Table 4 Search for ‘public health’ AND/OR ‘disability’ AND/OR ..
Related Figures (30)
TABLE 1 Journals overview: January 1990 to May 2014 TABLE 2 Geographical location of papers TABLE 3 Search for ‘public health’ AND .. FIGURE 2 Mapping theoretical approaches on to reviews of interventions. To conclude, neither an expansive nor a theoretical scoping on disability was as relevant as the combined, more focused, results that we gained from MeSH terms such as ‘public health’ AND ‘disability’. We increased hits a little by adding variations of (disab*). Additional piloting indicated that the Campbell Collaboration Library of Systematic Reviews and Joanna Briggs Institute Database of Systematic Reviews and Implementation Studies were important in accessing more specific information on public health and disability, particularly with regard to future priorities. We decided to use these three databases (the Cochrane Library, the Campbell Collaboration Library of Systematic Reviews and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Studies) together to build our review of specific interventions about disability and public health. The results of the theoretical scoping were slightly better for public health, in that this ensured a more general overview in terms of accessing public health issues in accordance with an ecological model on several levels from policy implementation to individual physical interventions.'?® However, the two reviewers found that the same results were obtained within an expansive scoping by rejecting doubles, or reviews of interventions that were on the same theme. To guide the scoping, the two reviewers decided to keep the idea of multilayered framework — combining expansive and theoretical scoping — and use it as an implicit guide (Figure 2). We also note the importance of rejecting interventions on the same theme to ensure an overview of policy issues, while reflecting areas in which research was lacking. TABLE 5 Deliberation participants FIGURE 3 The ICF (reprinted with permission from Towards a Common Language for Functioning, Disability and Health ICF, World Health Organization, 2002, www.who.int/classifications/icf/training/icfbeginnersguide.pdf.)?7 TABLE 6 Intervention or prevention -IGURE 4 The public health ecological model. Reprinted with permission from Dahlgren and Whitehead. FIGURE 5 Social determinants of diversity. FIGURE 6 The chronic deprivation/entrenched inequalities matrix (adapted from Yeo*™). FIGURE 7 Modelling the CRPD. Public health interventions could be seen to facilitate social justice and equality.'°'“7°476 The Joseph Rowntree Foundation’s work to ensure a dementia-friendly city or rights-based interventions to improve welfare rights advice, for example,’”” demonstrate the value of a more inclusive paradigm, informed by a respect for rights and a sensitivity to disabling experiences. However, evaluation designs for public health interventions typically remain linked, epistemologically and ontologically, to a (positivist) medical model.*”6“?8 Interventions, and the research evaluating them, can be disempowering, particularly when individual experience is denied’? or a population is regarded as vulnerable and their rights are framed paternalistically in terms of protection and within able-bodied norms. The scoping review suggested that disabled people often find themselves excluded from research and, in particular, from trial-based researc! on methodological grounds because they are viewed as ‘hard to reach’; their inclusion is seen as raising CCG, Clinical Commissioning Group; PPI, patient and public involvement. TABLE 7 The CRPD and public health indicators (continued) Research design TABLE 8 Translating Article 3 into indicators validity and reliability of the evidence presented when such measures are used.'”**? It is, therefore, important to be mindful that a public health landscape that is sensitive to disability does not replicate this Our discussion illustrates how using models and theories of disability can inform the use of our evaluative tools and begin a critical reflection on the norms and values behind the measures that we use. Our discussion is exploratory, offering an initial introduction. The lack of an informed evidence-based discussic makes this necessary, as do the norms of current practice, which often uncritically apply outcome measures without considering their relevance to the experiences of disabled populations. There are, however, exceptions, and a review of measures and their relevance to childhood neurodisability provides a potential template on which to base future work,“ although care would need to be taken to avoid accusations of ableism. More critical models of disability, for example, would wish to replace ‘neurodisability’ with ‘neurodiversity’. TABLE 10 Generic reviews of public health interventions Amber, nominal inclusion; green, inclusion; red, no inclusion TABLE 11 Reviews of public health and disability Amber, nominal inclusion; green, inclusion; red, no inclusion. Note Blank cells indicate that no response was received from study author TABLE 12 School-based physical activity reviews (continued) TABLE 13 Dementia-based physical activity review FIGURE 9 The IDEAS decision aid. In presenting our decision aid (Summarised in Figure 9), we emphasise that it should be regarded as ‘work in progress’, but it is nonetheless helpful in stimulating debate among commissioners and researchers. The decision aid, for example, could provide a resource, encouraging researchers to think about ways of respecting choice and ensuring the dignity of participants with impairments. It can also be used to evaluate current research evidence. Our review, however, indicated the danger of using rights-based approaches without thinking about how they link to empirical robustness and the needs of research, °°5%593 This is why we connected our decision aid to the use of RE-AIM (see Developing practical guidance for inclusive research practices). A member of our steering committee, Professor Simon Dyson, suggested that we call it the Inclusion, Dignity, Equality, Accessibility and Intersectionality (IDEAS) decision aid. FIGURE 12 Key elements for public health research incorporating disability into the development and evaluation process. Adapted, with the permission of the MRC, from 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:a1655.°74 To help guide you and to ensure awareness of your rights as a stakeholder in public health research you can use the IDEAS aid. The aid is based on Article 3 of the CRPD. The responsibilities for implementing this lie with the researchers, ethics committees and commissioners and not you. You might, however, want to use the aid to ask questions of the researchers. Appendix 3 Flow charts for stage 2 scoping Scoping Review Two: Part Two (generic interventions) TABLE 14 Charting individual evaluations of public health interventions
