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Book ; Online ; E-Book: Realist Trials and Systematic Reviews

Bonell, Chris / Melendez-Torres, G. J. / Warren, Emily

Rigorous, Useful Evidence to Inform Health Policy

2024

Abstract: Describing an innovative approach to the evaluation of complex health interventions, this book allows reader to assess what interventions work, how and for whom. Proposing how realist evaluation methods may be incorporated within trials and systematic ... ...

Abstract	Describing an innovative approach to the evaluation of complex health interventions, this book allows reader to assess what interventions work, how and for whom. Proposing how realist evaluation methods may be incorporated within trials and systematic reviews, this approach provides useful evidence to inform policy and scientific advancement.
MeSH term(s)	Health Policy. ; Therapies, Investigational/methods. ; Clinical Trials as Topic. ; Systematic Reviews as Topic. ; Evidence-Based Medicine.
Subject code	362.1
Language	English
Size	1 online resource (136 pages)
Edition	1st ed.
Publisher	Cambridge University Press
Publishing place	Cambridge
Document type	Book ; Online ; E-Book
Remark	Zugriff für angemeldete ZB MED-Nutzerinnen und -Nutzer
ISBN	1-009-45662-8 ; 1-009-45661-X ; 1-009-45660-1 ; 978-1-009-45662-3 ; 978-1-009-45661-6 ; 978-1-009-45660-9
Database	ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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Article ; Online: Whole-school interventions promoting student commitment to school to prevent substance use and violence, and improve educational attainment: a systematic review.

Ponsford, Ruth / Melendez-Torres, G J / Miners, Alec / Falconer, Jane / Bonell, Chris

Public health research (Southampton, England)

2024 Volume 12, Issue 2, Page(s) 1–290

Abstract: Background: Whole-school interventions modify the school environment to promote health. A subset of these interventions promotes student commitment to school to prevent substance (tobacco, alcohol, other drugs) use and/or violence. A previous review ... ...

Abstract	Background: Whole-school interventions modify the school environment to promote health. A subset of these interventions promotes student commitment to school to prevent substance (tobacco, alcohol, other drugs) use and/or violence. A previous review identified the theory of human functioning and school organisation as a comprehensive theory of such interventions, and found evidence that these interventions reduce substance use and/or violence. Objectives: The objectives were to search for, appraise and synthesise evidence to address the following questions: (1) What whole-school interventions promoting student commitment to school to prevent substance use and/or violence have been evaluated, what intervention subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? (2) What factors relating to setting, population and intervention affect implementation? (3) What are the effects on student substance use, violence and educational attainment? (4) What is the cost-effectiveness of such interventions? (5) Are intervention effects mediated by student commitment to school or moderated by setting or population? Data sources: A total of 56 information sources were searched (in January 2020), then an updated search of 48 of these was carried out (in May 2021). Reference lists were also searched and experts were contacted. Review methods: Eligible studies were process/outcome evaluations of whole-school interventions to reduce student violence or substance use among students aged 5-18 years attending schools, via actions aligning with the theory of human functioning and school organisation: modifying teaching to increase engagement, enhancing student-staff relationships, revising school policies, encouraging volunteering or increasing parental involvement. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised qualitatively. Outcome and economic data were synthesised narratively; outcome data were meta-analysed. Results: Searches retrieved 63 eligible reports on 27 studies of 22 interventions. We identified four intervention subtypes focused on student participation in school-wide decisions, improving staff-student relationships, increasing engagement in learning and involving parents. The theories of change of most intervention subtypes aligned closely with the theory of human functioning and school organisation, and informed refinement of an intervention theory of change. Theories of change for interventions increasing learning engagement did not align with this theory, aiming instead to increase school commitment primarily via social skills curricula. Factors influencing the implementation included whether or not interventions were tailorable, workable and well explained. Interventions with action groups comprising staff/students, etc. and providing local data were well implemented. Implementation was also affected by whether or not schools accepted the need for change and staff had the resources for delivery. Meta-analyses suggest small, but significant, intervention effects in preventing violence victimisation and perpetration, and substance use. There was sparse and inconsistent evidence of moderation and some evidence of mediation by student commitment to school. Two economic evaluations suggested that there is the potential for the interventions to be cost-effective. Limitations: The quality of the studies was variable and the economic synthesis was limited to two studies. Conclusions: Whole-school interventions aiming to promote student commitment to school share similar theories of change and factors affecting implementation. They have the potential to contribute to preventing violence and substance use among young people. Future trials should aim to optimise intervention effectiveness by better theorisation, and assess implementation and effect moderators and mediators. Study registration: This study is registered as PROSPERO CRD42019154334. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/151/05) and is published in full in
MeSH term(s)	Humans ; Educational Status ; Health Promotion ; Schools ; Students ; Substance-Related Disorders/prevention & control ; Violence/prevention & control
Language	English
Publishing date	2024-02-14
Publishing country	England
Document type	Journal Article ; Systematic Review
ISSN	2050-439X
ISSN (online)	2050-439X
DOI	10.3310/DWTR3299
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Testing and refining middle-range theory in evaluations of public-health interventions: evidence from recent systematic reviews and trials.

Bonell, Chris / Ponsford, Ruth / Meiksin, Rebecca / Melendez-Torres, G J

Journal of epidemiology and community health

2023 Volume 77, Issue 3, Page(s) 147–151

Abstract: Evaluations of public-health interventions might potentially be used to test and refine middle-range theory (ie, theory about the mechanisms, which generate outcomes that is analytically generalisable enough to span a range of contexts, interventions or ... ...

Abstract	Evaluations of public-health interventions might potentially be used to test and refine middle-range theory (ie, theory about the mechanisms, which generate outcomes that is analytically generalisable enough to span a range of contexts, interventions or outcomes, but specific enough to be salient in a given application). This approach has been suggested as one means of developing more informed assessments of how different interventions work and whether mechanisms might transfer across contexts. However, we have noticed that studies included in some of our recent systematic reviews are not oriented towards helping test middle-range theory because interventions draw on multiple middle-range theories (so that it is difficult to draw any conclusions about each middle-range theory based on their results) and these middle-range theories are insufficiently clear (with vague constructs) or parsimonious (with too many constructs) to be readily testable. Some studies might in future better contribute to testing and refining middle-range theory via focusing on interventions informed by one middle-range theory and focused on one mechanism at a time. Such 'proof-of-principle' studies should draw on middle-range theory that is sufficiently clear and parsimonious to allow such testing. These evaluations might facilitate more rigorous testing of middle-range theory and hence refinement of scientific knowledge. They might inform broader assessments of how mechanisms transfer across contexts aiding the development of future public-health interventions. Such studies would be a complement not an alternative to pragmatic studies of scalable complex interventions, often informed by more than one middle-range theory.
MeSH term(s)	Humans ; Public Health ; Systematic Reviews as Topic ; Outcome and Process Assessment, Health Care
Language	English
Publishing date	2023-01-04
Publishing country	England
Document type	Journal Article
ZDB-ID	391868-3
ISSN	1470-2738 ; 0142-467X ; 0141-7681 ; 0143-005X
ISSN (online)	1470-2738
ISSN	0142-467X ; 0141-7681 ; 0143-005X
DOI	10.1136/jech-2022-219776
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Article ; Online: Assessing Survey Items on Social Norms Relating to Dating and Relationship Violence and to Gender: Cognitive Interviews with Young People in England.

Meiksin, Rebecca / Ponsford, Ruth / Kyegombe, Nambusi / Kohli, Anjalee / Bonell, Chris

Journal of interpersonal violence

2023 Volume 39, Issue 5-6, Page(s) 1206–1227

Abstract: Widespread among adolescents in England, dating and relationship violence (DRV) is associated with subsequent injuries and serious mental health problems. While DRV prevention interventions often aim to shift harmful social norms, no established measures ...

Abstract	Widespread among adolescents in England, dating and relationship violence (DRV) is associated with subsequent injuries and serious mental health problems. While DRV prevention interventions often aim to shift harmful social norms, no established measures exist to assess relevant norms and their role in mediating DRV outcomes. We conducted cognitive interviews exploring the understandability and answerability of candidate measures of social norms relating to DRV and gender roles, informing measure refinement. In all, 11 participants aged 13 to 15 from one school in England participated. Cognitive interviews tested two items assessing descriptive norms (beliefs about what behaviors are typical), three assessing injunctive norms (beliefs about what is socially acceptable), and (for comparison) one assessing personal attitudes. Findings were summarized by drawing on interview notes. Summaries and interview notes were subjected to thematic analysis. For some participants, injunctive norms items required further explanation to clarify that items asked about others' views, not their own. Lack of certainty about, and perceived heterogeneity of, behaviors and views among a broad reference group detracted from answerability. Participants were better able to answer items for which they could draw on concrete experiences of observing or discussing relevant behaviors or social sanctions. Data suggest that a narrowed reference group could improve answerability for items assessing salient norms. Findings informed refinements to social norms measures. It is possible to develop social norms measures that are understandable and answerable for adolescents in England. Measures should assess norms that are salient and publicly manifest among a cohesive and influential reference group.
MeSH term(s)	Adolescent ; Humans ; Social Norms ; Gender Identity ; Violence ; Intimate Partner Violence ; Cognition
Language	English
Publishing date	2023-10-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2028900-5
ISSN	1552-6518 ; 0886-2605
ISSN (online)	1552-6518
ISSN	0886-2605
DOI	10.1177/08862605231204561
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Article ; Online: Are realist randomised controlled trials possible? A reflection on the INCLUSIVE evaluation of a whole-school, bullying-prevention intervention.

Warren, Emily A / Melendez-Torres, G J / Bonell, Chris

Trials

2022 Volume 23, Issue 1, Page(s) 82

Abstract: We previously proposed that realist randomised controlled trials could be used to evaluate how, for whom and under what conditions complex interventions can be used to activate mechanisms to improve health. While this idea was accepted by some, it was ... ...

Abstract	We previously proposed that realist randomised controlled trials could be used to evaluate how, for whom and under what conditions complex interventions can be used to activate mechanisms to improve health. While this idea was accepted by some, it was also met with resistance, particularly from some realist evaluators who believe that trials are inextricably positivist and dependent on constant conjunctions to understand causation, and that realist trials are unfeasible because participants and contexts will be insufficiently diverse to enable the testing of context-mechanism-outcome configurations. In this paper, we reflect on analyses of qualitative and quantitative data from the Initiating Change Locally in Bullying and Aggression through the School Environment (INCLSUIVE) trial, and whether these are useful and aligned with realism. We summarise the concerns expressed by realists and reflect on the philosophical and practical challenges that we encountered and whether or not they are related to the trial's design. Finally, we reflect on the trial's weaknesses and highlight areas that future researchers might consider when running realist trials. We conclude that realist randomised controlled trials are philosophically coherent, practically feasible, and can produce nuanced findings.
MeSH term(s)	Aggression ; Bullying/prevention & control ; Causality ; Humans ; Randomized Controlled Trials as Topic ; Schools
Language	English
Publishing date	2022-01-28
Publishing country	England
Document type	Letter
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-021-05976-1
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Article ; Online: Social Norms About Dating and Relationship Violence and Gender Among Adolescents: Systematic Review of Measures Used in Dating and Relationship Violence Research.

Meiksin, Rebecca / Bonell, Chris / Bhatia, Amiya / Melendez-Torres, G J / Kyegombe, Nambusi / Kohli, Anjalee

Trauma, violence & abuse

2023 Volume 25, Issue 1, Page(s) 448–462

Abstract: Adolescent dating and relationship violence (DRV) is widespread and associated with increased risk of subsequent poor mental health outcomes and partner violence. Shifting social norms (i.e., descriptive norms of perceived behavior and injunctive norms ... ...

Abstract	Adolescent dating and relationship violence (DRV) is widespread and associated with increased risk of subsequent poor mental health outcomes and partner violence. Shifting social norms (i.e., descriptive norms of perceived behavior and injunctive norms of acceptable behavior among a reference group of important others) may be important for reducing DRV. However, few DRV studies assess norms, measurement varies, and evidence on measure quality is diffuse. We aimed to map and assess how studies examining DRV measured social norms concerning DRV and gender. We conducted a systematic review of DRV literature reporting on the use and validity of such measures among participants aged 10-18 years. Searches included English peer-reviewed and grey literature identified via nine databases; Google Scholar; organization websites; reference checking; known studies; and expert requests. We identified 24 eligible studies from the Americas (
MeSH term(s)	Male ; Female ; Humans ; Adolescent ; Social Norms ; Violence/psychology ; Intimate Partner Violence ; Africa ; Europe
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2070884-1
ISSN	1552-8324 ; 1524-8380
ISSN (online)	1552-8324
ISSN	1524-8380
DOI	10.1177/15248380231155526
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Article ; Online: Approaches to consent in public health research in secondary schools.

Bonell, Chris / Humphrey, Neil / Singh, Ilina / Viner, Russell M / Ford, Tamsin

BMJ open

2023 Volume 13, Issue 6, Page(s) e070277

Abstract: Objectives: We assess different approaches to seeking consent in research in secondary schools.: Design: We review evidence on seeking active versus passive parent/carer consent on participant response rates and profiles. We explore the legal and ... ...

Abstract	Objectives: We assess different approaches to seeking consent in research in secondary schools. Design: We review evidence on seeking active versus passive parent/carer consent on participant response rates and profiles. We explore the legal and regulatory requirements governing student and parent/carer consent in the UK. Results: Evidence demonstrates that requiring parent/carer active consent reduces response rates and introduces selection biases, which impact the rigour of research and hence its usefulness for assessing young people's needs. There is no evidence on the impacts of seeking active versus passive student consent but this is likely to be marginal when researchers are directly in communication with students in schools. There is no legal requirement to seek active parent/carer consent for children's involvement in research on non-medicinal intervention or observational studies. Such research is instead covered by common law, which indicates that it is acceptable to seek students' own active consent when they are judged competent. General data protection regulation legislation does not change this. It is generally accepted that most secondary school students age 11+ are competent to provide their own consent for interventions though this should be assessed individually. Conclusion: Allowing parent/carer opt-out rights recognises their autonomy while giving primacy to student autonomy. In the case of intervention research, most interventions are delivered at the level of the school so consent can only practically be sought from head teachers. Where interventions are individually targeted, seeking student active consent for these should be considered where feasible.
MeSH term(s)	Child ; Humans ; Adolescent ; Public Health ; Schools ; Communication ; Marriage ; Parental Consent
Language	English
Publishing date	2023-06-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2022-070277
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Article ; Online: What factors influence implementation of whole-school interventions aiming to promote student commitment to school to prevent substance use and violence? Systematic review and synthesis of process evaluations.

Ponsford, Ruth / Falconer, Jane / Melendez-Torres, G J / Bonell, Chris

BMC public health

2022 Volume 22, Issue 1, Page(s) 2148

Abstract: Background: Whole-school interventions go beyond classroom health education to modify the school environment to promote health. A sub-set aim to promote student commitment to school to reduce substance use and violence (outcomes associated with low ... ...

Abstract	Background: Whole-school interventions go beyond classroom health education to modify the school environment to promote health. A sub-set aim to promote student commitment to school to reduce substance use and violence (outcomes associated with low commitment). It is unclear what factors influence implementation of such interventions. Methods: We conducted a systematic review including synthesis of evidence from process evaluations examining what factors affect implementation. Meta-ethnographic synthesis was informed by May's General Theory of Implementation. Results: Sixteen reports, covering 13 studies and 10 interventions were included in our synthesis. In terms of May's concept of 'sense-making', we found that school staff were more likely to understand what was required in implementing an intervention when provided with good-quality materials and support. Staff could sometimes wilfully or unintentionally misinterpret interventions. In terms of May's concept of 'cognitive participation', whereby staff commit to implementation, we found that lack of intervention adaptability could in particular undermine implementation of whole-school elements. Interventions providing local data were reported as helping build staff commitment. School leaders were more likely to commit to an intervention addressing an issue they already intended to tackle. Collaborative planning groups were reported as useful in ensuring staff 'collective action' (May's term for working together) to enact interventions. Collective action was also promoted by the presence of sufficient time, leadership and relationships. Implementation of whole-school interventions took time to build. Considering May's concept of 'reflexive monitoring' (formal or informal review of progress), this was important in assessing and enhancing implementation. 'Quick wins' could help maintain collective impetus to implement further intervention activities. Conclusion: We identified novel factors influencing implementation of whole-school elements such as: local adaptability of interventions; providing local data to build commitment; interventions addressing an issue already on school leaders' agenda; collaborative planning groups; and 'reflexive monitoring' as an explicit intervention component.
MeSH term(s)	Humans ; Health Promotion ; Schools ; Students/psychology ; Violence/prevention & control ; Substance-Related Disorders/prevention & control
Language	English
Publishing date	2022-11-22
Publishing country	England
Document type	Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-022-14544-4
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Article ; Online: Barriers and facilitators to the implementation of Health-Promoting School programmes targeting bullying and violence: a systematic review.

Sadjadi, Mahan / Blanchard, Laurence / Brülle, Rebecca / Bonell, Chris

Health education research

2021 Volume 36, Issue 5, Page(s) 581–599

Abstract: Health-Promoting School (HPS) interventions aim to reduce bullying and violence via curriculum, environmental and family/community-engagement components. Despite evidence of their effectiveness, factors influencing the implementation of such ... ...

Abstract	Health-Promoting School (HPS) interventions aim to reduce bullying and violence via curriculum, environmental and family/community-engagement components. Despite evidence of their effectiveness, factors influencing the implementation of such interventions are poorly understood. This systematic review aims to examine such factors by assessing qualitative process evaluations of HPS interventions aiming to reduce bullying, aggression or violence. A comprehensive systematic search of 12 databases was carried out, and 20 reports from 17 studies were included. Thematic synthesis was used to identify factors affecting implementation. Factors that enable implementation were related to programme characteristics and stakeholder buy-in, including support from leadership, teachers, students and parents. Good communication and staff climate were important. Interventions were better implemented when they framed health promotion as a core school business, were supported by a national policy, used local data to show need and effectiveness and provided high-quality, pragmatic and accessible staff training. The results of this review can serve to guide and facilitate the design and implementation of future bullying and violence prevention programmes. Since there is significant overlap in terms of the important pillars and guiding principles for all interventions guided by the HPS framework, the findings may apply to outcomes beyond bullying and violence.
MeSH term(s)	Bullying/prevention & control ; Health Promotion ; Humans ; Schools ; Students ; Violence/prevention & control
Language	English
Publishing date	2021-07-26
Publishing country	England
Document type	Journal Article ; Systematic Review
ZDB-ID	632781-3
ISSN	1465-3648 ; 0268-1153
ISSN (online)	1465-3648
ISSN	0268-1153
DOI	10.1093/her/cyab029
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Article ; Online: Schools should still be the last to close and first to open if there were any future lockdown.

Viner, Russell / Bonell, Chris / Blakemore, Sarah-Jayne / Hargreaves, James / Panovska-Griffiths, Jasmina

BMJ (Clinical research ed.)

2022 Volume 376, Page(s) o21

MeSH term(s)	COVID-19/epidemiology ; COVID-19/prevention & control ; England/epidemiology ; Humans ; Quarantine ; SARS-CoV-2 ; Schools
Language	English
Publishing date	2022-01-07
Publishing country	England
Document type	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.o21
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