23d. Discussion – Implications
Discuss implications of the results for practice, policy, and future research
Essential elements
Discuss implications of the results for practice and policy.
Make explicit recommendations for future research.
Explanation
There are many potential end users of a systematic review (such as patients, healthcare providers, researchers, insurers, and policy makers), each of whom will want to know what actions they should take given the review findings. Patients and healthcare providers may be primarily interested in the balance of benefits and harms, while policy makers and administrators may value data on organisational impact and resource utilisation. For reviews of interventions, authors might clarify trade-offs between benefits and harms and how the values attached to the most important outcomes of the review might lead different people to make different decisions. In addition, rather than making recommendations for practice or policy that apply universally, authors might discuss factors that are important in translating the evidence to different settings and factors that may modify the magnitude of effects.
Explicit recommendations for future research—as opposed to general statements such as “More research on this question is needed”—can better direct the questions future studies should address and the methods that should be used. For example, authors might consider describing the type of understudied participants who should be enrolled in future studies, the specific interventions that could be compared, suggested outcome measures to use, and ideal study design features to employ.
Example
“Implications for practice and policy: Findings from this review indicate that bystander programs have significant beneficial effects on bystander intervention behaviour. This provides important evidence of the effectiveness of mandated programs on college campuses. Additionally, the fact that our (preliminary) moderator analyses found program effects on bystander intervention to be similar for adolescents and college students suggests early implementation of bystander programs (i.e. in secondary schools with adolescents) may be warranted. Importantly, although we found that bystander programs had a significant beneficial effect on bystander intervention behaviour, we found no evidence that these programs had an effect on participants' sexual assault perpetration. Bystander programs may therefore be appropriate for targeting bystander behaviour, but may not be appropriate for targeting the behaviour of potential perpetrators. Additionally, effects of bystander programs on bystander intervention behaviour diminished by 6‐month post‐intervention. Thus, programs effects may be prolonged by the implementation of booster sessions conducted prior to 6 months post‐intervention.
Implications for research: Findings from this review suggest there is a fairly strong body of research assessing the effects of bystander programs on attitudes and behaviours. However, there are a couple of important questions worth further exploration…Our understanding of the causal mechanisms of program effects on bystander behaviour would benefit from further analysis (e.g., path analysis mapping relationships between specific knowledge/attitude effects and bystander intervention)…Our understanding of the differential effects of gendered versus gender neutral programs would benefit from the design and implementation of high-quality primary studies that make direct comparisons between these two types of programs (e.g., RCTs comparing the effects of two active treatment arms that differ in their gendered approach)…Our understanding of bystander programs' generalizability to non-US contexts would be greatly enhanced by high quality research conducted across the world.”1
Training
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