Advancing methods for prioritising health research
Submitting InstitutionPlymouth University
Unit of AssessmentAllied Health Professions, Dentistry, Nursing and Pharmacy
Summary Impact TypeSocietal
Research Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Studies In Human Society: Policy and Administration
Summary of the impact
This case study highlights a body of research around health Research
Priority Setting (RPS) that assists policy makers in effectively targeting
research that has the greatest potential health benefit. Empirical
research on RPS led to organizational changes, and new policies within the
Cochrane Collaboration along with new training resources and new RPS
exercises. A research gap on inequalities in the risk of oral cancer in
the English South Asian population led to an evidence synthesis exercise
being carried out by the National Institute for Health and Care Excellence
(NICE) and the formulation of a new public health guideline.
The research programme carried out by Moles, Professor of Oral Health
Services Research (2009- present at Plymouth University) and Nasser,
Clinical Lecturer in Evidence-Based Dentistry (2011- present at PU) is
dedicated to reducing gaps between the research needs of the public and
the research that actually gets conducted. Research Priority Setting (RPS)
processes assist policy makers in effectively targeting research that has
the greatest potential health benefit. This empirical research develops
and evaluates approaches to identify and prioritise important research
questions and monitors subsequent conduct, implementation and impact. The
research has focussed on two specific approaches: (a) analysing health
data to identify important research gaps to be addressed to reduce health
inequalities, and (b) methodological approaches to identify and rank
topics for systematic reviews.
Moles began analysing routinely collected health data at University
College London in 1999 and has developed this at Plymouth since 2009. The
early phase of the research demonstrated social and ethnic inequalities in
oral cancer incidence in England  and social inequality in hospital
admissions for dental conditions . This unveiled crucial research gaps
leading to the development of the research programme at PU with a focus on
identifying important research gaps in relation to health inequalities and
access to care. The programme was further expanded to explicitly
incorporate RPS methodologies following the recruitment of Nasser to PU.
In a project started in 2008 and transferred to PU, Nasser has been
evaluating RPS processes at organizational, stakeholder, and national
levels. The project has been funded by the Cochrane Collaboration (CC)
with international collaborators to research the CC's RPS processes .
The Cochrane Collaboration is a not-for-profit international network of
more than 28,000 people from over
100 countries working to help healthcare practitioners,
policy-makers, patients, their advocates and carers make well-informed
decisions about health care, by preparing, updating, and promoting the
accessibility of Cochrane
Systematic Reviews (CR).
To address the challenge identified by Moles on research gaps in relation
to social inequalities, Nasser developed an `equity lens' to better inform
the development and evaluation of RPS exercises . This was used to
evaluate the equity of the CC's RPS processes. For stakeholder groups,
Nasser's research developed an innovative approach combining RPS processes
with patient involvement and routinely collected health data to prioritize
topics in Germany for rapid health technology assessment . Nasser and
Sawicki (IQWiG) were commissioned by the Commonwealth Fund as one of four
groups to evaluate the evidence for policy-making, including the RPS
process, in the UK, Germany, Australia and France . The results of the
research programme, along with those of other research groups, were
presented at an international workshop hosted and funded by PU in 2012.
The research collaboration of Moles and Nasser identified gaps and
developed a first version of a conceptual framework on RPS that is being
used to conduct an extensive systematic review with thematic analysis of
RPS methodologies to evaluate the influence and impact of RPS methods on
the research pathway.
References to the research
All articles are published in peer reviewed journals. Plymouth University
based authors are marked in bold.
1. Moles DR, Fedele S, Speight PM, Porter SR, dos Santos Silva I.
Oral and pharyngeal cancer in South Asians and non-South Asians in
relation to socioeconomic deprivation in South East England. Br J
Cancer. 2008 Feb 12;98(3):633-5. doi: 10.1038/sj.bjc.6604191. 15
citations (Web of Science 14th June 2013). Impact Factor 5.042.
2. Moles DR, Ashley P. Hospital admissions for dental care in
children: England 1997-2006. Br Dent J. 2009 Apr 11;206(7):E14;
discussion 378-9. doi:10.1038/sj.bdj.2009.254.11 citations (Web of Science
14th June 2013)
3. Nasser M, Welch V, Tugwell P, Ueffing E, Doyle J, Waters E.
Ensuring relevance for Cochrane reviews: evaluating processes and methods
for prioritizing topics for Cochrane reviews. J Clin Epidemiol.
2013 May; 66 (5):474-82. doi: 10.1016/j.jclinepi.2012.01.001. 2 citations
(Web of Science 14th June 2013)
4. Nasser M, Ueffing E, Welch V, Tugwell P. An equity lens can
ensure an equity-oriented approach to agenda setting and priority setting
of Cochrane Reviews. J Clin Epidemiol. 2013 May; 66 (5):511-21.
doi: 10.1016/j.jclinepi.2012.11.013.1 citation (Web of Science 14th
5. Bastian H, Scheibler F, Knelangen M, Zschorlich B, Nasser M,
Waltering A.Choosing health technology assessment and systematic review
topics: the development of priority- setting criteria for patients' and
consumers' interests. Int J Technol Assess Health Care. 2011 Oct;
6. Chalkidou K, Tunis S, Lopert R, Rochaix L, Sawicki PT, Nasser M,
Xerri B. Comparative effectiveness research and evidence-based health
policy: experience from four countries. Milbank Q. 2009
Jun;87(2):339-67. doi: 10.1111/j.1468-0009.2009.00560.x.45 Citations (Web
of Science, 14th June 2013). Impact Factor 3.872
Details of the impact
The research had a direct impact on decisions by health service and
regulatory authorities. As part of its pathway of impact, the research
programme targeted the National Institute for Health and Care Excellence
(NICE) as a key health and regulatory authority impact target. It also
considered the Cochrane Collaboration (CC) as a strategic intermediate
target since Cochrane Systematic reviews are used to inform NICE clinical
guidelines. In August 2011, 731 Cochrane Reviews were used in 106 NICE
The research on the factors RPS exercises need to achieve in order to
maximize the impact of systematic reviews led to an organizational
change in the Cochrane Collaboration. It formed the basis for
developing a new Methods Group within the CC: the Cochrane Agenda and
Priority Setting Methods Group (launched in 2011). This Group acts to
translate the aforementioned research into policy guidance for research
units within Cochrane . The policy guidance is directed at all 14
Cochrane Centres and to 19 Branches in 30 countries, along with 53 review
groups and 13 fields and networks. The importance of the research was
recognized by CC awarding it the Bill Silverman Prize in 2012 and by Dame
Sally Davies at the UK & Ireland Cochrane Contributors meeting in
March 2013 highlighting this as a key development in Cochrane to ensure
that Cochrane reviews are relevant to the needs of the NHS [3,4].
Our research group shared the results of the projects, as they were
conducted through workshops to communicate key issues that emerge, to
raise awareness, and to increase public engagement in research. In an
initial survey in 2008, only half of the Cochrane review groups and fields
that responded (79% response rate) had a process in place for setting
priorities. Afterwards, all 53 review groups were required to develop and
report an approach for prioritization: an overview of the 2010 report is
available online . Some of the groups were informed by the awareness
activities of our research unit and others directly used the research when
developing their processes. One of the latter groups, the Cochrane
Musculoskeletal Review Group, published their work in a peer reviewed
Beyond the impact achieved through the targeted approach, the
peer-reviewed publications and conference presentations were picked up by
several organizations and led to additional impact. The research that
identified the link between the incidence of oral and pharyngeal cancer in
English South Asian communities and the prevalence of smokeless tobacco
usage from the Health Survey for England unveiled a research gap around
health inequality and its association with a risk behaviour that was
picked up by NICE, which decided to conduct a new technology assessment.
This directly contributed to the decision by NICE to conduct a formal
systematic evaluation of smokeless tobacco cessation technologies between
2011 and 2012 in order to identify the most appropriate prevention
strategies for incorporation within its public health guidance published
in 2012  to provide support specifically targeted at people in South
Asian communities. The NICE guideline, in which this research is
referenced under the section on Public Health Need and Practice, helps
people of South Asian origin who are living in England to stop using
traditional South Asian varieties of smokeless tobacco. Therefore, the
research also had a consequent impact in informing public health
In 2012, Cochrane Canada and Pan American Health Organisations (PAHO)
approached us to develop and organise online training resources on
research priority setting informed by the RPS research. These resources
are available online at no cost to all global health researchers and
Cochrane groups . The UK Cochrane Centre requested an additional
training session for the 25 UK-based Cochrane groups that was organized in
the UK and Ireland Cochrane Contributor Meeting for 2013 and it was used
to develop training resources on RPS Methods for the Yorks and Humber
Research Design Service, part of the NHS that supports researchers to
develop and design high quality research proposals [8,9]. Following the
publication of the results, NETSCC/NIHR has approached the unit for advice
on using the research to inform their processes. This led to a new
research grant proposal to test and pilot these results in their institute
along with NICE and the Association of Medical Charities. This is
currently under evaluation by the Medical Research Council.
Sources to corroborate the impact
- Alderson P, Tan T. The use of Cochrane Reviews in NICE Clinical
Guidelines. The Cochrane Library. August 09, 2011. http://www.thecochranelibrary.com/details/editorial/1312103/The-use-of-Cochrane-Reviews-in-NICE-clinical-guidelines.html.
Editorial by members of NICE describing the use of Cochrane Reviews in
NICE Clinical Guidelines.
- Cochrane Agenda and Priority Setting Methods Group http://capsmg.cochrane.org.
The official website of this new entity in the Cochrane Collaboration.
In addition to this, the information on the priority setting approaches
in Cochrane Groups in 2010 is available here: http://capsmg.cochrane.org/approaches-used-cochrane-review-groups-prioritization.
The first survey was published as part of the peer reviewed publication
(Ref 4- in under pinning research section)
- The Bill Silverman Prize http://www.cochrane.org/about-us/awards-scholarships-funding-initiatives/annual-prizes-and-awards/bill-silverman-prize.
- Keynote speech from Dame Sally Davies at the Opening Plenary, Cochrane
UK & Ireland 21st Anniversary Symposium. The importance of the
setting up of the Cochrane Agenda and Priority Setting Methods Group in
the production of timely evidence is stated from 34:00. http://youtu.be/OALmCIY-v7k
- Jaramillo A, Welch VA, Ueffing E, Gruen RL, Bragge P, Lyddiatt A,
Tugwell P. Prevention and self-management interventions are top
priorities for osteoarthritis systematic reviews. J Clin Epidemiol. 2012
Sep 17. doi:pii: S0895-4356(12)00219-3. 10.1016/j.jclinepi.2012.06.017.
[Epub ahead of print] PubMed PMID: 22995854. The research paper states
in the background that they have reviewed the evaluation on research
priority setting methods in Cochrane and developed a new approach for
priority setting topics for Cochrane Reviews based on the gaps that were
identified and needs to be addressed.
- Smokeless tobacco cessation - South Asians. National Institute for
Health and Clinical Excellence (NICE) Public Health Guideline. Sep 2012.
Cited by NICE in Public Health Guideline 39 as part of the evidence
underpinning the need for the research synthesis and guideline
- RPS webinars available on the Cochrane Canada website http://ccnc.cochrane.org/cochrane-canada-live-webinar-archive
- Master Class on Research Priority setting in UK and Ireland Cochrane
Contributor Meeting http://capsmg.cochrane.org/master-class-priority-setting-and-patient-engagement-march-21-2013
- Letter from the workshop organizers of the Yorks and Humber Research