Literature review: How to search, evaluate, synthesize, and present the evidence

This workshop will focus on… Searching through the literature for relevant sources; Evaluating the findings from your search; Synthesizing these findings; and Presenting the results.

But WHY do we need to conduct a literature review?

A literature review can help us to… Address an information need Find out whether the evaluation question has been asked before Find out what has been done in similar settings Determine what best practices already exist Discover what tools might be useful in our evaluation

Evaluate your practice What is the problem we need to solve? The Evidence to Practice Process What is the question we need answered? Select first choice resource where an answer may be found (e.g. the Cochrane library) Select second choice resource Design search strategy and carry out search Appraise and summarize the evidence Good Evidence Poor or insufficient evidence Assess the relevance of the evidence to your local situation and target groups Note: The Evidence to Practice Process is included in the Supplementary Materials handout (see page 14). Consider implications for your practice and resources, and those of the organizations you work with Improvement Apply the evidence to practice Evaluate your practice No improvement © 2003, Evidence Network: What Works for Children?

Where do we start?

Searching through the Literature

Define the Problem The target population E.g., Age, sex, ethnic group, diagnostic group The intervention The therapy that is of interest to your program The outcome The changes you would like to see in your target population

Find the Information Academic libraries Online databases Primary source: The original publication of new data, results, and theories Stice, E., Shaw, H., Burton, E., & Wade, E. (2006, April). Dissonance and healthy weight eating disorder prevention programs: a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74(2), 263-275. Retrieved September 18, 2008, from PubMed database. Secondary source: Summarizes or comments on primary sources in the context of the particular idea under study Pratt, B.M. & Woolfenden, S.R. (2002, April). Interventions for preventing eating disorders in children and adolescents. Cochrane Database of Systematic Reviews, Issue 2. Retrieved September 18, 2008, from the Cochrane database.

Online databases with free content… Centre for Reviews and Dissemination (CRD) http://www.crd.york.ac.uk/crdweb/ Cochrane Database of Systematic Reviews (CDSR) http://www.cochrane.org/ Turning Research Into Practice (TRIP) Database http://www.tripdatabase.com The International Network of Agencies for Health Technology Assessment http://www.inahta.org/ British Medical Journal www.bmj.com/ Directory of Open Access Journals (DOAJ) http://www.doaj.org/ Substance Abuse and Mental Health Services Administration (SAMHSA) http://www.samhsa.gov/ebpWebguide/index.asp Centre of Excellence evidence database http://www.onthepoint.ca/EvidenceDB/ Note: Databases are described in the Supplementary Materials handout (see pages 3 – 5).

Online databases with limited free content… PubMed http://www.ncbi.nlm.nih.gov/pubmed/ York University Health Research Guide http://www.library.yorku.ca/ccm/rg/nk/health.jsp British Medical Association (BMA) http://www.bma.org.uk/ap.nsf/Content/Evidencebasedhealthinformationon Note: Databases are described in the Supplementary Materials handout (see pages 3 – 5).

Databases available only by subscription… PsycINFO – American Psychological Association (APA) http://www.apa.org/psycinfo/ Allied and Complementary Medicine Database (AMED) http://www.bl.uk/collections/health/amed.html EMBASE http://www.embase.com/ Note: Databases are described in the Supplementary Materials handout (see pages 3 – 5).

Guidelines available online… Guidelines are a rich source of evaluated evidence, particularly if the question is about treatment or diagnosis of a relatively common medical condition Available for free: UK National Electronic Library for Health Guidelines Finder http://rms.nelh.nhs.uk/guidelinesfinder US National Guideline Clearing House at http://www.guidelines.gov Guidelines International Network (GIN) at http://www.g-i-n.net BMJ Publishing Group’s Clinical Evidence http://www.clinicalevidence.org/ceweb/conditions/index.jsp Note: Guidelines are described in the Supplementary Materials handout (see page 5).

Search through the Database Use key words from your question as search terms Use restrictions to refine the search A clearly defined patient group and intervention are the major parameters in most subject searches 3. Search by author, journal title etc. Note: Tips for searching databases are included in the Supplementary Materials handout (see page 6).

Approaches to research… Qualitative In-depth information about people’s experiences Focus on subjective meanings Typically small samples Emphasis on credibility and trustworthiness Quantitative Information about how different variables are related to one another Focus on objective measurement Typically large samples Emphasis on causality, reliability, validity

Types of studies you may find… Systematic reviews Randomised controlled trials Quasi-experimental design Evaluation studies with non-experimental designs Case control studies Cohort studies Population surveys Qualitative research Note: There are descriptions of the types of studies you may find in the Supplementary Materials handout (see page 7 – 9).

Evaluating the Results

Initial questions to consider… Do the title and abstract suggest a fit between the source and your evaluation? Are the articles peer reviewed? Is the study original? Who is the study about? Is it reasonable to expect that the results might apply to your target group? Are the claims made by the study plausible? Note: Questions to consider are included in the Supplementary Materials handout (see pages 11 – 12).

Have the authors addressed all outcomes of interest? What does the study add to what we already know? The authors’ credentials: are the authors associated with the field of study? Do they have relevant clinical experience? Are there any issues related to “researcher bias” that are not addressed? Note: Questions to consider are included in the Supplementary Materials handout (see pages 11 – 12).

The Purpose and Method Are the research questions clear, specific and answerable? Is the study design appropriate? Do the question, method and analysis of results match up? Is the sample appropriate? If a comparison group was used, was it really comparable to the group receiving the intervention? Did some people 'drop out' of the study, and if so, have the authors accounted for this in their conclusions? Note: Questions to consider are included in the Supplementary Materials handout (see pages 11 – 12).

Results and Conclusions Is the material presented in a way that is transparent and detailed in a way that can be easily examined and evaluated? How large is the effect of the intervention, if there is one? How precise is the estimate of the effect? How likely is it that the result was due to chance? Have the authors clearly shown how they came to their findings? Does the author explain study limitations? Do the conclusions match the findings? Are the conclusions supported by the analysis? Note: Questions to consider are included in the Supplementary Materials handout (see pages 11 – 12).

Synthesizing the Findings

Initial questions to consider… What are the most relevant sources? What are some common elements across sources? What is unique about each source? What are the key ideas/concepts being conveyed? Why would this be important? What are the limitations/gaps in the literature? (Note: this is particularly important, because it speaks to your contribution to the literature – i.e., your work may help fill this gap) Note: Tips for synthesizing findings are included in the Supplementary Materials handout (see page 13).

Develop a Summary Table Title and Publication Information Type of Source and Approach Overall Goal Main Ideas and Conclusion Limitations   Note: A sample of this summary table is included in the Supplementary Materials handout (see page 10).

Presenting the Findings

Planning the Literature Review What are the goals of the review? Who is the audience? What are your key messages? How should the review be organized?

Tips for Writing the Literature Review Use the right word in the right place Avoid awkward, rambling and run-on sentences Avoid sentence fragments Use clear, plain language Always use examples or statements to substantiate your point Feel free to use an active voice Note: Tips for writing the literature review are included in the Supplementary Materials handout (see page 13).

Next Steps Selecting measures? Framework design? Other ideas?

Visit our website for more information: www.onthepoint.ca Note: Sites to visit for more information are included in the Supplementary Materials handout (see page 14).