Background: systematic reviews and meta-analysis are often considered the highest value evidence in medical sciences. Evidence synthesis without meaningful stakeholder engagement, however, can overlook contextual factors that stakeholders consider influential.
Objectives: to present the Weight of Evidence as an evidence synthesis method that pushes conventional boundaries of what constitutes health service expertise through the formal inclusion of experiential knowledge from patients or communities, or both, and care providers together on even footing with epidemiological studies. This method was used to develop recommendations on how to reduce child protection investigations among young and disadvantaged mothers in Canada.
Methods: a conventional mixed-methods synthesis of factors contributing to child protection investigations among adolescent mothers in Canada was represented as a concept map. Through semi-structured interviews, 10 young mothers created cognitive maps to identify and weight factors they believe influence this outcome. We used Bayesian analysis to update evidence from the literature with young women’s perspectives. Using a realist framework, stakeholder explanations and published research informed explanatory statements describing processes contributing to child protection investigations. Young mothers, service providers and child protection workers adapted these explanations, which were then used to guide the identification of intervention strategies.
Results: factors identified by women focused less on individual 'risk factors' than those identified in the literature, and more on women’s support systems throughout the perinatal period. Bayesian updating provided a transparent way to represent diverse perspectives about factors contributing to the outcome, highlighting areas of agreement and disagreement between young women and published literature. Explanatory accounts suggested that social stigma, isolation and fragmentation of services complicated access to care. They also highlighted how lack of support for healthcare and child protection workers may limit their relationships with young women, and how specific policy or organizational structures can contribute to unresponsive care.
Conclusions: Weight of Evidence brings together quantitative, qualitative and experiential knowledge in a transparent and reproducible way to inform decision making. Placing the voice of young, marginalized mothers as authoritative over their own experiences led to a more complex and nuanced understanding of the challenges facing both clients and providers, with the aim of making services more responsive to the needs of young families.
Patient involvement: young, disadvantaged mothers were involved in setting the focus of this research, the interpretation of findings and generation of recommendations. Two young mothers with lived experience received training as peer researchers and contributed to all parts of this research.