Belinda Burford

Assessing the applicability of findings in systematic reviews of complex interventions can enhance the utility of reviews for decision making

Assessment of applicability is an essential part of the systematic review process. In the context of systematic reviews of the effects of interventions, applicability is an assessment of whether the findings of a review can be applied in a particular context or population. For more complex interventions, assessing applicability can be challenging because of greater diversity of, and interactions within and between, the intended population, intervention components, comparison conditions, and outcomes as well as a range of further considerations related to intervention context and theoretical basis. We recommend that review authors plan and conduct analyses to explain variations in effect and answer questions about mechanisms of action and influence of different settings, contexts, and populations. We also recommend that review authors provide rich descriptions of the setting, implementation details, resource use, and contexts of included studies and assess applicability for at least one target population, setting, and context. This should facilitate applicability assessments by end users. Consensus on terminology is needed and guidance should be developed for the synthesis of implementation information within reviews as well as the documentation of applicability judgments by review authors.

Testing the PRISMA-Equity 2012 reporting guideline: the perspectives of systematic review authors.

Reporting guidelines can be used to encourage standardised and comprehensive reporting of health research. In light of the global commitment to health equity, we have previously developed and published a reporting guideline for equity-focused systematic reviews (PRISMA-E 2012). The objectives of this study were to explore the utility of the equity extension items included in PRISMA-E 2012 from a systematic review author perspective, including facilitators and barriers to its use. This will assist in designing dissemination and knowledge translation strategies. We conducted a survey of systematic review authors to expose them to the new items in PRISMA-E 2012, establish the extent to which they had historically addressed those items in their own reviews, and gather feedback on the usefulness of the new items. Data were analysed using Microsoft Excel 2008 and Stata (version 11.2 for Mac). Of 151 respondents completing the survey, 18.5% (95% CI: 12.7% to 25.7%) had not heard of the PRISMA statement before, although 83.4% (95% CI: 77.5% to 89.3%) indicated that they plan to use PRISMA-E 2012 in the future, depending on the focus of their review. Most (68.9%; 95% CI: 60.8% to 76.2%) thought that using PRISMA-E 2012 would lead them to conduct their reviews differently. Important facilitators to using PRISMA-E 2012 identified by respondents were journal endorsement and incorporation of the elements of the guideline into systematic review software. Barriers identified were lack of time, word limits and the availability of equity data in primary research. This study has been the first to ‘road-test’ the new PRISMA-E 2012 reporting guideline and the findings are encouraging. They confirm the acceptability and potential utility of the guideline to assist review authors in reporting on equity in their reviews. The uptake and impact of PRISMA-E 2012 over time on design, conduct and reporting of primary research and systematic reviews should continue to be examined.

Strengthening evaluation to capture the breadth of public health practice: ideal vs. real.

Tahna L. Pettman2, Rebecca Armstrong1,2, Jodie Doyle1,2, Belinda Burford1,2, Laurie M. Anderson2, Tessa Hillgrove3, Nikki Honey3, Elizabeth Waters1,2 Jack Brockhoff Child Health and Wellbeing Program, McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia Cochrane Public Health Group, McCaughey Centre, Melbourne School of Population Health, University of Melbourne, Melbourne, Australia Knowledge and Environments for Health Unit, The Victorian Health Promotion Foundation (VicHealth), Carlton, Victoria, Australia Address correspondence to Tahna Pettman, E-mail: tpettman@unimelb.edu.au

Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR).

BackgroundHealth interventions fall along a spectrum from simple to more complex. There is wide interest in methods for reviewing ‘complex interventions’, but few transparent approaches for assessing intervention complexity in systematic reviews. Such assessments may assist review authors in, for example, systematically describing interventions and developing logic models. This paper describes the development and application of the intervention Complexity Assessment Tool for Systematic Reviews (iCAT_SR), a new tool to assess and categorise levels of intervention complexity in systematic reviews.MethodsWe developed the iCAT_SR by adapting and extending an existing complexity assessment tool for randomized trials. We undertook this adaptation using a consensus approach in which possible complexity dimensions were circulated for feedback to a panel of methodologists with expertise in complex interventions and systematic reviews. Based on these inputs, we developed a draft version of the tool. We then invited a second round of feedback from the panel and a wider group of systematic reviewers. This informed further refinement of the tool.ResultsThe tool comprises ten dimensions: (1) the number of active components in the intervention; (2) the number of behaviours of recipients to which the intervention is directed; (3) the range and number of organizational levels targeted by the intervention; (4) the degree of tailoring intended or flexibility permitted across sites or individuals in applying or implementing the intervention; (5) the level of skill required by those delivering the intervention; (6) the level of skill required by those receiving the intervention; (7) the degree of interaction between intervention components; (8) the degree to which the effects of the intervention are context dependent; (9) the degree to which the effects of the interventions are changed by recipient or provider factors; (10) and the nature of the causal pathway between intervention and outcome. Dimensions 1–6 are considered ‘core’ dimensions. Dimensions 7–10 are optional and may not be useful for all interventions.ConclusionsThe iCAT_SR tool facilitates more in-depth, systematic assessment of the complexity of interventions in systematic reviews and can assist in undertaking reviews and interpreting review findings. Further testing of the tool is now needed.

Tracking and understanding the utility of Cochrane reviews for public health decision-making

Cochrane reviews aim to support policy and practice decisions. Developing systematic strategies to understand the pathway from their production to actually making a difference in practice is difficult but extremely valuable. Such an exercise can help to determine meaningfulness of the reviews, identify their use in highlighting the spectrum of the primary evidence, flag opportunities to update and stimulate research gap analyses. This paper briefly describes our emerging approach to tracking and understanding the use, and usefulness, of published Cochrane Public Health Group (CPHG) reviews to date.

Assessing evidence in public health: the added value of GRADE

Akl EA, 2012, BMC PUBLIC HEALTH, V12, DOI 10.1186-1471-2458-12-386; Barbui C, 2010, PLOS MED, V7, DOI 10.1371-journal.pmed.1000322; Deeks JJ, 2003, HEALTH TECHNOL ASSES, V7, p[iii, 1]; Duclos P, 2012, VACCINE, V31, P12, DOI 10.1016-j.vaccine.2012.02.041; Durrheim DN, 2010, J EPIDEMIOL COMMUN H, V64, P387, DOI 10.1136-jech.2009.103226; European Centre for Disease Prevention and Control (ECDC), 2011, EV BAS METH PUBL HLT; Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P380, DOI 10.1016-j.jclinepi.2010.09.011; Guyatt GH, 2011, J CLIN EPIDEMIOL, V64, P1283, DOI 10.1016-j.jclinepi.2011.01.012; Rehfuess EA, 2011, J EPIDEMIOL COMMUN H, V65, P559, DOI 10.1136-jech.2010.130013; Schunemann H, 2010, J EPIDEMIOL COMMUNIT, V65; Sun X, 2010, BRIT MED J, V340, DOI 10.1136-bmj.c117; Sun X, 2012, BRIT MED J, V344, DOI 10.1136-bmj.e1553; WHO, GUID DEV EV BAS VACC

Fortification of rice with vitamins and minerals for addressing micronutrient malnutrition

Background Rice fortification with vitamins and minerals has the potential to increase the nutrition in rice-consuming countries where micronutrient deficiencies exist. Globally, 490 million metric tonnes of rice are consumed annually. It is the domi

Service brokerage for improving health outcomes in ex‐prisoners

This is the protocol for a review and there is no abstract. The objectives are as follows: This review aims to assess the effectiveness of interventions including a service brokerage component for people transitioning out of prison, on health outcomes post-release.

Using Evidence to Inform NCD Prevention and Health Promotion

The success of NCD prevention initiatives relies on a number of important factors, but one of the non-negotiables is an understanding of what strategies or programs have been implemented and evaluated before, and what contemporary epidemiological, qualitative, and contextual knowledge is available and reliable to inform. The method for finding and assessing the quality and relevance of contributing evidence requires tools that are useful to support policy and practice decision making. This chapter begins by outlining suggested essential components of systematic reviews that may be most useful in informing decisions about NCD prevention and health promotion, including theoretical frameworks or logic models, information on program implementation, outcomes, equity and ethics, and sustainability. The chapter also explores the realities of applying evidence to decisions in policy and practice settings, by discussing aspects of applicability and transferability of research evidence and outlining key questions often asked in policy and practice together with options for combining different types of evidence to inform decisions. Also provided are examples of processes that may assist with evidence-informed decision making.

Evidence Synthesis to Inform NCD Prevention and Health Promotion

Making informed choices about the use of resources and the likely success of proposed NCD prevention and health promotion initiatives requires knowledge of what strategies have been previously evaluated. This information can be openly and curiously sought through the process of a systematic appraisal of the research evidence. This chapter provides a brief overview of the evidence synthesis process for those who are likely to draw upon evidence reviews to inform their practice. Subcomponents discussed include planning an evidence review, formulating answerable questions about health issues and inequalities, searching for relevant research, including evidence from nonhealth sectors, and appraising its strength and trustworthiness. An understanding of these processes, forming the basic steps of systematic review methodology, and the links between the steps provides a framework for those who need to engage with the evidence as part of an evidence-informed decision-making process.