Evidence Acquisition and Evaluation for Evidence Summit on Population-Level Behavior Change to Enhance Child Survival and Development in Low- and Middle- Income Countries

This article summarises the background and methods for the acquisition and evaluation of the evidence used to achieve the goals of the Evidence Summit on Enhancing Child Survival and Development in Lower- and Middle-Income Countries by Achieving Population-Level Behavior Change, which was held in Washington, DC, United States (US), June 3-4 2013. It was hosted by the United States Agency for International Development (USAID), in collaboration with the United Nations Children's Fund (UNICEF) and the National Institute of Mental Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Centers for Disease Control and Prevention, The Communication Initiative, and the American Psychological Association. The summary below is part of a special issue of the Journal of Health Communication that is a product of the Evidence Summit.

As detailed here, the multi-year process that led up to the Summit began with the identification of focal questions intended to inform the United States (US) and low- and middle-income governments about behaviour change interventions that accelerate reductions in under-5 mortality and optimise healthy and protective child development to 5 years of age. Experts were selected who represent the research and programme communities, academia, relevant non-governmental organisations, and government agencies. They were assembled into evidence review teams (ERTs), which focused their subsequent work on 6 questions concerning interventions to achieve behaviour and social changes that are needed to accelerate reductions in under-five mortality and optimise healthy and protective child development to age five: What are the effective and sustainable interventions to promote and support behaviour changes required for and by families, mothers, and other caregivers? What are the effective means to facilitate and empower communities to organise and advocate for interventions to achieve behaviour and social changes? What types of sustainable health systems and policy supports are effective? What are the effective and sustainable interventions that focus on gender dynamics? What are the effective and sustainable interventions that address stigma and discrimination? What are the effective and sustainable interventions that use advances in science and technology?

This process was followed by the systematic gathering of relevant peer-reviewed literature that would inform these focal questions. Members of the ERTs were invited to add relevant articles not identified in the initial literature review, which was conducted by information specialists, to complete the bibliographies. (Details of the search processes and methods used for screening and quality reviews are described in the paper.) The ERTs were asked to comply with a specific evaluation framework for recommendations on practice and policy on the basis of both expert opinion and the quality of the data reviewed. After the screening and sorting processes were completed, ERT members were provided an online instrument for assessing the quality of the studies reported in the articles derived from the literature search and screening process and obtained through the call for evidence.

In parallel with the work of the Evidence Summit process, two 2-day consultations were held to discuss regional evidence for population-level social and behaviour change interventions, one for Africa and one for South Asia. For both consultations, regional evidence was gathered and case studies identified that were used to obtain regional feedback and to lay the groundwork for the final results of the Evidence Summit. Then, a technical working meeting was held in February 2013, which involved members of the 6 ERTs coming together to learn about the purpose of the Evidence Summit and its anticipated outcomes, discuss the initial review of the literature, and develop work plans for producing evidence synthesis articles and recommendations.

Ultimately, at the June Evidence Summit, each ERT provided an overview of their evidence synthesis and draft recommendations for policy, practice, and research. Participants were invited to identify other documents that the ERTs should consider in their reviews and to give written feedback on both the evidence syntheses and recommendations. Writing teams were formed from the ERTs, which used the draft evidence summaries and the feedback from the Summit to produce the reports published in the Journal of Health Communication, which can be accessed here. This excerpt from the paper summarises what was found during the evidence review process:

• "No broad consensus exists on a multidisciplinary conceptual model to link the individual, community, and systems-level domains to theories of change on how social and behavior change interventions lead to improvements in child survival and development.
• Research seldom addresses the continuum from changes in knowledge and attitudes to changes in healthy behaviors to meaningful changes in public health.
• Research seldom measures the effectiveness of interventions targeting communities, health systems, and policies. Methodological advances and scientific consensus on efficacy and effectiveness research at these levels are needed.
• Research methodologies for assessing interventions that address gender and stigma discrimination issues are largely absent.
• Although several well-established guidelines for assessing the quality of controlled trials and other empirical intervention research exist (e.g., the CONSORT check-list and the GRADE approach), consensus is lacking on guidelines within implementation science for assessing the quality of program evaluations, qualitative research, and other sources of information on effectiveness of behavior change interventions.
• Consensus guidelines are missing for reporting effect sizes in behavioral intervention research.
• Consensus is lacking on a framework for deriving recommendations on evidence-based practices in the area of behavior change that are more applicable to the challenges faced in low- and middle-income countries.
• Furthermore, consensus is needed on both behavior change and health outcome measures that should be routinely included in effectiveness research and program evaluation. These common measurement tools could facilitate meta-analyses and comparative effectiveness research."

According to the authors: "The lack of ideal evidence, or an ideal framework in which to evaluate evidence, should not deter the global health development and research communities from reviewing evidence regarding critical global health challenges. Doing so creates a transparent understanding of what is known, enabling better decision-making processes and more targeted and relevant research agendas while leveraging the tremendous resident expertise in the development, academic, and multilateral communities."