Emma Wilkins

Towards a methodology for cluster searching to provide conceptual and contextual “richness” for systematic reviews of complex interventions: case study (CLUSTER)

BackgroundSystematic review methodologies can be harnessed to help researchers to understand and explain how complex interventions may work. Typically, when reviewing complex interventions, a review team will seek to understand the theories that underpin an intervention and the specific context for that intervention. A single published report from a research project does not typically contain this required level of detail. A review team may find it more useful to examine a “study cluster”; a group of related papers that explore and explain various features of a single project and thus supply necessary detail relating to theory and/or context.We sought to conduct a preliminary investigation, from a single case study review, of techniques required to identify a cluster of related research reports, to document the yield from such methods, and to outline a systematic methodology for cluster searching.MethodsIn a systematic review of community engagement we identified a relevant project – the Gay Men’s Task Force. From a single “key pearl citation” we conducted a series of related searches to find contextually or theoretically proximate documents. We followed up Citations, traced Lead authors, identified Unpublished materials, searched Google Scholar, tracked Theories, undertook ancestry searching for Early examples and followed up Related projects (embodied in the CLUSTER mnemonic).ResultsOur structured, formalised procedure for cluster searching identified useful reports that are not typically identified from topic-based searches on bibliographic databases. Items previously rejected by an initial sift were subsequently found to inform our understanding of underpinning theory (for example Diffusion of Innovations Theory), context or both. Relevant material included book chapters, a Web-based process evaluation, and peer reviewed reports of projects sharing a common ancestry. We used these reports to understand the context for the intervention and to explore explanations for its relative lack of success. Additional data helped us to challenge simplistic assumptions on the homogeneity of the target population.ConclusionsA single case study suggests the potential utility of cluster searching, particularly for reviews that depend on an understanding of context, e.g. realist synthesis. The methodology is transparent, explicit and reproducible. There is no reason to believe that cluster searching is not generalizable to other review topics. Further research should examine the contribution of the methodology beyond improved yield, to the final synthesis and interpretation, possibly by utilizing qualitative sensitivity analysis.

Developing and Sustaining a Healthy School Community: Essential Elements Identified by School Health Champions.

Background: Comprehensive School Health (CSH) approaches to developing a healthy school community can be effective in supporting chronic disease prevention while positively impacting on student behaviour and academic performance. Although a CSH framework provides principles for action, there is a lack of evidence regarding the processes that best facilitate CSH work, and enable action. Objective: The purpose of this study was to identify and describe the elements of practice-based evidence that contribute to the success and sustainability of healthy school communities, through the identification of positive practices and lessons learned from a sample of projects in Alberta, Canada. Setting: School communities in Alberta, Canada. Design and methods: Key individuals from a list of operating CSH projects were invited for interview. An exploratory, qualitative design examined the perspectives of these ‘school health champions’. A total of 12 one-on-one interviews and one focus group with seven participants were completed, resulting in input from 19 individuals in total. Results: Elements to develop and sustain a healthy school community fall into one of two categories: (1) stakeholder buy-in and (2) adequate resources in the form of human resources, partnerships and peer support. Participants identified successful strategies for establishing buy-in from administrators, teachers, parents and students. Conclusion: To effectively mobilise a comprehensive school health framework, practical strategies for implementation are needed. While some of these strategies are context-specific, practice-based evidence that transcends the local context does exist and can be used more widely to support the development of a healthy school community.