Section outline

  • SYSTEMATIC REVIEW OF THE LITERATURE

    Once you have broadly agreed a particular aspect of the Public Health Problem you wish to study, you need to undertake a detailed literature review to find out what is already known about that aspect. To do so, you should develop a search strategy, conduct a literature search (using appropriate MeSH terms) and screen / sort citations, read / critically review the literature.

    In undertaking your literature review, you may find the PICOT scheme helpful in developing your ideas (but be aware that PICOT may not apply for all studies and there are other schemes you might prefer to follow, the important thing is to do this exercise systematically and use a well-established/proven framework or methodology – and ideally you should reference this):

    Asking the Public Health question—PICOT

    Population. To which population or part of your population does the question apply?

    Intervention or risk factor (exposure) or prevalence. For an intervention: is the intervention aimed at the individual or the population (e.g. the environment)? At what stage of the disease process are you aiming (e.g. primary or secondary prevention)? At what stage of development is the intervention? Is there a policy option available? What type of intervention is it (e.g. health care, health care organization, environmental modification, community-wide education etc.)?

    For a risk factor: can the risk for the population—rather than for the individual—be measured? What sort of risk factor is it (e.g. physiological variable, individual behaviour, social attribute, environmental exposure etc.)?

    For a prevalence question: what measurements are feasible?

    Comparison. What comparison group are you planning (e.g. before/after study, control group), if relevant?

    Outcome. Which outcome measure are you going to have (risk factor level, death, hospitalization, quality of life, cost-effectiveness etc.)? Over what time period is the outcome to be assessed, and how does this relate to the policy cycle length? Will estimates of cost be made?

    Type of evidence required. Is this an estimate of burden of illness aiming to quantify prevalence, risk or benefit? Is this to examine the impact of risks or benefits on health inequalities (such as an ‘equity audit’), or the impact of a health policy initiative? Is this an economic evaluation?

    RESEARCH SKILLS PROGRAM PART 1

    The first part of the research skills program (RSP) will introduce you to some basic ideas about research in general and about systematic literature reviews.

    Read the following documents and then take your time to work on the exercise - you will find that time spent on the exercise will be most helpful.

    • The research cycle File
      Students must
      View

      Please read this document which sets the scene for thinking about, and getting started on, research. It is one of the key background documents for this part of the Research Skills Programme

    • How to perform a literature review File
      Students must
      View

      Please read this document which outlines the steps for performing a literature review. It is one of the key background documents for this part of the Research Skills Programme, and will be very helpful in preparing you to work on your literature review

    • Exercise for the Research Skills Programme Part 1 Page
      Students must
      View

      Working through this exercise will be very useful to consolidate what you have seen in the resources above, and prepare you to start on your literature review

    • Owais et al. 2011: Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan File
      Students must
      View

      Exercise article to be assessed using CASP.

    • CASP assessment tool for Randomised Controlled Trials File
      Students must
      View
    • Reflection on Research Skills program Part 1 Forum
      Students must
      Make forum posts: 1

      This is for you to reflect on any issues relating to the information in the Research Skills Programme 1.

      Have you read each of the attachments?

      Does this help you think about the study you have in mind?

    • Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review URL
      Students must
      View

      Here is an example of a systematic review. Please focus on the Methods section. This is rather complex, but it a gold standard systematic literature review.

    • Example of an excellent systematic literature review URL
      Students must
      View

      Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review is an excellent example of a systematic literature review. Probably more extensive than you need, but please look through it for inspiration.

    • Summarising, synthesis and meta-analysis Page
      Students must
      Mark as done

      Following the literature review, you will want to synthesie what you have found. This discussion will help decide if a meta-analysis is warranted beyond making your synthesis.

    • Reflection on your literature review Forum
      Students must
      Make forum posts: 1

      This is to encourage you to reflect on how you would perform a literature review. You might want to consider if you can perform the following tasks on a review:

      Develop a protocol for the review which has the following features:

      • a clear research question and framework, such as PICOT, with all terms defined and key aspects of PRISMA and CASP guidelines incorporated.

      Perform the literature review with the following features:

      • Several sources explored (eg medical literature databases, appropriate non-medical databases, grey literature, specific journals).
      • Varied search strategy for each database as needed. Use of MeSH on non-MeSH headings or combination as needed.
      • Use of filters as required.
      • Save and list searches and search strategies by source.

      Sort citations:

      • Exclude duplicates.
      • Separate full-text and non-full text.
      • Exclude non-relevant papers (and give reasons).
      • Prioritise remaining papers (and give reasons).
      • Group remaining papers into meaningful sub-topics.
      • Create a flow-chart which summarises results (numbers/types of study).
      • Organise citations (using traditional citation rules) and create list of references.

      Read and critically review each paper.

      • Identify evidence type (where relevant) and create table summarising study designs of included articles.
      • Assess the quality of the studies and identify biases or other factors.
      • Extract relevant statistics from relevant papers.
      • Create summary tables (by sub-topics, include all articles in the review, cite first author, year, country, type of study, sample size, main results and critical comments, and relevance to your proposed study population.

      Summarise and synthesise.

      • Summarise critically.
      • Synthesise the evidence (by study type, source and conclusions if relevant).
      • Draw conclusions of the relevance to your research topic.

      Identify gaps in knowledge.

      • What gaps remain following the review.
      • How can these gaps lead to the project you plan to conduct.

      Identify clear research question for your project, informed by the literature review.

      • Is there a plausible hypothesis.
      • Can you quantify an expected result.
      • Can you identify a study population and a proposed intervention or study factor.