Article type
Year
Abstract
Introduction: Community-based interventions for health promotion and disease prevention are becoming the focus of much public health practice. Evaluations using randomized controlled trials are rarely feasible and often not appropriate.
Objective: To develop a method to systematically appraise and summarize evidence on the effectiveness of community-based interventions in public health nursing (PHN) practice, to assess the current literature for quality, and to draw conclusions about outcomes in the prevention of cancer, heart disease, smoking and injuries.
Methods: A comprehensive search, including 3 databases, hand searches, key informants, conference abstracts, library searches and reference lists, yielded 308 articles. Relevance, validity and data extraction tools specific to community-based research were developed and tested. Each article was assessed for relevance by a primary reader and a subset was reviewed independently by a second reader (kappa = 0.8). Included studies met the definition of community-based approaches within PHN scope of practice, and gave information on the process or outcome evaluation. 110 relevant articles (evaluating 80 projects) were assessed for quality by two independent readers, using criteria that included description of the project, issue identification, planning and action phases, information gathering and analysis. Data were extracted on the participants, strategies and results.
Results: 182 of the retrieved articles evaluated projects targeted at the relevant outcomes. A total of 44 project evaluations met the inclusion criteria. In all, 19 projects were judged to be strong, 11 moderate and 17 weak. Studies rated poorly most often on criteria of information gathering and analysis, and rated well most often on rationale and implementation. The most common action strategies were lobbying, use of mass media, and health campaigns. Positive outcomes from strong studies ranged from healthy public policy and community mobilization, to improved risk behaviours and decreased mortality.
Discussion: Methods of systematic review can be usefully applied and criteria developed to appraise research on the effects of community-based interventions, despite a lack of randomized controlled trials. Recommendations are made to enhance practice, research and the reporting of studies.
Objective: To develop a method to systematically appraise and summarize evidence on the effectiveness of community-based interventions in public health nursing (PHN) practice, to assess the current literature for quality, and to draw conclusions about outcomes in the prevention of cancer, heart disease, smoking and injuries.
Methods: A comprehensive search, including 3 databases, hand searches, key informants, conference abstracts, library searches and reference lists, yielded 308 articles. Relevance, validity and data extraction tools specific to community-based research were developed and tested. Each article was assessed for relevance by a primary reader and a subset was reviewed independently by a second reader (kappa = 0.8). Included studies met the definition of community-based approaches within PHN scope of practice, and gave information on the process or outcome evaluation. 110 relevant articles (evaluating 80 projects) were assessed for quality by two independent readers, using criteria that included description of the project, issue identification, planning and action phases, information gathering and analysis. Data were extracted on the participants, strategies and results.
Results: 182 of the retrieved articles evaluated projects targeted at the relevant outcomes. A total of 44 project evaluations met the inclusion criteria. In all, 19 projects were judged to be strong, 11 moderate and 17 weak. Studies rated poorly most often on criteria of information gathering and analysis, and rated well most often on rationale and implementation. The most common action strategies were lobbying, use of mass media, and health campaigns. Positive outcomes from strong studies ranged from healthy public policy and community mobilization, to improved risk behaviours and decreased mortality.
Discussion: Methods of systematic review can be usefully applied and criteria developed to appraise research on the effects of community-based interventions, despite a lack of randomized controlled trials. Recommendations are made to enhance practice, research and the reporting of studies.