scholarly journals Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
V J McGowan ◽  
S. Buckner ◽  
R. Mead ◽  
E. McGill ◽  
S. Ronzi ◽  
...  

Abstract Background Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments. Methods Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR). Results Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms – can all have positive impacts on health outcomes – particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear. Conclusions Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities. Trial registration PROSPERO CRD42019158309

2020 ◽  
Vol 16 (2) ◽  
pp. 121-136
Author(s):  
Jason Semprini

Purpose The purpose of this paper is to conduct a systematic review of published literature studying the health of African immigrants in the USA and to develop a formal set of recommendations for future researchers aiming to improve the health outcomes in this population. Design/methodology/approach A comprehensive search was initiated on PubMed, Cochrane, ERIC, DOAJ, Prospero and Scopus databases. Final inclusion criteria were: systematic reviews, studying African Immigrants in the USA, measuring a clinical health outcome, since 1999. Articles were screened in four stages by title, abstract, full-text of the review and full-text of the primary studies within each review. Data was abstracted by identifying general information, study population, outcome measurements, conclusions and recommendations of each review. Findings In the initial search, 519 potential reviews were identified. After removing duplicates, 473 articles were excluded by screening the title or abstract. After a full-text review of each article and primary study within each article, nine reviews were included in the final synthesis. Reviews covered Female Genital Cutting and Pregnancy Outcomes, Caesarean Births, Gestational Diabetes, Cancer, HIV/AIDS, Body-weight and Acculturation. Among the primary reports included in the final synthesis, less than 50 per cent studied African immigrants in the USA. African Americans living in the USA made up only 11 per cent of the pooled study sample. Research limitations/implications Immigrants from Africa are one of the fastest-growing populations in the USA. This group has been underrepresented in health research, leading to a poor understanding of the group’s health outcomes. Health researchers must adopt recommendations and prioritize studies that meet the health needs of Africans during this time of demographic transition. Originality/value Systematic reviews represent a bedrock of medical evidence and signify a solid understanding of accepted knowledge in the field. Systematic reviews, however, do not necessarily constitute the end of discovery. Researchers can use existing systematic reviews to critique previous studies or initiate future research. There remain significant research gaps analyzing the health outcomes, behaviors and treatment of subgroups of African immigrants living in the USA. Future research should shift toward the growing needs of the population, leveraging the strengths and diversity of African immigrants now living in the USA.


Author(s):  
Dean M Giustini ◽  
Syed Mustafa Ali ◽  
Matthew Fraser ◽  
Maged N Kamel Boulos

Introduction: Research examining the effective uses of social media (SM) in public health and medicine, especially in the form of systematic reviews (SRs), has grown considerably in the past decade. To our knowledge, no comprehensive synthesis of this literature has been conducted to date.Aims and methods: To conduct a systematic review of systematic reviews of the benefits and harms (“effects”) of SM tools and platforms (such as Twitter and Facebook) in public health and medicine. To perform a synthesis of this literature and create a ‘living systematic review’.Results: Forty-two (42) high-quality SRs were examined. Overall, evidence of SM’s effectiveness in public health and medicine was judged to be minimal. However, qualitative benefits for patients are seen in improved psychosocial support and psychological functioning. Health professionals benefited from better peer-to-peer communication and lifelong learning. Harms on all groups include the impact of SM on mental health, privacy, confidentiality and information reliability.Conclusions: A range of negatives and positives of SM in public health and medicine are seen in the SR literature but definitive conclusions cannot be made at this time. Clearly better research designs are needed to measure the effectiveness of social technologies. For ongoing updates, see the wiki “Effective uses of social media in health: a living systematic review of systematic reviews”. http://hlwiki.slais.ubc.ca/index.php/Effective_uses_of_social_media_in_healthcare:_a_living_systematic_review_of_reviews


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yannish Naik ◽  
Peter Baker ◽  
Sharif A. Ismail ◽  
Taavi Tillmann ◽  
Kristin Bash ◽  
...  

Abstract Background The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. Methods Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. Results The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. Conclusions The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. Trial registration Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tuba Saygın Avşar ◽  
Hugh McLeod ◽  
Louise Jackson

Abstract Background Smoking during pregnancy (SDP) and the postpartum period has serious health outcomes for the mother and infant. Although some systematic reviews have shown the impact of maternal SDP on particular conditions, a systematic review examining the overall health outcomes has not been published. Hence, this paper aimed to conduct an umbrella review on this issue. Methods A systematic review of systematic reviews (umbrella review) was conducted according to a protocol submitted to PROSPERO (CRD42018086350). CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, CRD Database and HMIC databases were searched to include all studies published in English by 31 December 2017, except those focusing exclusively on low-income countries. Two researchers conducted the study selection and quality assessment independently. Results The review included 64 studies analysing the relationship between maternal SDP and 46 health conditions. The highest increase in risks was found for sudden infant death syndrome, asthma, stillbirth, low birth weight and obesity amongst infants. The impact of SDP was associated with the number of cigarettes consumed. According to the causal link analysis, five mother-related and ten infant-related conditions had a causal link with SDP. In addition, some studies reported protective impacts of SDP on pre-eclampsia, hyperemesis gravidarum and skin defects on infants. The review identified important gaps in the literature regarding the dose-response association, exposure window, postnatal smoking. Conclusions The review shows that maternal SDP is not only associated with short-term health conditions (e.g. preterm birth, oral clefts) but also some which can have life-long detrimental impacts (e.g. obesity, intellectual impairment). Implications This umbrella review provides a comprehensive analysis of the overall health impacts of SDP. The study findings indicate that while estimating health and cost outcomes of SDP, long-term health impacts should be considered as well as short-term effects since studies not including the long-term outcomes would underestimate the magnitude of the issue. Also, interventions for pregnant women who smoke should consider the impact of reducing smoking due to health benefits on mothers and infants, and not solely cessation.


2020 ◽  
Author(s):  
Shimels Hussien Mohammed ◽  
Tesfa Dejenie Habtewold ◽  
Amanuel Godana Arero ◽  
Ahmad Esmaillzadeh

Abstract Background Malnutrition remains to be a major public health problem in developing countries, particularly among children under-5 years of age children who are more vulnerable to both macro and micro-nutrient deficiencies. Various systematic review and meta-analysis (SRM) studies were done on nutritional statuses of children in Ethiopia, but no summary of the findings was done on the topic. Thus, this umbrella review was done to summarize the evidence from SRM studies on the magnitude and determinants of malnutrition and poor feeding practices among under-5 children in Ethiopia. Methods PubMed, Embase, Scopus, Web of Sciences, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, and Google Scholar were searched for SRM studies on magnitude and risk factors of malnutrition and child feeding practice indicators in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and determinants of stunting, wasting, underweight, and poor child feeding practices were pooled and summarized with random-effects meta-analysis models. Result We included nine SRM studies, containing a total of 214,458 under-5 children from 255 observation studies. The summary estimates of prevalence of stunting, underweight, and wasting were 42% (95%CI=37-46%), 33% (95%CI=27-39%), and 15% (95%CI=12-19%), respectively. The proportion of children who met the recommendations for timely initiation of breastfeeding, exclusive breastfeeding during the first 6 months, and timely initiation of complementary feeding were 65%, 60%, and 62%, respectively. The proportion of children who met the recommendations for dietary diversity and meal frequency were 20%, and 56%, respectively. Only 10% of children fulfilled the minimum criteria of acceptable diet. There was a strong relationship between poor feeding practices and the state of malnutrition, and both conditions were related to various health, socio-economic, and environmental factors. Conclusion Child malnutrition and poor feeding practices are highly prevalent and of significant public health concern in Ethiopia. Only few children are getting proper complementary feeding. Multi-sectoral efforts are needed to improve children’s feeding practices and reduce the high burden of malnutrition in the country.


2017 ◽  
Vol 8 ◽  
Author(s):  
Dominique Kazan ◽  
Alison L. Calear ◽  
Philip J. Batterham

The effect of a relationship separation on wellbeing is substantial. However, without divorce parameters, individuals in dating or cohabiting relationships may struggle to access support mechanisms. A systematic review was conducted to identify controlled trials of interventions targeting individuals who have experienced a non-marital relationship separation, to supplement the divorce literature. The aim of the review was to assess the impact of these interventions on mental health. Five articles were identified through PsycINFO, PsycARTICLES and Medline databases. Overall, two of the trials reported a significant improvement in specific mental health outcomes at post-test and/or follow-up. Of the two trials demonstrating efficacy in mental health outcomes, one used a weekly, forgiveness-based group intervention and the other was a writing-based, self-initiated intervention. A lack of trials testing theory-driven interventions for relationship separation is of particular concern. Limitations of the existing literature and corresponding directions for future research are discussed.


2009 ◽  
Vol 31 (2) ◽  
pp. 210-221 ◽  
Author(s):  
K. E. Smith ◽  
C. Bambra ◽  
K. E. Joyce ◽  
N. Perkins ◽  
D. J. Hunter ◽  
...  

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