Reconsidering community based interventions

• systematic reviews
• community based intervention
• evaluation
• research

The systematic review of the literature “Community based programs to prevent poisoning in children 0–15 years” that is published in this issue prompted a debate between reviewers and authors (see p 43). This process revealed a number of important issues that warrant further analysis and comment. In this editorial I try to identify these issues to provide a foundation for further action.

The reviewers raised two basic questions. One suggested that the paper be rejected because it only found four articles of adequate scientific merit. The authors replied that a paper’s merit should be judged on the technical competence of the review and not on the results. They argued that a decision based on the number of articles found would amount to a publication bias against new or poorly funded fields.

The second issue concerned the notion of community based intervention. It was suggested that this field did not have sufficient coherence or precision to make it possible to generalise interventions. In response, the authors noted that the characteristics of community based models are well known. They include shared ownership of a problem and its solution by community members as well as experts. They pointed to the need for “a distinction between efficacy trials of specific counter-measures where the individual is the unit of study vs effectiveness trials involving community interventions”. While locked cabinets may be efficacious, community based programs that aim to reduce poisoning by encouraging widespread use of lockable cabinets are not necessarily effective. Because making a difference at the population level is the focus of injury prevention efforts we need to move from “what works” to “how to make it work on a large scale”.

The to and fro between reviewers and authors raised a number of issues. Two are at …