Article type
Year
Abstract
Objectives: To study the effectiveness of peer-based interventions in improving the physical, mental and psychosocial health of HIV positive women and to determine whether these strategies decrease health inequalities between advantaged and disadvantaged groups.
Methods: We pilot-tested methods of the proposed Cochrane Health Equity Interest Group. We included all eligible randomized controlled trials, interrupted time-series and controlled before-after studies of peer-based interventions in any setting. We searched MEDLINE, CENTRAL, Psychinfo, Embase, CINAHL, Sociofile, AMED, SIGLE and Social Work Abstracts to February 2004. Relevant non-governmental organizations, government bodies and key stakeholders working in the field of HIV/AIDS were contacted. We handsearched reference lists and conducted a comprehensive web-based search. Two independent reviewers abstracted data from eligible studies. We assessed methodological quality. A working definition of peer was developed to systematically assess studies for inclusion.
Results: Three trials were identified. Studies were not combined due to significant differences in intervention designs, populations and outcomes. All studies showed some benefit of peer-based interventions on health related outcomes and self-care behaviours. For example, participants participating in a peer-based education intervention reported improved social support, weighted mean difference 0.92 (95% confidence interval. 0.52 to 1.32), on a scale of one to five. Women also reported increased self efficacy for condom use, relative risk, 1.29 (95% confidence interval 1.01 to1.65). We encountered 3 significant challenges: 1) standardization of outcomes; 2) relevance of results to community-based organizations that deliver these types of programs; and 3) Defining peer appropriately and evaluating interventions in the context of this definition. We developed methods to overcome these challenges in consultation with key stakeholders. These methods will likely improve the usability of this systematic review for community- based health practitioners and may provide some important lessons for other Cochrane reviewers.
Conclusions: Bridging the gap between community level practitioners and the review process is a significant issue. The development of methods to incorporate results from community-based interventions and the relevance of Cochrane reviews to community-based practitioners should be addressed.
Methods: We pilot-tested methods of the proposed Cochrane Health Equity Interest Group. We included all eligible randomized controlled trials, interrupted time-series and controlled before-after studies of peer-based interventions in any setting. We searched MEDLINE, CENTRAL, Psychinfo, Embase, CINAHL, Sociofile, AMED, SIGLE and Social Work Abstracts to February 2004. Relevant non-governmental organizations, government bodies and key stakeholders working in the field of HIV/AIDS were contacted. We handsearched reference lists and conducted a comprehensive web-based search. Two independent reviewers abstracted data from eligible studies. We assessed methodological quality. A working definition of peer was developed to systematically assess studies for inclusion.
Results: Three trials were identified. Studies were not combined due to significant differences in intervention designs, populations and outcomes. All studies showed some benefit of peer-based interventions on health related outcomes and self-care behaviours. For example, participants participating in a peer-based education intervention reported improved social support, weighted mean difference 0.92 (95% confidence interval. 0.52 to 1.32), on a scale of one to five. Women also reported increased self efficacy for condom use, relative risk, 1.29 (95% confidence interval 1.01 to1.65). We encountered 3 significant challenges: 1) standardization of outcomes; 2) relevance of results to community-based organizations that deliver these types of programs; and 3) Defining peer appropriately and evaluating interventions in the context of this definition. We developed methods to overcome these challenges in consultation with key stakeholders. These methods will likely improve the usability of this systematic review for community- based health practitioners and may provide some important lessons for other Cochrane reviewers.
Conclusions: Bridging the gap between community level practitioners and the review process is a significant issue. The development of methods to incorporate results from community-based interventions and the relevance of Cochrane reviews to community-based practitioners should be addressed.