Tag: EPPI-Centre

Synthesising evidence

evidenceToday, returning to this blog after something of a gap, I find reason to reflect on the many flavours of evidence review which now exist.

In the RiSC project we’ve been using the EPPI-Centre approach, developed by people working at the Institute of Education in London. This framework has a number of desirable features, including the combination of a phase 1 mapping with a more in-depth phase 2 involving quality appraisal. Deciding the focus of phase 2 in an EPPI-Centre review involves discussion with stakeholding collaborators. That’s all to the good, proving that in evidence syntheses, as in primary data-generating studies, it is possible for researchers to work jointly with service user, carer and practitioner colleagues.

Last week, with other members of the Wales chapter of the COCAPP team, I spoke on our meta-narrative mapping of care planning and care coordination at a Swansea University seminar. Amongst other things meta-narrative mapping traces the different research traditions found within a given field. And, today, I mock-examined a delightful doctoral thesis containing a scoping review, which lays out what’s there but does not include formal quality appraisal. Then there are realist syntheses, where reviewers look across multiple studies for evidence of the generative mechanisms underpinning change in policy, services or practice. The list goes on, encompassing thematic literature reviews and, of course, Cochrane-style systematic reviews. This latter approach has been very important in driving the evidence-based practice movement, but personally I’ve always been a little disappointed at its insistence on hierarchies with randomised trials as the gold standard.

So how might decisions be made on selecting one approach over another? Practical considerations have a bearing, but perhaps more important are commitments to certain intellectual or other principles. We chose the EPPI-Centre approach in RiSC because we valued user, carer, practitioner and manager perspectives and wanted a way of hearing these and using them to inform our project. Realist reviewers sign up to particular sets of ideas on how programmes work, and meta-narrative mappers embrace the idea, and seek out examples, of paradigmatic differerence. Perhaps the key thing is to be aware of, and articulate, these in justifying the choices which inevitably have to be made.

Evidence syntheses and the RiSC study

I’ve been working on a document associated with the RiSC study today. RiSC is an evidence synthesis of ‘risk’ for young people moving into, through and out of inpatient mental health services. To guide our review we’re using a framework developed by members of the the EPPI-Centre, about which more can be found by clicking on the logo below:EPPI Centre

Distinct about the EPPI-Centre approach is the emphasis placed on engaging with representatives of groups and communities with interests in the area under review. In their Methods for Conducting Systematic Reviews document the EPPI-Centre people write:

Approaches to reviewing
Involving representatives of all those who might have a vested interest in a particular systematic review helps to ensure that it is a relevant and useful piece of research.
User involvement
Everyone has a vested interest in public policy issues such as health, education, work and welfare. Consequently everyone, whether they wish to be actively engaged or not, has a vested interest in what research is undertaken in these fields and how research findings are shared and put to use.
Reviews are driven by the questions that they are seeking to answer. Different users may have different views about why a particular topic is important and interpret the issues within different ideological and theoretical perspectives.
Involving a range of users in a review is important as it enables reviewers to recognise and consider different users’ implicit viewpoints and thus to make a considered decision about the question that the review is attempting to answer. The aim is to be transparent about why a review has the focus that it does, rather than assuming it is, or is attempting to be, everything to everyone.

In our review (as you’ll see if you download our protocol from the link given at the top of this post above) we’re combining a broad descriptive mapping of the territory with a more selective, in-depth, review guided by the priorities of stakeholder representatives. These are people with experience of using, working in or managing child and adolescent mental health services.

I like this approach to conducting evidence reviews, appreciating the commitment it demands to the agreement of topic areas and to being open in decision-making. All going well I’ll be continuing with some RiSC work tomorrow.