Synthesising evidence for equity impacts of population-based physical activity interventions: a pilot study

Abstract

Background: This study applied an equity lens to existing research to investigate what is known about the impact of population-level physical activity interventions on social inequalities.

Methods: We performed a pilot systematic review to assess the availability of information on the social distribution of intervention effects, the targeting or allocation of interventions, and the baseline characteristics of participants. This comprised (i) a rapid review of systematic reviews and (ii) a review and synthesis of a sample of primary studies included in the eligible systematic reviews.

Results: We found 19 systematic reviews of environmental and policy interventions. Relatively few of these (26%, n=5) were prospectively designed to examine effects on inequalities, and none were able to fully synthesise evidence of distributional effects. Over 40% of primary studies reported subgroup intervention effects; 18% reported socio-demographic interaction effects. Studies most often compared effectiveness by gender, followed by age, ethnicity, and socio-economic status. For gender, effects appeared to be evenly distributed overall, although heterogeneity in gradients between studies suggested that some interventions affect males and females differently.

Conclusions: Our findings suggest that it is feasible to generate better evidence about how public health interventions may affect health inequalities using existing data and innovative methods of research synthesis.

Figure 1

Flow diagram of selection process.

Figure 2

Results of the review of reviews (n=19). Bar counts do not sum to 19 because studies were double counted if they reported multiple types of relevant data across multiple PROGRESS-Plus items.

Figure 3

Results of the review of primary studies (n=87). Bar counts do not sum to 87 because studies were double counted if they reported multiple types of relevant data across multiple PROGRESS-Plus items.

Figure 4

Harvest plot of subgroup intervention effects in primary studies. The harvest plot summarises several aspects of the primary studies. Each block represents an individual study. The positioning of each block under one of the three headings reflects which of the three competing hypotheses is most supported by the findings of each study. The height of the bars represents the suitability of the study design (1-4), the number above each bar represents the study quality (1-6), and the tone of the bars indicates the outcome metric, (white for direct observation, grey for self-report, and black for objective measures of physical activity). The number within each bar is that of the citation number for the study (Additional file 1).