Removing hierarchies and working across professions – is this the future of the systematic review?

How one partnership working model has made researchers think again.

The partnership team

Our Research team has been working on a rapid systematic review of the impact of the determinants of inequality on mental health during the COVID-19 outbreak and other coronavirus outbreaks.

This project, which looks to assess evidence from existing studies and draw conclusions in a short period of time – has been carried out using a novel partnership working approach.

Chiara Lombardo (Senior Research Officer) and Lauren Weeks (Research Assistant)  from the Mental health Foundation formed the core team along with Noortje Uphoff (Research Fellow, Cochrane Common Mental Disorders, University of York ) and Gordon Johnston (independent Peer Researcher). The four lead researchers brought a range of experiences and skills to the project.

“I was delighted to have the opportunity to work on this review,” Gordon said. “I felt I was providing an important lived experience viewpoint throughout the project while also expanding my own research knowledge.”
Noortje commented on the success and what a positive experience it was working with Gordon: “working with Gordon from the beginning to the end of the project has been a great experience, and it would good to capture and acknowledge that from the perspective of us professional researchers.”

The process: Starting with a protocol

Cochrane systematic reviews look at published evidence in health care and health care policy.  They are usually carried out by university and clinical researchers and follow a formal process.

This always begins with writing and registering a detailed protocol. Which databases will be searched, what criteria will be used to include or exclude individual studies, what outcomes will be considered? The protocol is then followed exactly, acting as a roadmap for the review.

A protocol was developed and registered before the research work could begin. From the start, the core project team met weekly. This was vital in allocating and coordinating work, reviewing progress and meeting a tight timescale. The project was carried out under COVID-19 restrictions, meaning team members could not meet in person. All work was done remotely, and so these online meetings were vital. Lauren spoke of what she learnt from this project:

“I’d used Covidence (software to support systematic reviews) before this project completing a less rigorous review. However, this project really honed my Covidence skills and taught me how to conduct a systematic review from start to finish. You gain a real sense of achievement going through the motions of a review, which I found enjoyable.”

Keeping in contact

Team meetings were also a key forum for learning. Noortje was the only team member to have worked on a rapid systematic review before, so others initially relied on her expertise in the methodology and of the Covidence online system used for managing reviews. As progress was made, all researchers learned new skills and developed a strong sense of shared responsibility for the project.

“We all contributed equally to the work, learning as we went,” said Gordon. “At each step we divided tasks up based on skills and time available to make sure we stayed on track.”

Gordon and Chiara held regular feedback meetings, to revisit the workplan, address any training needs, and discuss feasible way in which we could have improved our working together. The direction of the project was adjusted according to our abilities and knowledge.  

“Lauren and I had sketched together a job description for Gordon and training slides to support our  journey. We were constantly reviewing our progress, and given the different skill sets, making sure no one was feeling left behind or not involved. I have always felt safe to ask any questions, and I felt gently prompted to go beyond the pure research results to see the practical implications into everyday life” Chiara reflected.

Selecting the data

The process of selecting the included reviews involved several steps. Firstly, databases were searched by Sarah Dawson, a Cochrane information specialist, with over 700 records found. All were screened by team members, with 55 of these then read in full and 25 from around the world finally selected. This involved a lot of work, and detailed discussion where there was disagreement or questions over inclusion. Team working was particularly important in this period, to ensure consistency of approach. Noortje spoke of the team’s contribution to the project:

“Everyone in the team contributed to all stages of the review process. The peer researcher brought a different perspective and his involvement in the design of the study and writing of the protocol has made me feel confident that the review asks questions which are important to the public. He also helped to make sure that findings were written up in a way that fairly and adequately reflects the evidence we found.”

The key data was then extracted from these 25 studies and detailed discussions took place among the team to synthesise the results and draw common conclusions. This was where differing experiences and a variety of viewpoints allowed a detailed analysis to take place.

An extra step: Hearing directly from people with personal experience

As many of the results related to those working in healthcare systems, a focus group of healthcare workers from a variety of roles and settings was assembled as an additional stage to enrich our understanding. This approach is more commonly used in the third sector and Chiara and Lauren’s experience of running similar sessions was very important. The key results were presented to the panel and their views sought on how the outcomes reflected their experiences. This gave a far greater understanding of, for example, whether findings from the Chinese experience of the pandemic were relevant to the UK. Chiara noted that:

“Running the focus groups gave new meaning to the data. We could add a narrative and contextualise the research articles we read to the day-to-day life of those who had faced challenges in their jobs due to COVID-19.”

What was learned from the review and by the researchers?

A final academic paper has been published and a Foundation policy briefing is being prepared with points that we want others to take action on. All of the core members of the team found this a very interesting process, particularly given their different backgrounds and experiences. It is clear that, unsurprisingly, partnership working had great benefits and strengthened the final outcomes.

“As a researcher working at a university, I usually conduct systematic reviews with other academics and clinicians. I believe working in collaboration with mental health charities, peer researchers and stakeholders, as we did in this project, greatly benefits the research,” said Noortje.
Lauren spoke of what she learnt from working in this partnership way: “I learned to do more rigorous elements of a review. But I think one of the main take home messages for me was the importance of including lived experience in research and including a variety of perspectives. I have always thought it important to have a lived experience voice present in research, yet seeing it first-hand really solidified this belief. It also makes you think of how important it is to include a variety of perspectives and to always try and get a diverse range of people working on a project. For example, it was great that we had a peer researcher, academic research and third-sector, public mental health researchers, yet it would have been great to think next time of thinking more broadly, such as around race, sexuality, gender and socio-economic background, to strengthen the variety of perspectives thought about when completing the review.”
Chiara voiced that she “echoed Lauren saying that I have learnt a more rigorous approach, but I also like to quote Gordon who would often say we want to produce research that doesn’t conclude saying ‘that more research is needed to reach our conclusions’!”  

We have produced a piece of research with clear conclusions, and clear policy implications, and I think that our approach has played an important role to reach that.

A partnership approach

This project has shown that research methods can be improved by partnership working, bringing different skills and experiences together. Academic, third sector and peer researchers worked well together here, forming a close team and finishing the project on time.

“I really enjoyed working in this team. I think the fact that it was three different disciplines coming together is what made it so enjoyable. There was an abundance of different viewpoints, perspectives and expertise and this added not only richness to the project but also to each other as individuals. It felt more lively, flexible and dynamic than a usual review, as whilst we still followed the rigorous steps there was more free-flowing conversation and discussion about what was important. Due to the variety of different perspectives and expertise, ideas that one may not have thought of as important would be flagged and discussed and it would broaden not only the depth of the paper but also your own understanding as a researcher.”
Lauren concluded on what the highlights of the project were to her. “As a result of this collaboration between our organisations, our research findings are more relevant and meaningful to policy-makers and the public, and therefore more likely to lead to a positive impact on people's mental health and wellbeing,” Noortje concluded.

The partnership approach has resulted in a detailed research study that has academic rigour, plus additional benefits from input beyond a traditional academic view. Perhaps we should call this a Systematic Review Plus.

This blog was written by Lauren Weeks, Gordon Johnstone, Chiara Lombardo and Noortje UpHoff.

Our Rapid Systematic Review has now been published.