Can we use non-research papers in systematic reviews to assess organisational processes? Lessons from a review on immunization advisory committees

Session: 

Oral session: Innovative solutions to challenges of evidence production (3)

Date: 

Monday 17 September 2018 - 14:20 to 14:30

Location: 

Carrick 1

All authors in correct order:

Blanchard L1, Bell S1, Howard N1
1 London School of Hygiene and Tropical Medicine, UK
Presenting author and contact person

Presenting author:

Laurence Blanchard

Contact person:

Laurence Blanchard
Abstract text
Background: The Global Vaccine Action Plan 2011-2020 encourages countries to establish and strengthen National Immunization Technical Advisory Groups (NITAGs). NITAGs produce evidence-based recommendations to guide national immunization programmes. In conducting a systematic review of NITAG structures and processes in low- and middle-income countries (LMICs), we found few published and unpublished studies and evaluations, and a large number of non research-based information (e.g. administrative, legal and descriptive documents). Non-research documents (NRDs) have been used in other contexts to shed light on organisational structures and contexts.

Objectives: To explore the use of NRDs in systematic reviews on organisational processes using NITAGs in LMICs as an example.

Methods: We searched seven databases and four websites. We screened references using eligibility criteria. We included published and unpublished research papers (including evaluations), descriptive documents, procedures, policies and members lists. We extracted data by country using closed values (e.g. yes/no) and quotes. We synthesized data narratively using descriptive statistics. Document type, authors’ affiliation and year were accounted to explore source reliability and author perspectives.

Results: We included 82 papers on 29 countries, of which 71 (87%) were NRDs. Nearly 90% of NRDs had authors potentially affiliated with NITAGs, making them prone to bias. Research papers were useful for collecting data on process implementation and challenges experienced by NITAGs. NRDs covered more countries and provided information on processes that were little documented in research papers, such as the management of conflict of interests. Information covered by both research and NRDs was generally consistent.

Conclusions: We adapted the methodology of systematic reviews to assess NITAG organisational processes using NRDs. Although with caveats, NRDs could complement research findings when the latter are scarce.

Patient or healthcare consumer involvement: We consulted three international organisations in the design of the review and five commented on the initial results. Outcomes selection was informed by interviews with NITAG, national government and international stakeholders, and observation of five NITAG meetings. These also served to fill data gaps.

Relevance to patients and consumers: 

In the past decade, establishing National Immunization Technical Advisory Groups (NITAGs) in low and middle-income countries has been a priority. NITAGs provide guidance to governments on their national immunization programme. Our collaboration with NITAG members and stakeholders highlighted the need to evaluate NITAGs and provide continuous support in order to improve their functionality. This included transparency, independence and the use of evidence. Non-research documents were useful to assess NITAG structures and processes related to these. Consultations helped us validating the results and developing relevant recommendations.