Knowledge mobilization activities to support decision-making by youth, parents, and adults using a systematic and living map of evidence and recommendations on COVID-19: protocol for a randomized controlled trial (preprint)

IntroductionThe COVID-19 pandemic underlined that guidelines and recommendations must be made more accessible and more understandable to the general public, including adults, parents, and youth, to improve health outcomes. The objective of this study is to evaluate, quantify, and compare the publics (youth, parents, and adult populations) understanding, usability, satisfaction, intention to implement, and preference for different ways of presenting COVID-19 health recommendations derived from the COVID-19 Living Map of Recommendations and Gateway to Contextualization (herein referred to as the RecMap). Methods and AnalysisThis is a protocol for a multi-method study. We will conduct pragmatic allocation-concealed, blinded superiority randomized controlled trials (RCT) in three populations to test alternative formats of presenting health recommendations: adults (21 years of age or older), parents (18 years or above and are a parent or legal guardian of a child under 18 years old), and youth (15 to 24 years old), with at least 240 participants in each population. The research will consist of a randomized online survey and an optional one-on-one interview. Prior to initiating the RCT, our interventions will have been refined with relevant stakeholder input. In each population group, the intervention arm will receive a plain language recommendation (PLR) format while the control arm will receive the corresponding original recommendation format as originally published by the guideline organizations (herein referred to as Standard Language Version). Our primary outcome is understanding, and our secondary outcomes are accessibility and usability, satisfaction, intended behavior, and preference for the two recommendation formats. Each populations results will be analyzed separately. However, we are planning a meta-analysis of the results across populations, and will also explore potential interaction and subgroup effects within each population. At the end of each survey, participants will be invited to participate in a one-on-one, virtual semi-structured interview to explore their user experience and their learning preferences and future research. All interviews will be transcribed and analyzed using the principles of thematic analysis and a hybrid inductive and deductive approach. Iterative member checking, triangulation, interpretation, and saturation of themes will be sought to enhance reliability. Ethics and DisseminationThrough Clinical Trials Ontario (CTO), the Hamilton Integrated Research Ethics Board has reviewed and approved this protocol (Project ID: 3856). The University of Alberta has approved the parent portion of the trial (Project ID:00114894). All potential participants will be required to provide informed consent. The findings from this study will be disseminated through open-access publications in peer-reviewed journals and using social media. Strengths and limitations of this studyO_LIWe are following a multi-method approach: randomized controlled trials and qualitative interviews. The qualitative results will supplement and help explain our quantitative findings. C_LIO_LIThis protocol is reported in accordance with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT), which enhances transparency and completeness. The trials use previously validated outcomes from similar trials. This will strengthen the credibility of our results. C_LIO_LIOur study is testing an optimized plain language recommendation format, which makes our intervention relevant to our stakeholder groups, and is recruiting internationally, which ensures the inclusion of a diverse population. Recruitment will take place online using social media, and data will be collected using an online survey. This allows for self-selection and limits accessibility to those who have no or limited digital access, which in turn limits generalizability. C_LIO_LIWhile the recommendations are offered in multiple languages through the RecMap, the study is only testing English plain language recommendation summaries. C_LI

Challenges of evidence synthesis during the 2020 COVID pandemic: a scoping review.

AIM: The objectives of this scoping review are to identify the challenges to conducting evidence synthesis during the COVID-19 pandemic and to propose some recommendations addressing the identified gaps. METHODS: A scoping review methodology was followed to map the literature published on the challenges and solutions of conducting evidence synthesis using the Joanna Briggs Methodology of performing scoping review. We searched several databases from the start of the Pandemic in December 2019 until 10th June 2021. RESULTS: A total of 28 publications was included in the review. The challenges cited in the included studies have been categorised into four distinct but interconnected themes including: upstream, Evidence synthesis, downstream and contextual challenges. These challenges have been further refined into issues with primary studies, databases, team capacity, process, resources, and context. Several proposals to improve the above challenges included: transparency in primary studies registration and reporting, establishment of online platforms that enables collaboration, data sharing and searching, the use of computable evidence and coordination of efforts at an international level. CONCLUSION: This review has highlighted the importance of including artificial intelligence, a framework for international collaboration and a sustained funding model to address many of the shortcomings and ensure we are ready for similar challenges in the future.

Physical Distancing, Face Masks, and Eye Protection to Prevent Person-Person COVID-19 Transmission: A Systematic Review and Meta-Analysis (preprint)

Background: Coronavirus disease 2019 (COVID-19) is spread person to person by virus through close contact. The optimal person-person distance and use of facemasks and/or eye protection to prevent disease transmission in healthcare and non-healthcare settings is debated.Methods: We systematically reviewed the impact of distance, masks, and eye protection on transmission of COVID-19, SARS, or MERS from 21 standard, World Health Organization (WHO)-specific and COVID-19-specific data sources from inception to April 15, 2020 for studies of any design and language 1) comparing different distances between those infected and the people close to them, mask use, or eye protection, or 2) contextual factors of acceptability, feasibility, resource use, and equity of these interventions. We screened studies, extracted data, and assessed risk of bias in duplicate. Frequentist and Bayesian meta-analyses and meta-regression for the main outcome of viral transmission were by random effects. Secondary outcomes were contextual factors. We rated certainty of evidence rating per GRADE. PROSPERO: 177047.Findings: We identified 0 RCTs and 164 relevant observational studies in healthcare and non-healthcare (community) settings from 16 countries across 6 continents. A physical distance of one metre or more compared to less than one metre from those infected was associated with 1) a lower risk of viral transmission (n=7782, 5.3% vs 15.5%; RD -10.2% [95%CI -11.5% to -7.5%], pooled adjusted odds ratio [aOR] 0.18 [95%CI 0.09-0.38], moderate certainty) and 2) incremental benefits with increasing distance, change in relative risk (RR) per metre 1.57 (moderate certainty). Facemask use was associated with less infection (n=2647, 2.7% vs 17.4%; RD -14.% [95% credible interval [CrI] -15.9% to -10.7%]; aOR 0.15 [95%CrI 0.07-0.34], low certainty), with stronger associations with N95 or similar (including powered) respirators compared to disposable surgical or similar (e.g. reusable 12-16-layer cotton) masks, p interaction =0.090; posterior probabilities for RR<1 of N95 vs surgical masks were >95% despite minimally informative priors; moderate certainty). Eye protection was associated with quantitatively similar lower risk of infection in 2 adjusted and 15 unadjusted studies (n=3751, 5.4% vs 16.0%; RD -10.6 [95%CI -12.5% to -7.7%]; RR 0.34 [95%CI 0.22-0.52]; aOR 0.22 [95%CI 0.12-0.39], low certainty).Interpretation: This meta-analysis supports physical distancing by more than one metre and provides quantitative estimates for models and contact tracing to inform policy. Although direct evidence is limited, the optimal use of masks, in particular N95 or similar respirators, may depend on risk assessment and contextual factors. Eye protection may provide significant additional benefits. Globally collaborative, well-conducted studies on preventative and therapeutic strategies are required but are challenging to achieve immediately and, thus, recommendations in the interim to curtail the COVID-19 pandemic should be informed by this systematic appraisal of current evidence.Funding Statement: Commissioned by the World Health Organization as a rapid review on March 25, 2020. The funders of the study helped with defining the scope of the question, but otherwise had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit it.Declaration of Interests: ML is an investigator of an ongoing clinical trial on medical masks versus N95 respirators for COVID-19 (NCT04296643). All other authors declare no competing interests. Ethics Approval Statement: The authors prospectively submitted the systematic review protocol for registration on PROSPERO (submission number 177047). This study followed PRISMA and MOOSE reporting guidelines.