Synthesising evidence for equity impacts of population-based physical activity interventions: a pilot study

International Journal of Behavioral Nutrition and Physical Activity

David Ogilvie²  David K Humphreys¹ 

[1] UKCRC Centre for Diet and Activity Research (CEDAR), Institute of Public Health, University of Cambridge, Box 296, Forvie Site, Cambridge, USA;MRC Epidemiology Unit, Institute of Public Health, Cambridge, USA

关键词: Research synthesis;    Interventions;    Inequalities;    Physical activity;   

Others  :  806867
DOI  :  10.1186/1479-5868-10-76

 received in 2012-10-18, accepted in 2013-06-11,  发布年份 2013

【 摘 要 】

Background

This study applied an equity lens to existing research to investigate what is known about the impact of population-level physical activity interventions on social inequalities.

Methods

We performed a pilot systematic review to assess the availability of information on the social distribution of intervention effects, the targeting or allocation of interventions, and the baseline characteristics of participants. This comprised (i) a rapid review of systematic reviews and (ii) a review and synthesis of a sample of primary studies included in the eligible systematic reviews.

Results

We found 19 systematic reviews of environmental and policy interventions. Relatively few of these (26%, n=5) were prospectively designed to examine effects on inequalities, and none were able to fully synthesise evidence of distributional effects. Over 40% of primary studies reported subgroup intervention effects; 18% reported socio-demographic interaction effects. Studies most often compared effectiveness by gender, followed by age, ethnicity, and socio-economic status. For gender, effects appeared to be evenly distributed overall, although heterogeneity in gradients between studies suggested that some interventions affect males and females differently.

Conclusions

Our findings suggest that it is feasible to generate better evidence about how public health interventions may affect health inequalities using existing data and innovative methods of research synthesis.

【 授权许可】

   
2013 Humphreys and Ogilvie; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]World Health Organization: Global recommendations on physical activity for health. Geneva: World Health Organization; 2010.
• [2]Department of Health: At least five a week: Evidence on the impact of physical activity and its relationship to health, a report from the Chief Medical Officer. London: Department of Health; 2004.
• [3]Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC: Physical activity and public health. JAMA 1995, 273(5):402-407.
• [4]Guthold R, Ono T, Strong KL, Chatterji S, Morabia A: Worldwide variability in physical inactivity: a 51-country survey. Am J Prev Med 2008, 34(6):486-494.
• [5]Beenackers MA, Kamphuis CBM, Giskes K, Brug J, Kunst AE, Burdorf A, van Lenthe FJ, King T, Thornton L, Bentley R: Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review. Int J Behav Nutr Phys Act 2012, 9(1):116.
• [6]Marmot M: Social determinants of health inequalities. Lancet 2005, 365(9464):1099-1104.
• [7]Evans T, Whitehead M, Diderichsen F, Bhuiya A, Wirth M: Introduction. In Challenging inequities in health. Edited by Evans T, Whitehead M, Diderichsen F, Bhuiya A, Wirth M. Oxford: Oxford University Press; 2001.
• [8]Marmot M: Achieving health equity: from root causes to fair outcomes. Lancet 2007, 370(9593):1153-1163.
• [9]CSDH: Closing the gap in a generation: health equity through action on the social determinants of health. In Final Report of the Commission on Social Determinants of Health. Geneva: World Health Organisation; 2008.
• [10]Macintyre S, Macdonald L, Ellaway A: Do poorer people have poorer access to local resources and facilities? The distribution of local resources by area deprivation in Glasgow, Scotland. Soc Sci Med 2008, 67(6):900-914.
• [11]Whitehead M: The concepts and principles of equity and health. Int J Health Serv 1992, 22(3):429-445.
• [12]World Health Organization: Prevalence of insufficient physical activity: situation and trends. Global Health Observatory (GHO): World Health Organisation; 2012.
• [13]Macera CA, Ham SA, Yore MM, Jones DA, Kimsey CD, Kohl HW III, Ainsworth BE III: Prevalence of physical activity in the United States: behavioral risk factor surveillance system, 2001. Prev Chronic Dis: public health res, practice, and policy 2005, 2(2):1-10.
• [14]Craig R, Mindell J, Hirani V: Health survey for England 2008: physical activity and fitness. Leeds: NHS Information Centre for Health and Social Care; 2009.
• [15]Bromley C, Given L, Ormston R: Scottish Centre for Social Research: The Scottish Health Survey 2009. Glasgow: The Scottish Government; 2009.
• [16]Macintyre S, Mutrie N: Socio-economic differences in cardiovascular disease and physical activity: stereotypes and reality. J R Soc Promot Health 2004, 124(2):66-69.
• [17]Gidlow C, Johnston LH, Crone D, Ellis N, James D: A systematic review of the relationship between socio-economic position and physical activity. Health Educ J 2006, 65(4):338-367.
• [18]Department of Health: Reducing health inequalities: an action report. In Our healthier nation. London: Department of Health; 1999.
• [19]Healthy people 2010: Understanding and improving health and objectives for improving health. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicId=1 webcite
• [20]White M, Adams J, Heywood P: How and why do interventions that increase health overall widen inequalities within populations. In Social inequality and public health. Edited by Babones SJ. Bristol: The Policy Press; 2009:65-82.
• [21]Acheson D: Round table discussion: health inequalities impact assessment. Bull World Health Organ 2000, 78(1):75-76.
• [22]Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J: An ecological approach to creating active living communities. Annu Rev Public Health 2006, 27(1):297-322.
• [23]Lorenc T, Petticrew M, Welch V, Tugwell P: What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health 2012.
• [24]Hart JT: The inverse care law. Lancet 1971, 297(7696):405-412.
• [25]Kahn EB, Ramsey LT, Brownson RC, Heath GW, Howze EH, Powell KE, Stone EJ, Rajab MW, Corso P: The effectiveness of interventions to increase physical activity: a systematic review. Am J Prev Med 2002, 22(4):73-107.
• [26]Hillsdon M, Foster C, Cavill N, Crombie H, Naidoo B: The effectiveness of public health interventions for increasing physical activity among adults: a review of reviews: evidence briefing summary. London: Health Development Agency; 2004.
• [27]Banks-Wallace J, Conn V: Interventions to promote physical activity among African American women. Public Health Nurs 2002, 19(5):321-335.
• [28]Yancey AK, Kumanyika SK, Ponce NA, McCarthy WJ, Fielding JE, Leslie JP, Akbar J: Population-based interventions engaging communities of color in healthy eating and active living: a review. Prev Chronic Dis: public health res, practice, and policy 2004, 1(1):1-18.
• [29]Cleland CL, Tully MA, Kee F, Cupples ME: The effectiveness of physical activity interventions in socio-economically disadvantaged communities: a systematic review. Prev Med 2012, 54(6):371-380.
• [30]Petticrew M, Roberts H: Systematic reviews in the social sciences: a practical guide. Oxford: Blackwell Publishing; 2006.
• [31]Active living research reference lists by year. http://www.activelivingresearch.org/resourcesearch/referencelist webcite
• [32]Kavanagh J, Oliver S, Lorenc T: Reflections on developing and using PROGRESS-Plus. Equity update 2008, 2:1-3.
• [33]Petticrew M, Tugwell M, Kristjansson E, Oliver S, Ueffing E, Welch V: Damned if you do, damned if you don't: subgroup analysis and equity. J Epidemiol Community Health 2012, 66(1):95-98.
• [34]Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A, Whitehead M, Worthy G: Population tobacco control interventions and their effects on social inequalities in smoking: systematic review. Tob Control 2008, 17(4):230-237.
• [35]Briss PA, Zaza S, Pappaioanou D, Fielding J, Wright-De Agüero L, Truman BI, Hopkins DP, Dolan Mullen P, Thompson RS, Woolf SH, et al.: Developing an evidence-based guide to community preventive services-methods. Am J Prev Med 2008, 18:35-43.
• [36]Thomas H: Quality assessment tool for quantitative studies. Hamilton, Ontario: Effective Public Health Practice Project; 2003.
• [37]Ogilvie D, Fayter D, Petticrew M, Sowden A, Thomas S, Whitehead M, Worthy G: The harvest plot: a method for synthesising evidence about the differential effects of interventions. BMC Med Res Methodol 2008, 8(1):8. BioMed Central Full Text
• [38]Baker PRA, Francis DP, Soares J, Weightman AL, Foster C: Community wide interventions for increasing physical activity. Cochrane Database Syst Rev 2011, 4:436-437.
• [39]Ogilvie D, Egan M, Hamilton V, Petticrew M: Promoting walking and cycling as an alternative to using cars: systematic review. BMJ 2004, 329(7469):763.
• [40]Ogilvie D, Foster CE, Rothnie H, Cavill N, Hamilton V, Fitzsimons CF, Mutrie N: Interventions to promote walking: systematic review. BMJ 2007, 334:1204.
• [41]Foster C, Hillsdon M: Changing the environment to promote health-enhancing physical activity. J Sports Sci 2004, 22(8):755-769.
• [42]Kremers S, de Buijn G-J, Wendel-Vos W, van Lenthe F, Brug J: Environmental interventions on physical activity in adults. In Environmental determinants and interventions for physical activity, nutrition and smoking: a review. Edited by Brug J, van Lenthe F. Maastricht: Universiteit Maastrict; 2005.
• [43]Department of Health: Tackling health inequalities: 10 years on: a review of developments in tackling health inequlities in England over the last 10 years. London: Department of Health; 2009.
• [44]Lagakos SW: The challenge of subgroup analyses — reporting without distorting. N Engl J Med 2006, 354(16):1667-1669.
• [45]Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008, 337:979-983.
• [46]Brookes ST, Whitely E, Egger M, Smith GD, Mulheran PA, Peters TJ: Subgroup analyses in randomized trials: risks of subgroup-specific analyses;: power and sample size for the interaction test. J Clin Epidemiol 2004, 57(3):229-236.
• [47]Mackenbach J: Tackling inequalities in health: the need for building a systematic evidence base. J Epidemiol Community Health 2003, 57(3):162.