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.
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:
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.
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.
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:
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:
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.
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.
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.