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：以人群为基础的酒精干预措施在减少总体人群的酒精消费和相关危害方面是有效的，然而，关于社会经济地位(SEP)对不平等的影响的证据有限。低SEP组被发现经历了不成比例的高水平的酒精可归因性死亡率。有必要确定干预措施，将整个人群的酒精消费总体水平降至最低，同时实现SEP群体的公平。此外，通过社区洞察力提高了人群健康和健康公平，但到目前为止，低SEP人群的外行成员还没有系统地从事干预研究。目标：总体目标是为以人群为基础的酒精干预对公平的影响创造一个证据基础。这是通过以下方式实现的：1)通过进行系统回顾和元分析，系统总结和分析哪些类型的干预措施实现了跨SEP群体的公平；以及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人群在已确定干预措施方面的障碍和偏好。方法：采用混合方法序贯三角设计，分为两个研究阶段：第一阶段，按照最新的质量指南进行系统评价。将在几个数据库(MEDLINE、EMBASE、SCOPUS和心理信息/心理文章)中进行系统的文献搜索。筛选、文本评估和数据提取将由两名独立的审查员进行。偏差风险将使用Cochrane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，并进行分组分析以测试潜在的调节效应。为了对证据的质量进行评级，将使用建议评估、开发和评估系统的评级。在第二阶段，我们会与社会各界人士进行小组讨论。它将包括一)热身阶段，在此阶段将介绍审查结果，二)小组讨论，以及三)鱼缸讨论。小组讨论将被录音。文本和小组共识将使用梅林的内容分析进行分析。两个研究阶段的结果将结合其实现公平影响的潜力进行综合，然后得出最终结论。公共卫生相关性：该项目具有创新性，与公共卫生高度相关，因为它提供了对基于人口的酒精干预措施的公平影响的全面看法，不仅考虑到人口影响，还考虑到社区的意见和意愿。该项目将产生新的知识，用于(进一步)发展注重公平和以证据为基础的公共卫生干预措施。

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.