Exploring the Implementation of Workplace-Focused Primary Prevention Efforts to Reduce Family Violence in a Regional City: The Need for Clarity, Capacity, and Communication

In response to the high burden of family and domestic violence (FDV), The Australian National Plan to End Violence Against Women and Children has established that primary prevention measures are necessary to reduce FDV's harmful impacts on health. The Community, Respect, and Equality (CRE) project is a primary prevention initiative aimed towards changing harmful social norms and practices that enable FDV in Geraldton, Western Australia. Organizations affiliated with the CRE are required to promote gender equality and a respectful work environment. However, there is a gap in the literature regarding the impact and effectiveness of such interventions, especially in rural/regional areas. As such, this study served to evaluate the project's effectiveness in a CRE-certified workspace, a local non-profit social services provider. Investigators conducted interviews to learn how the organization had implemented the CRE, and whether the CRE had had an impact on social norms and practices within the work environment. Findings indicated that the project had largely failed to permeate workplace culture due to a lack of effective promotion, low perceived benefits, and low resources. Future interventions must take persuasive measures, even for organizations perceived to be receptive to change.

Help-Seeking and Barriers to Care in Intimate Partner Sexual Violence: A Systematic Review

Intimate partner sexual violence (IPSV) is a prevalent phenomenon, yet an under-researched topic. Due to the complex nature of balancing love and fear, individuals who experience IPSV have unique needs and face unique barriers to seeking care. The purpose of this systematic review was to examine the literature on help-seeking and barriers to care in IPSV. Articles were identified through PubMed, CINAHL, PsycINFO, and Web of Science. Search terms included terms related to IPSV, intimate partner violence (IPV), domestic violence, sexual assault, and rape. The review was limited to the United States, and articles that were included needed to specifically measure or identify sexual violence in an intimate relationship and analyze or discuss IPSV in relation to help-seeking behaviors or barriers to care. Of the 17 articles included in this review, 13 were quantitative studies and four were qualitative studies. Various definitions and measurements of IPSV across studies included in this review make drawing broad conclusions challenging. Findings suggest that experiencing IPSV compared to experiencing nonsexual IPV (i.e., physical or psychological IPV) may increase help-seeking for medical, legal, and social services while decreasing help-seeking for informal support. Help-seeking can also reduce risk of future IPSV and decrease poor mental health outcomes. Barriers to seeking care in IPSV included social stigma, fear, and difficulty for individuals in identifying IPSV behaviors in their relationships as abuse. More inclusive research is needed among different populations including men, non-White individuals, nonheterosexual, and transgender individuals. Suggestions for research, practice, and policies are discussed.

Experiences of mental health professionals providing services to adults with intellectual disabilities and mental health problems: A systematic review and meta-synthesis of qualitative research studies

BACKGROUND

Mental health professionals play an important role in providing care and treatment for adults with intellectual disabilities. A number of studies use qualitative methods to explore the experiences of these professionals and their perspectives regarding the mental health services for this population. A systematic review using meta-ethnographic approach was undertaken to summarise this research.

METHOD

A systematic search found 14 relevant studies which were critically appraised. Key themes from these studies were extracted and synthesised.

RESULTS

Three main themes were identified: 1) Understanding the person, 2) Relational interaction and 3) Organisational factors.

CONCLUSIONS

The findings of this review identified the issues mental health professionals raised in relation to their work. They described the complex presenting problems as intense yet fulfilling therapeutic relationships with their clients and their wish to improve their knowledge and skills. They identified organisational issues that need to be addressed to improve staff morale and efficiency.

Identifying the Assumptions and Bias That Affect Screening and Brief Interventions for Harmful Alcohol Use

BACKGROUND

Screening for harmful alcohol use (HAU) is standard in clinical settings; however, self-reports of the quantity/frequency of use are often inconsistent with population survey data and objective assessment. Inaccuracies of self-reported alcohol use prompt exploration of patients' reluctance to share this information with their health care providers.

OBJECTIVES

The purpose of this article is to identify the assumptions and biases that affect screening and brief interventions for HAU.

METHOD

A total of 22 research articles were selected for a systematic review of the literature. The studies included prospective and retrospective studies, randomized controlled trials, case studies, and quantitative and qualitative research from 2015 to 2021.

RESULTS

This systematic review identified alcohol health literacy, the inherent bias of surveys and screening tools, stigma, avoidance bias, and the normalization/villainization of alcohol use as contributors to the assumptions and biases that affect screening and brief interventions for HAU.

CONCLUSIONS

Exploring these assumptions and biases presents opportunities to develop strategies that promote positive change.

Research Self-Efficacy and Productivity in Communication Sciences and Disorders Faculty

INTRODUCTION

In the field of Communication Sciences and Disorders (CSD) emphasis is placed on advancing research to inform evidence based practice. However, there is little information about the research support and productivity of current faculty members in the discipline. The aims of this study are: to describe the resources and workload of faculty at different types of institutions; to examine whether self-perception of research self-efficacy differs between faculty across institution types; and to investigate whether self-efficacy, institutional factors, or workload characteristics predict research productivity.

METHODS

CSD faculty (N = 144) completed an online survey about their institutions, departments, and research resources. Respondents rated their research self-efficacy using the Quantitative and/or Qualitative Research Self Efficacy Inventory. Total Research Productivity was tallied using the Total Research Productivity Index. Responses were analyzed according to the respondent institution's Carnegie Classification and faculty rank to provide a more comprehensive picture of faculty experiences at different kinds of institutions.

RESULTS

Faculty across institution types are equally confident in their research abilities and their confidence is related to similar tasks overall. Departmental resources for research are aligned with Carnegie Classifications of institutions. Faculty at research-focused institutions showed overall higher research productivity but also reported spending similar time on departmental service and teaching. Research productivity was predicted by Carnegie Classification and time spent in advisement and clinic supervision. Limited opportunities for doctoral funding and engagement of post-doctoral research fellows were noted.

CONCLUSIONS

The results of this study further our understanding of the resources and limitations for research in different types of programs that offer CSD degrees. This information is necessary to inform policy decisions regarding academic careers in CSD, provide context for students considering an academic career, and enhance the research productivity of the field.

Methodological standards for qualitative and mixed methods patient centered outcomes research

The Patient-Centered Outcomes Research Institute’s (PCORI) methodology standards for qualitative methods and mixed methods research help ensure that research studies are designed and conducted to generate the evidence needed to answer patients’ and clinicians’ questions about which methods work best, for whom, and under what circumstances. This set of standards focuses on factors pertinent to patient centered outcomes research, but it is also useful for providing guidance for other types of clinical research. The standards can be used to develop and evaluate proposals, conduct the research, and interpret findings. The standards were developed following a systematic process: survey the range of key methodological issues and potential standards, narrow inclusion to standards deemed most important, draft preliminary standards, solicit feedback from a content expert panel and the broader public, and use this feedback to develop final standards for review and adoption by PCORI’s board of governors. This article provides an example on how to apply the standards in the preparation of a research proposal.

A unified framework for bias assessment in clinical research

Methodological flaws, limitations, and inadequate practices in research are well known and pose threats to the internal validity of any research study. However, there are ways of safeguarding research conduct to reduce the chance of research producing distorted results. Numerous tools now exist to assess the incorporation of such safeguards into primary research studies (also known as quality and/or risk-of-bias assessment). These tools typically include a variety of items that are then checked against those implemented in the study. Despite a lot of research in this area, no comprehensive generic classification of safeguards across study designs exist, although attempts have been made to clarify aspects of this. We review the developments in this area as well as use preliminary data from 100 methodological studies to illustrate our proposed approach. We conclude by proposing a new framework for identifying research studies at risk of being biased and the information in this article will promote a unification of the diverse approaches to facilitating bias assessment in clinical research.

Feasibility, Process, and Effects of Short-Term Calorie Reduction in Cancer Patients Receiving Chemotherapy: An Integrative Review

Recent preclinical studies have shown the potential benefits of short-term calorie reduction (SCR) on cancer treatment. In this integrative review, we aimed to identify and synthesize current evidence regarding the feasibility, process, and effects of SCR in cancer patients receiving chemotherapy. PubMed, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, PsychINFO, and Embase were searched for original research articles using various combinations of Medical Subject Heading terms. Among the 311 articles identified, seven studies met the inclusion criteria. The majority of the reviewed studies were small randomized controlled trials or cohort study with fair quality. The results suggest that SCR is safe and feasible. SCR is typically arranged around the chemotherapy, with the duration ranging from 24 to 96 h. Most studies examined the protective effects of SCR on normal cells during chemotherapy. The evidence supports that SCR had the potential to enhance both the physical and psychological wellbeing of patients during chemotherapy. SCR is a cost-effective intervention with great potential. Future well-controlled studies with sufficient sample sizes are needed to examine the full and long-term effects of SCR and its mechanism of action.

Diet and nutrition information and support needs in pelvic radiotherapy: A systematic, mixed-methods review

INTRODUCTION

This study aimed to review diet and nutrition information and support needs of cancer patients who receive pelvic radiotherapy to inform the development of interventions to improve this area of care.

METHODS

The systematic review followed the PRISMA guidelines. Six electronic databases were searched for peer-reviewed studies of any design that assessed diet and nutrition needs after a pelvic cancer diagnosis. Narrative synthesis was used to integrate findings.

RESULTS

Thirty studies (12 quantitative, 15 qualitative, 3 mixed-methods) were included. Four themes, "content of dietary information"; "sources of information"; "sustaining dietary change"; and "views on the role of diet post-treatment," summarised evidence about provision of nutritional guidance following diagnosis, but also contrasting views about the role of diet post-diagnosis. Qualitative studies contributed considerably more to the synthesis, compared to quantitative studies. Included studies were of moderate to good quality; selection bias in quantitative studies and poor evidence of credibility and dependability in qualitative studies were highlighted.

CONCLUSION

There is some evidence of lack of nutrition support in pelvic cancer survivors, but methodological limitations of included studies may have had an impact on the findings. Future, prospective studies that focus on diet and nutrition needs post-diagnosis are warranted to improve care.

Supporting Independence at Home of People with Autism Spectrum Disorder: Literature Review

BACKGROUND.

The integration of a life environment enabling people with autism spectrum disorder (ASD) to fully exercise their independence must be well prepared.

PURPOSE.

Review and describe interventions intended to develop the independence at home of people with ASD.

METHOD.

The PRISMA method was used to perform a systematic review based on 19 keywords, grouped under three concepts: (a) population age (adolescents and adults), (b) diagnosis (ASD), and (c) independence.

FINDINGS.

Seven effective interventions were identified in the 20 selected articles: (a) video self-modeling, (b) video modeling, (c) behavioural interventions, (d) video prompting, (e) transition planning program, (f) training in the use of a cognitive aid, and (g) social skills group.

IMPLICATIONS.

The results of this review will help guide practitioners in the implementation of interventions that foster the development of independence at home of people with ASD.

Green walking groups: A mixed-methods review of the mental health outcomes for adults with mental health problems

Introduction

Evidence suggests group walking in natural environments is more beneficial to the general population’s mental health than walking indoors, in urban environments, and alone. Such ‘green walking groups’ have been suggested as an occupational therapy intervention that could be suitable for adults with mental health problems. However, there have been no reviews of the mental health outcomes of participating in green walking groups for this population.

Method

A mixed-methods literature review was conducted. A range of databases was systematically searched electronically. Papers that met pre-defined inclusion criteria were selected, critically appraised, and qualitative and quantitative data were extracted. Thematic analysis was used to identify key qualitative outcomes.

Findings

Six papers were included and eight mental health outcomes identified. The evidence suggests participants can experience connections with other people, connections with nature, and a sense of freedom. There is some limited evidence to support improvements to mood, self-esteem, reflection on life tasks, and symptoms of depression, with mixed evidence for experiencing a sense of achievement.

Conclusion

This review can be used to build the evidence base for the link between occupation and mental health, and inform the clinical decision-making of occupational therapists, who are well-placed to design and implement green walking groups.

Experiences of computer-based and conventional self-help interventions for eating disorders: A systematic review and meta-synthesis of qualitative research

OBJECTIVE

Self-help interventions have been demonstrated to be effective in treating bulimic-type eating disorders (EDs). In particular, computer-based interventions have received increasing attention due to their potential to reach a wider population. This systematic review aimed to synthesize findings from qualitative studies on users' experiences of self-help interventions for EDs and to develop an exploratory framework.

METHOD

A systematic review and meta-synthesis on seven peer-reviewed qualitative studies on structured computer and book-based self-help interventions for EDs was conducted using Noblit and Hare's (1988) 7-phase meta-ethnography. Four of the selected studies investigated computer-based self-help programs, and three of the studies investigated book-based guided self-help programs.

RESULTS

Six concepts were synthesized. They included intervention-related factors (anonymity and privacy; accessibility and flexibility; guidance) and user-related factors (agency/autonomy; self-motivation; and expectations/attitudes). The study revealed the "machine-like" and relational properties of the computer; the expansion of treatment time and space in psychological interventions, the changing role of the medical health professional from a "therapist" to a "guide," and a change from understanding interventions as a conclusive treatment plan to a starting point or stepping stone toward recovery.

DISCUSSION

Computer-based self-help interventions should take advantage of the "machine-like" properties of a computer (neutrality, availability, etc.) as well as its ability to facilitate human interactions. Users should also be facilitated to have a realistic understanding of the purpose of self-help interventions and the place of self-help interventions in their broader treatment plans to moderate expectations and attitudes.

Women's recovery from anorexia nervosa: a systematic review and meta-synthesis of qualitative research

Anorexia nervosa (AN) is a complex and challenging condition and recovery can be a slow and difficult process. Predicting factors remain largely unknown. This paper aims to systematically review qualitative studies which have investigated female service users' experiences of recovering from AN and carry out a meta-synthesis of the themes they identified. Meta-ethnography was used to select and synthesize the studies. Articles published between 2002 and 2017 were searched in PsycInfo, EMBASE, CINAHL and Medline. Studies were included if they explored recovery from AN using a qualitative methodology. The methodological quality of the studies was systematically and critically appraised. Fourteen studies were selected for inclusion. Common themes reported by participants describe the process of recovery from AN as dealing with a fragmented sense of self, a turning point where insight and commitment to recovery is developed, and, in recovery, a reclamation of self through meaningful relationships, rebuilding identity and self-acceptance. Recovery from AN is experienced as a complex psychological process with many contributing factors. Findings highlight the need to reconsider clinical practice and treatment provision to incorporate the psychological components of self-identity into recovery programs.

Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: first stage in the development of the CAMELOT tool

BACKGROUND

Qualitative evidence synthesis is increasingly used alongside reviews of effectiveness to inform guidelines and other decisions. To support this use, the GRADE-CERQual approach was developed to assess and communicate the confidence we have in findings from reviews of qualitative research. One component of this approach requires an appraisal of the methodological limitations of studies contributing data to a review finding. Diverse critical appraisal tools for qualitative research are currently being used. However, it is unclear which tool is most appropriate for informing a GRADE-CERQual assessment of confidence.

METHODOLOGY

We searched for tools that were explicitly intended for critically appraising the methodological quality of qualitative research. We searched the reference lists of existing methodological reviews for critical appraisal tools, and also conducted a systematic search in June 2016 for tools published in health science and social science databases. Two reviewers screened identified titles and abstracts, and then screened the full text of potentially relevant articles. One reviewer extracted data from each article and a second reviewer checked the extraction. We used a best-fit framework synthesis approach to code checklist criteria from each identified tool and to organise these into themes.

RESULTS

We identified 102 critical appraisal tools: 71 tools had previously been included in methodological reviews, and 31 tools were identified from our systematic search. Almost half of the tools were published after 2010. Few authors described how their tool was developed, or why a new tool was needed. After coding all criteria, we developed a framework that included 22 themes. None of the tools included all 22 themes. Some themes were included in up to 95 of the tools.

CONCLUSION

It is problematic that researchers continue to develop new tools without adequately examining the many tools that already exist. Furthermore, the plethora of tools, old and new, indicates a lack of consensus regarding the best tool to use, and an absence of empirical evidence about the most important criteria for assessing the methodological limitations of qualitative research, including in the context of use with GRADE-CERQual.

A Critical Review of the Impact of Sarcoma on Psychosocial Wellbeing

Background

Previous reviews of outcomes in specific sarcoma populations suggest patients have poor quality of life. In most of these reviews, there is a predominant focus on physical function rather than psychosocial outcome. The aim of this review was to describe the psychosocial impact of diagnosis and treatment on patients with all types of sarcoma.

Methods

Searches were conducted through six electronic databases for publications of any study design using a validated patient-reported outcome measure reporting the psychosocial impact in this population.

Results

Eighty-two studies fulfilled the inclusion criteria. Most (65%) were assessed of being of reasonable quality. The most common aspect of psychosocial wellbeing measured was quality of life (80%). Due to the heterogeneity of methods, outcomes, and populations, it was not possible to make definitive conclusions. It seems there is an improvement in the physical aspects of quality of life over time but not in psychosocial function or mental health. There was no change in mental health scores, but patients reported an improvement in adjusting to normal life. There are no differences according to the type of surgery patients receive, and psychosocial outcomes tend to be poorer than the general population. There is no consistency in identifying the factors that predict/influence psychosocial wellbeing.

Conclusion

The published literature does not provide a clear understanding of the impact of sarcoma diagnosis and treatment on psychosocial wellbeing. Instead, the review demonstrates a need for well-designed studies in this area and a more consistent approach to the measurement of patient-reported outcomes, which include psychosocial domains. Recommendations for future research have been proposed.

Reproductive Coercion: A Systematic Review

Reproductive coercion is a behavior that interferes with the autonomous decision-making of a woman, with regard to reproductive health. It may take the form of birth control sabotage, pregnancy coercion, or controlling the outcome of a pregnancy. The objectives of this article are to address the questions: (1) What is known about reproductive coercion, its prevalence, and correlates? (2) What strategies do women use to preserve their reproductive autonomy when experiencing reproductive coercion? (3) What interventions are effective to decrease reproductive coercion? In this review of 27 research studies, 12 contained findings regarding the general phenomenon of reproductive coercion and 19 contained findings about at least one component of reproductive coercion. Additionally, 11 studies contained findings related to the intersection of intimate partner violence (IPV) and reproductive coercion, 6 presented data on strategies women use to resist reproductive coercion, and 3 included intervention data. Variation in measurement makes synthesis of prevalence and correlate data challenging. The reviewed literature presents reproductive coercion as a phenomenon that disproportionately affects women experiencing concurrent IPV, women of lower socioeconomic status, single women, and African American, Latina and multiracial women. Women who experience reproductive coercion were found to present frequently for certain health services. Most data on reproductive coercion are descriptive, and there is need for further research to examine the co-occurrence with related phenomena such as IPV and unintended pregnancy. More research is also needed on the strategies women use to resist reproductive coercion as well as interventions aimed at survivors and perpetrators of reproductive coercion and health-care providers who encounter them.

Prostate cancer and the impact on couples: a qualitative metasynthesis

PURPOSE

To review and interpret existing qualitative literature on the experiences of couples affected by prostate cancer (PCa).

METHODS

A metasynthesis was carried out which included a systematic search of seven databases between 2000 and 2016. A modified version of Noblit and Hare's meta-ethnographic approach was used to synthesise qualitative study findings and inform overarching interpretations.

RESULTS

Thirty-seven studies focusing on the experiences of men with PCa and their partner dyad were included producing seven interconnected constructs. The construct accepting change vs seeking continuity reflects the range of ways individuals within the dyad and couples adjust to the diagnosis. Cultivating connection vs disengaging illustrates how couples seek to manage the impact of PCa and its treatment on their relationship, which may lead to a threatened identity, including sexual insecurities. Shielding me, you and us reflects the ways in which couples strive to protect themselves as individuals and/or each other from the impact of PCa. Being a partner and its challenges highlights the responsibilities partners assume and the impact of their supporting role. Yet, partners sometimes report feeling unsupported and side-lined both by the man they are caring for and by healthcare professionals. Couples often recognise the value of facing PCa together.

CONCLUSIONS

PCa affects both members of the dyad as individuals, as well as the couple's relationship. How best to support couples and how to overcome difficulties in expressing their concerns to one another requires further consideration. Healthcare professionals should endeavour to employ a couple-focused approach where appropriate.

Family resilience and adaptive coping in children with juvenile idiopathic arthritis: protocol for a systematic review

BACKGROUND

This systematic review is the first step in a study investigating the resilience methods and processes in families of children with juvenile idiopathic arthritis. In particular, this review will focus on chronic or persistent pain, as a common symptom of juvenile idiopathic arthritis, which is the most common rheumatic disease in childhood. The experience of persistent pain can add to the functional disability associated with juvenile idiopathic arthritis. Resilience has relevance to all areas of paediatric psychology, and targeted attention to child, sibling, and parent strengths within the context of paediatric chronic pain and juvenile idiopathic arthritis in particular will augment the field on numerous levels. The objective is to determine which resilience processes are associated with a favourable quality of life in terms of academic, communication, emotional, interpersonal, physical, psychological, and social well-being in families of children with chronic pain associated with JIA.

METHODS/DESIGN

This systematic review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the PRESS (Peer Review of Electronic Search Strategies) guideline. Longitudinal, cross-sectional, and treatment studies written in English will be included, as will grey literature (i.e. conference abstracts and dissertations). Studies involving participants who are 6-18 years of age, have been diagnosed with juvenile idiopathic arthritis, are experiencing chronic pain, and are currently undergoing treatment will be included regardless of sex, arthritis type, and type of treatment. Studies including siblings who are 6-18 years of age and the patient's parents will be included.

DISCUSSION

Research exploring resilience within the adult population is accruing. Shifting our focus to protective factors of resilience in the context of paediatric chronic pain, specifically juvenile idiopathic arthritis, is a novel and promising pursuit that has the potential to optimize and inform future clinical practice and interventions. A better understanding of the role of reliance in family adaptation will facilitate the development of more effective treatment approaches and lay the foundation for more effective self-management in paediatric chronic pain.

SYSTEMATIC REVIEW REGISTRATION

This protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (registration: CRD42016047226).

Grip Strength in Women Being Treated for Breast Cancer and Receiving Adjuvant Endocrine Therapy: Systematic Review

BACKGROUND

Adjuvant endocrine therapy in breast cancer has increased survival rates; however, it is not without musculoskeletal side effects.

PURPOSE

The purpose of this review was to systematically and critically appraise the available scientific evidence concerning the effect of adjuvant endocrine treatment on grip strength in women being treated for breast cancer.

DATA SOURCES AND STUDY SELECTION

The National Library of Medicine (MEDLINE-PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medical Database by Elsevier (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence Database (PEDro) were searched from inception to February 2017 for appropriate papers that could answer the focused question. The searches were independently screened by 2 reviewers. The data from 7 papers that met the eligibility criteria were processed for further analysis.

DATA EXTRACTION AND SYNTHESIS

The collective data and the statistical analysis of all included studies were summarized and presented in a descriptive manner. If not provided, based on data from the individual included studies, a mean percent change in grip strength was calculated. The included studies evaluating aromatase inhibitors had inconclusive outcomes, and studies with a follow-up of 6 or 12 months showed a percent reduction in grip strength varying from 0.1% to 9.7%. None of the included studies showed a significant decrease in grip strength in tamoxifen users, with a percent reduction in grip strength varying from 1.4% to 2.2%.

LIMITATIONS

The 7 studies included cohort studies lacking a control group.

CONCLUSIONS

There is inconclusive evidence for a small decrease in grip strength in women treated for breast cancer who are also receiving aromatase inhibitors. In those that use tamoxifen, grip strength did not change significantly.

Cancer Nursing Research Output in Africa 2005 to 2014: An Integrative Review

BACKGROUND

This study is the first review of African cancer nursing research as only 1 review focusing on South Africa was conducted in the past decade.

OBJECTIVE

The aim of this study was to identify, summarize, and synthesize the findings from previous independent studies conducted by nurses in Africa.

METHODS

The terms cancer nursing and oncology nursing and Africa were used to search PubMed, CINAHL, Web of Science, SA e-publications, and Scopus. Studies reporting research conducted in an African setting, coauthored by a nurse affiliated with an African institution and published between January 1, 2005, and December 31, 2014, in English were included. A data extraction sheet captured the data.

RESULTS

A potential 536 articles for possible inclusion were identified. Fifty met the inclusion requirements. Cancer in women (78%; n = 39) and prevention and early detection (62%; n = 31) were most commonly investigated. The work was primarily quantitative and collected data on some knowledge aspect from women in the community. Most of the studies (96%; n = 48) did not meet the criteria of high-quality work.

CONCLUSIONS

Africa's nurses have improved their research output in the field of cancer nursing considerably. Research focusing on the most prevalent cancers, the treatment, the patient living with cancer, the family, extended family, and community is lacking, as is work focusing on pain and other symptoms.

IMPLICATIONS FOR NURSING PRACTICE

Nurses in practice should assist nurse researchers to address the identified knowledge gaps to develop cancer nursing science and practice tailored to meet the unique needs of Africa.

Promotion of Well-being During Treatment for Childhood Cancer: A Literature Review of Art Interventions as a Coping Strategy

BACKGROUND

Scientific literature suggests that art interventions can assist children with cancer cope with physical and psychosocial difficulties associated with cancer treatment. Little is known about how the making of tangible visual art can be helpful and which proposed therapeutic mechanisms are clinically important.

OBJECTIVE

The purpose of this literature review is to assess and synthesize the research evidence regarding the role of art therapy/art-making interventions for promoting the well-being of children with cancer undergoing treatment.

METHODS

A search of electronic databases (MEDLINE [PubMed], CINAHL, PsycINFO) and EBM Reviews including Cochrane Database of Systematic Reviews (OVID) and manual review of references in articles accessed were undertaken. Inclusion criteria were as follows: research studies of any design; children with cancer undergoing treatment (2-21 years old), and art therapy/art-making intervention. Data extraction and quality appraisal were undertaken. Data were analyzed with an author-developed review sheet and synthesized into a table.

RESULTS

Six articles reporting 6 studies met the inclusion criteria. Studies were based on qualitative (n = 3) and mixed quantitative/qualitative (n = 3) methodologies. Three outcome categories emerged that outline potential therapeutic roles of art interventions.

CONCLUSIONS

Though sparse and developmental in nature, the existing evidence suggests that art interventions may potentially promote the well-being of children undergoing cancer treatment by reducing anxiety, fear, and pain and promoting collaborative behaviors; enhancing communication with the treatment team; and counteracting the disruption of selfhood that cancer treatment evokes.

IMPLICATIONS FOR PRACTICE

Further and higher-quality research is warranted before routinely integrating standardized art interventions into the treatment protocols for children with cancer.

A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men

Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.

Evidence and Evidence-Based Practices: Are We There Yet?

The purpose of this article is to move the field of intellectual and closely related developmental disabilities (IDD) towards a better understanding of evidence and evidence-based practices. To that end, we discuss (a) different perspectives on and levels of evidence, (b) commonly used evidence-gathering strategies, (c) standards to evaluate evidence, (d) the distinction between internal and external validity, and (e) guidelines for establishing evidence-based practices. We also describe how the conceptualization and use of evidence and evidence-based practices are changing to accommodate recent trends in the field.

A Systematic Review of Reproductive Coercion in International Settings

Reproductive coercion is behavior that interferes with a woman's autonomous reproductive decision-making. It may take the form of birth control sabotage, pregnancy coercion, or controlling the outcome of a pregnancy. Perpetrators may be partners, a partner's family, or the woman's family. This article reviews the literature on reproductive coercion in international settings. In this review of 10 research studies, findings are presented on prevalence and type of reproductive coercion, associated factors, specific tactics, relationship with intimate partner violence and domestic violence (in-laws particularly), and implications for women's reproductive health. Findings highlight reproductive coercion as a subset of intimate partner violence that is poorly understood, especially in international settings. More research is needed on protective factors, how interventions can capitalize on protective factors, and the strategies women use to resist reproductive coercion. Policy implications and recommendations are discussed with particular attention to issues related to diverse social and cultural environments.

Responding to maternal distress: from needs assessment to effective intervention

OBJECTIVES

To perform a needs assessment of maternal distress to plan the development of an intervention for the prevention and reduction of antenatal maternal distress.

METHODS

We searched PubMed, OVID and EBSCO and applied the PRECEDE logic model to select the data. Experts in the field validated the findings.

RESULTS

We identified 45 studies. Maternal distress was associated with diminished maternal and child's quality of life. Aetiological factors of maternal distress included past and present circumstances related to obstetric factors and to a woman's context of living, coping behaviour, and support mechanisms. Lacking knowledge of coping with (maternal) distress was identified as a predisposing factor. Reinforcing factors were relaxation, partner support, counselling experiences and positive interaction with the midwife. Enabling factors were the availability of a support network.

CONCLUSIONS

When planning the development of an antenatal intervention for maternal distress, it is advisable to focus on assessment of antenatal emotional wellbeing, the context of the woman's past and present circumstances, her coping behaviour and her environment. The identified predisposing factors, enabling and reinforcing factors should also be taken into consideration.

Ethnicity and the prostate cancer experience: a qualitative metasynthesis

Objectives

To summarize black and minority ethnic (BME) patients' and partners experiences of prostate cancer by examining the findings of existing qualitative studies.

Methods

We undertook a systematic metasynthesis of qualitative studies using a modified version of Noblit and Hare's “meta‐ethnography” approach, with a 2000‐2015 search of 7 databases.

Results

Thirteen studies of men from US and UK BME groups were included. We explored constructs with BME‐specific features. Health care provider relationships, formation of a spiritual alliance with God (which enhanced the participants' feeling of empowerment and ability to cope with the cancer), and living on for others (generally to increase cancer awareness), often connected to spiritual regrowth, were the 3 constructs most commonly reported. A magnified effect from erectile dysfunction was also common. Initially, this affected men's disclosure to others about their cancer and their sexual problems, but eventually men responded by shifting their conceptualizations of masculinity to sustain self and social identities. There was also evidence of inequality resulting from financial constraints and adversity that necessitated resilience in coping.

Conclusions

The prostate cancer experience of BME men and their partners is affected by a complex intersection of ethnicity with other factors. Health care services should acknowledge this. If providers recognize the men's felt masculinities, social identities, and spiritual beliefs and their shifting nature, services could be improved, with community as well as individual benefits. More studies are needed in diverse ethnic groups.

Diffusion tensor tractography imaging in pediatric epilepsy - A systematic review

PURPOSE

Recent years brought several experimental and clinical reports applying diffusion tensor tractography imaging (DTI) of the brain in epilepsy. This study was aimed to evaluate current evidence for adding the DTI sequence to the standard diagnostic magnetic resonance imaging (MRI) protocol in pediatric epilepsy.

MATERIAL AND METHODS

Rapid and qualitative systematic review (RAE, Rapid Evidence Assessment), aggregating relevant studies from the recent 7 years. The PubMed database was hand searched for records containing terms "tractography AND epilepsy." Only studies referring to children were included; studies were rated using "final quality of evidence."

RESULTS

Out of 144 screened records, relevant 101 were aggregated and reviewed. The synthesis was based on 73 studies. Case-control clinical studies were the majority of the material and comprised 43.8% of the material. Low 'confirmability' and low 'applicability' referred to 18 and 17 articles (29.5% and 27.9%), respectively. The sufficient quality of evidence supported performing DTI in temporal lobe epilepsy, malformations of cortical development and prior to a neurosurgery of epilepsy.

CONCLUSIONS

The qualitative RAE provides an interim estimate of the clinical relevance of quickly developing diagnostic methods. Based on the critical appraisal of current knowledge, adding the DTI sequence to the standard MRI protocol may be clinically beneficial in selected patient groups with childhood temporal lobe epilepsy or as a part of planning for an epilepsy surgery.

The need for evidence-based public health response in disasters

AIM

Broad outline of this paper was presented at the Evidence Aid Symposium, on 20 Sep 2014, at Hyderabad, India, before the 22nd Cochrane Colloquium.

METHODS

Survey of the field and review of literature.

RESULTS

Response to disasters is usually vulnerable to myths and misconceptions. Effective healthcare response requires evidence and information to meet various and often unpredictable eventualities. The knowledge base should facilitate rapid assessment of adverse health outcomes, availability healthcare infrastructure, appropriate organizational strategies, and selection of feasible medical interventions to deal with any given disaster. Most rapid surveys have to adopt some stratification and a cluster sampling design for representativeness. Qualitative research methods are useful to study organizational challenges. Adequate and accurate description of the context is important for interpretation of organization behavior studies. Testing efficacy of medical interventions by randomized trials is usually difficult, unless feasible study designs are planned in advance and ready for execution at short notice. A lot of disaster healthcare research literature is based on surveys and case studies, as these are more feasible. Hence, systematic reviews ought to rate the level of evidence from qualitative studies and adequately summarize the context of case studies.

CONCLUSIONS

Research on health response to disaster has picked up momentum only recently in the 21(st) century. There is also a need to develop disaster healthcare research capacities to address regional vulnerabilities. Generating evidence is not enough. Concerted societal action is needed to sensitize, train, and equip adequate human resources to fill in various key emergency medical and public health roles when disaster strikes.

Choosing the Best Evidence to Guide Clinical Practice: Application of AACN Levels of Evidence

Evidence-based nursing care is informed by research findings, clinical expertise, and patients’ values, and its use can improve patients’ outcomes. Use of research evidence in clinical practice is an expected standard of practice for nurses and health care organizations, but numerous barriers exist that create a gap between new knowledge and implementation of that knowledge to improve patient care. To help close that gap, the American Association of Critical-Care Nurses has developed many resources for clinicians, including practice alerts and a hierarchal rating system for levels of evidence. Using the levels of evidence, nurses can determine the strength of research studies, assess the findings, and evaluate the evidence for potential implementation into best practice. Evidence-based nursing care is a lifelong approach to clinical decision making and excellence in practice.

The role of patient experience and its influence on adherence to antidepressant treatment

Major depression can be a very challenging illness and although antidepressant agents are shown to provide benefit, many patients do not adhere to antidepressant treatment guidelines. Multiple factors contribute to adherence, including the influence of patient experience. The purpose of this article is to conduct a systematic review on the influence of patient experience with depression and antidepressant agents on treatment adherence. Thirteen research articles were selected for the review and revealed that patient past experience with depression and antidepressant agents, vicarious experiences, beliefs and attitudes, and the treatment experience itself can impact adherence. It is important for providers to be vigilant with assessment and include patient experience when developing a plan of care. This approach encourages shared decision making and a patient-centered focus for improved management of depression.

How an Occupational Therapist Should Conceptualise Self-Awareness following Traumatic Brain Injury in Childhood — A Literature Review

Introduction:

The development of self-awareness across childhood is a complex and protracted phenomenon. Little is known about the consequences of an interruption to development as a result of a traumatic brain injury in childhood. The aim of this paper was to review the available literature on self-awareness in children following a traumatic brain injury and relate the findings to occupational therapy practice with this group of children and young people.

Method:

A comprehensive search of the current literature relating to self-awareness following a traumatic brain injury.

Findings:

A small amount of theoretical and qualitative literature was sourced and critically appraised using appropriate tools. Although only nine relevant papers were identified, those that were evaluated were found to be of a high quality. The findings were supplemented with additional material from developmental psychology and adult brain injury literature.

Conclusion:

Occupational therapists are encouraged to conceptualise self-awareness in childhood traumatic brain injury within a developmental context. A fuller understanding of self-awareness in childhood and the consequences of an interruption to its development will help to establish age-appropriate interventions.

Older Adults' Experiences of Occupational Therapy Predischarge Home Visits: A Systematic Thematic Synthesis of Qualitative Research

Background:

Occupational therapists in many countries routinely perform predischarge home visits. Although there have been repeated calls to ascertain whether predischarge home visits are clinically and cost effective, there has been a tendency to neglect users' perceptions and experiences of this intervention.

Objective:

The objective was to conduct a systematic thematic synthesis of older adults' perceptions and experiences of predischarge home visits.

Method:

The search strategy was an electronic database search. Conference proceedings were hand searched and universities and occupational therapy professional bodies within Europe, Australia and North America were contacted.

Results:

Forty-four studies were initially identified, of which 13 studies (7 published, 6 unpublished) were selected for detailed screening. Only three qualitative studies met the inclusion criteria and, from this synthesis, two main themes emerged from the data. The first theme was older adults' perceptions of home visits and the second theme was acceptance of occupational therapy.

Conclusion:

Only a limited body of research has been conducted. This is surprising given the number of predischarge home visits that are performed. This thematic synthesis of qualitative research has highlighted that insufficient attention has been paid to older adults' perceptions of predischarge home visits.

Work-related cardiovascular disease risk factors using a socioecological approach: implications for practice and research

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of mortality. Numerous investigations have linked occupational factors and CVD. Occupational factors such as overtime work have an enormous effect on the CVD risk of industrial workers. However, risk factors for CVD are not systematically reviewed in the workplace. The purpose of the paper is to review work-related risk factors for CVD.

METHODS

A systematic review of work-related CVD risk factors was performed, yielding 180 articles. All articles were assessed in relation to inclusion and exclusion criteria, resulting in 44 articles being reviewed. The sole inclusion criteria was work-related environmental factors and intra/inter-personal factors (psychosocial factors), which is based on the socioecological perspective. The articles were also assessed regarding the quality of each study using the scoring methods developed by Cesario et al. and Brown et al.

CONCLUSION

The literature review demonstrated that work environment factors such as shift work, overtime work, and noise and chemical exposures; and psychosocial factors such as job stress, social support, and socioeconomic status cannot be explained or intervened by one single risk factor. Furthermore, certain occupational factors were shown to aggravate or attenuate other risk factors. The implication of these findings is to incorporate work-related environmental and psychosocial factors into assessment of the patient's CVD risks and intervention plan. Future research should also incorporate a well-defined conceptual framework to address the effects of work-related environmental and psychosocial factors on CVD among CVD patients.

Person-centered planning: analysis of research and effectiveness

Person-centered planning is a well known and widely used approach to individual program planning in the field of intellectual and developmental disabilities. Its purpose is to develop collaborative supports focused on community presence, community participation, positive relationships, respect, and competence. Because there is little research on its effectiveness, our purpose here was to (a) review the current status of effectiveness research; (b) describe its effectiveness in terms of outcomes or results; and (c) discuss the effectiveness of person-centered planning in relation to evidence-based practices. Analyzed studies suggest that, overall, this planning has a positive, but moderate, impact on personal outcomes for this population. The body of evidence provided in this review is weak with regard to criteria for evidence-based research.

Psychosocial adjustment of siblings of children with cancer: a systematic review

OBJECTIVES

To promote a broader understanding of the psychosocial impact of childhood cancer on siblings, a systematic review was undertaken. Directions for future research are proposed and clinical strategies are suggested for addressing the needs of these children.

METHODS

Searches of Medline, PsycINFO and CINAHL revealed 65 relevant qualitative, quantitative, or mixed methods' papers published between 1997 and 2008. These papers were rated for scientific merit and findings were extracted for summary.

RESULTS

Siblings of children with cancer do not experience elevated mean rates of psychiatric disorders, but a significant subset experiences post-traumatic stress symptoms, negative emotional reactions (e.g. shock, fear, worry, sadness, helplessness, anger, and guilt), and poor quality of life in emotional, family, and social domains. In general, distress is greater closer to time of diagnosis. School difficulties are also evident within 2 years of diagnosis. Qualitative studies reveal family-level themes such as loss of attention and status as well as positive outcomes including increased sibling maturity and empathy.

CONCLUSIONS

Research regarding siblings of children with cancer continues to be methodologically limited. The conclusions of qualitative and quantitative studies differ considerably. We propose a research agenda to propel this field forward including greater attention to alterations in normative development (as opposed to psychiatric conditions), development of more appropriate quantitative measures, examination of potential moderators of adaptation, and use of prospective longitudinal designs. Siblings of children with cancer are a psychosocially at-risk group and should be provided with appropriate supportive services.

Habitual physical activity can be increased in people with cerebral palsy: a systematic review

Objective: To determine if habitual physical activity could be increased in people with cerebral palsy.

Data sources: We searched electronic databases until February 2010 using key words related to concepts of cerebral palsy and physical activity. This search was supplemented with citation tracking.

Methods: Studies had to include participants with cerebral palsy who have habitual physical activity measured over at least one day after a therapy intervention. Two reviewers independently assessed study quality with the PEDro scale (quantitative studies) and Critical Appraisal Checklist for Qualitative Research (qualitative studies). For quantitative studies standardized mean differences were calculated and meta-analysis conducted. Qualitative data were synthesized thematically.

Results: Three randomized controlled trials (96 participants) and two qualitative studies (21 participants) were reviewed. Four studies evaluated exercise programmes, and one study an online educational and support programme. Meta-analysis showed that exercise programmes could increase habitual physical activity (δ = 1.0; 95% confidence interval (CI) 0.28 to 1.72). This result was reinforced by reports of increased daily activity in two qualitative studies. The online programme increased weekly minutes of moderate to vigorous physical activity (d = 0.81; 95% CI 0.17 to 1.45), and weekly step counts (d = 0.62; 95% CI 0.0 to 1.25). Positive effects were not maintained after programmes stopped. There was insufficient evidence to determine if demographic factors or programme characteristics, such as intensity and setting, were associated with outcomes.

Conclusion: Preliminary evidence suggests that exercise programmes and online support programmes can increase habitual physical activity in people with cerebral palsy, but effects are not maintained when programmes stop.

How do Computer Assistive Technologies Enhance Participation in Childhood Occupations for Children with Multiple and Complex Disabilities? A Review of the Current Literature

Functional impairments can limit the participation of children with disabilities in childhood occupations, which can be detrimental to their overall development and social and emotional wellbeing. The primary goal of occupational therapy for children with disabilities is to facilitate and enable active participation in meaningful occupations. Computer-based assistive technologies can be used as an enabler, allowing children with severe disabilities access to a variety of activities. The aim of this study was to establish how computer assistive technologies can have an impact on the participation of children with complex and multiple disabilities in childhood occupations and in the development of their occupational roles.

A comprehensive and systematic search and review of contemporary literature pertaining to computer use by children with severe and complex disabilities and its impact on a child's participation was undertaken. Articles included were critically appraised and analysed using a conceptual model of occupational therapy, with findings relating to the occupational performance areas of productivity, self-maintenance and leisure (a summary table is included). The findings supported the use of computer technologies for participation to a varying degree in all occupational performance areas, but were particularly positive in the areas of education, communication and play activities for children with disabilities.