Article type
Year
Abstract
Introduction: Decisions about programme planning and health policy must often rely on reviews of a broad range of interventions. In public health the impact of nursing interventions is under scrutiny.
Objective: To develop a method to systematically appraise and summarize review articles, and to assess the evidence for the effectiveness of a wide range of public health nursing (PHN) interventions in improving health outcomes for pregnant women, pre-school children and their families, using the review literature.
Methods: A search for published and unpublished reviews, using 2 databases, 90 key informants, hand searches, conference abstracts and reference lists, yielded 71 articles which were assessed for relevance and validity by two independent readers. Included articles were true reviews, that considered an intervention with the relevant population, within the scope of PHN practice, and gave information on a client outcome. Validity criteria included search and retrieval strategies, inclusion criteria, critical appraisal of studies, integration of results and adequacy of conclusions. Details of the interventions and associated outcomes were extracted from the strong and moderate reviews only.
Results: Of 36 relevant reviews, 10 were judged to be strong, 10 moderate, 7 weak and 9 very weak. Six of nine validity criteria were failed by more than 70% of the weak or very weak reviews. Strong and moderate reviews most often failed to provide evidence of a comprehensive search strategy or to report methods of combining results. Of these reviews, 8 considered prenatal interventions, 5 perinatal home visiting, and 7 postnatal interventions. They indicated good evidence of positive effects on a number of health out-comes for women and children, ranging from mental health and child abuse to client satisfaction and cost of care; for prenatal social support, prenatal education, enhanced prenatal care, home visiting, breast-feeding support, early intervention, parent education and multi-service postnatal programmes. For an equal number of outcomes there is some evidence of positive effect. However, for birthweight and some long-term measures of child development and parenting, the evidence is inadequate or indicates no effect.
Discussion: There is wide variation in the quality of reviews available on similar topics. The methods of a systematic overview can enhance the potential for good quality reviews to inform decision-makers. PHN interventions are effective in improving many aspects of maternal-child health.
Objective: To develop a method to systematically appraise and summarize review articles, and to assess the evidence for the effectiveness of a wide range of public health nursing (PHN) interventions in improving health outcomes for pregnant women, pre-school children and their families, using the review literature.
Methods: A search for published and unpublished reviews, using 2 databases, 90 key informants, hand searches, conference abstracts and reference lists, yielded 71 articles which were assessed for relevance and validity by two independent readers. Included articles were true reviews, that considered an intervention with the relevant population, within the scope of PHN practice, and gave information on a client outcome. Validity criteria included search and retrieval strategies, inclusion criteria, critical appraisal of studies, integration of results and adequacy of conclusions. Details of the interventions and associated outcomes were extracted from the strong and moderate reviews only.
Results: Of 36 relevant reviews, 10 were judged to be strong, 10 moderate, 7 weak and 9 very weak. Six of nine validity criteria were failed by more than 70% of the weak or very weak reviews. Strong and moderate reviews most often failed to provide evidence of a comprehensive search strategy or to report methods of combining results. Of these reviews, 8 considered prenatal interventions, 5 perinatal home visiting, and 7 postnatal interventions. They indicated good evidence of positive effects on a number of health out-comes for women and children, ranging from mental health and child abuse to client satisfaction and cost of care; for prenatal social support, prenatal education, enhanced prenatal care, home visiting, breast-feeding support, early intervention, parent education and multi-service postnatal programmes. For an equal number of outcomes there is some evidence of positive effect. However, for birthweight and some long-term measures of child development and parenting, the evidence is inadequate or indicates no effect.
Discussion: There is wide variation in the quality of reviews available on similar topics. The methods of a systematic overview can enhance the potential for good quality reviews to inform decision-makers. PHN interventions are effective in improving many aspects of maternal-child health.