Volume 215 - Issue 11
Towards consistent geographic reporting of Australian health research
Authors: Vincent L Versace, Hannah Beks and James Charles
Med J Aust 2021; 215 (11): 525-525. || doi: 10.5694/mja2.51344
Published online: 13 December 2021
Published online: 13 December 2021
To the Editor: As systematic reviews in the health literature increase,1 there is an emerging theme of reporting the geographic location of included studies.2,3,4,5,6,7 Approaches to classifying the geographic location of studies have varied. In the cases of Jennings and colleagues5 and Beks and colleagues,6 the authors captured information on study location and then assigned a geographic category. Jennings and colleagues5 followed the classification used by Eades and colleagues8 and combined RA1 and RA2 (originally based on the Australian Statistical Geographical Classification – Remoteness Area)9 to form an urban category. Although these two categories are both urban areas, the Remoteness Areas (RA) imply varying access to services. Beks et al6 opted to report on all five Australian Statistical Geography Standard (ASGS‐RA) categories. Acknowledging the different research questions — the commonality being a better understanding of Aboriginal health activity — Jennings et al5 concluded that urban areas (reported as a combination of RA1‐Major Cities of Australia and RA2‐Inner Regional Australia) were under‐represented, whereas Beks et al6 concluded that RA2‐Inner Regional Australia, RA3‐Outer Regional Australia and RA4‐Remote Australia were under‐represented.
When reporting systematic reviews, we recommend that results be presented using all available categories (eg, the five categories of the ASGS‐RA). Authors can then combine categories as required to address their specific research question. Of the reviews identified,2,3,4,5,6,7 the Modified Monash Model (MMM) is yet to be applied.10 With seven categories, the MMM builds upon the five categories of the ASGS‐RA and uses population and road distance to add further granularity. Given the large number of studies that are typically included in a review, it is likely there will be examples across multiple categories.
There is direct contemporary policy relevance in adopting the MMM, which spans workforce (eg, Department of Health programs are transitioning to MMM), research translation (eg, 2020 Rapid Applied Research Translation Grant Opportunity), and service delivery (eg, Medicare rebates on telehealth psychology consults).11
A uniform approach to the geographic classification of included studies in systematic reviews would enable greater comparability of findings across reviews. Consistent reporting using the MMM will likely enhance the uptake of health research, and subsequent systematic reviews, by policymakers and funding agencies. This will assist the objective allocation of resources and evaluation of activity of geographically focused programs.
Competing interests
No relevant disclosures.
References
- Fontelo P, Liu F. A review of recent publication trends from top publishing countries. Syst Rev 2018; 7: 147.
- Crawford‐Williams F, March S, Ireland MJ, et al. Geographical variations in the clinical management of colorectal cancer in Australia: a systematic review. Front Oncol 2018; 8: 116.
- Ireland MJ, March S, Crawford‐Williams F, et al. A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC Cancer 2017; 17: 95.
- Needham C, Sacks G, Orellana L, et al. A systematic review of the Australian food retail environment: Characteristics, variation by geographic area, socioeconomic position and associations with diet and obesity. Obes Rev 2020; 21: e12941.
- Jennings W, Spurling G, Shannon B, et al. Rapid review of five years of Aboriginal and Torres Strait Islander health research in Australia — persisting under‐representation of urban populations. Aust N Z J Public Health 2021; 45: 53–58.
- Beks H, Binder MJ, Kourbelis C, et al. Geographical analysis of evaluated chronic disease programs for Aboriginal and Torres Strait Islander people in the Australian primary health care setting: a systematic scoping review. BMC Public Health 2019; 19: 1115.
- Beks H, Ewing G, Charles JA, et al. Mobile primary health care clinics for Indigenous populations in Australia, Canada, New Zealand and the United States: a systematic scoping review. Int J Equity Health 2020; 19: 201.
- Eades SJ, Taylor B, Bailey S, et al. SEARCH Investigators. The health of urban Aboriginal people: insufficient data to close the gap. Med J Aust 2010; 193: 521–524. https://www.mja.com.au/journal/2010/193/9/health‐urban‐aboriginal‐people‐insufficient‐data‐close‐gap
- Australian Bureau of Statistics. Australian Standard Geographical Classification (ASGC). Canberra: ABS, 2011. https://www.abs.gov.au/websitedbs/D3310114.nsf/home/Australian+Standard+Geographical+Classification+(ASGC) (viewed Nov 2021).
- Modified Monash Model. Australian Department of Health (2019). https://www.health.gov.au/sites/default/files/documents/2020/07/modified‐monash‐model‐fact‐sheet.pdf (viewed Apr 2021).
- Versace VL, Skinner TC, Bourke L, et al. National analysis of the Modified Monash Model, population distribution and a socio‐ economic index to inform rural health workforce planning. Aust J Rural Health 2021; 29: 801–810.