SYNTHESIZING THE EVIDENCE FOR ACTIONSystematic Reviews for Evidence: The Cochrane and Campbell colla

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SYNTHESIZING THE EVIDENCE FOR ACTIONSystematic
Reviews for Evidence The Cochrane and Campbell
collaborations

• Peter Tugwell, Mark Petticrew, Betsy
  Kristjansson, Vivian Robinson.
  
• Centre for Global Health
• Institute for Population Health
• University of Ottawa, Canada

MRC Social and Public Health Sciences Unit
Glasgow
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Objectives

• What do the Cochrane and Campbell Collaborations
  have to do with the Global Forum?
  
• Need for equity considerations in systematic
  reviews
  
• Do Cochrane and Campbell contain information on
  health equity now?
  
• Methods to facilitate the inclusion of equity of
  outcomes Joint Cochrane and Campbell Interest
  Group

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Objectives

• What do the Cochrane and Campbell Collaborations
  have to do with the Global Forum?
  
• Need for equity considerations in systematic
  reviews
  
• Do Cochrane and Campbell contain information on
  health equity now?
  
• Proposed Joint Cochrane and Campbell Equity
  Interest Group

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Forum 7 Helping correct the 10/90 gap

• To review recent progress made in correcting the
  10/90 gap and discuss plans for the coming years
  for promoting priority health research for
  development and the fight against poverty.

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Forum 7 Helping correct the 10/90 gap

• To review recent progress made in correcting the
  10/90 gap and discuss plans for the coming years
  for promoting priority health research for
  development and the fight against poverty.
• After me, Jodie Doyle will be describing the
  priority setting exercise for future Cochrane
  Reviews

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How much agreement is there on the evidence for
interventions improving health in LMICs

• This is a increasing focus of the Cochrane and
  Campbell Collaborations
  
• .Developing Country Group
• .Health Promotion and Public Health Field
• .Equity Interventions Group
• .Many of the 50 Cochrane Review Groups

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Archie Cochrane
Obstetrician in United Kingdom
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Cochrane Collaboration Objectives

• To help people make well informed decisions by
  preparing, maintaining and promoting access to
  systematic reviews of studies on the effects of
  health and health care practices and policies.
• www.Cochrane.org

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Campbell Collaboration Objectives

• To help people make well informed decisions by
  preparing, maintaining and promoting access to
  systematic reviews of studies on the effects of
  
• E-----------, S-----, and L-----
  interventions.
  
• www.campbellcollaboration.org

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Campbell Collaboration Objectives

• To help people make well informed decisions by
  preparing, maintaining and promoting access to
  systematic reviews of studies on the effects of
  educational, legal and social interventions.
• www.campbellcollaboration.org/

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Donald T. Campbell(1917-1996)

• The Collaboration is named after the eminent
  psychologist who drew attention to the need for
  societies to assess more rigourously the effects
  of the social and educational policies and
  practices that are introduced and promoted

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Effectiveness research agenda

• Does the intervention cause more good than harm?
• How effective is it, and is it cost-effective?
• What interventions are most effective for
  reducing health inequities?
  
• How can the uptake of effective and appropriate
  interventions by health care consumers be
  improved?
  
• What are the most effective interventions for
  promoting the use of evidence by health care
  decision makers?

Slide from Jimmy Volmink
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Cochrane/Campbell reviews

• HIV 18 Reviews
• TB 8 Reviews
• Malaria 6 Reviews

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Cochrane/Campbell reviews being undertaken
relevant to the ten projected leading causes of
Disability-Adjusted Life Years in 2020, IN
DEVELOPING REGIONS

• reviews
• Unipolar major depression 17
• Road traffic accidents 5
• Ischaemic heart disease 14
• Chronic obstructive lung disease 19
• Cerebrovascular disease 35
• Tuberculosis 8
• Lower respiratory tract infections 15
• War injuries 7
• Diarrhoeal diseases 8
• HIV 18

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Malaria- what works?

• Insecticide-treated bednets for children
• Decrease child mortality due to malaria by 20
• Decrease mild malarial episodes by 48

Lengeler C. Insecticide-treated bednets and
curtains for preventing malaria (Cochrane Review)
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Malaria example Community effectiveness is
modified by access, diagnosis and
provider/consumer compliance
-Over 50 of efficacy is lost - in this case,
mostly due to low access-Poorest achieve less
efficacy, mostly due to low access
Community effectiveness is calculated as the
product of modifying factors
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Objectives

• Overview of the Cochrane and Campbell
  Collaborations
  
• Need for equity considerations in systematic
  reviews
  
• Do Cochrane and Campbell contain information on
  health equity now?
  
• Proposed Joint Cochrane and Campbell Equity
  Interest Group

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Equity

• When thinking of Health For All
• 1.Always insist on considering BOTH
• Mean results
• Distribution by Socio-economic position

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Equity

• When thinking of Health For All
• 1.Always insist on considering BOTH
• Mean results
• Distribution by Socio-economic position
• 2.InEquity Concept of Unfair
• Where the socio-economically disadvantaged have
  worse health and the inequality is avoidable
  
• Kawachi 2000Evans T et al, 2001Feachem 2001

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Action-Orientation Shift from static emphasis
upon health inequity analysis towards dynamic
identification and evaluation of measures that
can effectively bring about greater equity. Gwa
tkin 2001
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Action-orientation!
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Strategies for tackling health inequalities

• We need international exchange of experiences
• with developing and implementing interventions
• and policies to reduce socioeconomic
  inequalities
  
• in health in order to increase learning speed in
• this field
• J P Mackenbach BMJ 2002325102932

University of Ottawa IPH is Co-Convening with U
of Aberdeen in UK , a joint Interest Group in
Equity Interventions within Campbell and Cochrane
Collaborations
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Objectives

• To provide participants with an overview of the
  Cochrane and Campbell Collaborations
  
• To discuss the need for equity considerations in
  systematic reviews
  
• To give overview of the current equity relevance
  of Cochrane reviews.
  
• Proposed Joint Cochrane and Campbell Interest
  Group.

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Do Cochrane reviews include useful information
about Equity?

• 219 Reviews identified with search for Equity,
  Disadvantaged, Socioeconomic, low-income, for
  example
  
• Access to Breast and Cervical Cancer Screening
• Road traffic injuries (eg traffic calming,
  pedestrian education)
  
• Child health e.g. daycare, school-feeding
• Reproductive Health social support, home visits,
  pre and ante-natal care
  
• Infectious Disease HIV Prevention/Rx, TB
  therapy, Malaria
  
• Mental health (eg assertive community treatment)
• Adolescent Pregnancy
• Tobacco Smoking prevention and cessation
  reviews
  
• Substance abuse eg alcohol, drugs, harm-reduction

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Does Campbell contain useful information
regarding health equity?

• Education
• Interventions for Reducing School Truancy
• Effects of School-based Social Problem-Solving
  Interventions on Aggressive Behavior
  
• High School Dropout Prevention
• Interventions for Antisocial Behavior and Effects
  on Education and Crime
  
• Crime and Justice
• Scared Straight and Other Juvenile Awareness
  Programs for Preventing Juvenile Delinquency
  
• Interventions for incarcerated violent juvenile
  offenders
  
• Street lighting
• Hot spots policing
• Effects of neighbourhood watch
• Social Welfare
• Health effects of housing improvements
• School feeding
• Parenting interventions for teenage parents

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What does applying the Equity Lens to Cochrane
Reviews mean?

• Disadvantaged is not just Socio-economic Status!
  
  
• What other groupings of disadvantaged should one
  consider?
  

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Equity Gradients -Not just Socio-economic
Status!

• PROGRESS Evans and Brown.
• Place of Residence
• Race/ethnicity
• Occupation
• Gender
• Religion
• Education
• SES
• Social networks/resources

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Results reporting
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Results - Analysis

• 20 of Cochrane reviews contained 1 or more study
  conducted in a LMIC
  
• Only 1 Cochrane review (out of 95) reported
  differences in effect across socioeconomic
  factors
  
• to increase uptake of cervical cancer screening,
  transport incentives (eg parking vouchers) were
  more effective in low-income women
  
• 10 primary studies (out of 103) analyzed
  differences in treatment effectiveness across
  socioeconomic factors

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Objectives

• To provide participants with an overview of the
  Cochrane and Campbell Collaborations
  
• To discuss the need for equity considerations in
  systematic reviews
  
• To give overview of the current equity relevance
  of Cochrane reviews.
  
• Proposed Joint Cochrane and Campbell Group.

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Interest Group Cochrane/Campbell Systematic
reviews of Interventions to reduce socioeconomic
inequalities in healthAustralia Rosemary
Aldrich Elizabeth Harris Jodie DoyleCanada
Jeremy Grimshaw, Elizabeth Kristjansson, Jessie
McGowan, Vivian Robinson, Peter Tugwell, George
WellsChile Ilta LangeMexico Patricia Clark,
Gladys FabaNorway Andrew OxmanPhilippines
Tony Dans, Inday DansSouth Africa James
VolminkUK Trisha Greenhalgh, Andrew Haines,
Simon Lewin, Mark PetticrewUSA Lisa Bero
please join us! vrobin_at_uottawa,captugwell_at_uot
tawa.ca
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Activities to date

• Begun 6 Reviews as models
• School feeding programs for reducing
  socio-economic inequalities in health.
  Kristjansson, Tugwell, Petticrew et al
  
• Peer-based interventions to reduce health
  inequalities among HIV positive women, M Doull et
  al
  
• Smoking cessation programs for reducing health
  disparities. Petticrew, Ogilvie et al
  
• Home-based interventions for malaria and
  respiratory infections. Wells, Kallander, Tugwell
  et al
  
• Physical activity for disadvantaged youth.
  Beaulac, Kristjansson et al
  
• Prelim discussionsReducing inequities in the
  management of tuberculosis. Engel, Volmink, et al

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• Please join us!
• please join us! vrobin_at_uottawa,captugwell_at_uottaw
  a.ca