HIV health promotion and men who have sex with men (MSM): a systematic review integrating 'qualitative' studies and trials [abstract]

Abstract

Background: This review analysed and synthesised systematically the findings from studies of MSM's views and experiences of HIV-related sexual health, and integrated these with findings from trials of HIV-health promotion. It advances systematic review methodology: by synthesizing 'qualitative' and 'quantitative' research within a single review; and by developing the review methods in consultation with key potential review users. This paper describes the first of these advances and contributes to the work of the Cochrane Qualitative Research Methods Group. Objectives: To describe advances in the integration of 'qualitative' research with trials in a single systematic review. Our review addressed the following substantive question 'What are the barriers to, or facilitators of, HIV-related sexual health for MSM and what are MSM's perceptions and experiences of sexual health in the light of HIV?'. Methods: Exhaustive searches sought two types of studies: (i) trials to examine the effectiveness of HIV-health promotion for MSM; and (ii) studies using qualitative and other methods to describe the views and experiences of MSM ('views' studies). The methodological quality of both trials and 'views' studies was assessed using criteria appropriate for each study type. Three syntheses were conducted following methods developed in a review of children and healthy eating 1. Results: The first synthesis, a statistical meta-analysis, was able to identify the effectiveness of interventions for reducing the number of men reporting sero-discordant or unknown status unprotected anal intercourse (an outcome prioritized by policy makers, practitioners and advocates for MSM). In the second synthesis, author's descriptions of findings from ten 'views' studies were extracted verbatim and entered into a qualitative thematic synthesis. This synthesis identified barriers to, and facilitators of, HIV-related sexual health for MSM and their intervention needs. The third synthesis was a 'mixed methods' synthesis conducted across study types. This used the findings of the second synthesis to illuminate the findings of the first. More specifically this synthesis sought to identify whether the interventions evaluated by trials met the intervention needs of MSM; policy and community level interventions were notably absent and the needs of more vulnerable MSM were poorly addressed. Conclusions: This review confirmed the utility of including qualitative studies and conducting a 'mixed methods' synthesis to enrich the findings on intervention effectiveness with those about a) the appropriateness of interventions and b) promising interventions to test in the future. Whilst developed for reviews in public health, our method is potentially applicable across a wide range of topics and is offered as one way in which Cochrane reviews might integrate qualitative studies whilst preserving the unique contribution of well-conducted trials for assessing the effects of interventions. Acknowledgements: The review described in this abstract was funded as part of a programme of work on evidence-based health promotion funded by the Department of Health (England). The views expressed are those of the authors and not necessarily those of the Department of Health. References: 1. Thomas J, Harden A, Oakley A, Oliver S, Sutcliffe K, Rees R, Brunton G, Kavanagh J (2004) Integrating qualitative research with trials in systematic reviews: an example from public health. BMJ (In press)