Collaborating to plan efficient public health guideline evidence reviews

The National Institute for Health and Care Excellence (NICE) produces public health guidelines. Information specialists collaborate with technical analysts to perform systematic searches for evidence reviews (ERs). Public health ERs require searches from multiple disciplines across a range of sources leading to high volumes of results. The purpose of the project was to provide evidence to support the choice of sources for new topics. It aimed to retrospectively analyse a sample of NICE public health ERs by examining which sources retrieved publications. Medical databases found the highest proportion of publications, but smaller subject focussed databases and search techniques also contributed. These findings justify use of a range of sources for public health reviews and help the planning of ERs.

"It’s Not Smooth Sailing": Bridging the Gap Between Methods and Content Expertise in Public Health Guideline Development

Background: The development of reliable, high quality health-related guidelines depends on explicit and transparent processes, methods aimed at minimising risks of bias and the inclusion of all relevant expertise and perspectives. While the methodological aspects of guidelines have been a focus to improve their quality, less is known about the social processes involved, for example, how guideline group members interact and communicate with one another, and how the evidence is considered in informing recommendations. With this in in mind, we aimed to empirically examine the perspectives and experiences of the key participants involved in developing public health guidelines for the Australian National Health and Medical Research Council (NHMRC). Design: This study was conducted using constructivist grounded theory as described by Charmaz, which informed our sampling, data collection, coding and analysis of interviews with key participants involved in developing public health guidelines. Setting: Australian public health guidelines commissioned by the NHMRC. Participants: Twenty experts that were involved in Australian NHMRC public health guideline development, including working committee members with content topic expertise (n=16) and members of evidence review groups responsible for evaluating the evidence (n=4). Results: Public health guideline development in Australia is a divided process. The division is driven by 3 related factors: the divergent disciplinary background and expertise that each group brings to the process; the methodological limitations of the framework, inherited from clinical medicine, that is used to assess the evidence; and barriers to communication between content experts and evidence reviewers around respective roles and methodological limitations. Conclusion: Our findings suggest several improvements for a more functional and unified guideline development process: greater education of the working committee on the methodological process employed to evaluate evidence, improved communication on the role of the evidence review groups and better facilitation of the process so that the evidence review groups feel their contribution is valued.

Greater Adherence to Recommended Morning Physical Activity is Associated With Greater Total Intervention-Related Physical Activity Changes in Bariatric Surgery Patients

Background:This study examines whether performance of bout-related physical activity (PA) during morning hours is related to greater overall bout-related PA increases within a preoperative PA intervention for bariatric surgery (BS) patients.Methods:Participants with severe obesity (n = 33; mean age = 45.6 ± 9.6 years; BMI = 45.7 ± 7.0 kg/m2) seeking BS were randomized to and completed 6 weeks of preoperative PA counseling (retention = 82.5%). Participants were encouraged to walk daily at a moderate intensity in bouts ≥ 10 minutes during morning hours to overcome time-related obstacles and establish a PA habit. Timing and amount of bout-related moderate-to-vigorous PA (MVPA) was assessed via objective monitor at pre- and postintervention.Results:Greater proportion of bout-related MVPA performed during morning hours (4:00 AM–12:00 PM) at postintervention was associated with larger total increases in bout-related MVPA minutes/day (β = .40, P = .03). At postintervention, a greater proportion of participants whose longest MVPA bouts occurred during morning hours (n = 11) achieved the public health guideline (ie, ≥150 bout-related MVPA minutes/week) versus those whose longest MVPA bouts occurred during nonmorning hours (n = 19; 63.6% vs. 26.3%, P = .04).Conclusions:Intervention-related increases in PA tended to be greatest when PA was performed in the morning. Morning exercise may be a viable strategy for promoting habitual PA in inactive BS patients.

Socio-Demographic Variations in Walking for Transport and for Recreation or Exercise Among Adult Australians

Background:Walking is integral to strategies to promote physical activity. We identified socio-demographic variations in walking for transport, and for recreation or exercise.Methods:Representative population data (n = 3392) from Australia were collected using computer assisted telephone interviewing, to examine adults’ participation in moderate- or brisk-paced walking for transport and walking for recreation or exercise; walking “sufficient” to meet the current public health guideline (≥ 150 min/wk); and, the contributions of total walking to meeting the guideline for total physical activity.Results:Rates of sufficient walking for transport (10% for men, 9% for women) were lower than those for walking for recreation or exercise (14% for both genders). Few socio-demographic differences emerged. Men over age 60 y were significantly less likely (OR = 0.40) to walk for transport; men age 45 to 59 y were more likely (OR = 1.56) to walk for recreation or exercise. Walking contributed more toward meeting the current public health guideline among women (15% to 21%) than among men (6% to 8%).Conclusions:There is potential for socially equitable increases in participation, through a focus on both walking for transport and on walking for recreation or exercise; attention to gender differences would be helpful.