Evaluating the effectiveness of public health interventions: the role and activities of the Cochrane Collaboration

Public health decision makers, funders, practitioners, and the public are increasingly interested in the evidence that underpins public health decision making. Decisions in public health cover a vast range of activities. With the ever increasing global volume of primary research, knowledge and changes in thinking and approaches, quality systematic reviews of all the available research that is relevant to a particular practice or policy decision are an efficient way to synthesise and utilise research efforts. The Cochrane Collaboration includes an organised entity that aims to increase the quality and quantity of public health systematic reviews, through a range of activities. This paper aims to provide a glossary of the terms and activities related to public health and the Cochrane Collaboration.

Effectiveness of treatment programmes for depression among adults with mild/moderate intellectual disability

Background The current study describes the development and evaluation of group treatment programme for people with mild/moderate intellectual disability (ID).
Methods A total of 34 participants (16 males, 18 females) completed the treatment programme and 15 participants (six males, nine females) comprised a control group.
Results Compared to the control group, the intervention group showed an improvement in levels of depression, positive feelings about the self, and lower levels of automatic negative thoughts after the intervention. These changes were maintained at 3-month follow-up.
Conclusions These results demonstrate that intervention programmes are effective for the treatment of depression among people with ID.

The dynamics of adult education : effectiveness of financial education seminars

This study examines the impact of adult education seminars in superannuation investments for retirement has on the investment intentions and decision making of those adults attending the seminars.  The socio-political context of the data is that of an aging population and a future government being unable to afford the current level of age pensions being paid, and attempting to encourage individuals to plan and provide for their own financial well-being in retirement.  Three themes emerged from the data and were seen to be representative of the major issues found in adult education for financial self-sufficiency: education for knowledge, education for decision making, and education for action.  In an attempt to measure the immediate impact of the seminar on the attendees decision making, the investment intentions of seminar attendees were captured at the start and end of the seminar. This was followed up three months later to see whether the intentions expressed at the end of the seminar had been implemented.  The immediate impact of the seminar was to encourage the respondents to express an intention to increase their investment strategy, however when the follow-up was done three months later, the results were mixed. Some respondents who did not express an intention to change their investment strategy actually made changes, and other respondents who did express an intention to make a change, did not do so.

Assessing cost-effectiveness in mental health : family interventions for schizophrenia and related conditions

Objective: Existing evidence suggests that family interventions can be effective in reducing relapse rates in schizophrenia and related conditions. Despite this, such interventions are not routinely delivered in Australian mental health services. The objective of the current study is to investigate the incremental cost-effectiveness ratios (ICERs) of introducing three types of family interventions, namely: behavioural family management (BFM); behavioural intervention for families (BIF); and multiple family groups (MFG) into current mental health services in Australia.

Method: The ICER of each of the family interventions is assessed from a health sector perspective, including the government, persons with schizophrenia and their families/carers using a standardized methodology. A two-stage approach is taken to the assessment of benefit. The first stage involves a quantitative analysis based on disability-adjusted life years (DALYs) averted. The second stage involves application of 'second filter' criteria (including equity, strength of evidence, feasibility and acceptability to stakeholders) to results. The robustness of results is tested using multivariate probabilistic sensitivity analysis.

Results: The most cost-effective intervention, in order of magnitude, is BIF (A$8000 per DALY averted), followed by MFG (A$21 000 per DALY averted) and lastly BFM (A$28 000 per DALY averted). The inclusion of time costs makes BFM more cost-effective than MFG. Variation of discount rate has no effect on conclusions.

Conclusions: All three interventions are considered 'value-for-money' within an Australian context. This conclusion needs to be tempered against the methodological challenge of converting clinical outcomes into a generic economic outcome measure (DALY). Issues surrounding the feasibility of routinely implementing such interventions need to be addressed.

Portable sick leave in the Victorian building industry : managing cumulative employee benefits in the absence of employment security

The trend away from full-time permanent employment raises questions about the relevance of traditional approaches to managing and compensating employees. Employment in the Australian building industry is characterised by short-term, project-based employment. Employers and unions in the industry have adopted alternative compensation models to accommodate the short-term nature of employment, most notably through portable benefit schemes. In 1997, the Victorian building industry extended the range of portable benefits to include sick leave. Empirical evidence suggests a relationship between employee absence behaviour and accrual entitlement models. Research reported here supports this link, and suggests that both employers and employees can benefit from an alternative, portable, approach to accrued entitlements. Employers can benefit because employees may be less likely to take an instrumental approach to their entitlements. Employees benefit because they are able to accrue entitlements for the period they remain in the building industry, irrespective of the extent to which they change jobs.