Potential of Public Health Systematic Reviews to Impact on Primary Research

1. Potential of Public Health Systematic Reviews toImpact on Primary Research Professor Laurence Moore September 2007

2. What role can systematic reviews play? • Key source of evidence based information to • support and develop practice, • support professional development by helping to identify • new and emerging developments and • gaps in knowledge • Systematic reviews provide a synthesis of robust studies which no policy maker or practitioner, however diligent, could possibly hope to read themselves

3. Value of systematic reviews • Systematic reviews seek to extract information systematically from studies which meet inclusion criteria • Recommendations for research and practice • Policy-research-policy, relevance and impact • Intervention choice, research questions, implementation • Research Methods • Research and evaluation design

4. HPPH Guidelines • Advisory Group of users and researchers • Policy relevant interventions • Broad scope of study designs • Quality assessment • Theoretical framework • Integrity of intervention • Integrating qualitative and quantitative studies • Heterogeneity • Ethics, Equity and inequalities • Sustainability • Context • Applicability

5. Guidelines and Primary Research • Used to inform primary research design, implementation and evaluation • Ensuring primary research meets requirements of systematic reviews • Quality • Rigour • Applicability and transferability • Equity

6. Complexity of interventions to change behaviour • Effective interventions are likely to: • Be theoretically based • Involve complex interactions • Of sufficient intensity • Reinforced at multiple levels • Vary in effectiveness depending on context

7. Naïve interventions • Not theoretically based • Not fully developed • Feasibility and acceptability untested • Relatively easy to get funding to do trials of such interventions, rather than to obtain funding for pilot / feasibility / development studies of more sophisticated interventions

8. Evidence base conundrum • Good quality RCTS successfully conducted, evaluating weak interventions. Small effect sizes. • Good quality complex interventions evaluated using weak research designs. Biased effect estimates.

9. Complexity of behavioural change RCT design questioned Expert group / consensus statements High chance of dogma and received wisdom prevailing over data and evidence New methodological tools Mixed methods research designs Implementation and context What works For whom, how, in what circumstances Carpe deum Complexity and research synthesis in public health / health promotion

10. Specific impacts on public health research (1) • Improve study quality • Promote research rigour and stronger study design • Promote mixed methods • Improve reporting of studies • Enhance evidence base on equity • Reporting of SES sub-group analyses • Assess context-dependent heterogeneity • Assess implementation-dependent heterogeneity

11. Specific impacts on public health research (2) • Visible source of expertise, advice, feasibility • Move away from the ‘black box’ • Increase sophistication of research funders and consumers • Heighten awareness among policy/practice of wider value of evaluations – not to judge but to learn

12. Conclusions • Systematic reviews have an important role in informing and promoting high quality primary research • Advancing SR methods for PH contributes to evidence base beyond the end product of a SR • Contribution of PHRG to both reviews and primary research • Bicycle lane analogy