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Li L, Avendano M. Lone parents' employment policy and adolescents' socioemotional development: Quasi-experimental evidence from a UK reform. Soc Sci Med 2023; 320:115754. [PMID: 36758496 DOI: 10.1016/j.socscimed.2023.115754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/04/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
Studies suggest that welfare-to-work programmes increase lone mother's employment, but their impact on child and adolescent socioemotional development is unclear. The lone parent obligation (LPO) reform introduced a requirement for lone mothers entitled to unconditional Income Support (IS) to seek paid work actively as a condition to receive benefits. We use data from the UK Millennium Cohort Study to examine the impact of work search requirements for lone parents on child and adolescent socioemotional development. We apply a difference-in-differences approach that exploits gradual changes from 2008 to 2017 in children's maximum eligibility age to receive IS and assess effects on child and adolescent Strengths and Difficulties Questionnaire (SDQ) scores. We find that the LPO reform led to a ten-percentage point increase in lone mothers' employment but no change in the risk of family poverty. The reform led to a small but statistically significant increase in adolescents' SDQ scores, which indicated worse mental health and was largely driven by increased emotional problems. It also led to an increase in mothers' distress and poor self-rated health, and mothers' reports that time spent with children was insufficient. Our findings highlight the need to consider trade-offs between employment gains and child and adolescent socioemotional development in assessing the net impact of welfare-to-work policies targeting lone parents.
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Affiliation(s)
- Liming Li
- Department of Global Health & Social Medicine, King's College London, London, UK.
| | - Mauricio Avendano
- Department of Global Health & Social Medicine, King's College London, London, UK; Center for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
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Munthe‐Kaas H, Nøkleby H, Rosenbaum S. User experiences of structured stakeholder engagement to consider transferability: The TRANSFER approach. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1284. [PMID: 36908834 PMCID: PMC9577259 DOI: 10.1002/cl2.1284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Systematic reviews are increasingly used to inform decision-making in health, education, social care and environmental protection. However, decision makers still experience barriers to using reviews, including not knowing how findings might translate to their own contexts, and lack of collaboration with systematic review authors. The TRANSFER approach is a novel method that aims to support review authors to systematically and transparently collaborate with stakeholders to consider context and the transferability of review findings from the beginning of the review process. Such collaboration is intended to improve the usefulness and relevance of review findings for decision makers. Objectives We aim to explore the user experience of the TRANSFER approach conversation guide, and in doing so gain a better understanding of the role and perceived value of stakeholder engagement in systematic reviews for informed decision-making. Methods We conducted four user tests of groups using the guide, organized around simulated meetings between review authors and stakeholders. Review authors led the meeting using the TRANSFER approach conversation guide. We audio-recorded and observed the meetings, collected feedback forms and conducted semi-structured interviews with review authors following the meeting. We analysed the data using framework analysis to examine the user experience of the TRANSFER approach conversation guide and of stakeholder engagement more generally. Results Seventeen participants in four user groups participated in the user tests. Most participants were generally positive toward the structured approach using the conversation guide, and felt it would be useful in systematic review projects. We observed examples of misunderstanding of the terminology included in the guide, and received multiple suggestions for how to make the conversation guide more user friendly. We observed numerous challenges related to the hypothetical nature of a user test, including lack of familiarity with the review question/topic among participants and lack of preparation for the meeting. Conclusions Review authors and stakeholders are positive toward using a structured approach to guide collaboration within the context of a systematic review. The TRANSFER conversation guide helps participants to discuss the review question and context in a structured way. Such structured collaboration could help to improve the usefulness and relevance of systematic reviews for decision making by improving the review question, inclusion criteria and consideration of transferability of review findings. The conversation guide needs to be modified to improve user experience. Further research is needed to explore stakeholder collaboration and the use of the TRANSFER conversation guide in systematic review processes.
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Affiliation(s)
- Heather Munthe‐Kaas
- Reviews and Health Technology AssessmentsNorwegian Institute of Public HealthOsloNorway
- Present address:
Centre for Epidemic Interventions ResearchNorwegian Institute of Public HealthOsloNorway
| | - Heid Nøkleby
- Reviews and Health Technology AssessmentsNorwegian Institute of Public HealthOsloNorway
| | - Sarah Rosenbaum
- Reviews and Health Technology AssessmentsNorwegian Institute of Public HealthOsloNorway
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Shah N, Walker IF, Naik Y, Rajan S, O'Hagan K, Black M, Cartwright C, Tillmann T, Pearce-Smith N, Stansfield J. National or population level interventions addressing the social determinants of mental health - an umbrella review. BMC Public Health 2021; 21:2118. [PMID: 34794401 PMCID: PMC8599417 DOI: 10.1186/s12889-021-12145-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background Social circumstances in which people live and work impact the population’s mental health. We aimed to synthesise evidence identifying effective interventions and policies that influence the social determinants of mental health at national or scaled population level. We searched five databases (Cochrane Library, Global Health, MEDLINE, EMBASE and PsycINFO) between Jan 1st 2000 and July 23rd 2019 to identify systematic reviews of population-level interventions or policies addressing a recognised social determinant of mental health and collected mental health outcomes. There were no restrictions on country, sub-population or age. A narrative overview of results is provided. Quality assessment was conducted using Assessment of Multiple Systematic Reviews (AMSTAR 2). This study was registered on PROSPERO (CRD42019140198). Results We identified 20 reviews for inclusion. Most reviews were of low or critically low quality. Primary studies were mostly observational and from higher income settings. Higher quality evidence indicates more generous welfare benefits may reduce socioeconomic inequalities in mental health outcomes. Lower quality evidence suggests unemployment insurance, warm housing interventions, neighbourhood renewal, paid parental leave, gender equality policies, community-based parenting programmes, and less restrictive migration policies are associated with improved mental health outcomes. Low quality evidence suggests restriction of access to lethal means and multi-component suicide prevention programmes are associated with reduced suicide risk. Conclusion This umbrella review has identified a small and overall low-quality evidence base for population level interventions addressing the social determinants of mental health. There are significant gaps in the evidence base for key policy areas, which limit ability of national policymakers to understand how to effectively improve population mental health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12145-1.
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Affiliation(s)
- Neha Shah
- City University London, Northampton Square, EC1V 0HB, London, UK.
| | - Ian F Walker
- Hull York Medical School, University of York, Heslington, York, YO10 5DD, England
| | - Yannish Naik
- Leeds Teaching Hospitals NHS Trust, Great St George Street, Leeds, LS1 3EX, England
| | - Selina Rajan
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine, London, WC1E 7H, UK
| | - Kate O'Hagan
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Michelle Black
- School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent, Sheffield, S1 4DA, England
| | - Christopher Cartwright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, England
| | - Taavi Tillmann
- Centre for Global Non-Communicable Disease, Institute for Global Health, UCL, 30 Guilford, London, WC1N 1EH, UK
| | - Nicola Pearce-Smith
- Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, UK
| | - Jude Stansfield
- School of Health and Community Studies, Leeds Beckett University, Portland Building, PD519, Portland Place, Leeds, LS1 3HE, UK
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Naik Y, Baker P, Ismail SA, Tillmann T, Bash K, Quantz D, Hillier-Brown F, Jayatunga W, Kelly G, Black M, Gopfert A, Roderick P, Barr B, Bambra C. Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health 2019; 19:1678. [PMID: 31842835 PMCID: PMC6915896 DOI: 10.1186/s12889-019-7895-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. METHODS Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. RESULTS The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. CONCLUSIONS The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. TRIAL REGISTRATION Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.
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Affiliation(s)
- Yannish Naik
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Peter Baker
- Global Health and Development Group, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
| | - Sharif A. Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Taavi Tillmann
- Centre for Global Non-Communicable Diseases, Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Kristin Bash
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Darryl Quantz
- NW School of Public Health, Health Education England North West, First Floor Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL UK
| | - Frances Hillier-Brown
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN UK
| | - Wikum Jayatunga
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Gill Kelly
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Michelle Black
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Anya Gopfert
- Junior Doctor and National Medical Director’s Fellow, London, UK
| | - Peter Roderick
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Ben Barr
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Clare Bambra
- Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
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Katikireddi SV, Molaodi OR, Gibson M, Dundas R, Craig P. Effects of restrictions to Income Support on health of lone mothers in the UK: a natural experiment study. LANCET PUBLIC HEALTH 2019; 3:e333-e340. [PMID: 29976327 PMCID: PMC6038023 DOI: 10.1016/s2468-2667(18)30109-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/27/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the UK, lone parents must seek work as a condition of receiving welfare benefits once their youngest child reaches a certain age. Since 2008, the lower age limit at which these Lone Parent Obligations (LPO) apply has been reduced in steps. We used data from a nationally representative, longitudinal, household panel study to analyse the health effects of increased welfare conditionality under LPO. METHODS From the Understanding Society survey, we used data for lone mothers who were newly exposed to LPO when the age cutoff was reduced from 7 to 5 years in 2012 (intervention group 1) and from 10 to 7 years in 2010 (intervention group 2), as well as lone mothers who remained unexposed (control group 1) or continuously exposed (control group 2) at those times. We did difference-in-difference analyses that controlled for differences in the fixed characteristics of participants in the intervention and control groups to estimate the effect of exposure to conditionality on the health of lone mothers. Our primary outcome was the difference in change over time between the intervention and control groups in scores on the Mental Component Summary (MCS) of the 12-item Short-Form Health Survey (SF-12). FINDINGS The mental health of lone mothers declined in the intervention groups compared with the control groups. For intervention group 1, scores on the MCS decreased by 1·39 (95% CI -1·29 to 4·08) compared with control group 1 and by 2·29 (0·00 to 4·57) compared with control group 2. For intervention group 2, MCS scores decreased by 2·45 (-0·57 to 5·48) compared with control group 1 and by 1·28 (-1·45 to 4·00) compared with control group 2. When pooling the two intervention groups, scores on the MCS decreased by 2·13 (0·10 to 4·17) compared with control group 1 and 2·21 (0·30 to 4·13) compared with control group 2. INTERPRETATION Stringent conditions for receiving welfare benefits are increasingly common in high-income countries. Our results suggest that requiring lone parents with school-age children toseek work as a condition of receiving welfare benefits adversely affects their mental health. FUNDING UK Medical Research Council, Scottish Government Chief Scientist Office, and National Health Service Research Scotland.
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Affiliation(s)
- Srinivasa Vittal Katikireddi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Oarabile R Molaodi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Marcia Gibson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ruth Dundas
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Campbell M, Thomson H, Fenton C, Gibson M. Lone parents, health, wellbeing and welfare to work: a systematic review of qualitative studies. BMC Public Health 2016; 16:188. [PMID: 26911510 PMCID: PMC4766630 DOI: 10.1186/s12889-016-2880-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 02/17/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lone parents and their children experience higher than average levels of adverse health and social outcomes, much of which are explained by high rates of poverty. Many high income countries have attempted to address high poverty rates by introducing employment requirements for lone parents in receipt of welfare benefits. However, there is evidence that employment may not reduce poverty or improve the health of lone parents and their children. METHODS We conducted a systematic review of qualitative studies reporting lone parents' accounts of participation in welfare to work (WtW), to identify explanations and possible mechanisms for the impacts of WtW on health and wellbeing. Twenty one bibliographic databases were searched. Two reviewers independently screened references and assessed study quality. Studies from any high income country that met the criteria of focussing on lone parents, mandatory WtW interventions, and health or wellbeing were included. Thematic synthesis was used to investigate analytic themes between studies. RESULTS Screening of the 4703 identified papers and quality assessment resulted in the inclusion of 16 qualitative studies of WtW in five high income countries, USA, Canada, UK, Australia, and New Zealand, covering a variety of welfare regimes. Our synthesis found that WtW requirements often conflicted with child care responsibilities. Available employment was often poorly paid and precarious. Adverse health impacts, such as increased stress, fatigue, and depression were commonly reported, though employment and appropriate training was linked to increased self-worth for some. WtW appeared to influence health through the pathways of conflict and control, analytical themes which emerged during synthesis. WtW reduced control over the nature of employment and care of children. Access to social support allowed some lone parents to manage the conflict associated with employment, and to increase control over their circumstances, with potentially beneficial health impacts. CONCLUSION WtW can result in increased conflict and reduced control, which may lead to negative impacts on mental health. Availability of social support may mediate the negative health impacts of WtW.
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Affiliation(s)
- Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Hilary Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Candida Fenton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - Marcia Gibson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
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Drummond J, Schnirer L, So S, Mayan M, Williamson DL, Bisanz J, Fassbender K, Wiebe N. The protocol for the Families First Edmonton trial (FFE): a randomized community-based trial to compare four service integration approaches for families with low-income. BMC Health Serv Res 2014; 14:223. [PMID: 24885729 PMCID: PMC4060625 DOI: 10.1186/1472-6963-14-223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 05/06/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Families with low incomes experience an array of health and social challenges that compromise their resilience and lead to negative family outcomes. Along with financial constraints, there are barriers associated with mental and physical health, poorer education and language. In addition, vulnerable populations experience many services as markedly unhelpful. This combination of family and service barriers results in reduced opportunities for effective, primary-level services and an increased use of more expensive secondary-level services (e.g., emergency room visits, child apprehensions, police involvement). A systematic review of effective interventions demonstrated that promotion of physical and mental health using existing service was critically important. METHODS/DESIGN The Families First Edmonton Trial (FFE) tests four service integration approaches to increase use of available health and social services for families with low-income. It is a randomized, two-factor, single-blind, longitudinal effectiveness trial where low-income families (1168) were randomly assigned to receive either (1) Family Healthy Lifestyle plus Family Recreation service integration (Comprehensive), (2) Family Healthy Lifestyle service integration, (3) Family Recreation service integration, or (4) existing services. To be eligible families needed to be receiving one of five government income assistance programs. The trial was conducted in the City of Edmonton between January 2006 and August 2011. The families were followed for a total of three years of which interventional services were received for between 18 and 24 months. The primary outcome is the number of family linkages to health and social services as measured by a customized survey tool "Family Services Inventory". Secondary outcomes include type and satisfaction with services, cost of services, family member health, and family functioning. Where possible, the measures for secondary outcomes were selected because of their standardization, the presence of published norming data, and their utility as comparators to other studies of low-income families. As an effectiveness trial, community and government partners participated in all committees through a mutually agreed upon governance model and helped manage and problem solve with researchers. DISCUSSION Modifications were made to the FFE trial based on the pragmatics of community-based trials. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT00705328.
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Affiliation(s)
- Jane Drummond
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton Alberta, AB T6G 1C9, Canada
| | - Laurie Schnirer
- Faculty of Extension, University of Alberta, Edmonton, AB T5J 4P6, Canada
| | - Sylvia So
- Faculty of Extension, University of Alberta, Edmonton, AB T5J 4P6, Canada
| | - Maria Mayan
- Faculty of Extension, University of Alberta, Edmonton, AB T5J 4P6, Canada
| | - Deanna L Williamson
- Department of Human Ecology, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Jeffrey Bisanz
- Department of Psychology, Faculty of Arts, University of Alberta, Edmonton, AB T6G 2E9, Canada
| | - Konrad Fassbender
- Department of Oncology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Natasha Wiebe
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB T6G 1C9, Canada
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Thomson H. Improving utility of evidence synthesis for healthy public policy: the three Rs (relevance, rigor, and readability [and resources]). Am J Public Health 2013; 103:e17-23. [PMID: 23763400 PMCID: PMC4007892 DOI: 10.2105/ajph.2013.301400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2013] [Indexed: 11/04/2022]
Abstract
Systematic reviews have the potential to promote knowledge exchange between researchers and decision-makers. Review planning requires engagement with evidence users to ensure preparation of relevant reviews, and well-conducted reviews should provide accessible and reliable synthesis to support decision-making. Yet, systematic reviews are not routinely referred to by decision-makers, and innovative approaches to improve the utility of reviews is needed. Evidence synthesis for healthy public policy is typically complex and methodologically challenging. Although not lessening the value of reviews, these challenges can be overwhelming and threaten their utility. Using the interrelated principles of relevance, rigor, and readability, and in light of available resources, this article considers how utility of evidence synthesis for healthy public policy might be improved.
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Affiliation(s)
- Hilary Thomson
- MRC/CSO Social & Public Health Science Unit, Glasgow, United Kingdom.
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