Reilly, R., Harfield, S., Evans, K., Warren, S., Peters, M., Cass, A., Brown, A., Gorham, G., Gomersall, J. (2015) Systematic review using the JBI Mixed Method approach: An application using diverse evidence from Aboriginal and Torres Strait Islander healthcare JBI International Methodology Symposium 3 – 4 September 2015
Background: Traditionally systematic review was limited to the synthesis of evidence from randomised controlled trials addressing questions of treatment efficacy to inform clinical decision making. Over time the scope of systematic review has expanded and institutes like the Joanna Briggs Institute (JBI) now offer guidance and tools to support the review of diverse types of evidence and even text-based expert opinion. Method guidance for a mixed-method review that synthesises diverse types of evidence is a recent methodological development of the Institute. This presentation reports the process and tentative findings of a recently conducted review that set out to use the JBI mixed method approach.
Methods: The review sought to synthesise quantitative, economic and qualitative evidence on outpatient chronic kidney disease management programs for Indigenous people in Australia, New Zealand and Canada. The review addressed questions relating to their clinical effectiveness, cost effectiveness and acceptability, as well as barriers and facilitators of implementation. The JBI mixed-method review process was followed according to best practice guidelines and JBI tools for critical appraisal and data extraction were used for each evidence type.
Results: Six quantitative studies, 2 economic and 2 qualitative studies were included in the review. These were from geographically and culturally diverse populations in New Zealand and Australia. They provided evidence of effectiveness on a range of relevant clinical indicators, some limited evidence that programs that slow progression of CKD are a good investment, and that insufficient funding may prevent the delivery of best practice care. Service-provider experiences revealed a range of factors that are likely to facilitate the implementation of appropriate and effective CKD care for Indigenous people.
Discussion: The review highlights the value of including diverse forms of evidence in reviews for informing policy and clinical decision making and the challenges confronting reviewers when the studies identified are few and have very different population and intervention characteristics. It raises the question of when it is more appropriate to use the JBI mixed method versus comprehensive versus completely segregated systematic review approach. This is particularly important in relation to questions on Indigenous health, where attempting to synthesise evidence derived from complex settings and diverse socio-cultural environments may not be straight-forward or appropriate.
Rachel Reilly, Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, North Tce, Adelaide, 5000 Rachel.Reilly@sahmri.com