Health Equity: 02/07/11

Monday, February 7, 2011

[EQ] Improving the user experience of evidence - Evidence summaries tailored to health policy-makers

Improving the user experience of evidence.
A design approach to evidence-informed heath care

Sarah E.Rosenbaum
Norwegian Knowledge Centre for the Health Services, Oslo, Norway

Available online at: http://bit.ly/icI4ua

“……Evidence about the benefits and harms of health care interventions has the potential to improve quality of care. Syntheses of the best available evidence - systematic reviews - can provide valuable information for health care clinicians and policy makers, but these publications are often too lengthy to be useful for decision makers in time-pressed contexts. Condensed summaries of reviews may help, but there is little research about how to design such summaries (what content to include and how to present it), how they will be experienced by users, and their effect. Earlier research to create summaries of Cochrane Reviews has also shown that condensing complex data can be challenging and lead to misrepresentation

This thesis builds on a series of studies examining these issues from several perspectives, with the designed artifact as the main focal point. An underlying assumption for all of this work is that the design of artifacts in which evidence is embedded may shape or influence users’ experiences of this evidence. Given that these artifacts are, in effect, mediating between the domains of evidence production and evidence use (by policymakers, clinicians or the public), they warrant far more attention that they appear to have received to date.

Multiple methods are employed, including a framework from design practice domain.

· The first study is a set of user tests, examining health professionals’user experience of the Cochrane Library (where Cochrane Reviews are published).
The second study involves exploring user and stakeholder feedback to inform iterations of a Summary of Findings Table for Cochrane Reviews.

· The third study is an evaluation of the effect of including a Summary of Findings Table in a Cochrane Review (compared to a Review with no table) on user satisfaction, understanding and time spent to find key messages.

· The fourth study explores user and stakeholder feedback to inform the development of a template for short summaries of systematic reviews that are tailored for health policy makers in low and middle-income countries……”

Evidence summaries tailored to health policy-makers in low- and middle-income countries

Sarah E Rosenbaum,a Claire Glenton,b Charles Shey Wiysonge,c Edgardo Abalos,d Luciano Mignini,d Taryn Young,e Fernando Althabe,f Agustín Ciapponi,f Sebastian Garcia Marti,f Qingyue Meng,g Jian Wang,g Ana Maria De la Hoz Bradford,h Suzanne N Kiwanuka,i Elizeus Rutebemberwa,i George W Pariyo,i Signe Flottorp a & Andrew D Oxman a
a Norwegian Knowledge Centre for the Health Services, Oslo, Norway.

b Sintef, Trondheim, Norway.

c School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.

d Centro Rosarino de Estudios Perinatales, Santa Fe, Argentina.

e South African Cochrane Centre, Cape Town, South Africa.

f Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

g Centre for Health Management and Policy, Shandong University, Jinan, China.

h Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia.

I Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.

Bulletin of the World Health Organization (BLT) -Volume 89, Number 1, January 2011

Available online at: http://bit.ly/gpNl8I

“…..Policy-makers liked a graded entry format (i.e. short summary with key messages up front). They particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally-relevant detail in the original review. Some struggled to understand the text and numbers. Three issues made redesigning the summaries particularly challenging:
(i) participants had a poor understanding of what a systematic review was;
(ii) they expected information not found in the systematic reviews and
(iii) they wanted shorter, clearer summaries. Solutions included adding information to help understand the nature of a systematic review, adding more references and making the content clearer and the document quicker to scan….”

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[EQ] Social conditions, health equity, and human rights

Social conditions, health equity, and human rights

Paula Braveman, Professor of Family and Community and Director of the Center on Social Disparities in Health at the University of California, San Francisco, USA

Health and Human Rights: An International Journal, North America, 1214 12 2010.

Available online at: http://bit.ly/ibi6rb

“…….The fields of health equity and human rights have different languages, perspectives, and tools for action, yet they share several foundational concepts.

This paper explores connections between human rights and health equity, focusing particularly on the implications of current knowledge of how social conditions may influence health and health inequalities, the metric by which health equity is assessed.

The role of social conditions in health is explicitly addressed by both
1) the concept that health equity requires equity in social conditions, as well as in other modifiable determinants, of health; and
2) the right to a standard of living adequate for health.

The indivisibility and interdependence of all human rights — civil and political as well as economic and social — together with the right to education, implicitly but unambiguously support the need to address the social (including political) determinants of health, thus contributing to the conceptual basis for health equity. The right to the highest attainable standard of health strengthens the concept and guides the measurement of health equity by implying that the reference group for equity comparisons should be one that has optimal conditions for health.

The human rights principles of non-discrimination and equality also strengthen the conceptual foundation for health equity by identifying groups among whom inequalities in health status and health determinants (including social conditions) reflect a lack of health equity; and by construing discrimination to include not only intentional bias, but also actions with unintentionally discriminatory effects.

In turn, health equity can make substantial contributions to human rights
1) insofar as research on health inequalities provides increasing understanding and empiric evidence of the importance of social conditions as determinants of health; and, more concretely,
2) by indicating how to operationalize the concept of the right to health for the purposes of measurement and accountability, which have been elusive.
Human rights laws and principles and health equity concepts and technical approaches can be powerful tools for mutual strengthening, not only by contributing toward building awareness and consensus around shared values, but also by guiding analysis and strengthening measurement of both human rights and health equity….”

[EQ] Social Science Research in the Neglected Tropical Diseases

Social Science Research in the Neglected Tropical Diseases

Edited by Pascale Allotey and Subhash Pokhrel
Health Research Policy and Systems – January 2011

Available online at: http://bit.ly/hdf4ID

“…….The neglected tropical diseases (NTDs) are a group of conditions identified as affecting the poorest and most disadvantaged populations in the world.
The scale of social science research in the neglected tropical diseases (NTDs) is particularly less prominent compared to other areas of research.
This series attempts to identify whether there are increased roles for the social sciences in the activities for the control of neglected tropical diseases.
Specifically, this series aims to answer the following questions:

1. What defines the NTDs?

2. What are the current approaches to the control of NTDs?

3. What role do the social sciences currently play in this agenda?

4. Should there be greater role for the social sciences and if so what factors contribute or hinder a greater role? ….”

Does mass drug administration for the integrated treatment of neglected tropical diseases really work?
Assessing evidence for the control of schistosomiasis and soil-transmitted helminths in Uganda
Melissa Parker, Tim Allen [PDF]

Social sciences research in neglected tropical diseases 3:
Investment in social science research in neglected diseases of poverty: a case study of Bill and Melinda Gates Foundation
Subhash Pokhrel, Daniel Reidpath, Pascale Allotey [PDF]

Social sciences research in neglected tropical diseases 2: A bibliographic analysis
Daniel D Reidpath, Pascale Allotey, Subhash Pokhrel [PDF]

Social sciences research in neglected tropical diseases 1:
the ongoing neglect in the neglected tropical diseases
Pascale Allotey, Daniel D Reidpath, Subhash Pokhrel [PDF]