Are there important differences in health system arrangements that may mean an option could not work in the same way?
Option 1: Essay Title:
Cochrane review applicability discussion: Structured applicability of the Cochrane review by Oyo-Ita and colleagues on ‘Interventions for improving coverage of
childhood immunisation in low- and middle-income countries’ to [insert name of the country you have chosen].
The review is here: https://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008145.pub3/full
Or
Option 2: Essay Title:
Cochrane review applicability discussion: Structured applicability of the Cochrane review by Saeterdal and colleagues on ’Interventions aimed at communities to inform
and/or educate about early childhood vaccination’ to [insert name of the country you have chosen].
The review is here:
https://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010232.pub2/full
INSTRUCTIONS
The essay must be around 3500 words including tables.
Reference style APA6.
The perspective you will take as the author of the essay and the country you choose:
Imagine you are working in a health department in a country of your choosing. In your work, you have been asked to consider the applicability of the findings of a
Cochrane review for your health system.
The background for this request is that a new policy is being developed to improve vaccination rates and the head of the Vaccination Section needs information about
the effectiveness of various interventions in order to decide where investment should happen.
It is not your job to make a recommendation – only to consider the applicability of the interventions to your context, health system and society.
First, select which country you are in. It is sensible to choose a country and health system you know well or where you can get reliable information about vaccination.
This can be from grey literature, that is,in government reports or articles which provide data on what is happening in your country.
Tips:
If you are doing Option 1 essay, it may be easier to choose a low or middle income country.
If you are doing Option 2, it is fine to choose a low and middle income country but it is also possible to choose a high income country. In other words, it is a much
harder essay to write if you choose a high income country for Option 1.
If you choose a large country such as India, you may find it more sensible to choose a state or region, because discussing country-wide applicability issues would be
challenging.
If you chose Option 1, you may only want to select some of the interventions types included in this review because discussing the applicability of all the different
types would be too complicated.
DETAILS FOR WHAT GOES IN THE ESSAY
1. Brief introduction outlining what your essay will be doing
2. A section which outlines the childhood vaccination issues for your country of choice
Please provide a section to set the context for your essay, ie outlines the childhood vaccination issues for the government/people living in your country of choice:
rates, coverage, efforts to improve rates so far, etc. The information in this section must be derived from reports or articles that you find yourself, and that refers
to data from your country of choice. However, if you have difficulty getting up-to-date data, you could use this World Bank site which has country data for DPT:
https://data.worldbank.org/indicator/SH.IMM.IDPT.
3. A short summary of the findings of the Cochrane review you have chosen
Provide a short summary of the findings of the Cochrane review.
You may find additional useful information about the interventions in the Characteristics of Included Studies tables.
You do NOT need to go and find other evidence about effectiveness to support your choice of interventions.
4. A structured discussion of the five SUPPORT questions
This is the main part of the essay.
I would like you to conduct a structured assessment of the applicability of the Cochrane review, using the five-question SUPPORT check list to guide your structured
assessment.
The five questions come from this open access article:
Lavis JN, Oxman AD, Souza NM, Lewin S, Gruen RL, Fretheim A. 2009. SUPPORT Tools for evidence-informed health policymaking (STP) 9: Assessing the applicability of the
findings of a systematic review. Health Research Policy and Systems 7 (Suppl 1): S9, https://www.health-policy-systems.com/content/7/S1/S9
The five questions are:
1. Were the studies included in the systematic review conducted in the same setting or were the findings consistent across settings or time periods?
2. Are there important differences in on-the-ground realities and constraints that might substantially alter the feasibility and acceptability of an option?
3. Are there important differences in health system arrangements that may mean an option could not work in the same way?
4. Are there important differences in the baseline conditions that might yield different absolute effects even if the relative effectiveness was the same?
5. What insights can be drawn about options, implementation, and monitoring and evaluation?
Please address all five questions.
Please read the whole of the Lavis SUPPORT article first, because it has clear instructions and some guidance (see Tables 1 & 2) on how to conduct a structured
assessment of applicability of the evidence from the review to your setting.
In preparing your answers to these five questions, you must draw on relevant literature provided in the subject, including at least two of the following:
• Issues with public health evidence: see Frommer M & Rychetnik L (2003) ‘From Evidence-Based Medicine to Evidence-Based Public Health’ In V. Lin and B. Gibson (eds)
Evidence-Based Health Policy: Problems and Possibilities Oxford: Oxford University Press, p56-69. This will be on the LMS.
• Issues in the knowledge to action cycle: see Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. (2006) Lost in knowledge translation: time
for a map? J Contin Educ Health Prof: 26(1):13-24. Publicly available here: https://pram.mcgill.ca/seminars/i/Graham_2006_Lost_in_Knowledge_Translation.pdf
• Issues in systematic reviews and drawing conclusions: see Petticrew M (2003) Why certain systematic reviews reach uncertain conclusions. BMJ 326. Publicly available
here: https://www.bmj.com/content/326/7392/756.1.long
• Issues in relating evidence to policy decisions: see Bowen S & Zwi AB (2005) Pathways to “Evidence-informed” policy and practice: a framework for action. PLoS
Medicine 2(7). Available here: https://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020166
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