RESUMEN
Systematic reviews framed by PICOS (Populations, Interventions, Comparisons, Outcomes, and Study designs) have been valuable for synthesizing evidence about the effects of interventions. However, this framework is limited in its utility for exploring the influence of variations within populations or interventions, or about the mechanisms of action or causal pathways thought to mediate outcomes, other contextual factors that might similarly moderate outcomes, or how and when these mechanisms and elements interact. Valuable insights into these issues come from configurative as well as aggregative methods of synthesis. This article considers the range of evidence that can be used in systematic reviews of interventions to investigate complexity in terms of potential sources of variation in interventions and their effects, and presents a continuum of purposes for, and approaches to, evidence synthesis. Choosing an appropriate synthesis method takes into account whether the purpose of the synthesis is to generate, explore, or test theories. Taking complexity into account in a synthesis of economic evidence similarly shifts emphasis from evidence synthesis strategies focused on aggregation toward configurative strategies that aim to develop, explore, and refine (in advance of testing) theories or explanations of how and why interventions are more or less resource intensive, costly or cost-effective in different settings, or when implemented in different ways.
Asunto(s)
Proyectos de Investigación , Literatura de Revisión como Asunto , HumanosRESUMEN
OBJECTIVE: To describe the development of a multidimensional conceptual framework capable of drawing out the implications for policy and practice of what is known about public involvement in research agenda setting. BACKGROUND: Public involvement in research is growing in western and developing countries. There is a need to learn from collective experience and a diverse literature of research, policy documents and reflective reports. METHODS: Systematic searches of research literature, policy and lay networks identified reports of public involvement in research agenda setting. Framework analysis, previously described for primary research, was used to develop the framework, which was then applied to reports of public involvement in order to analyse and compare these. FINDINGS: The conceptual framework takes into account the people involved; the people initiating the involvement; the degree of public involvement; the forum for exchange; and methods used for decision making. It also considers context (in terms of the research focus and the historical, geographical or institutional setting), and theoretical basis. CONCLUSIONS: The framework facilitates learning across diverse experiences, whether reported in policy documents, reflections or formal research, to generate a policy- and practice-relevant overview. A further advantage is that it identifies gaps in the literature which need to be filled in order to inform future research about public involvement.
Asunto(s)
Participación de la Comunidad/métodos , Relaciones Comunidad-Institución , Conducta Cooperativa , Investigación sobre Servicios de Salud/métodos , Toma de Decisiones en la Organización , Política de Salud , Prioridades en Salud , Humanos , Modelos TeóricosRESUMEN
OBJECTIVE: To examine parents' and health professionals' views on informed choice in newborn blood spot screening, and assess information and communication needs. DESIGN AND PARTICIPANTS: A qualitative study involving semi-structured telephone interviews and focus groups with 47 parents of children who were either found to be affected or unaffected by the screened conditions, and 35 health professionals with differing roles in newborn blood spot screening programmes across the UK. RESULTS AND CONCLUSIONS: Parents and health professionals recognize a tension between informed choice in newborn blood spot screening and public health screening for children. Some propose resolving this tension with more information and better communication, and some with rigorous dissent procedures. This paper argues that neither extensive parent information, nor a signed dissent model adequately address this tension. Instead, clear, brief and accurate parent information and effective communication between health professionals and parents, which take into account parents' information needs, are required, if informed choice and public health screening for children are to coexist successfully.