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Dr Jonathan Shepherd Principal Research Fellow

Assessing quality in systematic reviews of the effectiveness of health promotion and public health (HP/PH): Areas of consensus and dissension. Dr Jonathan Shepherd Principal Research Fellow Southampton Health Technology Assessments Centre (SHTAC), School of Medicine,

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Dr Jonathan Shepherd Principal Research Fellow

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  1. Assessing quality in systematic reviews of the effectiveness of health promotion and public health (HP/PH): Areas of consensus and dissension Dr Jonathan Shepherd Principal Research Fellow Southampton Health Technology Assessments Centre (SHTAC), School of Medicine, University of Southampton, UK

  2. Objectives of today’s presentation • Present results of a series of interviews with systematic reviewers in HP/PH • Challenges faced by systematic reviewers • Barriers / facilitators around assessing quality • Barriers / facilitators around learning to do systematic reviews of HP/PH

  3. Methods • Stage 1 – detailed methodological mapping of random sample of HP/PH systematic reviews (n=30) • Stage 2 – Semi-structured interviews with a sample of systematic reviewers in HP/PH (n=17)

  4. Methods (2) • Purposive (n=17) • Cochrane Colloquium (Melbourne, 2005) (n=10/17 interviews) • UK / telephone (2006) (n=7/17 interviews) • Content analysis approach to categorise data into themes • Data analysed using NVivo (2.0)

  5. Methods (3): Interviewees

  6. Results (1): challenges to doing systematic reviews

  7. Results (2): barriers to, and facilitators of, quality assessment

  8. Results (3): Barriers to, and facilitators of, quality assessment (cont) “I mean it is difficult in, you know that there are judgement calls all the time, it isn’t you know it, none of these things are nice easy tick boxes and there’s so many judgements right the way through” “I’ve never met a set of guidelines where they completely dispense with the idea that you make a new judgement” Interviewee 14

  9. Results (4): Consensus on quality assessment criteria? • Majority thought there was generally no consensus… • …but more consensus for RCTs • Concept of “Multiple consensus” • Realistic to achieve consensus in HP/PH?

  10. Results (4) consensus on quality assessment criteria (cont.) “I’m not sure that that matters that much because people will always do things in different ways. And the idea of forcing an orthodoxy in an area which is incredibly diverse as public health systematic reviews. I mean, I think imagination and lateral thinking bring just as much other help as systematic methods” Interviewee 13

  11. Results (5) Learning to do systematic reviews

  12. Results (6): Challenges in helping others to do reviews

  13. Conclusions: key overarching themes • Complexity of many HP/PH reviews

  14. Conclusions: key overarching themes (cont) “It’s big and diverse, that’s why it’s so much easy just to stick with randomised control trials and be done with it. Or even if you do community trials, cluster randomised, still it’s easier. I think once you move beyond it gets very difficult” Interviewee 4

  15. Conclusions: key overarching themes (cont) • Complexity of many HP/PH reviews • Time and resources • Subjectivity

  16. Recommendations • Adequate planning and resourcing of complex HP/PH systematic reviews • Better reporting of HP/PH studies • Training for critical appraisal • opportunities for ‘hands on’ learning • acknowledging subjectivity

  17. Acknowledgements • University of Southampton • Professor Katherine Weare • Interviewees who took part in the research • EPPI-Centre, London • Cochrane Public Health Group email: jps@soton.ac.uk

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