Prioritization of primary research based on a mixed-methods systematic review

Session: 

Oral session: Priority setting (1)

Date: 

Sunday 16 September 2018 - 12:10 to 12:20

Location: 

Carrick 2

All authors in correct order:

Dockx K1, Van Remoortel H1, Vande Veegaete A1, De Buck E2, Vandekerckhove P3
1 Centre for Evidence-Based Practice, Belgian Red Cross, Belgium
2 Centre for Evidence-Based Practice, Belgian Red Cross, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Belgium
3 Belgian Red Cross, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven; Faculty of Medicine and Health Sciences, Ghent University, Belgium
Presenting author and contact person

Presenting author:

Kimberly Dockx

Contact person:

Kimberly Dockx
Abstract text
Background: The Belgian Red Cross (BRC) uses systematic reviews (SRs) to:
1) achieve an evidence-based substantiation of its activities; 2) identify relevant knowledge gaps; and 3) fill gaps by setting up primary research.
One of these gaps concerns the effect of hand washing and sanitation (HW&S) promotion programs to induce behavior change in low- and middle-income countries (LMIC), for which a mixed-methods SR (MMSR) was conducted.

Objectives: To use a MMSR to: 1) identify knowledge gaps concerning HW&S promotion programs; 2) design a primary field study.

Methods: The MMSR studied: 1) the effectiveness of HW&S promotional programs, and 2) factors influencing their implementation. The primary outcome was HW&S behavior change, which was subdivided into uptake (during implementation), adherence (≤ 12 months follow-up ) or longer-term use (> 12 months follow-up). Knowledge gaps were defined as topics for which ≤ 1 study was identified, or when the available evidence was of very low quality. These gaps were discussed with a group of stakeholders with HW&S field experience. A balance was made between gaps in evidence and operational context and needs.

Results: The MMSR identified 42 quantitative and 28 qualitative studies. Figure 1 shows the available HW&S evidence and the identified knowledge gaps (in grey). The MMSR showed that: 1) HW&S promotional programs can be effective, 2) a single most effective program could not be identified and a combination of different promotional elements is probably the most effective strategy. We identified several barriers and facilitators for implementation i.e. using short communication messages. Following a stakeholder discussion, BRC decided to design a primary field study, investigating the effectiveness of a community-based (CB) program versus a combined intervention, i.e. CB + theory-based, on HW&S behavior during uptake and adherence in Tanzania. By incorporating identified barriers and facilitators in the design of the study, effectiveness of the intervention may increase.

Conclusions: Quantitative and qualitative input from a MMSR can be useful to identify knowledge gaps and to inform the design of a primary field study.

Patient or healthcare consumer involvement: The MMSR and the primary study take into account the needs of people from LMIC by closely working with stakeholders with field experience.

Attachments: 

Image icon Figure 1_Identifying knowledge gaps in the HW&S sector.jpg

Relevance to patients and consumers: 

Diarrhea is ubiquitous, particularly among adults and children in LMIC, and may lead to mortality. Hand washing with water and soap at critical times was shown to reduce the risk of diarrhea with 39-47%. Despite its enormous health impact, only 5-25% of people in LMIC are estimated to wash their hands with water and soap after fecal contact. This underscores the need for large-scale hand washing interventions. The MMSR and the primary field study take into account the needs of people from LMIC by closely working with stakeholders with field experience.