Systematic Review and Evidence-Informed Decision Making for the Public
Will school-milk program works to improve nutritional status and cognitive performance of Indonesian school children? Should adolescent school girls be given iron pills? Should poor pregnant women be given cash transfer or in-kind transfer to improve their food intake? How should supplementary feeding among children and women be designed to reduce stunting? Is it needed at all? In what circumstances will it be crucial? There are so many questions and so many decisions to make by the policy makers, especially in the field of public health, including public health nutrition. Indeed, none of those questions are easy to answer, especially when it involves allocating a lot of resources for the decision to be implemented.
Ideally, all those questions should actually be answered by scientific evidence before any public policy is made, in order that public policy be categorized as evidence-based policy. Evidence is crucial to good public policy in two respects: firstly it helps policymakers work out which policy options are likely to achieve the best results, and secondly, it helps in getting a policy implemented in circumstances where there is opposition to it.
However, translating research into practices and policy is not easy. Many opportunities to use evidence for public policy are missed. As was mentioned by Lee Jong-Wook (Former Director General of World Health Organization for 2003-2006), there is a big gap between what has been known scientifically and what has been put to practice. Moreover Lee Jong-Wok stated that “action without knowledge is wasted effort” and “knowledge without action is wasted resources”. Bridging the know-do gap is one of the most important challenges for public health nutrition in this century.
The next questions are how to bridge this gap between what have been produced by researchers and what should be decided by policy makers? One of the effort to take scientific evidence to policy makers is by putting the scientific evidence in a format that can easily be digested by policy makers, for example in a form of policy brief. Development of policy brief needs to be based on extensive reviews of evidence, among others in the form a systematic review of scientific evidence. Results of individual studies need to be interpreted and translated alongside the body of evidence. Moreover, single studies rarely provide sufficient evidence for practice change (especially small studies in specific populations). Thus, stronger evidence is sometimes needed to support policy and it can take a form of systematic reviews of several studies.
Systematic reviews are summaries of research evidence that address a clearly formulated question using systematic and explicit methods to: (i) identify, select, and critically appraise relevant research; and (ii) collect and analyze data from the studies that are included in the review. Systematic reviews reduce the risk of bias in selecting and interpreting the results of studies, reduce the risk of being misled by chance in identifying studies for inclusion, or the risk of focusing on only a subset of relevant evidence, provide a critical appraisal of the available research, and place individual studies in the context of all of the relevant evidence. This way, systematic reviews increase certainty about the effects of an intervention. Systematic reviews of research evidence are a more appropriate source of research evidence for decision-making than a single research study or selected set of studies.
Considering the importance of bridging the know-do gap, the Southeast Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO RECFON) conducted a post graduate training on Systematic Review and Evidence-Informed Decision Making in Nutrition on April 23-27, 2018. The training was given by DR. Tari Turner (Senior Research Fellow at Cochrane Australia and Co-Editor-in-Chief of Journal of Health Research and Policy System), DR. Grace Wangge (Research Manager of SEAMEO RECFON) and DR. Indah Suci Widyahening (Lecturer at Department of Community Medicine Faculty of Medicine and Head of International Relation Office, Universtas Indonesia). The training was attended by 23 participants with various backgrounds from Indonesia, Lao PDR and Malaysia. The training was expected to equipped participants with knowledge and skills to conduct a systematic review of scientific evidence starting from statement of objectives, searching and identification of individual studies, study selection, identification of risk of bias and systematic synthesis of review results for both quantitative and qualitative studies. The method includes lecture and hands-on practice of development of scientific review protocol and conducting scientific review. At the end of the training, the participants were introduced to knowledge on how to translate results of systematic reviews into a policy brief.