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

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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.