Presented at the Cochrane Canada 8th Annual Symposium Evidence in Uncertain Times: Meeting the Challenge

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

12. Results

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