Healthcare professionals may practice differently because they are afraid of litigation or patient complaints. If so, this could lead to lower-quality care and unnecessary costs. We aimed to find out how clinicians understand these issues, and how so-called ‘defensive practice’ might impact on healthcare delivery.
A qualitative evidence synthesis was conducted, to explore young people’s experiences of online ED content.
To ensure that the work was relevant to the current UK context it was informed by stakeholder involvement.
A systematic map of evidence on specialist adult services for victim-survivors of sexual violence
and abuse, including:
- studies of people’s views about services in the UK
- evaluations of interventions (using controlled and before-and-after designs, and cost-effectiveness studies) from OECD countries,
- systematic reviews containing these kinds of studies
To inform their development of a Long COVID plan, and support future policy and service delivery, the Department of Health and Social Care in England requested regular evidence scans of the Long COVID literature. Regular updates are provided on two strands of research:
a) published and ongoing systematic reviews on Long COVID.
b) published randomised controlled trials evaluating treatment or rehabilitation for Long COVID.
Digital interventions can play a number of different roles to support behaviour change in the prevention, treatment of and recovery from alcohol and drug misuse. A systematic map was conducted to answer the following:
1) What is the possible range of digital alcohol and drug interventions?
2) Which types of interactive digital alcohol and drug interventions are currently available for use by service users and individuals in England?
3) What systematic reviews provide findings for digital alcohol and drug interventions at each point along the prevention/treatment/recovery pathway?
4) Which types of digital alcohol and drug interventions have been evaluated in primary research?
This review addresses the question: what is known from qualitative research about the views or experiences of patients, clinicians, families or other stakeholders regarding under- and overtreatment at the end of life?
This database contains a brief overview of 194 systematic reviews on the acceptability and uptake of vaccines for children, young people and adults, published between 2010 and 2020*. It provides the user with information about the broad scope of the reviews, in terms of their overall aims and vaccine and population focus.
The term ‘precision public health’ (PPH) refers to the use of novel data sources and/or computer science-driven methods of data analysis to predict risk or outcomes, in order to improve how interventions are targeted or tailored. Data may include, for example, information from social media or devices, genomic or clinical data, and information from healthcare services.In this critical review, a pragmatic non-systematic review was conducted to outline key assumptions underpinning the PPH approach and identify potential challenges in its application.
Against a backdrop of mandatory social distancing during the COVID-19 pandemic, this review sought to understand how remotely delivered interventions to reduce social isolation and loneliness among older adults may be effectively delivered.
In response to the COVID-19 pandemic, we are maintaining an up-to-date map of the current evidence that we partition into broad domains for easy exploration.
We sought to understand how people affected by adverse childhood experiences (ACEs) can best be supported. In order to address this, we conducted a review of evidence which involved three components: a qualitative synthesis of UK views studies; a systematic review of reviews which measured the effectiveness of interventions to support people affected by ACEs; and a stakeholder workshop with young people with lived experience of ACEs.
A systematic map of the research literature that has investigated the effectiveness and appropriateness of public health services that are currently provided by community pharmacies.
Energy drinks containing caffeine are increasingly part of everyday life. There is concern in the UK about the consumption of caffeinated energy drinks (CEDs) among young people under age 18. As no upper limit of caffeine intake has been established for young people, calls have been made to regulate energy drink sales to those under 18 years.
The use of screen-based electronic devices plays a central part in the lives of many children and young people (CYP), though this raises concerns about their possible impact on CYP’s mental health and psychosocial wellbeing. This systematic map of relevant reviews was commissioned by the National Institute for Health Research (NIHR) Policy Research Programme (PRP) for the Department of Health and Social Care and will be of interest to policymakers, practitioners, and researchers.
This systematic review was commissioned by Public Health England. The aim was to help decision-makers, such as service commissioners and providers in Local Authorities in the UK, determine which kinds of LWMPs for children aged 0-11 years they should be providing. The novel systematic review methods used will be of interest to researchers examining complex interventions.
This review was commissioned by the DHSC and the NHS Social Care Medicines, Diagnostics and Personalised Medicines Unit. Findings will be of interest to local commissioners, health practitioners and managers, patients, members of the public and researchers.
The broad aim of this review, is to explore the factors that may enhance, or limit, the effectiveness of interventions or services designed to promote self-care for minor ailments and to synthesise evaluations of existing interventions/services to estimate their effectiveness.
This systematic review provides policy-makers and people involved in delivering vaccination promotion interventions with an overview of what is known about HCWs’ perceptions and attitudes. The focus on qualitative evidence and contextual data from intervention studies can help us to understand what problems may be encountered in implementing interventions, and also to gain a broader and more critical understanding of the contexts of vaccination promotion.
Our work focused on the nature and extent of empirical research evidence on Lyme disease in humans, within four separate review areas:
- Lyme surveillance: What is known about the completeness of surveillance data from studies which compare different data sources?
- Experiences of diagnosis: What are patients’, clinicians’ and researchers’ perspectives and experiences of diagnosis of Lyme disease?
- Experiences of treatment: What are patients’, clinicians’ and researchers’ perspectives and experiences of treatment of Lyme disease?
- Prevention: What is the effectiveness and UK applicability of interventions?
This review was commissioned to inform considerations around the potential to develop an administrative compensation scheme for medically acquired birth injury in England. The overall aim was to develop preliminary theoretical frameworks of the mechanisms that might influence engagement in ‘no-fault type’ compensation schemes and that might influence outcomes for affected individuals and families.
People with autism spectrum disorder without learning disability (‘high-functioning’ autism or HFA) often experience social isolation, difficulties with activities of daily living, unemployment, and mental and physical health problems. Current guidance in England recommends that local authorities provide preventive ‘low-level’ support for adults with HFA, including social support, practical assistance and access to services. This project evaluated the effects of all forms of supportive intervention for adults with HFA. It also involved mapping current practice to provide an overview of services for adults with HFA in England.
The aim of this review was to provide guidance on what a good (tier 2) lifestyle weight management service “looks like”, identifying the kinds of services which should be commissioned in particular situations. The systematic review involves: a) a fine-grained analysis of the key features of weight management programmes and the contextual features which may affect their success, b) an in-depth analysis of studies that report people’s experience of weight management services to identify the barriers to and facilitators and c) an exploration of the intervention features, contextual issues and identified barriers/facilitators that are present/absent in the most successful interventions.
Focussing on the cost-effectiveness of UK-based studies, and of contraception and health promotion interventions, this review supported program commissioning decisions taken by local authorities. Findings will be of interest to local commissioners, sexual health practitioners and managers, advocacy groups and researchers.
This review sought to understand whether workplace health programmes are effective for improving health and business outcomes, and to identify the characteristics of WHPs that are thought to influence their success. To address these issues, we undertook a systematic review of three sources of evidence: systematic reviews examining intervention effectiveness; research on stakeholders’ views and experiences; and key workplace health policy documents.
Rates of mental health service use appear to differ between some ethnic groups and individual survey analyses indicate that the prevalence of mental ill-health in the English general population may be greater in some minority ethnic groups than others. This review used systematic methods to seek findings about the prevalence of different mental health disorders in different ethnic groups in the UK, and describe the extent and nature of the available survey evidence.
Highly active antiretroviral therapy (HAART) is the current standard treatment for individuals co-infected with HIV and hepatitis C. The impact of HAART and antiretroviral (ARV) monotherapy on liver disease in this population is unclear. This systematic review aimed to evaluate the effect of HAART and ARV monotherapy on liver disease progression and liver-related mortality in individuals co-infected with HIV and hepatitis C, including in patients with haemophilia.
This report takes the form of a systematic map examining the volume and nature of research concerning sex-selective abortion. The map is not intended to supply an answer to the question ‘What is the extent of sex-selective abortion in England, Wales and Scotland?’ Rather, the aim is to describe the volume and key characteristics of research in this area, i.e., to identify and describe the research that has been carried out.
This project was commissioned by National Institute for Health and Care Excellence (NICE) in order to provide updated evidence to inform NICE community engagement guidance. This was undertaken as an update and expansion of a previous EPPI Centre review of community engagement (O’Mara-Eves et al. 2013).
Individuals infected with hepatitis C virus (HCV) can develop extrahepatic conditions which may have a significant impact on life expectancy and quality of life. We conducted a systematic review to assess the causal relationship between HCV and extrahepatic conditions and the impact of HCV upon health-related quality of life in the UK.
Paediatric medication errors (PME) have the potential to cause unnecessary pain or harm to child patients and, in extreme cases, can result in death. This review examines evidence on three key issues: the extent and nature of the problem in the UK; whether interventions, such as electronic prescribing, can reduce PME incidents; and how to develop and implement effective interventions.
The review has been conducted in the context of high levels of concern about obesity in children in the UK. Children are likely to experience immediate physical and psychosocial problems as a result of being obese and are at a higher risk of obesity as they grow older. Increases in obesity also represent considerable financial costs. Children’s attitudes to and beliefs about their bodies, which can include high levels of body dissatisfaction, have also raised concern.
This review was used to inform an expert review of the regulation of cosmetic procedures headed by Sir Bruce Keogh for the UK Secretary of State for Health. It addresses a range of questions, key to current debates on which population groups undergo these procedures, the risk of poor outcomes, informed consent, and the ability to screen for pre-existing conditions.
An overview of systematic reviews that examine the efficacy of social care interventions for supporting the four outcomes set out in the Adult Social Care Outcomes Framework (ASCOF): quality of life, delaying and reducing the need for support (prevention), satisfaction with services, and safeguarding of vulnerable adults. The overview examines which social care interventions evaluated in systematic reviews have been found to be effective, which have not been found to be effective and which have been found to be harmful. The overview also examines evidence on how much impact effective social care interventions have.
Delayed diagnosis results in serious consequences for patients and healthcare professionals and can incur substantial financial costs. While research focusing upon cancer suggests that late diagnosis leads to increased morbidity and mortality, the evidence for other conditions is less clear. The report describes the nature and extent of the literature on late diagnosis across other conditions.
Despite current clinical guidance which recommends the use of non-pharmacological approaches (treatments or therapies other than medication) to improve behavioural and psychological symptoms in patients with dementia, the widespread use of antipsychotics for these patients continues. We carried out an ‘overview’ of reviews which involved examining thirty recent systematic reviews in order to summarise their results on the effectiveness of alternative treatments.
This systematic review was commissioned to provide a comprehensive overview of evidence on the impact of plain packaging in order to inform a public consultation on the issue.
Following recent interest in community-based courses aimed at adults who want to learn to cook, this systematic review aimed to identify the kinds of home cooking course that have been evaluated in the UK and to summarise findings from reliable evaluations.
This report describes the findings and methods of a systematic review of research exploring how young people aged 11-18 years access tobacco in the UK. The research sought to understand the relative importance of both retail and social sources of tobacco for young people. It was commissioned to support policy development to reduce young people's rates of smoking.
The birth of a first child is an important change for women and for families. The aim of this systematic review was to collect and analyse research studies examining women’s experiences of having their first child by asking questions about what research has been undertaken that studies the influences, identified by women, which affect them in becoming a mother and how these influences changed since the 1970s. The research was funded by the UK Economic and Social Research Council.
This report describes the findings and methods of a systematic review of research that explores the relationship between obesity and educational attainment in childeren and young people.
The review explores the socioeconomic value of nursing and midwifery, focussing particularly on the areas of mental healthcare, healthcare for chronic and long-term conditions, and the effects of role substitution between different healthcare providers. The review was undertaken to inform the work of the Prime Minister’s Commission on the Future of Nursing and Midwifery.
This review examines recent research findings from the UK where children aged from four to eleven provide views about their own body sizes or about the body sizes of others. Such perspectives can inform the ways in which interventions to prevent or deal with obesity aim to bring about positive outcomes. The review has been conducted in the context of high levels of concern about obesity in children in the UK. It is hoped that it will help inform policy and the commissioning of further research in ways that put children’s experiences in the forefront.
There is considerable interest in the use of ‘incentive’ or ‘reward’ schemes to encourage healthy behaviours. The scoping review assesses the extent and nature of the international research literature on incentives in the areas of physical activity and healthy eating, weight management and smoking cessation. One hundred and twenty-eight records of trials, RCTs and systematic reviews were identified.
The aim of this report is to increase what is known about promoting good mental health and mental health inequalities. It focuses on the role of interventions based on the techniques of cognitive behavioural therapy (CBT)for preventing and reducing suicidality, depression and anxiety in young people. A further aim of the study is to use the systematic review as a case-study to applying an ‘equity lens’ to a review topic, by building on work completed in an earlier systematic map and methodological review.
Targeted Youth Support (TYS) is an initiative aimed at vulnerable young people and involves ensuring that agencies work together to meet young people’s needs. The initiative’s rationale is that a collaborative, ‘joined-up’ approach is needed because young people may have complex and multiple needs which cannot be met by mainstream or specialist services in isolation. This report was commissioned by the Department for Children, Schools and Families (DCSF) to explore what works for young people in relation to the outcomes prioritised by the TYS initiative.
Health inequalities are recognised as an important problem nationally and internationally. There is policy interest in improving the health of the most disadvantaged, reducing the gap between the most and least disadvantaged, and reducing gradients across the whole population. This report describes an attempt to look at how much health promotion and public health research relating to young people has tackled health inequalities, and in what ways it has done this.
Since 2004, tackling obesity has been a policy priority for the UK government and efforts have particularly focused on halting the increases in childhood obesity. This work aimed to locate and describe existing review-level evidence on the effectiveness of social and environmental interventions for the prevention or reduction of obesity and overweight, with its focus on evidence relating to children and young people.
For research to be credible, relevant and ethical it needs to reflect the diversity and multi-cultural nature of our society. This report combines a review of relevant literature with an in-depth look at research practice to examine the extent to which socially diverse populations have been, or might be, reflected in research. While the work has a focus on health promotion and public health research with children and young people, its key messages are relevant to research in all topics with a range of age groups.
Both internationally and in the UK, there is widespread concern about rising rates of overweight and obesity and the consequences of this for individuals, for population health and for the wider society. This concern is not yet matched by either a clear map of interventions provided for children and young people or a robust evidence base on the effectiveness of interventions. The potential range of such interventions is very wide, with sound evaluation facing both methodological and practical challenges.
While the randomised controlled trial (RCT) is generally regarded as the design of choice for assessing the effects of health care, within the social sciences there is considerable debate about the relative suitability of RCTs and non-randomised studies (NRSs) for evaluating public policy interventions. This review aims to determine whether RCTs lead to the same effect size and variance as NRSs of similar policy interventions; and whether these findings can be explained by other factors associated with the interventions or their evaluation.
In industrialised countries such as England and Wales, unintended injury (which ranges from sprains in sport to hospitalisation and death due to drugs or transport crashes) is the leading cause of death in children aged 0 to 14 years, and a major cause of death in young adults aged 15 to 24. It is also a major cause of ill health and disability in these age groups. There is a large body of research on young people and their perceived propensity to take risks. Common sense suggests that an increased willingness to place oneself at risk will result an increased likelihood of physical injury. However, given that pathways to injury are complex and not always well understood, the UK Department of Health commissioned a large systematic review to examine this multifaceted issue.
'Life checks' have been proposed by the English Department of Health as a personalised service providing support and advice at key stages throughout the lifespan to help people to maintain and improve their health. For young people, the proposed key stage for a life check is the transition between primary and secondary school sat ages 11 to 12 years. This review was a scoping exercise to identify the size and scope of the available research evidence relevant to the life check proposal for young people.
The James Lind Alliance has been funded by the Medical Research Council (MRC) and the Department of Health to foster discussion among patients and clinicians (doctors, nurses, therapists, and others who treat patients) about variations in health care practice and the related unanswered research questions about the effects of care. The Alliance has assembled an initial bibliography of reports of studies comparing patients’ and clinicians’ research questions and outcome priorities with researchers’ priorities or activities relevant to this aim. It was not known whether there were other, similar studies that could inform discussions among patients and clinicians, by reporting either their ideas about priorities for new research, or ways in which these priorities might be identified.
There is widespread concern about the decrease in physical activity and the increase in obesity and chronic diseases in the UK, especially among children and young people. There is also considerable interest in the social and environmental benefits of a shift away from car travel to non-motorised forms of transport, such as walking and cycling. Walking and cycling provides people with the opportunity to build physical activity into their daily lives. This systematic review brings together the relevant research literature to examine children’s, young people’s and parent’s views about what helps and hinders them in walking and cycling to school, and combines these with the results of a recent systematic review of the effectiveness of interventions to promote a shift from car travel to more active forms of transport.
There is widespread policy concern with high rates of unintended teenage pregnancy in the UK, the highest in Western Europe. Social disadvantage and teenage pregnancy are strongly related. This review systematically examines research relating to policy initiatives aimed at tackling the social exclusion associated with unintended teenage pregnancy and young parenthood. Two separate reviews of evidence were conducted: a review of evidence relating to the prevention of unintended pregnancy; and a review of the research evidence relating to the support of teenage parents.
There is considerable and growing, interest in the possibility that providing direct incentives of one kind or another can encourage healthy behaviours. This systematic review brings together the relevant research literature to examine the impact of single or dual component incentives schemes in encouraging positive health and other social behaviours in young people aged 11-19. It also examines ongoing incentive-based schemes in more detail.
There is considerable policy interest in the use of incentives to promote positive behaviour in children and young people. However, there is uncertainty about whether this approach works, and if so, what the underlying mechanisms are. This report summarises ongoing activity in the use of incentive schemes both in the UK and internationally.
There is considerable policy interest in the use of incentives to promote positive behaviour in children and young people. However, there is uncertainty about whether this approach works, and if so, what the underlying mechanisms are. There is no recent evidence-based summary of the international research literature to inform policy decisions. This review is a scoping exercise to identify the nature and extent of a) international research studies evaluating incentive schemes and b) ongoing incentive schemes in the UK.
Cigarette smoking in pregnancy is common, particularly where there is low income and social disadvantage. Smoking in pregnancy increases the risk of babies having low birthweight and being born too early. Babies often struggle to cope with life outside the womb and can suffer ill health later in life. Many mothers find it hard to stop, or to reduce, smoking during pregnancy even knowing the benefits this may have, because smoking can help them cope with stress. We wanted to know what are the effects of smoking cessation programmes for pregnant women and how relevant are they to women’s concerns and for guiding the how programmes are conducted.
Men who have sex with men (MSM) remain the group at greatest risk of acquiring HIV infection in the UK, and initial behaviour changes to reduce the risk of HIV are not being maintained. This review analyses and synthesises the findings from studies of the views and experiences of MSM concerning HIV-related sexual health, and integrates these with findings from effectiveness studies.
How are consumers involved in deciding what research should be undertaken, and do they have any influence? What helps or hinders their influence?
Healthy eating is encouraged amongst children in the belief that they will benefit from the long term physiological consequences of a good diet in childhood, and that healthy eating in childhood is more likely to lead to healthy eating later in life. An over-consumption of energy-dense foods has been linked with obesity, and the proportion of children classed as obese is rising. Diets high in fruit and vegetables have been associated with reductions in a range of diseases. Recent surveys have found that British children are eating less than half the recommended five portions of fruit and vegetables per day. There is also evidence to suggest that material and social context affect children’s intake. This report describes a systematic review aiming to survey what is known about the barriers to, and facilitators of, healthy eating amongst children aged four to 10 years old. It focuses in particular on barriers and facilitators in relation to fruit and vegetables.
Physical activity promotion is high on the public health policy agenda in the UK. Evidence regarding increased prevalence of obesity and inactivity amongst children in the UK is mounting. Children are a particularly important group, as low levels of physical activity in childhood have been linked with low levels in adulthood. Material and social context affect children's participation in physical activity, with those at greatest risk of inactivity belonging to groups considered to be 'socially excluded'.This review was undertaken to address what is known about the barriers to, and facilitators of, physical activity amongst children aged four to 10. It aimed to bring together the findings from 'qualitative' as well as 'quantitative' research on these barriers and facilitators.
Suicide prevention amongst young men aged under 35 is an urgent health policy priority in the UK. Although there is currently an incomplete picture of risk and protective factors, promising health promotion approaches may include strengthening communication and support for problems between young men and their peers, families, friends, advice services, GPs, and other professionals. This project undertook a scoping exercise to identify whether systematic reviews which might help to identify effective health promotion interventions of relevance to suicide prevention amongst young men aged 19-34 have already been carried out; and if not, what a new review in this area might look like.
This review synthesises the results of three previous reviews:
- Young people and mental health: a systematic review of research on barriers and facilitators
- Young people and healthy eating: a systematic review of research on barriers and facilitators
- Young people and physical activity: a systematic review of research on barriers and facilitators
Physical activity promotion is high on the health policy agenda in the UK. Evidence regarding increased prevalence of obesity and inactivity amongst young people is mounting. Our objectives were to provide a summary of evidence to help develop, implement and evaluate interventions for promoting physical activity amongst young people. We had a particular focus on young people from socially excluded groups and upon interventions targeting structural or environmental barriers to physical activity (e.g. poor access to facilities).
The promotion of good nutrition is high on the health policy agenda in the UK. Young people are a particularly important group, as poor eating habits established during teenage years may be maintained into adulthood, creating a number of cardiovascular and other health-related problems later in life. Putting policy into practice means developing and implementing effective interventions for, and with, young people. Our objectives were to provide a summary of evidence to help develop, implement and evaluate interventions for promoting physical activity amongst young people. We had a particular focus on young people at greatest risk for poor nutrition from socially excluded groups and upon interventions targeting ‘structural’ or ‘environmental’ (e.g. access to healthy foods) barriers to healthy eating.
Promoting good mental health has been identified as a high priority for health policy, and young people are a key group for action. Our objectives were to provide a summary of evidence to help develop, implement and evaluate interventions for promoting good mental health amongst young people. We had a particular focus on young people from socially excluded groups and upon interventions to prevent suicide and self-harm, and associated depression, and the promotion of self-esteem and coping strategies.
Using peers to deliver health promotion interventions to young people is an increasingly fashionable strategy, especially in Europe and North America. It is based on the assumption that peers may be seen as more credible sources of information than adult, professionally trained, health educators, and may be particularly helpful in reaching 'at risk' young people. The review critically examined the claim that the peer-delivered approach is a more appropriate and effective method of promoting young people's health than traditional ones.
This study investigated the methods used to conduct; reviews of the effectiveness of health promotion interventions. It aimed to determine how different review methods affected the conclusions drawn, and to make recommendations on how effectiveness reviews in health promotion should be carried out.
With a growing commitment to evidence-based health services, there is an urgent need for information about the effectiveness of health promotion to be readily available and understood by people providing and purchasing services. The aim of this project was to help people purchasing and providing health promotion services develop the skills they need to make sense of evidence about effectiveness.
We aimed to explore the literature on health promotion for young people, specifically in the areas of accident prevention, mental health, nutrition, physical activity, sexual health and substance abuse, in order to describe the needs and views of young people with respect to their health and the range of interventions undertaken, and to make recommendations for future research.
Men who have sex with men are the largest group of people affected by HIV/AIDS in the industrialized west. There are indications that the behavioural changes of the early 1980s in the direction of safer sexual behaviour have not been maintained. This study identifies and critically reviews health promotion interventions in HIV prevention and sexual health for men who have sex with men, in order to inform future prevention strategy in the UK.
Reports available offline
Some of our older reports are currently only available in print format. To obtain these, please contact us:
Effectiveness of health promotion interventions in the workplace: a review (1998) available from the Health Development Agency [updated]
Review of effectiveness of sexual health promotion interventions for young people (March 1996)
Review of effectiveness of health promotion interventions to prevent accidents in older people (June 1995)
Young people and smoking (May 1995)
Review of effectiveness of workplace health promotion interventions