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The effectiveness of community engagement in public health interventions for disadvantaged groups: a meta-analysis.

O'Mara-Eves A, Brunton G, Oliver S, Kavanagh J, Jamal F, Thomas J - BMC Public Health (2015)

Bottom Line: The overall effect size for health behaviour outcomes is d = .33 (95% CI .26, .40).Although the type of community engagement was not a significant moderator of effect, we identified some trends across studies.There is insufficient evidence to determine whether one particular model of community engagement is more effective than any other.

View Article: PubMed Central - PubMed

Affiliation: Social Science Research Unit, UCL Institute of Education, London, UK. a.omara-eves@ioe.ac.uk.

ABSTRACT

Background: Inequalities in health are acknowledged in many developed countries, whereby disadvantaged groups systematically suffer from worse health outcomes such as lower life expectancy than non-disadvantaged groups. Engaging members of disadvantaged communities in public health initiatives has been suggested as a way to reduce health inequities. This systematic review was conducted to evaluate the effectiveness of public health interventions that engage the community on a range of health outcomes across diverse health issues.

Methods: We searched the following sources for systematic reviews of public health interventions: Cochrane CDSR and CENTRAL, Campbell Library, DARE, NIHR HTA programme website, HTA database, and DoPHER. Through the identified reviews, we collated a database of primary studies that appeared to be relevant, and screened the full-text documents of those primary studies against our inclusion criteria. In parallel, we searched the NHS EED and TRoPHI databases for additional primary studies. For the purposes of these analyses, study design was limited to randomised and non-randomised controlled trials. Only interventions conducted in OECD countries and published since 1990 were included. We conducted a random effects meta-analysis of health behaviour, health consequences, self-efficacy, and social support outcomes, and a narrative summary of community outcomes. We tested a range of moderator variables, with a particular emphasis on the model of community engagement used as a potential moderator of intervention effectiveness.

Results: Of the 9,467 primary studies scanned, we identified 131 for inclusion in the meta-analysis. The overall effect size for health behaviour outcomes is d = .33 (95% CI .26, .40). The interventions were also effective in increasing health consequences (d = .16, 95% CI .06, .27); health behaviour self-efficacy (d = .41, 95% CI .16, .65) and perceived social support (d = .41, 95% CI .23, .65). Although the type of community engagement was not a significant moderator of effect, we identified some trends across studies.

Conclusions: There is solid evidence that community engagement interventions have a positive impact on a range of health outcomes across various conditions. There is insufficient evidence to determine whether one particular model of community engagement is more effective than any other.

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Plot of effect size estimates by their standard errors, with different markers for effect size estimates based on binary and continuous data.
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Fig7: Plot of effect size estimates by their standard errors, with different markers for effect size estimates based on binary and continuous data.

Mentions: One phenomenon that appeared to be related to the effect size estimates was the size of the study, as indicated by the funnel plot in Figure 7. To explore whether the sample size might explain some of the variation in the effect size estimates, we conducted a post hoc un-weighted meta-regressione. This model tested whether the log of the sample size of each study predicted the size of the effect for health behaviour outcomes. The results indicated that, although sample size was not a significant predictor of the effect size estimate (B = −.10, SE = .08), it explained about 10% of the variance in the effect size estimates (as indicated by the model R2). As such, it is likely that sample size accounts for some of the heterogeneity observed amongst the effect size estimates. Our discussion of the relationship between the theory of change and sample size above (see also Table 4) might suggest that sample size is confounded with other explanatory variables.Figure 7


The effectiveness of community engagement in public health interventions for disadvantaged groups: a meta-analysis.

O'Mara-Eves A, Brunton G, Oliver S, Kavanagh J, Jamal F, Thomas J - BMC Public Health (2015)

Plot of effect size estimates by their standard errors, with different markers for effect size estimates based on binary and continuous data.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374501&req=5

Fig7: Plot of effect size estimates by their standard errors, with different markers for effect size estimates based on binary and continuous data.
Mentions: One phenomenon that appeared to be related to the effect size estimates was the size of the study, as indicated by the funnel plot in Figure 7. To explore whether the sample size might explain some of the variation in the effect size estimates, we conducted a post hoc un-weighted meta-regressione. This model tested whether the log of the sample size of each study predicted the size of the effect for health behaviour outcomes. The results indicated that, although sample size was not a significant predictor of the effect size estimate (B = −.10, SE = .08), it explained about 10% of the variance in the effect size estimates (as indicated by the model R2). As such, it is likely that sample size accounts for some of the heterogeneity observed amongst the effect size estimates. Our discussion of the relationship between the theory of change and sample size above (see also Table 4) might suggest that sample size is confounded with other explanatory variables.Figure 7

Bottom Line: The overall effect size for health behaviour outcomes is d = .33 (95% CI .26, .40).Although the type of community engagement was not a significant moderator of effect, we identified some trends across studies.There is insufficient evidence to determine whether one particular model of community engagement is more effective than any other.

View Article: PubMed Central - PubMed

Affiliation: Social Science Research Unit, UCL Institute of Education, London, UK. a.omara-eves@ioe.ac.uk.

ABSTRACT

Background: Inequalities in health are acknowledged in many developed countries, whereby disadvantaged groups systematically suffer from worse health outcomes such as lower life expectancy than non-disadvantaged groups. Engaging members of disadvantaged communities in public health initiatives has been suggested as a way to reduce health inequities. This systematic review was conducted to evaluate the effectiveness of public health interventions that engage the community on a range of health outcomes across diverse health issues.

Methods: We searched the following sources for systematic reviews of public health interventions: Cochrane CDSR and CENTRAL, Campbell Library, DARE, NIHR HTA programme website, HTA database, and DoPHER. Through the identified reviews, we collated a database of primary studies that appeared to be relevant, and screened the full-text documents of those primary studies against our inclusion criteria. In parallel, we searched the NHS EED and TRoPHI databases for additional primary studies. For the purposes of these analyses, study design was limited to randomised and non-randomised controlled trials. Only interventions conducted in OECD countries and published since 1990 were included. We conducted a random effects meta-analysis of health behaviour, health consequences, self-efficacy, and social support outcomes, and a narrative summary of community outcomes. We tested a range of moderator variables, with a particular emphasis on the model of community engagement used as a potential moderator of intervention effectiveness.

Results: Of the 9,467 primary studies scanned, we identified 131 for inclusion in the meta-analysis. The overall effect size for health behaviour outcomes is d = .33 (95% CI .26, .40). The interventions were also effective in increasing health consequences (d = .16, 95% CI .06, .27); health behaviour self-efficacy (d = .41, 95% CI .16, .65) and perceived social support (d = .41, 95% CI .23, .65). Although the type of community engagement was not a significant moderator of effect, we identified some trends across studies.

Conclusions: There is solid evidence that community engagement interventions have a positive impact on a range of health outcomes across various conditions. There is insufficient evidence to determine whether one particular model of community engagement is more effective than any other.

Show MeSH