Table 4

Strength of evidence from qualitative data

Health domainQuality*Quantity†Consistency‡Strength of evidence§
Pain and injuryFive good, two fair, two poor9Consistent:
100% associate WC and pain
Fatigue and energy expenditureThree good, two fair, two poor7Consistent:
100% associate WC and increased fatigue
StressTwo good, one poor3Inconsistent:
2 (66%) good quality studies associate WC and increased stress, one study found no effect
Perinatal healthTwo good, one poor3Consistent:
100% associate WC and reduced perinatal health or care access
Social vulnerabilityFive good, three fair, three poor11Consistent:
100% associate WC and worse social vulnerability
General healthTwo good2Inconsistent:
1 (50%) associate WC and poorer health, 1 (50%) associate WC and better health
  • *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.