Systematic review of complex public health interventions: the example of patient safety culture

Abstract

Complex interventions are groups of interventions that usually involve changing behaviors. Such interventions are especially relevant to solve public health problems that require different strategies to be solved, as obesity and violence, for example. They offer support for decision making process. Present paper discusses concepts and methods to interpret scientific evidence of complex interventions assessed in systematic reviews. To context the processes of searching and critical assessment, we illustrated a scenario of strengthening the culture of patient safety in the hospital setting. The example is discussed from the definition of a wellstructured research question, which consists in defining the target population, characterization of intervention, comparison, outcome and context. Then we present the data sources to identify systematic reviews of complex interventions. We also present critical assessment criteria to help certifying the reliability of the systematic review. Ultimately, the interpretation of findings from weak evidence is discussed facing other parameters uses in decision making process. The practice of using systematic reviews about public health interventions is a strategy to allow to the process of policy-making in public health to identify the most effective intervention. This method is prone to contribute to health promotion to the population.