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Handling Complexity in Evidence from systematic reviews and meta-analyses of Public Health Interventions (CEPHI project)

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  • Title:
    Handling Complexity in Evidence from systematic reviews and meta-analyses of Public Health Interventions (CEPHI project)
  • Author: Kneale, Dylan ; O'Mara-Eves, Alison ; Candy, Bridget ; Sutcliffe, Katy ; Cain, Lizzie ; Oliver, Sandy ; Hutchinson Pascal, Niccola ; Thomas, James
  • Subjects: co-production ; Context ; evidence ; generalisability ; logic model ; meta-analysis ; QCA ; recalibration ; secondary data analysis ; systematic review
  • Description: Background: The development of evidence-based strategies to tackle complex public health issues has been widely recommended. Nevertheless, methodologically robust sources of evidence may not necessarily be perceived as useful to decision-making in local settings. Despite their high regard, the ability to utilise evidence from meta-analyses and systematic reviews is hampered by the lack of explicit connection between the contexts in which interventions were evaluated and the context in which the evidence is to be applied. In this research we seek to develop approaches for exploring and enhancing the generalisability of meta-analysis through additional synthesis. Approach: Mixed methods design underpinned by co-production. This involved co-producing a systems-based logic model and conducting secondary syntheses of existing systematic review evidence to develop new analysis approaches. Methods: This research focusses on children’s health as a case example and the identification of school-based interventions to help improve children’s health. The research included three work packages (WPs): WP1: Through a series of workshops with stakeholders, we co-produced a systems-based logic model that helps to identify contextual features of interest and how they interact to influence children’s health. This co-production was transformative for the research and helped to reframe children’s health away from a stigmatizing and individualistic focus on obesity to a broader focus on children’s health. The systems-based logic model is an output in its own right, and was also be used to guide later stages. WP2: This work package developed and refined new approaches in examining the generalisability of evidence, drawing on WP1. First, we assessed how using existing observational data and employing statistical approaches (namely reweighting of effect sizes, binary logistic regressions, and cluster analysis) in novel ways can help to create an overall measure of effect from meta-analysis that is more applicable to a defined population and/or more interpretable for decision-making. Next, we explored the utility of Qualitative Comparative Analysis (QCA) in examining the influence of context. Drawing on set-theory, we attempted to use QCA to examine configurations of different contextual features that align with more successful interventions. WP3: Given that the primary motivation of this project is that end-users are not utilising review evidence because of its disconnect with their particular local circumstances, we explored the utility of the proposed enhancements to address this issue. Discussion: This project has identified (i) a participatory approach for conceptualising health systems; (ii) refined approaches and developed new methods for exploring the influence of context in meta-analytic evidence; and (iii) demonstrated the important of co-production in challenging researchers’ assumptions about how systems and factors influence health (in this case children’s health). The methodological advancements developed in this research for examining context in meta-analysis provide useful adjunct evidence to decision-makers, alongside existing meta-analytic evidence. Here we have focused on four approaches, where two in particular appear to provide a clearer message around the likely impact of contextual and population factors for decision-making. While caveats surround all four approaches, we believe that all four show further potential. However, understanding the potential of these approaches was hindered by an absence of contextual data reported within studies. The results of this research highlight the gulf between the deep and nuanced way in which diverse groups of stakeholders understand the factors that influence children’s health, and the sparse treatment of context by researchers within trials and systematic reviews.
  • Publisher: EPPI Centre (UCL)
  • Creation Date: 2022
  • Language: English
  • Source: UCL Discovery
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