Inventory of interventions to reduce health inequalities: Pan-Canadian Health Inequalities Reporting Initiative

The inventory of interventions to reduce health inequalities is built upon 4 comprehensive, systematic reviews. The reviews were conducted by Upstream Lab, a non-profit research lab associated with the MAP Centre for Urban Health Solutions at St. Michael’s Hospital. The objective of these reviews was to identify interventions that address social determinants of health to promote the adoption of healthy behaviors in 4 key areas:

• unhealthy eating
• physical inactivity
• tobacco use
• alcohol use

The core research question guiding these reviews was:

Do interventions addressing the social determinants of health (e.g., socio-economical position [e.g. education, income, occupation], or intermediary social determinants of health [built environments, area of residency, housing conditions, food security and access, environmental exposure, access to healthcare, social capital]) in high-income countries have the potential to improve health behaviors (unhealthy eating, physical inactivity, tobacco and alcohol use)?

Eligibility criteria

To ensure the inclusion of relevant studies, specific criteria were established for both inclusion and exclusion.

Inclusion criteria

• Primary research publications that utilize quantitative or mixed-methods designs and provide data on the impact of interventions targeting social determinants of health on health-related behaviors.
  • The 4 health behaviors examined are unhealthy eating, physical inactivity, tobacco use, and alcohol use.
  • The focus is on interventions within healthy populations.
• Studies involving trials on generally healthy children and adults who exhibit unhealthy behaviors in 1 of the 4 areas described above.
  • Targeted interventions are included if the population of interest is identified as experiencing socioeconomic disadvantage or vulnerability to health inequities, such as financially challenged individuals and people of color.
• Studies must be conducted in countries classified as high-income by the World Bank.
• The publication timeframe for eligible studies is from January 1, 1990, to the present.
• Both peer-reviewed publications and grey literature sources are considered.

Exclusion criteria

• Studies that include participants with specific health conditions (other than obesity) or pregnant women.
• Non-interventional studies—for instance, case-control studies, prevalence or incidence estimations in cross-sectional studies, and studies that assess the relationship between risk factors and unhealthy behavior without reporting on the impacts of an intervention.
• Studies that assess the impact of interventions that do not directly target social determinants of health, such as pharmacological studies and studies with interventions focused solely on behavioral risk factors (for example, cognitive behavioral therapy, behavioral interventions, health education not complemented by interventions on social determinants of health).
  • However, studies with multiple interventions targeting both behavior and social determinants of health are included.
• Economic evaluations that do not present data on the impact of an intervention on unhealthy behavior.
• Secondary research studies (for example, studies where conclusions are derived from previous research or analysis of pre-existing data sources, such as reviews, comparative research of case studies, and news reports).
• Non-primary research studies, such as case reports, opinion pieces like commentaries, news reports and editorials, study protocols and proposals.
• Conference abstracts.
• Qualitative studies, although mixed-methods studies are eligible for inclusion, but only the quantitative component is extracted.
• Non-human primary studies.

Search methodology and study selection

• Upstream Lab executed the initial phases of the search, following protocols established for 4 systematic reviews, 1 for each of the health behaviors of interest.
• Searches for peer-reviewed, indexed literature employed strategies incorporating both free text and indexed terms related to the 4 health behaviors, interventions, social determinants of health, and high-income countries. Boolean Operators were used to refine searches.

Database searches

The search encompassed the following databases, with coverage from 1990 onwards:

• MEDLINE (via Ovid)
• Cochrane
• Embase
• CINAHL
• PsychINFO
• Web of Science
• Scopus
• Applied Social Sciences Index & Abstracts
• Sociological Abstracts
• International Bibliography of the Social Sciences
• PAIS Index (searched simultaneously via ProQuest)

If you have questions about the specific search strategies that were used for Medline (Ovid), in order to extract the inventory of interventions to reduce health inequalities articles on this page, please contact us at health.inequalities-inegalites.en.sante@phac-aspc.gc.ca.

Grey literature searches

Searches for grey literature were conducted utilizing resources such as

• the New York Academic of Medicine’s Grey Literature Report (1996 to 2006)
• the OpenGrey databases (up until 2018)
• various health and agriculture-focused websites (for unhealthy eating)

Screening and data extraction

Title and abstract screening were carried out in duplicate by 2 reviewers in an independent manner. Any disagreements were resolved through consultation with a third reviewer.

Abstracts meeting the eligibility criteria were then progressed to full-text screening. The procedure for full-text screening varied across reviews:

• for the reviews on unhealthy eating and physical inactivity, a single reviewer screened each full-text article
• for the reviews on tobacco and alcohol consumption, full-text eligibility was evaluated in duplicate by 2 reviewers in an independent manner

Data extraction was performed by a team of 2 to 4 members using a pre-piloted data collection form.

Number of interventions identified, by