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Mohamed S, Chipeta MG, Kamninga T, Nthakomwa L, Chifungo C, Mzembe T, Vellemu R, Chikwapulo V, Peterson M, Abdullahi L, Musau K, Wazny K, Zulu E, Madise N. Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews. Syst Rev 2023; 12:198. [PMID: 37858208 PMCID: PMC10585784 DOI: 10.1186/s13643-023-02361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.
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Affiliation(s)
- Sahra Mohamed
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Michael G Chipeta
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi.
| | | | - Lomuthando Nthakomwa
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Chimwemwe Chifungo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Themba Mzembe
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Victor Chikwapulo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Leyla Abdullahi
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Eliya Zulu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
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Rameez S, Nasir A. Barriers to mental health treatment in primary care practice in low- and middle-income countries in a post-covid era: A systematic review. J Family Med Prim Care 2023; 12:1485-1504. [PMID: 37767443 PMCID: PMC10521856 DOI: 10.4103/jfmpc.jfmpc_391_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 09/29/2023] Open
Abstract
General primary care workers and family physicians are a crucial work force in managing the mental health of people in any given region. However, the barriers they face in low- and middle-income countries (LMICs) may be worsened by the pandemic. This review aims to bring together evidence about mental health treatment challenges experienced by people in LMICs in primary care settings. The review focuses on the shortage of essential mental healthcare services, stigma and lack of competent primary care professionals in establishing these services and their importance in the COVID-19 pandemic context. The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy included keyword search terms (MeSH) to perform a search across three electronic databases - Critical Appraisal Skills Program assessed PubMed, SpringerLink, and Cochrane and quality of the articles. The articles selected were analyzed through thematic analysis to identify the main themes and conclude our findings. Findings indicate that out of 1792 publications found, 14 studies matched the desired criteria for the studies. Endnotes, database search filters, and Covidence data extraction tools were used to generate the relevant articles in this study. This study shows that primary care institutions have financial and management issues in providing mental health services and a shortage of competent mental health experts in primary care, especially mental health-trained family physicians. The study also identifies community stigma as the most prevalent barrier to seeking mental health therapy, reflecting the lack of community health education in LMICs.
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Affiliation(s)
- Sahar Rameez
- Student Health and Wellbeing Organization (SHAW), Pakistan
| | - Almas Nasir
- Pakistan Association of Lifestyle Medicine, Pakistan
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Farrar N, Elliott D, Houghton C, Jepson M, Mills N, Paramasivan S, Plumb L, Wade J, Young B, Donovan JL, Rooshenas L. Understanding the perspectives of recruiters is key to improving randomised controlled trial enrolment: a qualitative evidence synthesis. Trials 2022; 23:883. [PMID: 36266700 PMCID: PMC9585862 DOI: 10.1186/s13063-022-06818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Recruiting patients to randomised controlled trials (RCTs) is often reported to be challenging, and the evidence base for effective interventions that could be used by staff (recruiters) undertaking recruitment is lacking. Although the experiences and perspectives of recruiters have been widely reported, an evidence synthesis is required in order to inform the development of future interventions. This paper aims to address this by systematically searching and synthesising the evidence on recruiters’ perspectives and experiences of recruiting patients into RCTs. Methods A qualitative evidence synthesis (QES) following Thomas and Harden’s approach to thematic synthesis was conducted. The Ovid MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, ORRCA and Web of Science electronic databases were searched. Studies were sampled to ensure that the focus of the research was aligned with the phenomena of interest of the QES, their methodological relevance to the QES question, and to include variation across the clinical areas of the studies. The GRADE CERQual framework was used to assess confidence in the review findings. Results In total, 9316 studies were identified for screening, which resulted in 128 eligible papers. The application of the QES sampling strategy resulted in 30 papers being included in the final analysis. Five overlapping themes were identified which highlighted the complex manner in which recruiters experience RCT recruitment: (1) recruiting to RCTs in a clinical environment, (2) enthusiasm for the RCT, (3) making judgements about whether to approach a patient, (4) communication challenges, (5) interplay between recruiter and professional roles. Conclusions This QES identified factors which contribute to the complexities that recruiters can face in day-to-day clinical settings, and the influence recruiters and non-recruiting healthcare professionals have on opportunities afforded to patients for RCT participation. It has reinforced the importance of considering the clinical setting in its entirety when planning future RCTs and indicated the need to better normalise and support research if it is to become part of day-to-day practice. Trial registration PROSPERO CRD42020141297 (registered 11/02/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06818-4.
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Affiliation(s)
- Nicola Farrar
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, Áras Moyola, National University of Ireland Galway, Galway, Ireland
| | - Marcus Jepson
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Nicola Mills
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Sangeetha Paramasivan
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Lucy Plumb
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,UK Kidney Association, UK Renal Registry, Bristol, UK
| | - Julia Wade
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, L69 3GB, UK
| | - Jenny L Donovan
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Leila Rooshenas
- Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Protective Factors for LGBTI+ Youth Wellbeing: A Scoping Review Underpinned by Recognition Theory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111682. [PMID: 34770199 PMCID: PMC8583439 DOI: 10.3390/ijerph182111682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022]
Abstract
Considerable research has been undertaken regarding the mental health inequalities experienced by lesbian, gay, bisexual, transgender and intersex (LGBTI+) youth as a consequence of societal and individual prejudice, stigma and discrimination. Far less research has focussed on protective factors that promote wellbeing for this population. A scoping review was conducted using a six-stage methodological framework, and is reported in accordance with the PRISMA-ScR statement. This explored the extent, range and nature of the peer-reviewed, published, academic literature on what is known about the protective factors that promote LGBTI+ youth wellbeing. Six databases were systematically searched applying Population–Concept–Context key inclusion criteria, complemented by contact with authors to identify additional sources, reference checks and hand searches. Ninety-six individual research records were identified and analysed, drawing from Honneth’s Recognition Theory. Interpersonal relations with parents (n = 40), peers (n = 32) and providers (n = 22) were associated with indicators of enhanced wellbeing, as were LGBTI+ community relations (n = 32). Importantly, online (n = 10), faith (n = 10) and cultural (n = 5) communities were potentially protective. Content and thematic analysis highlighted the importance of Gay–Straight Alliances (GSAs) (n = 23) offering powerful protective opportunities through intersecting interpersonal, community and legal forms of recognition. GSAs enhance allyship by peers and providers (n = 21), facilitate access to LGBTI+ community networks (n = 11) and co-exist alongside inclusive policies (n = 12), curricular (n = 5) and extracurricular activities (n = 1). This scoping review underscores the need to move beyond the predominant focus on risk factors for LGBTI+ youth, which subsequently inform protectionist approaches. It concludes with an appeal to develop mechanisms to apply recognitive justice to policy, practice and, importantly, future research directions. This emphasises the salience of enhanced understandings of inclusion, which is rights-based, universally available and of potential benefit to all.
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Farrar N, Elliott D, Jepson M, Houghton C, Young B, Donovan J, Rooshenas L. Recruiters' perspectives and experiences of trial recruitment processes: a qualitative evidence synthesis protocol. BMJ Open 2021; 11:e045233. [PMID: 34686547 PMCID: PMC8543629 DOI: 10.1136/bmjopen-2020-045233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Recruitment to randomised trials (RCTs) is often challenging. Reviews of interventions to improve recruitment have highlighted a paucity of effective interventions aimed at recruiters and the need for further research in this area. Understanding the perspectives and experiences of those involved in RCT recruitment can help to identify barriers and facilitators to recruitment, and subsequently inform future interventions to support recruitment. This protocol describes methods for a proposed qualitative evidence synthesis (QES) of recruiters' perspectives and experiences relating to RCT recruitment. METHODS AND ANALYSIS The proposed review will synthesise studies reporting clinical and non-clinical recruiters' perspectives and experiences of recruiting to RCTs. The following databases will be searched: Ovid MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, ORRCA and Web of Science. A thematic synthesis approach to analysing the data will be used. An assessment of methodological limitations of each study will be performed using the Critical Appraisal Skills Programme tool. Assessing the confidence in the review findings will be evaluated using the GRADE Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) tool. ETHICS AND DISSEMINATION The proposed QES will not require ethical approval as it includes only published literature. The results of the synthesis will be published in a peer-reviewed journal and publicised using social media. The results will be considered alongside other work addressing factors affecting recruitment in order to inform future development and refinement of recruitment interventions. PROSPERO REGISTRATION NUMBER CRD42020141297.
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Affiliation(s)
- Nicola Farrar
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Marcus Jepson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Galway, Ireland
| | - Bridget Young
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Jenny Donovan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- Population Health Sciences, University of Bristol, Bristol, UK
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Heggie R, Boyd K, Wu O. How has implementation been incorporated in health technology assessments in the United Kingdom? A systematic rapid review. Health Res Policy Syst 2021; 19:118. [PMID: 34407834 PMCID: PMC8371806 DOI: 10.1186/s12961-021-00766-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Health interventions in a clinical setting may be complex. This is particularly true of clinical interventions which require systems reorganization or behavioural change, and/or when implementation involves additional challenges not captured within a clinical trial setting. Medical Research Council guidance on complex interventions highlights the need to consider economic evaluation alongside implementation. However, the extent to which this guidance has been adhered to, and how, is unclear. The failure to incorporate implementation within the evaluation of an intervention may hinder the translation of research findings into routine practice. This will have consequences for patient care. This study examined the methods used to address implementation within health research conducted through funding from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. METHODS We conducted a rapid review using a systematic approach. We included all NIHR HTA monographs which contained the word "implementation" within the title or abstract published between 2014 and 2020. We assessed the studies according to existing recommendations for specifying and reporting implementation approaches in research. Additional themes which were not included in the recommendation, but were of particular relevance to our research question, were also identified and summarized in a narrative synthesis. RESULTS The extent to which implementation was formally incorporated, and defined, varied among studies. Methods for examining implementation ranged from single stakeholder engagement events to the more comprehensive process evaluation. There was no obvious pattern as to whether approaches to implementation had evolved over recent years. Approximately 50% (22/42) of studies included an economic evaluation. Of these, two studies included the use of qualitative data obtained within the study to quantitatively inform aspects relating to implementation and economic evaluation in their study. DISCUSSION A variety of approaches were identified for incorporating implementation within an HTA. However, they did not go far enough in terms of incorporating implementation into the actual design and evaluation. To ensure the implementation of clinically effective and cost-effective interventions, we propose that further guidance on how to incorporate implementation within complex interventions is required. Incorporating implementation into economic evaluation provides a step in this direction.
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Affiliation(s)
- Robert Heggie
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Kathleen Boyd
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Olivia Wu
- Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low- and middle-income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1156. [PMID: 37131925 PMCID: PMC8356350 DOI: 10.1002/cl2.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The preconception period is an ideal time to introduce interventions relating to nutrition and other lifestyle factors to ensure good pregnancy preparedness, and to promote health of mothers and babies. In adolescents, malnutrition and early pregnancy are the common challenges, particularly among those who live in low- and middle-income countries (LMIC) where 99% of all maternal and newborn deaths occur. These girls receive little or no attention until their first pregnancy and often the interventions after pregnancy are too late to revert any detrimental health risks that may have occurred due to malnutrition and early pregnancy. Objectives To synthesise the evidence of the effectiveness of preconception care interventions relating to delayed age at first pregnancy, optimising inter-pregnancy intervals, periconception folic acid, and periconception iron-folic acid supplementation on maternal, pregnancy, birth and child outcomes. Search Methods Numerous electronic databases (e.g., CINAHL, ERIC) and databases of selected development agencies or research firms were systematically searched for all available years up to July 2019. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished studies. Selection Criteria Primary studies, including large-scale programme evaluations that assessed the effectiveness of interventions using randomised controlled trials (RCTs) or quasi-experimental designs (natural experiments, controlled before-after studies, regression discontinuity designs, interrupted time series [ITS]), that targeted women of reproductive age (i.e., 10-49 years) during the pre- and periconceptional period in LMICs were included. Interventions were compared against no intervention, standard of care or placebo. Data Collection and Analysis Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data and assessed risk of bias. We used random-effects model to conduct meta-analyses, given the diverse contexts, participants, and interventions, and separate meta-analyses for the same outcome was performed with different study designs (ITS, RCTs and controlled before after studies). For each comparison, the findings were descriptively summarised in text which included detailing the contextual factors (e.g., setting) to assess their impact on the implementation and effectiveness of each intervention. Main Results We included a total of 43 studies; two of these were included in both delaying pregnancy and optimising interpregnancy intervals resulting in 26 studies for delaying the age at first pregnancy (14 RCTs, 12 quasi-experimental), four for optimising interpregnancy intervals (one RCT, three quasi-experimental), five on periconceptional folic acid supplementation (two RCTs, three quasi-experimental), and 10 on periconceptional iron-folic acid supplementation (nine RCTs, one quasi-experimental). Geographically, studies were predominantly conducted across Africa and Asia, with few studies from North and Central America and took place in a combination of settings including community, schools and clinical. The education on sexual health and contraception interventions to delay the age at first pregnancy may make little or no difference on risk of unintended pregnancy (risk ratio [RR], 0.42; 95% confidence internal [CI], 0.07-3.26; two studies, =490; random-effect; χ 2 p .009; I 2 = 85%; low certainty of evidence using GRADE assessment), however, it significantly improved the use of condom (ever) (RR, 1.54; 95% CI, 1.08-2.20; six studies, n = 1604; random-effect, heterogeneity: χ 2 p .004; I 2 = 71%). Education on sexual health and and provision of contraceptive along with involvement of male partneron optimising interpregnancy intervals probably makes little or no difference on the risk of unintended pregnancies when compared to education on sexual health only (RR, 0.32; 95% CI, 0.01-7.45; one study, n = 45; moderate certainty of evidence using GRADE assessments). However, education on sexual health and contraception intervention alone or with provision of contraceptive showed a significant improvement in the uptake of contraceptive method. We are uncertain whether periconceptional folic acid supplementation reduces the incidence of neural tube defects (NTDs) (RR, 0.53; 95% CI, 0.41-0.77; two studies, n = 248,056; random-effect; heterogeneity: χ 2 p .36; I 2 = 0%; very low certainty of evidence using GRADE assessment). We are uncertain whether preconception iron-folic acid supplementation reduces anaemia (RR, 0.66; 95% CI, 0.53-0.81; six studies; n = 3430, random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessment) even when supplemented weekly (RR, 0.70; 95% CI, 0.55-0.88; six studies; n = 2661; random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessments),and in school set-ups (RR, 0.66; 95% CI, 0.51-0.86; four studies; n = 3005; random-effect; heterogeneity: χ 2 p < .0001; I 2 = 87%; very low certainty of evidence using GRADE assessment). Data on adverse effects were reported on in five studies for iron-folic acid, with the main complaint relating to gastrointestinal side effects. The quality of evidence across the interventions of interest was variable (ranging from very low to moderate) which may be attributed to the different study designs included in this review. Concerning risk of bias, the most common concerns were related to blinding of participants and personnel (performance bias) and whether there were similar baseline characteristic across intervention and comparison groups. Authors' Conclusions There is evidence that education on sexual health and contraception interventions can improve contraceptive use and knowledge related to sexual health, this review also provides further support for the use of folic acid in pregnancy to reduce NTDs, and notes that weekly regimes of IFA are most effective in reducing anaemia. However the certainty of the evidence was very low and therefore more robust trials and research is required, including ensuring consistency for reporting unplanned pregnancies, and further studies to determine which intervention settings (school, community, clinic) are most effective. Although this review demonstrates promising findings, more robust evidence from RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | - Sophie G. E. Kedzior
- Faculty of Health and Medical Sciences, Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | | | - Yamna Jadoon
- Department of PaediatricsAga Khan University HospitalKarachiPakistan
| | - Jai K. Das
- Division of Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
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Harding JF, Knab J, Zief S, Kelly K, McCallum D. A Systematic Review of Programs to Promote Aspects of Teen Parents' Self-sufficiency: Supporting Educational Outcomes and Healthy Birth Spacing. Matern Child Health J 2021; 24:84-104. [PMID: 31965469 PMCID: PMC7497377 DOI: 10.1007/s10995-019-02854-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Expectant and parenting teens experience many challenges to achieving self-sufficiency and promoting their children’s healthy development. Teen parents need support to help them address these challenges, and many different types of programs aim to support them. In this systematic review, we examine the research about programs that aim to support aspects of teen parents’ self-sufficiency by promoting their educational outcomes and healthy birth spacing. Methods We conducted a comprehensive literature search of published and unpublished literature to identify studies of programs to support teen parents that met this review’s eligibility criteria. The quality and execution of the eligible study research designs were assessed to determine whether studies’ findings were at risk of bias. We then extracted information about study characteristics, outcomes, and program characteristics for studies considered to provide rigorous evidence. Results We identified 58 eligible studies. Twenty-three studies were considered to provide rigorous evidence about either education, contraceptive use, or repeat pregnancy or birth. Seventeen of these studies showed at least one favorable effect on an outcome in one of these domains, whereas the other six did not show any significant or substantial effects in these domains. These 17 studies represent 14 effective programs. Discussion Effective programs to support expectant and parenting teens have diverse characteristics, indicating there is no single approach for promoting teens’ education and healthy birth spacing. More rigorous studies of programs to support teen parents are needed to understand more about how to support teen fathers and the program characteristics associated with effectiveness. Electronic supplementary material The online version of this article (10.1007/s10995-019-02854-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jean Knab
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543-2393, USA
| | - Susan Zief
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543-2393, USA
| | - Kevin Kelly
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543-2393, USA
| | - Diana McCallum
- Mathematica, P.O. Box 2393, Princeton, NJ, 08543-2393, USA
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Knighting K, Pilkington G, Noyes J, Roe B, Maden M, Bray L, Jack B, O’Brien M, Downing J, Mateus C, Spencer S. Respite care and short breaks for young adults aged 18–40 with complex health-care needs: mixed-methods systematic review and conceptual framework development. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The number of young adults with complex health-care needs due to life-limiting conditions/complex physical disability has risen significantly over the last 15 years, as more children now survive into adulthood. The transition from children to adult services may disrupt provision of essential respite/short break care for this vulnerable population, but the impact on young adults, families and providers is unclear.
Aim
To review the evidence on respite care provision for young adults (aged 18–40 years) with complex health-care needs, provide an evidence gap analysis and develop a conceptual framework for respite care.
Design
A two-stage mixed-methods systematic review, including a knowledge map of respite care and an evidence review of policy, effectiveness, cost-effectiveness and experience.
Data sources
Electronic databases and grey/unpublished literature were searched from 2002 to September 2019. The databases searched included Cumulative Index to Nursing and Allied Health Literature, MEDLINE, EMBASE, PsycINFO, Applied Social Sciences Index and Abstracts, Health Management Information Consortium, PROSPERO, Turning Research into Practice, COnNECT+, British Nursing Index, Web of Science, Social Care Online, the National Institute for Health Research Journals Library, Cochrane Effective Practice and Organisation of Care specialist register, databases on The Cochrane Library and international clinical trials registers. Additional sources were searched using the CLUSTER (Citations, Lead authors, Unpublished materials, Scholar search, Theories, Early examples, Related projects) approach and an international ‘call for evidence’.
Methods and analysis
Multiple independent reviewers used the SPICE (Setting, Perspective, Intervention/phenomenon of interest, Comparison, Evaluation) framework to select and extract evidence for each stage, verified by a third reviewer. Study/source characteristics and outcomes were extracted. Study quality was assessed using relevant tools. Qualitative evidence was synthesised using a framework approach and UK policy was synthesised using documentary content analysis. GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) was used to assess confidence in the evidence. Logic models developed for each type of respite care constituted the conceptual framework.
Results
We identified 69 sources (78 records) from 126,267 records. The knowledge map comprised the following types of respite care: residential, home based, day care, community, leisure/social provision, funded holidays and emergency. Seven policy intentions included early transition planning and prioritising respite care according to need. No evidence was found on effectiveness and cost-effectiveness. Qualitative evidence focused largely on residential respite care. Facilitators of accessible/acceptable services included trusted and valued relationships, independence and empowerment of young adults, peer social interaction, developmental/age-appropriate services and high standards of care. Barriers included transition to adult services, paperwork, referral/provision delay and travelling distance. Young adults from black, Asian and minority ethnic populations were under-represented. Poor transition, such as loss of or inappropriate services, was contrary to statutory expectations. Potential harms included stress and anxiety related to safe care, frustration and distress arising from unmet needs, parental exhaustion, and a lack of opportunities to socialise and develop independence.
Limitations
No quantitative or mixed-methods evidence was found on effectiveness or cost-effectiveness of respite care. There was limited evidence on planned and emergency respite care except residential.
Conclusions
Policy intentions are more comprehensively met for young people aged < 18 years who are accessing children’s services. Young adults with complex needs often ‘fall off a cliff’ following service withdrawal and this imbalance needs addressing.
Future work
Research to quantify the effectiveness and cost-effectiveness of respite care to support service development and commissioning. Development of a core set of outcomes measures to support future collation of evidence.
Study registration
This study is registered as PROSPERO CRD42018088780.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katherine Knighting
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Gerlinde Pilkington
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Brenda Roe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Barbara Jack
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Mary O’Brien
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
| | - Julia Downing
- International Children’s Palliative Care Network, Edge Hill University, Ormskirk, UK
| | - Céu Mateus
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sally Spencer
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
- Health Research Institute, Edge Hill University, Ormskirk, UK
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10
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Cherewick M, Lebu S, Su C, Richards L, Njau PF, Dahl RE. Study Protocol of a Distance Learning Intervention to Support Social Emotional Learning and Identity Development for Adolescents Using Interactive Mobile Technology. Front Public Health 2021; 9:623283. [PMID: 33585394 PMCID: PMC7879395 DOI: 10.3389/fpubh.2021.623283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The maturational period from age 10 to 14-often referred to as very young adolescents (VYAs)-represents a dynamic period of learning and neurobehavioral development as individuals transition from childhood to adolescence. This developmental period presents a window of opportunity for strategic investment to improve trajectories of health, education and well-being among young people. More specifically, neurodevelopmental changes during pubertal maturation influence neural circuitry involved in processing emotions, risks, rewards and social relationships. Technology can be leveraged to create social emotional learning experiences for VYAs and provide opportunities for flexible, distance learning in low-income countries. The aim of this study protocol is to detail how insights from developmental science can be used to inform the intervention design, implementation and evaluation of a distance learning, social emotional learning intervention for VYAs. Methods: This study will be delivered to 500 VYAs in Temeke District, Dar es salaam. Study participants will watch culturally-relevant, animated videos on social emotional mindsets and skills and content will be paired with experiential learning activities over a period of 10 weeks. A nested smart-phone based study will practice learning social emotional skills and mindsets through engagement with multi-media material via the WhatsApp messenger application. Surveys and in-depth interviews will be administered to adolescents, their parents/caregivers and teachers before and after the intervention to evaluate the effect of the intervention on study outcomes. Discussion: This study is among the first to provide results on how to effectively design a distance-learning intervention to promote social emotional learning and identity development within a low-resource context. The findings will provide substantial evidence to inform new intervention approaches that are effective in low-resource contexts and strategies to reach scale among similar programs invested in leveraging technology to support adolescent health and development. Clinical Trial registration: Study registered with ClinicalTrials.gov. Identifier number NCT0445807.
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Affiliation(s)
- Megan Cherewick
- Department of Health Sciences, California State University East Bay, Hayward, CA, United States
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Christine Su
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Lisa Richards
- Health for a Prosperous Nation, Dar es Salaam, Tanzania
| | | | - Ronald E. Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
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11
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Cherewick M, Lebu S, Su C, Dahl RE. An Intervention to Enhance Social, Emotional, and Identity Learning for Very Young Adolescents and Support Gender Equity: Protocol for a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e23071. [PMID: 33206624 PMCID: PMC7808886 DOI: 10.2196/23071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The onset of puberty is a pivotal period of human development that is associated with significant changes in cognitive, social, emotional, psychological, and behavioral processes that shape identity formation. Very early adolescence provides a critical opportunity to shape identity formation around gender norms, attitudes, and beliefs before inequitable gender norms are amplified during and after puberty. OBJECTIVE The aim of the Discover Learning Project is to integrate strategic insights from developmental science to promote positive transformation in social, emotional, and gender identity learning among 10- to 11-year-olds in Tanzania. Through a pragmatic randomized controlled trial, the intervention scaffolds the development of critical social and emotional mindsets and skills (curiosity, generosity, persistence, purpose, growth mindset, and teamwork) delivered by conducting 18 after-school, technology-driven, experiential learning sessions in small, mixed-gender groups. METHODS The Discover Learning Intervention is a 3-arm randomized controlled trial that will be delivered to 579 participants selected from four public primary schools in Temeke District, Dar es Salaam, Tanzania. Randomization will be done at the individual level into 3 treatment groups receiving incremental intervention components. The treatment components include Discover Learning content curated into child-friendly videos, facilitated discussions, and a parent-child workbook, to be implemented over two phases, each 6 weeks long. A baseline survey will be administered to participants and their parents prior to the intervention. The process will be observed systematically, and data will be collected using surveys, in-depth interviews, observations, and focus group discussions with adolescents, parents, teachers, and facilitators conducted prior, during, and after each implementation phase. RESULTS This study builds on formative and pilot studies conducted with the target population to inform the design of the intervention. The results will generate new evidence that will inform strategies for achieving scale in Tanzania and provide insights for replication of similar programs that are invested in gender-transformative interventions in peri-urban, low-resource settings. CONCLUSIONS The Discover Learning Intervention makes an important contribution to the field of adolescent developmental science as an intervention designed for very young adolescents in a low-resource setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04458077; https://clinicaltrials.gov/ct2/show/NCT04458077. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/23071.
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Affiliation(s)
- Megan Cherewick
- Department of Health Sciences, California State University East Bay, Hayward, CA, United States
| | - Sarah Lebu
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Christine Su
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
| | - Ronald E Dahl
- Institute of Human Development, University of California Berkeley, Berkeley, CA, United States
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12
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Houghton C, Dowling M, Meskell P, Hunter A, Gardner H, Conway A, Treweek S, Sutcliffe K, Noyes J, Devane D, Nicholas JR, Biesty LM. Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 10:MR000045. [PMID: 33026107 PMCID: PMC8078544 DOI: 10.1002/14651858.mr000045.pub2] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Randomised trials (also referred to as 'randomised controlled trials' or 'trials') are the optimal way to minimise bias in evaluating the effects of competing treatments, therapies and innovations in health care. It is important to achieve the required sample size for a trial, otherwise trialists may not be able to draw conclusive results leading to research waste and raising ethical questions about trial participation. The reasons why potential participants may accept or decline participation are multifaceted. Yet, the evidence of effectiveness of interventions to improve recruitment to trials is not substantial and fails to recognise these individual decision-making processes. It is important to synthesise the experiences and perceptions of those invited to participate in randomised trials to better inform recruitment strategies. OBJECTIVES To explore potential trial participants' views and experiences of the recruitment process for participation. The specific objectives are to describe potential participants' perceptions and experiences of accepting or declining to participate in trials, to explore barriers and facilitators to trial participation, and to explore to what extent barriers and facilitators identified are addressed by strategies to improve recruitment evaluated in previous reviews of the effects of interventions including a Cochrane Methodology Review. SEARCH METHODS We searched the Cochrane Library, Medline, Embase, CINAHL, Epistemonikos, LILACS, PsycINFO, ORRCA, and grey literature sources. We ran the most recent set of searches for which the results were incorporated into the review in July 2017. SELECTION CRITERIA We included qualitative and mixed-methods studies (with an identifiable qualitative component) that explored potential trial participants' experiences and perceptions of being invited to participate in a trial. We excluded studies that focused only on recruiters' perspectives, and trials solely involving children under 18 years, or adults who were assessed as having impaired mental capacity. DATA COLLECTION AND ANALYSIS Five review authors independently assessed the titles, abstracts and full texts identified by the search. We used the CART (completeness, accuracy, relevance, timeliness) criteria to exclude studies that had limited focus on the phenomenon of interest. We used QSR NVivo to extract and manage the data. We assessed methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We used thematic synthesis to analyse and synthesise the evidence. This provided analytical themes and a conceptual model. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. Our findings were integrated with two previous intervention effectiveness reviews by juxtaposing the quantitative and qualitative findings in a matrix. MAIN RESULTS We included 29 studies (published in 30 papers) in our synthesis. Twenty-two key findings were produced under three broad themes (with six subthemes) to capture the experience of being invited to participate in a trial and making the decision whether to participate. Most of these findings had moderate to high confidence. We identified factors from the trial itself that influenced participation. These included how trial information was communicated, and elements of the trial such as the time commitment that might be considered burdensome. The second theme related to personal factors such as how other people can influence the individual's decision; and how a personal understanding of potential harms and benefits could impact on the decision. Finally, the potential benefits of participation were found to be key to the decision to participate, namely personal benefits such as access to new treatments, but also the chance to make a difference and help others. The conceptual model we developed presents the decision-making process as a gauge and the factors that influence whether the person will, or will not, take part. AUTHORS' CONCLUSIONS This qualitative evidence synthesis has provided comprehensive insight into the complexity of factors that influence a person's decision whether to participate in a trial. We developed key questions that trialists can ask when developing their recruitment strategy. In addition, our conceptual model emphasises the need for participant-centred approaches to recruitment. We demonstrated moderate to high level confidence in our findings, which in some way can be attributed to the large volume of highly relevant studies in this field. We recommend that these insights be used to direct or influence or underpin future recruitment strategies that are developed in a participant-driven way that ultimately improves trial conduct and reduces research waste.
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Affiliation(s)
- Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Aislinn Conway
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katy Sutcliffe
- Department of Social Science, Social Science Research Unit, UCL Institute of Education, London, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Jane R Nicholas
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
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13
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Moore DA, Nunns M, Shaw L, Rogers M, Walker E, Ford T, Garside R, Ukoumunne O, Titman P, Shafran R, Heyman I, Anderson R, Dickens C, Viner R, Bennett S, Logan S, Lockhart F, Thompson Coon J. Interventions to improve the mental health of children and young people with long-term physical conditions: linked evidence syntheses. Health Technol Assess 2020; 23:1-164. [PMID: 31122334 DOI: 10.3310/hta23220] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness of interventions to treat them. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2). DATA SOURCES For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted. REVIEW METHODS The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen's d). When appropriate, random-effects meta-analyses produced pooled effect sizes (d). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project. RESULTS Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research. LIMITATIONS Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis. CONCLUSIONS There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project. STUDY REGISTRATION This study is registered as PROSPERO CRD42011001716. FUNDING The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Darren A Moore
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Morwenna Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Erin Walker
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Child Mental Health Group, University of Exeter Medical School, Exeter, UK
| | - Ruth Garside
- The European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, UK
| | - Obi Ukoumunne
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Penny Titman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Roz Shafran
- University College London Institute of Child Health, London, UK
| | - Isobel Heyman
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rob Anderson
- Evidence Synthesis & Modelling for Health Improvement, University of Exeter Medical School, Exeter, UK
| | - Chris Dickens
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Russell Viner
- University College London Institute of Child Health, London, UK
| | - Sophie Bennett
- University College London Institute of Child Health, London, UK
| | - Stuart Logan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Fiona Lockhart
- Biomedical Research Centre Patient & Public Involvement Group, University College London Hospitals, London, UK
| | - Jo Thompson Coon
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula, University of Exeter Medical School, Exeter, UK
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14
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2020; 12:E606. [PMID: 32110886 PMCID: PMC7146400 DOI: 10.3390/nu12030606] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (n = 26), to optimize inter-pregnancy intervals (n = 4), and supplementation of folic acid (n = 5) or a combination of iron and folic acid (n = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42-2.05; two studies, n = 911; I2 = 0%) and (RR = 2.25, 95% CI = 1.29-3.93; one study, n = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41-0.77; two studies, n = 248,056; I2 = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53-0.81; six studies; n = 3430, I2 = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, Australia;
| | - Sophie G. E. Kedzior
- Robinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, Australia;
| | - Wajeeha Tariq
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Yamna Jadoon
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Jai K. Das
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Zulfiqar A. Bhutta
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
- Centre for Global Child Health, the SickKids Hospital, Toronto, ON M5G 0A4, Canada
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15
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Garzón-Orjuela N, Samacá-Samacá D, Moreno-Chaparro J, Ballesteros-Cabrera MDP, Eslava-Schmalbach J. Effectiveness of Sex Education Interventions in Adolescents: An Overview. Compr Child Adolesc Nurs 2020; 44:15-48. [PMID: 32048888 DOI: 10.1080/24694193.2020.1713251] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this overview was to identify and evaluate the effectiveness of sex education interventions aimed at reducing sexual risk behaviors in adolescents. A search was conducted of systematic reviews in English, Spanish and Portuguese from 1946 until July 2018 in the following databases: MEDLINE (Ovid), EMBASE, Scopus, PsyArticles, Cochrane Central Register of Controlled Trials, LILACS and additional resources. The extraction and analysis of data was synthesized in a narrative mode describing intervention, population, and key outcomes such as decreased risky sexual behavior, decreases in sexually transmitted infections, and adolescent pregnancy. There were 2289 potentially relevant studies, of which 31 systematic reviews related to adolescent interventions were included. It was demonstrated that interventions involve parents and the community as participants, are based on audiovisual media and school workshops, and their emphasis is on information and training in school. Different reviews framed in methods of psychosocial intervention based on community groups and the home as a fundamental axis were reported. Finally, a large amount of scientific evidence related to the subject was identified. New directions are presented for interventions in sexual education for adolescents based on the combination of actions and techniques, the implementation of digital technology, and socio-cultural and contextual adaptations.
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Affiliation(s)
- Nathaly Garzón-Orjuela
- Equity-in-Health Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Daniel Samacá-Samacá
- Equity-in-Health Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jaime Moreno-Chaparro
- Equity-in-Health Group, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.,School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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16
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Personhood and Dementia Care: A Qualitative Evidence Synthesis of the Perspectives of People With Dementia. THE GERONTOLOGIST 2019; 61:e85-e100. [DOI: 10.1093/geront/gnz159] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background and Objectives
Personhood is considered the cornerstone of person-centered care for people with dementia. However, there is little research on personhood in dementia care from the perspective of the person with dementia themselves. This article presents a qualitative evidence synthesis of the experiences and perceptions of people with dementia on personhood in dementia care.
Research Design and Methods
A systematic search of nine databases was conducted. In addition to initial screening, CART analysis was used to determine the most relevant papers. Thematic synthesis was conducted on 20 papers. The CASP tool was used to examine the quality of the included papers. GRADE CERQual analysis examined confidence in the review findings.
Results
People with dementia experience many changes due to the disease and the experience of being cared for in different settings. Personhood is affirmed through personal interactions with family, friends, other care recipients, and formal caregivers, as well as through continued engagement in social and occupational roles.
Discussion and Implications
The review has important implications for practice, regulation, and policy. The person and their personhood should be protected rather than undermined, and relationships should be enhanced not diminished by the formal care process. The focus should be on creating and amplifying opportunities for people with dementia to affirm the self through interactions with others and engaging in occupational and social roles to ensure continuity of self.
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17
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Booth A, Briscoe S, Wright JM. The "realist search": A systematic scoping review of current practice and reporting. Res Synth Methods 2019; 11:14-35. [PMID: 31714016 DOI: 10.1002/jrsm.1386] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 11/06/2022]
Abstract
The requirement for literature searches that identify studies for inclusion in systematic reviews should be systematic, explicit, and reproducible extends, at least by implication, to other types of literature review. However, realist reviews commonly require literature searches that challenge systematic reporting; searches are iterative and involve multiple search strategies and approaches. Notwithstanding these challenges, reporting of the "realist search" can be structured to be transparent and to facilitate identification of innovative retrieval practices. Our six-component search framework consolidates and extends the structure advanced by Pawson, one of the originators of realist review: formulating the question, conducting the background search, searching for program theory, searching for empirical studies, searching to refine program theory and identifying relevant mid-range theory, and documenting and reporting the search process. This study reviews reports of search methods in 34 realist reviews published within the calendar year of 2016. Data from all eligible reviews were extracted from the search framework. Realist search reports poorly differentiate between the different search components. Review teams often conduct a single "big bang" multipurpose search to fulfill multiple functions within the review. However, it is acknowledged that realist searches are likely to be iterative and responsive to emergent data. Overall, the search for empirical studies appears most comprehensive in conduct and reporting detail. In contrast, searches to identify and refine program theory are poorly conducted, if at all, and poorly reported. Use of this framework offers greater transparency in conduct and reporting while preserving flexibility and methodological innovation.
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Affiliation(s)
- Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Simon Briscoe
- Exeter HS&DR Evidence Synthesis Centre, Institute of Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Judy M Wright
- Academic Unit of Health Economics, Leeds Institute of Health Science, University of Leeds, Leeds, UK
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18
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Thompson Coon J, Gwernan-Jones R, Garside R, Nunns M, Shaw L, Melendez-Torres GJ, Moore D. Developing methods for the overarching synthesis of quantitative and qualitative evidence: The interweave synthesis approach. Res Synth Methods 2019; 11:507-521. [PMID: 31725951 PMCID: PMC7383598 DOI: 10.1002/jrsm.1383] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/30/2019] [Accepted: 10/16/2019] [Indexed: 01/30/2023]
Abstract
The incorporation of evidence derived from multiple research designs into one single synthesis can enhance the utility of systematic reviews making them more worthwhile, useful, and insightful. Methodological guidance for mixed-methods synthesis continues to emerge and evolve but broadly involves a sequential, parallel, or convergent approach according to the degree of independence between individual syntheses before they are combined. We present two case studies in which we used novel and innovative methods to draw together the findings from individual but related quantitative and qualitative syntheses to aid interpretation of the overall evidence base. Our approach moved beyond making a choice between parallel, sequential, or convergent methods to interweave the findings of individual reviews and offers three key innovations to mixed-methods synthesis methods: The use of intersubjective questions to understand the findings of the individual reviews through different lenses, Immersion of key reviewers in the entirety of the evidence base, and Commencing the process during the final stages of the synthesis of individual reviews, at a point where reviewers are developing an understanding of initial findings. Underlying our approach is the process of exploration and identification of links between and across review findings, an approach that is fundamental to all evidence syntheses but usually occurs at the level of the study. Adapting existing methods for exploring and identifying patterns and links between and across studies to interweave the findings between and across reviews may prove valuable.
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Affiliation(s)
- Jo Thompson Coon
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Ruth Gwernan-Jones
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Ruth Garside
- European Centre for Environment and Human Health, University of Exeter, United Kingdom
| | - Michael Nunns
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Liz Shaw
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - G J Melendez-Torres
- College of Health and Medicine, University of Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Darren Moore
- Graduate School of Education, University of Exeter, United Kingdom of Great Britain and Northern Ireland
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Pilkington G, Knighting K, Bray L, Downing J, Jack BA, Maden M, Mateus C, Noyes J, O'Brien MR, Roe B, Tsang A, Spencer S. The specification, acceptability and effectiveness of respite care and short breaks for young adults with complex healthcare needs: protocol for a mixed-methods systematic review. BMJ Open 2019; 9:e030470. [PMID: 31213455 PMCID: PMC6588989 DOI: 10.1136/bmjopen-2019-030470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The number of young adults with complex healthcare needs due to life-limiting conditions/complex physical disability has risen significantly as children with complex conditions survive into adulthood. Respite care and short breaks are an essential service, however, needs often go unmet after the transition to adult services, leading to a significant impact on the life expectancy and quality of life for this population. We aim to identify, appraise and synthesise relevant evidence to explore respite care and short breaks provision for this population, and to develop a conceptual framework for understanding service models. METHODS AND ANALYSIS A mixed-methods systematic review conducted in two stages: (1) knowledge map and (2) evidence review. We will comprehensively search multiple electronic databases; use the Citations, Lead authors, Unpublished materials, Google Scholar, Theories, Early examples, and Related projects (CLUSTER) approach, search relevant websites and circulate a 'call for evidence'. Using the setting, perspective, intervention/phenomenon of interest, comparison and evaluation framework, two reviewers will independently select evidence for inclusion into a knowledge map and subsequent evidence review, extract data relating to study and population characteristics, methods and outcomes; and assess the quality of evidence. A third reviewer will arbitrate where necessary.Evidence will be synthesised using the following approaches: quantitative (narratively/conducting meta-analyses where appropriate); qualitative (framework approach); policy and guidelines (documentary analysis informed approach). An overall, integrated synthesis will be created using a modified framework approach. We will use Grading of Recommendations Assessment, Development and Evaluation (GRADE)/GRADE-Confidence in the Evidence from Reviews of Qualitative Research to assess the strength and confidence of the synthesised evidence. Throughout, we will develop a conceptual framework to articulate how service models work in relation to context and setting. ETHICS AND DISSEMINATION Ethical approval is not required as this is a systematic review. We will present our work in academic journals, at appropriate conferences; we will disseminate findings across networks using a range of media. Steering and advisory groups were established to ensure findings are shared widely and in accessible formats. PROSPERO REGISTRATION NUMBER CRD42018088780.
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Affiliation(s)
- Gerlinde Pilkington
- Postgraduate Medical Institute (PGMI), Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Katherine Knighting
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Lucy Bray
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Julia Downing
- International Children's Palliative Care Network, Assagay, South Africa
- Edge Hill University, Ormskirk, UK
| | - Barbara A Jack
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Ceu Mateus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jane Noyes
- School of Health Sciences, Bangor University, Bangor, UK
| | - Mary R O'Brien
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Brenda Roe
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Anthony Tsang
- Research and Innovation Team, Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
| | - Sally Spencer
- Postgraduate Medical Institute (PGMI), Faculty of Health & Social Care, Edge Hill University, Ormskirk, UK
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Kayes NM, Martin RA, Bright FA, Kersten P, Pollock A. Optimizing the real-world impact of rehabilitation reviews: increasing the relevance and usability of systematic reviews in rehabilitation. Eur J Phys Rehabil Med 2019; 55:331-341. [PMID: 30990002 DOI: 10.23736/s1973-9087.19.05793-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite a growing portfolio of rehabilitation reviews, uptake of review findings into practice remains slow, with review findings perceived to be lacking in relevance and usability for stakeholders. Key aspects of review design, production and dissemination have been identified to contribute to this knowledge translation (KT) gap. AIM The aim of this study is to identify strategies relevant to rehabilitation review design, production and dissemination which have the potential to optimize uptake of review findings into practice. RESULTS Two strategies are discussed, drawing on case examples of existing rehabilitation reviews, including: 1) involving stakeholders in review design, production and dissemination; and 2) moving towards theory-based, mixed methods review design. The merits of these strategies are discussed with reference to the unique and specific characteristics of the rehabilitation context, where there is complexity inherent in the multiple interacting components across population, intervention, context and implementation processes. CONCLUSIONS Moving towards theory-based, mixed methods reviews which involve stakeholders may be a critical first step in supporting uptake of review findings into rehabilitation practice. Doing so also has the potential to support advances in knowledge and practice in rehabilitation through theory development, as well as creating the context for evidence-based practice.
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Affiliation(s)
- Nicola M Kayes
- Center for Person-centered Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand -
| | - Rachelle A Martin
- Rehabilitation Teaching and Research Unit, University of Otago and Burwood Academy of Independent Living, Christchurch, New Zealand
| | - Felicity A Bright
- Center for Person-centered Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Paula Kersten
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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21
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Frederiksen BN, Rivera MI, Ahrens KA, Malcolm NM, Brittain AW, Rollison JM, Moskosky SB. Clinic-Based Programs to Prevent Repeat Teen Pregnancy: A Systematic Review. Am J Prev Med 2018; 55:736-746. [PMID: 30342636 PMCID: PMC10411458 DOI: 10.1016/j.amepre.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
CONTEXT The purpose of this paper is to synthesize and evaluate the evidence on the effectiveness of repeat teen pregnancy prevention programs offered in clinical settings. EVIDENCE ACQUISITION Multiple databases were searched for peer-reviewed articles published from January 1985 to April 2016 that included key terms related to adolescent reproductive health services. Analysis of these studies occurred in 2017. Studies were excluded if they focused solely on sexually transmitted disease/HIV prevention services, or occurred outside of a clinic setting or the U.S., Canada, Europe, Australia, or New Zealand. Inclusion and exclusion criteria further narrowed the studies to those that included information on at least one short-term (e.g., increased knowledge); medium-term (e.g., increased contraceptive use); or long-term (e.g., decreased repeat teen pregnancy) outcome, or identified contextual barriers or facilitators for providing adolescent-focused family planning services. Standardized abstraction methods and tools were used to synthesize the evidence and assess its quality. Only studies of clinic-based programs focused on repeat teen pregnancy prevention were included in this review. EVIDENCE SYNTHESIS The search strategy identified 27,104 citations, 940 underwent full-text review, and 120 met the adolescent-focused family planning services inclusion criteria. Only five papers described clinic-based programs focused on repeat teen pregnancy prevention. Four studies found positive (n=2) or null (n=2) effects on repeat teen pregnancy prevention; an additional study described facilitators for helping teen mothers remain linked to services. CONCLUSIONS This review identified clinic-based repeat teen pregnancy prevention programs and few positively affect factors that may reduce repeat teen pregnancy. Access to immediate postpartum contraception or home visiting programs may be opportunities to meet adolescents where they are and reduce repeat teen pregnancy. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
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Affiliation(s)
- Brittni N Frederiksen
- Office of the Assistant Secretary for Health, Office of Population Affairs, HHS, Rockville, Maryland.
| | - Maria I Rivera
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katherine A Ahrens
- Office of the Assistant Secretary for Health, Office of Population Affairs, HHS, Rockville, Maryland
| | | | - Anna W Brittain
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Susan B Moskosky
- Office of the Assistant Secretary for Health, Office of Population Affairs, HHS, Rockville, Maryland
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22
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Estrada F, Suárez-López L, Hubert C, Allen-Leigh B, Campero L, Cruz-Jimenez L. Factors associated with pregnancy desire among adolescent women in five Latin American countries: a multilevel analysis. BJOG 2018; 125:1330-1336. [DOI: 10.1111/1471-0528.15313] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/26/2022]
Affiliation(s)
- F Estrada
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - L Suárez-López
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - C Hubert
- CONACYT - National Institute of Public Health-Reproductive Health Division; Mexico
| | - B Allen-Leigh
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Campero
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
| | - L Cruz-Jimenez
- Reproductive Health Division; Centre for Population Health Research; National Institute of Public Health; Cuernavaca Morelos Mexico
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23
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Pottegård A, Broe A, Stage TB, Brøsen K, Hallas J, Damkier P. Use of Dicloxacillin and Risk of Pregnancy among Users of Oral Contraceptives. Basic Clin Pharmacol Toxicol 2018; 123:288-293. [PMID: 29504695 DOI: 10.1111/bcpt.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 02/21/2018] [Indexed: 11/27/2022]
Abstract
The antibiotic dicloxacillin has been shown to induce drug-metabolizing CYP enzymes to a clinically relevant extent. In this study, we investigated whether the use of dicloxacillin confers an increased risk of unwanted pregnancy among oral contraceptive users. The study population comprised Danish women falling pregnant (1997-2015) during oral contraceptive use, defined as having filled a prescription for an oral contraceptive within 120 days both before and after the estimated date of conception. Data were analysed using a case-crossover approach. For each woman, we assessed the use of dicloxacillin preceding the date of conception and during 10 previous control periods and estimated the odds ratio for such unintended pregnancies associated with the use of dicloxacillin. Among 364 women using dicloxacillin prior to conception, 40 (11%) were exposed to dicloxacillin at the time of conception, yielding an odds ratio (OR) associating use of dicloxacillin to unintended pregnancy of 1.18 (95% CI 0.84-1.65). Supplementary and sensitivity analyses generally returned similar estimates, except for a slightly increased risk among users of progestogen-only oral contraceptives (OR 1.83, 95% CI 0.63-5.34). Analysis of other antibiotics as negative controls yielded results close to unity (ORs ranging from 0.83 to 1.13). In conclusion, our study found no evidence for an increased risk of oral contraceptive failure when using dicloxacillin. However, acknowledging study limitations, we suggest the use of supplementary barrier methods during treatment with dicloxacillin, until our findings are confirmed in further studies.
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Affiliation(s)
- Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne Broe
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Tore B Stage
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kim Brøsen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Exploring young mothers' experiences with postpartum contraception in Ottawa: results from a multimethods qualitative study. Contraception 2018; 97:434-438. [PMID: 29326036 DOI: 10.1016/j.contraception.2017.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/19/2017] [Accepted: 12/28/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Postpartum contraception plays a significant role in reducing subsequent pregnancy. However, young mothers in Ottawa, the capital of Canada, face various barriers when trying to access contraception after delivery. Through this project, we aimed to explore these barriers and understand the decision-making processes of young mothers surrounding postpartum contraception. STUDY DESIGN We conducted 10 semistructured in-depth interviews with young mothers living in Ottawa who had experienced a subsequent pregnancy within 24months of their first childbirth. In addition, we interviewed 10 key informants who work with teenage mothers. We audio-recorded and transcribed all interviews and analyzed them using inductive and deductive techniques. We used ATLAS.ti software to manage our data. RESULTS Both young mothers and key informants report that teen mothers in Ottawa often do not use postpartum contraception or inconsistently use their chosen contraceptive method. Many factors, including cost, personal beliefs, personal priorities and knowledge, influence young mothers' decision making surrounding contraception. CONCLUSIONS Our study suggests that when young mothers do not use postpartum contraception, the reasons are complex; for some, this is a choice, and for others, this is the result of systems-level, service delivery and information barriers. Supporting policies to ensure that a full range of contraceptive methods are available and affordable and developing educational programs in Ottawa that are sex-positive and nonjudgmental appear warranted. IMPLICATIONS Ensuring that a full method mix, including contraceptive implants, is available to and affordable for young mothers in Ottawa could meet significant needs. Addressing existing systems-level, service delivery and information barriers through supporting evidence-based policies and sex-positive and nonjudgmental educational programs appears warranted.
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Zanchi M, Mendoza-Sassi RA, Silva MRD, Almeida SGD, Teixeira LO, Gonçalves CV. Pregnancy recurrence in adolescents in Southern Brazil. Rev Assoc Med Bras (1992) 2017; 63:628-635. [PMID: 28977089 DOI: 10.1590/1806-9282.63.07.628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/03/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the pregnancy recurrence among adolescents and young people in a city located in the extreme south of Brazil and to identify associated factors. METHOD One hundred and twelve (112) women participated, having delivered their children in 2010, while adolescents. The sample was stratified in two stages, being the first a census of the whole population of the city and the second a convenience sample. For statistical analysis, Pearson Chi-square test was used, with a significance level of 5%. RESULTS The recurrence rate was 53.6%, with an average of 28.6 months. At the time of delivery, in 2010, recurrence was significantly associated with level of education (p=0.044) as well as not being in school (p=0.036). In 2014, the factors associated were level of education (p<0.001), transcript of grades (p=0.030) and income (p=0.030). CONCLUSION Recurrence of teenage pregnancy represents a lack of importance given to formal education, a fact that mitigates the opportunities and hinders insertion in the labor market, creating a cycle of social inequality. Multidisciplinary efforts involving schools, health services and the youth in educational activities are thus vital, aiming at critical thinking to transform reality.
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Affiliation(s)
- Mariza Zanchi
- PhD Student, Health Science Graduate Program, Faculdade de Medicina da Universidade Federal do Rio Grande (Famed-FURG), Rio Grande, RS, Brazil
| | | | | | | | - Lisiane Ortiz Teixeira
- PhD Student, Health Science Graduate Program, Faculdade de Medicina da Universidade Federal do Rio Grande (Famed-FURG), Rio Grande, RS, Brazil
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Fortier E, Foster AM. “It was kind of like if it happens it happens. It wasn’t planned, it wasn’t intentional”: Young mothers’ experiences with subsequent pregnancy in Ottawa, Canada. Facets (Ott) 2017. [DOI: 10.1139/facets-2017-0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Young mothers constitute a vulnerable population in Canada. Teens with children are at significant risk of subsequent pregnancy, a dynamic that can exacerbate health, emotional, and socio-economic challenges. We aimed to understand better the dynamics shaping “rapid repeat pregnancy” among young mothers in Ottawa, explore young mothers’ subsequent pregnancy experiences, and identify how services could be improved in Canada’s capital. In 2016, we conducted in-depth interviews with 10 young mothers and semi-structured interviews with 10 key informants working with pregnant and parenting youth. We analyzed interviews for content and themes using a multi-phased, iterative process. Four major themes emerged: (1) young mothers often plan their pregnancies actively or passively; (2) violence before, during, and after pregnancy is common; (3) mental health and substance abuse issues shape pregnancy risk; and (4) becoming pregnant often serves as a source of motivation for young mothers. Our results further indicate that young mothers have difficulty finding youth-friendly, non-judgmental support services and that integrated, multidisciplinary services offering individually tailored support and building on women’s strengths will likely be more successful in helping young mothers prevent subsequent pregnancies. Increasing awareness about existing services and supporting efforts that approach teen pregnancy comprehensively and holistically appear warranted.
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Affiliation(s)
- Elyse Fortier
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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An umbrella review of meta-analyses of interventions to improve maternal outcomes for teen mothers. J Adolesc 2017; 59:97-111. [PMID: 28601024 DOI: 10.1016/j.adolescence.2017.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/12/2017] [Accepted: 05/29/2017] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to perform an umbrella review of meta-analyses of intervention studies designed to improve outcomes of pregnant or parenting teenagers. An extensive search retrieved nine reports which provided 21 meta-analyses analyses. Data were extracted by two reviewers. Methodological quality was assessed using the AMSTAR Instrument. Most effect sizes were small but high quality studies showed significant outcomes for reduced low birth weight (RR = 0.60), repeat pregnancies/births (OR = 0.47-0.62), maternal education (OR = 1.21-1.83), and maternal employment (OR = 1.26). Several parenting outcomes (parent-child teaching interaction post-intervention [SMD = -0.91] and at follow-up [SMD = -1.07], and parent-child relationship post-intervention [SMD = -0.71] and at follow-up [SMD = -0.90]) were significant, but sample sizes were very small. Many reports did not include moderator analyses. Behavioral interventions offer limited resources and occur too late to mitigate the educational and social disparities that precede teen pregnancy. Future intervention research and policies that redress the social determinants of early childbearing are recommended.
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Irresponsible and responsible resource management in obstetrics. Best Pract Res Clin Obstet Gynaecol 2017; 43:87-106. [PMID: 28268060 DOI: 10.1016/j.bpobgyn.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/16/2016] [Accepted: 12/19/2016] [Indexed: 01/02/2023]
Abstract
Low budgets constrain and high budgets stimulate choices. In high-income countries, this economic reality may lead to overuse of healthcare services and pose unnecessary risks for mothers and infants. Options for improvement can be created at different levels of healthcare systems. Pregnancy provides an effective opportunity to profile maternal risks and represents a vulnerable but potentially modifiable period from prenatal life to adulthood. In response to system-inherent false incentives, professional responsibility requires obstetricians to strive to improve the future health of families and their offspring despite disincentives for doing so. This chapter addresses professionally responsible resource management in obstetrics and identifies implications for patients, care givers, communities, policy makers, and academic faculties.
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Charles JM, Rycroft-Malone J, Aslam R, Hendry M, Pasterfield D, Whitaker R. Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances. BMC Pregnancy Childbirth 2016; 16:271. [PMID: 27644695 PMCID: PMC5029024 DOI: 10.1186/s12884-016-1066-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence. METHODS A multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives. RESULTS The searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers' triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence. CONCLUSIONS Pregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence. TRIAL REGISTRATION PROSPERO CRD42012003168.
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Affiliation(s)
- Joanna M. Charles
- Centre for Health Economics & Medicines Evaluation, Ardudwy, Normal Site, Bangor University, Bangor, Gwynedd LL57 2PZ UK
| | - Jo Rycroft-Malone
- School of Healthcare Sciences, Fron Heulog, Bangor University, Bangor, Gwynedd LL57 2EF UK
| | - Rabeea’h Aslam
- Liverpool Review and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Maggie Hendry
- North Wales Centre for Primary Care Research, Gwenfro Units 4-8, Wrexham Technology Park, Wrexham, UK
| | - Diana Pasterfield
- North Wales Centre for Primary Care Research, Gwenfro Units 4-8, Wrexham Technology Park, Wrexham, UK
| | - Rhiannon Whitaker
- Whitaker Research Ltd. Cae Ffos, Treborth Road, Bangor, Gwynedd LL57 2RJ UK
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