Scoping review for informing and refining the question of a complex Cochrane review

Article type
Authors
Schoones A1, Durao S2
1Centre for Evidence Based Healthcare, South Africa
2South African Cochrane Centre, South Africa
Abstract
Background:
The burden from food insecurity is high, especially in low- and middle-income countries (LMICs). A systematic review would help identify effective interventions to address the issue, but the food security field is complex, and requires careful thought when formulating the most relevant research question.

Objectives:
To conduct a scoping review of systematic reviews of interventions addressing food insecurity in LMICs, identify and map existing reviews, and better conceptualize the question for a new Cochrane Review that will address a gap in the evidence-base.

Methods:
We searched eight electronic databases (May/July 2013) for systematic reviews of interventions addressing food insecurity implemented in LMICs, compared with any control, and measuring any outcomes. We performed duplicate screening and data extraction, and assessed methodological quality using AMSTAR. We summarized PICOS components, and stated how these informed our review question.

Results:
We screened 1161 records, and included 29 reviews (Table 1 summarizes their characteristics). To visualize the evidence gaps, we mapped the reviews by their interventions and outcomes (Fig 1). Sixteen reviews had poor methodological quality (AMSTAR < 6). Of the 10 good quality reviews (AMSTAR 8 to 10), four addressed food access, of which two only reported on proxy food expenditure outcomes. Existing reviews addressed specific high risk groups, we will therefore aim to include broader communities. As fewer reviews address food access, we will include studies addressing this dimension of food security. Eighteen included reviews did not specify a control. Our control will be ‘no intervention’ as this is the most common scenario in LMICs. Included reviews measured a variety of food and nutrition security, and nutritional status outcomes, which we will include. Thirteen reviews included a variety of study designs, which we will also do, as RCTs in this field are scarce and we aim to include the best available evidence.

Conclusions:
A scoping review can be a valuable first step of a systematic review on a complex topic, for formulating and refining the research question.