An adaptable framework for analysing diversity, context and inequalities in systematic reviews

Tags: Oral
Oliver S1, Jull J2, Ang L1, Stansfield C1, Bangpan M1, D'Souza P3
1University College London, Institute of Education, UK, 2University of Ottawa, Canada, 3 University College London, Institute of Education, UK

Background: There is increasing interest in research evidence to inform policy about health (where evidence-based medicine originated) and international development, which cuts across all areas of public policy. The emphasis on health inequalities in the former, and diversity of context in the latter, raises a challenge when synthesising research findings drawn from different populations.

Methods: We compared how inequalities had been analysed in systematic reviews for health using the mnemonic PROGRESS-Plus with the multilevel, ecological framework of social determinants of health. We tested the utility of similar ecological frameworks for investigating diversity, context and inequalities for systematic reviews addressing other topics.

Results: PROGRESS-Plus provided a flexible framework for extracting data and conducting subgroup analyses, but appeared unstructured and incomplete. In comparison, ecological frameworks were more coherent, theory driven and dynamic; they also helped identify more contextual factors and encouraged systems thinking. They were successfully applied to various topics such as: children and peacebuilding; microfinance and empowerment; problematic masculinities; and contraceptive choices.

Conclusions: A multi-level, ecological framework can be adapted to diverse topics to: 1) help identify important contextual factors; and 2) structure the collection of data required to answer questions about the applicability of interventions and the transferability of findings to new contexts.