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Missing Pieces:
                  Identifying the gaps in public health
                         effectiveness evidence

                               Daiva Tirilis, Hon B.A . (Health Studies)
                                Lyndsey McRae, McMaster University
                                          Kara DeCorby, MSc
                                     Maureen Dobbins, RN, PhD




Cochrane Symposium Ottawa, ON May 20, 2010
The Health Evidence
                                      Team

Maureen Dobbins, Director     Kara DeCorby, Project Coordinator      Heather Husson Project Manager
Tel: 905 525-9140 ext 22481   Tel: (905) 525-9140 ext. 20461         Tel: (905) 525-9140 ext. 20462
E-mail:                       E-mail: kdecorby@health-evidence.ca    E-mail: hhusson@health-evidence.ca
     dobbinsm@mcmaster.ca




Paula Robeson    Lori Greco       Daiva Tirilis               Lyndsey McRae        Kathryn Spoelstra
Knowledge Broker Knowledge Broker Research Assistant          Research Assistant   Research Assistant
Our Funders




Cochrane Symposium Ottawa, ON May 20, 2010
A special thank you to the National
    Collaborating Centre for Methods
    and Tools for funding this Report




Cochrane Symposium Ottawa, ON May 20, 2010
What is                 health-evidence.ca?
            A searchable, online registry of
         quality-rated review literature created to
              support public health and health
               promotion decision making.

          health-evidence.ca includes over 342
                   Cochrane reviews

Cochrane Symposium Ottawa, ON May 20, 2010
Cochrane Symposium Ottawa, ON May 20, 2010
Background
    High-quality review evidence is crucial for
     evidence-informed decision making in public
     health given that they summarize what is
     known about a given intervention, thus
     provide a more accurate estimate of its
     effectiveness.1,2
    Certain topic areas are poorly
     represented in the review literature

   1. Chan, K.S., Morton, S.C., & Shekelle, P.G. (2004). Systematic reviews for evidence-based management: Howto find them and what to do with
        them. American Journal of Care Management, 10(11 part I), 806-812.
   2. Howes, F., Doyle, J., Jackson, N., & Waters, E. (2004). Evidence-based public health: The importanc3e of finding ‘difficult to locate’ public
        health and health promotion intervention studies for systematic reviews. Journal of Public Health, 26(1), 101-104.

Cochrane Symposium Ottawa, ON May 20, 2010
Objectives

   1) To identify where gaps in systematic
      reviews evaluating public health
      interventions exist

   2) To identify topics for which many
      reviews exist, and require a review of
      reviews


Cochrane Symposium Ottawa, ON May 20, 2010
Methods
     Reviewed registry content by:
      1) Topic Area
      2) Population
      3) Intervention Location
      4) Intervention Strategy

     Determined proportion of reviews with
      strong, moderate or weak methodological
      quality
Cochrane Symposium Ottawa, ON May 20, 2010
Cochrane Symposium Ottawa, ON May 20, 2010
Methods
    When discussing major topic areas
      Limited Reviews   n = 1-100
      Moderate Reviews n = 101-200
      Many Reviews      n = 201+

     When discussing sub-topic areas
       Limited Reviews n = < 5
       Moderate Reviews n = 5 – 20
       Many Reviews n = 20+

Cochrane Symposium Ottawa, ON May 20, 2010
Results
EXCERPT Table 1: Overview of major topic headings

 KEYWORD                              TOTAL         Strong   Moderate   Weak
 Focus of Review: Main Topic Areas (in alphabetical order)
 Addiction/Substance Use                268           129       66       69
 Adolescent Health                      251           120       58       73
 Adult Health                           400           205      105       90
 Child Health                           316           158       82       75
 Chronic Diseases                       477           253      104      118
 Communicable Disease/Infection         195           108       45       42
 Infant Health                          122            72       27       23
 Injury Prevention/Safety               226           138       51       36
 Mental Health                          220           119       57       44
 Nutrition                              283           156       66       61
 Parenting, Infants and Children        232           130       54       47
 Physical Activity                      254           123       65       66
 Reproductive Health                    171           101       34       36
 Senior Health                          104            64       25       15
 Sexual Health                          151            74       39       36
 Sexually Transmitted Infections        157            65       42       50
Ample Evidence
             Sub-topics with > 20 Reviews

    These 63 sub-topics included:
         Disease Transmission (32)
         Alcohol Abuse/Use (45)
         Healthy Weight (51)
         Smoking Cessation (74)
         Lifestyle Behaviours (145)




Cochrane Symposium Ottawa, ON May 20, 2010
Missing Pieces
             Main Public Health Topics Areas in
             need of Reviews of Interventions




Cochrane Symposium Ottawa, ON May 20, 2010
Missing Pieces
             Sub-Topics with < 5 Reviews

 These 135 sub-topic areas included:
   Lung Cancer
   Needle Exchange
   Oral Hygiene
   Food Service Inspection
   Poverty Reduction
   Eating Disorders



Cochrane Symposium Ottawa, ON May 20, 2010
Missing Pieces
             Sub-Topics with 0 Reviews

   43 sub-topics had no reviews:
      Asbestos
      Carbon Monoxide Poisoning
      Head lice/Pediculosis
      Air bags
      Botulism
      Food processing & Inspection
      Elder Abuse

Cochrane Symposium Ottawa, ON May 20, 2010
Missing Pieces
             Study Populations



        Specific Cultural Groups (41)
        High-risk Groups (40)
        First Nations, Inuit and Metis (6)




Cochrane Symposium Ottawa, ON May 20, 2010
Missing Pieces
             Intervention Locations

           Health Bus (1)
           Farms (5)
           Hospices (5)
           Family Centres (9)
           Camps (11)
           Restaurants (11)
           Day Care Centres (32)
           Health Departments (32)


Cochrane Symposium Ottawa, ON May 20, 2010
Missing Pieces
             Intervention Strategies



      Emergency Preparedness (2)
      Surveillance (20)
      Public Health Inspection and Environmental
       Health (22)
      Advocacy (30)




Cochrane Symposium Ottawa, ON May 20, 2010
Where are the high-quality
  reviews?

   Wide variation in the QUANTITY of
    reviews available for certain topics
                         BUT
                                   In general 50% of the reviews
                                   available across topics were
                                   of high QUALITY


Cochrane Symposium Ottawa, ON May 20, 2010
Conclusions

  1. Author higher-level syntheses
  2. Prioritize reviews where gaps exist
  3. Focus funding




Cochrane Symposium Ottawa, ON May 20, 2010
Future Initiatives

          Dissemination
          Higher-level Syntheses
          KT Capacity Development




Cochrane Symposium Ottawa, ON May 20, 2010
Contact Information
   Maureen Dobbins
   905 525-9140 ext 22481
   dobbinsm@mcmaster.ca

   Lyndsey McRae
   lmcrae@health-evidence.ca

   General Inquiries
   info@health-evidence.ca


Cochrane Symposium Ottawa, ON May 20, 2010

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Missing Pieces: Identifying the gaps in public health

  • 1. Missing Pieces: Identifying the gaps in public health effectiveness evidence Daiva Tirilis, Hon B.A . (Health Studies) Lyndsey McRae, McMaster University Kara DeCorby, MSc Maureen Dobbins, RN, PhD Cochrane Symposium Ottawa, ON May 20, 2010
  • 2. The Health Evidence Team Maureen Dobbins, Director Kara DeCorby, Project Coordinator Heather Husson Project Manager Tel: 905 525-9140 ext 22481 Tel: (905) 525-9140 ext. 20461 Tel: (905) 525-9140 ext. 20462 E-mail: E-mail: kdecorby@health-evidence.ca E-mail: hhusson@health-evidence.ca dobbinsm@mcmaster.ca Paula Robeson Lori Greco Daiva Tirilis Lyndsey McRae Kathryn Spoelstra Knowledge Broker Knowledge Broker Research Assistant Research Assistant Research Assistant
  • 3. Our Funders Cochrane Symposium Ottawa, ON May 20, 2010
  • 4. A special thank you to the National Collaborating Centre for Methods and Tools for funding this Report Cochrane Symposium Ottawa, ON May 20, 2010
  • 5. What is health-evidence.ca? A searchable, online registry of quality-rated review literature created to support public health and health promotion decision making. health-evidence.ca includes over 342 Cochrane reviews Cochrane Symposium Ottawa, ON May 20, 2010
  • 6. Cochrane Symposium Ottawa, ON May 20, 2010
  • 7. Background  High-quality review evidence is crucial for evidence-informed decision making in public health given that they summarize what is known about a given intervention, thus provide a more accurate estimate of its effectiveness.1,2  Certain topic areas are poorly represented in the review literature 1. Chan, K.S., Morton, S.C., & Shekelle, P.G. (2004). Systematic reviews for evidence-based management: Howto find them and what to do with them. American Journal of Care Management, 10(11 part I), 806-812. 2. Howes, F., Doyle, J., Jackson, N., & Waters, E. (2004). Evidence-based public health: The importanc3e of finding ‘difficult to locate’ public health and health promotion intervention studies for systematic reviews. Journal of Public Health, 26(1), 101-104. Cochrane Symposium Ottawa, ON May 20, 2010
  • 8. Objectives 1) To identify where gaps in systematic reviews evaluating public health interventions exist 2) To identify topics for which many reviews exist, and require a review of reviews Cochrane Symposium Ottawa, ON May 20, 2010
  • 9. Methods  Reviewed registry content by: 1) Topic Area 2) Population 3) Intervention Location 4) Intervention Strategy  Determined proportion of reviews with strong, moderate or weak methodological quality Cochrane Symposium Ottawa, ON May 20, 2010
  • 10. Cochrane Symposium Ottawa, ON May 20, 2010
  • 11. Methods  When discussing major topic areas  Limited Reviews n = 1-100  Moderate Reviews n = 101-200  Many Reviews n = 201+  When discussing sub-topic areas  Limited Reviews n = < 5  Moderate Reviews n = 5 – 20  Many Reviews n = 20+ Cochrane Symposium Ottawa, ON May 20, 2010
  • 13. EXCERPT Table 1: Overview of major topic headings KEYWORD TOTAL Strong Moderate Weak Focus of Review: Main Topic Areas (in alphabetical order) Addiction/Substance Use 268 129 66 69 Adolescent Health 251 120 58 73 Adult Health 400 205 105 90 Child Health 316 158 82 75 Chronic Diseases 477 253 104 118 Communicable Disease/Infection 195 108 45 42 Infant Health 122 72 27 23 Injury Prevention/Safety 226 138 51 36 Mental Health 220 119 57 44 Nutrition 283 156 66 61 Parenting, Infants and Children 232 130 54 47 Physical Activity 254 123 65 66 Reproductive Health 171 101 34 36 Senior Health 104 64 25 15 Sexual Health 151 74 39 36 Sexually Transmitted Infections 157 65 42 50
  • 14. Ample Evidence Sub-topics with > 20 Reviews  These 63 sub-topics included:  Disease Transmission (32)  Alcohol Abuse/Use (45)  Healthy Weight (51)  Smoking Cessation (74)  Lifestyle Behaviours (145) Cochrane Symposium Ottawa, ON May 20, 2010
  • 15. Missing Pieces Main Public Health Topics Areas in need of Reviews of Interventions Cochrane Symposium Ottawa, ON May 20, 2010
  • 16. Missing Pieces Sub-Topics with < 5 Reviews  These 135 sub-topic areas included:  Lung Cancer  Needle Exchange  Oral Hygiene  Food Service Inspection  Poverty Reduction  Eating Disorders Cochrane Symposium Ottawa, ON May 20, 2010
  • 17. Missing Pieces Sub-Topics with 0 Reviews  43 sub-topics had no reviews:  Asbestos  Carbon Monoxide Poisoning  Head lice/Pediculosis  Air bags  Botulism  Food processing & Inspection  Elder Abuse Cochrane Symposium Ottawa, ON May 20, 2010
  • 18. Missing Pieces Study Populations  Specific Cultural Groups (41)  High-risk Groups (40)  First Nations, Inuit and Metis (6) Cochrane Symposium Ottawa, ON May 20, 2010
  • 19. Missing Pieces Intervention Locations  Health Bus (1)  Farms (5)  Hospices (5)  Family Centres (9)  Camps (11)  Restaurants (11)  Day Care Centres (32)  Health Departments (32) Cochrane Symposium Ottawa, ON May 20, 2010
  • 20. Missing Pieces Intervention Strategies  Emergency Preparedness (2)  Surveillance (20)  Public Health Inspection and Environmental Health (22)  Advocacy (30) Cochrane Symposium Ottawa, ON May 20, 2010
  • 21. Where are the high-quality reviews? Wide variation in the QUANTITY of reviews available for certain topics BUT In general 50% of the reviews available across topics were of high QUALITY Cochrane Symposium Ottawa, ON May 20, 2010
  • 22. Conclusions 1. Author higher-level syntheses 2. Prioritize reviews where gaps exist 3. Focus funding Cochrane Symposium Ottawa, ON May 20, 2010
  • 23. Future Initiatives  Dissemination  Higher-level Syntheses  KT Capacity Development Cochrane Symposium Ottawa, ON May 20, 2010
  • 24. Contact Information Maureen Dobbins 905 525-9140 ext 22481 dobbinsm@mcmaster.ca Lyndsey McRae lmcrae@health-evidence.ca General Inquiries info@health-evidence.ca Cochrane Symposium Ottawa, ON May 20, 2010