Better evidence for a better world

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Better evidence for a better world
Better evidence for a better world

Better evidence for a better world (169)

Additional Info

  • Authors Eleanor Ott, Paul Montgomery
  • Published date 2015-01-02
  • Coordinating group(s) Social Welfare
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2015.4
  • Records available in English, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    There is no rigorous evidence on how to improve outcomes for resettled refugees

    There is insufficient evidence to determine whether programmes to improve the economic self-sufficiency and well-being of resettled refugees are effective or not. This does not mean that these programmes do not have important effects, only that the available evidence does not indicate what these effects may be.

    What is the review about?

    Over 59.5 million people have been forced from their homes globally of which 19.5 million are classified as refugees. Refugee resettlement programmes are offered to those who have particular needs or who must be moved to countries other than those in which they initially seek protection: 28 countries currently offer UNHCR-registered programmes, including the USA, Canada, and Australia. The USA alone invests $1 billion in resettlement programmes each year.

    One aim of resettlement programmes is to facilitate the economic integration of refugees. Support programmes include training, education, and mental health services. But resettled refugees often experience high levels of unemployment and poverty.

    This review assesses the effects of programmes to improve the self-sufficiency and well-being of resettled refugees. Outcomes are employment, cash assistance, income levels, ability to keep a job, and quality of life.

    What is the aim of this review?

    This Campbell systematic review examines the effects of programmes on the economic self-sufficiency and well-being of resettled refugees. The review identified 23 relevant studies but none of these could be included in the analysis due weaknesses in study design.

    What studies were included in the review?

    Eligible studies examine outcomes for refugees who have been part of a government resettlement programme and who were between the ages of 18 and 64 years at the time of the programme.

    No studies met the inclusion criteria of this review. Twenty-three studies were identified which were not included in the review because their design meant that the effects measured could not be clearly attributed to the programmes.

    What were the main findings of the review?

    What helps refugees and are resettlement programs effective?

    The lack of available evidence means we do not know for sure how to help resettled refugees improve their economic integration or well-being. This does not mean that programmes for resettled refugees do not have effects, either positive or negative. The available evidence is insufficient to determine what the effects of the programmes are. Resettlement programmes also meet their goal in moving refugees and may have many other positive effects not explored here, such as on the safety of refugees.

    What do the findings in this review mean?

    The lack of knowledge and rigorous research on the impacts of programming for resettled refugees is surprising given the political importance of such programmes, the levels of investment involved, and the number of people affected.

    Such weaknesses have been officially recognised by, for example, the United States Government Accountability Office, which admits that little is still known “about which approaches are most effective in improving the economic status of refugees.”

    Policy makers are faced with the challenge of having to make decisions without a robust research base to inform them.

    There is a knowledge gap about the effects of programmes to support resettled refugees which should be filled by rigorous research. Studies should be informed by clear questions and objectives. Robust methodologies should be used, including appropriate comparison groups and the planned collection of data on key outcomes.

    How up-to-date is this review?

    The review authors searched for interventions from studies from 1980 until September 2013.

  • Spanish

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

Additional Info

  • Authors Trine Filges, Anne-Sofie Due Knudsen, Majken Mosegaard Svendsen, Krystyna Kowalski, Lars Benjaminsen, Anne-Marie Klint Jorgensen
  • Published date 2015-01-02
  • Coordinating group(s) Social Welfare
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2015.3
  • Records available in English, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    Cognitive-behavioural therapies to treat non-opioid drug use in young people is no better or worse than other treatments

    Cognitive-Behavioural Therapy (CBT) is no better – or worse – in reducing youth’s drug use than other interventions when used in outpatient settings.

    What did the review study?

    Youth’s use of non-opioid drugs such as cannabis, amphetamines, ecstasy or cocaine is a severe problem worldwide. Cognitive Behavioural Therapy (CBT) is widely used as a substance abuse treatment with young people. CBT aims to reduce the drug use of adolescents by improving their skills to problem solve, cope with stress and by enhancing their self confidence to resist opportunities to use drugs.

    This review looks at whether CBT is better at reducing the use of non-opioid drugs among young people aged 13-21 than other treatments provided to adolescents in outpatient settings.

    What is the aim of this review?

    This Campbell systematic review examines the effects of Cognitive Behavioural Therapy (CBT) when used in outpatient settings to reduce drug use (of e.g. cannabis, amphetamines,

    ecstasy, or cocaine) among young people aged 13-21. The review summarizes findings from seven studies, all of which were

    randomised controlled trials.

    What studies are included?

    Studies included in this review compare the effects of CBT on youth’s abstinence, drug use and other outcomes with a broad range of other, mostly therapy-based, treatments. CBT interventions are included which are delivered by professionals to clients individually or in groups in outpatient settings. They may have additional components, such as motivational interviewing, but CBT was the primary intervention.

    Seven unique studies are included, reported in 17 papers. All seven studies are randomised controlled trials, six of which were conducted in the US, and one in the Netherlands. Together, the studies involve 953 study participants.

    Is CBT more or less effective than other treatments used in outpatient settings to reduce the use of non-opioid drugs among adolescents aged 13-21?

    CBT is no better than other treatments in ensuring total abstinence from non-opioid drugs or in reducing their use among adolescents who are in substance abuse treatment in an outpatient setting. This overall result is the same no matter if CBT is used with an additional component of motivational interviewing or not. There are also no better effects from CBT on other outcomes such as youth’s social functioning, school problems, criminal activity and treatment retention.

    What do the findings in this review mean?

    CBT is not any better at reducing the use of non-opioid drugs among adolescents than other treatments when used in outpatient settings.

    The review is based on only a small number of studies, several of which show weaknesses and flaws in their methodology. There is a need to fund additional trials of CBT interventions, based on rigorous study designs and with a potential to add to the global CBT evidence base. The majority of included CBT studies were conducted in the U.S. The findings of this review may therefore only have limited applicability in other social and cultural settings. Future trials of CBT interventions should be conducted in a broader range of countries.

    How up-to-date is this review?

    The review authors searched for studies until September 2012.

  • Spanish

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

Additional Info

  • Authors Patrice Villettaz, Gwladys Gillieron, Martin Killias
  • Published date 2015-01-02
  • Coordinating group(s) Crime and Justice
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2015.1
  • Records available in English, Norwegian, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    Effects of custodial versus non-custodial sanctions on re-offending

    Custodial sentences, such as prison, are no better than non-custodial sentences in reducing re-offending.

    What is this review about?

    Those who commit illegal acts may re-offend. It is important to know which sanctions reduce re-offending and if some approaches are more effective than others.

    There are two kinds of sanctions. Custodial sanctions deprive offenders of their freedom of movement by placing them in institutions such as prisons, halfway houses, or ‘boot camps’. Non-custodial sanctions (also known as ‘alternative’ or ‘community’ sanctions) include community work, electronic monitoring, and fines. This review examines whether custodial and non-custodial sanctions have different effects on the rates of re-offending.

    What is the aim of this review?

    This Campbell systematic review compares effects of custodial and non-custodial sentences on re-offending. The authors found fourteen high-quality studies, including three randomised controlled trials and two natural experiments.

    Which studies are included in this review?

    Included studies had at least two groups: a custodial group and a non-custodial group. Sanctions had to be imposed following a criminal offence, and there had to be at least one measure of re-offending, such as new arrests.

    Fourteen high-quality studies comparing custodial and non-custodial sentences are included in the analysis. The studies span the period from 1961 to 2013 and are mostly from the USA, Europe and Australia.

    Do custodial sanctions have different effects from non-custodial sanctions on re-offending?

    No. High quality studies show that custodial sentences are no better or worse than non-custodial sentences in reducing re-offending.

    Some studies with weaker designs suggest that prison is followed by higher re-offending rates than non-custodial sanctions. However, these results may be affected by selection bias; that is, offenders who were less likely to re-offend were more likely to be given a non-custodial sentence.

    What do the results mean?

    Imprisonment is no more effective than community-based sanctions in reducing re-offending. Despite this evidence, almost all societies across the world continue to use custodial sentences as the main crime control strategy.

    In terms of rehabilitation, short confinement is not better or worse than “alternative” solutions. Many studies of sentencing practices were found that used weak and biased methods. Better evidence should be used by policy makers and practitioners, for example from randomised controlled trials or natural experiments. Although several such studies are included in this review, additional high quality studies are needed.

    Other non-custodial approaches to offender rehabilitation also need to be evaluated, such as those provided through employment or other social networks.

    How up to date is this review?

    The review authors searched for studies done from 1961 up to 2013.

  • Norwegian

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  • Spanish

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

Additional Info

  • Authors Cyrus Samii, Laura Paler, Larry Chavis, Parashar Kulkarni, Matthew Lisiecki
  • Published date 2014-12-19
  • Coordinating group(s) International Development
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2014.10
  • Records available in English, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    Decentralized forest management programs can reduce deforestation rates but there is limited evidence to assess poverty outcomes

    Decentralized forest management programs reduce deforestation rates, although the effects may be modest. More research is needed to assess whether such programs reduce the income of poor households.

    What is this review about?

    An estimated 10–17 per cent of global carbon emissions are the result of deforestation. Forests also act as carbon sinks, absorbing carbon emissions from other sources. Therefore, preserving natural forests is an important component of managing climate change.

    Decentralized forest management programs transfer the responsibility and authority for managing forests (for example, deciding which areas are protected and which areas can be exploited) from central governments to local authorities. Such programs have the primary goal of reducing deforestation, but there is debate as to whether they can meet this goal while also reducing poverty.

    This review examines the evidence for the effects of decentralized forest management programs on deforestation and poverty outcomes in low- and middle-income countries (LMICs).

    What is the aim of this review?

    This Campbell Systematic Review examines the impact of decentralized forest management on deforestation and poverty in developing countries. The review summarises evidence from eight quantitative studies (quasi-experimental studies with statistical adjustment for bias) and four qualitative studies.

    What studies are included?

    To be eligible for inclusion, studies were required to be conducted in LMICs and evaluate a decentralized forest management program, defined as a program where the formal responsibility for forest management passes from centralized to local authorities. Studies were included if they assessed any type of poverty outcome for populations living near natural growth forest and/or any type of deforestation outcome.

    The studies reporting the effects on forest conservation were conducted in Bolivia, India, Kenya and Nepal; the studies reporting the effects on human welfare were conducted in Ethiopia, Malawi and Uganda.

    What are the effects of decentralised forest management on deforestation and poverty?

    Decentralized forest management programs reduce deforestation rates on average, but the effects are modest.

    Decentralized forest management programs increase average household income in the affected community, but little evidence is available on the effects of such programs on the incomes of poor households. One study from Uganda suggests that decentralised forest management programs may reduce the income of poorer households.

    How do institutional and social conditions affect the outcomes of decentralised forest management programs?

    No quantitative evidence was found to assess how institutional and social conditions affect decentralized forest management programs. Qualitative studies show that some programs do not have the institutional capacity to be effective. Democratically accountable programs may have larger effects, but only if the community supports conservation goals.

    How has this intervention worked?

    Decentralized forest management programs are based on the assumption that local authorities have better knowledge of local conditions, leading to more efficient forest policies that are more responsive to community interests. Local authorities may also have better incentives for sustainable forest management.

    What do the findings of this review mean?

    Proponents of decentralized forest management programs suggest that such programs can contribute to both environmental and poverty reduction outcomes. This review showed that little research has been conducted on the poverty reduction benefits of such programs, and no studies have jointly evaluated both conservation and poverty outcomes. Research is also lacking in the countries where decentralised forest management has the most potential, such as Indonesia and Brazil.

    How up-to-date is this review?

    The review authors searched for qualitative and quantitative studies up to August 2013, and conducted a second search for relevant qualitative studies up to November 2013.

  • Spanish

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

Additional Info

  • Authors Cyrus Samii, Matthew Lisiecki, Parashar Kulkarni, Laura Paler, Larry Chavis
  • Published date 2014-12-19
  • Coordinating group(s) International Development
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2014.11
  • Records available in English, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    Payment for environmental services have only modest effects on deforestation

    Payment for Environmental Services (PES) programmes have only modest effects on deforestation and are not cost-effective. PES programmes are more likely to attract wealthier farmers, and are less effective in poor areas.

    What is the review about?

    Forests store carbon, which helps mitigate the effect of carbon emissions. However, the amount of forest cover is declining at a rate of over seven million hectares a year.

    Payment for environmental services are voluntary contracts to supply an environmental service in exchange for payment. In this review, the service being paid for is the maintenance or rehabilitation of natural forests.

    The review examines how PES programmes affect deforestation, factors affecting programme effectiveness, and whether PES should also aim to reduce poverty.

    What is the aim of this review?

    This Campbell systematic review examines the effects of Payment for Environmental Services (PES) programmes on deforestation and poverty, and whether environmental and poverty reduction goals conflict with one another. The review summarizes evidence from 11 studies covering six PES programmes in four countries.

    Which studies are included in this review?

    The review includes evaluations of PES programmes which report deforestation and poverty outcomes compared to outcomes in a ‘non-PES’ comparison group. Eleven studies are included, covering six programmes in four countries: Costa Rica, China, Mexico, and Mozambique. Nine studies provide evidence on environmental effects, and two on poverty effects. None of the studies report both poverty and environmental outcomes.

    The studies all have methodological weaknesses. None use random assignment. Therefore, the effect of PES on deforestation may be over-estimated because: (1) PES programmes may be applied to areas of land that landowners do not intend to deforest, and (2) landowners may ‘compensate’ by cutting down trees on lands that are not included in PES programmes.

    How effective are PES programmes?

    There is evidence of moderate quality which suggests that PES programmes only have a modest effect on deforestation. On average the rate of deforestation is reduced by 0.21 per cent per year. This very modest impact means that almost all the land for which PES payments were made would have remained forested even in the absence of payments. PES may be slightly more effective in iincreasing forest cover than it is at preventing deforestation.

    PES improved participating households’ incomes by 4 per cent in Mozambique, and by 14 per cent in China. However, PES programmes are (1) more likely to benefit wealthier landowners, and (2) less effective in poor areas. Participation by the poor is constrained by documentary requirements, high transaction costs, and lack of understanding of programmes.

    One study measured impact separately in poorer areas, reporting no effect on deforestation in those areas. This one finding suggests there may be a trade-off between conservation and poverty reduction efforts, but more evidence is needed.

    What determines how well PES programmes work?

    A number of factors affect how well PES programmes work:

    • Attempts to distribute resources fairly divert programme resources away from areas most at risk from deforestation.
    • Systems of monitoring deforestation may overestimate compliance and effectiveness.
    • Programme effectiveness may be undermined by corruption, for example by landowner organizations lobbying for higher payments.

    What do the findings of this review mean?

    The modest effectiveness of PES programmes means that they are not cost-effective. Relative to the extensive investment to measure forest conditions, efforts to assess the effects of PES programmes on deforestation and poverty are limited and methodologically weak. Funders wanting to support cost-effective measures to reduce deforestation should incorporate high-quality evaluation designs into future PES programmes, preferably with random assignment.

    How up-to-date is this review?

    The review authors searched for studies published up to November 2013.

  • Spanish

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

Additional Info

  • Authors Lisa De La Rue, Joshua Polanin, Dorothy Espelage, Terri Pigott
  • Published date 2014-11-03
  • Coordinating group(s) Education
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2014.7
  • Records available in English, Norwegian, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    School-based programs to prevent dating violence do not change behaviour

    School-based programmes to prevent violence in dating relationships improve knowledge about violence, attitudes that are less accepting of violence in relationships, and awareness of appropriate attitudes to conflict resolution. But they have little impact on behaviour change.

    What is this review about?

    Abuse occurs in an estimated 3-10% of young people’s intimate relationships. Psychological, physical and sexual violence in dating relationships have a significant impact on the mental and physical health of young people. Dating violence can have long-term consequences, such as depression, eating disorders, and substance abuse, and affect school performance.

    This review summarises evidence on programmes to prevent dating violence implemented in middle and high schools (Grades 6-12).

    What is the aim of this review?

    This Campbell systematic review examines the effectiveness of school-based interventions to reduce or prevent violence in intimate relationships. The review focused on programmes to change attitudes and beliefs, reduce perpetration and victimization, and change behaviours. The systematic review included 23 studies.

    What studies are included?

    Only studies of school-based interventions to reduce or prevent teen dating violence or sexual violence in intimate relationships were included. Some studies used previously developed programmes, such as Love U2, Safe Dates, and Connections: Relationships and Marriage. Others used adapted or newly developed programmes.

    To qualify for inclusion in the review, the programmes had to measure the impacts of the interventions on one or more of the following: (a) knowledge about dating violence, (b) attitudes to dating violence, (c) acceptance of rape myths, (d) dating violence perpetration, (e) dating violence victimization, (f) ability to recognize both safe and unhealthy behaviours in intimate partner disputes.

    Only studies with a well-defined control group were included. This systematic review summarizes data from 23 studies, 14 of which assessed as having a high risk of bias. The included studies were conducted in the USA and Canada.

    How effective are the school-based programmes?

    Prevention programmes improve young people’s knowledge about, and attitudes towards, dating violence. These effects were sustained at follow up. Students in the intervention group showed moderate increases in knowledge about dating violence, a lower acceptance of stereotypical ‘rape myths’, and moderate improvements in appropriately resolving conflicts in interpersonal relationships.

    A limited number of studies examined the effects of school-based programmes on the amount of violence perpetrated and on victimization. These studies suggest that prevention programmes have little impact on behaviour.

    What are the implications of this review for policy makers and decision makers?

    Programmes to prevent violence in relationships are important, because of the impacts that violence has on adolescents’ wellbeing, and the risk of its long-term consequences. Existing programmes need to be designed to better support behaviour change. Skill-building components among pupils may help achieve this goal.

    What are the research implications of this review?

    Prevention efforts require changes to both attitudes and behaviour. Future studies may need to focus more on measuring actual behaviours, rather than just knowledge and attitudes. Programmes may also need to consider contextual social factors, such as the influence of peers, on the social and behavioural development of young people.

    All the included studies were from North America. Research from other areas is needed.

    How up-to-date is this review?

    The search was completed in July 2013.

  • Norwegian

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  • Spanish

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Additional Info

  • Authors Brian Reichow, Erin Barton, Brian Boyd, Kara Hume
  • Published date 2014-11-03
  • Coordinating group(s) Education
  • Type of document Review
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2014.9

Additional Info

  • Authors Jos Vaessen, Ana Rivas, Maren Duvendack, Richard Palmer Jones, Frans Leeuw, Ger van Gils, Ruslan Lukach, Nathalie Holvoet, Johan Bastiaensen, Jorge Garcia Hombrados, Hugh Waddington
  • Published date 2014-11-03
  • Coordinating group(s) International Development
  • Type of document Review
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2014.8

Additional Info

  • Authors Hugh Waddington, Birte Snilstveit, Jorge Garcia Hombrados, Martina Vojtkova, Jock Anderson, Howard White
  • Published date 2014-09-01
  • Coordinating group(s) Education, International Development
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/CSR.2014.6
  • Records available in English, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    Farmer field schools improve agricultural practices, yields and incomes in small pilot programmes, but not in large-scale programmes

    Farmer field schools improve farmers’ knowledge and adoption of better practices, and increase agricultural production and income. However, knowledge of better practices does not spread to neighbouring farmers who do not participate in the program, and large-scale programmes are not effective.

    What is this review about?

    The purpose of farmer field schools is to improve farmers’ skills to empower them to make better decisions. Different programmes have different objectives, but they often aim to reduce pesticides use, promote better farming practices and boost yields or income. Field schools use facilitators who employ participatory, experiential learning methods over an entire growing season. For example, farmer field schools use ‘practice plots’ where farmers can compare results from different farming methods. In contrast to traditional agricultural extension projects, which mainly teach simple practices such as applying fertilisers, farmer field schools often teach holistic techniques, such as integrated pest management.

    Farmer field schools have been widely used across Asia, Africa and Latin America, reaching an estimated 10–15 million farmers.

    This review examines the effectiveness of farmer field schools in changing farmer knowledge and practice, and improving yields, income, environmental impact and farmer empowerment.

    What is the aim of this review?

    This Campbell Systematic Review examines the effectiveness of farmer field schools in improving intermediate outcomes (such as knowledge and pesticide use) and final outcomes (such as agricultural yields, incomes and empowerment) in low- and middle-income countries, as well as implementation factors associated with programme success and failure. The review sythesises evidence from 92 impact evaluations, of which 15 were of sufficient quality for policy-oriented findings, and 20 qualitative studies.

    What studies are included?

    The review includes 92 impact evaluation studies conducted in low or middle-income countries. The review also includes 20 qualitative evaluations of the barriers to and enablers of change in farmer field school projects.

    What are the effects of farmer field schools on agricultural and environmental outcomes?

    Farmer field schools improve farmers’ knowledge and adoption of beneficial practices, and reduce overuse of pesticides. This leads to positive outcomes for farmers: on average, a 13 per cent increase in agricultural yields and a 20 per cent increase in income. Farmer field schools also reduce pesticide use and environmental degradation. However, the evidence for these outcomes comes from short-term evaluations of pilot programmes, and no studies with a low risk of bias are available.

    In programmes that were delivered at a national scale, studies conducted more than two years after implementation did not show any positive outcomes from the programme. For large-scale programmes, recruiting and training appropriate facilitators was problematic.

    What are other outcomes of farmer field schools?

    Empowerment is a major objective of many farmer field schools, but few rigorous studies collected information on this outcome. A few qualitative studies suggest participating farmers feel more confident.

    Farmers who do not participate in farmer field schools do not learn from neighbours who do participate. The complex concepts taught in farmer field schools may be difficult to learn through conversations and self-study, so the experience gained in farmer field schools may be a key reason the intervention works.

    What do the findings in this review mean?

    Farmer field schools can be effective in specific contexts and may be suitable for gradual scale-up, but are unlikely to be suitable for large-scale problems. However, the evidence base on large-scale implementation of farmer field schools is limited. Hence more rigorous studies, examining the implementation and effectiveness of nationwide programmes, are needed.

    How up-to-date is this review?

    The review authors searched for studies published until October 2012.

  • Spanish

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Additional Info

  • Authors Sean Grant, Amanda Parsons, Jennifer Burton, Paul Montgomery, Kristen Underhill, Evan Mayo-Wilson
  • Published date 2014-05-01
  • Coordinating group(s) Social Welfare
  • Type of document Review Plain language summary
  • Library Image Library Image
  • See the full review https://onlinelibrary.wiley.com/doi/10.4073/csr.2014.3
  • Records available in English, Spanish
  • English

    PLAIN LANGUAGE SUMMARY

    Home visits appear not to be effective, but better evidence may show some benefits for some groups from some interventions

    Home visits by health and social care professionals aim to prevent cognitive and functional impairment in older adults, thus reducing institutionalisation and prolonging life. Overall, home visits do not achieve these aims. Higher quality evidence is needed to determine how and for whom home visits may be effective.

    What did the review study?

    Home visits by health and social care professionals are a preventive intervention targeted primarily towards older adults. Their main aim is to maintain the health and autonomy of community-dwelling older adults. This type of preventive intervention involves strategies to reduce a variety of risk factors older adults face for morbidity and mortality relating to physical, functional, psychological, environmental and social issues.

    This review examines the effectiveness of home visits in reducing impairment, institutionalization, and death in older adults. Factors that may moderate effects are identified.

    What is the aim of this review?

    This Campbell systematic review assesses the effectiveness of home visits in preventing impairment, institutionalization, and death in older adults, as well as identifying factors that may moderate effects. The review summarises findings from 64 studies.

    Fourteen of the studies were undertaken in Great Britain, and the USA each, 11 in Canada, 5 in the Netherlands, 3 in Japan, 4 in Australia and New Zealand each, 2 each in Denmark, Taiwan, and Sweden, and 1 each in Switzerland, Finland and Italy.

    What studies are included?

    Included studies are randomized controlled trials assessing the effectiveness of visits by health or social care professionals (not directly related to recent hospital discharge) for persons aged 65 years and above who are living at home. Less than 50% of the study population had to be without dementia.

    A total of 64 studies with 28,642 participants were included. All studies are from developed countries, with the largest number from the USA and the UK, with 14 studies each.

    What are the main results in this review?

    Overall home visits are not effective in maintaining the health and autonomy of community-dwelling older adults. Preventive home visits did not reduce absolute mortality, and did not have a significant overall effect on the number of people who were institutionalised.

    There is high quality evidence of no effect on falls from interventions targeting fall prevention. There is low quality evidence of small statistically significant positive effects for functioning and quality of life.

    It is possible that some programmes have modest effects on institutionalisation and hospitalisation. However, heterogeneity in target population and intervention design, as well as poor reporting of in studies of design, implementation and the control condition make this difficult to determine.

    What do the findings in this review mean?

    Home visits for community-dwelling older adults do not significantly reduce mortality and morbidity. Estimates of treatment effects were statistically precise. So further small studies of multi-component interventions compared with usual care would be unlikely to change the conclusion.

    However, there is a possibility that there may be beneficial effects of some interventions for some populations. Poor reporting of how interventions and comparisons were implemented means these cannot be identified in this review. If researchers continue evaluations on these types of interventions, a clear theory of change describing the programme theory of change and implementation is needed, and all measured outcomes must be reported.

    How up-to-date is this review?

    The review authors searched for studies published until December 2012.

  • Spanish

    Click on 'Download PDF' on the right to view the plain language summary in Spanish.

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