Abstract
Individuals with low levels of education systematically have worse health than those with medium or high levels of education. Yet there are few examples of attempts to summarize the evidence supporting the efficacy of interventions targeting health-related behavior among individuals with low education levels, and a large part of the literature is descriptive rather than analytical. A rapid review was carried out to examine the impact of such interventions. Special attention was given to the relative impact of the interventions among individuals with low education levels and their potential to reduce health inequality. Of 1,365 articles initially identified, only 31 were deemed relevant for the review, and of those, nine met the inclusion and quality criteria. The comparability of included studies was limited due to differences in study design, sample characteristics, and definitions of exposure and outcome variables. Therefore, instead of performing a formal meta-analysis, an overall assessment of the available evidence was made and summarized into some general conclusions. We found no support for the notion that the methods used to reduce smoking decrease inequalities in health between educational groups. Evidence was also limited for decreasing inequality through interventions regarding dietary intake, physical activity and mental health. Only one study was found using an intervention designed to decrease socioeconomic inequalities by increasing the use of breast cancer screening. Thus, we concluded that there is a lack of support regarding this type of intervention as well. Therefore, the main conclusion is that solid evidence is lacking for interventions aimed at individual determinants of health and that more research is needed to fill this gap in knowledge.
Highlights
Many governments currently embrace the notion that public health policy should address health itself and its social determinants
Two interventions occurred within school settings [21,22], two were web-based [14,19], two were implemented within a public health service setting [16,20], one involved a home-nurse visitation service [17], and one was in a maternal healthcare setting for first-time parent groups [15], and another one was in a mobile health communication research facility [18] (Table 1)
We found limited evidence for decreasing inequality through interventions regarding dietary intake [21], physical activity[22], and mental health [16,17]
Summary
Rapid reviews use streamlined traditional methods for systematic review to help synthesize and communicate evidence within a shortened time frame [11]. Interventions for reducing health inequalities within four months and was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analysis [12]). We conducted database searches between November 2014 and February 2015 on PubMed (Medline), Embase, CINAHL, SocINDEX, PsycINFO, and Web of Science for the years 1990– 2015. Reference lists of key papers were searched, including cited grey literature such as reports, dissertations and working papers. This did not generate any articles beyond those found in the initial database searches. The combined search strategy for CINAHL, PsycINFO, and SocINDEX was (MH”health status+” OR “health promotion”) AND “educational status” AND (interventions OR prevention)
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