Supplementary Search Methods Were More Effective and Offered Better Value than Bibliographic Database Searching: A Case Study from Public Health and Environmental Enhancement

Background: We undertook a systematic review to evaluate the health benefits of environmental enhancement and conservation activities. We were concerned that a conventional process of study identification, focusing on exhaustive searches of bibliographic databases as the primary search method, would be ineffective, offering limited value. The focus of this study is comparing study identification methods. We compare (1) an approach led by searches of bibliographic databases with (2) an approach led by supplementary search methods. We retrospectively assessed the effectiveness and value of both approaches. Methods: "Effectiveness" was determined by comparing (1) the "total number of studies" identified and screened and (2) the number of includable studies "uniquely identified" by each approach. "Value" was determined by comparing included study quality and by using qualitative sensitivity analysis to explore the contribution of studies to the synthesis. Results: The bibliographic databases approach identified 21,409 studies to screen and 2 included qualitative studies were uniquely identified. Study quality was moderate, and contribution to the synthesis was minimal. The supplementary search approach identified 453 studies to screen and 9 included studies were uniquely identified. Four quantitative studies were poor quality but made a substantive contribution to the synthesis; 5 studies were qualitative: 3 studies were good quality, one was moderate quality, and 1 study was excluded from the synthesis due to poor quality. All 4 included qualitative studies made significant contributions to the synthesis. Conclusions: This case study found value in aligning primary methods of study identification to maximise location of relevant evidence.