Train the Trainer Course book - Cochrane Public Health Group

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Intervention(s) As described earlier, reviewers may choose to lump similar interventions in a review, or split the review by addressing a specific intervention. Reviewers may also consider ‘approaches’ to health promotion rather than topic-driven interventions, for example, peer-led strategies for changing behaviour. In addition, reviewers may want to limit the review by focusing on the effectiveness of a particular type of theory-based intervention (eg. Transtheoretical model) for achieving certain health outcomes (eg. smoking cessation). Comparison(s) It is important to specify the comparison intervention for the review. Comparison interventions may be no intervention, another intervention or standard care/practice. The choice of comparison or control has large implications for the interpretation of results. A question addressing one intervention versus no intervention is a different question than one comparing one intervention versus standard care/practice. Example: DiCenso A, Guyatt G, Willan A, Griffith L. Interventions to reduce unintended pregnancies among adolescents: systematic review of randomised controlled trials. BMJ 2002;324:1426-34. The majority of the studies included in this review address primary prevention of unintended pregnancy versus standard care/practice. Therefore, this review is not addressing whether primary prevention is effective, it is simply investigating the effect of specific interventions compared to standard practice. This is a much smaller gap to investigate an effect, as it is usually easier to find a difference when comparing one intervention versus no intervention. Intervention Effect Effect --------------------------------------------------------------------------------------------------------------------------- Standard practice Effect --------------------------------------------------------------------------------------------------------------------------- No intervention Effect --------------------------------------------------------------------------------------------------------------------------- Figure Two. The difference between comparing the effect of one intervention versus no intervention and one intervention versus standard practice. For example, many of the school-based interventions in the review are compared to normal sexual education in the schools, and are shown to be ineffective for reducing unintended pregnancies. Yet the interpretation of the results read “primary prevention strategies do not delay the initiation of sexual intercourse or improve the use of birth control among young men and women”. This reads that the review question has sought to address primary prevention versus no intervention. Rather, the review addressed whether theory-led interventions are more effective than standard care/practice. Outcome(s) The outcome(s) chosen for the review must be meaningful to the users of the review. The discrepancy between the outcomes and interventions that reviewers choose to include in the review and the outcomes and interventions that lay people prefer to be included has been well-described. 1 34
To investigate both the implementation of the intervention and its effects reviewers will need to include both process indicators as well as outcome measures. Unanticipated (side-effects) as well as anticipated effects should be investigated in addition to cost-effectiveness, where appropriate. Reviewers will also need to decide if proximal/immediate, intermediate or distal outcomes are to be assessed. If only intermediate outcomes are measured (eg. blood sugar levels in persons with diabetes, change in knowledge and attitudes) reviewers need to determine how strong the linkage is to more distal outcomes (eg. cardiovascular disease, behaviour change). The use of theory can assist with determining this relationship. In addition, reviewers should decide if only objective measures are to be included (eg. one objective measure of smoking status is saliva thiocyanate or alveolar carbon monoxide) or subjective measures (eg. self-reported smoking status), or a combination of both (discussing the implications of this decision). Examples of review questions Poorly designed questions: 1. Are condoms effective in preventing HIV? 2. Which interventions reduce health inequalities among people with HIV? Answerable questions: 1. In men who have sex with men, does condom use reduce the risk of HIV transmission? 2. In women with HIV, do peer-based interventions reduce health inequalities? Are mass media interventions effective in preventing smoking in young people? Problem, population Intervention Comparison Outcome Types of studies Young people, under 25 years of age 1. Television 2. Radio 3. Newspapers 4. Billboards 5. Posters 6. Leaflets 7. Booklets Types of study designs to include No intervention 1. objective measures of smoking 2. self-reported smoking behaviour 3. Intermediate measures (intentions, attitudes, knowledge) 4. Process measures (eg. media reach) 1. RCT (and quasi-RCT) 2. Controlled before and after studies 3. Time series designs The decisions about which type(s) of study design to include will influence subsequent phases of the review, particularly the search strategies, choice of quality assessment criteria, and the analysis stage (especially if a statistical meta-analysis is to be performed). The decision regarding which study designs to include in the review should be dictated by the intervention (the review question) or methodological appropriateness, and not vice versa. 2,3 If the review question has been clearly formulated then knowledge of the types of study designs needed to 35
Page 1 and 2: TRAIN-THE-TRAINER HANDBOOOK Two-day
Page 3: Contents Introduction .............
Page 6 and 7: Additional reading: Textbooks: Oliv
Page 8 and 9: 2) ONCE REGISTRATIONS HAVE BEEN REC
Page 11: OUTLINE OF TWO-DAY WORKSHOP 9:00am
Page 15 and 16: Unit One: Background to Systematic
Page 17 and 18: Reviews of clinical interventions v
Page 19 and 20: FACILITATOR’S GUIDE Time required
Page 21 and 22: Unit Two: International Systematic
Page 25 and 26: Unit Three: Resources Required Lear
Page 27: Formulate review question Establish
Page 31 and 32: Unit Four: Developing a Protocol Le
Page 33 and 34: Establish an Advisory Group whose m
Page 37: Unit Five: Asking an Answerable Que
Page 41 and 42: Process evaluations: these studies
Page 43 and 44: REFERENCES 1. Oliver S. 1997. Explo
Page 45 and 46: FACILATOR’S GUIDE Time required:
Page 47 and 48: Unit Six: Finding The Evidence Lear
Page 49 and 50: CA38392 (NCI) Language English Entr
Page 51 and 52: Where to locate studies a) Electron
Page 53 and 54: ADDITIONAL READING Harden A, Peersm
Page 55 and 56: 45. "Diet-Fat-Restricted"/ all subh
Page 57 and 58: Brunton G, Harden A, Rees R, Kavana
Page 59 and 60: 1. Start with the primary concept,
Page 61 and 62: 5. Because adolescent has no narrow
Page 63: 12. Complete searches 8-12 and 13-2
Page 67 and 68: Unit Seven: Data Abstraction Learni
Page 69: FACILITATOR’S GUIDE Time required
Page 72 and 73: Introduction of bias into the condu
Page 74 and 75: population on gender, age, or educa
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Page 83 and 84: QUALITY ASSESSMENT TOOL FOR QUANTIT
Page 85 and 86: G) ANALYSIS (Q1) Is there a sample
Page 87 and 88: DICTIONARY for the Effective Public
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(i) (ii) If the study was reported
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F) WITHDRAWALS AND DROP-OUTS Q1 Ind
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C) CONFOUNDERS Strong Moderate Weak
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Emphasise that the criteria to appr
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Randomised controlled trial - criti
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calculation? Yes Partially No (Q2)
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Controlled before and after study -
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RATE THIS SECTION Strong Moderate W
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Pope C, Mays N. Qualitative Researc
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Screening Questions 1 Was there a c
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A Checklist for Evaluating Evidence
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Where studies are more homogenous,
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esulting from some community interv
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Reviewers should use the RE-AIM mod
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Economic efficiency Harms Economic
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9. Swerrissen H, Crisp BR. The sust
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Exercise: Allow participants 20 min
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who had participated in their smoki
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Critical Appraisal Skills Programme
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2 points out of the possible 4 poin
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- search for non-English language s
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9. Were all important outcomes cons
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Train the Trainer Course book - Cochrane Public Health Group

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