What is a Scoping Review Protocol?

A scoping review protocol is essentially a detailed plan outlining the objectives, methods, and criteria for conducting a scoping review. Think of it as the blueprint before building a house. Scoping reviews aim to map the existing literature on a particular topic, identifying key concepts, research gaps, and types of evidence available. Publishing the protocol beforehand ensures transparency and reduces the potential for bias, as the researchers commit to a specific methodology before seeing the results of their search.

This is particularly relevant in the context of digital health technologies in rural primary care. Given the rapid evolution of these technologies and the diverse range of applications, a systematic approach is crucial to synthesize the available evidence effectively. Without a clearly defined protocol, reviews can be susceptible to cherry-picking studies that support a particular viewpoint or technology, leading to skewed conclusions.

PRISMA-ScR and JBI Framework

The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and the JBI (Joanna Briggs Institute) framework are two commonly used tools to guide the development and reporting of scoping reviews. The PRISMA-ScR provides a standardized set of reporting items, ensuring that all key aspects of the review process are clearly documented. The JBI framework offers a comprehensive methodology for conducting scoping reviews, from defining the research question to synthesizing and reporting the findings.

Using these frameworks adds another layer of rigor to the review process. It forces researchers to think critically about each step, from defining the scope of the review to selecting appropriate search terms and data extraction methods. This is not just academic window dressing; it is about trying to standardize a field where standardization is difficult. It is worth noting that no guidance, including PRISMA-ScR and JBI, can eliminate bias entirely.

The Catch: Limitations and Potential Biases

While scoping review protocols are valuable, they are not without limitations. One potential issue is the scope itself. A poorly defined research question can lead to a review that is either too broad, capturing irrelevant studies, or too narrow, missing important evidence. Furthermore, the search strategy may be inadequate, failing to identify all relevant publications. The review may also be limited by the databases searched, potentially overlooking studies published in less common or regional journals.

Another source of bias can arise during the study selection and data extraction phases. Researchers may unintentionally favor studies that align with their pre-existing beliefs or that report positive results. This is why it's important to have multiple reviewers independently assess the eligibility of studies and extract data, with any disagreements resolved through discussion or consultation with a third reviewer. The protocol should explicitly outline these processes to minimize subjectivity.

It is also crucial to consider potential conflicts of interest. Who is funding the review? Are the authors affiliated with companies that develop or market the digital health technologies being evaluated? These factors can influence the interpretation of the findings, even if unintentionally. Transparency regarding funding sources and author affiliations is essential for readers to assess the potential for bias.

Economic and Workflow Considerations

The implementation of digital health technologies in rural primary care settings is not just a matter of clinical effectiveness; it also has significant economic and workflow implications. The cost of these technologies can be a barrier for many rural clinics, particularly those with limited budgets. Furthermore, the integration of new technologies into existing workflows can be challenging, requiring training and support for healthcare providers.

Scoping reviews can help to identify the most cost-effective and practical digital health solutions for rural primary care. By mapping the available evidence on different technologies, reviews can inform decision-making regarding resource allocation and implementation strategies. However, it is important to consider the specific context of each rural community, as the needs and resources may vary considerably. For example, a telemedicine program may be highly effective in one community but not feasible in another due to lack of internet access or local support.

Clinicians need to consider how the workflow will be affected. Will more staff be needed? How will billing codes need to be adjusted? These are important elements to consider before implementing new telemedicine practices.