Establishing the Effectiveness of Public Health Interventions Using Sequential Meta-Analysis: Case Study Using Stair-Promotion Interventions

Abstract

In this role she teaches medical students about the importance and principles of public health, and particularly the primary prevention of chronic disease. Her research area is physical activity and public health, where she aims to advance knowledge and understanding of 'what works' to get populations more active to reduce the burden of noncommunicable diseases. Karen's interest in this field spans the measurement of physical activity, population level interventions, evaluation and policy research. She has been involved in developing national and international physical activity recommendations as well as supporting a range of countries to develop national physical activity strategies. Karen spends her spare time being active and is a keen open water swimmer. Published ArticlesBauman A, Milton K, Kariuki M, Fedel K, Lewicka M. Is there sufficient evidence regarding signagebased stair-use interventions? A sequential meta-analysis. BMJ Open. 2017; 7: e012459. AbstractPrevention trials often generate significant health or risk factor improvements, but these improvements are limited to the selected samples of people enrolled in these studies. In order to make population health gains, we need to develop methods for translating evidence from these trials into practice at the broader community and population levels. One barrier to this process is researchers themselves, who conduct replications of small-scale trials, rather than conducting intervention research at scale. Our example of this is interventions to encourage short episodes of physical activity through signs promoting stair use. We pooled the evidence from these interventions from 1980 to 2014. We carried out a meta-analysis to estimate the proportion of people that changed from the elevator to the stairs following the introduction of signage. Our innovation was to use a sequential meta-analysis method, usually described in relation to clinical settings and trials. We used this method to estimate when there was sufficient evidence of stair-sign effectiveness for public health actions to be scaled-up, and we found this was around 2006. Studies since then have not contributed new evidence to the field. Methods here enabled us to see when policymakers should have implemented this intervention to the community at large, and researchers then should have focused their investigations on identifying barriers and facilitators to their implementation and assessing intervention effects at scale. Learning OutcomesDescribe the research evidence that is generated by individual studies in stair use promotion Outline the transferability of research methods across disciplines Explain the purpose and usefulness of sequential meta-analysis Discuss the applicability of sequential meta-analysis to public health interventions Appreciate the need for research translation of effective interventions Case Study