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Latin America, Africa, and Asia have high incidences of syphilis. New approaches are needed to understand and reduce disease transmissibility. In health care, spatial analysis is important to map diseases and understand their epidemiologic aspects.
The proposed scoping review will identify and map the use of spatial analysis as a tool for syphilis-related research in health care.
This protocol was based on the Joanna Briggs Institute manual, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). We will conduct searches in Embase; Lilacs, via the Virtual Health Library (Biblioteca Virtual en Salud; BVS), in Portuguese and English; Medline/PubMed; Web of Science; Cumulative Index to Nursing and Allied Health Literature (CINAHL); and Scopus. Gray literature will be searched for in Google Scholar, the Digital Library of Theses and Dissertations, the Catalog of Theses and Dissertations of the Coordination of Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior; CAPES), Open Access Theses and Dissertations, ProQuest Dissertations and Theses Global, and the Networked Digital Library of Theses and Dissertations. The main research question is “How has spatial analysis been used in syphilis-related research in health care?” Studies are included if they have the full text available, address syphilis, and use geographic information systems software and spatial analysis techniques, regardless of sample characteristics or size. Studies published as research articles, theses, dissertations, and government documents will also be considered, with no location, time, or language restrictions. Data will be extracted using a spreadsheet adapted from the Joanna Briggs Institute. Quantitative and qualitative data will be analyzed using descriptive statistics and a thematic analysis, respectively.
The results will be presented according to the PRISMA-ScR guidelines and will summarize the use of spatial analysis in syphilis-related research in health care in countries with different contexts, factors associated with spatial cluster formation, population health impacts, contributions to health systems, challenges, limitations, and possible research gaps. The results will guide future research and may be useful for health and safety professionals, managers, public policy makers, the general population, the academic community, and health professionals who work directly with people with syphilis. Data collection is projected to start in June 2023 and end in July 2023. Data analysis is scheduled to take place in August and September 2023. We expect to publish results in the final months of 2023.
The review may reveal where syphilis incidence has the highest incidence, which countries most use spatial analysis to study syphilis, and whether spatial analysis is applicable to syphilis in each continent, thereby contributing to discussion and knowledge dissemination on the use of spatial analysis as a tool for syphilis-related research in health care.
Open Science Framework CNVXE; https://osf.io/cnvxe
PRR1-10.2196/43243
Spatial analyses are techniques performed on geographic data that describe an entire geographic region or a single point in space [
The evolution of computer science has improved and expanded software development, increasing the applicability and accessibility of spatial analysis [
In the context of health care, it is equally important to consider the location and characteristics of where people seek care. Thus, spatial epidemiology has evolved rapidly in recent years. Research has developed to include geocoding, distance estimation, residential mobility, record linking, data integration, spatial and spatiotemporal clustering, small area estimation, and Bayesian applications for disease mapping. Computer-based geographic information systems for integrating and analyzing geographic data are applicable in epidemiology, contributing, for example, to disease mapping, rate smoothing, cluster or hot spot analysis, and spatial modeling [
Documenting the role of the geographic environment where individuals live and interact (often called “activity spaces”) will improve our understanding of health outcomes. This is because the place where an individual lives or works can be considered as a potential determinant of disease; this has profound political implications for local health interventions and resource-allocation decisions and will ultimately lead to a reduction in health disparities [
Previous research has used spatial analysis to map disease distribution (eg, for multiple sclerosis [
Syphilis spreads via sexual or vertical transmission. It can be asymptomatic, can manifest as spots on hands and feet, and can affect the functioning of several organs (in the systemic phase). Gestational syphilis and congenital syphilis directly impact reproductive and child health. During pregnancy, syphilis may lead to abortion, stillbirth, premature birth, neonatal death, and early or late congenital manifestations [
A previous study used spatial analysis to assess the epidemiological status of congenital syphilis in Brazil and found that the most affected municipalities were those with a large migratory flow, those bordering other countries, and those with many tourists [
In China, researchers reported spatiotemporal changes in the incidence of syphilis; eastern coastal provinces showed a declining trend, whereas inland provinces showed an increasing trend, suggesting an association between epidemiological and economic issues [
New strategies are needed to reduce syphilis transmission, such as spatial analysis, which has previously been applied in syphilis-related research [
A scoping review identifying and globally mapping the application of spatial analysis in syphilis-related research would help researchers, managers, and health policy makers manage methodologies for disease control. Thus, this study describes a protocol for a scoping review to identify and map the use of spatial analysis in syphilis-related research in health care.
This is a protocol for a scoping review to answer broad research questions based on defined selection criteria [
The stages of the scoping review include (1) definition and alignment of research objectives and questions; (2) development and alignment of inclusion criteria; (3) description of the search for evidence, selection and extraction of data, and presentation of evidence; (4) the search for evidence; (5) selection of evidence; (6) extraction of evidence; (7) analysis of evidence; (8) presentation of the results; and (9) a summary of the evidence, conclusions, and the implications of the findings [
The mnemonic PCC (population, concept, context) underlay formulation of the research question. This model allows broadly mapping information to identify knowledge gaps, present key concepts, quantify aspects of interest, and expose practices and evidence of a particular theme [
Studies will be included if the full text is available, they address syphilis, and they use any geographic information systems software and spatial analysis technique. Studies will be included independently of sample characteristics and size. Studies published as research articles, theses, dissertations, and government documents will be considered with no location, time, or language restrictions. An external translator will be used when needed.
Studies will be excluded if they are literature reviews, debates, documents, editorials, expert opinions, comments, opinion articles, or conference or poster abstracts. Studies that do not have syphilis as the primary outcome, have an insufficient methodological description, or do not answer the research question will also be excluded.
The search strategy will be conducted in 3 steps to reach the largest number of publications possible.
An exploratory search on PubMed and the Virtual Health Library (Biblioteca Virtual en Salud; BVS) was conducted to identify the main medical subject heading (MeSH) terms and health sciences descriptors (Descritores em Ciências da Saúde; DeCS) related to the topic. The search strategy was built using 4 controlled health vocabularies, including DeCS, MeSH, Emtree, and the Tesauro Cumulative Index to Nursing and Allied Health Literature (CINAHL), to identify relevant studies and expand the results in different databases.
A search was conducted to identify synonyms and keywords. The search strategy was then expanded, checked, and improved by a librarian. Descriptors were combined with natural language [
Definition of the PCC (population, concept, context) mnemonic elements.
Mnemonic elements | Definition | Keywords |
Population | People diagnosed with syphilis | Syphilis; treponema pallidum; treponema infections |
Concept | Spatial analysis | Spatial analysis; geographic information system; geographic information systems; disease hotspot; spatiotemporal analysis; spatiotemporal analysis; geographic mapping |
Context | Health care | Identification by document reading |
After defining a search strategy with high sensitivity, data collection will be performed in the following databases: Embase, Lilacs (in Portuguese and English) via the BVS, Medline/PubMed, Web of Science, CINAHL, and Scopus.
For a gray literature search, we will consult Google Scholar, the Digital Library of Theses and Dissertations, the Catalog of Theses and Dissertations from the Coordination of Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior; CAPES), Open Access Theses and Dissertations, ProQuest Dissertations and Theses Global, and the Networked Digital Library of Theses and Dissertations.
The reference lists of selected articles will be searched to track down eligible sources not retrieved with the search strategy. Authors of the included studies will be consulted by email for any additional information if needed.
The search strategy will be adapted to each database. The free version of Rayyan (Qatar Foundation) [
After the pilot test, 2 blind reviewers (JdCD and YTP) will use Rayyan [
After reading the full text, potentially eligible publications will be retrieved in full via their titles and abstracts and exported to a Microsoft Excel database (2020 version; Microsoft Corp). Full texts will be analyzed and reasons for exclusion will be recorded. Information regarding the selection of publications, eligibility criteria, and reasons for inclusion and exclusion will be reported in the PRISMA-ScR flowchart [
Data will be extracted using a spreadsheet built in Microsoft Excel (
Two reviewers will map the application of spatial analysis in syphilis-related research using geographic data and by identifying where the study was performed. The map will be developed using a Google spreadsheet.
Data extraction variables.
Variable | Standardized method |
First author and year of publication | Identify the first author and year of publication of the study |
Objective | Detail the study objective |
Study design | Detail the study design described by the author or authors |
Data collection procedures | List the data collection technique or techniques used |
Geographic extent | Identify the city, state, region, or country where the study was conducted |
Syphilis, gestational syphilis, congenital syphilis | Identify the classification of syphilis |
Period (in years) of the collected data | Identify the period of data collection |
Visualization software | Identify the geographic visualization software |
Spatial analysis method | Describe the methodology developed in the spatial analysis |
Results | Describe the main study results |
Challenges and limitations | Describe the main study challenges and limitations mentioned by the authors related to using spatial analysis |
Results will be interpreted qualitatively and quantitatively and presented using a PRISMA-ScR flowchart [
The final report guided by PRISMA-ScR will include the results in flowcharts, graphs, or figures [
After carrying out the previous steps, we will prepare a summary of the results of the scoping review linked to the objective of the study. This way, the conclusion of the study will be grounded and presented effectively. We will highlight knowledge gaps that may arise in the development of the scoping review to provide direction for future studies.
This protocol will guide a scoping review to identify and map the use of spatial analysis as a tool in syphilis-related research in health care. The results will be presented according to the PRISMA-ScR guidelines [
This protocol will enable method replication following the principles of open science [
Data collection is projected to start in June 2023 and end in July 2023. Data analysis is scheduled to take place in August and September 2023. We expect to publish the results of the scoping review in the final months of 2023.
This protocol will guide a scoping review to identify and map the use of spatial analysis as a tool in syphilis-related research in health care. Spatial analysis in health care research can identify the spatial distribution of high-incidence diseases, identify associations in their distribution with determining factors, and support direct health planning and actions [
The United Nations proposed the elimination of congenital syphilis by 2030, reducing its incidence to 0.5 cases per 1000 live births [
The research team involved in this protocol has experience studying syphilis and spatial analysis and has knowledge and experience in scoping reviews. A librarian helped develop the high-sensitivity search strategy, which is based on a combination of 4 vocabularies and will expand the results and allow access to the literature; an especially important point is the lack of time and language restrictions.
A test search with terms for epidemiology, treatment, prevalence, and incidence was performed in the thematic context group (on the use of spatial analysis in health care). However, the search had restricted results and directed the research question to a certain type of technique, creating bias. Thus, we left the “context” field empty and searched for all possibilities for using spatial analysis in health care.
The study limitations will include the lack of a search for institutional sites in all countries (ie, for gray literature at these sites), but this should not affect study development. We will select essential databases to minimize this limitation. The use of descriptors and search terms in only English and Portuguese may be another limitation of the study.
This study protocol presents the main methodological steps that will guide the proposed scoping review and identify and map studies that use spatial analysis as a tool in syphilis-related research in health care. The review may reveal areas with the highest incidence of syphilis, identify which countries most use spatial analysis to study syphilis, and determine the applicability of the technique for syphilis research in each continent.
The results will be published in open access and peer-reviewed journals, favoring the dissemination of knowledge in the scientific community.
Table S1. Complete strategy for searching Medline/Pubmed.
Biblioteca Virtual en Salud
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Cumulative Index to Nursing and Allied Health Literature
Descritores em Ciências da Saúde
Joanna Briggs Institute
population, concept, context
Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Extension for Scoping Reviews
International Prospective Register of Systematic Reviews
All authors declared that they had insufficient or no funding to support open access publication of this manuscript, including from affiliated organizations or institutions, funding agencies, or other organizations. JMIR Publications provided article processing fee (APF) support for the publication of this article. Part of the APF was supported by the Sífilis Não program, a project by the Brazilian Ministry of Health in partnership with the Federal University of Rio Grande do Norte.
JdCD contributed to conception of the study; JdCD, RHL, and RARdS contributed to study methodology; JdCD, RHL, and RARdS contributed to data management; JdCD, RHL, YTP, and CdSRM contributed to formal analysis; RARdS contributed to administration and supervision; JdCD and RHL contributed to original writing; and JdCD, RHL, YTP, CdSRM, and RARdS contributed to writing, review, and editing of the manuscript. All authors read and agreed with the final version of the manuscript.
None declared.