Applying a social equity lens to population-based alcohol interventions: a systematic review and meta-analysis combined with a community-based participatory research approach

背景资料：基于人口的酒精干预措施在减少酒精消费和整体人口的相关危害方面是有效的，但是，关于社会经济地位对不平等的影响的证据有限。已发现SEP较低的组经历了酒精归因的死亡率的预防性较高的水平。有必要确定干预措施，尽量减少整个人口的酒精消费水平，同时实现SEP群体之间的公平。此外，人口健康和健康公平性，通过社区洞察力，但到目前为止，低SEP人群的外行成员还没有系统地参与干预研究。目的：总体目标是为基于人口的酒精干预措施的公平影响建立证据基础。这是通过以下方式实现的：1）通过进行系统性审查和荟萃分析，系统地总结和分析哪些类型的干预措施在SEP群体中实现了公平; 2）通过与社区非专业成员进行小组讨论的主题分析，获得社区洞察力，以更深入地了解低SEP人群对所确定的干预措施的障碍和偏好。研究方法：将使用混合方法序贯三角设计，包括两个研究阶段：在第一阶段，将根据最新的质量指南进行系统评价。将在多个数据库（MEDLINE、EMBASE、Scopus和PsycINFO/PsycArticles）中进行系统性文献检索。筛选、文本评估和数据提取将由两名独立审查员进行。偏倚风险将使用科克伦公共卫生审查小组推荐的"定量研究质量评估工具"进行评估。将计算随机效应成对荟萃分析，并进行亚组分析以检验潜在的调节效应。为了对证据的质量进行分级，将使用建议评估、开发和评价系统的分级。在第二阶段，将与社会上的非专业人士进行小组讨论。它将包括i）热身阶段，其中将介绍审查结果，ii）小组讨论，以及iii）鱼缸讨论。小组讨论将录音。将使用Mayring的内容分析法对成绩单和小组共识进行分析。两个研究阶段的结果将在得出最终结论之前综合考虑其实现公平影响的潜力。公共卫生相关性：该项目具有创新性，与公共卫生高度相关，因为它不仅考虑到人口影响，而且考虑到社区的观点和愿望，就基于人口的酒精干预措施的公平影响提供了一个全面的观点。该项目将产生新的知识，用于（进一步）制定以公平为导向的循证公共卫生干预措施。

Background: Population-based alcohol interventions are effective in reducing alcohol consumption and related harms of the overall population, however, there is limited evidence on the effects on inequalities by socioeconomic position (SEP). Lower SEP groups have been found to experience disproportionally higher levels of alcohol-attributable mortality. There is a need to identify interventions which minimize overall levels of alcohol consumption in entire populations, while achieving equity across SEP groups. Furthermore, population health and health equity are enhanced through community insight, but so far lay members of populations with low SEP have not been systematically engaged in intervention research. Aims: The overall aim is to create an evidence base for the equity impact of population-based alcohol interventions. This is achieved by 1) systematically summarizing and analyzing which types of interventions achieve equity across SEP groups by conducting a systematic review and meta-analysis; and 2) obtaining community insight to gain a deeper understanding of the barriers and preferences of low SEP populations regarding the identified interventions by conducting thematic analysis of panel discussions with lay members of the community. Methods: A mixed methods sequential triangulation design will be used, consisting of two research phases: In phase 1, a systematic review will be conducted, following the latest quality guidelines. A systematic literature search in several databases (MEDLINE, EMBASE, Scopus, and PsycINFO/ PsycArticles) will be conducted. Screening, text assessment and data extraction will be conducted by two independent reviewers. Risk of Bias will be assessed using the "Quality Assessment Tool for Quantitative Studies" recommended by the Cochrane Public Health Review Group. Random-effect pairwise meta-analysis will be calculated, and subgroup analyses will be performed to test for potential moderator effects. To grade the quality of evidence, the Grading of Recommendations Assessment, Development, and Evaluation system will be used. In phase 2, a panel discussion with lay members of the community will be conducted. It will consist of i) a warm-up phase, in which the review findings will be presented, ii) group discussions, and iii) a fishbowl discussion. The panel discussion will be audio-recorded. The transcripts and panel consensus will be analyzed using content analysis by Mayring. Results of both research phases will then be integrated with regard to their potential to achieve equity impact before drawing a final conclusion. Public Health Relevance: The project is innovative and highly relevant for public health as it provides a holistic view on equity impact on population-based alcohol interventions considering not only population impact, but also community views and wishes. The project will generate new knowledge to be used for (further) developments of equity-oriented and evidence-based public health interventions.