A Rapid Literature Review of Multi-Criteria Decision Support Methods in the Context of One Health for All-Hazards Threat Prioritization

Abstract

BackgroundMulti-Criteria Decision Analysis (MCDA) is a decision support tool that can be used in public health emergency management. The use of a One Health lens in MCDA can support the prioritization of threats and interventions which cut across the human, animal, and environmental domains. Previous literature reviews have focused on creating a snapshot of MCDA methodological trends. Our study provides an update to the MCDA methods literature with key considerations from a One Health perspective and addresses the application of MCDA in an all-hazards decision-making context.MethodsWe conducted a literature search on MEDLINE, EMBASE, SCOPUS, the CAB database, and a limited online gray literature search in partnership with a librarian from Health Canada. Articles were limited to those published in the year 2010 or later in a high-income setting (OECD member countries).ResultsSixty-two articles were included for synthesis. Of these articles, most were Canadian studies (20%); and prioritized health risks, threats, and interventions in the human domain (69%). Six commonly used prioritization criteria were identified: threat, health, intervention, strategic, social, and economic impact. Stakeholders were engaged in 85% of studies and commonly consisted of government groups, non-governmental groups, subject matter experts, and the public. While most articles (65%) included elements of One Health based on our definition, only 5 studies (9%) explicitly acknowledged One Health as a guiding principle for the study. Forty seven percentage of studies noted that MCDA was beneficial in supporting the decision-making process.ConclusionCurrent literature on health prioritization presents some variability in the depth of integration of the One Health framework and on the use of various MCDA methodologies given prioritization objectives. Studies which applied a comprehensive One Health approach, prioritized disparate threats, or conducted cyclical prioritizations for governing bodies were broad in scope, but sparse. The results of our review indicate the need for better guidance on the integration of a One Health approach and the use of various MCDA methods given the main prioritization objectives.

Prioritisation processes for programme implementation and evaluation in public health: A scoping review

“…Overall, we found that 14 literature sources gave evidence for use or utility of the frameworks or criteria to some extent, based on actual observations, a formal assessment or anecdotal evidence ( 4 , 10 , 17 , 20 , 21 , 23 , 25 , 27 , 29 – 32 , 39 , 40 ).…”

“…The remaining nine “specific” papers had a greater focus on the prioritisation of specific public health interventions and policies and frequently cited criteria relating to “social considerations” ( n = 7), as well as “equity/fairness/ethics/equality,” “political considerations” and the “feasibility” and “cost-effectiveness” of the programmes/interventions/policies ( n = 6 each) ( 4 , 16 , 18 , 19 , 28 , 33 , 39 , 46 , 47 ). Studies categorised as “generic” ( n = 26) had a broader focus on public health interventions or multiple disease areas/risk factors ( 3 , 5 , 8 , 10 , 15 , 17 , 20 – 24 , 26 , 29 , 30 , 34 – 38 , 41 – 45 , 48 , 49 ). These studies frequently cited criteria relating to “burden of disease” ( n = 23), “health impacts of the intervention” ( n = 22), and “social considerations” ( n = 19).…”

“…For instance, decisions made at micro and meso levels often involved stakeholders from local public health bodies and regional level commissioners ( 3 , 5 , 8 , 15 , 19 – 24 , 26 , 29 , 30 , 37 , 41 , 43 ). Macro-level prioritisation was centred on decision-making at a country level and involved national government officials and directors of national public health organisations ( 4 , 8 , 15 , 17 , 18 , 25 , 28 , 31 , 32 , 35 , 36 , 38 , 40 , 47 ).…”

“…Overall, 27 of the included studies in this review reported on the approaches or processes used to carry out the prioritisation process such as multi-criteria decision analysis (MCDA), programme budgeting and marginal analysis (PBMA), accountability for reasonableness (A4R) and the Delphi process. Eight of the primary studies as well as in primary studies included in four reviews used MCDA, which was the most used method for prioritisation ( 8 , 10 , 15 – 17 , 23 , 27 , 28 , 40 , 41 , 43 , 50 ). Four studies used the PBMA approach ( 16 , 21 , 29 , 30 ).…”

“…Five sources provided empirical or quantitative assessments or evidence of utility ( 17 , 23 , 25 , 29 , 30 ). The first assessed stakeholder views on the usefulness of the RKI pathogen prioritisation process via a survey ( 25 ).…”