A protocol for a systematic review of the effectiveness of interventions to reduce exposure to lead through consumer products and drinking water.

The toxic heavy metal lead continues to be a leading environmental risk factor, with the number of attributable deaths having doubled between 1990 and 2010. Although major sources of lead exposure, in particular lead in petrol, have been significantly reduced in recent decades, lead is still used in a wide range of processes and objects, with developing countries disproportionally affected. The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels and associated health outcomes in children, pregnant women and the general population

Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model

Abstract : Background Adherence to antiretroviral therapy (ART) and long-term uninterrupted engagement in HIV care is difficult for HIV-positive people, and randomized trials of specific techniques to promote adherence often show small or negligible effects. Understanding what influences decision- making in HIV-positive people in Africa may help researchers and policy makers in the development of broader, more effective interventions and policies..

Evidence synthesis workshops: moving from face-to-face to online learning

Postgraduate training is moving from face-to-face workshops or courses to online learning to help increase access to knowledge, expertise and skills, and save the cost of face-to-face training. However, moving from face-to-face to online learning for many of us academics is intimidating, and appears even more difficult without the help of a team of technologists. In this paper, we describe our approach, our experiences and the lessons we learnt from converting a Primer in Systematic Reviews face-to-face workshop to a 6-week online course designed for healthcare professionals in Africa. We learnt that the team needs a balance of skills and experience, including technical know-how and content knowledge; that the learning strategies needed to achieve the learning objectives must match the content delivery. The online approach should result in both building knowledge and developing skills, and include interactive and participatory approaches. Finally, the design and delivery needs to keep in mind the limited and expensive internet access in some resource-poor settings in Africa

Testing for saturation in qualitative evidence syntheses: An update of HIV adherence in Africa

Background A systematic review of randomised trials may be conclusive signalling no further research is needed; or identify gaps requiring further research that may then be included in review updates. In qualitative evidence synthesis (QES), the rationale, triggers, and methods for updating are less clear cut. We updated a QES on adherence to anti-retroviral treatment to examine if thematic saturation renders additional research redundant. Methods We adopted the original review search strategy and eligibility criteria to identify studies in the subsequent three years. We assessed studies for conceptual detail, categorised as ‘rich’ or ‘sparse’, coding the rich studies. We sought new codes, and appraised whether findings confirmed, extended, enriched, or refuted existing themes. Finally, we examined if the analysis impacted on the original conceptual model. Results After screening 3895 articles, 301 studies met the inclusion criteria. Rich findings from Africa were available in 82 studies; 146 studies were sparse, contained no additional information on specific populations, and did not contribute to the analysis. New studies enriched our understanding on the relationship between external and internal factors influencing adherence, confirming, extending and enriching the existing themes. Despite careful evaluation of the new literature, we did not identify any new themes, and found no studies that refuted our theory. Conclusions Updating an existing QES using the original question confirmed and sometimes enriched evidence within themes but made little or no substantive difference to the theory and overall findings of the original review. We propose this illustrates thematic saturation. We propose a thoughtful approach before embarking on a QES update, and our work underlines the importance of QES priority areas where further primary research may help, and areas where further studies may be redundant

Enhancing Public Health Systematic Reviews With Diagram Visualization

Systematic reviews provide a critical summary of a body of knowledge that links research to decision making, whether to inform public health, clinical medicine, medical education, system-level changes, or advocacy. Good reviews are accessed by a wide range of audiences, including health service users, health service providers, and policy decision makers. Because the topics studied, the thinking behind the review questions, the analytical plan, and the review’s interpretation in the broader policy context are often complex, diagrams can play an important role in communicating the review to the reader. Indeed, graphic design is increasingly important for researchers to communicate their work to each other and the wider world.1 Visualizing the topic under study facilitates discussion, helps understanding by making complexity more accessible, provokes deeper thinking, and makes concepts more memorable.2 Higher impact scientific articles tend to include more diagrams, possibly because diagrams improve clarity and thereby lead to more citations or because high-impact articles tend to include novel, complex ideas that require visual explanation.3 Merriam-Webster’s Dictionary defines a diagram as “a graphic design that explains rather than represents, especially: a drawing that shows arrangement and relations (as of parts).”4 Established standards exist for visualizing the flow of studies through a review,5 risk of bias, and individual study and meta-analysis results in forest plots; these are not the subject of this editorial. We consider diagrams that communicate the conceptual framework underpinning reviews. Diagrams include “logic models,” “framework models,” or “conceptual models”—terms that are often used interchangeably and inconsistently in the literature.6 We examine how diagrams can help review authors and readers and offer guidance for presenting information diagrammatically. We based our work on a purposive search for diagrams from the Cochrane Library and sources of reviews more likely to illustrate conceptual frameworks. Drawing on the data and our own experience, we adapted rapid appraisal methods7 for analyzing documents, taking an iterative, inductive approach to understand what enhances the clarity and utility of diagrams. We then related this learning to methodological articles of systematic reviewing and science communication (Appendix A, available as a supplement to the online version of this article at http://www.ajph.org). We built on our collective experience of diagrams in reviews and helping others to develop them. We first describe diagrams’ various purposes. Then we discuss what we recognized, as systematic review readers, authors, and editors, as important steps to creating a good diagram. Next, we consider how diagrams can enhance the review process for authors. We discuss these findings in relation to methodologies that routinely integrate diagrams into structure systematic reviews: framework synthesis8 and logic models of illness or treatment pathways, where principles and agreed good practice are emerging.9 Finally, we discuss theories underpinning science communication.1

Integrated knowledge translation to advance noncommunicable disease policy and practice in South Africa: Application of the exploration, preparation, implementation, and sustainment (epis) framework

In response to the “know–do” gap, several initiatives have been implemented to enhance evidenceinformed decision-making (EIDM). These include individual training, organizational culture change management, and legislative changes. The importance of relationships and stakeholder engagement in EIDM has led to an evolution of models and approaches including integrated knowledge translation (IKT). IKT has emerged as a key strategy for ensuring that engagement is equitable, demand-driven, and responsive. As a result, the African-German Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) incorporated an IKT approach to infuence non‑ communicable diseases (NCD) policy and practice. We documented the phased process of developing, implement‑ ing, and monitoring the IKT approach in South Africa; and explored the appropriateness of using the exploration, preparation, implementation, and sustainment (EPIS) framework for this purpose

An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries

CITATION: Rehfuess, Eva A., et al. 2016. An approach for setting evidence-based and stakeholder-informed research priorities in low- and middle-income countries. Bulletin of the World Health Organization, 94:297–305, doi:10.2471/BLT.15.162966.The original publication is available at http://www.who.int/bulletin/en/ENGLISH SUMMARY : To derive evidence-based and stakeholder-informed research priorities for implementation in African settings, the international research consortium Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) developed and applied a pragmatic approach. First, an online survey and face-to-face consultation between CEBHA+ partners and policy-makers generated priority research areas. Second, evidence maps for these priority research areas identified gaps and related priority research questions. Finally, study protocols were developed for inclusion within a grant proposal. Policy and practice representatives were involved throughout the process. Tuberculosis, diabetes, hypertension and road traffic injuries were selected as priority research areas. Evidence maps covered screening and models of care for diabetes and hypertension, population-level prevention of diabetes and hypertension and their risk factors, and prevention and management of road traffic injuries. Analysis of these maps yielded three priority research questions on hypertension and diabetes and one on road traffic injuries. The four resulting study protocols employ a broad range of primary and secondary research methods; a fifth promotes an integrated methodological approach across all research activities. The CEBHA+ approach, in particular evidence mapping, helped to formulate research questions and study protocols that would be owned by African partners, fill gaps in the evidence base, address policy and practice needs and be feasible given the existing research infrastructure and expertise. The consortium believes that the continuous involvement of decision-makers throughout the research process is an important means of ensuring that studies are relevant to the African context and that findings are rapidly implemented.http://www.who.int/bulletin/volumes/94/4/15-162966-ab/en/Publisher's versio

Integrated Knowledge Translation for Non-Communicable Diseases: Stories from Sub-Saharan Africa

Integrated Knowledge Translation (IKT) is a key strategy for contextualising, tailoring, and communicating research for policy and practice. In this viewpoint, we provide examples of how partners from five countries in sub-Saharan Africa used IKT to advance interventions for curbing non-communicable diseases in their contexts and how these strategies were magnified during the COVID-19 pandemic in some cases. The stories highlight the importance of deliberate and reinforced capacity building, authentic relationship enhancement, adaptable and user-informed stakeholder engagement, and agile multi-sectoral involvement

Mixed method evaluation of the CEBHA+ integrated knowledge translation approach : a protocol

CITATION: Pfadenhauer, L. M., et al. 2021. Mixed method evaluation of the CEBHA+ integrated knowledge translation approach : a protocol. Health Research Policy and Systems, 19:7, doi:10.1186/s12961-020-00675-w.The original publication is available at https://health-policy-systems.biomedcentral.comBackground: The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) is a research consortium concerned with the prevention, diagnosis and treatment of non-communicable diseases. CEBHA+ seeks to engage policymakers and practitioners throughout the research process in order to build lasting relationships, enhance evidence uptake, and create long-term capacity among partner institutions in Ethiopia, Malawi, Rwanda, South Africa and Uganda in collaboration with two German universities. This integrated knowledge translation (IKT) approach includes the formal development, implementation and evaluation of country specific IKT strategies. Methods: We have conceptualised the CEBHA+ IKT approach as a complex intervention in a complex system. We will employ a comparative case study (CCS) design and mixed methods to facilitate an in-depth evaluation. We will use quantitative surveys, qualitative interviews, quarterly updates, and a policy document analysis to capture the process and outcomes of IKT across the African CEBHA+ partner sites. We will conduct an early stage (early 2020) and a late-stage evaluation (early 2022), triangulate the data collected with various methods at each site and subsequently compare our findings across the five sites. Discussion: Evaluating a complex intervention such as the CEBHA+ IKT approach is complicated, even more so when undertaken across five diverse countries. Despite conceptual, methodological and practical challenges, our comparative case study addresses important evidence gaps: While involving decision-makers in the research process is gaining traction worldwide, we still know very little regarding (i) whether this approach really makes a difference to evidence uptake, (ii) the mechanisms that make IKT successful, and (iii) relevant differences across socio-cultural contexts. The evaluation described here is intended to provide relevant insights on all of these aspects, notably in countries in Sub-Saharan Africa, and is expected to contribute to the science of IKT overall.https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-020-00675-wPublisher's versio