (AMI) to seeking medical help/arrival at hospital.

METHODS

A systematic review was conducted. Fifteen electronic databases, the internet, and bibliographies of included studies were searched, and experts in the field of cardiac care were contacted. Randomised controlled trials (RCTs), controlled trials, and before and after studies conducted in any setting that assessed an intervention aimed at reducing time from onset of signs and symptoms of an AMI to seeking medical help and/or arrival in hospital were eligible for inclusion.

RESULTS

Eleven media/public education intervention studies met the inclusion criteria. Five (one controlled and four before and after studies) reported the intervention to have a statistically positive effect on delay time and six (two RCTs and four before and after studies) reported no statistically significant effect. Three (one RCT and two before and after studies) of five studies evaluating the effect of the intervention on emergency department visits reported an increase in this outcome as a result of the intervention, and both studies (one RCT and one before and after study) examining calls made to emergency switchboards reported an increase in this outcome after the intervention.

CONCLUSIONS

There was little evidence that media/public education interventions reduced delay. There is some evidence that they may result in an increase in emergency switchboard calls and emergency department visits. Despite substantial expenditure of time and effort, methodological deficiencies of the studies mean that it is not possible to make definitive recommendations.

Community interventions for preventing smoking in young people

BACKGROUND

Decisions to smoke are made within a broad social context. Community interventions use co-ordinated, widespread, multi-component programmes to try and influence behaviour.

OBJECTIVES

To determine the effectiveness of community interventions in preventing the uptake of smoking in young people.

SEARCH STRATEGY

The Tobacco Addiction group specialised register, Medline and other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and contact was made with content area specialists. Searches were updated in September 2002.

SELECTION CRITERIA

Randomised and non randomised controlled trials that assessed the effectiveness of multi-component community interventions compared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking behaviour in young people under the age of 25 years.

DATA COLLECTION AND ANALYSIS

Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined using qualitative narrative synthesis.

MAIN RESULTS

Seventeen studies were included in the review, 46 studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with six using random allocation of schools or communities. Of thirteen studies which compared community interventions to no intervention controls, two, which were part of cardiovascular disease prevention programmes, reported lower smoking prevalence. Of three studies comparing community interventions to school-based programmes only, one found differences in reported smoking prevalence. One study reported a lower rate of increase in prevalence in a community receiving a multi-component intervention compared to a community exposed to a mass media campaign alone. One study reported a significant difference in smoking prevalence between a group receiving a media, school and homework intervention compared to a group receiving the media component only.

REVIEWER'S CONCLUSIONS

There is some limited support for the effectiveness of community interventions in helping prevent the uptake of smoking in young people.

Interventions for improving communication with children and adolescents about a family member's cancer

BACKGROUND

A diagnosis of cancer creates multiple problems for affected families, including major changes in living patterns, roles and relationships. It has not been common practice for families and health practitioners to share information with children or adolescents about a family member's cancer, or to allow them to express their feelings about this. In recent years, however, researchers and practitioners have begun to recognise that children and adolescents might appreciate and benefit by being better informed about, and having more opportunity to communicate their responses to, cancer in the family.

OBJECTIVES

To examine the effects of different ways of enhancing communication with children and/or adolescents about a family member's cancer and its treatment.

SEARCH STRATEGY

We searched the following sources: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library, Issue 1 2003; MEDLINE (1966 to January week 2 2003); EMBASE (1985 to 2003 week 6); CINAHL (1982 to February Week 1 2003); ERIC (1966 to 23 January 2003); PsycINFO (1985 to February week 1 2003). For the original (1999) version of this review we also searched the following databases: CancerLIT, Health Management Information Consortium, British Nursing Index, IAC Health & Wellness, JICSTE-Plus, Pascal, Linguistics and Language Behavior Abstracts, Mental Health Abstracts, AMED, HUMN, MANTIS and ASSIA. Bibliographies of identified studies were also checked and contact made with experts in the field.

SELECTION CRITERIA

Randomised and non-randomised controlled trials, and controlled and uncontrolled before and after studies that evaluated the effects of interventions to enhance communication with children and/or adolescents about a family member's cancer and its treatment.

DATA COLLECTION AND ANALYSIS

Data on knowledge and understanding, coping, adjustment and wellbeing were extracted by one reviewer and checked by another reviewer. Study quality was assessed using six criteria. A qualitative synthesis of the results is presented.

MAIN RESULTS

Five studies satisfied the selection criteria: one non-randomised controlled before and after study, and four uncontrolled before and after studies. They differed in terms of the interventions evaluated and the outcomes measured. One study of a camping program and two studies of structured group interventions reported improvements in cancer-related knowledge. One out of two structured group intervention studies found significant reductions in psychological and social problems. The camping program study reported significant improvements in siblings' behaviour. One structured group intervention study reported significantly more positive mood states after the intervention. Another structured group intervention study reported significantly lower levels of anxiety after the intervention.

REVIEWER'S CONCLUSIONS

Different methods of communicating with children and adolescents about a family member's cancer have not been widely evaluated in controlled trials. There is weak evidence to suggest that some interventions, such as structured group interventions, may lead to improvements in knowledge and understanding, in coping, anxiety, adjustment and wellbeing. More research is needed to investigate the comparative value of these interventions.

False-negative results in screening programs. Medical, psychological, and other implications

OBJECTIVES

Assessment of the appropriateness of screening programs involves consideration of the harms as well as the benefits. These harms include the risk of false-negative results, the consequences of which have remained underinvestigated. This paper reports the results of a systematic literature review that aimed to assess the medical psychological, economic, and legal consequences of false-negative results in national screening programs.

METHODS

The review included a comprehensive literature search and contact with experts to identify relevant literature. Most studies that were identified presented only anecdotal evidence. However, thirteen studies presented quantitative information on medical consequences of false negatives, eight studies presented information on psychological consequences, and two studies presented information on economic consequences.

RESULTS

The strength of evidence from most of the primary studies was low. There is some evidence, however, that false-negative results may have a large legal impact. There is also a consensus in the literature that false negatives may have a negative impact on public confidence on screening; evidence is however limited.

CONCLUSIONS

False negatives are evident even in high-quality screening programs. They may have the potential to delay the detection of breast and cervical cancer, but there is little evidence to help in assessing their psychological consequences. They also may lead to legal action being taken by those affected and may reduce public confidence in screening. Their impact may be reduced by provision of full information to participants about the benefits and limitations of screening programs and by increasing public education on these issues.

Evidence-informed patient choice. Practical issues of involving patients in decisions about health care technologies

Evidence-informed patient choice involves providing people with research-based information about the effectiveness of health care options and promoting their involvement in decisions about their treatment. Although the concept seems desirable, the processes and outcomes of evidence-informed patient choice are poorly understood, and it should be carefully evaluated.

The social circumstances of anxiety and its symptoms among Anglo-Jews

In this community study of orthodox-affiliated Jews in London the social circumstances of anxiety were examined. By contrast with previous work on women in London, danger and early adversity bore only a weak relationship with anxiety in this sample. Eventfullness had the strongest relationship with anxiety of all the circumstances examined. Women were more likely to suffer from borderline anxiety than were men, but there were no gender differences in case anxiety. Women had more eventful lives than men but this could not solely account for gender differences in anxiety. Findings suggest the importance of cultural factors in aetiology.

Mental health promotion in high-risk groups

This article summarises a systematic review of the literature on promoting mental health in high-risk groups. The review suggests that there are a variety of effective interventions for preventing mental health problems in high-risk groups. This has implications for the scope of practice of nurses and others working in a range of services, including midwifery, health visiting, school health, mental health, terminal care, district nursing and primary health care.

The costs and benefits of boundary maintenance: stress, religion and culture among Jews in Britain

This paper examines stress among two groups of orthodox Jews suggested to differ in the strength of the boundary of their religious group. Comparisons were made between the two groups, and with urban and rural groups studied by other researchers. Proportions of boundary-maintenance events (events whose threat had been caused or exacerbated by Jewishness) and of severe events, and proportions and rates of regular, irregular and disruptive events were examined. Boundary-maintenance events were higher among the more religiously orthodox affiliated group, and among whom religious observance was indeed reported to be higher. It was suggested that conditions of higher boundary maintenance would be associated with higher rates and proportions of regular events and with lower rates and proportions of irregular and disruptive events. Generally, the analyses supported this expectation. Boundary-maintenance events themselves were somewhat less severe, though not less likely to be irregular or disruptive than other events. Depression was shown to be unrelated to boundary-maintenance events and (surprisingly) unrelated to contextual threat when the effects of irregularity-disruption were controlled. Depression was, however, strongly related to irregular and disruptive events. The results are compared with those of related work, and suggest that the general lowering effect of affiliation to a religious group may be partly explained by the effects of boundary maintenance, which involves stress, but of a less depressogenic kind than the disruptive stress associated with conditions of low/no boundary maintenance. The findings have implications for understanding the relations between culture and mental disorder.

Gender and depression in Anglo-Jewry

This study found similar prevalence of case depression among men as among women in a sample of 339 Jews affiliated to orthodox synagogues (157 men and 182 women). There were significant gender differences in several social-situational factors and symptoms, mostly in the direction that would suggest that case depression would be higher among women than among men. That this was not so is suggested to be the result of the cultural milieu: social factors that have been found to be associated with depression in other groups of people did not function as risk or vulnerability factors among the Jews studied. In particular, the evidence indicates the importance of specific cultural-religious values in contributing towards the prevalences that were observed. These values included the esteem attached to women's central role in family management and the low use of alcohol and suicide as escape routes from depression.

Development of child-centered disease-specific questionnaires for living with asthma

Contemporary developments in the management of chronic diseases such as diabetes and asthma offer possibilities for optimal control, but patients increasingly need to take on responsibilities for self care. Health professionals require comprehensive assessments of outcome that include data reflecting patients' perceptions of their disorder and its management. Disease-specific, patient-centered questionnaires for evaluation of adults' health-related quality of life are available for diabetes and asthma. Little progress is evident in relation to pediatric instruments. This paper describes the development of such an instrument for measurement of 8- to 11-year-olds' perceptions of their asthma--the CAQ-B Psychometric characteristics of the CAQ-B are reported: principal axis factor analysis resulted in the derivation of four subscales reflecting children's perceptions of both active and passive aspects of living with asthma, together with their perceptions of its severity and any associated distress. Preliminary explorations with CAQ-B included comparisons of parents', doctors', and children's ratings of severity; comparisons of data from asthmatic and nonasthmatic children; comparisons of data from boys and girls.