Meta‐analysis is a method that combines estimates from studies conducted on different samples, in different contexts, or at different times. Social scientists increasingly use meta‐analyses to aggregate evidence and learn about general substantive phenomena. We develop a framework to examine the theoretical foundations of meta‐analysis, with emphasis on clarifying the role of external validity. We identify the conditions under which multiple studies are target‐equivalent, meaning they identify the same empirical target. Our main result shows that external validity and harmonization, in comparisons made and how outcomes are measured, are necessary and sufficient for target‐equivalence. We examine common formulations of meta‐analysis—fixed‐ and random‐effects models—developing the theoretical assumptions that underpin them and providing design‐based identification results for these models. We then provide practical guidance based on our framework and results. Our results reveal limits to agnostic approaches to the combination of causal evidence from multiple studies.
Easier said than done High-profile instances of police brutality in the last few years have brought attention to patterns of abuse that have existed since the inception of modern policing. There have been many calls for police reform, a process that in many countries has taken the form of increased police engagement with communities. Blair et al . report the results of a large-scale experiment testing the effectiveness of this approach across six countries in the Southern Hemisphere (see the Perspective by Tobon). They found that such community engagement did not increase trust in the police and it did not reduce crime. Improving relationships between police and community may require deeper structural changes before or in addition to approaches such as community policing. —SNV
BackgroundThe need for palliative care in sub-Saharan Africa is staggering: this region shoulders over 67% of the global burden of HIV/AIDS and cancer. However, provisions for these essential services remain limited and poorly integrated with national health systems in most nations. Moreover, the evidence base for palliative care in the region remains scarce. This study chronicles the development and evaluation of DataPall, an open-source electronic medical records system that can be used to track patients, manage data, and generate reports for palliative care providers in these settings.DataPall was developed using design criteria encompassing both functional and technical objectives articulated by hospital leaders and palliative care staff at a leading palliative care center in Malawi. The database can be used with computers that run Windows XP SP 2 or newer, and does not require an internet connection for use. Subsequent to its development and implementation in two hospitals, DataPall was tested among both trained and untrained hospital staff populations on the basis of its usability with comparison to existing paper records systems as well as on the speed at which users could perform basic database functions. Additionally, all participants evaluated this program on a standard system usability scale.ResultsIn a study of health professionals in a Malawian hospital, DataPall enabled palliative care providers to find patients’ appointments, on average, in less than half the time required to locate the same record in current paper records. Moreover, participants generated customizable reports documenting patient records and comprehensive reports on providers’ activities with little training necessary. Participants affirmed this ease of use on the system usability scale.ConclusionsDataPall is a simple, effective electronic medical records system that can assist in developing an evidence base of clinical data for palliative care in low resource settings. The system is available at no cost, is specifically designed to chronicle care in the region, and is catered to meet the technical needs and user specifications of such facilities.
Pervasive overuse and degradation of common pool resources (CPRs) is a global concern. To sustainably manage CPRs, effective governance institutions are essential. A large literature has developed to describe the institutional design features employed by communities that successfully manage their CPRs. Yet, these designs remain far from universally adopted. We focus on one prominent institutional design feature, community monitoring, and ask whether nongovernmental organizations or governments can facilitate its adoption and whether adoption of monitoring affects CPR use. To answer these questions, we implemented randomized controlled trials in six countries. The harmonized trials randomly assigned the introduction of community monitoring to 400 communities, with data collection in an additional 347 control communities. Most of the 400 communities adopted regular monitoring practices over the course of a year. In a meta-analysis of the experimental results from the six sites, we find that the community monitoring reduced CPR use and increased user satisfaction and knowledge by modest amounts. Our findings demonstrate that community monitoring can improve CPR management in disparate contexts, even when monitoring is externally initiated rather than homegrown. These findings provide guidance for the design of future programs and policies intended to develop monitoring capabilities in communities. Furthermore, our harmonized, multisite trial provides sustainability science with a new way to study the complexity of socioecological systems and builds generalizable insights about how to improve CPR management.
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