Faculty Opinions recommendation of Realist review--a new method of systematic review designed for complex policy interventions.

Abstract Background Countries are currently seeking evidence-informed policy options to address antimicrobial resistance (AMR). While rigorous evaluations of AMR interventions are the ideal, they are far from the current reality. Additionally, poor reporting and documentation of AMR interventions impede efforts to use evidence to inform future evaluations and policy interventions. Objectives To critically evaluate reporting quality gaps in AMR intervention research. Methods To evaluate the reporting quality of studies, we conducted a descriptive synthesis and comparative analysis of studies that were included in a recent systematic review of government policy interventions aiming to reduce human antimicrobial use. Reporting quality was assessed using the SQUIRE 2.0 checklist of 18 items for reporting system-level interventions to improve healthcare. Two reviewers independently applied the checklist to 66 studies identified in the systematic review. Results None of the studies included complete information on all 18 SQUIRE items (median score = 10, IQR = 8–11). Reporting quality varied across SQUIRE items, with 3% to 100% of studies reporting the recommended information for each SQUIRE item. Only 20% of studies reported the elements of the intervention in sufficient detail for replication and only 24% reported the mechanism through which the intervention was expected to work. Conclusions Gaps in the reporting of impact evaluations pose challenges for interpreting and replicating study results. Failure to improve reporting practice of policy evaluations is likely to impede efforts to tackle the growing health, social and economic threats posed by AMR.

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Impact of national interventions to promote responsible antibiotic use: a systematic review

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz348 ◽

2019 ◽

Vol 75 (1) ◽

pp. 14-29 ◽

Cited By ~ 7

Author(s):

Jane Mingjie Lim ◽

Shweta Rajkumar Singh ◽

Minh Cam Duong ◽

Helena Legido-Quigley ◽

Li Yang Hsu ◽

...

Keyword(s):

Systematic Review ◽

National Level ◽

Public Health Problem ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Middle Income ◽

Middle Income Countries ◽

Policy Interventions ◽

The Impact

Abstract Background Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. Methods We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. Results We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. Conclusions National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

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Can Policy Interventions Affect HIV-Related Behaviors? A Systematic Review of the Evidence from Low- and Middle-Income Countries

AIDS and Behavior ◽

10.1007/s10461-016-1615-3 ◽

2016 ◽

Vol 21 (3) ◽

pp. 626-642 ◽

Cited By ~ 5

Author(s):

Kevin R. O’Reilly ◽

Erica d’Aquila ◽

Virginia Fonner ◽

Caitlin Kennedy ◽

Michael Sweat

Keyword(s):

Systematic Review ◽

Middle Income ◽

Middle Income Countries ◽

Policy Interventions ◽

Low And Middle Income

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Social inequalities in physical activity: do environmental and policy interventions help to reduce the gap? A pilot systematic review

The Lancet ◽

10.1016/s0140-6736(13)60406-7 ◽

2012 ◽

Vol 380 ◽

pp. S50 ◽

Cited By ~ 1

Author(s):

David K Humphreys ◽

David Ogilvie

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Social Inequalities ◽

Policy Interventions

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A systematic review and realist synthesis on toilet paper hoarding: COVID or not COVID, that is the question

PeerJ ◽

10.7717/peerj.10771 ◽

2021 ◽

Vol 9 ◽

pp. e10771

Author(s):

Javier Labad ◽

Alexandre González-Rodríguez ◽

Jesus Cobo ◽

Joaquim Puntí ◽

Josep Maria Farré

Keyword(s):

Systematic Review ◽

General Population ◽

Personality Traits ◽

Social Cognitive ◽

Cognitive Biases ◽

Realist Review ◽

Secondary Outcome ◽

Stressful Situation ◽

Related Factors ◽

Toilet Paper

Objective To explore whether the coronavirus disease 2019 (COVID-19) pandemic is associated with toilet paper hoarding and to assess which risk factors are associated with the risk of toilet paper hoarding. Design A systematic review and realist review were conducted. Data sources PubMed, Web of Science, Scopus and PsycINFO were searched (systematic review). PubMed, pre-prints and grey literature were also searched (realist review). The databases were searched from inception until October 2020. Study selection There were no restrictions on the study design. Outcomes and measures For the systematic review, toilet paper hoarding was the main outcome, and pathological use of toilet paper was the secondary outcome. For the realist review, the context-mechanisms-outcome (CMO) scheme included the COVID-19 pandemic (context), four proposed mechanisms, and one outcome (toilet paper hoarding). The four potential mechanisms were (1) gastrointestinal mechanisms of COVID-19 (e.g. diarrhoea), (2) social cognitive biases, (3) stress-related factors (mental illnesses, personality traits) and (4) cultural aspects (e.g. differences between countries). Eligibility criteria for selecting studies All studies of human populations were considered (including general population studies and clinical studies of patients suffering from mental health problems). Results The systematic review identified 14 studies (eight studies for the main outcome, six studies for the secondary outcome). Three surveys identified the role of the COVID-19 threat in toilet paper hoarding in the general population. One study pointed to an association between a personality trait (conscientiousness) and toilet paper buying and stockpiling as well as an additional significant indirect effect of emotionality through the perceived threat of COVID-19 on toilet paper buying and stockpiling. Six case reports of pathological use of toilet paper were also identified, although none of them were associated with the COVID-19 pandemic. The realist review suggested that of all the mechanisms, social cognitive biases and a bandwagon effect were potential contributors to toilet paper hoarding in the general population. The stressful situation (COVID-19 pandemic) and some personality traits (conscientiousness) were found to be associated with toilet paper hoarding. Cultural differences were also identified, with relatively substantial effects of toilet paper hoarding in several Asian regions (Australia, Japan, Taiwan and Singapore). Conclusions The COVID-19 pandemic has been associated with a worldwide increase in toilet paper hoarding. Social media and social cognitive biases are major contributors and might explain some differences in toilet paper hoarding between countries. Other mental health-related factors, such as the stressful situation of the COVID-19 pandemic, fear of contagion, or particular personality traits (conscientiousness), are likely to be involved. Registration PROSPERO CRD42020182308

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Effectiveness of the non-pharmaceutical public health interventions against COVID-19; a protocol of a systematic review and realist review

PLoS ONE ◽

10.1371/journal.pone.0239554 ◽

2020 ◽

Vol 15 (9) ◽

pp. e0239554

Author(s):

Shabnam Iezadi ◽

Saber Azami-Aghdash ◽

Akbar Ghiasi ◽

Aziz Rezapour ◽

Hamid Pourasghari ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Realist Review ◽

Health Interventions ◽

Public Health Interventions

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Realist review - a new method of systematic review designed for complex policy interventions

Journal of Health Services Research & Policy ◽

10.1258/1355819054308530 ◽

2005 ◽

Vol 10 (1_suppl) ◽

pp. 21-34 ◽

Cited By ~ 1133

Author(s):

Ray Pawson ◽

Trisha Greenhalgh ◽

Gill Harvey ◽

Kieran Walshe

Keyword(s):

Empirical Evidence ◽

Public Services ◽

Local Level ◽

Social Systems ◽

Realist Review ◽

Policy And Practice ◽

Programme Theory ◽

Theoretical Understanding ◽

Social Interventions ◽

Policy Interventions

Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Part of the problem is one of complexity. In health services and other public services, we are dealing with complex social interventions which act on complex social systems-things like league tables, performance measures, regulation and inspection, or funding reforms. These are not ‘magic bullets‘ which will always hit their target, but programmes whose effects are crucially dependent on context and implementation. Traditional methods of review focus on measuring and reporting on programme effectiveness, often find that the evidence is mixed or conflicting, and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes. This paper offers a model of research synthesis which is designed to work with complex social interventions or programmes, and which is based on the emerging ‘realist’ approach to evaluation. It provides an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. The first step is to make explicit the programme theory (or theories) - the underlying assumptions about how an intervention is meant to work and what impacts it is expected to have. We then look for empirical evidence to populate this theoretical framework, supporting, contradicting or modifying the programme theories as it goes. The results of the review combine theoretical understanding and empirical evidence, and focus on explaining the relationship between the context in which the intervention is applied, the mechanisms by which it works and the outcomes which are produced. The aim is to enable decision-makers to reach a deeper understanding of the intervention and how it can be made to work most effectively. Realist review does not provide simple answers to complex questions. It will not tell policy-makers or managers whether something works or not, but will provide the policy and practice community with the kind of rich, detailed and highly practical understanding of complex social interventions which is likely to be of much more use to them when planning and implementing programmes at a national, regional or local level.

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