Table 4.

Strength of evidence from qualitative data

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.