quantitative research topics in public health

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What are the trending topics in Public Health and related disciplines?

You can identify some of the most discussed and influential topics with the help of Altmetric attention scores, which take into account several outlets including social media, news articles, and policy documents.

Drawing from a selection of Public Health and Medicine journals, we have compiled a list of the articles that have been mentioned the most over the past few months.

Discover the articles that are trending right now, and catch up on current topics in Public Health and related disciplines. We will update our collection every few weeks; come back to this page to be on top of the latest conversations in Public Health and Medicine. Previously featured articles are listed here .

You can also sign up for e-alerts to make sure you never miss the latest research from our journals.

*Last updated October 2021*

Age and Ageing

Alcohol and alcoholism, american journal of epidemiology, annals of work exposures and health, epidemiologic reviews, european journal of public health, family practice, health education research, health policy and planning, health promotion international, international health, international journal of epidemiology, international journal for quality in health care, journal of public health, journal of travel medicine, journal of tropical pediatrics, nicotine & tobacco research, transactions of the royal society of tropical medicine & hygiene, behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression.

There is moderate-certainty evidence that behaviour change interventions are associated with increased physical activity levels among older hospitalised patients.

Attention-Deficit/Hyperactivity Disorder and Alcohol and Other Substance Use Disorders in Young Adulthood: Findings from a Canadian Nationally Representative Survey

This study from Canada found that one in three young adults with ADHD had a lifetime alcohol use disorder, and that young adults with ADHD were also three times more likely to develop a substance use disorder. Targeted outreach and interventions for this extremely vulnerable population are warranted.

Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality

According to this study, resuming evictions in summer 2020 was associated with increased COVID-19 incidence and mortality in US states, with an estimated 433,700 excess cases and 10,700 excess deaths. Explore more research on COVID-19 in a curated collection from the AJE: https://academic.oup.com/aje/pages/covid-19

The Development of a Covid-19 Control Measures Risk Matrix for Occupational Hygiene Protective Measures

The British Occupational Hygiene Society (BOHS) developed a control banding matrix for employers and others to help assess the risks of COVID-19 infection, and calls for further work to validate the reliability of the tool. Browse the Annals' collection on occupational hygiene for virus protection: https://academic.oup.com/annweh/pages/covid-19 

Immunization to Protect the US Armed Forces: Heritage, Current Practice, and Prospects

In 1777, George Washington ordered a mandatory inoculation program for his troops, in what would become the first mass immunization mandate in the US. This archival article discussess and contextualizes immunization practices for US Armed Forces.

Does face mask use elicit risk-compensation? Quasi-experimental evidence from Denmark during the SARS-CoV-2 pandemic

Responding to concerns that that face mask use could elicit a false sense of security and lead to riskier behaviours, this study from Denmark found that mask use overall correlated positively with protective behaviours.

Evidence reversals in primary care research: a study of randomized controlled trials

While medical practice is often undermined by subsequent investigation, randomized trials relevant to primary care generally hold up over time.

Social media influencers can be used to deliver positive information about the flu vaccine: findings from a multi-year study

This study shows the potential for using social media influencers to inspire positive engagements on pro-vaccine health messaging. For more content on accurate information's importance for public health, browse the latest article collection from HER: https://academic.oup.com/her/pages/covid-19

COVID-19 Preparedness and Response Plans from 106 countries: a review from a health systems resilience perspective

Current emergency response planning does not have adequate coverage to maintain health systems functionality for essential health service delivery alongside emergency-specific interventions and healthcare. The findings from this study can help align health emergency planning with broader population health needs.

Rise and demise: a case study of public health nutrition in Queensland, Australia, over three decades

This case study shows that that ongoing efforts are needed to improve sustainability of nutrition policy and programmes to address all diet-related diseases.

Institutional and behaviour-change interventions to support COVID-19 public health measures: a review by the Lancet Commission Task Force on public health measures to suppress the pandemic

This review article outlines evidence for a range of institutional measures and behaviour-change measures, and highlights research and knowledge gaps.

Quantifying impacts of the COVID-19 pandemic through life-expectancy losses: a population-level study of 29 countries 

The COVID-19 pandemic triggered significant mortality increases in 2020 of a magnitude not witnessed since World War II in Western Europe or the breakup of the Soviet Union in Eastern Europe.

Gender in the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist

The authors propose an update to the Equator’s Consolidated criteria for reporting qualitative research (COREQ) checklist, with the aim of enhancing inclusivity.

Rate of reinfections after SARS-CoV-2 primary infection in the population of an Italian province: a cohort study

This study confirms previous findings on a low risk of SARS-CoV-2 reinfection. If confirmed, these findings suggest that more targeted restriction policies can be applied to the subjects that recovered after a first infection. Read highly cited papers on COVID-19 from the Journal of Public Health: https://academic.oup.com/jpubhealth/pages/covid-19

The reproductive number of the Delta variant of SARS-CoV-2 is far higher compared to the ancestral SARS-CoV-2 virus

Given the Delta variant's high reproductive number associated with higher transmissibility, in a context of globally still low vaccine coverage rates and lower vaccine effectiveness, public health and social measures will need to be substantially strengthened. A high reproductive number also means that much higher vaccine coverage rates need to be achieved compared to the originally assumed.

Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis

Neurological complications are rare in children suffering from COVID-19. Still, these children are at risk of developing seizures and encephalopathy, more in those suffering from severe illness.

Reactions to Sales Restrictions on Flavored Vape Products or All Vape Products Among Young Adults in the United States

The researchers examined support for and perceived impact of e-cigarette sales restrictions. Findings suggest that bans on flavored vape products could have a positive impact on lower-risk users, but that other young adult user subgroups may not experience benefit.

Covid-19 and Health at Work 

An editorial from the earlier stages of the pandemic highlights the importance of properly fitted respirators for worker safety and outlines occupational hygiene measures.

Lessons from the field: delivering trachoma mass drug administration safely in a COVID-19 context

Guidelines for safe mass drug administration for neglected tropical diseases were developed in a COVID-19 context; training and implementation were assessed through an observation checklist.

For more research on the impact of COVID-19 on NTDs, explore the March 2021 special issue: https://academic.oup.com/trstmh/issue/115/3

Previously featured

Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Trajectories of Alcohol Use and Related Harms for Managed Alcohol Program Participants over 12 Months Compared with Local Controls: A Quasi-Experimental Study

Estimating the Effect of Social Distancing Interventions on COVID-19 in the United States

Selecting Controls for Minimizing SARS-CoV-2 Aerosol Transmission in Workplaces and Conserving Respiratory Protective Equipment Supplies

What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries?

Denialism: what is it and how should scientists respond?

Acute cooling of the feet and the onset of common cold symptoms

The effect of falsely balanced reporting of the autism–vaccine controversy on vaccine safety perceptions and behavioral intentions

Climate change: an urgent priority for health policy and systems research

Power, control, communities and health inequalities I: theories, concepts and analytical frameworks

Research ethics in context: understanding the vulnerabilities, agency and resourcefulness of research participants living along the Thai–Myanmar border

Tobacco smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia

Quality and safety in the time of Coronavirus: design better, learn faster

Years of life lost associated with COVID-19 deaths in the United States

In-flight transmission of SARS-CoV-2: a review of the attack rates and available data on the efficacy of face masks

Stability of the Initial Diagnosis of Autism Spectrum Disorder by DSM-5 in Children: A Short-Term Follow-Up Study

Impact of Tobacco Smoking on the Risk of COVID-19: A Large Scale Retrospective Cohort Study

Mental health of staff working in intensive care during COVID-19

The benefits and costs of social distancing in high- and low-income countries

A classification tree to assist with routine scoring of the Clinical Frailty Scale

Recent Advances in the Potential of Positive Allosteric Modulators of the GABAB Receptor to Treat Alcohol Use Disorder

The recent oubreak of smallpox in Meschede, West Germany

Your Hair or Your Service: An Issue of Faith for Sikh Healthcare Professionals During the COVID-19 Pandemic

Emerging Infections: Pandemic Influenza

Identifying the views of adolescents in five European countries on the drivers of obesity using group model building 

Novel multi-virus rapid respiratory microbiological point-of-care testing in primary care: a mixed-methods feasibility evaluation

Public health crisis in the refugee community: little change in social determinants of health preserve health disparities

In search of ‘community’: a critical review of community mental health services for women in African settings

COVID-19, a tale of two pandemics: novel coronavirus and fake news messaging 

Disrupting vaccine logistics

Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations

Measurement and monitoring patient safety in prehospital care: a systematic review

Black Lives Matter protests and COVID-19 cases: relationship in two databases

The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China

Severe Malnutrition and Anemia Are Associated with Severe COVID in Infants

A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes

Healthcare workers and protection against inhalable SARS-CoV-2 aerosols

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Peer-reviewed

Research Article

Recent quantitative research on determinants of health in high income countries: A scoping review

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium

Roles Conceptualization, Data curation, Funding acquisition, Project administration, Resources, Supervision, Validation, Visualization, Writing – review & editing

• Vladimira Varbanova, 
• Philippe Beutels

• Published: September 17, 2020
• https://doi.org/10.1371/journal.pone.0239031
• Peer Review
• Reader Comments

Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature.

We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013—July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis.

Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health.

Conclusions

We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants’ influence.

Citation: Varbanova V, Beutels P (2020) Recent quantitative research on determinants of health in high income countries: A scoping review. PLoS ONE 15(9): e0239031. https://doi.org/10.1371/journal.pone.0239031

Editor: Amir Radfar, University of Central Florida, UNITED STATES

Received: November 14, 2019; Accepted: August 28, 2020; Published: September 17, 2020

Copyright: © 2020 Varbanova, Beutels. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This study (and VV) is funded by the Research Foundation Flanders ( https://www.fwo.be/en/ ), FWO project number G0D5917N, award obtained by PB. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Identifying the key drivers of population health is a core subject in public health and health economics research. Between-country comparative research on the topic is challenging. In order to be relevant for policy, it requires disentangling different interrelated drivers of “good health”, each having different degrees of importance in different contexts.

“Good health”–physical and psychological, subjective and objective–can be defined and measured using a variety of approaches, depending on which aspect of health is the focus. A major distinction can be made between health measurements at the individual level or some aggregate level, such as a neighborhood, a region or a country. In view of this, a great diversity of specific research topics exists on the drivers of what constitutes individual or aggregate “good health”, including those focusing on health inequalities, the gender gap in longevity, and regional mortality and longevity differences.

The current scoping review focuses on determinants of population health. Stated as such, this topic is quite broad. Indeed, we are interested in the very general question of what methods have been used to make the most of increasingly available region or country-specific databases to understand the drivers of population health through inter-country comparisons. Existing reviews indicate that researchers thus far tend to adopt a narrower focus. Usually, attention is given to only one health outcome at a time, with further geographical and/or population [ 1 , 2 ] restrictions. In some cases, the impact of one or more interventions is at the core of the review [ 3 – 7 ], while in others it is the relationship between health and just one particular predictor, e.g., income inequality, access to healthcare, government mechanisms [ 8 – 13 ]. Some relatively recent reviews on the subject of social determinants of health [ 4 – 6 , 14 – 17 ] have considered a number of indicators potentially influencing health as opposed to a single one. One review defines “social determinants” as “the social, economic, and political conditions that influence the health of individuals and populations” [ 17 ] while another refers even more broadly to “the factors apart from medical care” [ 15 ].

In the present work, we aimed to be more inclusive, setting no limitations on the nature of possible health correlates, as well as making use of a multitude of commonly accepted measures of general population health. The goal of this scoping review was to document the state of the art in the recent published literature on determinants of population health, with a particular focus on the types of determinants selected and the methodology used. In doing so, we also report the main characteristics of the results these studies found. The materials collected in this review are intended to inform our (and potentially other researchers’) future analyses on this topic. Since the production of health is subject to the law of diminishing marginal returns, we focused our review on those studies that included countries where a high standard of wealth has been achieved for some time, i.e., high-income countries belonging to the Organisation for Economic Co-operation and Development (OECD) or Europe. Adding similar reviews for other country income groups is of limited interest to the research we plan to do in this area.

In view of its focus on data and methods, rather than results, a formal protocol was not registered prior to undertaking this review, but the procedure followed the guidelines of the PRISMA statement for scoping reviews [ 18 ].

We focused on multi-country studies investigating the potential associations between any aggregate level (region/city/country) determinant and general measures of population health (e.g., life expectancy, mortality rate).

Within the query itself, we listed well-established population health indicators as well as the six world regions, as defined by the World Health Organization (WHO). We searched only in the publications’ titles in order to keep the number of hits manageable, and the ratio of broadly relevant abstracts over all abstracts in the order of magnitude of 10% (based on a series of time-focused trial runs). The search strategy was developed iteratively between the two authors and is presented in S1 Appendix . The search was performed by VV in PubMed and Web of Science on the 16 th of July, 2019, without any language restrictions, and with a start date set to the 1 st of January, 2013, as we were interested in the latest developments in this area of research.

Eligibility criteria

Records obtained via the search methods described above were screened independently by the two authors. Consistency between inclusion/exclusion decisions was approximately 90% and the 43 instances where uncertainty existed were judged through discussion. Articles were included subject to meeting the following requirements: (a) the paper was a full published report of an original empirical study investigating the impact of at least one aggregate level (city/region/country) factor on at least one health indicator (or self-reported health) of the general population (the only admissible “sub-populations” were those based on gender and/or age); (b) the study employed statistical techniques (calculating correlations, at the very least) and was not purely descriptive or theoretical in nature; (c) the analysis involved at least two countries or at least two regions or cities (or another aggregate level) in at least two different countries; (d) the health outcome was not differentiated according to some socio-economic factor and thus studied in terms of inequality (with the exception of gender and age differentiations); (e) mortality, in case it was one of the health indicators under investigation, was strictly “total” or “all-cause” (no cause-specific or determinant-attributable mortality).

Data extraction

The following pieces of information were extracted in an Excel table from the full text of each eligible study (primarily by VV, consulting with PB in case of doubt): health outcome(s), determinants, statistical methodology, level of analysis, results, type of data, data sources, time period, countries. The evidence is synthesized according to these extracted data (often directly reflected in the section headings), using a narrative form accompanied by a “summary-of-findings” table and a graph.

Search and selection

The initial yield contained 4583 records, reduced to 3686 after removal of duplicates ( Fig 1 ). Based on title and abstract screening, 3271 records were excluded because they focused on specific medical condition(s) or specific populations (based on morbidity or some other factor), dealt with intervention effectiveness, with theoretical or non-health related issues, or with animals or plants. Of the remaining 415 papers, roughly half were disqualified upon full-text consideration, mostly due to using an outcome not of interest to us (e.g., health inequality), measuring and analyzing determinants and outcomes exclusively at the individual level, performing analyses one country at a time, employing indices that are a mixture of both health indicators and health determinants, or not utilizing potential health determinants at all. After this second stage of the screening process, 202 papers were deemed eligible for inclusion. This group was further dichotomized according to level of economic development of the countries or regions under study, using membership of the OECD or Europe as a reference “cut-off” point. Sixty papers were judged to include high-income countries, and the remaining 142 included either low- or middle-income countries or a mix of both these levels of development. The rest of this report outlines findings in relation to high-income countries only, reflecting our own primary research interests. Nonetheless, we chose to report our search yield for the other income groups for two reasons. First, to gauge the relative interest in applied published research for these different income levels; and second, to enable other researchers with a focus on determinants of health in other countries to use the extraction we made here.

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https://doi.org/10.1371/journal.pone.0239031.g001

Health outcomes

The most frequent population health indicator, life expectancy (LE), was present in 24 of the 60 studies. Apart from “life expectancy at birth” (representing the average life-span a newborn is expected to have if current mortality rates remain constant), also called “period LE” by some [ 19 , 20 ], we encountered as well LE at 40 years of age [ 21 ], at 60 [ 22 ], and at 65 [ 21 , 23 , 24 ]. In two papers, the age-specificity of life expectancy (be it at birth or another age) was not stated [ 25 , 26 ].

Some studies considered male and female LE separately [ 21 , 24 , 25 , 27 – 33 ]. This consideration was also often observed with the second most commonly used health index [ 28 – 30 , 34 – 38 ]–termed “total”, or “overall”, or “all-cause”, mortality rate (MR)–included in 22 of the 60 studies. In addition to gender, this index was also sometimes broken down according to age group [ 30 , 39 , 40 ], as well as gender-age group [ 38 ].

While the majority of studies under review here focused on a single health indicator, 23 out of the 60 studies made use of multiple outcomes, although these outcomes were always considered one at a time, and sometimes not all of them fell within the scope of our review. An easily discernable group of indices that typically went together [ 25 , 37 , 41 ] was that of neonatal (deaths occurring within 28 days postpartum), perinatal (fetal or early neonatal / first-7-days deaths), and post-neonatal (deaths between the 29 th day and completion of one year of life) mortality. More often than not, these indices were also accompanied by “stand-alone” indicators, such as infant mortality (deaths within the first year of life; our third most common index found in 16 of the 60 studies), maternal mortality (deaths during pregnancy or within 42 days of termination of pregnancy), and child mortality rates. Child mortality has conventionally been defined as mortality within the first 5 years of life, thus often also called “under-5 mortality”. Nonetheless, Pritchard & Wallace used the term “child mortality” to denote deaths of children younger than 14 years [ 42 ].

As previously stated, inclusion criteria did allow for self-reported health status to be used as a general measure of population health. Within our final selection of studies, seven utilized some form of subjective health as an outcome variable [ 25 , 43 – 48 ]. Additionally, the Health Human Development Index [ 49 ], healthy life expectancy [ 50 ], old-age survival [ 51 ], potential years of life lost [ 52 ], and disability-adjusted life expectancy [ 25 ] were also used.

We note that while in most cases the indicators mentioned above (and/or the covariates considered, see below) were taken in their absolute or logarithmic form, as a—typically annual—number, sometimes they were used in the form of differences, change rates, averages over a given time period, or even z-scores of rankings [ 19 , 22 , 40 , 42 , 44 , 53 – 57 ].

Regions, countries, and populations

Despite our decision to confine this review to high-income countries, some variation in the countries and regions studied was still present. Selection seemed to be most often conditioned on the European Union, or the European continent more generally, and the Organisation of Economic Co-operation and Development (OECD), though, typically, not all member nations–based on the instances where these were also explicitly listed—were included in a given study. Some of the stated reasons for omitting certain nations included data unavailability [ 30 , 45 , 54 ] or inconsistency [ 20 , 58 ], Gross Domestic Product (GDP) too low [ 40 ], differences in economic development and political stability with the rest of the sampled countries [ 59 ], and national population too small [ 24 , 40 ]. On the other hand, the rationales for selecting a group of countries included having similar above-average infant mortality [ 60 ], similar healthcare systems [ 23 ], and being randomly drawn from a social spending category [ 61 ]. Some researchers were interested explicitly in a specific geographical region, such as Eastern Europe [ 50 ], Central and Eastern Europe [ 48 , 60 ], the Visegrad (V4) group [ 62 ], or the Asia/Pacific area [ 32 ]. In certain instances, national regions or cities, rather than countries, constituted the units of investigation instead [ 31 , 51 , 56 , 62 – 66 ]. In two particular cases, a mix of countries and cities was used [ 35 , 57 ]. In another two [ 28 , 29 ], due to the long time periods under study, some of the included countries no longer exist. Finally, besides “European” and “OECD”, the terms “developed”, “Western”, and “industrialized” were also used to describe the group of selected nations [ 30 , 42 , 52 , 53 , 67 ].

As stated above, it was the health status of the general population that we were interested in, and during screening we made a concerted effort to exclude research using data based on a more narrowly defined group of individuals. All studies included in this review adhere to this general rule, albeit with two caveats. First, as cities (even neighborhoods) were the unit of analysis in three of the studies that made the selection [ 56 , 64 , 65 ], the populations under investigation there can be more accurately described as general urban , instead of just general. Second, oftentimes health indicators were stratified based on gender and/or age, therefore we also admitted one study that, due to its specific research question, focused on men and women of early retirement age [ 35 ] and another that considered adult males only [ 68 ].

Data types and sources

A great diversity of sources was utilized for data collection purposes. The accessible reference databases of the OECD ( https://www.oecd.org/ ), WHO ( https://www.who.int/ ), World Bank ( https://www.worldbank.org/ ), United Nations ( https://www.un.org/en/ ), and Eurostat ( https://ec.europa.eu/eurostat ) were among the top choices. The other international databases included Human Mortality [ 30 , 39 , 50 ], Transparency International [ 40 , 48 , 50 ], Quality of Government [ 28 , 69 ], World Income Inequality [ 30 ], International Labor Organization [ 41 ], International Monetary Fund [ 70 ]. A number of national databases were referred to as well, for example the US Bureau of Statistics [ 42 , 53 ], Korean Statistical Information Services [ 67 ], Statistics Canada [ 67 ], Australian Bureau of Statistics [ 67 ], and Health New Zealand Tobacco control and Health New Zealand Food and Nutrition [ 19 ]. Well-known surveys, such as the World Values Survey [ 25 , 55 ], the European Social Survey [ 25 , 39 , 44 ], the Eurobarometer [ 46 , 56 ], the European Value Survey [ 25 ], and the European Statistics of Income and Living Condition Survey [ 43 , 47 , 70 ] were used as data sources, too. Finally, in some cases [ 25 , 28 , 29 , 35 , 36 , 41 , 69 ], built-for-purpose datasets from previous studies were re-used.

In most of the studies, the level of the data (and analysis) was national. The exceptions were six papers that dealt with Nomenclature of Territorial Units of Statistics (NUTS2) regions [ 31 , 62 , 63 , 66 ], otherwise defined areas [ 51 ] or cities [ 56 ], and seven others that were multilevel designs and utilized both country- and region-level data [ 57 ], individual- and city- or country-level [ 35 ], individual- and country-level [ 44 , 45 , 48 ], individual- and neighborhood-level [ 64 ], and city-region- (NUTS3) and country-level data [ 65 ]. Parallel to that, the data type was predominantly longitudinal, with only a few studies using purely cross-sectional data [ 25 , 33 , 43 , 45 – 48 , 50 , 62 , 67 , 68 , 71 , 72 ], albeit in four of those [ 43 , 48 , 68 , 72 ] two separate points in time were taken (thus resulting in a kind of “double cross-section”), while in another the averages across survey waves were used [ 56 ].

In studies using longitudinal data, the length of the covered time periods varied greatly. Although this was almost always less than 40 years, in one study it covered the entire 20 th century [ 29 ]. Longitudinal data, typically in the form of annual records, was sometimes transformed before usage. For example, some researchers considered data points at 5- [ 34 , 36 , 49 ] or 10-year [ 27 , 29 , 35 ] intervals instead of the traditional 1, or took averages over 3-year periods [ 42 , 53 , 73 ]. In one study concerned with the effect of the Great Recession all data were in a “recession minus expansion change in trends”-form [ 57 ]. Furthermore, there were a few instances where two different time periods were compared to each other [ 42 , 53 ] or when data was divided into 2 to 4 (possibly overlapping) periods which were then analyzed separately [ 24 , 26 , 28 , 29 , 31 , 65 ]. Lastly, owing to data availability issues, discrepancies between the time points or periods of data on the different variables were occasionally observed [ 22 , 35 , 42 , 53 – 55 , 63 ].

Health determinants

Together with other essential details, Table 1 lists the health correlates considered in the selected studies. Several general categories for these correlates can be discerned, including health care, political stability, socio-economics, demographics, psychology, environment, fertility, life-style, culture, labor. All of these, directly or implicitly, have been recognized as holding importance for population health by existing theoretical models of (social) determinants of health [ 74 – 77 ].

https://doi.org/10.1371/journal.pone.0239031.t001

It is worth noting that in a few studies there was just a single aggregate-level covariate investigated in relation to a health outcome of interest to us. In one instance, this was life satisfaction [ 44 ], in another–welfare system typology [ 45 ], but also gender inequality [ 33 ], austerity level [ 70 , 78 ], and deprivation [ 51 ]. Most often though, attention went exclusively to GDP [ 27 , 29 , 46 , 57 , 65 , 71 ]. It was often the case that research had a more particular focus. Among others, minimum wages [ 79 ], hospital payment schemes [ 23 ], cigarette prices [ 63 ], social expenditure [ 20 ], residents’ dissatisfaction [ 56 ], income inequality [ 30 , 69 ], and work leave [ 41 , 58 ] took center stage. Whenever variables outside of these specific areas were also included, they were usually identified as confounders or controls, moderators or mediators.

We visualized the combinations in which the different determinants have been studied in Fig 2 , which was obtained via multidimensional scaling and a subsequent cluster analysis (details outlined in S2 Appendix ). It depicts the spatial positioning of each determinant relative to all others, based on the number of times the effects of each pair of determinants have been studied simultaneously. When interpreting Fig 2 , one should keep in mind that determinants marked with an asterisk represent, in fact, collectives of variables.

Groups of determinants are marked by asterisks (see S1 Table in S1 Appendix ). Diminishing color intensity reflects a decrease in the total number of “connections” for a given determinant. Noteworthy pairwise “connections” are emphasized via lines (solid-dashed-dotted indicates decreasing frequency). Grey contour lines encircle groups of variables that were identified via cluster analysis. Abbreviations: age = population age distribution, associations = membership in associations, AT-index = atherogenic-thrombogenic index, BR = birth rate, CAPB = Cyclically Adjusted Primary Balance, civilian-labor = civilian labor force, C-section = Cesarean delivery rate, credit-info = depth of credit information, dissatisf = residents’ dissatisfaction, distrib.orient = distributional orientation, EDU = education, eHealth = eHealth index at GP-level, exch.rate = exchange rate, fat = fat consumption, GDP = gross domestic product, GFCF = Gross Fixed Capital Formation/Creation, GH-gas = greenhouse gas, GII = gender inequality index, gov = governance index, gov.revenue = government revenues, HC-coverage = healthcare coverage, HE = health(care) expenditure, HHconsump = household consumption, hosp.beds = hospital beds, hosp.payment = hospital payment scheme, hosp.stay = length of hospital stay, IDI = ICT development index, inc.ineq = income inequality, industry-labor = industrial labor force, infant-sex = infant sex ratio, labor-product = labor production, LBW = low birth weight, leave = work leave, life-satisf = life satisfaction, M-age = maternal age, marginal-tax = marginal tax rate, MDs = physicians, mult.preg = multiple pregnancy, NHS = Nation Health System, NO = nitrous oxide emissions, PM10 = particulate matter (PM10) emissions, pop = population size, pop.density = population density, pre-term = pre-term birth rate, prison = prison population, researchE = research&development expenditure, school.ref = compulsory schooling reform, smoke-free = smoke-free places, SO = sulfur oxide emissions, soc.E = social expenditure, soc.workers = social workers, sugar = sugar consumption, terror = terrorism, union = union density, UR = unemployment rate, urban = urbanization, veg-fr = vegetable-and-fruit consumption, welfare = welfare regime, Wwater = wastewater treatment.

https://doi.org/10.1371/journal.pone.0239031.g002

Distances between determinants in Fig 2 are indicative of determinants’ “connectedness” with each other. While the statistical procedure called for higher dimensionality of the model, for demonstration purposes we show here a two-dimensional solution. This simplification unfortunately comes with a caveat. To use the factor smoking as an example, it would appear it stands at a much greater distance from GDP than it does from alcohol. In reality however, smoking was considered together with alcohol consumption [ 21 , 25 , 26 , 52 , 68 ] in just as many studies as it was with GDP [ 21 , 25 , 26 , 52 , 59 ], five. To aid with respect to this apparent shortcoming, we have emphasized the strongest pairwise links. Solid lines connect GDP with health expenditure (HE), unemployment rate (UR), and education (EDU), indicating that the effect of GDP on health, taking into account the effects of the other three determinants as well, was evaluated in between 12 to 16 studies of the 60 included in this review. Tracing the dashed lines, we can also tell that GDP appeared jointly with income inequality, and HE together with either EDU or UR, in anywhere between 8 to 10 of our selected studies. Finally, some weaker but still worth-mentioning “connections” between variables are displayed as well via the dotted lines.

The fact that all notable pairwise “connections” are concentrated within a relatively small region of the plot may be interpreted as low overall “connectedness” among the health indicators studied. GDP is the most widely investigated determinant in relation to general population health. Its total number of “connections” is disproportionately high (159) compared to its runner-up–HE (with 113 “connections”), and then subsequently EDU (with 90) and UR (with 86). In fact, all of these determinants could be thought of as outliers, given that none of the remaining factors have a total count of pairings above 52. This decrease in individual determinants’ overall “connectedness” can be tracked on the graph via the change of color intensity as we move outwards from the symbolic center of GDP and its closest “co-determinants”, to finally reach the other extreme of the ten indicators (welfare regime, household consumption, compulsory school reform, life satisfaction, government revenues, literacy, research expenditure, multiple pregnancy, Cyclically Adjusted Primary Balance, and residents’ dissatisfaction; in white) the effects on health of which were only studied in isolation.

Lastly, we point to the few small but stable clusters of covariates encircled by the grey bubbles on Fig 2 . These groups of determinants were identified as “close” by both statistical procedures used for the production of the graph (see details in S2 Appendix ).

Statistical methodology

There was great variation in the level of statistical detail reported. Some authors provided too vague a description of their analytical approach, necessitating some inference in this section.

The issue of missing data is a challenging reality in this field of research, but few of the studies under review (12/60) explain how they dealt with it. Among the ones that do, three general approaches to handling missingness can be identified, listed in increasing level of sophistication: case-wise deletion, i.e., removal of countries from the sample [ 20 , 45 , 48 , 58 , 59 ], (linear) interpolation [ 28 , 30 , 34 , 58 , 59 , 63 ], and multiple imputation [ 26 , 41 , 52 ].

Correlations, Pearson, Spearman, or unspecified, were the only technique applied with respect to the health outcomes of interest in eight analyses [ 33 , 42 – 44 , 46 , 53 , 57 , 61 ]. Among the more advanced statistical methods, the family of regression models proved to be, by and large, predominant. Before examining this closer, we note the techniques that were, in a way, “unique” within this selection of studies: meta-analyses were performed (random and fixed effects, respectively) on the reduced form and 2-sample two stage least squares (2SLS) estimations done within countries [ 39 ]; difference-in-difference (DiD) analysis was applied in one case [ 23 ]; dynamic time-series methods, among which co-integration, impulse-response function (IRF), and panel vector autoregressive (VAR) modeling, were utilized in one study [ 80 ]; longitudinal generalized estimating equation (GEE) models were developed on two occasions [ 70 , 78 ]; hierarchical Bayesian spatial models [ 51 ] and special autoregressive regression [ 62 ] were also implemented.

Purely cross-sectional data analyses were performed in eight studies [ 25 , 45 , 47 , 50 , 55 , 56 , 67 , 71 ]. These consisted of linear regression (assumed ordinary least squares (OLS)), generalized least squares (GLS) regression, and multilevel analyses. However, six other studies that used longitudinal data in fact had a cross-sectional design, through which they applied regression at multiple time-points separately [ 27 , 29 , 36 , 48 , 68 , 72 ].

Apart from these “multi-point cross-sectional studies”, some other simplistic approaches to longitudinal data analysis were found, involving calculating and regressing 3-year averages of both the response and the predictor variables [ 54 ], taking the average of a few data-points (i.e., survey waves) [ 56 ] or using difference scores over 10-year [ 19 , 29 ] or unspecified time intervals [ 40 , 55 ].

Moving further in the direction of more sensible longitudinal data usage, we turn to the methods widely known among (health) economists as “panel data analysis” or “panel regression”. Most often seen were models with fixed effects for country/region and sometimes also time-point (occasionally including a country-specific trend as well), with robust standard errors for the parameter estimates to take into account correlations among clustered observations [ 20 , 21 , 24 , 28 , 30 , 32 , 34 , 37 , 38 , 41 , 52 , 59 , 60 , 63 , 66 , 69 , 73 , 79 , 81 , 82 ]. The Hausman test [ 83 ] was sometimes mentioned as the tool used to decide between fixed and random effects [ 26 , 49 , 63 , 66 , 73 , 82 ]. A few studies considered the latter more appropriate for their particular analyses, with some further specifying that (feasible) GLS estimation was employed [ 26 , 34 , 49 , 58 , 60 , 73 ]. Apart from these two types of models, the first differences method was encountered once as well [ 31 ]. Across all, the error terms were sometimes assumed to come from a first-order autoregressive process (AR(1)), i.e., they were allowed to be serially correlated [ 20 , 30 , 38 , 58 – 60 , 73 ], and lags of (typically) predictor variables were included in the model specification, too [ 20 , 21 , 37 , 38 , 48 , 69 , 81 ]. Lastly, a somewhat different approach to longitudinal data analysis was undertaken in four studies [ 22 , 35 , 48 , 65 ] in which multilevel–linear or Poisson–models were developed.

Regardless of the exact techniques used, most studies included in this review presented multiple model applications within their main analysis. None attempted to formally compare models in order to identify the “best”, even if goodness-of-fit statistics were occasionally reported. As indicated above, many studies investigated women’s and men’s health separately [ 19 , 21 , 22 , 27 – 29 , 31 , 33 , 35 , 36 , 38 , 39 , 45 , 50 , 51 , 64 , 65 , 69 , 82 ], and covariates were often tested one at a time, including other covariates only incrementally [ 20 , 25 , 28 , 36 , 40 , 50 , 55 , 67 , 73 ]. Furthermore, there were a few instances where analyses within countries were performed as well [ 32 , 39 , 51 ] or where the full time period of interest was divided into a few sub-periods [ 24 , 26 , 28 , 31 ]. There were also cases where different statistical techniques were applied in parallel [ 29 , 55 , 60 , 66 , 69 , 73 , 82 ], sometimes as a form of sensitivity analysis [ 24 , 26 , 30 , 58 , 73 ]. However, the most common approach to sensitivity analysis was to re-run models with somewhat different samples [ 39 , 50 , 59 , 67 , 69 , 80 , 82 ]. Other strategies included different categorization of variables or adding (more/other) controls [ 21 , 23 , 25 , 28 , 37 , 50 , 63 , 69 ], using an alternative main covariate measure [ 59 , 82 ], including lags for predictors or outcomes [ 28 , 30 , 58 , 63 , 65 , 79 ], using weights [ 24 , 67 ] or alternative data sources [ 37 , 69 ], or using non-imputed data [ 41 ].

As the methods and not the findings are the main focus of the current review, and because generic checklists cannot discern the underlying quality in this application field (see also below), we opted to pool all reported findings together, regardless of individual study characteristics or particular outcome(s) used, and speak generally of positive and negative effects on health. For this summary we have adopted the 0.05-significance level and only considered results from multivariate analyses. Strictly birth-related factors are omitted since these potentially only relate to the group of infant mortality indicators and not to any of the other general population health measures.

Starting with the determinants most often studied, higher GDP levels [ 21 , 26 , 27 , 29 , 30 , 32 , 43 , 48 , 52 , 58 , 60 , 66 , 67 , 73 , 79 , 81 , 82 ], higher health [ 21 , 37 , 47 , 49 , 52 , 58 , 59 , 68 , 72 , 82 ] and social [ 20 , 21 , 26 , 38 , 79 ] expenditures, higher education [ 26 , 39 , 52 , 62 , 72 , 73 ], lower unemployment [ 60 , 61 , 66 ], and lower income inequality [ 30 , 42 , 53 , 55 , 73 ] were found to be significantly associated with better population health on a number of occasions. In addition to that, there was also some evidence that democracy [ 36 ] and freedom [ 50 ], higher work compensation [ 43 , 79 ], distributional orientation [ 54 ], cigarette prices [ 63 ], gross national income [ 22 , 72 ], labor productivity [ 26 ], exchange rates [ 32 ], marginal tax rates [ 79 ], vaccination rates [ 52 ], total fertility [ 59 , 66 ], fruit and vegetable [ 68 ], fat [ 52 ] and sugar consumption [ 52 ], as well as bigger depth of credit information [ 22 ] and percentage of civilian labor force [ 79 ], longer work leaves [ 41 , 58 ], more physicians [ 37 , 52 , 72 ], nurses [ 72 ], and hospital beds [ 79 , 82 ], and also membership in associations, perceived corruption and societal trust [ 48 ] were beneficial to health. Higher nitrous oxide (NO) levels [ 52 ], longer average hospital stay [ 48 ], deprivation [ 51 ], dissatisfaction with healthcare and the social environment [ 56 ], corruption [ 40 , 50 ], smoking [ 19 , 26 , 52 , 68 ], alcohol consumption [ 26 , 52 , 68 ] and illegal drug use [ 68 ], poverty [ 64 ], higher percentage of industrial workers [ 26 ], Gross Fixed Capital creation [ 66 ] and older population [ 38 , 66 , 79 ], gender inequality [ 22 ], and fertility [ 26 , 66 ] were detrimental.

It is important to point out that the above-mentioned effects could not be considered stable either across or within studies. Very often, statistical significance of a given covariate fluctuated between the different model specifications tried out within the same study [ 20 , 49 , 59 , 66 , 68 , 69 , 73 , 80 , 82 ], testifying to the importance of control variables and multivariate research (i.e., analyzing multiple independent variables simultaneously) in general. Furthermore, conflicting results were observed even with regards to the “core” determinants given special attention, so to speak, throughout this text. Thus, some studies reported negative effects of health expenditure [ 32 , 82 ], social expenditure [ 58 ], GDP [ 49 , 66 ], and education [ 82 ], and positive effects of income inequality [ 82 ] and unemployment [ 24 , 31 , 32 , 52 , 66 , 68 ]. Interestingly, one study [ 34 ] differentiated between temporary and long-term effects of GDP and unemployment, alluding to possibly much greater complexity of the association with health. It is also worth noting that some gender differences were found, with determinants being more influential for males than for females, or only having statistically significant effects for male health [ 19 , 21 , 28 , 34 , 36 , 37 , 39 , 64 , 65 , 69 ].

The purpose of this scoping review was to examine recent quantitative work on the topic of multi-country analyses of determinants of population health in high-income countries.

Measuring population health via relatively simple mortality-based indicators still seems to be the state of the art. What is more, these indicators are routinely considered one at a time, instead of, for example, employing existing statistical procedures to devise a more general, composite, index of population health, or using some of the established indices, such as disability-adjusted life expectancy (DALE) or quality-adjusted life expectancy (QALE). Although strong arguments for their wider use were already voiced decades ago [ 84 ], such summary measures surface only rarely in this research field.

On a related note, the greater data availability and accessibility that we enjoy today does not automatically equate to data quality. Nonetheless, this is routinely assumed in aggregate level studies. We almost never encountered a discussion on the topic. The non-mundane issue of data missingness, too, goes largely underappreciated. With all recent methodological advancements in this area [ 85 – 88 ], there is no excuse for ignorance; and still, too few of the reviewed studies tackled the matter in any adequate fashion.

Much optimism can be gained considering the abundance of different determinants that have attracted researchers’ attention in relation to population health. We took on a visual approach with regards to these determinants and presented a graph that links spatial distances between determinants with frequencies of being studies together. To facilitate interpretation, we grouped some variables, which resulted in some loss of finer detail. Nevertheless, the graph is helpful in exemplifying how many effects continue to be studied in a very limited context, if any. Since in reality no factor acts in isolation, this oversimplification practice threatens to render the whole exercise meaningless from the outset. The importance of multivariate analysis cannot be stressed enough. While there is no “best method” to be recommended and appropriate techniques vary according to the specifics of the research question and the characteristics of the data at hand [ 89 – 93 ], in the future, in addition to abandoning simplistic univariate approaches, we hope to see a shift from the currently dominating fixed effects to the more flexible random/mixed effects models [ 94 ], as well as wider application of more sophisticated methods, such as principle component regression, partial least squares, covariance structure models (e.g., structural equations), canonical correlations, time-series, and generalized estimating equations.

Finally, there are some limitations of the current scoping review. We searched the two main databases for published research in medical and non-medical sciences (PubMed and Web of Science) since 2013, thus potentially excluding publications and reports that are not indexed in these databases, as well as older indexed publications. These choices were guided by our interest in the most recent (i.e., the current state-of-the-art) and arguably the highest-quality research (i.e., peer-reviewed articles, primarily in indexed non-predatory journals). Furthermore, despite holding a critical stance with regards to some aspects of how determinants-of-health research is currently conducted, we opted out of formally assessing the quality of the individual studies included. The reason for that is two-fold. On the one hand, we are unaware of the existence of a formal and standard tool for quality assessment of ecological designs. And on the other, we consider trying to score the quality of these diverse studies (in terms of regional setting, specific topic, outcome indices, and methodology) undesirable and misleading, particularly since we would sometimes have been rating the quality of only a (small) part of the original studies—the part that was relevant to our review’s goal.

Our aim was to investigate the current state of research on the very broad and general topic of population health, specifically, the way it has been examined in a multi-country context. We learned that data treatment and analytical approach were, in the majority of these recent studies, ill-equipped or insufficiently transparent to provide clarity regarding the underlying mechanisms of population health in high-income countries. Whether due to methodological shortcomings or the inherent complexity of the topic, research so far fails to provide any definitive answers. It is our sincere belief that with the application of more advanced analytical techniques this continuous quest could come to fruition sooner.

Supporting information

S1 checklist. preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (prisma-scr) checklist..

https://doi.org/10.1371/journal.pone.0239031.s001

S1 Appendix.

https://doi.org/10.1371/journal.pone.0239031.s002

S2 Appendix.

https://doi.org/10.1371/journal.pone.0239031.s003

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Common Data Types in Public Health Research

Quantitative data.

• Quantitative data is measurable, often used for comparisons, and involves counting of people, behaviors, conditions, or other discrete events (Wang, 2013).
• Quantitative data uses numbers to determine the what, who, when, and where of health-related events (Wang, 2013).
• Examples of quantitative data include: age, weight, temperature, or the number of people suffering from diabetes.

Qualitative Data

• Qualitative data is a broad category of data that can include almost any non-numerical data.
• Qualitative data uses words to describe a particular health-related event (Romano).
• This data can be observed, but not measured.
• Involves observing people in selected places and listening to discover how they feel and why they might feel that way (Wang, 2013).
• Examples of qualitative data include: male/female, smoker/non-smoker, or questionnaire response (agree, disagree, neutral).
• Measuring organizational change.
• Measures of clinical leadership in implementing evidence-based guidelines.
• Patient perceptions of quality of care.

Data Sources

Primary data sources.

• Primary data analysis in which the same individual or team of researchers designs, collects, and analyzes the data, for the purpose of answering a research question (Koziol & Arthur, nd).

Advantages to Using Primary Data

• You collect exactly the data elements that you need to answer your research question (Romano).
• You can test an intervention, such as an experimental drug or an educational program, in the purest way (a double-blind randomized controlled trial (Romano).
• You control the data collection process, so you can ensure data quality, minimize the number of missing values, and assess the reliability of your instruments (Romano).

Secondary Data Sources

• Existing data collected for another purposes, that you use to answer your research question (Romano).

Advantages of Working with Secondary Data

• Large samples
• Can provide population estimates : for example state data can be combined across states to get national estimates (Shaheen, Pan, & Mukherjee).
• Less expensive to collect than primary data (Romano)
• It takes less time to collect secondary data (Romano).
• You may not need to worry about informed consent, human subjects restriction (Romano).

Issues in Using Secondary Data

• Study design and data collection already completed (Koziol & Arthur, nd).
• Data may not facilitate particular research question o Information regarding study design and data collection procedures may be scarce.
• Data may potentially lack depth (the greater the breadth the harder it is to measure any one construct in depth) (Koziol & Arthur, nd).
• Certain fields or departments (e.g., experimental programs) may place less value on secondary data analysis (Koziol & Arthur, nd).
• Often requires special techniques to analyze statistically the data.

• Research article
• Open access
• Published: 03 February 2021

A review of the quantitative effectiveness evidence synthesis methods used in public health intervention guidelines

• Ellesha A. Smith   ORCID: orcid.org/0000-0002-4241-7205 1 ,
• Nicola J. Cooper 1 ,
• Alex J. Sutton 1 ,
• Keith R. Abrams 1 &
• Stephanie J. Hubbard 1  

BMC Public Health volume  21 , Article number:  278 ( 2021 ) Cite this article

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The complexity of public health interventions create challenges in evaluating their effectiveness. There have been huge advancements in quantitative evidence synthesis methods development (including meta-analysis) for dealing with heterogeneity of intervention effects, inappropriate ‘lumping’ of interventions, adjusting for different populations and outcomes and the inclusion of various study types. Growing awareness of the importance of using all available evidence has led to the publication of guidance documents for implementing methods to improve decision making by answering policy relevant questions.

The first part of this paper reviews the methods used to synthesise quantitative effectiveness evidence in public health guidelines by the National Institute for Health and Care Excellence (NICE) that had been published or updated since the previous review in 2012 until the 19th August 2019.The second part of this paper provides an update of the statistical methods and explains how they address issues related to evaluating effectiveness evidence of public health interventions.

The proportion of NICE public health guidelines that used a meta-analysis as part of the synthesis of effectiveness evidence has increased since the previous review in 2012 from 23% (9 out of 39) to 31% (14 out of 45). The proportion of NICE guidelines that synthesised the evidence using only a narrative review decreased from 74% (29 out of 39) to 60% (27 out of 45).An application in the prevention of accidents in children at home illustrated how the choice of synthesis methods can enable more informed decision making by defining and estimating the effectiveness of more distinct interventions, including combinations of intervention components, and identifying subgroups in which interventions are most effective.

Conclusions

Despite methodology development and the publication of guidance documents to address issues in public health intervention evaluation since the original review, NICE public health guidelines are not making full use of meta-analysis and other tools that would provide decision makers with fuller information with which to develop policy. There is an evident need to facilitate the translation of the synthesis methods into a public health context and encourage the use of methods to improve decision making.

Peer Review reports

To make well-informed decisions and provide the best guidance in health care policy, it is essential to have a clear framework for synthesising good quality evidence on the effectiveness and cost-effectiveness of health interventions. There is a broad range of methods available for evidence synthesis. Narrative reviews provide a qualitative summary of the effectiveness of the interventions. Meta-analysis is a statistical method that pools evidence from multiple independent sources [ 1 ]. Meta-analysis and more complex variations of meta-analysis have been extensively applied in the appraisals of clinical interventions and treatments, such as drugs, as the interventions and populations are clearly defined and tested in randomised, controlled conditions. In comparison, public health studies are often more complex in design, making synthesis more challenging [ 2 ].

Many challenges are faced in the synthesis of public health interventions. There is often increased methodological heterogeneity due to the inclusion of different study designs. Interventions are often poorly described in the literature which may result in variation within the intervention groups. There can be a wide range of outcomes, whose definitions are not consistent across studies. Intermediate, or surrogate, outcomes are often used in studies evaluating public health interventions [ 3 ]. In addition to these challenges, public health interventions are often also complex meaning that they are made up of multiple, interacting components [ 4 ]. Recent guidance documents have focused on the synthesis of complex interventions [ 2 , 5 , 6 ]. The National Institute for Health and Care Excellence (NICE) guidance manual provides recommendations across all topics that are covered by NICE and there is currently no guidance that focuses specifically on the public health context.

Research questions

A methodological review of NICE public health intervention guidelines by Achana et al. (2014) found that meta-analysis methods were not being used [ 3 ]. The first part of this paper aims to update and compare, to the original review, the meta-analysis methods being used in evidence synthesis of public health intervention appraisals.

The second part of this paper aims to illustrate what methods are available to address the challenges of public health intervention evidence synthesis. Synthesis methods that go beyond a pairwise meta-analysis are illustrated through the application to a case study in public health and are discussed to understand how evidence synthesis methods can enable more informed decision making.

The third part of this paper presents software, guidance documents and web tools for methods that aim to make appropriate evidence synthesis of public health interventions more accessible. Recommendations for future research and guidance production that can improve the uptake of these methods in a public health context are discussed.

Update of NICE public health intervention guidelines review

Nice guidelines.

The National Institute for Health and Care Excellence (NICE) was established in 1999 as a health authority to provide guidance on new medical technologies to the NHS in England and Wales [ 7 ]. Using an evidence-based approach, it provides recommendations based on effectiveness and cost-effectiveness to ensure an open and transparent process of allocating NHS resources [ 8 ]. The remit for NICE guideline production was extended to public health in April 2005 and the first recommendations were published in March 2006. NICE published ‘Developing NICE guidelines: the manual’ in 2006, which has been updated since, with the most recent in 2018 [ 9 ]. It was intended to be a guidance document to aid in the production of NICE guidelines across all NICE topics. In terms of synthesising quantitative evidence, the NICE recommendations state: ‘meta-analysis may be appropriate if treatment estimates of the same outcome from more than 1 study are available’ and ‘when multiple competing options are being appraised, a network meta-analysis should be considered’. The implementation of network meta-analysis (NMA), which is described later, as a recommendation from NICE was introduced into the guidance document in 2014, with a further update in 2018.

Background to the previous review

The paper by Achana et al. (2014) explored the use of evidence synthesis methodology in NICE public health intervention guidelines published between 2006 and 2012 [ 3 ]. The authors conducted a systematic review of the methods used to synthesise quantitative effectiveness evidence within NICE public health guidelines. They found that only 23% of NICE public health guidelines used pairwise meta-analysis as part of the effectiveness review and the remainder used a narrative summary or no synthesis of evidence at all. The authors argued that despite significant advances in the methodology of evidence synthesis, the uptake of methods in public health intervention evaluation is lower than other fields, including clinical treatment evaluation. The paper concluded that more sophisticated methods in evidence synthesis should be considered to aid in decision making in the public health context [ 3 ].

The search strategy used in this paper was equivalent to that in the previous paper by Achana et al. (2014)[ 3 ]. The search was conducted through the NICE website ( https://www.nice.org.uk/guidance ) by searching the ‘Guidance and Advice List’ and filtering by ‘Public Health Guidelines’ [ 10 ]. The search criteria included all guidance documents that had been published from inception (March 2006) until the 19th August 2019. Since the original review, many of the guidelines had been updated with new documents or merged. Guidelines that remained unchanged since the previous review in 2012 were excluded and used for comparison.

The guidelines contained multiple documents that were assessed for relevance. A systematic review is a separate synthesis within a guideline that systematically collates all evidence on a specific research question of interest in the literature. Systematic reviews of quantitative effectiveness, cost-effectiveness evidence and decision modelling reports were all included as relevant. Qualitative reviews, field reports, expert opinions, surveillance reports, review decisions and other supporting documents were excluded at the search stage.

Within the reports, data was extracted on the types of review (narrative summary, pairwise meta-analysis, network meta-analysis (NMA), cost-effectiveness review or decision model), design of included primary studies (randomised controlled trials or non-randomised studies, intermediate or final outcomes, description of outcomes, outcome measure statistic), details of the synthesis methods used in the effectiveness evaluation (type of synthesis, fixed or random effects model, study quality assessment, publication bias assessment, presentation of results, software). Further details of the interventions were also recorded, including whether multiple interventions were lumped together for a pairwise comparison, whether interventions were complex (made up of multiple components) and details of the components. The reports were also assessed for potential use of complex intervention evidence synthesis methodology, meaning that the interventions that were evaluated in the review were made up of components that could potentially be synthesised using an NMA or a component NMA [ 11 ]. Where meta-analysis was not used to synthesis effectiveness evidence, the reasons for this was also recorded.

Search results and types of reviews

There were 67 NICE public health guidelines available on the NICE website. A summary flow diagram describing the literature identification process and the list of guidelines and their reference codes are provided in Additional files  1 and 2 . Since the previous review, 22 guidelines had not been updated. The results from the previous review were used for comparison to the 45 guidelines that were either newly published or updated.

The guidelines consisted of 508 documents that were assessed for relevance. Table  1 shows which types of relevant documents were available in each of the 45 guidelines. The median number of relevant articles per guideline was 3 (minimum = 0, maximum = 10). Two (4%) of the NICE public health guidelines did not report any type of systematic review, cost-effectiveness review or decision model (NG68, NG64) that met the inclusion criteria. 167 documents from 43 NICE public health guidelines were systematic reviews of quantitative effectiveness, cost-effectiveness or decision model reports and met the inclusion criteria.

Narrative reviews of effectiveness were implemented in 41 (91%) of the NICE PH guidelines. 14 (31%) contained a review that used meta-analysis to synthesise the evidence. Only one (1%) NICE guideline contained a review that implemented NMA to synthesise the effectiveness of multiple interventions; this was the same guideline that used NMA in the original review and had been updated. 33 (73%) guidelines contained cost-effectiveness reviews and 34 (76%) developed a decision model.

Comparison of review types to original review

Table  2 compares the results of the update to the original review and shows that the types of reviews and evidence synthesis methodologies remain largely unchanged since 2012. The proportion of guidelines that only contain narrative reviews to synthesise effectiveness or cost-effectiveness evidence has reduced from 74% to 60% and the proportion that included a meta-analysis has increased from 23% to 31%. The proportion of guidelines with reviews that only included evidence from randomised controlled trials and assessed the quality of individual studies remained similar to the original review.

Characteristics of guidelines using meta-analytic methods

Table  3 details the characteristics of the meta-analytic methods implemented in 24 reviews of the 14 guidelines that included one. All of the reviews reported an assessment of study quality, 12 (50%) reviews included only data from randomised controlled trials, 4 (17%) reviews used intermediate outcomes (e.g. uptake of chlamydia screening rather than prevention of chlamydia (PH3)), compared to the 20 (83%) reviews that used final outcomes (e.g. smoking cessation rather than uptake of a smoking cessation programme (NG92)). 2 (8%) reviews only used a fixed effect meta-analysis, 19 (79%) reviews used a random effects meta-analysis and 3 (13%) did not report which they had used.

An evaluation of the intervention information reported in the reviews concluded that 12 (50%) reviews had lumped multiple (more than two) different interventions into a control versus intervention pairwise meta-analysis. Eleven (46%) of the reviews evaluated interventions that are made up of multiple components (e.g. interventions for preventing obesity in PH47 were made up of diet, physical activity and behavioural change components).

21 (88%) of the reviews presented the results of the meta-analysis in the form of a forest plot and 22 (92%) presented the results in the text of the report. 20 (83%) of the reviews used two or more forms of presentation for the results. Only three (13%) reviews assessed publication bias. The most common software to perform meta-analysis was RevMan in 14 (58%) of the reviews.

Reasons for not using meta-analytic methods

The 143 reviews of effectiveness and cost effectiveness that did not use meta-analysis methods to synthesise the quantitative effectiveness evidence were searched for reasons behind this decision. 70 reports (49%) did not give a reason for not synthesising the data using a meta-analysis and 164 reasons were reported which are displayed in Fig.  1 . Out of the remaining reviews, multiple reasons for not using a meta-analysis were given. 53 (37%) of the reviews reported at least one reason due to heterogeneity. 30 (21%) decision model reports did not give a reason and these are categorised separately. 5 (3%) reviews reported that meta-analysis was not applicable or feasible, 1 (1%) reported that they were following NICE guidelines and 5 (3%) reported that there were a lack of studies.

Frequency and proportions of reasons reported for not using statistical methods in quantitative evidence synthesis in NICE PH intervention reviews

The frequency of reviews and guidelines that used meta-analytic methods were plotted against year of publication, which is reported in Fig.  2 . This showed that the number of reviews that used meta-analysis were approximately constant but there is some suggestion that the number of meta-analyses used per guideline increased, particularly in 2018.

Number of meta-analyses in NICE PH guidelines by year. Guidelines that were published before 2012 had been updated since the previous review by Achana et al. (2014) [ 3 ]

Comparison of meta-analysis characteristics to original review

Table  4 compares the characteristics of the meta-analyses used in the evidence synthesis of NICE public health intervention guidelines to the original review by Achana et al. (2014) [ 3 ]. Overall, the characteristics in the updated review have not much changed from those in the original. These changes demonstrate that the use of meta-analysis in NICE guidelines has increased but remains low. Lumping of interventions still appears to be common in 50% of reviews. The implications of this are discussed in the next section.

Application of evidence synthesis methodology in a public health intervention: motivating example

Since the original review, evidence synthesis methods have been developed and can address some of the challenges of synthesising quantitative effectiveness evidence of public health interventions. Despite this, the previous section shows that the uptake of these methods is still low in NICE public health guidelines - usually limited to a pairwise meta-analysis.

It has been shown in the results above and elsewhere [ 12 ] that heterogeneity is a common reason for not synthesising the quantitative effectiveness evidence available from systematic reviews in public health. Statistical heterogeneity is the variation in the intervention effects between the individual studies. Heterogeneity is problematic in evidence synthesis as it leads to uncertainty in the pooled effect estimates in a meta-analysis which can make it difficult to interpret the pooled results and draw conclusions. Rather than exploring the source of the heterogeneity, often in public health intervention appraisals a random effects model is fitted which assumes that the study intervention effects are not equivalent but come from a common distribution [ 13 , 14 ]. Alternatively, as demonstrated in the review update, heterogeneity is used as a reason to not undertake any quantitative evidence synthesis at all.

Since the size of the intervention effects and the methodological variation in the studies will affect the impact of the heterogeneity on a meta-analysis, it is inappropriate to base the methodological approach of a review on the degree of heterogeneity, especially within public health intervention appraisal where heterogeneity seems inevitable. Ioannidis et al. (2008) argued that there are ‘almost always’ quantitative synthesis options that may offer some useful insights in the presence of heterogeneity, as long as the reviewers interpret the findings with respect to their limitations [ 12 ].

In this section current evidence synthesis methods are applied to a motivating example in public health. This aims to demonstrate that methods beyond pairwise meta-analysis can provide appropriate and pragmatic information to public health decision makers to enable more informed decision making.

Figure  3 summarises the narrative of this part of the paper and illustrates the methods that are discussed. The red boxes represent the challenges in synthesising quantitative effectiveness evidence and refers to the section within the paper for more detail. The blue boxes represent the methods that can be applied to investigate each challenge.

Summary of challenges that are faces in the evidence synthesis of public health interventions and methods that are discussed to overcome these challenges

Evaluating the effect of interventions for promoting the safe storage of cleaning products to prevent childhood poisoning accidents

To illustrate the methodological developments, a motivating example is used from the five year, NIHR funded, Keeping Children Safe Programme [ 15 ]. The project included a Cochrane systematic review that aimed to increase the use of safety equipment to prevent accidents at home in children under five years old. This application is intended to be illustrative of the benefits of new evidence synthesis methods since the previous review. It is not a complete, comprehensive analysis as it only uses a subset of the original dataset and therefore the results are not intended to be used for policy decision making. This example has been chosen as it demonstrates many of the issues in synthesising effectiveness evidence of public health interventions, including different study designs (randomised controlled trials, observational studies and cluster randomised trials), heterogeneity of populations or settings, incomplete individual participant data and complex interventions that contain multiple components.

This analysis will investigate the most effective promotional interventions for the outcome of ‘safe storage of cleaning products’ to prevent childhood poisoning accidents. There are 12 studies included in the dataset, with IPD available from nine of the studies. The covariate, single parent family, is included in the analysis to demonstrate the effect of being a single parent family on the outcome. In this example, all of the interventions are made up of one or more of the following components: education (Ed), free or low cost equipment (Eq), home safety inspection (HSI), and installation of safety equipment (In). A Bayesian approach using WinBUGS was used and therefore credible intervals (CrI) are presented with estimates of the effect sizes [ 16 ].

The original review paper by Achana et al. (2014) demonstrated pairwise meta-analysis and meta-regression using individual and cluster allocated trials, subgroup analyses, meta-regression using individual participant data (IPD) and summary aggregate data and NMA. This paper firstly applies NMA to the motivating example for context, followed by extensions to NMA.

Multiple interventions: lumping or splitting?

Often in public health there are multiple intervention options. However, interventions are often lumped together in a pairwise meta-analysis. Pairwise meta-analysis is a useful tool for two interventions or, alternatively in the presence of lumping interventions, for answering the research question: ‘are interventions in general better than a control or another group of interventions?’. However, when there are multiple interventions, this type of analysis is not appropriate for informing health care providers which intervention should be recommended to the public. ‘Lumping’ is becoming less frequent in other areas of evidence synthesis, such as for clinical interventions, as the use of sophisticated synthesis techniques, such as NMA, increases (Achana et al. 2014) but lumping is still common in public health.

NMA is an extension of the pairwise meta-analysis framework to more than two interventions. Multiple interventions that are lumped into a pairwise meta-analysis are likely to demonstrate high statistical heterogeneity. This does not mean that quantitative synthesis could not be undertaken but that a more appropriate method, NMA, should be implemented. Instead the statistical approach should be based on the research questions of the systematic review. For example, if the research question is ‘are any interventions effective for preventing obesity?’, it would be appropriate to perform a pairwise meta-analysis comparing every intervention in the literature to a control. However, if the research question is ‘which intervention is the most effective for preventing obesity?’, it would be more appropriate and informative to perform a network meta-analysis, which can compare multiple interventions simultaneously and identify the best one.

NMA is a useful statistical method in the context of public health intervention appraisal, where there are often multiple intervention options, as it estimates the relative effectiveness of three or more interventions simultaneously, even if direct study evidence is not available for all intervention comparisons. Using NMA can help to answer the research question ‘what is the effectiveness of each intervention compared to all other interventions in the network?’.

In the motivating example there are six intervention options. The effect of lumping interventions is shown in Fig.  4 , where different interventions in both the intervention and control arms are compared. There is overlap of intervention and control arms across studies and interpretation of the results of a pairwise meta-analysis comparing the effectiveness of the two groups of interventions would not be useful in deciding which intervention to recommend. In comparison, the network plot in Fig.  5 illustrates the evidence base of the prevention of childhood poisonings review comparing six interventions that promote the use of safety equipment in the home. Most of the studies use ‘usual care’ as a baseline and compare this to another intervention. There are also studies in the evidence base that compare pairs of the interventions, such as ‘Education and equipment’ to ‘Equipment’. The plot also demonstrates the absence of direct study evidence between many pairs of interventions, for which the associated treatment effects can be indirectly estimated using NMA.

Network plot to illustrate how pairwise meta-analysis groups the interventions in the motivating dataset. Notation UC: Usual care, Ed: Education, Ed+Eq: Education and equipment, Ed+Eq+HSI: Education, equipment, and home safety inspection, Ed+Eq+In: Education, equipment and installation, Eq: Equipment

Network plot for the safe storage of cleaning products outcome. Notation UC: Usual care, Ed: Education, Ed+Eq: Education and equipment, Ed+Eq+HSI: Education, equipment, and home safety inspection, Ed+Eq+In: Education, equipment and installation, Eq: Equipment

An NMA was fitted to the motivating example to compare the six interventions in the studies from the review. The results are reported in the ‘triangle table’ in Table  5 [ 17 ]. The top right half of the table shows the direct evidence between pairs of the interventions in the corresponding rows and columns by either pooling the studies as a pairwise meta-analysis or presenting the single study results if evidence is only available from a single study. The bottom left half of the table reports the results of the NMA. The gaps in the top right half of the table arise where no direct study evidence exists to compare the two interventions. For example, there is no direct study evidence comparing ‘Education’ (Ed) to ‘Education, equipment and home safety inspection’ (Ed+Eq+HSI). The NMA, however, can estimate this comparison through the direct study evidence as an odds ratio of 3.80 with a 95% credible interval of (1.16, 12.44). The results suggest that the odds of safely storing cleaning products in the Ed+Eq+HSI intervention group is 3.80 times the odds in the Ed group. The results demonstrate a key benefit of NMA that all intervention effects in a network can be estimated using indirect evidence, even if there is no direct study evidence for some pairwise comparisons. This is based on the consistency assumption (that estimates of intervention effects from direct and indirect evidence are consistent) which should be checked when performing an NMA. This is beyond the scope of this paper and details on this can be found elsewhere [ 18 ].

NMA can also be used to rank the interventions in terms of their effectiveness and estimate the probability that each intervention is likely to be the most effective. This can help to answer the research question ‘which intervention is the best?’ out of all of the interventions that have provided evidence in the network. The rankings and associated probabilities for the motivating example are presented in Table  6 . It can be seen that in this case the ‘education, equipment and home safety inspection’ (Ed+Eq+HSI) intervention is ranked first, with a 0.87 probability of being the best intervention. However, there is overlap of the 95% credible intervals of the median rankings. This overlap reflects the uncertainty in the intervention effect estimates and therefore it is important that the interpretation of these statistics clearly communicates this uncertainty to decision makers.

NMA has the potential to be extremely useful but is underutilised in the evidence synthesis of public health interventions. The ability to compare and rank multiple interventions in an area where there are often multiple intervention options is invaluable in decision making for identifying which intervention to recommend. NMA can also include further literature in the analysis, compared to a pairwise meta-analysis, by expanding the network to improve the uncertainty in the effectiveness estimates.

Statistical heterogeneity

When heterogeneity remains in the results of an NMA, it is useful to explore the reasons for this. Strategies for dealing with heterogeneity involve the inclusion of covariates in a meta-analysis or NMA to adjust for the differences in the covariates across studies [ 19 ]. Meta-regression is a statistical method developed from meta-analysis that includes covariates to potentially explain the between-study heterogeneity ‘with the aim of estimating treatment-covariate interactions’ (Saramago et al. 2012). NMA has been extended to network meta-regression which investigates the effect of trial characteristics on multiple intervention effects. Three ways have been suggested to include covariates in an NMA: single covariate effect, exchangeable covariate effects and independent covariate effects which are discussed in more detail in the NICE Technical Support Document 3 [ 14 ]. This method has the potential to assess the effect of study level covariates on the intervention effects, which is particularly relevant in public health due to the variation across studies.

The most widespread method of meta-regression uses study level data for the inclusion of covariates into meta-regression models. Study level covariate data is when the data from the studies are aggregated, e.g. the proportion of participants in a study that are from single parent families compared to dual parent families. The alternative to study level data is individual participant data (IPD), where the data are available and used as a covariate at the individual level e.g. the parental status of every individual in a study can be used as a covariate. Although IPD is considered to be the gold standard for meta-analysis, aggregated level data is much more commonly used as it is usually available and easily accessible from published research whereas IPD can be hard to obtain from study authors.

There are some limitations to network meta-regression. In our motivating example, using the single parent covariate in a meta-regression would estimate the relative difference in the intervention effects of a population that is made up of 100% single parent families compared to a population that is made up of 100% dual parent families. This interpretation is not as useful as the analysis that uses IPD, which would give the relative difference of the intervention effects in a single parent family compared to a dual parent family. The meta-regression using aggregated data would also be susceptible to ecological bias. Ecological bias is where the effect of the covariate is different at the study level compared to the individual level [ 14 ]. For example, if each study demonstrates a relationship between a covariate and the intervention but the covariate is similar across the studies, a meta-regression of the aggregate data would not demonstrate the effect that is observed within the studies [ 20 ].

Although meta-regression is a useful tool for investigating sources of heterogeneity in the data, caution should be taken when using the results of meta-regression to explain how covariates affect the intervention effects. Meta-regression should only be used to investigate study characteristics, such as the duration of intervention, which will not be susceptible to ecological bias and the interpretation of the results (the effect of intervention duration on intervention effectiveness) would be more meaningful for the development of public health interventions.

Since the covariate of interest in this motivating example is not a study characteristic, meta-regression of aggregated covariate data was not performed. Network meta-regression including IPD and aggregate level data was developed by Samarago et al. (2012) [ 21 ] to overcome the issues with aggregated data network meta-regression, which is discussed in the next section.

Tailored decision making to specific sub-groups

In public health it is important to identify which interventions are best for which people. There has been a recent move towards precision medicine. In the field of public health the ‘concept of precision prevention may [...] be valuable for efficiently targeting preventive strategies to the specific subsets of a population that will derive maximal benefit’ (Khoury and Evans, 2015). Tailoring interventions has the potential to reduce the effect of inequalities in social factors that are influencing the health of the population. Identifying which interventions should be targeted to which subgroups can also lead to better public health outcomes and help to allocate scarce NHS resources. Research interest, therefore, lies in identifying participant level covariate-intervention interactions.

IPD meta-analysis uses data at the individual level to overcome ecological bias. The interpretation of IPD meta-analysis is more relevant in the case of using participant characteristics as covariates since the interpretation of the covariate-intervention interaction is at the individual level rather than the study level. This means that it can answer the research question: ‘which interventions work best in subgroups of the population?’. IPD meta-analyses are considered to be the gold standard for evidence synthesis since it increases the power of the analysis to identify covariate-intervention interactions and it has the ability to reduce the effect of ecological bias compared to aggregated data alone. IPD meta-analysis can also help to overcome scarcity of data issues and has been shown to have higher power and reduce the uncertainty in the estimates compared to analysis including only summary aggregate data [ 22 ].

Despite the advantages of including IPD in a meta-analysis, in reality it is often very time consuming and difficult to collect IPD for all of the studies [ 21 ]. Although data sharing is becoming more common, it remains time consuming and difficult to collect IPD for all studies in a review. This results in IPD being underutilised in meta-analyses. As an intermediate solution, statistical methods have been developed, such as the NMA in Samarago et al. (2012), that incorporates both IPD and aggregate data. Methods that simultaneously include IPD and aggregate level data have been shown to reduce uncertainty in the effect estimates and minimise ecological bias [ 20 , 21 ]. A simulation study by Leahy et al. (2018) found that an increased proportion of IPD resulted in more accurate and precise NMA estimates [ 23 ].

An NMA including IPD, where it is available, was performed, based on the model presented in Samarago et al. (2012) [ 21 ]. The results in Table  7 demonstrates the detail that this type of analysis can provide to base decisions on. More relevant covariate-intervention interaction interpretations can be obtained, for example the regression coefficients for covariate-intervention interactions are the individual level covariate intervention interactions or the ‘within study interactions’ that are interpreted as the effect of being in a single parent family on the effectiveness of each of the interventions. For example, the effect of Ed+Eq compared to UC in a single parent family is 1.66 times the effect of Ed+Eq compared to UC in a dual parent family but this is not an important difference as the credible interval crosses 1. The regression coefficients for the study level covariate-intervention interactions or the ‘between study interactions’ can be interpreted as the relative difference in the intervention effects of a population that is made up of 100% single parent families compared to a population that is made up of 100% dual parent families.

• Complex interventions

In many public health research settings the complex interventions are comprised of a number of components. An NMA can compare all of the interventions in a network as they are implemented in the original trials. However, NMA does not tell us which components of the complex intervention are attributable to this effect. It could be that particular components, or the interacting effect of multiple components, are driving the effectiveness and other components are not as effective. Often, trials have not directly compared every combination of components as there are so many component combination options, it would be inefficient and impractical. Component NMA was developed by Welton et al. (2009) to estimate the effect of each component of the complex interventions and combination of components in a network, in the absence of direct trial evidence and answers the question: ‘are interventions with a particular component or combination of components effective?’ [ 11 ]. For example, for the motivating example, in comparison to Fig.  5 , which demonstrates the interventions that an NMA can estimate effectiveness, Fig.  6 demonstrates all of the possible interventions of which the effectiveness can be estimated in a component NMA, given the components present in the network.

Network plot that illustrates how component network meta-analysis can estimate the effectiveness of intervention components and combinations of components, even when they are not included in the direct evidence. Notation UC: Usual care, Ed: Education, Eq: Equipment, Installation, Ed+Eq: Education and equipment, Ed+HSI: Education and home safety inspection, Ed+In: Education and installation, Eq+HSI: Equipment and home safety inspection, Eq+In: equipment and installation, HSI+In: Home safety inspection and installation, Ed+Eq+HSI: Education, equipment, and home safety inspection, Ed+Eq+In: Education, equipment and installation, Eq+HSI+In: Equipment, home safety inspection and installation, Ed+Eq+HSI+In: Education, equipment, home safety inspection and installation

The results of the analyses of the main effects, two way effects and full effects models are shown in Table  8 . The models, proposed in the original paper by Welton et al. (2009), increase in complexity as the assumptions regarding the component effects relax [ 24 ]. The main effects component NMA assumes that the components in the interventions each have separate, independent effects and intervention effects are the sum of the component effects. The two-way effects models assumes that there are interactions between pairs of the components, so the effects of the interventions are more than the sum of the effects. The full effects model assumes that all of the components and combinations of the components interact. Component NMA did not provide further insight into which components are likely to be the most effective since all of the 95% credible intervals were very wide and overlapped 1. There is a lot of uncertainty in the results, particularly in the 2-way and full effects models. A limitation of component NMA is that there are issues with uncertainty when data is scarce. However, the results demonstrate the potential of component NMA as a useful tool to gain better insights from the available dataset.

In practice, this method has rarely been used since its development [ 24 – 26 ]. It may be challenging to define the components in some areas of public health where many interventions have been studied. However, the use of meta-analysis for planning future studies is rarely discussed and component NMA would provide a useful tool for identifying new component combinations that may be more effective [ 27 ]. This type of analysis has the potential to prioritise future public health research, which is especially useful where there are multiple intervention options, and identify more effective interventions to recommend to the public.

Further methods / other outcomes

The analysis and methods described in this paper only cover a small subset of the methods that have been developed in meta-analysis in recent years. Methods that aim to assess the quality of evidence supporting a NMA and how to quantify how much the evidence could change due to potential biases or sampling variation before the recommendation changes have been developed [ 28 , 29 ]. Models adjusting for baseline risk have been developed to allow for different study populations to have different levels of underlying risk, by using the observed event rate in the control arm [ 30 , 31 ]. Multivariate methods can be used to compare the effect of multiple interventions on two or more outcomes simultaneously [ 32 ]. This area of methodological development is especially appealing within public health where studies assess a broad range of health effects and typically have multiple outcome measures. Multivariate methods offer benefits over univariate models by allowing the borrowing of information across outcomes and modelling the relationships between outcomes which can potentially reduce the uncertainty in the effect estimates [ 33 ]. Methods have also been developed to evaluate interventions with classes or different intervention intensities, known as hierarchical interventions [ 34 ]. These methods were not demonstrated in this paper but can also be useful tools for addressing challenges of appraising public health interventions, such as multiple and surrogate outcomes.

This paper only considered an example with a binary outcome. All of the methods described have also been adapted for other outcome measures. For example, the Technical Support Document 2 proposed a Bayesian generalised linear modelling framework to synthesise other outcome measures. More information and models for continuous and time-to-event data is available elsewhere [ 21 , 35 – 38 ].

Software and guidelines

In the previous section, meta-analytic methods that answer more policy relevant questions were demonstrated. However, as shown by the update to the review, methods such as these are still under-utilised. It is suspected from the NICE public health review that one of the reasons for the lack of uptake of methods in public health could be due to common software choices, such as RevMan, being limited in their flexibility for statistical methods.

Table  9 provides a list of software options and guidance documents that are more flexible than RevMan for implementing the statistical methods illustrated in the previous section to make these methods more accessible to researchers.

In this paper, the network plot in Figs.  5 and 6 were produced using the networkplot command from the mvmeta package [ 39 ] in Stata [ 61 ]. WinBUGS was used to fit the NMA in this paper by adapting the code in the book ‘Evidence Synthesis for Decision Making in Healthcare’ which also provides more detail on Bayesian methods and assessing convergence of Bayesian models [ 45 ]. The model for including IPD and summary aggregate data in an NMA was based on the code in the paper by Saramago et al. (2012). The component NMA in this paper was performed in WinBUGS through R2WinBUGS, [ 47 ] using the code in Welton et al. (2009) [ 11 ].

WinBUGS is a flexible tool for fitting complex models in a Bayesian framework. The NICE Decision Support Unit produced a series of Evidence Synthesis Technical Support Documents [ 46 ] that provide a comprehensive technical guide to methods for evidence synthesis and WinBUGS code is also provided for many of the models. Complex models can also be performed in a frequentist framework. Code and commands for many models are available in R and STATA (see Table  9 ).

The software, R2WinBUGS, was used in the analysis of the motivating example. Increasing numbers of researchers are using R and so packages that can be used to link the two softwares by calling BUGS models in R, packages such as R2WinBUGS, can improve the accessibility of Bayesian methods [ 47 ]. The new R package, BUGSnet, may also help to facilitate the accessibility and improve the reporting of Bayesian NMA [ 48 ]. Webtools have also been developed as a means of enabling researchers to undertake increasingly complex analyses [ 52 , 53 ]. Webtools provide a user-friendly interface to perform statistical analyses and often help in the reporting of the analyses by producing plots, including network plots and forest plots. These tools are very useful for researchers that have a good understanding of the statistical methods they want to implement as part of their review but are inexperienced in statistical software.

This paper has reviewed NICE public health intervention guidelines to identify the methods that are currently being used to synthesise effectiveness evidence to inform public health decision making. A previous review from 2012 was updated to see how method utilisation has changed. Methods have been developed since the previous review and these were applied to an example dataset to show how methods can answer more policy relevant questions. Resources and guidelines for implementing these methods were signposted to encourage uptake.

The review found that the proportion of NICE guidelines containing effectiveness evidence summarised using meta-analysis methods has increased since the original review, but remains low. The majority of the reviews presented only narrative summaries of the evidence - a similar result to the original review. In recent years, there has been an increased awareness of the need to improve decision making by using all of the available evidence. As a result, this has led to the development of new methods, easier application in standard statistical software packages, and guidance documents. Based on this, it would have been expected that their implementation would rise in recent years to reflect this, but the results of the review update showed no such increasing pattern.

A high proportion of NICE guideline reports did not provide a reason for not applying quantitative evidence synthesis methods. Possible explanations for this could be time or resource constraints, lack of statistical expertise, being unaware of the available methods or poor reporting. Reporting guidelines, such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), should be updated to emphasise the importance of documenting reasons for not applying methods, as this can direct future research to improve uptake.

Where it was specified, the most common reported reason for not conducting a meta-analysis was heterogeneity. Often in public health, the data is heterogeneous due to the differences between studies in population, design, interventions or outcomes. A common misconception is that the presence of heterogeneity implies that it is not possible to pool the data. Meta-analytic methods can be used to investigate the sources of heterogeneity, as demonstrated in the NMA of the motivating example, and the use of IPD is recommended where possible to improve the precision of the results and reduce the effect of ecological bias. Although caution should be exercised in the interpretation of the results, quantitative synthesis methods provide a stronger basis for making decisions than narrative accounts because they explicitly quantify the heterogeneity and seek to explain it where possible.

The review also found that the most common software to perform the synthesis was RevMan. RevMan is very limited in its ability to perform advanced statistical analyses, beyond that of pairwise meta-analysis, which might explain the above findings. Standard software code is being developed to help make statistical methodology and application more accessible and guidance documents are becoming increasingly available.

The evaluation of public health interventions can be problematic due to the number and complexity of the interventions. NMA methods were applied to a real Cochrane public health review dataset. The methods that were demonstrated showed ways to address some of these issues, including the use of NMA for multiple interventions, the inclusion of covariates as both aggregated data and IPD to explain heterogeneity, and the extension to component network meta-analysis for guiding future research. These analyses illustrated how the choice of synthesis methods can enable more informed decision making by allowing more distinct interventions, and combinations of intervention components, to be defined and their effectiveness estimated. It also demonstrated the potential to target interventions to population subgroups where they are likely to be most effective. However, the application of component NMA to the motivating example has also demonstrated the issues around uncertainty if there are a limited number of studies observing the interventions and intervention components.

The application of methods to the motivating example demonstrated a key benefit of using statistical methods in a public health context compared to only presenting a narrative review – the methods provide a quantitative estimate of the effectiveness of the interventions. The uncertainty from the credible intervals can be used to demonstrate the lack of available evidence. In the context of decision making, having pooled estimates makes it much easier for decision makers to assess the effectiveness of the interventions or identify when more research is required. The posterior distribution of the pooled results from the evidence synthesis can also be incorporated into a comprehensive decision analytic model to determine cost-effectiveness [ 62 ]. Although narrative reviews are useful for describing the evidence base, the results are very difficult to summarise in a decision context.

Although heterogeneity seems to be inevitable within public health interventions due to their complex nature, this review has shown that it is still the main reported reason for not using statistical methods in evidence synthesis. This may be due to guidelines that were originally developed for clinical treatments that are tested in randomised conditions still being applied in public health settings. Guidelines for the choice of methods used in public health intervention appraisals could be updated to take into account the complexities and wide ranging areas in public health. Sophisticated methods may be more appropriate in some cases than simpler models for modelling multiple, complex interventions and their uncertainty, given the limitations are also fully reported [ 19 ]. Synthesis may not be appropriate if statistical heterogeneity remains after adjustment for possible explanatory covariates but details of exploratory analysis and reasons for not synthesising the data should be reported. Future research should focus on the application and dissemination of the advantages of using more advanced methods in public health, identifying circumstances where these methods are likely to be the most beneficial, and ways to make the methods more accessible, for example, the development of packages and web tools.

There is an evident need to facilitate the translation of the synthesis methods into a public health context and encourage the use of methods to improve decision making. This review has shown that the uptake of statistical methods for evaluating the effectiveness of public health interventions is slow, despite advances in methods that address specific issues in public health intervention appraisal and the publication of guidance documents to complement their application.

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The dataset supporting the conclusions of this article is included within the article.

Abbreviations

National institute for health and care excellence

• Network meta-analysis

Individual participant data

Home safety inspection

Installation

Credible interval

Preferred reporting items for systematic reviews and meta-analyses

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Acknowledgements

We would like to acknowledge Professor Denise Kendrick as the lead on the NIHR Keeping Children Safe at Home Programme that originally funded the collection of the evidence for the motivating example and some of the analyses illustrated in the paper.

ES is funded by a National Institute for Health Research (NIHR), Doctoral Research Fellow for this research project. This paper presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The funding bodies played no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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KA is supported by Health Data Research (HDR) UK, the UK National Institute for Health Research (NIHR) Applied Research Collaboration East Midlands (ARC EM), and as a NIHR Senior Investigator Emeritus (NF-SI-0512-10159). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. KA has served as a paid consultant, providing unrelated methodological advice, to; Abbvie, Amaris, Allergan, Astellas, AstraZeneca, Boehringer Ingelheim, Bristol-Meyers Squibb, Creativ-Ceutical, GSK, ICON/Oxford Outcomes, Ipsen, Janssen, Eli Lilly, Merck, NICE, Novartis, NovoNordisk, Pfizer, PRMA, Roche and Takeda, and has received research funding from Association of the British Pharmaceutical Industry (ABPI), European Federation of Pharmaceutical Industries & Associations (EFPIA), Pfizer, Sanofi and Swiss Precision Diagnostics. He is a Partner and Director of Visible Analytics Limited, a healthcare consultancy company.

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Key for the Nice public health guideline codes. Available in NICEGuidelinesKey.xlsx .

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Smith, E.A., Cooper, N.J., Sutton, A.J. et al. A review of the quantitative effectiveness evidence synthesis methods used in public health intervention guidelines. BMC Public Health 21 , 278 (2021). https://doi.org/10.1186/s12889-021-10162-8

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Jamalludin Ab Rahman

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Ab Rahman, J. (2021). Quantitative Methods in Global Health Research. In: Haring, R., Kickbusch, I., Ganten, D., Moeti, M. (eds) Handbook of Global Health. Springer, Cham. https://doi.org/10.1007/978-3-030-05325-3_9-1

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151+ Public Health Research Topics [Updated 2024]

The important area of public health research is essential to forming laws, influencing medical procedures, and eventually enhancing community well-being. As we delve into the vast landscape of public health research topics, it’s essential to understand the profound impact they have on society.

This blog aims to provide a comprehensive guide to selecting and understanding the diverse array of public health research topics.

Overview of Public Health Research Topics

Table of Contents

Public health research encompasses a wide range of subjects, reflecting the interdisciplinary nature of the field. From epidemiology and health policy to environmental health and infectious diseases, researchers navigate through various dimensions to address complex health challenges.

Each category holds its own significance, contributing to the overall understanding of public health dynamics.

Key Considerations in Selecting Public Health Research Topics

• Current Relevance: Assess the timeliness of potential topics by considering recent health trends, emerging issues, and societal concerns.
• Impact on Public Health: Evaluate the potential impact of the research on improving health outcomes, addressing disparities, or influencing policy and interventions.
• Feasibility and Resources: Gauge the practicality of conducting research on a particular topic, considering available resources, data accessibility, and research infrastructure.
• Ethical Considerations: Scrutinize the ethical implications of the research, ensuring it aligns with ethical standards and guidelines, especially when dealing with vulnerable populations or sensitive topics.

Top 151+ Public Health Research Topics

Epidemiology.

• The Impact of Social Determinants on Disease Outcomes
• Patterns and Trends in Emerging Infectious Diseases
• Investigating Health Disparities among Different Ethnic Groups
• Childhood Obesity and its Long-Term Health Consequences
• Assessing the Effectiveness of Contact Tracing in Disease Control

Health Policy

• Universal Healthcare: Comparative Analysis of Global Models
• The Role of Telemedicine in Improving Healthcare Access
• Evaluating Mental Health Policies and Their Impact on Communities
• Assessing the Impact of Affordable Care Act on Public Health
• Vaccine Policies and Public Perception: A Comprehensive Study

Environmental Health

• Climate Change and Health: Adapting to the Challenges
• Air Quality and Respiratory Health in Urban Environments
• Waterborne Diseases and Strategies for Safe Water Supply
• Occupational Health Hazards: A Comprehensive Workplace Analysis
• The Impact of Green Spaces on Mental Health in Urban Areas

Infectious Diseases

• Antimicrobial Resistance: Strategies for Mitigation
• Vaccination Strategies and Herd Immunity
• Global Health Security: Preparedness for Pandemics
• The Impact of Vector-Borne Diseases on Public Health
• Emerging Trends in Antibiotic-Resistant Infections

Chronic Diseases

• Lifestyle Interventions for Preventing Cardiovascular Diseases
• Genetic Factors in the Development of Cancer: A Comprehensive Study
• Aging and Health: Addressing the Healthcare Needs of the Elderly
• Diabetes Prevention Programs: Efficacy and Implementation
• Mental Health in Chronic Disease Patients: Bridging the Gap

Maternal and Child Health

• Maternal Mortality: Understanding Causes and Prevention
• The Impact of Breastfeeding on Infant Health and Development
• Childhood Immunization: Barriers and Strategies for Improvement
• Teenage Pregnancy and Its Long-Term Health Consequences
• Mental Health Support for Postpartum Women: Current Gaps and Solutions

Health Behavior and Promotion

• Smoking Cessation Programs: Effectiveness and Challenges
• Physical Activity Promotion in Schools: Strategies for Success
• Nutrition Education and Its Impact on Healthy Eating Habits
• Mental Health Awareness Campaigns: Assessing Public Perceptions
• The Role of Social Media in Health Promotion

Global Health

• Assessing the Impact of International Aid on Global Health
• Water, Sanitation, and Hygiene (WASH) Programs in Developing Countries
• The Role of Non-Governmental Organizations in Global Health
• Communicable Disease Control in Refugee Populations
• Global Access to Essential Medicines: Challenges and Solutions

Community Health

• Community-Based Participatory Research: Best Practices and Challenges
• The Impact of Community Health Workers on Health Outcomes
• Health Literacy and its Relationship to Health Disparities
• Assessing the Effectiveness of Mobile Health (mHealth) Interventions
• Community Resilience in the Face of Public Health Crises

Healthcare Quality and Patient Safety

• Hospital-Acquired Infections: Strategies for Prevention
• Patient Safety Culture in Healthcare Organizations
• Quality Improvement Initiatives in Primary Care Settings
• Healthcare Accreditation: Impact on Patient Outcomes
• Implementing Electronic Health Records: Challenges and Benefits

Mental Health

• Stigma Reduction Programs for Mental Health Disorders
• Integrating Mental Health into Primary Care Settings
• The Impact of COVID-19 on Mental Health: Long-Term Implications
• Mental Health in the Workplace: Strategies for Employee Well-being
• Suicide Prevention Programs: Effectiveness and Outreach

Health Disparities

• Racial Disparities in Healthcare: Addressing Systemic Inequities
• LGBTQ+ Health Disparities and Inclusive Healthcare Practices
• Socioeconomic Status and Access to Healthcare Services
• Geographical Disparities in Health: Rural vs. Urban
• The Impact of Gender on Health Outcomes and Access to Care

Public Health Education

• Evaluation of Public Health Education Programs
• Innovative Approaches to Teaching Public Health Concepts
• Online Health Education Platforms: Opportunities and Challenges
• Interdisciplinary Training in Public Health: Bridging Gaps
• Continuing Education for Public Health Professionals: Current Landscape

Digital Health

• The Role of Wearable Devices in Health Monitoring
• Telehealth Adoption: Barriers and Opportunities
• Health Apps for Chronic Disease Management: User Perspectives
• Blockchain Technology in Healthcare: Privacy and Security Implications
• Artificial Intelligence in Disease Diagnosis and Prediction

Health Economics

• Cost-Effectiveness of Preventive Health Interventions
• The Impact of Healthcare Financing Models on Access to Care
• Pharmaceutical Pricing and Access to Essential Medicines
• Economic Evaluation of Health Promotion Programs
• Health Insurance Coverage and Health Outcomes: A Global Perspective

Innovations in Public Health

• 3D Printing in Healthcare: Applications and Future Prospects
• Gene Editing Technologies and their Ethical Implications
• Smart Cities and Public Health: Integrating Technology for Well-being
• Nanotechnology in Medicine: Potential for Disease Treatment
• The Role of Drones in Public Health: Surveillance and Intervention

Food Safety and Nutrition

• Foodborne Illness Outbreaks: Investigating Causes and Prevention
• Sustainable Food Systems: Implications for Public Health
• Nutritional Interventions for Malnutrition in Developing Countries
• Food Labeling and Consumer Understanding: A Critical Review
• The Impact of Fast Food Consumption on Public Health

Substance Abuse

• Opioid Epidemic: Strategies for Prevention and Treatment
• Harm Reduction Approaches in Substance Abuse Programs
• Alcohol Consumption Patterns and Public Health Outcomes
• Smoking and Mental Health: Exploring the Connection
• Novel Psychoactive Substances: Emerging Threats and Strategies

Occupational Health

• Workplace Stress and Mental Health: Intervention Strategies
• Occupational Hazards in Healthcare Professions: A Comparative Analysis
• Ergonomics in the Workplace: Improving Worker Health and Productivity
• Night Shift Work and Health Consequences: Addressing Challenges
• Occupational Health and Safety Regulations: A Global Overview

Disaster Preparedness and Response

• Pandemic Preparedness and Lessons from COVID-19
• Natural Disasters and Mental Health: Post-Traumatic Stress
• Emergency Response Systems: Improving Timeliness and Efficiency
• Communicating Health Risks During Emergencies: Public Perception
• Collaborative Approaches to Disaster Response in Global Health

Cancer Research

• Precision Medicine in Cancer Treatment: Current Advancements
• Cancer Screening Programs: Efficacy and Challenges
• Environmental Factors and Cancer Risk: Exploring Connections
• Survivorship Care Plans: Enhancing Quality of Life after Cancer
• Integrative Therapies in Cancer Care: Complementary Approaches

Sexual and Reproductive Health

• Access to Contraception in Developing Countries: Challenges and Solutions
• Comprehensive Sex Education Programs: Impact on Teen Pregnancy
• Reproductive Health Rights: Global Perspectives and Challenges
• Infertility Treatment: Ethical Considerations and Societal Impact
• Maternal and Child Health in Conflict Zones: Addressing Challenges

Cardiovascular Health

• Hypertension Prevention Programs: Strategies and Effectiveness
• Cardiovascular Disease in Women: Gender-Specific Risk Factors
• Innovations in Cardiac Rehabilitation Programs
• Artificial Heart Technology: Advancements and Ethical Implications
• Impact of Air Pollution on Cardiovascular Health: A Global Concern

Social Determinants of Health

• Educational Attainment and Health Outcomes: Exploring Links
• Income Inequality and its Impact on Population Health
• Social Support Networks and Mental Health: A Comprehensive Study
• Neighborhood Environments and Health Disparities
• Employment and Health: The Interplay of Work and Well-being

Genomics and Public Health

• Population Genomics and its Implications for Public Health
• Genetic Counseling and Education: Empowering Individuals and Families
• Ethical Issues in Genetic Research: Privacy and Informed Consent
• Pharmacogenomics: Tailoring Drug Therapies to Individual Genotypes
• Gene-Environment Interactions in Disease Risk: Unraveling Complexities

Public Health Ethics

• Informed Consent in Public Health Research: Current Practices
• Ethical Challenges in Global Health Research: Balancing Priorities
• Confidentiality in Public Health Reporting: Striking the Right Balance
• Research with Vulnerable Populations: Ethical Considerations
• Ethical Implications of Emerging Technologies in Healthcare

Health Communication

• The Role of Media in Shaping Public Health Perceptions
• Health Literacy Interventions: Improving Understanding of Health Information
• Social Media Campaigns for Public Health Promotion: Best Practices
• Tailoring Health Messages for Diverse Audiences: Cultural Competency
• Risk Communication in Public Health Emergencies: Lessons Learned

Nutrigenomics

• Personalized Nutrition Plans based on Genetic Makeup
• Impact of Nutrigenomics on Chronic Disease Prevention
• Ethical Considerations in Nutrigenomics Research
• Public Perceptions of Nutrigenomic Testing: A Qualitative Study
• Integrating Nutrigenomics into Public Health Policies

Public Health and Artificial Intelligence

• Predictive Analytics in Disease Surveillance: Harnessing AI for Early Detection
• Ethical Considerations in AI-Driven Health Decision Support Systems
• Machine Learning in Epidemiology: Predicting Disease Outbreaks
• Natural Language Processing in Public Health: Text Mining for Insights
• Bias in AI Algorithms: Implications for Health Equity

Health Disparities in Aging

• Geriatric Health Disparities: Bridging the Gap in Elderly Care
• Ageism in Healthcare: Addressing Stereotypes and Discrimination
• Social Isolation and Health Consequences in Aging Populations
• Access to Palliative Care for Older Adults: A Global Perspective
• Alzheimer’s Disease and Ethnic Disparities in Diagnosis and Treatment
• Loneliness and Mental Health in the Elderly: Interventions and Support

Research Methodologies in Public Health

Public health research employs various methodologies, including quantitative, qualitative, and mixed-methods approaches. Each method brings its own strengths to the research process, allowing researchers to gain a comprehensive understanding of the complex issues they investigate. 

Community-based participatory research is another valuable approach, emphasizing collaboration with communities to address their specific health concerns.

Challenges and Opportunities in Public Health Research

While public health research is immensely rewarding, it comes with its own set of challenges. Funding constraints, ethical dilemmas, the need for interdisciplinary collaboration, and the integration of technology pose both obstacles and opportunities. 

Researchers must navigate these challenges to ensure their work has a meaningful impact on public health.

In conclusion, public health research topics are diverse and dynamic, reflecting the complex nature of the field. As researchers embark on their journeys, they must carefully consider the relevance, impact, and ethical implications of their chosen topics. 

The collaborative and interdisciplinary nature of public health research positions it as a powerful tool in addressing the health challenges of our time. By exploring the depths of these topics, researchers contribute to the collective effort to build healthier and more equitable communities. 

As we move forward, a continued exploration of relevant public health research topics is essential for shaping the future of healthcare and improving the well-being of populations worldwide.

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Quantitative and Qualitative Methods for Public Health

This course focuses on quantitative methods, which are designed to precisely estimate population parameters and measure the association between biologic, social, environmental, and behavioral factors and health conditions in order to define the determinants of health and disease and, ultimately, to understand causal pathways.

However, it is important to acknowledge the importance of qualitative methods which provide a means of understanding public health problems in greater depth by providing contextual information regarding a population's beliefs, opinions, norms, and behaviors. This type of information is difficult to capture using traditional quantitative methods, yet it can be vitally important for understanding the "why" for many health problems and also the "how" in terms of how to achieve improvements in health outcomes.

These two approaches might be thought of as the positivist and the constructivist approaches. In positivist research data are more easily quantified, but they are disconnected from the context in which they occur. For example, people of lower socioeconomic status are more likely to smoke tobacco, but the data collected does not indicate why. However, with a constructivist approach, the exposures that people are subjected to (or choose) are better understood in the context of their personal circumstances and the significance that people attribute to things in their environment.

Qualitative methods provide a means of understanding health problems and potential barriers and solutions in greater detail, and they provide an opportunity to understand the "how" and "why" and to identify overlooked issues and themes.

The table below, from the introductory course on fundamentals of public health, highlights some of the major differences between quantitative and qualitative research.

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226 Hot Public Health Thesis Topics For Top Grades

Are you stuck trying to get the best current public health research topics for thesis and writing it? If yes, know you are not alone. A lot of students find the tasks challenging, but we are here to help. Keep reading our informative guide that demonstrates how to prepare an engaging public health paper.

We will also highlight hot 226 health policy topics for paper and other public health ideas for dissertation that you can use for top grades. Why settle for less when we can help you select the best college or university papers?

What Is Public Health?

Before looking at the top public health statistics undergraduate thesis topics or other public health research ideas, let’s start with the definition. So, what is public health?

According to the World Health Organization (WHO), public health is “the art and science of preventing diseases, helping to prolong life and promote health using organized efforts. Good examples of public health efforts include preventing outbreaks, educating the public on health choices, promoting fitness, preparing for emergencies, and avoiding the spread of infectious diseases. Public health

How To Write A Great Public Health Dissertation

If you are a graduate or masters student, one of the most comprehensive documents that you need to prepare is the dissertation. It is an expansive paper and comes at the end of your course. Remember that you need to ensure it is prepared well because a team of professors will ultimately evaluate it. So, here are the main steps that you need to follow to prepare a high quality dissertation:

Identify the topic of study Comprehensively research the topic and identify the main points to support it Develop the thesis statement for the dissertation (this thesis will ultimately be tested after gathering your data) Develop an outline for the dissertation. This guide should tell you what to write at what specific instance. Here is a sample outline: Topic of the study Introduction. Start with the thesis statement, followed by the objectives of the study. Then, the rest of the introduction should be used to set the background for the study. Literature review: Review relevant resources about the topic. Methodology: Explain the methodology that was used during the study. Is Results and analysis: Provide the results gathered during the study. Discussion and conclusion: Here, you should discuss the study results and demonstrate whether they approve or disapprove the thesis statement. If you found any gaps in the previous studies, highlight them too and call for further studies. Bibliography: This is a list of all the resources you used to prepare the paper. Write the first draft following the outline we have just listed above. Write the final copy by refining the first draft, proofreading, and editing it.

Awesome Public Health Thesis Topics

Here are the leading thesis topics in public health for top grades. You can use them as they are or tweak a little to suit your preference.

Public Health Thesis Topics In Mental Issues

• What is the role of public health in addressing mental issues in society?
• Seasonal affective disorder: A review of the disorder’s prevalence rates.
• Society should always listen to the needs of mentally ill persons.
• Eating disorders in adults: A review of the treatment strategies used for adults in the UK.
• What is the relation between climate change and emerging public health issues?
• Comparing depression prevalence rates in the UK to those of the US.
• What are the main causes of anxiety disorders in society?
• A review of the connection between HIV/AIDS and mental health issues in society.
• Running a public health facility: What is the most important equipment?
• Emerging public health issues in developing countries.
• Analyzing the psychological problems of breast cancer.
• What strategies should people use to prevent their mental health from social media dangers?
• A review of the public health benefits associated with active lifestyles.
• Stress: Why is it a major risk factor for mental health in many communities?
• What are the most common mental health issues in society today?
• Comparing the rates of depression and stress in China and the UK.
• Addressing anxiety-related disorders: Is cognitive-behavior therapy the best treatment method?
• A review of the economic burden of living with a person suffering from anxiety disorders.
• How does depression impact the quality of life?
• Comparing training of public health officers in the US to India.

Unique Research Topics In Public Health

• Surrogacy: A review of associated ethical issues.
• Prevalence of medical errors in hospitals: A review of the policies used to prevent the problem in the United States.
• Blood transfusion: What are the side effects?
• A review of doctors’ roles in promoting healthy lifestyles.
• Maintaining healthy body weight: Comparing the effectiveness of the recommended methods.
• A review of organ donation trends in Europe and Asia.
• Analyzing the ethical factors around cloning: When should it be allowed?
• The ethics of human experimentation.
• Comparing the rates of heart attacks in women to men in the United States.
• What are the main causes of heart attacks? Can it be prevented?
• Progress in diabetes studies and treatment: Is it possible to get a cure in the future?
• Biological weapons and their impacts on society: A review of the Leukemia rates in Japan.
• Pre-diabetes in children: What are the main symptoms, and how can it be addressed?

Public Health Paper Topics On COVID-19

• How will COVID-19 change life?
• What are the advantages and disadvantages of self-isolation?
• Life lessons that you learned during the COVID-19 pandemic.
• What challenges has your community faced during COVID-19 pandemic?
• School life during COVID-19 pandemic.
• A review of mass media operations during pandemic.
• What projects did you undertake during the pandemic?
• A review of projects that your community undertook during the COVID-19 pandemic.
• A closer look at the backlash against Asians in Europe at the start COVID-19 pandemic period.
• Preparing for the next pandemic: What lessons did the world learn from the COVID-19 pandemic?
• The best strategies for staying healthy during a pandemic.
• Is there anything that we could have done to prevent the COVID-19 pandemic?
• Comparing the effectiveness of Europe and American healthcare preparedness for tackling disasters.
• A review of mental health status in a community of your choice during the COVID-19 pandemic.
• A review of COVID-19 emergence theories: Which one do you think is more credible?
• Comparing the impacts of the COVID-19 pandemic to Ebola.
• Vaccines development for viral infections: What made the development of the COVID-19 vaccine possible so fast, whereas that of HIV/AIDS has taken so long?
• A review of the vaccine development process.
• Time for review: How effectively do you think your government responded to the COVID-19 pandemic?
• Rethinking public health on a global scale: Demonstrating why effective healthcare is only possible when looked at globally.

Interesting Public Health Research Topic Ideas

• What is the importance of learning public health in school?
• Identify and review a common public health issue in your community.
• The history of human health: Comparing what was considered healthy in ancient times to what is referred to as healthy today.
• Going vegan: How can it impact your health?
• Excessive weight: Is it the new threat to human civilization?
• Is bodybuilding healthy?
• Body positive: Is it a new health standard or ignorance of body issues?
• Things to consider when selecting healthy food to eat.
• Why psychological health should be part of every community in society.
• The health of newborns: What is the difference between their healthcare and that of adults?
• Emerging trends in the healthcare industry: How can the latest trends benefit society?
• Comparing depression and anxiety in two countries of your choice.
• Physical wellness must include healthy behavioral patterns and nutrition.
• A sense of belonging is paramount to personal and community health.
• What is the relationship between spirituality and public health?
• A review of stigmatization of mental health issues in a community of your choice.
• Is it possible to prevent depression?
• At what point should children start learning sex-related education?
• Comparing the two main public health issues in two cities: London and New York.
• What is the relationship between poverty and public health?

Hot Researchable Topics In Public Health

• The resurgence of measles in society: The best guidance for clinicians.
• Tackling the growing national drug problem.
• Bioterrorism preparedness for global disasters.
• A review of recent vitamin D recommendations for older adults.
• Strategies for maintaining maternal mortality at low levels across the globe.
• Efforts by Asian governments to reduce infections from using unsafe water.
• Over-the-counter drug abuse in Europe: Compare two countries of your choice.
• Health care providers’ roles in preventing bullying in society.
• Knowledge management in the UK healthcare organizations.
• The health benefits of good healthcare waste management.
• Characteristics of dental wastes in hospitals.
• Comparing the most prevalent public health issues in developed and developing nations.
• Latest trends in financing public health.
• The relevance of clinical epidemiology in public health.
• Evidence based public health.
• Epidemiological burden of HIV/AIDS in developing countries.
• Addressing cervical cancer in developing countries: Is it possible to eliminate it completely?
• Ethics in public health clinical research.
• Comparing the strategies used in teaching and motivating public health professionals in developing and developed countries.

Research Topics In Public Health For Masters

• Advertising and impacts on food choices in the community.
• The use of stem cell technologies for cancer treatment: What are the latest trends?
• Bio-printing: Is it the future of organ transplants?
• Nutrition education: How does it promote healthy diets?
• Exercising: What role does it play in promoting strength and balance in the elderly?
• Weight loss surgery: What are the key advantages and disadvantages?
• Heart disease is a major public health issue in society.
• Alternative strategies for treating depression in society: Are they effective?
• Healthcare leadership and its importance in public health.
• Legal aspects of public health care in the society.
• Mental disabilities in patients: A review of the emerging trends in the UK.
• How does the United States promote the development of public health?
• Inequalities in medicine: What impact does it have in public health?
• The most controversial issues in public health in the UK.
• What are the most preferred storage systems for medical supplies in the UK public health facilities?
• Reimagining the public health systems on the globe: Where do you see the UK health system in the next 20 years?

Top Thesis Topics In Dental Public Health

• Common oral health issues in Ireland.
• A review of common problems of endodontically treated teeth.
• The role of good leadership skills in dental education.
• Child management techniques between male and female practitioners.
• What role does ergonomics play in dentistry?
• Dental material and bio-engineering: What are the latest trends?
• A review of the relationship between diabetes and oral health in the society.
• The role of electronic health care record systems used in public health.
• Comparing dental health issues in the developing and developed countries.
• A review of public awareness of dental health issues in a community of choice.
• How can you ensure that all the food you buy is safe and healthy?
• What strategies are used by your local health community to promote dental awareness?
• Dental health management in California: What do you think should be done differently?
• Are you satisfied with the strategies used to address dental issues?

Hot Thesis Topics Public Health

• Mandatory overtime work for medical staff: How does it impact their commitment to their job?
• Nursing shortage and its impact in public health.
• Strategies for improving public health in the EU.
• Mental health issues among asylum seekers in the United States.
• Common mental issues among veterans returning from war: A case study of the United States.
• What functions does management play in healthcare settings when handling key public health issues?
• How poor relationships between nurses and doctors can impact public health services delivery.
• Third-party players in public health and their roles.
• Financial reporting standards in public health facilities.
• What is the correlation between revenue collection in society and the quality of patient services?
• Reviewing the coordination of public health officials during disasters.
• The importance of staff training on quality of health services.
• Comparing the differences between alternative medicine and conventional medicine in addressing public health issues in society.
• Obesity: What are the main causes in child-going age?
• A review of health consequences of caffeine.
• Medical marijuana: What are the main pros and cons?
• A review of the US Farm Bill Amendments that legalized use of cannabis in the US.
• Doing sports: Is it always healthy?
• Low-fat or low-carb diet: Which one is better in addressing overweight and diabetes issues?
• Preventing communicable diseases: Evaluating the prevention strategies used in Asia.
• What is the estimated cost of treating heart problems?

Controversial Public Health Dissertation Topics

• Smoking and impacts of current efforts to address cancer in the society.
• A review of the main causes of heart attacks in society today.
• Tobacco ads: Evaluating their impacts and the relationship to the current cancer trends in the society.
• Sleep disorders: Explain why they should be considered a public health issue.
• Staffing shortage and the impacts in fighting COVID-19 pandemic in Asia.
• Analyzing risk management of treating different diseases in the community.
• COVID-19 pandemic in numbers: Comparing the infection rates in the developed and developing countries.
• Reviewing strategies used in the US public health system to achieve equity: How effective are they?
• Analyzing the main challenges in the UK medical care system.
• Rising cases of suicides in the society: What are the main causes?
• A comprehensive review of strategies used to prevent suicides in the 21st century in the US.
• Use of vaccines to prevent diseases: Do adults still need the vaccines?
• Heat-related deaths: What strategies should be adopted?
• Chronic-diseases prevention: Comparing the strategies used in developing and developed countries.
• Are we becoming too dependent on antibiotics in fighting diseases?
• Opioid crisis: Are the doctors to blame for it?
• Use of blockchain in growing accuracy of clinical trials in medicine.
• What dangers are posed by nuclear wastes in society?
• Assessing US industrial facilities compliance rates to cut down emissions.
• Using clean energy as a strategy of improving public health: What are the expectations?
• What is the healthiest country?
• Evaluating the correlation between gaming and deviant behavior among children in society.
• COVID-19 could have been prevented if WHO was more vigilant?

Public Health Research Questions

• Is the high cost of medical healthcare in the United States justified?
• What is the correlation between poverty and poor health in society?
• Should health care for homeless people be free?
• Unconventional medicine: Should it be part of the UK healthcare system?
• Should doctors be responsible for medical errors?
• Should medical officers or health facilities be allowed to promote selective medical products?
• Should all healthcare facilities in the UK be required to have translators for non-English speaking clients?
• Mental health issues associated with domestic violence: A case study of France.
• Is it a good idea to legalize euthanasia?
• What are the benefits of using surgical masks in public?
• What are the most important lessons from the different waves of the COVID-19 pandemic reported on the globe?
• Who is more responsible for the COVID-19 pandemic?
• Ebola or COVID-19 pandemic: Which is worse?
• What are the main causes of epidemics on the globe?
• Public health planning: What are the most important things to think about?
• Should governments pay the cost of rehabilitating drug addicts in society?
• Teaching children healthy lifestyles: What are the best strategies?
• What problems do people with autism face in society?
• What are the leading causes of child mortality in your community?
• Gun violence in the United States: Should it be considered a public health issue?
• What illnesses are considered foodborne?

Easy Topics In Public Health

• All workplaces should support breastfeeding.
• What are the best strategies to reduce pollution in society?
• Public health benefits of recycling waste in society.
• Reviewing the causes of poor water quality in the developing world.
• Comparing water quality standards policies in the UK and US.
• Health impacts of the rapid depletion of o-zone depletion.
• Better planning of infrastructural development is important for healthier societies: Discuss.
• The US is better prepared to handle pandemics that might arise after the COVID-19 pandemic. Discuss.
• A review of common diseases spread by vectors.
• A review of key policies installed to protect employee health.
• Legal age for consuming energy drinks should be set by the government to address the problem of diabetes.
• Smoking: Should it be banned in public?
• What are the best strategies for raising awareness in public?
• Can reducing the workload of employees in manufacturing facilities improve their health?
• Sunbathing should be restricted to prevent the risk of cancer: Discuss.
• Should abortion be banned in society?
• School-related stress: How can it be prevented?
• Should birth control be made available and free for all teenagers?
• What should be categorized as a bad health habit?
• Compare and contrast two common treatment methods for treating behavioral disorders.
• Internet addiction: What are the main dangers of internet addiction?

Other Public Health Topics For Research

• How to stay healthy and safe during a pandemic.
• Using a bicycle instead of driving is healthier.
• Common mental disorders in India.
• What is the biggest health issue among young people?
• The impact of exercising in teenagers.
• Why do teenagers experiment with drugs?
• What impact does dispositional violence have on mental disorders?
• Is telemedicine helpful in promoting better healthcare?
• Unproven alternative medicine: What are the associated risks?
• What alternatives do we have for antibiotics?
• What is the difference between private and public healthcare?
• A review of the main health issues associated with puberty.
• What is the most dangerous disease of the 21st century?
• Why are some people still afraid of vaccines?
• Experimental treatment: Why do people agree to undergo it?
• How can we improve the health of people living with chronic illnesses?
• The best strategies to make people aware of the basics of healthcare.
• A review of the growing awareness about reproductive health in the society.

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Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

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15 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

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The value of qualitative methods to public health research, policy and practice

Institute of Mental Health, University of Nottingham Faculty of Medicine and Health Sciences, Triumph Road, Nottingham NG7 2UH, UK

A O’Caithain

The University of Sheffield, Sheffield, UK

Sheffield Hallam University, Sheffield, UK

This article reviews the role and use of qualitative methods in public health research.

‘Signs of quality’ are introduced to help guide potential authors to publish their qualitative research in public health journals. We conclude that high-quality qualitative research offers insights that quantitative research cannot. It is time for all public health journals to recognise the value of qualitative research and increase the amount that they publish.

Introduction

In this article, we briefly review the role and use of qualitative methods in public health research and its significance for research, policy and practice. Historically, public health research has been largely dependent on quantitative research rooted in medical science. Qualitative research approaches, however, are able to provide the ‘lived experience’ perspective of patients, practitioners and the public on any aspect of public health.

To inform this article, we searched the most recent original research articles published in ten of the most widely cited public health journals in the world (generally those with the highest impact factor, including Perspectives in Public Health ). The list of journals can be found in Table 1 .

The methods used in 100 recently published original research articles in 10 public health journals

We examined 100 of the most recently published original research articles (10 from each journal up until May, 2021) to discover how many of these reported qualitative methods. The findings from this quick review can be found in Table 1 below. The review revealed that 85 articles reported quantitative methods, 11 reported mixed-methods, and only 4 reported qualitative methods. In our review, we deliberately did not include one public health journal, Critical Public Health because it specialises in publishing qualitative public health research studies. With only four qualitative research papers out of the most recent 100 public health original research articles published in the top journals, we have decided to publish this article first to encourage qualitative research practices in public health, second to highlight the value of qualitative research, third to briefly identify what makes ‘good qualitative research’ and finally to promote increased submissions of original qualitative research in this and other public health journals.

Reporting Qualitative Health Research

Qualitative research has its origins in Interpretivism. As such, it has been widely used in the social sciences, in contrast to the medical sciences that historically have largely embraced the positivist tradition. Typically, public health research has followed the positivist tradition although qualitative research methodology appears more often in public health journals than top medical journals. For example, a cursory examination of the Lancet indicates that it does not appear to publish any qualitative research and the British Medical Journal ( BMJ ) rarely does so. In 2016, the BMJ published an open letter from 76 senior academics from 11 countries inviting its editors to: ‘ … reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission ’. 1 Included in their support for qualitative research articles in the BMJ , they observe that many of the journal’s top papers have been qualitative studies. This letter has been cited 250 times in the literature, largely supportive of their views. In their reply to the letter, Editors of the BMJ acknowledge that: ‘ … we agree they can be valuable, and recognise that some research questions can only be answered by using qualitative methods ’. 2 In so much as we can tell to date, the BMJ has not changed its practice. Fortunately, published accounts of qualitative research in various other health disciplines flourishes, for example, there are now at least two health journals that are exclusively designed for this purpose ( Qualitative Health Research and International Journal of Qualitative Studies on Health and Well-being ).

The Value of Qualitative Health Research

The following quotation succinctly argues the need for qualitative research methods in public health:

Public health, we believe, needs both epidemiology and qualitative research. Without epidemiology we cannot answer questions about the prevalence of and association between health determinants and outcomes. Without qualitative enquiry, it is difficult to explain how individuals interpret health and illness in their everyday lives, or to understand the complex workings of the social, cultural and institutional systems that are central to our health and wellbeing. 3

In particular, given a situation with complex phenomena involving human experience and behaviour, quantitative research may equally excel in finding out ‘what and when?’, but qualitative research may equally be needed to find out ‘why, how and how come?’. Green and Britten 4 summarise the role of qualitative research in health, and we have adapted their key points to apply to public health:

• Qualitative methods can help bridge the gap between scientific evidence and public health policy and practice by investigating human perceptions and experiences.
• Recognising the limits of quantitative approaches and that different research questions require different kinds of research.
• Qualitative research findings provide rigorous and firsthand accounts of public health educational, promotional and clinical practices in everyday contexts.
• Qualitative research can be used to help inform individual health choices and health promotion initiatives within communities.

Doing High-Quality Qualitative Research

Quality is unlikely to be the only reason that so little qualitative research finds its way into public health journals; even research articles of the highest quality may be met with resistance from reviewers and editors. Nonetheless it is important to attend to quality. Articles using qualitative methods require the same rigour as articles reporting quantitative methods; however, the criteria for assessing rigour are different. When assessing qualitative articles, we need to remember that what is considered rigorous in the social sciences is not necessarily the same as what is considered rigorous in the medical sciences and vice versa. Either way, what is important is that public health journals publish high-quality research studies, whatever methodology is employed. The following quotation is helpful in focusing on the need for rigour in qualitative approaches to healthcare research:

The use of qualitative research in health care enables researchers to answer questions that may not be easily answered by quantitative methods. Moreover, it seeks to understand the phenomenon under study in the context of the culture or the setting in which it has been studied … (however this) … requires researchers in health care who attempt to use it, to have a thorough understanding of its theoretical basis, methodology and evaluation techniques. 5

As quoted above, Al-Busaidi, 5 asserts that qualitative health researchers need an appreciation of theory and methodologies and use of both in all research and evaluation studies. What is most important in any qualitative study is that the research question is clear and the method is appropriate to answer the research question. We can therefore begin to ask critical questions of any qualitative article submitted for publication in public health journals:

• Is the research question clear?
• Is the method appropriate for addressing the research question?
• Is there an explanation as to how and why this method is appropriate?
• What are the theories referred to in this study and how are these applied?
• Are these theories consistent throughout the study?
• Has the sample been critiqued to make readers aware of who is not included and how this might affect findings?
• Is the analysis grounded in the data?
• Does the analysis address questions of the data so that insights are identified that go beyond simply describing what participants have said?
• Are there clearly articulated implications for public health practice?

In addition to these fundamental questions, to help researchers report qualitative research, there are two frameworks that help to maintain standards for the conduct and reporting of the method. The first is COREQ (Consolidated criteria for reporting qualitative research). 6 This is a 32-point checklist of three domains: research team and reflexivity, study design and analysis and findings. The second is Standards for Reporting Qualitative Research (SRQR), 7 which is a 21-point check-list following the same format. Together, these are both useful tools for helping researchers think about what they need to consider when conducting qualitative research and for helping reviewers assess articles using qualitative methods. We are not suggesting that qualitative researchers should use these frameworks as tick-box checklists, although they may be used to enable researchers to think through important elements of qualitative research that may be otherwise overlooked. At the end of this article, we supply weblinks to enable the reader to inspect these two frameworks.

‘Signs of Quality’ for Reporting Qualitative Public Health Research

Rather than leave the reader baffled by frameworks and checklists, we propose a number of ‘signs of quality’ that we would expect to see when reviewing articles submitted to this or any other high-quality public health journal.

The research question is clearly identified and clearly related to public health policy or practice and the chosen method is appropriate for answering that question. A rationale is offered to justify the study and the methods used.

Ethical questions are considered, the study has been conducted and reported in an ethical manner, and ethical approval has been granted from a recognised ethics committee.

How the study was implemented needs to be reported as clearly as possible including: how access to participants was achieved, what questions were asked, and how the analysis was conducted.

The study needs to be both theoretically and practically consistent. For example, if the study claims to be narrative research, did the questions elicit stories and is narrative theory used in analysis?

Collaborative

In recent years, health services in many countries have embraced patient and public involvement and co-production in both research and practice. Such initiatives are designed to draw our attention to service users’ views, needs and desires. This agenda sits very well with qualitative research methodologies.

Contribution

Every research study needs to make a contribution to the body of knowledge concerning the subject under investigation. If there is theoretical and practical consistency throughout the study and it has been competently conducted and analysed, the reader should come away with a sense of learning something new on the topic. This insight should be easy for a reader to take away from each article and the easiest way to do this is to articulate it clearly in the conclusion in the abstract as well as the conclusion in the body of the paper. Conclusions of ‘it’s complex’ or ‘there were five issues affecting this phenomenon’ fail to offer useful insights. They may be a signal of an under-analysed study. It will be much more helpful to readers to state a single key issue that adds to the evidence base and that helps members of the population, policy-makers, or practitioners to understand the phenomenon under study or take action on it.

Examples of Good Qualitative Research from this Journal

In order to exemplify the principles, we espouse in this article, we refer to two recent articles published in Perspectives in Public Health that use qualitative methods. First, Lozano-Sufrategui et al. 8 aimed to ‘… understand the behaviour changes men who attended a weight loss programme engage in during weight maintenance … ’. To achieve this aim, the research team encouraged men on a weight loss programme to keep photo-diaries of themselves and to talk about their progress with the researchers. The research is innovative in its approach and uniquely reports the participants’ thoughts, feelings and behaviours. It highlights the importance of drawing on the diversity of methods that exist beyond face-to-face interviews. The second example is Eley et al. 9 who conducted interviews and focus groups in four countries in order to ‘ … explore school educators’ attitudes, behaviours and knowledge towards food hygiene, safety and education .’ Using this approach, they were able to explore individual and group views on this subject thus identifying not only the need for more educational resources but barriers and opportunities in the process. While reading these articles, it becomes immediately apparent that these studies were able to gain insight into the respective topics that quantitative methods could never achieve. What qualitative research facilitates is the human connection between interviewer and interviewee and in that process, together with the guarantee of confidentiality, people are able to speak in-depth about their experiences and perceptions, from which much can be learned. In these two examples, the qualitative findings give insights into the thoughts and feelings of the participants and enable a greater understanding of how the researchers were able to draw their conclusions from the research.

A review of top public health journals identified that the vast majority of research that is being currently published in high-ranking public health journals use quantitative methods. High-quality qualitative research offers insights that quantitative research cannot. It is time for all public health journals to recognise the value of qualitative research and increase the amount of high-quality qualitative research that they publish.

COREQ link :

http://cdn.elsevier.com/promis_misc/ISSM_COREQ_Checklist.pdf

SRQR link :

https://onlinelibrary.wiley.com/pb-assets/assets/15532712/SRQR_Checklist-1529502683197.pdf

Conflict of Interest: The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship and/or publication of this article.

Contributor Information

T Stickley, Institute of Mental Health, University of Nottingham Faculty of Medicine and Health Sciences, Triumph Road, Nottingham NG7 2UH, UK.

A O’Caithain, The University of Sheffield, Sheffield, UK.

C Homer, Sheffield Hallam University, Sheffield, UK.

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Pbhl 6500 research methods in public health.

Learn the how, when and why of public health research.

Format: Online Duration: 8 weeks

What is research? How do we conduct research? And what can we do with it? Research is what moves public health forward. It answers questions, validates hunches and saves lives. MPH 6006 Methods of Research in Public Health pulls together the key elements of the research process.

In this course, you'll examine research study designs used in epidemiology, explore components of the research process and the scientific method and focus in-depth on issues related to protecting human subjects in public health research.

Early on, you and your classmates will identify a research problem and go step-by-step through the research process, from hypothesis to data gathering to evaluation to validation and finally to reporting your findings. Sharing observations as a group will be enlightening and will enhance your learning experience. This project will illustrate the process and uses of research in public health.

What You'll Learn in MPH 6006

This course explores research design, collection and reporting of data, interpretation of findings, inferential procedures and current public health research. You will focus on the whole research process: from developing a research question, to collecting and analyzing data, to writing a journal article/report and presenting your findings.

Course Topics

Throughout this course, weekly topics may include but are not limited to the following:

• Research Process, Designs, and Human Subjects Protection
• Research Question and Literature Review
• Data Collection and SPSS
• Descriptive Data Analysis
• Inferential Data Analysis
• Reporting the Results
• Interpreting the Results
• Writing a Draft Journal Article

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Upon completion of MPH 6006 Methods of Research in Public Health, you will be able to:

• Understand the role of the scientific method in advancing the mission of public health.
• Distinguish among the different measurement scales and the implications for selection of statistical methods to be used based on these distinctions.
• Formulate health-related research questions, test hypotheses and design a basic study to answer these questions.
• Apply ethical principles in public health research.
• Develop written and oral presentations based on statistical analyses for both public health professionals and educated lay audiences.

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• Streamlining Drug Development and Improving Public Health through Quantitative Medicine: An Introduction to the CDER Quantitative Medicine Center of Excellence - 04/25/2024

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Event Title Streamlining Drug Development and Improving Public Health through Quantitative Medicine: An Introduction to the CDER Quantitative Medicine Center of Excellence April 25, 2024

About this event:.

This virtual workshop will be hosted by the newly established FDA Center for Drug Evaluation and Research (CDER) Quantitative Medicine Center of Excellence (QM CoE). The purpose of this workshop is to introduce the CDER QM CoE, providing an overview of the scope, goals, and current state, while gaining feedback from the public on needs and opportunities in education, outreach, and policy.

Background:

QM involves the development and application of exposure-based, biological, and quantitative modeling and simulation approaches derived from nonclinical, clinical, and real-world sources to inform drug development, regulatory decision-making, and patient care. The newly established CDER QM CoE is a coordinating body intended to spur innovation and foster comprehensive integration of QM approaches to advance therapeutic medical product development and promote public health. As part of its goal to engage the drug development, research, and patient communities, the QM CoE is holding this workshop to orient stakeholders its mission and scope and to dialogue on opportunity areas.

Workshop Objectives:

• Provide an overview of the newly formed QM CoE, including discussion of the current goals, initiatives, and priority areas
• Engage with stakeholders to inform future QM CoE initiatives in education, outreach, and policy development

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For questions regarding this event, please contact [email protected] .

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Home » 500+ Quantitative Research Titles and Topics

500+ Quantitative Research Titles and Topics

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Quantitative research involves collecting and analyzing numerical data to identify patterns, trends, and relationships among variables. This method is widely used in social sciences, psychology , economics , and other fields where researchers aim to understand human behavior and phenomena through statistical analysis. If you are looking for a quantitative research topic, there are numerous areas to explore, from analyzing data on a specific population to studying the effects of a particular intervention or treatment. In this post, we will provide some ideas for quantitative research topics that may inspire you and help you narrow down your interests.

Quantitative Research Titles

Quantitative Research Titles are as follows:

Business and Economics

• “Statistical Analysis of Supply Chain Disruptions on Retail Sales”
• “Quantitative Examination of Consumer Loyalty Programs in the Fast Food Industry”
• “Predicting Stock Market Trends Using Machine Learning Algorithms”
• “Influence of Workplace Environment on Employee Productivity: A Quantitative Study”
• “Impact of Economic Policies on Small Businesses: A Regression Analysis”
• “Customer Satisfaction and Profit Margins: A Quantitative Correlation Study”
• “Analyzing the Role of Marketing in Brand Recognition: A Statistical Overview”
• “Quantitative Effects of Corporate Social Responsibility on Consumer Trust”
• “Price Elasticity of Demand for Luxury Goods: A Case Study”
• “The Relationship Between Fiscal Policy and Inflation Rates: A Time-Series Analysis”
• “Factors Influencing E-commerce Conversion Rates: A Quantitative Exploration”
• “Examining the Correlation Between Interest Rates and Consumer Spending”
• “Standardized Testing and Academic Performance: A Quantitative Evaluation”
• “Teaching Strategies and Student Learning Outcomes in Secondary Schools: A Quantitative Study”
• “The Relationship Between Extracurricular Activities and Academic Success”
• “Influence of Parental Involvement on Children’s Educational Achievements”
• “Digital Literacy in Primary Schools: A Quantitative Assessment”
• “Learning Outcomes in Blended vs. Traditional Classrooms: A Comparative Analysis”
• “Correlation Between Teacher Experience and Student Success Rates”
• “Analyzing the Impact of Classroom Technology on Reading Comprehension”
• “Gender Differences in STEM Fields: A Quantitative Analysis of Enrollment Data”
• “The Relationship Between Homework Load and Academic Burnout”
• “Assessment of Special Education Programs in Public Schools”
• “Role of Peer Tutoring in Improving Academic Performance: A Quantitative Study”

Medicine and Health Sciences

• “The Impact of Sleep Duration on Cardiovascular Health: A Cross-sectional Study”
• “Analyzing the Efficacy of Various Antidepressants: A Meta-Analysis”
• “Patient Satisfaction in Telehealth Services: A Quantitative Assessment”
• “Dietary Habits and Incidence of Heart Disease: A Quantitative Review”
• “Correlations Between Stress Levels and Immune System Functioning”
• “Smoking and Lung Function: A Quantitative Analysis”
• “Influence of Physical Activity on Mental Health in Older Adults”
• “Antibiotic Resistance Patterns in Community Hospitals: A Quantitative Study”
• “The Efficacy of Vaccination Programs in Controlling Disease Spread: A Time-Series Analysis”
• “Role of Social Determinants in Health Outcomes: A Quantitative Exploration”
• “Impact of Hospital Design on Patient Recovery Rates”
• “Quantitative Analysis of Dietary Choices and Obesity Rates in Children”

Social Sciences

• “Examining Social Inequality through Wage Distribution: A Quantitative Study”
• “Impact of Parental Divorce on Child Development: A Longitudinal Study”
• “Social Media and its Effect on Political Polarization: A Quantitative Analysis”
• “The Relationship Between Religion and Social Attitudes: A Statistical Overview”
• “Influence of Socioeconomic Status on Educational Achievement”
• “Quantifying the Effects of Community Programs on Crime Reduction”
• “Public Opinion and Immigration Policies: A Quantitative Exploration”
• “Analyzing the Gender Representation in Political Offices: A Quantitative Study”
• “Impact of Mass Media on Public Opinion: A Regression Analysis”
• “Influence of Urban Design on Social Interactions in Communities”
• “The Role of Social Support in Mental Health Outcomes: A Quantitative Analysis”
• “Examining the Relationship Between Substance Abuse and Employment Status”

Engineering and Technology

• “Performance Evaluation of Different Machine Learning Algorithms in Autonomous Vehicles”
• “Material Science: A Quantitative Analysis of Stress-Strain Properties in Various Alloys”
• “Impacts of Data Center Cooling Solutions on Energy Consumption”
• “Analyzing the Reliability of Renewable Energy Sources in Grid Management”
• “Optimization of 5G Network Performance: A Quantitative Assessment”
• “Quantifying the Effects of Aerodynamics on Fuel Efficiency in Commercial Airplanes”
• “The Relationship Between Software Complexity and Bug Frequency”
• “Machine Learning in Predictive Maintenance: A Quantitative Analysis”
• “Wearable Technologies and their Impact on Healthcare Monitoring”
• “Quantitative Assessment of Cybersecurity Measures in Financial Institutions”
• “Analysis of Noise Pollution from Urban Transportation Systems”
• “The Influence of Architectural Design on Energy Efficiency in Buildings”

Quantitative Research Topics

Quantitative Research Topics are as follows:

• The effects of social media on self-esteem among teenagers.
• A comparative study of academic achievement among students of single-sex and co-educational schools.
• The impact of gender on leadership styles in the workplace.
• The correlation between parental involvement and academic performance of students.
• The effect of mindfulness meditation on stress levels in college students.
• The relationship between employee motivation and job satisfaction.
• The effectiveness of online learning compared to traditional classroom learning.
• The correlation between sleep duration and academic performance among college students.
• The impact of exercise on mental health among adults.
• The relationship between social support and psychological well-being among cancer patients.
• The effect of caffeine consumption on sleep quality.
• A comparative study of the effectiveness of cognitive-behavioral therapy and pharmacotherapy in treating depression.
• The relationship between physical attractiveness and job opportunities.
• The correlation between smartphone addiction and academic performance among high school students.
• The impact of music on memory recall among adults.
• The effectiveness of parental control software in limiting children’s online activity.
• The relationship between social media use and body image dissatisfaction among young adults.
• The correlation between academic achievement and parental involvement among minority students.
• The impact of early childhood education on academic performance in later years.
• The effectiveness of employee training and development programs in improving organizational performance.
• The relationship between socioeconomic status and access to healthcare services.
• The correlation between social support and academic achievement among college students.
• The impact of technology on communication skills among children.
• The effectiveness of mindfulness-based stress reduction programs in reducing symptoms of anxiety and depression.
• The relationship between employee turnover and organizational culture.
• The correlation between job satisfaction and employee engagement.
• The impact of video game violence on aggressive behavior among children.
• The effectiveness of nutritional education in promoting healthy eating habits among adolescents.
• The relationship between bullying and academic performance among middle school students.
• The correlation between teacher expectations and student achievement.
• The impact of gender stereotypes on career choices among high school students.
• The effectiveness of anger management programs in reducing violent behavior.
• The relationship between social support and recovery from substance abuse.
• The correlation between parent-child communication and adolescent drug use.
• The impact of technology on family relationships.
• The effectiveness of smoking cessation programs in promoting long-term abstinence.
• The relationship between personality traits and academic achievement.
• The correlation between stress and job performance among healthcare professionals.
• The impact of online privacy concerns on social media use.
• The effectiveness of cognitive-behavioral therapy in treating anxiety disorders.
• The relationship between teacher feedback and student motivation.
• The correlation between physical activity and academic performance among elementary school students.
• The impact of parental divorce on academic achievement among children.
• The effectiveness of diversity training in improving workplace relationships.
• The relationship between childhood trauma and adult mental health.
• The correlation between parental involvement and substance abuse among adolescents.
• The impact of social media use on romantic relationships among young adults.
• The effectiveness of assertiveness training in improving communication skills.
• The relationship between parental expectations and academic achievement among high school students.
• The correlation between sleep quality and mood among adults.
• The impact of video game addiction on academic performance among college students.
• The effectiveness of group therapy in treating eating disorders.
• The relationship between job stress and job performance among teachers.
• The correlation between mindfulness and emotional regulation.
• The impact of social media use on self-esteem among college students.
• The effectiveness of parent-teacher communication in promoting academic achievement among elementary school students.
• The impact of renewable energy policies on carbon emissions
• The relationship between employee motivation and job performance
• The effectiveness of psychotherapy in treating eating disorders
• The correlation between physical activity and cognitive function in older adults
• The effect of childhood poverty on adult health outcomes
• The impact of urbanization on biodiversity conservation
• The relationship between work-life balance and employee job satisfaction
• The effectiveness of eye movement desensitization and reprocessing (EMDR) in treating trauma
• The correlation between parenting styles and child behavior
• The effect of social media on political polarization
• The impact of foreign aid on economic development
• The relationship between workplace diversity and organizational performance
• The effectiveness of dialectical behavior therapy in treating borderline personality disorder
• The correlation between childhood abuse and adult mental health outcomes
• The effect of sleep deprivation on cognitive function
• The impact of trade policies on international trade and economic growth
• The relationship between employee engagement and organizational commitment
• The effectiveness of cognitive therapy in treating postpartum depression
• The correlation between family meals and child obesity rates
• The effect of parental involvement in sports on child athletic performance
• The impact of social entrepreneurship on sustainable development
• The relationship between emotional labor and job burnout
• The effectiveness of art therapy in treating dementia
• The correlation between social media use and academic procrastination
• The effect of poverty on childhood educational attainment
• The impact of urban green spaces on mental health
• The relationship between job insecurity and employee well-being
• The effectiveness of virtual reality exposure therapy in treating anxiety disorders
• The correlation between childhood trauma and substance abuse
• The effect of screen time on children’s social skills
• The impact of trade unions on employee job satisfaction
• The relationship between cultural intelligence and cross-cultural communication
• The effectiveness of acceptance and commitment therapy in treating chronic pain
• The correlation between childhood obesity and adult health outcomes
• The effect of gender diversity on corporate performance
• The impact of environmental regulations on industry competitiveness.
• The impact of renewable energy policies on greenhouse gas emissions
• The relationship between workplace diversity and team performance
• The effectiveness of group therapy in treating substance abuse
• The correlation between parental involvement and social skills in early childhood
• The effect of technology use on sleep patterns
• The impact of government regulations on small business growth
• The relationship between job satisfaction and employee turnover
• The effectiveness of virtual reality therapy in treating anxiety disorders
• The correlation between parental involvement and academic motivation in adolescents
• The effect of social media on political engagement
• The impact of urbanization on mental health
• The relationship between corporate social responsibility and consumer trust
• The correlation between early childhood education and social-emotional development
• The effect of screen time on cognitive development in young children
• The impact of trade policies on global economic growth
• The relationship between workplace diversity and innovation
• The effectiveness of family therapy in treating eating disorders
• The correlation between parental involvement and college persistence
• The effect of social media on body image and self-esteem
• The impact of environmental regulations on business competitiveness
• The relationship between job autonomy and job satisfaction
• The effectiveness of virtual reality therapy in treating phobias
• The correlation between parental involvement and academic achievement in college
• The effect of social media on sleep quality
• The impact of immigration policies on social integration
• The relationship between workplace diversity and employee well-being
• The effectiveness of psychodynamic therapy in treating personality disorders
• The correlation between early childhood education and executive function skills
• The effect of parental involvement on STEM education outcomes
• The impact of trade policies on domestic employment rates
• The relationship between job insecurity and mental health
• The effectiveness of exposure therapy in treating PTSD
• The correlation between parental involvement and social mobility
• The effect of social media on intergroup relations
• The impact of urbanization on air pollution and respiratory health.
• The relationship between emotional intelligence and leadership effectiveness
• The effectiveness of cognitive-behavioral therapy in treating depression
• The correlation between early childhood education and language development
• The effect of parental involvement on academic achievement in STEM fields
• The impact of trade policies on income inequality
• The relationship between workplace diversity and customer satisfaction
• The effectiveness of mindfulness-based therapy in treating anxiety disorders
• The correlation between parental involvement and civic engagement in adolescents
• The effect of social media on mental health among teenagers
• The impact of public transportation policies on traffic congestion
• The relationship between job stress and job performance
• The effectiveness of group therapy in treating depression
• The correlation between early childhood education and cognitive development
• The effect of parental involvement on academic motivation in college
• The impact of environmental regulations on energy consumption
• The relationship between workplace diversity and employee engagement
• The effectiveness of art therapy in treating PTSD
• The correlation between parental involvement and academic success in vocational education
• The effect of social media on academic achievement in college
• The impact of tax policies on economic growth
• The relationship between job flexibility and work-life balance
• The effectiveness of acceptance and commitment therapy in treating anxiety disorders
• The correlation between early childhood education and social competence
• The effect of parental involvement on career readiness in high school
• The impact of immigration policies on crime rates
• The relationship between workplace diversity and employee retention
• The effectiveness of play therapy in treating trauma
• The correlation between parental involvement and academic success in online learning
• The effect of social media on body dissatisfaction among women
• The impact of urbanization on public health infrastructure
• The relationship between job satisfaction and job performance
• The effectiveness of eye movement desensitization and reprocessing therapy in treating PTSD
• The correlation between early childhood education and social skills in adolescence
• The effect of parental involvement on academic achievement in the arts
• The impact of trade policies on foreign investment
• The relationship between workplace diversity and decision-making
• The effectiveness of exposure and response prevention therapy in treating OCD
• The correlation between parental involvement and academic success in special education
• The impact of zoning laws on affordable housing
• The relationship between job design and employee motivation
• The effectiveness of cognitive rehabilitation therapy in treating traumatic brain injury
• The correlation between early childhood education and social-emotional learning
• The effect of parental involvement on academic achievement in foreign language learning
• The impact of trade policies on the environment
• The relationship between workplace diversity and creativity
• The effectiveness of emotion-focused therapy in treating relationship problems
• The correlation between parental involvement and academic success in music education
• The effect of social media on interpersonal communication skills
• The impact of public health campaigns on health behaviors
• The relationship between job resources and job stress
• The effectiveness of equine therapy in treating substance abuse
• The correlation between early childhood education and self-regulation
• The effect of parental involvement on academic achievement in physical education
• The impact of immigration policies on cultural assimilation
• The relationship between workplace diversity and conflict resolution
• The effectiveness of schema therapy in treating personality disorders
• The correlation between parental involvement and academic success in career and technical education
• The effect of social media on trust in government institutions
• The impact of urbanization on public transportation systems
• The relationship between job demands and job stress
• The correlation between early childhood education and executive functioning
• The effect of parental involvement on academic achievement in computer science
• The effectiveness of cognitive processing therapy in treating PTSD
• The correlation between parental involvement and academic success in homeschooling
• The effect of social media on cyberbullying behavior
• The impact of urbanization on air quality
• The effectiveness of dance therapy in treating anxiety disorders
• The correlation between early childhood education and math achievement
• The effect of parental involvement on academic achievement in health education
• The impact of global warming on agriculture
• The effectiveness of narrative therapy in treating depression
• The correlation between parental involvement and academic success in character education
• The effect of social media on political participation
• The impact of technology on job displacement
• The relationship between job resources and job satisfaction
• The effectiveness of art therapy in treating addiction
• The correlation between early childhood education and reading comprehension
• The effect of parental involvement on academic achievement in environmental education
• The impact of income inequality on social mobility
• The relationship between workplace diversity and organizational culture
• The effectiveness of solution-focused brief therapy in treating anxiety disorders
• The correlation between parental involvement and academic success in physical therapy education
• The effect of social media on misinformation
• The impact of green energy policies on economic growth
• The relationship between job demands and employee well-being
• The correlation between early childhood education and science achievement
• The effect of parental involvement on academic achievement in religious education
• The impact of gender diversity on corporate governance
• The relationship between workplace diversity and ethical decision-making
• The correlation between parental involvement and academic success in dental hygiene education
• The effect of social media on self-esteem among adolescents
• The impact of renewable energy policies on energy security
• The effect of parental involvement on academic achievement in social studies
• The impact of trade policies on job growth
• The relationship between workplace diversity and leadership styles
• The correlation between parental involvement and academic success in online vocational training
• The effect of social media on self-esteem among men
• The impact of urbanization on air pollution levels
• The effectiveness of music therapy in treating depression
• The correlation between early childhood education and math skills
• The effect of parental involvement on academic achievement in language arts
• The impact of immigration policies on labor market outcomes
• The effectiveness of hypnotherapy in treating phobias
• The effect of social media on political engagement among young adults
• The impact of urbanization on access to green spaces
• The relationship between job crafting and job satisfaction
• The effectiveness of exposure therapy in treating specific phobias
• The correlation between early childhood education and spatial reasoning
• The effect of parental involvement on academic achievement in business education
• The impact of trade policies on economic inequality
• The effectiveness of narrative therapy in treating PTSD
• The correlation between parental involvement and academic success in nursing education
• The effect of social media on sleep quality among adolescents
• The impact of urbanization on crime rates
• The relationship between job insecurity and turnover intentions
• The effectiveness of pet therapy in treating anxiety disorders
• The correlation between early childhood education and STEM skills
• The effect of parental involvement on academic achievement in culinary education
• The impact of immigration policies on housing affordability
• The relationship between workplace diversity and employee satisfaction
• The effectiveness of mindfulness-based stress reduction in treating chronic pain
• The correlation between parental involvement and academic success in art education
• The effect of social media on academic procrastination among college students
• The impact of urbanization on public safety services.

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