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Community-engaged Evidence Synthesis to Inform Public Health Policy and Clinical Practice: A Case Study

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Background: This case study documents the work of the Rhode Island Arts and Health Advisory Group, which convened in 2016 to develop a set of policy, clinical practice, and research recommendations for implementation by the Rhode Island Department of Health, The Rhode Island State Council on the Arts, and partners. Comprised of artists, clinicians, community members, and patients, the group partnered with researchers to complete an evidence synthesis project of arts-based health care interventions. Methods: The group took a community-engaged approach to evidence synthesis, featuring the use of online, and in-person training materials to facilitate the codesign and coexecution of the evidence synthesis protocol. The final evidence map was translated into an online evidence map to facilitate analysis and discussion on arts-based interventions in health care. Results: The evidence map informed the development of recommendations for advancing the integration of arts and health in the state. The project evaluation indicated that our community-engaged approach to evidence synthesis promoted engagement as defined by the PCORI Engagement Strategy Rubric (ie, reciprocal relationships, partnership, colearning, transparency, honesty, and trust). Participation also improved community research partners confidence in engaging with the health care system, developed greater empathy and understanding of others in the community, and increased interest in using science or research in advocacy efforts. Conclusions: Engaging community partners in evidence synthesis promotes community dialogue and engagement in research, specifically towards: (1) elucidating outcomes of import to patients and communities that are not represented in the medical literature; and (2) identifying comparisons among interventions that resonate with patients and communities.
Community-engaged Evidence Synthesis to Inform Public
Health Policy and Clinical Practice
A Case Study
Stacey Springs, PhD,*Valerie Rofeberg, ScM,* Sherilyn Brown, MA,Steven Boudreau
Spencer Phillips Hey, PhD,¶ and Jay Baruch, MD#
Background: This case study documents the work of the Rhode
Island Arts and Health Advisory Group, which convened in 2016 to
develop a set of policy, clinical practice, and research recom-
mendations for implementation by the Rhode Island Department of
Health, The Rhode Island State Council on the Arts, and partners.
Comprised of artists, clinicians, community members, and patients,
the group partnered with researchers to complete an evidence syn-
thesis project of arts-based health care interventions.
Methods: The group took a community-engaged approach to evi-
dence synthesis, featuring the use of online, and in-person training
materials to facilitate the codesign and coexecution of the evidence
synthesis protocol. The nal evidence map was translated into an
online evidence map to facilitate analysis and discussion on arts-
based interventions in health care.
Results: The evidence map informed the development of recom-
mendations for advancing the integration of arts and health in the state.
The project evaluation indicated that our community-engaged ap-
proach to evidence synthesis promoted engagement as denedbythe
PCORI Engagement Strategy Rubric (ie, reciprocal relationships,
partnership, colearning, transparency, honesty, and trust). Participation
also improved community research partners condence in engaging
with the health care system, developed greater empathy and under-
standing of others in the community, and increased interest in using
science or research in advocacy efforts.
Conclusions: Engaging community partners in evidence synthesis
promotes community dialogue and engagement in research, specif-
ically towards: (1) elucidating outcomes of import to patients and
communities that are not represented in the medical literature; and
(2) identifying comparisons among interventions that resonate with
patients and communities.
Key Words: community engagement, community-based partic-
ipatory research, evidence synthesis, systematic reviews, evidence-
based medicine, research literacy
(Med Care 2019;57: S253S258)
BACKGROUND
Good decision-making by policy makers, insurers,
health systems administrators and funding agencies requires
access to evidence that is applicable to their local context and
responds to the needs of their constituencies.1Evidence
synthesis methods support the adoption and translation of
evidence by using rigorous methods to identify, select and
analyze relevant evidence. The most well-known among these
methods is the systematic review, a scientic investigation
that focuses on a specic question and uses explicit, pre-
planned scientic protocols to identify, select, assess, and
summarize similar but separate studies.2
Systematic reviews often address very specic questions
and focus on a narrow scope of populations and interventions,
which may enhance the validity of the reportsndings but
can also reduce its applicability and uptake (Israel 1998).
Another barrier to uptake of evidence by decision makers is
that systematic reviews are often reported as long, text-heavy
documents. Many decision makers have been shown to be
more receptive to evidence presented and summarized
graphically with emphasis placed on the most important (or
actionable) results and minimization of methods details.3,4
This case study describes a collaborative study started
in 2016, when the Rhode Island Arts and Health Advisory
Group (hereafter: The Advisory Group) convened to de-
velop a set of policy, clinical practice, and research recom-
mendations to be implemented by the state Department of
From the *Center for Evidence Synthesis in Health, Brown University School
of Public Health; Swearer Center for Public Service, Brown University;
Rhode Island State Council on the Arts; §Rhode Island Department of
Health, Providence, RI; Program on Regulation, Therapeutics, and Law
(PORTAL), Brigham and Womens Hospital; ¶Center for Bioethics,
Harvard Medical School, Boston, MA; and #Alpert Medical School of
Brown University, Providence, RI.
The authors sought approval from the Brown University Institutional Review
Board (IRB) and obtained appropriate exemption human subjects review.
The participants of the evaluation described herein provided consent to
participate and for the use of their anonymized data.
Supported by a grant from The Rhode Island Foundation (Springs), AHRQ
R25HS23299 (Springs, Rofeberg), AHRQ K12HS022998 (Springs) and
supported by the Rhode Island Department of Health, Rhode Island
Council on the Arts.
S.P.H. receives funding from The Laura and John Arnold Foundation. The
remaining authors declare no conict of interest.
Reprints: Stacey Springs, PhD, Center for Evidence Synthesis in Health,
Brown University School of Public Health, Box G-S121-8, Providence,
RI 02912. E-mail: stacey_springs@brown.edu.
Copyright © 2019 The Author(s). Published by Wolters Kluwer Health, Inc.
This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0
(CCBY-NC-ND), where it is permissible to download and share the
work provided it is properly cited. The work cannot be changed in any
way or used commercially without permission from the journal.
ISSN: 0025-7079/19/5710-S253
ORIGINAL ARTICLE
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Health and to promote the role of arts in health more broadly.
Arts-based interventions can include many different artistic
modalities, such as music, dance, theater, literature, visual art,
architecture, interior design, and are designed to enhance
health care, promote public health and support community
well-being.5These interventions are delivered by creative arts
therapists and include expressive arts therapies and artists in
health care settings and are accessible across the continuum
of care, from in-patient to community-based programs.5An
emerging evidence base demonstrates the efcacy and com-
parative effectiveness of these interventions relative to more
traditional health interventions (eg, drugs), as well as the
positive role that arts-based interventions can play in affecting
social determinants of health such as social isolation, resilience,
and personal self-efcacy.
The Advisory Groupcomprised of artists, clinicians,
community members, and patientsdecided to develop an
evidence map of arts-based health care interventions to better
understand the quantity and quality of existing evidence, to
establish gaps in evidence and identify areas where sufcient
evidence exists to develop systematic reviews or actionable
evidence-based policy. Evidence mapping is an emerging re-
search synthesis technique that employs a systematic and
replicable methodology to aggregate and organize data about
heterogenous or complex interventions in a logical way, pri-
marily as a technique for identifying latent connections or
patterns of effect between interventions and populations that
can be used to inform policyand systems-level questions.
The evidence map method is especially useful for categorizing
the state of the literature in order to generate hypothesesthat
is, motivating the need for further reviews and/or primary
research by identifying gaps in the evidence. In contrast to
traditional quantitative methods of evidence synthesis, such as
statistical meta-analyses, evidence mapping relies on the tab-
ular, qualitative and descriptive synthesis and is often de-
signed to characterize the quantity and quality of a body of
literature without formal quality or risk of bias assessments
using study design features.6As an analytic technique, evi-
dence mapping thus prioritizes breadth and scope over pre-
cision. But this trade-off makes the approach potentially far
more useful for decision makers whose purview is broad or
concerns a heterogenous population, such as health system
administrators, public policy makers, and research funders.
During initial meetings between researchers and the
Advisory Group, the team deliberated the benets and limitations
to evidence synthesis in the policy context and determined that 2
modications should be made to improve applicability, uptake,
and dissemination of evidence synthesis in our project. First, we
adopted a community-engaged approach to evidence synthesis
and provided training and mentoring to our community research
partners (CRPs) to codesign, coproduce and codisseminate an
evidence map. Second, we recognized that to disseminate the
ndings of our research, the report and results of our research
would need to be accessible beyond the walls of academia. We
agreed that publication in a journal was desirable, but the rst
obligation was to identify a means of dissemination that would
inform policy makers, health care providers and remain acces-
sible to our CRPs. The group decided to develop an interactive,
online evidence map in collaboration with the Aero Data Lab, a
data science, ethics, and policy consulting group afliated with
the Harvard Medical School (www.rhodeislandartsandhealth.
com/research-database).
In what follows, we outline and elaborate our approach
for this project, innovating on well-established methods of
evidence synthesis by: (1) training and mentoring CRPs; and
(2) developing an online, interactive evidence map to support
dissemination and implementation of evidence.
METHODS
Our community-engaged approach to evidence syn-
thesis included both stakeholders and CRPs participating in
the development and implementation of evidence synthesis
protocols. Stakeholders are routinely engaged in systematic
reviews to provide topical expertise, improve the identication
of pertinent evidence and emerging outcomes of import, in-
forming and consulting at regular intervals. Our project relied
on a complement of stakeholders that represented local health
care organizations, health policy and governmental ofces,
not-for-prot organizations, arts and humanities organizations
working with health care organizations and providers, and
local artists. Selection of stakeholders was guided by the 7P
framework devised by Concannon et al.7The role of each
stakeholder was to inform our work, meeting with us at 2
different time points: rst, to review and comment on the
protocol and interim ndings, and second, to review our
recommendations and interactive evidence map.
The CRPs were invited to participate as research partners
on the project, collaborating on both the study design and re-
search process itself. The community-engaged approach draws
upon a number of research frameworks, including community-
based participatory research, participatory action research, and
patient-centered outcomes research. These approaches share
several common themes: (1) engaging community members in
choosing research topics, developing projects, collecting data,
and interpreting results; (2) acknowledging the importance of
existing systems (social, political, cultural, and economic) to
health behaviors and outcomes; (3) emphasizing both qualitative
and quantitative research methods; and (4) prioritizing translation
of the ndings into practice and policy.8
Training Community Partners For Successful
Community-engaged Evidence Synthesis
Research
The training team consisted of 2 research method-
ologists with expertise in evidence synthesis methods (S.S.,
V.R.), an Associate Professor of Emergency Medicine at the
Alpert Medical School, Brown University (J.B.), the Chief
Administrative Ofcer of the Rhode Island Department of
Public Health (S.B.), the Director of Arts and Health, Rhode
Island State Council on the Arts (S.B.). The training program
adapted expert guidance from the Institute of Medicine,
Agency for Healthcare and Research Quality Effective Health
Care Program, and the Cochrane Handbook for Systematic
Reviews of Interventions.911 for the community audience.
Over the course of the 18-month project, members of
the group learned evidence synthesis methods (eg, developing
key research questions, search strategy, screening abstracts,
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data extraction) through didactic training and mentorship via
the Brown University School of Public Health Evidence-
based Practice Center. The training included 3 phases:
(1) Considering Evidence Synthesis-based Approaches; (2)
Research Protocol Development; and (3) Evidence Synthesis
and Policy Recommendations. The research team (CRPs and
training team) convened monthly meetings for 1.52.5 hours.
Each session included 3045 minutes of lecture/discussion
designed to introduce a key evidence synthesis concept,
method or technique as described in the learning objectives
(Fig. 1). Remaining time in each session was devoted to
interactive activities to inform decision-making around
protocol details and strategic planning for the use and
implementation of the evidence. Initial sessions prov-
ided opportunities to discuss the concepts of evidence-based
medicine, what constitutes evidence in health care, how
quality is considered in the context of peer-reviewed literature
and the role of gray literature in evidence synthesis.
The second phase focused on the codevelopment of the
evidence map protocol. This phase introduced CRPs to the 6
steps of the evidence synthesis process with relevant examples,
detailing how to make protocol decisions related to preparing
the research question, developing the search strategy, screening
relevant abstracts, extract data, analyzing the evidence and re-
porting ndings (Fig. 1). The team was responsible for learning
the steps, making decisions for conducting the research and
subsequently completing each task. Team meetings were
focused on supporting each of these 3 objectives. The team
was committed to making decisions through consensus,
normative group technique was employed to introduce the
topic, frame the question, provide time for introspection,
promote discussion, and come to a consensus. To support the
conduct of the protocol outside of the research meetings, the
methods leads (S.S. and V.R.) created recordings using a
webinar platform to demonstrate each task (eg, searching
literature, screening abstracts) and circulated these recordings to
the team so participants could review at their own pace.
Development of on Online, Interactive Evidence
Map Guided by Community Input
The initial product of our evidence review was a
spreadsheet of data elements extracted from the published
literature. We established a partnership with Aero Data Lab
(a project founded by SPH), which is an international col-
laboration of scientists, ethicists, and policy makers devel-
oping interactive, online evidence synthesis and data
visualization tools intended to enhance the transparency and
efciency of the research enterprise. One of the visualization
methods developed at Aero Data Lab is an outcome matrix,
which plots a sample of studies or trials by primary study
outcome along with the x-axis and intervention type along the
y-axis. We adapted this method, using arts-based inter-
ventions categories for the x-axis and patient populations for
the y-axis, to create an online, living evidence map of arts-
based interventions in health care (Fig. 2). The current
evidence map can be found at www.rhodeislandartsandhealth.
com/research-database.
Rening the evidence map required discussion and
iteration led by the CRPs. Training in evidence synthesis
and screening the abstracts prepared the CRPs for the rst
discussion on how to code the data, to distill the messages
of the evidence into something accessible to the reader but
not so much that the message is lost. The CRPs were very
keen to embrace the messinessas they would say, that
this eld includes many nuanced approaches to integrating
arts into health. They admonished that there is a danger in
oversimplication for the sake of neat packaging. A number
of CRPs made note that the training they received made
them feel more comfortable in these conversations and
pushing backon the researchers at the table. For example,
the CRPs expressed concern that the interventionsdid not
fully describe the use and uptake of arts-based interventions
in health care. The rst version of the map categorized the
interventions (x-axis) and populations (y-axis) according to
detailed descriptions in the article abstracts and full text.
However, this produced an unwieldy taxonomy, often
conating arts interventions delivered by trained art thera-
pists with those programs designed and delivered without
an art therapist. This obscured important insights
about patterns of effect and outcomes within and across
categories.
We thus worked collaboratively to identify a taxon-
omy of interventions that was robust enough to capture
sufcient detail and resonate with the local practice, but not
FIGURE 1. Training was completed in 3 phases (left, gray boxes) covering important topics (right) delivered over the course of 12
sessions.
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so detailed and heterogeneous that it rendered the map
incomprehensible. In this way, the CRPs provided critical
feedback on the proposed protocol for data extraction and
worked collaboratively with researchers to build a taxon-
omy that reected both the available evidence and the nu-
ance of how these interventions are applied in the
community. The community level perceptions are important
to building an evidence base poised for translation and
dissemination. Absent a robust understanding of how evi-
dence synthesis worked, the CRPs may not have raised the
issue, deferring to the research team, or would not have
been able to effectively collaborate to nd an appropriate
solution to their concerns.
RESULTS
Our CRPs screened over 6000 studies to ultimately
develop an evidence map yielding 481 studies, including
30,000 participants across all age ranges. The most fre-
quently studied populations include behavioral health, cancer
patients, and aging populations, which align with priorities set
forth by the Rhode Island Department of Health. The syn-
thesis of the evidence will be published in a forthcoming
manuscript with our community partners as coauthors.
The process of developing the protocol and reviewing
the literature with the CRPs led to robust discussions,
driven by evidence and supported by the local context. For
example, the map yields >80 studies on the role of dance
in neurodegenerative diseases, such as Parkinson disease.
One of our CRPs provides community-based dance classes
for Parkinson patients. Understanding the strengths and
limitations of evidence has led her to collaborate with local
neurologists to consider whether sufcient evidence exists
to develop local clinical practice guidelines for the use of
dance in this population and if these studies could be used
to support coverage of dance classes for these patients.
More generally, the CRPs were able to review the evidence
andidentifythatmanyartsinterventions and populations
participating in arts programming were not currently
represented in the literature. This is a valuable insight for
CRPs and stakeholders alike, as it clearly establishes where
there is a need for further research.
The interactive evidence map serves as a tool to navigate
the relevant, existing literature and the key features were in-
formed by our CRPs. The map provides information on studies,
locating them by the population of interest on the y-axis, coded
by their condition (ie, Cancer patients), by stage of life/age (ie,
Children), or by their role in health care (ie, Caregivers,
including clinical and family caregivers) derived from the text of
the publication. This coding was developed by the CRPs to
support the use of the map by health care providers and public
health professionals in the state as they consider interventions
for high priority populations, but also patients and families in-
terested in what works for themhowever, they dene them-
selves. The x-axis represents the types of arts-based
interventions, coded with support of our CRPs and stakeholders
from information provided by study authors.
Each bubble at the nexus of the population/intervention
descriptors represents an individual study identied in the liter-
ature, the size of the bubble indicates the total number of par-
ticipants in each study. Bubbles are semitransparent and darker
colors indicate multiple studies testing the same intervention/
population combination.
Using the cursor, the user can hover over a bubble to
reveal further detail about the studies. These details were con-
sidered as useful to all potential end users without presenting too
much information that may be useful to only a portion of the
audience. We take for example studies on ParkinsonsDisease
and Dance. Study details include the PubMed ID (if available),
Condition Detail (if provided in text), Number Enrolled in the
Study and Intervention Detail, if provided (in this case, the paper
is about a specictypeofdanceTangoand is therefore
specied). Clicking on a particular study will automatically link
to the abstract in PubMed.
The evidence map is accessible and available online
(www.rhodeislandartsandhealth.com/research-database) and,
FIGURE 2. The figure is a screenshot capture of the outcome matrix available as part of the interactive, online evidence map. The
y-axis represents the populations and x-axis represents the types of arts-based interventions, coded with support of our community
research partners and stakeholders from information provided by study authors. Each bubble represents an individual study
identified in the literature, the size of the bubble indicates the total number of participants in each study. Bubbles are semi-
transparent and darker colors indicate multiple studies testing the same intervention/population combination. ALS indicates
amyotrophic lateral sclerosis; COPD, chronic obstructive pulmonary disease.
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as part of the next phase of the project, will remain updated
with new studies and the CRPs are working to add new
functionality to make the map more meaningful to end users.
The evidence map also helped to demonstrate the
importance of high-quality study design and reporting. For
example, our CRPs observed that many studies could not be
included on the map because they failed to adequately de-
scribe their populations, interventions, or results. Other
studies were included on the map, but only reported out-
comes that were limited import to patients and communities
or did not seem to represent the lived experience or patients.
Our CRPs noted that this opportunity to critically appraise
the medical literature gave them a great perspective on how
studies can be designed to resonate more fully with the
needs of patients and communities. The CRPs were sur-
prised at the number of studies that only captured clinical or
biometric outcome measurements, for example, studies of
dance for patients with neurodegenerative disease. This was
seen as a missed opportunity to capture psychosocial out-
comes, dimensions of health care utilization and measures of
caregiver well-being.
Where many studies existed, the conversation included
discussion of qualityspecically how to measure quality in
these studies, how study quality would impact their decision-
making. These robust conversations were aided by having the
interactive tool to provide examples of key evidence syn-
thesis.
The inclusion of CRPs requires an extra commitment
by research methodologists to ensure they are trained and
supported throughout the process. In our project, attrition was
low, and our group maintained a quorum throughout. The
commitment required in terms of time and effort are not
nominal investments by CRPs or researchers. Translating
evidence into policy and practice is often a challenging en-
deavor and it is often easy to forget that communicating and
translating the methods and techniques of evidence synthesis
identifying, selecting, assessing and analyzing evidence
is important as well.
For the government stakeholders involved in this work,
the evidence map was used to support the development of
public health and clinical practice recommendations and to
inform their implementation strategies. These include the
alignment of the arts and health evidence map with the state
population health goals to determine if existing evidence can
be leveraged to support current public health programming,
promoting evidence-based arts-based interventions as part of
clinical practice and developing collaborations between artists
and researchers to document the role of arts in health care and
well-being.
Finally, the interactive map provided the CRPs with
user-friendly access to the results of their work. Advisory
Group members have already utilized the evidence map to
support grant applications to promote the uptake of arts-
based interventions to address the opioid crisis and
have received funding to ll evidence gaps identied by
the map.
Our project evaluation included an online survey and
debrieng sessions after each phase of the process and as
indicated by the CRPs. The survey measured indicators of
engagement in research as described in the Patient-Centered
Outcomes Research Institute (PCORI) Engagement Strat-
egy Rubric (ie, reciprocal relationships, partnership, co-
learning, transparency, honesty, and trust).12 The survey
revealed that our approach to evidence synthesis measured
high on all aspects of engagement. Participation also im-
proved CRPs condence in engaging with the health care
system, developed greater empathy and understanding of
others in the community and increased interest in using science
or research in advocacy efforts. We also measured the tangible
skills developed as part of our training, with most participants
indicating that they feel condent in their abilities to develop a
research question, search the medical literature, read a journal
article and identify a population, intervention or outcome in a
journal article. The strongest factors that motivated participation
in this work were helping patients receive better care, belief that
participation can result in meaningful ndings, receiving in-
formation on the research and how it is conducted. The majority
of our CRPs indicated that they are more likely to collaborate
with researchers after this experience.
CONCLUSIONS
Our case study demonstrates the feasibility and utility
of training CRPs in evidence synthesis methods to promote
the uptake and dissemination of evidence within the context
of public health policy and clinical practice. Stakeholders in
evidence synthesis play an important role in consulting and
informing on the composition and direction of the protocol
and nal reporting. The unique role of the CRP comple-
ments the stakeholder role by empowering nonresearchers to
participate in the research process. Our work indicates that
community-engaged evidence synthesis promotes com-
munity dialogue and engagement in research, specically
towards: (1) elucidating outcomes of import to patients and
communities that are not represented in the medical liter-
ature; and (2) identifying comparisons among interventions
that resonate with patients and communities.
Translating the ndings of evidence synthesis prod-
ucts into an interactive, online tool enabled richer engage-
ment with the parameters of the map. The online map
served an important role in fullling the commitments made
by the researchers to ensure that products of collaboration
were accessible and meaningful to community partners. The
stakeholders and audience of our report have demonstrated
that an accessible evidence map allows them to explore the
literature and understand the breadth, distribution, and gaps
in evidence.
There is an intrinsic and extrinsic benet for researchers
mentoring others in evidence synthesis and for community
partners acquiring the set of skills necessary to critically in-
terpret evidence and complete an evidence report. Or as one
of our CRPs put it: This project has allowed me to put
something back into the system that has nourished me, per-
sonally and professionally, for decades. Since entering this
world of scientic research in our eld, I view my interactions
with clients from a more rigorous and [with a] long-term
perspective.Community Research Partner, Rhode Island
Arts & Health Advisory Group.
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ACKNOWLEDGMENTS
The authors express their gratitude and all of the im-
portant contributions of our community research partners in
all aspects of our research and stakeholders for providing
thoughtful insights.
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... To develop recommendations, the advisory group undertook a systematic review of the published research on arts in health by codesigning and executing the protocol, culminating in a review of the existing literature on relevant artsbased interventions, reported as an evidence map (Springs et al., 2019). The map was created by the advisory group to inform understanding of the evidence for the purpose of supporting responsible policy development. ...
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In an arts in public health research team, artists may be undervalued as key research collaborators because of the difficulties in skillful integration of experts who possess not only different bodies of knowledge but also different ways of examining and valuing the world. Under the stewardship of two Rhode Island state agencies, an innovative research-driven enterprise, comprising researchers, clinicians, and community artists, was brought together to integrate arts-based interventions into statewide public health policy and practice. Here, we examine our work with the Rhode Island Arts and Health Advisory Group as a case study to illuminate our experiences in collaborating with artists on public health policy and practice research. Using existing frameworks from the literature, we define the attributes of, and challenges to, successful research collaborations and identify from our work how these apply to interdisciplinary collaborations between artists and public health practitioners. To support others working at the nexus of arts in public health, we include key experiences that were specific to the engagement of artists in research teams.
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Background: We completed a scoping review on the barriers and facilitators to use of systematic reviews by health care managers and policy makers, including consideration of format and content, to develop recommendations for systematic review authors and to inform research efforts to develop and test formats for systematic reviews that may optimise their uptake. Methods: We used the Arksey and O'Malley approach for our scoping review. Electronic databases (e.g., MEDLINE, EMBASE, PsycInfo) were searched from inception until September 2014. Any study that identified barriers or facilitators (including format and content features) to uptake of systematic reviews by health care managers and policy makers/analysts was eligible for inclusion. Two reviewers independently screened the literature results and abstracted data from the relevant studies. The identified barriers and facilitators were charted using a barriers and facilitators taxonomy for implementing clinical practice guidelines by clinicians. Results: We identified useful information for authors of systematic reviews to inform their preparation of reviews including providing one-page summaries with key messages, tailored to the relevant audience. Moreover, partnerships between researchers and policy makers/managers to facilitate the conduct and use of systematic reviews should be considered to enhance relevance of reviews and thereby influence uptake. Conclusions: Systematic review authors can consider our results when publishing their systematic reviews. These strategies should be rigorously evaluated to determine impact on use of reviews in decision-making.
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Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.
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The expansion of evidence-based practice across sectors has lead to an increasing variety of review types. However, the diversity of terminology used means that the full potential of these review types may be lost amongst a confusion of indistinct and misapplied terms. The objective of this study is to provide descriptive insight into the most common types of reviews, with illustrative examples from health and health information domains. Following scoping searches, an examination was made of the vocabulary associated with the literature of review and synthesis (literary warrant). A simple analytical framework -- Search, AppraisaL, Synthesis and Analysis (SALSA) -- was used to examine the main review types. Fourteen review types and associated methodologies were analysed against the SALSA framework, illustrating the inputs and processes of each review type. A description of the key characteristics is given, together with perceived strengths and weaknesses. A limited number of review types are currently utilized within the health information domain. Few review types possess prescribed and explicit methodologies and many fall short of being mutually exclusive. Notwithstanding such limitations, this typology provides a valuable reference point for those commissioning, conducting, supporting or interpreting reviews, both within health information and the wider health care domain.
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This review examined how to best communicate and disseminate evidence, including uncertain evidence, to inform health care decisions. The review focused on three primary objectives-comparing the effectiveness of: (1) communicating evidence in various contents and formats that increase the likelihood that target audiences will both understand and use the information (KQ 1); (2) a variety of approaches for disseminating evidence from those who develop it to those who are expected to use it (KQ 2); and (3) various ways of communicating uncertainty-associated health-related evidence to different target audiences (KQ 3). A secondary objective was to examine how the effectiveness of communication and dissemination strategies varies across target audiences, including evidence translators, health educators, patients, and clinicians. We searched MEDLINE®, the Cochrane Library, Cochrane Central Trials Registry, PsycINFO®, and the Web of Science. We used a variety of medical subject headings (MeSH terms) and major headings, and used free-text and title and abstract text-word searches. The search was limited to studies on humans published from 2000 to March 15, 2013, for communication and dissemination, given the prior systematic reviews, and from 1966 to March 15, 2013, for communicating uncertainty. We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, and abstractions, and quality ratings and group consensus to resolve disagreements. We used group consensus to grade strength of evidence. The search identified 4,152 articles (after removing duplicates) for all three KQs. After dual review at the title/abstract stage and full-text review stage, we retained 61 articles that directly (i.e., head to head) compared strategies to communicate and disseminate evidence. Across the KQs, many of the comparisons yielded insufficient evidence to draw firm conclusions. For KQ 1, we found that investigators frequently blend more than one communication strategy in interventions. For KQ 2, we found that, compared with single dissemination strategies, multicomponent dissemination strategies are more effective at enhancing clinician behavior, particularly for guideline adherence. Key findings for KQ 3 indicate that evidence on communicating overall strength of recommendation and precision was insufficient, but certain ways of communicating directness and net benefit may be helpful in reducing uncertainty. The lack of comparative research evidence to inform communication and dissemination of evidence, including uncertain evidence, impedes timely clinician, patient, and policymaker awareness, uptake, and use of evidence to improve the quality of care. Expanding investment in communication, dissemination, and implementation research is critical to the identification of strategies to accelerate the translation of comparative effectiveness research into community and clinical practice and the direct benefit of patient care.
Community-based Participatory Research: Assessing the Evidence (Evidence Report/ Technology Assessment No 99, Prepared by RTI-University of North Carolina Evidence-based Practice Center under Contract No 290-02-0016, AHRQ Publication 04-E022-2)
  • M Viswanathan
  • A Ammerman
  • E Eng
Viswanathan M, Ammerman A, Eng E, et al. Community-based Participatory Research: Assessing the Evidence (Evidence Report/ Technology Assessment No 99, Prepared by RTI-University of North Carolina Evidence-based Practice Center under Contract No 290-02-0016, AHRQ Publication 04-E022-2). Rockville, MD: Agency for Healthcare Research and Quality; 2004.
Finding What Works in Health Care: Standards for Systematic Reviews
  • Institute Of Medicine
Institute of Medicine. Finding What Works in Health Care: Standards for Systematic Reviews. Washington, DC: The National Academies Press; 2011.
Available at: www.pcori.org/sites/default/ files/Engagement-Rubric.pdf
  • Rubric Pcori Engagement
PCORI Engagement Rubric. PCORI (Patient-Centered Outcomes Research Institute); 2014. Available at: www.pcori.org/sites/default/ files/Engagement-Rubric.pdf. Accessed November 19, 2018.