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Whereas studies were of high quality regarding outcome operationalization and statistical analyses, overall quality was moderate to low due to poor intervention description, population characterization and potential biases.
Behavioral intervention technologies (BITs) designed to prevent depression in adolescence, especially standalone web-based interventions, have shown mixed outcomes, likely due to poor intervention adherence.
Additionally, the level of poor intervention reporting we observed in the majority of trials would have hampered the ability of researchers to obtain all three elements required for the calculation of dose (e.g. the most recent Cochrane review [8] was only able to examine the effect of 18 doses of exercise on cardiovascular mortality out of 24 trials).
This can result in poor intervention outcomes and wasted efforts.
Seemingly low levels of adherence, however, may not necessarily be associated with poor intervention delivery.
Poor intervention reporting in stroke systematic reviews is prevalent, compounded by poor trial reporting.
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Third, given prevalent market failures faced by the poor, interventions to complement safety net programs and improve the livelihoods of subsistence entrepreneurs are required.
In principle, such work may help to avoid wasting resources evaluating ineffective interventions because rigorous development and testing will reject poor interventions and unfeasible trials before they reach full-scale evaluation [ 2, 3].
However, it has not been accompanied by any concrete pro-poor interventions, and it risks excluding many of the urban poor who otherwise would have benefited from the upgrade.
Argentinean experience demonstrated that without targeted pro-poor interventions or safety nets, the poor are disproportionately affected in terms of utilization of health services [ 11].
The high expenditure incurred on drugs alone highlights the need for expediting pro-poor interventions like exemptions and waivers aimed at improving access to health care for the vulnerable poor and rural dwellers.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com