Health domain | Quality* | Quantity† | Consistency‡ | Strength of evidence§ |
Pain and injury | Five good, two fair, two poor | 9 | Consistent: 100% associate WC and pain | Strong |
Fatigue and energy expenditure | Three good, two fair, two poor | 7 | Consistent: 100% associate WC and increased fatigue | Strong |
Stress | Two good, one poor | 3 | Inconsistent: 2 (66%) good quality studies associate WC and increased stress, one study found no effect | Strong |
Perinatal health | Two good, one poor | 3 | Consistent: 100% associate WC and reduced perinatal health or care access | Strong |
Social vulnerability | Five good, three fair, three poor | 11 | Consistent: 100% associate WC and worse social vulnerability | Strong |
General health | Two good | 2 | Inconsistent: 1 (50%) associate WC and poorer health, 1 (50%) associate WC and better health | Inconclusive |
*Quality score based on CASP tool, qualitative and quantitative data of mixed methods studies rated separately, such that total number of rating scores can be greater than number of studies.
†Number of studies.
‡Inconsistent: if ≤75% of the available studies reported the same conclusion.
§Evidence based on quality, number and the outcome of studies: strong=provided by generally consistent findings in multiple high-quality qualitative studies; moderate=generally consistent findings in one high-quality study and one low-quality qualitative study, or in multiple low-quality studies; inconclusive evidence=only one study available or inconsistent findings in multiple studies.20
WC, water carriage.