Starting with the proposition that "if we want more evidence-based practice, we need more practice-based evidence," this article (a) offers questions and guides that practitioners, program planners, and policy makers can use to determine the applicability of evidence to situations and populations other than those in which the evidence was produced (generalizability), (b) suggests criteria that reviewers can use to evaluate external validity and potential for generalization, and (c) recommends procedures that practitioners and program planners can use to adapt evidence-based interventions and integrate them with evidence on the population and setting characteristics, theory, and experience into locally appropriate programs. The development and application in tandem of such questions, guides, criteria, and procedures can be a step toward increasing the relevance of research for decision making and should support the creation and reporting of more practice-based research having high external validity.

Evaluating the Relevance, Generalization, and Applicability of Research Issues in External Validation and Translation Methodology

Background There is increasing pressure to tackle the wider social determinants of health through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development. Methods Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport. Results Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, particularly interventions in the fields of housing and the work environment. Conclusion Intervention studies that address inequalities in health are a priority area for future public health research.

https://jech.bmj.com/content/jech/64/4/284.full.pdf

Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews

http://centertrt.org/content/docs/Training_Resources/PA_Access/Effectiveness_of_Worksite_Interventions_for_Nutr_and_PA.pdf

The Effectiveness of Worksite Nutrition and Physical Activity Interventions for Controlling Employee Overweight and Obesity. A Systematic Review

Systematic reviews of public health interventions are fraught with challenges. Complexity is inherent; this may be due to multi-component interventions, diverse study populations, multiple outcomes measured, mixed study designs utilized and the effect of context on intervention design, implementation and effectiveness. For policy makers and practitioners to use systematic reviews to implement effective public health programmes, systematic reviews must include this information, which seeks to answer the questions posed by decision makers, including recipients of programmes. This necessitates expanding the traditional evaluation of evidence to incorporate the assessment of theory, integrity of interventions, context and sustainability of the interventions and outcomes. Unfortunately however, the critical information required for judging both the quality of a public health intervention and whether or not an intervention is worthwhile or replicable is missing from most public health intervention studies. When the raw material is not available in primary studies the systematic review process becomes even more challenging. Systematic reviews, which highlight these critical gaps, may act to encourage better reporting in primary studies. This paper provides recommendations to reviewers on the issues to address within a public health systematic review and, indirectly, provides advice to researchers on the reporting requirements of primary studies for the production of high quality systematic reviews.

Criteria for the systematic review of health promotion and public health interventions.

Workplace Health Promotion: A Meta-Analysis of Effectiveness

Evidence-based public health concerns the development and implementation of effective programmes and policies. For policy makers and practitioners to implement effective programmes they must have considered the information that is available on which interventions have been shown to work, or not to work (or caused harm). One form of high quality evidence-based information available to decision makers is a systematic review of research of effectiveness. A systematic review is defined as ‘a review of a clearly formulated question that uses systematic and explicit methods to identify, select and critically appraise relevant research, and to collect and analyse data from the studies included in the review’. Many of the tools of research synthesis were developed by American social scientists in the 1960s. However, today’s focus on evidence in health has been largely driven by the evidencebased medicine movement. Some authors have argued that there are concerns that in cost-conscious environments only those interventions for which there is sufficient evidence to complete a review would be supported. In public health the infrastructure that supports and enables the conduct of a review lags behind that of evidence-based medicine and extends beyond the employment of randomized controlled trials. This increased complexity has resulted in an unfortunate focus on the appropriateness (or not) of randomized controlled trials as the priority study design rather than what constitutes evidence in public health and how this should be evaluated. However, after diverging views, the focus has now moved towards ensuring that reviews in public health meet the needs of public health practitioners. Conducting systematic reviews of complex public health interventions is methodologically challenging. The following section outlines many of the issues faced when reviewing evidence of public health intervention effectiveness.

/pdf/the-challenges-of-systematically-reviewing-public-health-2mkqyo0c84.pdf

The challenges of systematically reviewing public health interventions.

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The challenges of systematically reviewing public health interventions.