Does a scoping review need a protocol?

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bmjopen-2017-019311supp001.pdf

bmjopen-2017-019311supp002.pdf

• The present protocol is for a scoping review of published systematic reviews, as a pragmatic way of dealing with the large evidence base available on obesity prevention in children.

• The present scoping review aims to use 11 electronic databases and tailored search strings which have been iteratively refined in order to increase the likelihood of retrieving as many relevant published article reviews as possible.

• Only article reviews published in English in scientific journals will be considered eligible for inclusion.

• A quality assessment of the article reviews included in the scoping review will not be performed, as this would be beyond the aim of a scoping review.

Protocol design

The scoping review is informed by the framework proposed by Arksey and OMalley36 which has been further developed by Levacetal45 and the Joanna Briggs Institute.46 This recommends to organise the review process in at least five stages.36

• Stage 1. Identifying the research question.

• Stage 2. Identifying relevant studies.

• Stage 3. Study selection.

• Stage 4. Charting the data.

• Stage 5. Collating, summarising and reporting the results.

The original framework proposed by Arksey and OMalley suggests an optional consultation exercise (stage 6) with key stakeholders in order to identify additional references about potential studies to include as well as collect their feedback about the findings uncovered by the scoping review. Although a consultation with key stakeholders would represent a valuable exercise, the present scoping review will not encompass one because of time and budget constraints.

Stage 1: identifying the research questions

Preliminarily to identifying the research question, an exploratory review of the literature on childhood obesity helped refine the scope of the present protocol. This phase informed the decision not to use any criteria to restrict the review to specific study populations (eg, specific age groups) as it became clear that overweight and obesity need to be addressed as early as possible and also opportunistically, as weight gain in children appears to be a good predictor of obesity in adulthood.12 1620

On the basis of the initial exploratory research, the following research questions were identified:

1. What types of interventions to prevent childrens obesity are addressed in the literature?

2. What are the children populations targeted by these interventions?

3. In what settings are these interventions provided?

4. Are these interventions effective?

5. Which measures are used to assess obesity in children?

6. If these interventions are effective, what is the scale of the reduction in childhood obesity?

7. What are the barriers and facilitators to effective implementation of these interventions?

8. What evidence is there of the effectiveness of these interventions when they are combined?

Stage 2: identifying relevant studies

Following the framework of Arksey and OMalley, the second stage of the scoping review process aimed to identify the criteria that will be used to select the studies for inclusion in the review. Although a scoping review is designed to cover a broad spectrum of literature, these criteria will guide the search and help filter for relevant sources.

The scoping review will include published systematic reviews that can be retrieved from the following electronic databases: Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, Google Scholar, Joanna Briggs Library, MEDLINE/PubMed, National Health Service Economic Evaluation Database, PsycInfo, Scopus, SocIndex and Web of Science. Reference lists of reviews found through the electronic search will be checked to ensure that relevant articles are included in the scoping review.

Based on the initial exploratory research, we agreed the following eligibility criteria:

• Type of publication: journal articles.

• Time frame: any.

• Language: English.

• Study population: children and adolescents, aged below 18.

• Types of intervention: interventions aiming at preventing childhood obesity.

• Types of review articles: systematic reviews, meta-analyses, scoping reviews, evidence maps, rapid reviews, literature reviews, evidence syntheses, reviews of reviews, narrative reviewsand critical reviews.

Based on the initial scoping process, it was agreed to exclude: conference abstracts, book reviews, commentaries or editorial articles, reviews focusing on the adult population (individuals aged 18 year or above) and reviews focusing on interventions for the treatment of obesity (eg, bariatric surgery), rather than its prevention.

As suggested by Levacetal,45 the team used an iterative process to identify also key search terms. Initially, the following keywords were used: child*, obes*, weight*, intervention, prevent*and review. The review articles retrieved were then screened for their titles, abstracts and index terms. An academic librarian was consulted and advised on the most appropriate Medical Subject Headings terms for the search and how to modify them for the different databases used. Based on this exploratory scoping phase, the search strings for each database were finalised (online supplementary material 1). Articles were retrieved from each database and imported into a reference management software.

Stage 3: study selection

The third stage of the framework of Arksey and OMalleys framework aims to identify the studies that will be included in the scoping review. The team consolidated the results of the searches run on the different databases and removed studies retrieved from more than one database in order to exclude duplicates. A member of the team will then screen titles and abstracts of the articles to exclude those that do not meet the eligibility criteria identified in the second stage of the protocol. For those fulfilling the eligibility criteria, the full article will be retrieved.

A sample (ie, 20%) of the retrieved articles will be screened by another team member to ensure a consistent application of the eligibility criteria for inclusion in the review. Titles and abstracts of the articles for which the first reviewer could not determine whether they are eligible for inclusion will also be reviewed. Disagreements about study eligibility of the sampled articles will be discussed between the two reviewers until consensus is reached or by arbitration of a third reviewer, if required. The process of study selection is reported using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart, which will be updated once the review is completed (online supplementary material 2).

Stage 4: charting the data

Based on the preliminary scoping phase, a data extraction framework was developed. It includes 19 categories that will be used to assess the full review articles retrieved from the literature fulfilling the eligibility criteria for inclusion (table 1).

Alongside standard bibliographical information (ie, authors, title, journaland year of publication), type and objectives of the review will be reported. For each article, information on the interventions covered by the review, characteristics of the study populations, definition of overweight/obesity adopted in the reviews, setting, length and intensity of the interventions, types of outcomes assessed, information on the effectiveness of the interventions and facilitators and barriers for the implementation of the interventions will be tabled.

The framework will be pilot tested by two team members on a sample of the included studies (ie, 10% of the complete list of retrieved studies) in order to ensure that the coding framework is consistently applied. If necessary, the categories will be modified and the data extraction framework revised accordingly. Questions arising when piloting the framework will be discussed by the team and possible disagreement will be resolved through team consultations.

The same two members of the team will be in charge of independently charting the data from each included review study, following the data extraction framework. In order to ensure inter-rater reliability, a sample (ie, 20%) of the included articles independently reviewed will then be compared by the two members of the team. Discrepancies in extracted data will be discussed between the two reviewers until consensus is reached or by arbitration of a third reviewer, if required.

Stage 5: collating, summarising and reporting the results

The analysis of the data collected using the data extraction framework will provide information on the body of research that has been conducted on interventions to prevent obesity in children. For example, evidence on the interventions to tackle children obesity will be presented by age groups in order to show at what point in the lifecourse andwhat types of interventions are more effective and, hence, worth pursuing. Also, it will be possible to highlight the clinical effectiveness of the interventions reviewed (eg, the change in the BMI of participants included in the review studies) and their material impact on the population in need (eg, how the distribution of study participants by BMI groups changes before and after the intervention). Conversely, it will also show areas that have been underresearched and may require further investigation. Results will be presented in an aggregate and visual form (eg, using tables and charts), as appropriate.

Contributors: P-BVB contributed to develop the research questions and the methods and contributed substantially to the drafting and editing. CDP conceived of the idea the scoping review, developed the research questions and contributed to the development of the methods. She contributed extensively to the drafting and editing of the manuscript. GB supervised the preparation of the protocol and critically reviewed the manuscript. All authors have approved the final manuscript.

Funding: P-BVB and GB were funded by the Department of Management at the London School of Economics and Political Science. CDP was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) North Thames at Barts Health NHS Trust.

Disclaimer: The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Competing interests: None declared.

Patient consent: Not required.

Provenance and peer review: Not commissioned; externally peer reviewed.