Systematic reviews – do they ‘work’ in informing decision-making around health inequalities?

Abstract

The question of ‘what works’ is a fundamental one not only for politicians and policy makers who need to devise or implement policies on everything from reducing juvenile crime to increasing the national wealth, but it is also fundamental for citizens on the receiving end of interventions. The observation that some things work better than others (and other things work not at all) is commonplace. So is scepticism among the public and professionals about grand claims for the effectiveness of policies, particularly given our understanding that modest interventions normally have modest effects. Whilst research can help in informing decisions about what works, conflicting research findings, and simple information overload often simply cloud the issue. Literature reviews may be designed to solve (or at least address) the problems of information management, but these reviews may themselves conflict. Take, for example, literature reviews of the effectiveness of mentoring in young people to reduce anti-social behaviour. The findings of reviews may conflict not just because of differences in inclusion criteria but because authors appraise and synthesize information on the outcomes differently (for example, not differentiating between more and less objective sources of outcome data, which vary in the extent to which they are prone to bias). Moreover, the outcomes themselves – stated satisfaction with the service, higher self-esteem, or a reduc