Participants who were younger and those with a higher education level and better economic status had a statistically significantly higher health literacy level. Older people with a health literacy level of 7 points and above had a higher knowledge level and bowel cleanliness index, a showed better compliance with bowel preparation. The results highlight the need for developing a customized education intervention program that can improve health literacy for successful bowel preparation and examination of the older population undergoing colonoscopy.Compared to young adults, it is difficult for the older people with relatively low health literacy to perform proper bowel preparation for a colonoscopy. This study aims to identify the relationship between knowledge, compliance with bowel preparation, and bowel cleanliness with health literacy in older patients undergoing colonoscopy. The participants were 110 older people undergoing colonoscopy, recruited from an endoscopy hospital in G metropolitan city, South Korea. Data obtained from a structured questionnaire that included items on health literacy and knowledge of and compliance with bowel preparation, and the Aronchick bowel cleanliness scale. The data were analyzed using descriptive statistics, χ-test, Pearson’s correlation,  According to the “Causes of Death Statistics in 2020” from the Korea National Statistical Office, 27.0% of all deaths was attributable to cancer, accounting for a total of 82,204 people, making it the number one cause of death among Koreans . ColorecColonoscopy is considered the most useful diagnostic test for early detection of colorectal cancer and various other colon lesions . Its diaThe guidelines for quality control indicators for colonoscopy presented by the US Multi-Society Task Force on Colorectal Cancer emphasize that adequate bowel preparation should be part of at least 85% of the total number of colonoscopy cases . HoweverIn contrast to literacy, which refers only to the ability to read and write words or sentences, health literacy is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions .” In preIn Korea, it has been reported that the proportion of people with low health literacy is 38%, which is higher than the average of 22% in OECD countries . AccordiAs the older population is expected to increase, it is important to identify their health literacy level and provide an educational intervention program to improve it ,27. AccoThe participants’ general characteristics, knowledge, compliance of bowel preparation, bowel cleanliness, and health literacy level;Differences in health literacy, knowledge, compliance of bowel preparation, and bowel cleanliness based on participants’ characteristics;The correlation between health literacy and related variables;The differences in the knowledge, bowel preparation compliance, and bowel cleanliness based on participants’ health literacy level.This study was conducted to identify relationships between health literacy and knowledge, compliance with bowel preparation, and bowel cleanliness in elderly patients who are undergoing colonoscopy. To elaborate, we aimed to identify the following:This study used a cross-sectional descriptive design. Using a convenience sampling method, older patients aged 65-years and older were recruited in October 2020. Participants were patients who visited H Hospital with 275 beds, located in G Metropolitan City, Korea. The participants included older adults who did not have any problems with cognitive ability, communication, and daily life activities. The evaluation of the participants’ cognitive level, communication and daily living level was confirmed through the initial interview with the gastroenterologist at the outpatient colonoscopy room. Only participants who fully understood the purpose and process of the study and voluntarily consented were included. Further, 95 samples were calculated as the minimum sample size when the effect size was 0.5, with a significance level of 0.05 and a power of 0.80; the samples were set in a two-sided test using the G-power 3.1 program. Considering the dropout rate of 15%, 114 older individuals were recruited. After excluding four individuals whose responses were incomplete or invalid, data of 110 individuals were analyzed.This study used a structured questionnaire consisting of 49 items: 14 items on the participants’ general characteristics, 12 items on health literacy, 11 items on knowledge, 11 items on compliance with bowel preparation, and 1 item on bowel cleanliness. The tools used in this study were obtained with the permission of the original authors.Health literacy. Health literacy measures have been developed based on the Rapid Estimate of Adult Literacy in Medicine (REALM) tool that assesses adult patients’ understanding of medical words and related terms [ed terms . In thised terms . This shed terms . First, ed terms . CronbacKnowledge of bowel preparation. Knowledge of bowel preparation was measured using a tool developed by Yu [ed by Yu , which wed by Yu  based oned by Yu , KR-20 wCompliance of bowel preparation. Compliance with bowel preparation was measured using a tool developed by Yu [ed by Yu , and lated by Yu  based oned by Yu , CronbacBowel cleanliness. The Aronchick Bowel Preparation Scale, which has been shown to have good validity, was used to evaluate the degree to which the colonic mucosa can be clearly observed by removing feces from the large intestine [ntestine . The docGeneral characteristics of the participants. The general characteristics of the participans included 14 items: gender, age, religion, marital status, education level, income, preferred eating habits, colonoscopy experience, abdominal surgery experience, underlying diseases, family history, family support, constipation, and types of health insurance.Data collection was performed in outpatient department of the colonoscopy laboratory of H Hospital, located in G Metropolitan City. The research team explained the overall study in detail to the colonoscopy doctor and department head of the endoscopy center before seeking approval and cooperation related to data collection. Because the hospital where this study was conducted has an endoscopy center, the number of daily visits of adult patients is high. Among the adults visiting the endoscopy center, the older people who met the selection criteria were continuously and conveniently recruited. Study participants were asked to fill out the form 30 min before the start of the colonoscopy. It took about 15–20 min to fill out the questionnaire. The questionnaire was completed in a separate area in the outpatient setting where privacy was maintained. Participants were given time to fully understand and the contents of the questionnaire, and they were allowed to ask the researcher questions. The bowel cleanliness index after colonoscopy was directly written on the case report form by the gastroenterologist who performed the colonoscopy. Prior to data collection, this study was reviewed and approved by the Institutional Research Ethics Review Board of University C . The purpose of the study and the method of participation were sufficiently informed to older people aged ≥ 65 years who visited the colonoscopy center if they met the criteria for participant selection. It was explained that the collected data would remain anonymous and would be used only for research purposes. Written consent was also obtained from the study participants. The participants were informed that they could withdraw from the study at any point of time. To ensure the anonymity of the participants, the surveys were coded and collected without personal information. After the survey was completed, a small gift (about USD 3) was provided to the study participants. None of the participants complained of any unexpected discomfort when participating in the survey. t-tests, analysis of variance (ANOVA), and Scheffé post hoc tests. Correlations between variables were analyzed using Pearson’s correlation. The t-test and analysis of covariance (ANCOVA) were used to determine the differences in the relevant variables according to health literacy.Data were analyzed using IBM SPSS v 26.0. The levels of health literacy, knowledge, implementation, and intestinal cleanliness were analyzed using descriptive statistics. Differences in study variables according to participant characteristics were analyzed using Participants’ mean age was 71.01 ± 5.05 years, 63.6% were women, and 77.3% reported that they were living with a spouse. Furthermore, 56.4% had graduated from middle school or lower; 30.0% earned a current monthly income; and most of them had health insurance. The proportion of participants who received family support while preparing for colonoscopy was 52.7%, while the remaining answered that they had prepared without assistance. Regarding health-related characteristics, 54.5% had an underlying disease and 67.3% had a previous colonoscopy experience. About 30.0% of the participants usually preferred meat in their diet and 25.5% of subjects were experiencing constipation problems at the time of the survey .The health literacy score was 7.55 ± 2.95 out of 12 points. Among the sub-domains, the health-related terms section had a score of 4.02 ± 1.20 points, while comprehension and numeracy had a score of 3.54 ± 2.04 points. The knowledge of bowel preparation score was 7.97 ± 2.81 out of 11 points. The average score for knowledge about bowel cleansing agents was 2.96 ± 1.50, and that for dietary knowledge was 5.01 ± 1.77.The average level of compliance with the bowel preparation guidelines was 3.38 ± 0.38 on a four-point scale. The level of taking the bowel cleansing agents was at 3.25 ± 0.46 points, and compliance with the dietary guidelines was at 3.52 ± 0.58 points. The average bowel cleanliness score was 3.32 ± 1.15, that is, 17.3% for “excellent”, 25.5% for “good”, 10.0% for “poor”, and 9.1% for “inadequate”, based on the Aronchick Bowel Preparation Scale .Health literacy showed statistically significant differences for age (F = 18.44), education level (t = −4.16), monthly income (t = −3.88), insurance type (t = 2.03), and constipation (t = −2.31). The level of knowledge was statistically significantly different according to age (F = 4.01) and family support (t = −2.64); the level of compliance with the guidelines was statistically significantly different by gender (t = 2.45), marital status (t = 2.29), monthly income (t = 2.19), and family support (t = −2.14). There was a statistically significant difference in bowel cleanliness according to monthly income (t = 2.50) .On the bowel cleanliness scale, a score of 1 out of 5 indicated the best condition, based on the Aronchick Bowel Preparation Scale. To facilitate the interpretation of the results of the correlation analysis, the results were analyzed using inverse transformation. Health literacy had a statistically significant positive correlation with knowledge (r = 0.20), compliance (r = 0.29), and bowel cleanliness (r = 0.36). The higher the health literacy, the better the knowledge, compliance with guidelines, and bowel cleanliness. In the sub-domain analysis, knowledge and compliance related to taking bowel cleansing agents were, statistically, significantly related to health literacy; however, knowledge and compliance level related to the diet before the test were not correlated .p < 0.05; Older people with a health literacy level greater than seven points had a high level of knowledge (taking a bowel cleansing agent), a high level of compliance for bowel preparation, and a high bowel cleanliness index . In the sub-domain, the score for knowledge of bowel cleansing was 59.0 and for knowledge related to diet was 83.5. In a previous study of 98 adults who had undergone colonoscopy , these sWe recommend a critical review of the education on colonoscopy preparation that has been provided by hospitals. This way, experts can replace difficult terms with easy-to-understand ones for older people. Other graphic changes can also be made, such as increasing the font size or inserting additional pictures or illustrations for better comprehension ,46,49,50The average level of compliance for bowel preparation was 3.38 ± 0.38 points (84.5 points out of 100). In the sub-domain, the score for compliance with bowel cleansing agents was 81.2 and for compliance with dietary guidelines was 88.0. In a previous experimental study on Korean adults , compliaThe bowel cleanliness level was an average of 3.32 ± 1.15 points on the Aronchick scale , and 42.We also found that the higher the health literacy of the older people, the higher the knowledge of bowel preparation, level of compliance with bowel-cleansing agents, and index of bowel cleanliness. For older people to successfully carry out the guidelines for bowel preparation, systematic interventions to increase their health literacy should be conducted to improve their understanding and knowledge of the procedure. A recent review study on educational interventions for bowel preparation reported that interventions, such as educational booklets, visual materials using illustrations, videos, short messages, phone counseling, social network services, and other applications were effective . In a stWhen providing education for older people to prepare for colonoscopy, it is necessary to consider what educational approach should be taken to effectively convey knowledge and help patients prepare and implement the guidelines on their own. In particular, unlike other diagnostic tests, the preparation process for colonoscopy requires older people to perform it themselves. Therefore, differentiated education is necessary whereby individual patients’ health literacy is taken into consideration , especiaWe believe that our study is meaningful because it investigates the health literacy, knowledge, implementation of guidelines, and bowel cleanliness of older Korean patients undergoing colonoscopy. Our results suggest the need for more and better education on colonoscopy preparation; it must also be ensured that the education is differentiated with respect to the health literacy of each patient. We hope that modifying current approaches accordingly may increase the quality and success of this procedure, and ultimately improve patient outcomes.Nevertheless, our study has some limitations. Because we employed a small number of older Korean people at one hospital as our participants, our results may have limited generalizability. One solution is expanding the sample size to include more patients and institutions across a wider geography. In addition, in a recent systematic review  that anaFor a successful colonoscopy through proper bowel preparation, the health literacy of older people should be considered. We, thus, recommend a critical review of the existing colonoscopy education provided to older people at hospitals. For older peole who are scheduled for a colonoscopy, health literacy should be evaluated in advance, and individualized education should be planned and provided. Regarding future research, we propose an experimental study that applies an individual educational intervention program to improve the health literacy of older people and evaluates the improvement of various patient outcomes, such as the incidence of side effects, frequency of retests, and reduction in medical costs.


Evidence maps are a relatively new approach to systematically identify and report the range of research activity in broad topic areas or policy domains. Although they go under various names, they have the common feature of adopting a systematic approach to mapping begins with a broad question, theme or issue which defines the scope of the evidence map. For reasons discussed below, we adopt the term Evidence and Gap Map to refer to the specific approach being proposed for Campbell, and evidence map to refer collectively to the range of approaches which have been adopted. As we describe in Part 2, evidence mapping of various forms has been around for at least 15 years.A range of different approaches to evidence mapping and synthesis have been developed to support evidence informed policy making. In 2016,  conducteMaps often provide a foundation for further, more focused research synthesis. They are used to guide users to high quality research, inform research priority setting, and help to define the focus of evidence synthesis such as systematic reviews . In the health sector maps were intended to provide clinicians, researchers, clients, and caregivers with tools and guidance to engage in evidence‐based decision making. Maps allow for identification of research gaps which is particularly important for interventions that are implemented without insufficient evidence .The popularity of mapping has grown in recent years. A map of maps for international development interventions identified 73 maps, with half of all completed maps commissioned in 2016 .This paper reviews the range of mapping methodologies being adopted across different sectors. The motivation for this paper is to develop general principles for maps, and particularly to inform the development of standards for the Campbell Collaboration as a basis for the publication of Evidence and Gap Maps in the Campbell Library. The approaches discussed include systematic map ; Oakley; Salina evidencePapers mentioned above have discussed and presented overview of different types of evidence mapping, scoping and synthesis. The focus is on the various approaches towards evidence syntheses products whereas the focus of this paper is on the methodological approach of organisations working on evidence maps.The purposes of this paper are to:Identify various organisations that produce evidence mapsStudy the different approaches used for generating the evidence maps.Identify uniqueness and similarities in each step List all the ways in which evidence map can be generatedDiscuss areas of commonality and dissimilarity for each step between the different organizations.Propose some common standards for evidence maps.We present a brief history of evidence mapping before turning to an analysis of the approach to evidence mapping broken down into stages: definition of map, scope, inclusion criteria, critical appraisal, screening and searching, coding, presentation and reporting, use and maintenance. We conclude with some general principles for evidence mapping.The earliest evidence maps we identified are from 2003. That year saw publication of a map by the Yale Prevention Research Centre in collaboration with Complementary and Alternative Medicine (CAM) ; see TabIn 2005 EPPI‐Centre published a mapping methodology which was adapted the following year by the Social Care Institute for Excellence (SCIE) in response to a lack of empirical data to answer specific questions using systematic reviews, and a perceived need for a methodology to describe the literature in a broader field of interest than that typically covered in a single review.In 2010, 3ie produced its first evidence map, labelled the Evidence Gap Map. The organisation's experience in preparing maps for a range of topics in international development is reviewed by Snilstveit . SeveralEach of the agencies producing maps has a different approach, and each defines evidence map differently. A review of the definitions (see Annex 1 for full definitions) shows the following eight components contained in the definitions see 1:SystematicThe type of evidence includedThe content of the mapThe structure of the mapTransparencyVisual or graphical displayAccompanying description of mapIntended usersWhat is perhaps missing in the definitions is a more explicit statement that mapping commonly tells us what evidence there is, but not what this evidence says ‐ though some maps do include information on effects. This point is often misunderstood by those commissioning evidence maps and so should be made clear up front where it is the case.From these definitions we suggest the following comprehensive definition. Elements in square brackets […] may be considered optional.‘An evidence and gap map is a systematic [visual] presentation of the availability of relevant evidence [of effects] for a particular policy domain. The evidence is identified by a search following a pre‐specified, published search protocol.  ’.Evidence and gap maps have two sets of relatives. The first relatives are other evidence synthesis research outputs. The second are different evidence platforms.Evidence maps may be a way of curating (or brokering) a body of evidence to make it accessible to users. We distinguish three main evidence platforms with successively higher levels of curation or brokering:Evidence databases which contain evidence relating to a specific sector, e.g. ERIC for education, Epistimonikos for health, and the 3ie database for international development. Evidence databases differ from library catalogues and general databases, such as Scholar Google, since they are oriented to a particular audience, and possibly particular types of evidence. Both Epistimonikos and the 3ie database are restricted to systematic reviews and primary studies of effects.Evidence maps which classify the evidence which relates to a particular sector or issue, including some reporting of the features (but not content) of the evidence.Evidence portals which present evidence findings in a way in which is intended to be accessible to policy makers and practitioners. Examples are the Teacher and Learning Toolkit of the Education Endowment Foundation, and the IES's What Works Clearing House.Beyond evidence portals there are evidence‐based guidelines and checklists which contain recommendations and directions. These last three are different from databases and maps as databases and maps take users back to the research studies, whereas portals etc. present the evidence to inform decision‐making without the user needing to consult the research directly.This paper is focused on evidence maps. A companion paper will discuss evidence portals.For nearly all the agencies reviewed, evidence maps generally have a broad thematic scope covering a range of interventions and outcomes. For example, 3ie maps generally cover a sector or broad sub‐sector such as forest conservation , youth aDepartment of Veteran Affairs has topics such as ‘Women veteran health research literature’ and ‘Evidence map on mindfulness’ . Since 2007, the Global Evidence Mapping Initiative has mapped 1,644 neurotrauma publications, covering fifty‐three high priority questions . An example of evidence map by Global Evidence Mapping Initiative is ‘Social and communication disorder following brain injury’. Social Care Institute for Excellence maps cover areas such as the extent and impact of parental mental health problems on families, and the acceptability Salina Bates, 2006), accessibility and effectiveness of interventions, second examines the recovery approach in day services in adult mental health care .As of January 2018, the Epistemonikos database contains over 115,000 documents, of which 22,649 are systematic reviews, 76,834 are primary studies and 17,144 are structured summaries of evidence. The database is available in nine different languages: Arabic, German, English, Spanish, Italian, Dutch, Portuguese, Chinese, and French. It contains 7,266 official translations, 642 collaborative translations and 899,022 automated translations . The datIZA's World of Labour presents reviews on issues related to labour market policy and related economic issues such as ‘Do immigrant workers depress the wages of native workers?’. The revThe scope of Sightsaver's evidence map is limited to eye health. They have published five evidence maps so far, on cataract, diabetic retinopathy, glaucoma, trachoma and refractive error. The Beam Exchange evidence map is focused on market‐based approaches to promote economic development, improve access to services and reduce poverty .The IRC has published five evidence maps covering the organization's five main outcomes areas: health, education, economic wellbeing, safety, and power. In addition, there are three cross‐cutting maps on cash transfer interventions, service delivery interventions, and interventions in humanitarian emergencies.The scope of the evidence maps of the Collaboration for Environmental Evidence is typically broader. Examples include woodfuel value chain  and farm land abandonment at high altitude .An exception to this general broad scope of maps is the Evidence Based Policing Matrix which has just one outcome (reducing crime and disorder) rather than a set of outcomes.ODI  summarizUNICEF‐Innocenti have published an evidence gap map (EGM) of the evidence base for adolescent interventions in low‐ and middle‐income countries (LMICs). The thematic scope broadly corresponds with the UNICEF adolescent well‐being outcome domains of protection, participation and livelihoods.All the agencies reviewed state pre‐specified inclusion criteria for their evidence maps. Inclusion criteria for maps use the PICOS approach of population, intervention, relevant comparison groups , outcomes, and eligible study designs. In practice, there will usually be some iteration between the studies identified and finalizing the intervention and outcome categories.Most agencies produce maps including both systematic reviews and primary studies. Exceptions are the Evidence‐Based Policing Matrix which only includes primary studies, and both SBU and Sightsavers maps include only systematic reviews.3ie EGMs are maps of effectiveness studies, and so the primary studies are only studies of effects, that is impact evaluations. Unlike systematic reviews, evidence maps may include on‐going studies. This is especially the case for on‐going reviews since registering review protocols is common practice, which remains less the case for primary studies. 3ie staff have argued that the term EGM should be restricted to this sort of map . compareEpistemonikos uses systematic reviews as the fundamental piece of the database architecture and includes articles linked to an included systematic review i.e. overviews of reviews including evidence‐based policy briefs and guidelines, primary studies included in systematic reviews, and structured summaries of that evidence.Some agencies restrict their included studies in specific ways. UNICEF‐Innocenti exclude transferable skills and youth employment‐related interventions and outcomes as other EGMs address these. Beam exchange evidence gap includes empirical data with studies not earlier than 2000 as this when original framework document for making markets work better for the poor (M4P) was developed.Critical appraisal for the quality of studies indicates the confidence in the study findings. For example, in 3ie maps systematic reviews are colour coded green, orange and red corresponding to high, medium and low confidence in study findings. 3ie does not conduct critical appraisal of primary studies on the grounds that it would be too time consuming given the time frame in which maps are usually produced (3‐6 months). In 2017, BEAM Exchange updated the original evidence inclusion protocol to include an additional evidence quality grading system, which assesses all evidence documents as either ‘high confidence’ (represented by purple ‘bubbles’) or ‘low confidence’ (represented by orange ‘bubbles’).Critical appraisal is applied using a pre‐specific critical appraisal tool or chechklist. 3ie, UNICEF‐Innocenti and Sightsavers use and adapted version of the SURE checklist, and in SBU and ODI apply the AMSTAR checklist. Epistemonikos presents critical appraisal of articles included in structured summaries. For CEE, critical appraisal  may be performed to some extent, but this is typically restricted to an assessment of study internal validity , since external validity  cannot typically be assessed for the broad topics often investigated with systematic maps. The Evidence Based Policing Matrix reports primary studies only, for which critical appraisal is performed using Scientific Methods Scale (SMS). Critical appraisal is not presented by SCIE and GEMI.Our recommendation that critical appraisal of all included studies is desirable, and should be performed unless resources do not allow it.Search is comprehensive and systematic, similar to systematic review search strategy and is sometimes more purposive for Impact Evaluations.source varies among organisations and may include:The choice of database of systematic reviewskey evidence repositoriesacademic databasereference snowballinghand searchingexpert consultationswebsites of professional and government organisation.search strategy adopted by these organizations for evidence maps and there is uniform adoption of a comprehensive and systematic search and involves search across all the sources found relevant for the research question. However in ‘3ie’ search for IE may be more purposive.There is considerable overlap in the source for search is that, ‘3ie’ does not involve hand searching of journals or literatures and ‘Evidence Based Policing Matrix’ specifically involves searching website of professional and government organization.Key difference in the In Epistemonikos, articles coming from different databases are de‐duplicated using software and a manual revision of borderline cases.Coding captures key features of included studies allowing analysis of the map. The more data are captured then the more dimensions the map can have, or filters be applied to restrict the map to a subset of the evidence by user‐determined criteria.The following domains have been used by different organisations for classifying included studies  of included systematic reviewsprimary study design critical appraisal of included studiesinformation about intervention effectivenessIn addition, study publication details are of course coded so that users can locate the evidence underlying the map. How these data are represented is discussed in the next section on reporting / presentation.Intervention categories, Outcome categories and study designs are used for coding in all the methodologies of evidence mapping. Representation of Outcome categories in 3ie gap maps and Evidence Based Policing Matrix differ, in Evidence Based Policing Matrix, key intervention dimensions , evaluation design and outcome . The EBPM is also an exception in being the only map to report what the evidence says .Typically, In Epistemonikos, once the document is uploaded, meta‐data and relational panel allows entering document metadata such as document's category like primary studies, systematic reviews, overviews and the document's relation.Five approaches have been used for presentation of evidence maps by the different organisations: the 5D bubble plot, a 3D‐matrix, a 2D‐matrix, as geographical map and descriptive report with/without visualisation. In the latter two cases additional dimensions may be added through use of different colors, symbols and size to plot studies in the map.Each of these approaches is described in turn.The 5D‐Bubble format is used by Evidence Based Synthesis Program. The bubble plot shows five dimensions to display information: the x and y axes show the effect and size of the literature respectively. Each bubble reflects three dimensions: there is a separate bubble of each intervention, with the size of the bubble representing the number of reviews for that intervention and the color of the bubble the intervention category. Figure shows an example of bubble plot.A 3D‐Matrix is used by ‘Evidence Based Policing Matrix’ to display single studies in three dimensions: intervention categories on the X axis , the specificity of the intervention from general to focused, and its degree of proactivity, from reactive to highly proactive. Each study is plotted by a circle or triangle, color coded to show study findings, i.e. effects are added as a fourth dimension in the map. This approach shows of studies which, if they are for a common intervention, are referred to as “realms of effectiveness.” These realms of effectiveness are said to provide insights into the nature and commonalities of effective police strategies and can be used by police agencies to guide various aspects of their operations. However, this approach is not a formal evidence synthesis, and encourages a vote‐counting approach to assess the evidence.3ie present their evidence gap maps in a 2D‐intervention‐outcome framework that provides links to summaries of included studies. Traffic light color coding is used to indicate the quality of the systematic review evidence in the gap map so that users can visually assess the state of the evidence in the field use symbols. The same assessment is not made for primary studies. The size of each circle represents the number of studies.Sightsaver EGMs are based on a matrix framework designed to capture evidence on specific interventions or focus areas. The focus areas for which reviews were identified are found along the x axis, and the strength of evidence is shown along the y axis. The bubbles in the matrix cells denote the existence of a systematic or literature review examining the relevant focus area. Clicking on a bubble will open up a summary page. The strength of evidence presented in the reviews is categorised as:strong if the review found strong evidence in response to the research question or outcomeinconclusive if the review reported mixed resultsweak if the review found weak or no evidence in response to the research question or outcomeThe BEAM Evidence Map and database compiles and presents robust evidence on the impact and effectiveness of market system approaches.The vertical axis: the type of intervention which contributed to the results described in the document.Horizontal axis: the results level of the evidence which the document containsA matrix of evidence is a table displaying all the systematic reviews answering a question, and all of the studies included in these reviews. The matrix displays the systematic reviews in the y‐axis, and the studies included in those reviews in the x‐axis.All the systematic reviews in the table address the question of interest (i.e. Melatonin for jet lag) or a broader question that includes the question of interest .IRC evidence maps are not available as online tool but are available in downloadable Excel format.The cells are color‐coded based on the study's conclusion:Green: Evidence of meaningful, positive impact in a given contextYellow: Not yet conclusive evidence of meaningful, positive impact in a given contextRed: Evidence of no or negative impact in a given contextImpact evaluations are put in as light yellowIZA World of Labor article map indicates for which countries empirical evidence on a specific topic exists. The list of key and additional references provided in the article provides the basis for this map.If empirical evidence exists for one particular country, that country will be shown in a different color, varying from yellow to different shades of green. The colour of the country indicate how it is classified according to the classifications used in The Global Competitiveness Report (GCR) 2014–2015  by the WThe number shown inside the pin indicates how many relevant academic studies address this policy question.An additional feature is that maps may be available online, with the possibility that the user can click on a map entry to access either a record giving study information, i.e. publication details and a summary of the study. These summaries typically include information on:Geographical locationBackgroundMethodsMain findingssize of the treatment effectthe individual included clinical indicationsthe assessed outcomescharacteristics of the identified reviewsthe comparator against which the treatment effect was estimateSome agencies do not provide visualization but present the results of the mapping in a descriptive report. A descriptive report describes the overall amount of evidence and its characteristics, such as geographical distribution and which study designs have been used. The reports identify knowledge gaps and knowledge clusters.Agencies like SBU present in the form of a descriptive report and a table to show where there is evidence as shown in the figure below.Global Evidence Mapping Initiative presents ‘output tables’ called maps along with descriptive report.Collaboration for Environmental Evidence use pivot tables and pivot charts to easily visualize the quantity  of evidence across a suite of meta‐data variables. Sometimes they present study meta‐data as a layer within a geographical information system (GIS). That may be a simple world map showing the location and number of included studies .Descriptive reports outlining methodologies are used by ‘Global Evidence Mapping Initiative’, ‘Social Care Institute for Excellence’, ‘Collaboration for Environmental Evidence’ and ‘Evidence for Policy and Practice Information and Coordinating Centre (EPPI‐Centre)’. Some organizations, such as 3ie and the Veterans' Association, which provide visualizations, also provide a descriptive report.There are variations in whether the evidence can be accessed through the map. The interactive nature of 3ie maps, for example, means the user can access a database record for each included study, which in turn has a link to the study itself, though that may be behind a paywall. Link to summary of findings and conclusion is provided with IRC, Beam Exchange, ODI and Sightsavers.Evidence map have varied use, depending on the mandate of organizations:i.Research: To describe the nature, characteristics and volume of research in a particular area and inform research design. Also to set agenda for future research.ii.Systematic review planning: initial steps in the planning of a systematic reviewiii.Identify evidence gaps: To identify evidence gaps by comparing the key research questions identified by stakeholders with the available literature.iv.Funding: used by funders for evaluating the need for further funded research when reviewing a grant applicationv.Policy decisions: To inform policy and practice guide the formulation and selection of strategies in policing, develop an agenda for future policing research and serve as a practice‐oriented research translation tool that may better facilitate the adoption of evidence‐based policing and evidence‐based funding.inform research for commissioning and facilitating the use of evidence to inform decision making by ‘3ie’, ‘The Global Evidence Mapping Initiative’, ‘Social Care Institute for Excellence’, ‘Collaboration for Environmental Evidence’, ‘Evidence based Synthesis Program’ and ‘Evidence Based Policing Matrix’..Evidence maps are used to systematic review planning, or even to help make a decision about whether or not to undertake a systematic review.‘Evidence for Policy and Practice Information and Co‐ordinating Centre’, use evidence map as a part of the initial steps in identify evidence gaps by ‘3ie’, Social Care Institute for Excellence’, ‘Collaboration for Environmental Evidence, ‘Evidence based Synthesis Program’. For example, SBU, used findings as to gaps for evidence for treating ADHD as the basis for a consultation exercise to identify the top ten research priorities .Evidence maps have also been used to funding decisions by ‘Swedish Agency For Health Technology Assessment and Assessment of Social Services’, The Global Evidence Mapping Initiative’ ‘Collaboration for Environmental Evidence’ and ‘3ie’.Have been used for annual grant programme and policy decision and as translation tool for adoption of evidence based research and funding, particularly due to visual representation of evidence and gaps.‘3ie’ evidence map and ‘Evidence Based Policing Matrix’ are used to inform The search for an evidence map is undertaken up to a particular point of time. The map thus becomes out of date as new evidence accumulates. Maps more than two to three years old are less useful as a guide to research priorities, though this is partly mitigated if the map has successfully captured on‐going studies. Hence, as with systematic reviews, to stay relevant maps need to be updated or maintained.Of the agencies reviewed, the Evidence Based Policing Matrix and Epistemonikos are updated on a regular basis. SBU updates the evidence gap in their database but not the evidence maps.Some like Global Evidence Mapping Initiative, Collaboration for Environmental Evidence has a policy that maps should be updated, but there is no mechanism for ensuring that this happens.Based on the above discussion Based on the discussion we propose the following principles for producing evidence maps:Clearly determine the intended purpose of the planned evidence map, including the type of evidence to be included (e.g. effectiveness) and the planned structure of the mapDefine the scope of the map, which should be stated as a clear titleHave an ex ante search strategy and coding form (which should include stakeholder engagement in defining the map framework and then be piloted)Include on‐going studies in the map by searching registries for primary studies and reviewsInclude critical appraisal of the quality of evidenceHave a visual representation in at least two dimensions, with possible additional dimensions or filtersBe accompanied by a descriptive report.Be updated within three years of last completion, preferably annually if scope is broad or field changing rapidly.Evidence and gap map definitions


Background: The aim of this systematic review is to analyze the available literature on the introduction of allergenic foods and gluten among preterm infants. Methods: A systematic review of published studies concerning the introduction of gluten and allergenic foods in preterm infants was performed on PubMed and on the Cochrane Library. Results: Of the 174 PubMed results, 15 papers were considered suitable for the review. A total of 83 records were identified through the Cochrane Library search; eight papers were included in the review. Additional papers were identified from the reference lists of included studies. A secondary search was conducted on the same databases to find recommendations and advice regarding healthy full-term infants that could be translated to preterm infants. Therefore, 59 additional papers were included in the review. Conclusions: Current guidelines for the introduction of solid food cannot be directly transposed to preterm infants. Further research is needed to provide evidence-based guidelines regarding weaning in preterm infants. To date, we can suggest that in preterm infants allergenic foods and gluten may be introduced when complementary feeding is started, any time after 4 months of corrected age, avoiding delayed introduction and irrespective of infants’ relative risk of developing allergy. Avoiding large amounts of gluten during the first few weeks after gluten introduction and during infancy is advised, despite limited evidence to support this recommendation. The period of complementary feeding (CF) represents a significant part of the 1000-day critical window [There are no guidelines available regarding the age of initiation of CF in preterm infants (<37 weeks gestation) who are at risk of altered postnatal growth ,3. In 19None of the scientific societies working on nutrition in infancy, including the European Society of Pediatric Gastroenterology and Nutrition (ESPGHAN), AAP or the Canadian Pediatric Society (CPS), indicate the time of introduction of CF for preterm infants . The lacThe introduction of allergenic foods and gluten has always been considered a challenge of CF in healthy full-term infants. In preterm infants, this is an issue of great concern. Given the absence of specific guidelines at present, the purpose of this paper is to review the available literature concerning the introduction of allergenic foods and gluten among preterm infants.A systematic review of published studies regarding the introduction of gluten and allergenic foods in preterm infants was performed. No limitation regarding year of publication was applied. http://www.ncbi.nlm.nih.gov/pubmed/, accessed on 1 March 2021) and the Cochrane Library . Recommendations, reviews, study protocols for reviews and trials published up to 1 March 2021 were eligible.The following databases were searched: PubMed . Of the potentially relevant studies, the integral papers were gathered. Their eligibility for inclusion was independently evaluated by two reviewers (F.Ch. and E.M.).Of the 174 PubMed results, 15 papers were deemed relevant for the review ,25,26,27Searching through the reference lists of the included studies, other papers were also selected. Given the shortage of available literature regarding the introduction of allergenic foods and gluten in preterm infants, the search was extended to include papers on this same issue in full-term infants. This additional search was carried out on PubMed and the Cochrane Library: 64 papers were selected and included in the review ,85,86,87The main characteristics of the included studies are reported in This review aimed to analyze the literature for data to provide specific recommendations for the preterm infant concerning the introduction of allergenic foods and gluten among preterm infants.We found a paucity of quality studies aimed at preterm infants and decided to supplement our search with results from studies and guidelines for term infants. However, these data should be used with caution as the preterm infant is not fully comparable to the term infant, even when corrected for age. Intestinal motility and permeability, hormonal and immune systems and the microbiome of the preterm infant are different. All this makes it essential and urgent to continue research in this direction.Preterm infants were considered to be at higher risk of developing food allergies due to increased gut permeability , increasLow levels of antibodies to cow’s milk and gliadin were found in preterm infants ,47. A laSome studies proposed that preterm infants are at increased risk of allergies ,5, notabThe most common pediatric food allergies are reactions to cow’s milk, hen’s egg, soy, peanuts, tree nuts, wheat, fish and shellfish. Although the majority of children with milk or egg allergies will become tolerant, few are at risk of developing atopic disorders or respiratory allergic diseases . Over thAs a result, the European Society of Pediatric Allergy and Clinical Immunology (EAACI) and the ESPGHAN have produced joint guidelines .In 2014 the EAACI Guidelines were released, providing evidence-based recommendations for primary prevention of food allergies . The AAPIn 2016, a systematic review and meta-analysis by Ierodiakonou  showed tThese data conflict with previous recommendations to delay the introduction of allergenic foods to the infant’s diet and suggests that current guidelines may need to be revised ,58,59. TA systematic review of 14 studies by Larson  has put In light of these discoveries and having reviewed the available evidence, in 2017, the ESPGHAN CoN provided new recommendations for the introduction of CF .The formulation of distinct recommendations for breastfed and formula-fed infants is not advisable. In a recent review, Agostoni et al.  found noIn February 2021, the update of the 2014 EAACI guideline was published , based oEczema is considered the highest risk factor for developing IgE-mediated food allergy; however, children without risk factors still develop food allergy . GuidancOther allergens should be introduced around 6 months but not before 4 months as well. During introduction of CF, infants should be fed a diverse diet in order to help foster prevention of food allergy . The 2021 EAACI guidelines try to answer the questions on the optimal timing and doses of food allergens that should be used to induce tolerance . HoweverCeliac disease (CD) is a chronic, multi-organ autoimmune disease that affects the small bowel in genetically predisposed persons precipitated by the ingestion of gluten. Based on analysis of the Norwegian MoBa cohort, the development of CD in children is not associated with intrauterine growth .Prevention of the occurrence of CD with infant feeding practices has been extensively discussed. In 2008, the ESPGHAN CoN recommended avoiding both early (<4 months of age) and late (>7 months of age) gluten introduction. It also recommended introducing gluten while breastfeeding . A recenTwo recent RCTs ,64 and tBreastfeeding had no preventive effect on the development of CDA or CD during childhood according to the systematic review by Szajewska . Only liDespite the negative results of studies testing different strategies of the timing of gluten introduction, a high quantity of gluten remains a suggested risk factor . Higher Even though breastfeeding should be encouraged for its well-known health benefits, neither any breastfeeding nor breastfeeding during gluten introduction has been demonstrated to influence the risk of CD ,75. IntrGluten may be introduced into the infant’s diet anytime between 4 and 12 months of age. The age of gluten introduction in infants in this age range does not seem to influence the absolute risk of developing CDA or CD during childhood . There iESPGHAN currently recommends avoiding large doses of gluten soon after its introduction and during infancy , despiteNo recommendation was made on gluten introduction in children from families with first-degree relatives with CD . The verIt is well known that in children with no genetic predisposition for CD, the timing and mode of gluten introduction do not influence the risk. Though the recommendations are only valuable to genetically predisposed infants because they are the only ones at risk of developing CD after gluten introduction, the protocol must be applied to all infants, given that genetic risk alleles are generally not known at the time of introduction of CF ,69. AdviThe introduction of allergenic food and gluten is a major concern of CF. As we reported, the loss of gluten tolerance is a dynamic process; neither breastfeeding nor the delayed introduction are effective in preventing the later development of CD. Concerning food allergy prevention, the current paradigm is shifting from avoidance to controlled exposure, with increasing amounts of evidence to support the early introduction of potentially allergenic foods to aid in the development of oral tolerance.To date, there is a severe shortage of evidence-based recommendations regarding CF in preterm infants , with CFIn light of the strict interrelationship between early nutrition and long-term health, specific recommendations on the optimal timing and strategy of complementary food introduction in preterm infants are needed, with a special focus on their specific nutritional requirements. Given the contrasting reports, RCTs specifically designed to assess the benefits and the risks of the age when and the way in which CF is started in preterm infants are needed . Some RC−“Highly allergenic” foods and gluten should be introduced during CF, after 4 months of corrected age, irrespective of infants’ relative risk of developing allergy. It is not recommended to delay or avoid such foods. −Large amount of gluten are to be avoided soon after its introduction and during infancy, despite limited evidence to support this recommendation.Having reviewed the literature and given the available evidence, our conclusions and recommendations regarding CF in preterm infants are that:These conclusions are summarized in Further research is needed to provide evidence-based guidelines regarding weaning preterm infants.


According to Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization, HIV is the leading cause of youth mortality in Africa, and the second cause of death among young people worldwide. Global commitments to reverse the HIV epidemic will only be achieved if strategies prioritize children and youth. Relevant evidence reviews found mixed evidence that HIV prevention may be addressed through economic strengthening activities such as financial education for youth. There was some evidence related to the potential for plural interventions that include both financial and sexual, reproductive health education. However, there is limited quality evidence that focused on HIV vulnerable youth in low‐ and middle‐income countries (LMICs).This systematic review assessed the scope and strength of evidence for financial education and plural interventions aimed at reducing HIV vulnerability for youth, orphans and vulnerable children (OVC) in LMICs.Standard methodological procedures expected of systematic reviews were used. Six scientific and 24 grey literature sites were searched for relevant studies in English, French, Spanish and Arabic published between 1990 and 2016. Experimental and quasi‐experimental research methods were considered where data was gathered at baseline and at least 6 months after the end of the intervention. Mixed‐methods studies were considered provided they demonstrated validity in terms of randomization, appropriate sampling and controls, and minimization of bias errors and attrition. Evidence was then analysed and mapped to show types of financial and plural interventions by outcome type, direction and strength of evidence through qualitative assessments by the team. In addition, meta‐analysis of odds ratios was conducted to validate the strength of evidence. This analysis illustrated the relative effect or weight of interventions on HIV‐related outcomes based on confidence levels and sample sizes.Of 5,216 records, 16 moderate to higher quality studies representing 10 interventions were identified, mostly focusing on HIV‐vulnerable girls in Sub‐Saharan Africa. More than half of the interventions were plural and included access to finance and counselling or supports to improve confidence, negotiating ability and social conditions. Most studies used an experimental design. Only 11 of the 16 studies had comparable enough measures to be validated with meta‐analysis of odds ratios.The strongest evidence showed plural education interventions with self‐efficacy supports, with and without savings to have positive effects on HIV‐related outcomes. These outcomes included improved knowledge, attitudes and reduced sexual risk‐taking behaviour. Evidence also showed improved self‐efficacy from plural interventions, the changes in confidence, negotiating ability and social conditions that enable people to act on knowledge. Self‐efficacy seems important as both a set of conditions to support reduced vulnerabilities and a way to measure them in terms of outcomes. While positive effects were also observed related to increased savings and improved attitudes toward saving, generally interventions showed mixed effects on financial and economic outcomes.This systematic review supports emerging evidence that plural interventions are associated with positive health and economic outcomes for vulnerable youth and children in LMIC. Even so, as a body of evidence, it is not clear which components are effective at producing favourable outcomes. Therefore, asset theories linking financial education and asset building with favourable outcomes for vulnerable youth are not as clear as may be commonly assumed. Quality evidence is needed in more settings separating out economic, health and self‐efficacy components to better understand pathways and effects on outcomes. Segmentation in quantitative studies will enhance our understanding of asset, capability and self‐efficacy theories for greater impact. Mixed methods and qualitative studies will be important complements to enhance our understanding of contextual conditions and how to build assets and self‐efficacy in HIV vulnerable youth and OVC. Global commitments to reverse the HIV epidemic will only be achieved if strategies focus on children and youth. There is some positive evidence linking economic interventions and HIV reduction.1.1.2This systematic review summarizes outcome evidence of financial education for young people and plural interventions  aimed to reduce HIV vulnerability for youth, orphans, and vulnerable children in low and middle‐income countries (LMICs).1.1.3Eligible studies evaluated financial education, with and without savings services, as well as plural interventions with and without social supports (such as mentoring).Experimental and quasi‐experimental research methods were considered, where data were gathered at baseline and at least 6 months after the end of the intervention.Sixteen moderate‐ to higher‐quality studies representing 10 interventions were identified, mostly focusing on HIV‐vulnerable girls in Sub‐Saharan Africa. However, a meta‐analysis of odds ratios is restricted to the 11 studies (on six interventions) that had comparable measures.1.1.4Evidence for plural education interventions with self‐efficacy supports with and without savings—all show a positive effect on outcomes related to HIV‐related knowledge and attitudes, and reduced sexual risk‐taking behavior.The evidence also shows improved self‐efficacy from plural interventions, the changes in confidence and social conditions that enable people to act on knowledge.However, while some financial and plural interventions show positive effects on savings and improved attitudes toward saving, generally interventions showed mixed effects on the full range of financial and economic outcomes, such as asset building and engagement in income‐generating activities.1.1.5This systematic review supports the growing evidence that plural interventions are associated with positive health and economic outcomes for vulnerable youth and children in LMICs. Even so, as a body of evidence, it is not clear which components are effective at producing favorable outcomes.Asset theories linking financial education and asset building with favorable outcomes for vulnerable youth are not as clear as may be commonly assumed.Self‐efficacy is also unclear but seems important as both a set of conditions to support reduced vulnerabilities and a way to measure them in terms of outcomes.Quality evidence is needed in more settings separating out economic, health, and self‐efficacy components to better understand pathways and effects on outcomes.Experimental methods are appropriate to segment components for better analysis and understanding. Mixed methods and qualitative methods will be important complements to experimental research, to enhance our understanding of how to build assets and self‐efficacy in HIV‐vulnerable youth, orphans, and other vulnerable children.1.1.6The review authors searched for studies published up to January 2017.22.1This systematic review assessed outcome evidence of financial education and plural interventions aimed to reduce HIV vulnerability for youth, orphans, and vulnerable children in LMICs. Relevant evidence reviews found both positive, negative and mixed evidence that HIV prevention may be addressed through economic strengthening activities such as financial education for youth. There was some evidence related to the potential for plural interventions that combine financial education with sexual and reproductive health education but limited quality evidence that focused on outcomes for HIV vulnerable youth in low‐ and middle‐income countries.2.28 Financial education, with and without finance, as well as plural education  with and without social supports such as mentoring were included. Experimental and quasi‐experimental research methods were considered where data was gathered at baseline and at least 6 months after the end of the intervention. Mixed‐methods studies were considered provided they demonstrated validity in terms of randomization, appropriate sampling and controls, and minimization of bias errors and attrition.To address this gap, PubMed, EconLit, Cochrane Library, Web of Science, Popline, Economia y Negocios, and 24 grey literature sites were searched for relevant studies in English, French, Spanish, and Arabic published between 1990 and 2016 with reference checking and citation searches. The search stopped in January 2017. Eligible studies focused on financial education offered to orphans and vulnerable children and youth in LMICs as defined by the United Nations.The team systematically reviewed the scope and strength of impact evidence of financial education and plural interventions for HIV‐vulnerable youth and orphans and vulnerable children (OVC) in LMIC, with a focus on outcome analysis. Standard methodological procedures expected of systematic reviews were used. Of 5,216 records, 16 moderate to higher‐quality studies representing 10 interventions were identified, mostly focusing on HIV‐vulnerable girls in Sub‐Saharan Africa. More than half of the interventions were plural and included access to finance and counseling or social supports. Most used an experimental design. The strongest odds ratio effects were found to be by plural interventions on HIV‐related outcomes. Observed improvements included increased HIV‐related knowledge, attitudes, reduced sexual risk‐taking behavior, and improved self‐efficacy. While positive effects were also observed related to increased savings and improved attitudes toward saving, generally interventions showed mixed effects on financial and economic outcomes. Results are also limited by the 11 studies (on six interventions) that had comparable enough variables and treatment conditions to be validated in the meta‐analysis of odds ratios.2.3This review supports emerging evidence that plural interventions are associated with positive health and economic outcomes for vulnerable youth and children in LMIC. Even so, as a body of evidence, it is not clear which components are effective at producing favorable outcomes. Asset theories linking financial education and asset building with favorable outcomes for vulnerable youth are not as clear as may be commonly assumed. Self‐efficacy is also unclear but seems important as both a set of conditions to support reduced vulnerabilities and a way to measure them in terms of outcomes. Quality evidence is needed in more settings separating out economic, health, and self‐efficacy components to better understand pathways and effects on outcomes. Experimental methods are appropriate to segment components for better analysis and understanding. Mixed methods and qualitative methods will be important complements to experimental research to enhance our understanding of how to build assets and self‐efficacy in HIV vulnerable youth and OVC.33.1Global commitments to reverse the HIV epidemic will only be achieved if strategies focus on children and youth based on United Nations definitions.3.2There is positive evidence linking economic interventions and HIV reduction. Kim, Pronyk, Barnett, and Watts , p. 61 fHowever, other evidence suggests that increased economic strengthening does not necessarily translate to improved health and HIV prevention. Kennedy et al. , p. 13 fThere is growing recognition that in HIV‐prevention, economic vulnerability is best addressed alongside other vulnerabilities through multiple interventions, such as health education, counseling, safe spaces, training in negotiating ability, and well‐being  as World Bank defined.4A diverse teamTwo independent reviewers screened records based on the title, and where unclear, abstract and main text. Related and cited papers were sought. The search stopped in January 2017. After exclusions and duplicates were removed, 51 studies were selected for quality assessment.4.1Three independent reviewers screened full‐text articles and critically rated the quality of evidence‐based on conceptual rigor ; methodological rigor   approach  or randomised controlled trials (RCT), which compare outcome variables between an intervention group and a control group in two periods, a baseline and the intervention endline. In most studies, they combined design terms as randomized controlled, experimental or quasi‐experimental.4.3Sixteen studies were included in the body of evidence representing 10 interventions. See Appendix In terms of context, eight of these studies alone were related to the SUUBI and SUUBI‐Maka programs in Uganda (representing two interventions). Seven of the interventions took place in Sub‐Saharan Africa and three in Asia. Seven focused on female youth and three on mixed populations. Four of the interventions were in urban settings, four in a rural setting, and two in a mixed setting. Outreach mechanisms or venues included five interventions in community clubs or spaces, four in schools and one in savings groups.In terms of mechanisms, eight interventions were plural‐focused and two were financial or economic. Berry et al.  was an eEight studies (seven interventions) reported on HIV‐related outcomes, six studies (five interventions) reported on self‐efficacy outcomes, 10 studies (six interventions) on financial and economic outcomes, and two studies (one intervention) reported on education outcomes.55.1This section reports the results of two financial and nine plural education interventions emphasizing the outcome effects. See the evidence map Figure  for the One intervention  with mixed results on financial and economic outcomes. A study in Uganda combined financial education with savings in one treatment arm and savings‐only in the other  and savings  interventions offered self‐efficacy supports and savings services with six positive effects on HIV outcomes and four positive effects on self‐efficacy. In three of the interventions, plural education led to positive outcomes compared with either health education or financial education alone. The effects on financial and economic outcomes were more mixed with five positive outcome effects and four with no effect.The earlier intervention in Ghana showed that plural education had the same positive effects on savings behavior  had comparable enough treatment variables and setting conditions.As the evidence map Figure  shows, tThe quality of the evidence for plural education with savings and self‐efficacy supports was mixed. All but two studies, related to the SUUBI and SUUBI‐Maka program in Uganda and three rated low due to internal validity issues and small sample sizes. Only four studies  through the boxes depict the length of the CI. The longer the lines, the wider the CI, the less precise the study results, as the case of Ssewamala et al. , contrar2 = 64.8% in this analysis (I2 < 75%), we used a fixed‐effect model.Heterogeneity measures the variability between studies, this describes the percentage of variation across studies, an indication of how comparable studies in the analysis are if the 95% CI overlap 1 the studies are regarded as homogeneous, as the cases of Ssewamala et al. , SsewamaThe results are with the caveat that format data is not the same in all the studies,  for a regression analysis). Studies do not use the same HIV outcome variables. Some studies reported more than one dependent variable, or used three waves. For comparability, only the first and the last wave were used. Data used to generate the forest plot odd ratio graph come from the reported in the studies but not from the primary source of the authors (not raw data).6.4Practitioner studies and evidence reviews using qualitative and mixed‐methods helped to inform the analysis in this review by providing nuance to the analysis around vulnerabilities, capabilities, and self‐efficacy CYFI, . In a loThe evidence reviews and studies of closest relevance to financial education and youth were conducted by Aflatoun, a Dutch organization, which has developed one of the most widely used financial education curricula combining financial and social education, particularly for children and youth. Aflatoun carried out two systematic reviews on the topic of financial education for children and youth in 2014 and an independent study in 2017 as well as a global desk review of financial education's contribution to girl's economic empowerment. The 2014 qualitative review showed some positive effects. However, 11 of the 21 studies were located in the United States and the review was not specifically focused on vulnerable populations  may reduce HIV vulnerabilities in vulnerable children and youth in LMIC. There is a small body of evidence on which to build and refine practice, research, and policies. Nevertheless, the evidence is scant, difficult to compare and quality mixed. While positive effects have been shown across a number of studies, it is often not clear which components are effective at producing favorable outcomes.One of the challenges of building the body of evidence is, ironically, the very plural approach that seems to be developing the base of evidence. The bundling of financial education with such diverse services such as other forms of education and awareness‐building, economic, and health‐related support services makes impact monitoring challenging. Some are highly focused such as sexual and reproductive health education. Others focus on rights awareness and negotiating skills. Also, outreach mechanisms are very much part of the intervention given outreach through a group, or a home or a community center with either peer or trusted adult mentoring may help to provide the social supports and protective assets that form part of self‐efficacy for vulnerable youth and children. While the bundling of these intervention components may be more effective for certain outcomes, it is difficult to parse out which aspects of the population, the contextual and household conditions, program design and outreach lead to favorable outcomes. While plural approaches seem to be important to address the multiple and reinforcing aspects of HIV vulnerabilities, monitoring outcome pathways becomes challenging with so many components.Financial education seems important combined with sexual and reproductive health education for vulnerable youth and children but there is little evidence to understand the relationship between the two forms of education and favorable outcomes. Financial education arms even had mixed effects on financial and economic outcomes for the two studies examined and the value‐added of finance is unclear. Overall, whether financial or plural education, there were mixed effects on financial and economic outcomes.Asset theory pathways linking economic strengthening to reduced vulnerabilities are not as clear as may be commonly assumed for vulnerable children and youth. There is a need to better understand outcome pathways and the mechanisms through which both economic empowerment and bodily integrity or autonomy for HIV‐vulnerable youth and children are achieved.Self‐efficacy, both as a condition (to be supported) and as a set of outcomes, seems critical to these pathways but details are unclear. The four interventions that aimed for self‐efficacy outcomes had moderate to low quality studies. Household conditions and, arguably, self‐efficacy supports such as counseling, peer mentoring, negotiation, and self‐esteem training were present in studies with positive outcomes but not isolated in the analysis. Likewise, the outreach mechanism or setting, whether in community, schools or savings groups was not isolated for analysis. Studies did not increase understanding of the relationship between positive self‐efficacy and positive HIV outcomes.Single studies show that gender, age, circumstances of orphanage affect outcomes. However, literature and emerging evidence support that self‐efficacy is more complex than personal well‐being. Negotiating power and the ability to build economic security and retain assets, protect bodily integrity are linked to personal self‐esteem and structural elements such as vulnerabilities that limit choice, social supports, living and livelihood conditions, gendered social norms.7.1Plural approaches  have shown the potential to reduce HIV vulnerabilities in vulnerable children and youth in LMIC. In order to better understand pathways to build economic security, assets, bodily integrity, and self‐efficacy, it is critical to understand what sets of conditions, programs, and policy levers lead to reduced vulnerabilities for children and youth in a structural context of limited options.At a policy level, it is important to ask what types of evaluations and research are needed to fill the gaps in evidence around promising practices.Experimental research and evaluation have an important role to play. Experimental and quasi‐experimental studies, as found in this review, help the broader economic and health sectors to isolate and analyze intervention components. For these health and economic practitioners and researchers, much greater attention needs to be paid to understanding what particular components lead to favorable outcomes. In particular, it would be helpful to better understand the target population , effectiveness of different program components  what aspects of family or household conditions contribute, what kind of counseling or mentoring supports and by peers and/or trusted adults.However, as the earlier literature review and additional studies illustrated, mixed methods and qualitative analyses that permit a nuanced understanding of context may be important complements to the highly specific and localized experimental research. Mixed methods and qualitative studies have helped to better understand self‐efficacy, structural issues, and the inter‐relatedness of economic vulnerabilities with health and other vulnerabilities. While there is agreement about the complexity of vulnerability, building assets, and self‐efficacy, much more needs to be understood about how these vulnerabilities are reduced in the face of personal and structural barriers.Single settings, single approaches to programming or single methods of research will not support the nuanced understanding that is necessary to reduce vulnerabilities in HIV‐vulnerable youth and OVC. Donors and policymakers would do well to continue to fund and support cross‐disciplinary, cross‐sectoral, and multi‐methods research in these areas. Such complexity demands our most creative and collaborative synergies to fill the global gap in this emerging but important body of evidence.Content: Nanci Lee, Sabrina Beeler Stücklin, Patricia Lopez RodriguezSystematic review methods: Nanci Lee, Sabrina Beeler Stücklin, Meryem El Alaoui FarisStatistical analysis: Patricia Lopez RodriquezInformation retrieval: Nanci Lee, Sabrina Beeler Stücklin, Patricia Lopez Rodriguez, Meryem El Alaoui Faris, Ida MukakaThis work was supported by FHI 360 with funding from the United States Agency for International Development (USAID).The authors have no conflicts of interest to declare.The review will be updated when there are a sufficient number of new studies available, provided the authors are able to attract the necessary resources for doing so.