The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation.
BACKGROUND
Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigate the body of research excluding the anecdotal reports and better understand primary and analytical research for PHEP, a scoping review was conducted with two objectives: first, to develop a thematic map focused on primary research; and second, to use this map to inform and guide an understanding of knowledge gaps relevant to research and practice in PHEP.


METHODS
A scoping review was conducted based on established methodology. Multiple databases of indexed and grey literature were searched based on concepts of public health, emergency, emergency management/preparedness and evaluation/evidence. Inclusion and exclusion criteria were applied iteratively. Primary research studies that were evidence-based or evaluative in nature were included in the final group of selected studies. Thematic analysis was conducted for this group. Stakeholder consultation was undertaken for the purpose of validating themes and identifying knowledge gaps. To accomplish this, a purposive sample of researchers and practicing professionals in PHEP or closely related fields was asked to complete an online survey and participate in an in-person meeting. Final themes and knowledge gaps were synthesized after stakeholder consultation.


RESULTS
Database searching yielded 3015 citations and article selection resulted in a final group of 58 articles. A list of ten themes from this group of articles was disseminated to stakeholders with the survey questions. Survey findings resulted in four cross-cutting themes and twelve stand-alone themes. Several key knowledge gaps were identified in the following themes: attitudes and beliefs; collaboration and system integration; communication; quality improvement and performance standards; and resilience. Resilience emerged as both a gap and a cross-cutting theme. Additional cross-cutting themes included equity, gender considerations, and high risk or at-risk populations.


CONCLUSIONS
In this scoping review of the literature enhanced by stakeholder consultation, key themes and knowledge gaps in the PHEP evidence base were identified which can be used to inform future practice-oriented research in PHEP.
Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada. yasmin.khan@oahpp.ca.|Division of Emergency Medicine, Department of Medicine, University of Toronto, 2075 Bayview Ave, C753, Toronto, ON, M4N 3M5, Canada. yasmin.khan@oahpp.ca.
Yasmin
Y
Khan
Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada. ghazal.fazli@utoronto.ca.|School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada. ghazal.fazli@utoronto.ca.
Ghazal
G
Fazli
British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada. bonnie.henry@gov.bc.ca.|School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada. bonnie.henry@gov.bc.ca.
Bonnie
B
Henry
Peel Public Health, 7120 Hurontario Street, P.O Box 667 - RPO Streetsville, Mississauga, ON, L5M 2C2, Canada. eileen.devilla@peelregion.ca.|Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. eileen.devilla@peelregion.ca.
Eileen
E
de Villa
Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada. charoula.tsamis@oahpp.ca.
Charoula
C
Tsamis
Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada. moira.grant@oahpp.ca.
Moira
M
Grant
Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, M5G 1V2, Canada. brian.schwartz@oahpp.ca.|Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. brian.schwartz@oahpp.ca.
Brian
B
Schwartz
D002959:Civil Defense / Q000379:methods*; D006801:Humans; D011634:Public Health / Q000379:methods*; D012017:Referral and Consultation; D012106:Research