Papers by Jonathan Shepherd
Health education research, Jun 1, 2012
We systematically reviewed school-based skills building behavioural interventions for the prevent... more We systematically reviewed school-based skills building behavioural interventions for the prevention of sexually transmitted infections. References were sought from 15 electronic resources, bibliographies of systematic reviews/included studies and experts. Two authors independently extracted data and quality-assessed studies. Fifteen randomized controlled trials (RCTs), conducted in the United States, Africa or Europe, met the inclusion criteria. They were heterogeneous in terms of intervention length, content, intensity and ...
Health Technology …, Jan 1, 2010
Background
Schools are an important setting for health promotion and teachers have an integral... more Background
Schools are an important setting for health promotion and teachers have an integral role to play in promoting children and young people’s health and well-being. Adequate initial teacher training (ITT) and continuing professional development in health is therefore important.
Objectives
To conduct a survey of initial teacher training providers in England and a systematic review of effectiveness to assess how health and well-being is covered on courses, and to identify barriers and facilitators to effective training.
Methods
Methods included an online questionnaire survey with a sample of 220 ITT course managers in England; interviews with a purposive sample of 19 of the course managers responding to the questionnaire; and a two-stage systematic review comprising a descriptive map of the characteristics of international research studies of health teacher training and a detailed synthesis of a subset of studies specifically on pre-service training. Databases (including MEDLINE, EMBASE, The Campbell Library and PsycINFO) were searched from the period of database inception up to May 2011.
Results
The overall response rate for the survey was 34%. The majority (89%) of respondents agreed that it was either important or very important to cover health within the ITT curriculum. The most commonly covered topics on courses were Every Child Matters (100%), child protection (100%), emotional health (99%) and antibullying (97%). Fewer course managers reported covering healthy eating (63%), sex and relationships (62%), drugs (56%), alcohol (41%) and smoking (34%). Many interviewees expressed a holistic view of education and believed that health was important in the ITT curriculum. However, there was variability in how health was addressed across and within institutions. Trainee teachers' experience of addressing child health on school placement was also variable. Facilitators to covering health included interests and backgrounds of ITT staff; staff health-related professional experience; availability of health expertise from external agencies; supportive government policy frameworks; and interprofessional and interdepartmental working. The main barriers were limited curriculum time; health being perceived to be a lower priority than other aspects of training; health no longer a high government priority in education; and lack of funding. A total of 170 studies met the eligibility criteria for the descriptive map. The majority covered teacher training in relation to sexual and reproductive health, drugs and alcohol or mental and emotional health. A total of 21 publications (20 studies) were prioritised for the synthesis. All were evaluations of health training for pre-service teachers, and just under half were from the UK. Twelve studies reported outcomes (impact of training on teachers, but not pupils), many of which were single cohort before-and-after studies. Sixteen studies reported processes. Following training there were some increases in trainee teachers' factual knowledge of health and a general increase in their confidence to address health issues. In general, training was acceptable and well received by trainees. Evidence suggested that effective training should include practical experience and skills and be personally relevant and take into account individual needs. Barriers to health training identified from the studies included lack of time, balancing breadth and depth, and variation in training provision.
Conclusions
Among those surveyed there appears to be general support for health and well-being in ITT. However, further research on the longer-term impact of ITT around health and well-being is needed, particularly in the early career period. The main limitation of this research was the low response rate (34%) to the survey.
Systematic reviews play an increasingly important role in decision making in health promotion and... more Systematic reviews play an increasingly important role in decision making in health promotion and public health. However, little has been published on how systematic reviewers acquire necessary knowledge and skills, and on the challenges they face in producing reviews. Semistructured interviews were conducted with a purposive sample of 17 systematic reviewers of health promotion. They described practice, training, and mentoring as being key ways that they learned reviewing skills, often in combination. Practice-based learning was considered to be particularly beneficial. Training was generally easy to access, though questions were raised about the feasibility of training stakeholders such as health professionals to become reviewers. It was suggested that an understanding of research methods is beneficial for novice reviewers. While funding opportunities for doing reviews are available, long-term investment is needed to support an infrastructure for the production of high-quality systematic reviews of important health promotion priorities.
Health Technol …, Jan 1, 2009
How to obtain copies of this and other HTA programme reports An electronic version of this public... more How to obtain copies of this and other HTA programme reports An electronic version of this publication, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable CD-ROM is also available (see below).
Health Technology …, Jan 1, 2010
How to obtain copies of this and other HTA programme reports An electronic version of this title,... more How to obtain copies of this and other HTA programme reports An electronic version of this title, in Adobe Acrobat format, is available for downloading free of charge for personal use from the HTA website (www.hta.ac.uk). A fully searchable DVD is also available (see below).
… in Health Care, Jan 1, 2007
There is a need for innovative methodologies to identify and prioritize topics for health technol... more There is a need for innovative methodologies to identify and prioritize topics for health technology assessment (HTA). A pilot project to evaluate the methodology for specialty mapping was undertaken in the area of child and adolescent health. Two case studies are presented, in the area of sexually transmitted infections and acute pain. The methodology comprised sequential stages, based on principles of systematic review. A "stakeholder model" encouraged wider participation. Key stages included identifying the topic area and setting the scope; developing a care pathway; searching for clinical guidelines/guidance, and evaluation literature; synthesis and mapping of literature to the "nodes" of the care pathway to highlight gaps; prioritizing the topics with stakeholders; and referring priorities to the appropriate agencies. A total of thirty guidelines/guidance documents and sixteen evaluation studies were mapped across the two case studies. In some nodes of the care pathway, more literature was mapped than others, suggesting important gaps in research and policy guidance. Sixty-two policy questions were identified and were rated by stakeholders in prioritization workshops. The highest priorities have been considered by senior committees for likely commissioning as research or guidelines/guidance. This is one of the few published examples of innovative methodology to identify and prioritize topics for HTA. Specialty mapping can make a positive contribution to the policy agenda, with several research and policy gaps being fed into existing prioritization channels. Adequate time, resources, and capacity is required particularly in engaging stakeholders and developing a care pathway. Implementation of specialty mapping in other topic areas with on-going evaluation is recommended.
International journal of technology …, Jan 1, 2009
Traditionally, patients with chronic hepatitis C virus (HCV) infection have not received treatmen... more Traditionally, patients with chronic hepatitis C virus (HCV) infection have not received treatment until their infection reaches the moderate to severe stage. The aim of this systematic review was to assess the clinical effectiveness of pegylated (PEG) and non-pegylated interferon (IFN) alfa and ribavirin (RBV) for the treatment of adults with histologically mild HCV. We performed a sensitive search of fourteen electronic bibliographic databases for literature that met criteria defined in a research protocol. Two reviewers independently selected studies, extracted data and assessed methodological quality. Ten randomized, controlled trials (RCTs) were included. Treatment with PEG + RBV combination therapy resulted in significantly higher sustained virological response (SVR) rates than treatment with IFN + RBV combination therapy. Treatment for 48 weeks with PEG + RBV was significantly more effective than the same treatment for 24 weeks. Significantly higher SVR rates were seen with IFN + RBV compared with either IFN monotherapy or no treatment. In the meta-analysis (four IFN trials), the relative risk of not experiencing an SVR was 0.59 (95 percent CI, 0.51 - 0.69) and was statistically significant (p < .00001). SVRs were higher for patients with genotype non-1 compared with genotype 1 for both PEG + RBV and IFN + RBV treatments. Patients with histologically mild HCV can be successfully treated with both PEG and IFN combination therapy, and response rates are broadly comparable with those achieved in patients with advanced disease. Treating patients in the early milder stages of HCV is, therefore, a clinically effective option.
Health Education, Jan 1, 1997
Abstract: Presents the results of an investigation into effective methods of peer-led sexual heal... more Abstract: Presents the results of an investigation into effective methods of peer-led sexual health promotion work with young gay and bisexual men. The study recruited a group of young gay and bisexual men from Southampton who underwent training to participate in a ...
HIV health promotion and men who have sex with men (MSM): a systematic review of research relevan... more HIV health promotion and men who have sex with men (MSM): a systematic review of research relevant to the development and implementation of effective and appropriate interventions A searchable database which includes the studies reviewed in this report is available on the EPPI-Centre website (http://eppi.ioe.ac.uk).
… in health care, Jan 1, 2005
To assess the clinical-effectiveness and cost-effectiveness of pegylated interferon alfa (2a and ... more To assess the clinical-effectiveness and cost-effectiveness of pegylated interferon alfa (2a and 2b) combined with ribavirin in previously untreated patients with moderate to severe chronic hepatitis C, compared with the current standard treatment, which is nonpegylated interferon alfa combined with ribavirin. Systematic review and economic evaluation. A sensitive search strategy was applied to several electronic bibliographic databases. Relevant studies were critically appraised and meta-analyzed. A hypothetical cohort of 1,000 patients entered a Markov model and were followed up for a more than 30-year period to predict natural history, duration spent in each health state, and treatment costs. Two fully published Phase III randomized controlled trials were included. Methodological quality was generally good. Dual therapy with pegylated interferon was significantly more effective than nonpegylated dual therapy with a pooled sustained virological response rate (SVR) of 55 percent (95 percent confidence interval [CI], 52-58 percent) compared with 46 percent (95 percent CI, 43-49 percent). The pooled relative risk of remaining infected was 0.83 (95 percent CI, 0.76-0.91 percent). Genotype was the strongest predictor of outcome, with SVRs in patients with the more responsive genotypes 2 and 3 reaching up to 80 percent. The incremental cost per quality-adjusted life year (QALY) for pegylated dual therapy compared with nonpegylated dual therapy was 12,123 pounds sterling. The cost per QALY remained under 30,000 pounds sterling for most patient subgroups and in sensitivity analyses. Pegylated interferon is clinically effective, represents good value for the money, and is a significant advance in the treatment of this insidious disease.
... Shepherd, Jonathan and Garcia, Jo and Oliver, Sandy and Harden, Angela and Rees, Rebecca and ... more ... Shepherd, Jonathan and Garcia, Jo and Oliver, Sandy and Harden, Angela and Rees, Rebecca and Brunton, Ginny and Oakley, Ann (2002) Barriers to, and facilitators of, the health of young people: a systematic review of evidence on young people's views and ... ID Code: 3713. ...
A systematic review was conducted to examine the barriers to, and facilitators of, physical activ... more A systematic review was conducted to examine the barriers to, and facilitators of, physical activity among young people (11-16 years). The review focused on the wider determinants of health, examining community-and society-level interventions. Four trials and 16 studies of young people's views were included. Evidence for the effectiveness of the interventions was limited, with some suggestions of improvements in knowledge and possible differences according to gender. Young women in particular identified barriers to physical activity associated with certain ways of providing physical education in schools. Young people in general identified a need for increased choice and facilities within the community and emphasized physical activity's social side. Some of the barriers and facilitators identified by young people had been addressed by 'soundly evaluated' effective interventions but significant gaps were identified where no evaluated interventions appear to have been published (e.g. initiatives explicitly addressing gender issues or the combination of sport and other leisure activities), or where there were no soundly evaluated interventions. Rigorous evaluation is required particularly to assess initiatives that address the limited practical and material resources that young people identify as barriers to physical activity.
Price A, Waugh N. Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment o... more Price A, Waugh N. Interferon alfa (pegylated and non-pegylated) and ribavirin for the treatment of mild chronic hepatitis C: a systematic review and economic evaluation.
Health Education …, Jan 1, 2000
A systematic review was conducted to determine the effectiveness of health education intervention... more A systematic review was conducted to determine the effectiveness of health education interventions to promote sexual risk reduction behaviours amongst women in order to reduce transmission of human papillomavirus (HPV), a leading agent in the development of cervical cancer. A comprehensive search was conducted to identify relevant studies. Studies were included in the review if they evaluated educational interventions targeting women only and measured the impact on either a behavioural outcome such as condom use for sexual intercourse, partner reduction or abstinence, or a clinical outcome such as incidence of a STD. Thirty studies met the inclusion criteria for the review; all had the primary aim of preventing HIV and other STDs rather than cervical cancer. Ten of the 30 studies were considered to provide the strongest evidence for a causal relationship between the intervention and the change in outcomes measured. Each of these 10 most rigorous studies showed a statistically significant positive effect on sexual risk reduction, typically with increased use of condoms for vaginal intercourse. This positive effect was generally sustained up to 3 months after intervention. It was concluded that educational interventions targeting socially and economically disadvantaged women in which information provision is complemented by sexual negotiation skill development can encourage at least short-term sexual risk reduction behaviour. This effect has the potential to reduce the transmission of HPV and thus possibly reduce the incidence of cervical carcinoma.
Health education …, Jan 1, 2006
A systematic review was conducted to examine the barriers to, and facilitators of, physical activ... more A systematic review was conducted to examine the barriers to, and facilitators of, physical activity among young people (11-16 years). The review focused on the wider determinants of health, examining community-and society-level interventions. Four trials and 16 studies of young people's views were included. Evidence for the effectiveness of the interventions was limited, with some suggestions of improvements in knowledge and possible differences according to gender. Young women in particular identified barriers to physical activity associated with certain ways of providing physical education in schools. Young people in general identified a need for increased choice and facilities within the community and emphasized physical activity's social side. Some of the barriers and facilitators identified by young people had been addressed by 'soundly evaluated' effective interventions but significant gaps were identified where no evaluated interventions appear to have been published (e.g. initiatives explicitly addressing gender issues or the combination of sport and other leisure activities), or where there were no soundly evaluated interventions. Rigorous evaluation is required particularly to assess initiatives that address the limited practical and material resources that young people identify as barriers to physical activity.
... Rebecca and Shepherd, Jonathan and Brunton, Ginny and Oliver, Sandy and Oakley, Ann (2001) Yo... more ... Rebecca and Shepherd, Jonathan and Brunton, Ginny and Oliver, Sandy and Oakley, Ann (2001) Young people and mental health: a systematic review of research on barriers and facilitators. EPPI Report . EPPI-Centre, Institute of Education, University of London , London. ...
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Papers by Jonathan Shepherd
Schools are an important setting for health promotion and teachers have an integral role to play in promoting children and young people’s health and well-being. Adequate initial teacher training (ITT) and continuing professional development in health is therefore important.
Objectives
To conduct a survey of initial teacher training providers in England and a systematic review of effectiveness to assess how health and well-being is covered on courses, and to identify barriers and facilitators to effective training.
Methods
Methods included an online questionnaire survey with a sample of 220 ITT course managers in England; interviews with a purposive sample of 19 of the course managers responding to the questionnaire; and a two-stage systematic review comprising a descriptive map of the characteristics of international research studies of health teacher training and a detailed synthesis of a subset of studies specifically on pre-service training. Databases (including MEDLINE, EMBASE, The Campbell Library and PsycINFO) were searched from the period of database inception up to May 2011.
Results
The overall response rate for the survey was 34%. The majority (89%) of respondents agreed that it was either important or very important to cover health within the ITT curriculum. The most commonly covered topics on courses were Every Child Matters (100%), child protection (100%), emotional health (99%) and antibullying (97%). Fewer course managers reported covering healthy eating (63%), sex and relationships (62%), drugs (56%), alcohol (41%) and smoking (34%). Many interviewees expressed a holistic view of education and believed that health was important in the ITT curriculum. However, there was variability in how health was addressed across and within institutions. Trainee teachers' experience of addressing child health on school placement was also variable. Facilitators to covering health included interests and backgrounds of ITT staff; staff health-related professional experience; availability of health expertise from external agencies; supportive government policy frameworks; and interprofessional and interdepartmental working. The main barriers were limited curriculum time; health being perceived to be a lower priority than other aspects of training; health no longer a high government priority in education; and lack of funding. A total of 170 studies met the eligibility criteria for the descriptive map. The majority covered teacher training in relation to sexual and reproductive health, drugs and alcohol or mental and emotional health. A total of 21 publications (20 studies) were prioritised for the synthesis. All were evaluations of health training for pre-service teachers, and just under half were from the UK. Twelve studies reported outcomes (impact of training on teachers, but not pupils), many of which were single cohort before-and-after studies. Sixteen studies reported processes. Following training there were some increases in trainee teachers' factual knowledge of health and a general increase in their confidence to address health issues. In general, training was acceptable and well received by trainees. Evidence suggested that effective training should include practical experience and skills and be personally relevant and take into account individual needs. Barriers to health training identified from the studies included lack of time, balancing breadth and depth, and variation in training provision.
Conclusions
Among those surveyed there appears to be general support for health and well-being in ITT. However, further research on the longer-term impact of ITT around health and well-being is needed, particularly in the early career period. The main limitation of this research was the low response rate (34%) to the survey.
Schools are an important setting for health promotion and teachers have an integral role to play in promoting children and young people’s health and well-being. Adequate initial teacher training (ITT) and continuing professional development in health is therefore important.
Objectives
To conduct a survey of initial teacher training providers in England and a systematic review of effectiveness to assess how health and well-being is covered on courses, and to identify barriers and facilitators to effective training.
Methods
Methods included an online questionnaire survey with a sample of 220 ITT course managers in England; interviews with a purposive sample of 19 of the course managers responding to the questionnaire; and a two-stage systematic review comprising a descriptive map of the characteristics of international research studies of health teacher training and a detailed synthesis of a subset of studies specifically on pre-service training. Databases (including MEDLINE, EMBASE, The Campbell Library and PsycINFO) were searched from the period of database inception up to May 2011.
Results
The overall response rate for the survey was 34%. The majority (89%) of respondents agreed that it was either important or very important to cover health within the ITT curriculum. The most commonly covered topics on courses were Every Child Matters (100%), child protection (100%), emotional health (99%) and antibullying (97%). Fewer course managers reported covering healthy eating (63%), sex and relationships (62%), drugs (56%), alcohol (41%) and smoking (34%). Many interviewees expressed a holistic view of education and believed that health was important in the ITT curriculum. However, there was variability in how health was addressed across and within institutions. Trainee teachers' experience of addressing child health on school placement was also variable. Facilitators to covering health included interests and backgrounds of ITT staff; staff health-related professional experience; availability of health expertise from external agencies; supportive government policy frameworks; and interprofessional and interdepartmental working. The main barriers were limited curriculum time; health being perceived to be a lower priority than other aspects of training; health no longer a high government priority in education; and lack of funding. A total of 170 studies met the eligibility criteria for the descriptive map. The majority covered teacher training in relation to sexual and reproductive health, drugs and alcohol or mental and emotional health. A total of 21 publications (20 studies) were prioritised for the synthesis. All were evaluations of health training for pre-service teachers, and just under half were from the UK. Twelve studies reported outcomes (impact of training on teachers, but not pupils), many of which were single cohort before-and-after studies. Sixteen studies reported processes. Following training there were some increases in trainee teachers' factual knowledge of health and a general increase in their confidence to address health issues. In general, training was acceptable and well received by trainees. Evidence suggested that effective training should include practical experience and skills and be personally relevant and take into account individual needs. Barriers to health training identified from the studies included lack of time, balancing breadth and depth, and variation in training provision.
Conclusions
Among those surveyed there appears to be general support for health and well-being in ITT. However, further research on the longer-term impact of ITT around health and well-being is needed, particularly in the early career period. The main limitation of this research was the low response rate (34%) to the survey.
OBJECTIVES:
To determine whether randomised controlled trials (RCTs) lead to the same effect size and variance as non-randomised studies (NRSs) of similar policy interventions, and whether these findings can be explained by other factors associated with the interventions or their evaluation.
DATA SOURCES:
Two RCTs were resampled to compare randomised and non-randomised arms. Comparable field trials were identified from a series of health promotion systematic reviews and a systematic review of transition for youths with disabilities. Previous methodological studies were sought from 14 electronic bibliographic databases (Applied Social Sciences Index and Abstracts, Australian Education Index, British Education Index, CareData, Dissertation Abstracts, EconLIT, Educational Resources Information Centre, International Bibliography of the Sociological Sciences, ISI Proceedings: Social Sciences and Humanities, PAIS International, PsycINFO, SIGLE, Social Science Citation Index, Sociological Abstracts) in June and July 2004. These were supplemented by citation searching for key authors, contacting review authors and searching key internet sites.
REVIEW METHODS:
Analyses of previous resampling studies, replication studies, comparable field studies and meta-epidemiology investigated the relationship between randomisation and effect size of policy interventions. New resampling studies and new analyses of comparable field studies and meta-epidemiology were strengthened by testing pre-specified associations supported by carefully argued hypotheses.
RESULTS:
Resampling studies offer no evidence that the absence of randomisation directly influences the effect size of policy interventions in a systematic way. Prior methodological reviews and meta-analyses of existing reviews comparing effects from RCTs and non-randomised controlled trials (nRCTs) suggested that effect sizes from RCTs and nRCTs may indeed differ in some circumstances and that these differences may well be associated with factors confounded with design. No consistent explanations were found for randomisation being associated with changes in effect sizes of policy interventions in field trials.
CONCLUSIONS:
From the resampling studies we have no evidence that the absence of randomisation directly influences the effect size of policy interventions in a systematic way. At the level of individual studies, non-randomised trials may lead to different effect sizes, but this is unpredictable. Many of the examples reviewed and the new analyses in the current study reveal that randomisation is indeed associated with changes in effect sizes of policy interventions in field trials. Despite extensive analysis, we have identified no consistent explanations for these differences. Researchers mounting new evaluations need to avoid, wherever possible, allocation bias. New policy evaluations should adopt randomised designs wherever possible.