How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses

Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.

Thou shalt versus thou shalt not: a meta-synthesis of GPs' attitudes to clinical practice guidelines

BACKGROUND

GPs' adherence to clinical practice guidelines is variable. Barriers to guideline implementation have been identified but qualitative studies have not been synthesised to explore what underpins these attitudes.

AIM

To explore and synthesise qualitative research on GPs' attitudes to and experiences with clinical practice guidelines.

DESIGN OF STUDY

Systematic review and meta-synthesis of qualitative studies.

METHOD

PubMed, CINAHL, EMBASE, Social Science Citation Index, and Science Citation Index were used as data sources, and independent data extraction was carried out. Discrepancies were resolved by consensus. Initial thematic analysis was conducted, followed by interpretative synthesis.

RESULTS

Seventeen studies met the inclusion criteria. Five were excluded following quality appraisal. Twelve papers were synthesised which reported research in the UK, US, Canada, and the Netherlands, and covered different clinical guideline topics. Six themes were identified: questioning the guidelines, GPs' experience, preserving the doctor-patient relationship, professional responsibility, practical issues, and guideline format. Comparative analysis and synthesis revealed that GPs' reasons for not following guidelines differed according to whether the guideline in question was prescriptive, in that it encouraged a certain type of behaviour or treatment, or proscriptive, in that it discouraged certain treatments or behaviours.

CONCLUSION

Previous analyses of guidelines have focused on professional attitudes and organisational barriers to adherence. This synthesis suggests that the purpose of the guideline, whether its aims are prescriptive or proscriptive, may influence if and how guidelines are received and implemented.

Women's experiences of their pregnancy and postpartum body image: a systematic review and meta-synthesis

BACKGROUND

Pregnancy-related physical changes can have a significant impact on a woman's body image. There is no synthesis of existing literature to describe the intricacies of women's experiences of their body, and relevant clinical implications.

METHODS

Four electronic databases were searched in February 2014 using predefined search terms. English-language, qualitative studies published between January 1992 and December 2013 exploring pregnancy and postpartum body image were included. Following quality appraisal, 17 papers were synthesised using the interpretive thematic synthesis approach within a social constructionist framework.

RESULTS

Three themes were highlighted: "Public Event: 'Fatness' vs. Pregnancy", "Control: Nature vs. Self", and "Role: Woman vs. Mother". Women perceived the pregnant body to be out of their control and as transgressing the socially constructed ideal, against which they tried to protect their body image satisfaction. Women perceived the physical manifestation of the mothering role as incongruent to their other roles as a wife or partner, or working woman. Body dissatisfaction dominated the postpartum period.

CONCLUSIONS

Women's perception of their pregnancy body image is varied and depends on the strategies they use to protect against social constructions of female beauty. Women have unrealistic expectations for their postpartum body, highlighting this as an area where women need better support. Attending to women's narratives about their pregnant body may identify at-risk women and provide an opportunity for health professionals to provide support to either address or accept body image dissatisfaction. Clinical communication training may enable health professionals to explore body image concerns with women and guide them in identifying ways of accepting or reducing any dissatisfaction.

African American, Chinese, and Latino family caregivers' impressions of the onset and diagnosis of dementia: cross-cultural similarities and differences

PURPOSE

We explored cross-cultural similarities and differences in minority family caregivers' perceptions of the onset and diagnosis of Alzheimer's disease in their relatives, with specific attention to clinical encounters.

DESIGN AND METHODS

We performed a meta-synthesis of three qualitative studies conducted in Massachusetts with 22 African American, Latino, and Chinese caregivers.

RESULTS

All participants conveyed striking similarities of thought about normalization of cognitive symptoms until one critical event, usually relocation, precipitated family awareness that an elder's behavior was not the result of "normal aging." A lack of knowledge about Alzheimer's disease, rather than culturally influenced beliefs, was the major deterrent to having an elder's memory assessed. Community physicians' failure to recognize Alzheimer's disease or refer to specialists was more problematic than language or ethnic differences. Physicians' disrespect for caregivers' concerns about memory loss was particularly noted by African Americans, stigmatization of persons with Alzheimer's disease was noted by Chinese, and fears that acculturation would end family home care was noted by Latinos.

IMPLICATIONS

Amid ethnocultural differences, there are many similarities in needs that offer providers the possibility to unify quality improvements in Alzheimer's disease outreach, education, and physicians' services. Suggestions include providing the public with more confidential access to Alzheimer's disease information, increasing dementia awareness among community physicians, motivating clinicians to adopt culturally sensitive communication patterns, and providing community education to reduce normalization by families and stigmatization of persons with Alzheimer's disease.

The psychological experience of living with head and neck cancer: a systematic review and meta-synthesis

OBJECTIVE

To summarise patients' experiences of head and neck cancer (HNC) by examining the findings of existing qualitative studies

METHODS

We undertook a systematic review and meta-synthesis of qualitative studies in 29 published articles using Noblit and Hare's 'meta-ethnography' approach to synthesise findings. The inclusion criteria were primary qualitative studies, focusing on HNC patients' experience and an English abstract. Seven databases were systematically searched.

RESULTS

The articles focused on the experience of having HNC, the experience of treatments and the role of information. Our synthesis identified six core concepts-uncertainty and waiting, disruption to daily life, the diminished self, making sense of the experience, sharing the burden and finding a path. People experienced significant disruption to normal daily activities, because of the physical and emotional effects of HNC and its treatment. Day-to-day challenges were compounded by social and existential changes and a palpable loss of the individual's sense of self and future. In order to find a way through the considerable uncertainty and daily challenge of living with and beyond HNC, patients made continual efforts to make sense of their experience. Supportive relationships with their social network, HNC peers and healthcare professionals were particularly important, but support following treatment completion was sometimes limited. Perceptions of the future were affected by whether they saw life as diminished, merely changed or even enhanced by the experience of cancer.

CONCLUSIONS

This review supports further specific research into these emerging themes and provides a context for future work, informing interventions to improve patients' experiences.

Appraising Qualitative Research for Evidence Syntheses: A Compendium of Quality Appraisal Tools

As the movement toward evidence-based health policy continues to emphasize the importance of including patient and public perspectives, syntheses of qualitative health research are becoming more common. In response to the focus on independent assessments of rigor in these knowledge products, over 100 appraisal tools for assessing the quality of qualitative research have been developed. The variety of appraisal tools exhibit diverse methods and purposes, reflecting the lack of consensus as to what constitutes appropriate quality criteria for qualitative research. It is a daunting task for those without deep familiarity of the field to choose the best appraisal tool for their purpose. This article provides a description of the structure, content, and objectives of existing appraisal tools for those wanting to evaluate primary qualitative research for a qualitative evidence synthesis. We then discuss common features of appraisal tools and examine their implications for evidence synthesis.

The barriers, benefits and facilitators of leisure time physical activity among people with spinal cord injury: a meta-synthesis of qualitative findings

Physical activity (PA) can have a positive impact upon health and well-being for people with spinal cord injury (SCI). Despite these benefits, people with SCI are within the most physically inactive segment of society that comprises disabled people. This original meta-synthesis of qualitative research was undertaken to explore the barriers, benefits and facilitators of leisure time physical activity (LTPA) among people with SCI. Articles published since 2000 were identified through a rigorous search of electronic databases, supported with a hand search of relevant journals and papers. In total, 64 papers were read in full, and based on inclusion criteria, 18 were relevant for review. The key themes constructed from the data were summarised, compared and synthesised. Eight interrelated concepts were identified as barriers, benefits and/or facilitators of LTPA: (i) well-being (WB); (ii) environment; (iii) physical body; (iv) body-self relationship; (v) physically active identity; (vi) knowledge; (vii) restitution narrative; (viii) perceived absences. Based on the synthesised evidence, healthcare professionals need to appreciate the relationships between the barriers, benefits and facilitators of LTPA in order to successfully promote a physically active lifestyle. Equally, a more critical attitude to PA promotion is called for in terms of possible adverse consequences.

Beliefs and perception about mental health issues: a meta-synthesis

BACKGROUND

Mental health literacy is the beliefs and knowledge about mental health issues and their remedies. Attitudes and beliefs of lay individuals about mental illness are shaped by personal knowledge about mental illness, knowing and interacting with someone living with mental illness, and cultural stereotypes. Mental health issues are increasing and are alarming in almost every part of the world, and hence compiling this review provides an opportunity to understand the different views regarding mental disorders and problems as well as to fill the gap in the published literature by focusing only on the belief system and perception of mental health problems among general population.

METHOD

The methodology involved a systematic review and the meta-synthesis method, which includes synthesizing published qualitative studies on mental health perception and beliefs.

SAMPLE

Fifteen relevant published qualitative and mixed-method studies, regarding the concept of mental health, were identified for meta-synthesis.

ANALYSIS

All the themes of the selected studies were further analyzed to give a broader picture of mental health problems and their perceived causes and management. Only qualitative studies, not older than 2010, focusing on beliefs about, attitudes toward, and perceptions of mental health problems, causes, and treatments were included in this review.

RESULTS

The findings are divided into four major categories, namely, 1) symptoms of mental health issues, 2) description of mental health issues, 3) perceived causes, and 4) preferred treatment and help-seeking behavior. Each category contains themes and subthemes based on published studies.

CONCLUSION

The findings reveal multiple causes of, descriptions of, and treatment options for mental health problems, thereby providing insight into different help-seeking behaviors. Clarity is offered by highlighting cultural differences and similarities in mental health beliefs and perceptions about the causes of mental health problems. The implications of the studies and recommendations based on current findings are also discussed.

Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies

AIMS AND OBJECTIVES

To explore nurses' views regarding implementing advance care planning for older people.

BACKGROUND

Advance care planning is recommended as a way for older people to discuss their future care with family members and health professionals. Nurses play key roles in the process of advance care planning, including ensuring that patients are informed of their rights and that decisions are known to, and respected by, the health care team. Thus, understanding of nurses' experiences and perspectives regarding implementing advance care planning for older people is a significant topic for review.

DESIGN

Qualitative meta-synthesis.

METHODS

Four databases including CINAHL plus, Medline [EBSCOhost], EMBASE, and PsycINFO were searched, and 1844 articles were initially screened. Finally, 18 articles were critically appraised and a thematic synthesis was undertaken.

RESULTS

Four themes were identified regarding implementation of advance care planning: perceived disadvantages and advantages of advance directives; nurses' responsibility and roles; facilitators and barriers; and nurses' needs and recommendations. Nurses felt that advance directives provided more advantages than disadvantages. Nurses generally believed that they were well positioned to engage in advance care planning conversations. Nurses perceived barriers relating to older people, families, environment, time, culture, cost, language and knowledge of health care teams with regard to advance care planning. In nurses' needs, education and support were highlighted.

CONCLUSIONS

This study provides useful knowledge for implementing advance care planning through illustrating nurses' experiences and perspectives. The results showed that nurses were more concerned about barriers in relation to working environment, teamwork, time and knowledge of health care team members than older people's characteristics, when implementing advance care planning.

RELEVANCE TO CLINICAL PRACTICE

The findings provide nurses and administrators with information to develop related policies and education. Additionally, the appointment of nurses to formal roles related to advance care planning is appropriate and warranted.

Couples' shared experiences of dementia: a meta-synthesis of the impact upon relationships and couplehood

OBJECTIVES

There is a growing recognition of dementia as a condition that affects both members of a couple individually while also influencing the relational bond between them. This is an area which potentially has important service implications. Accordingly, the aim of this review was to elaborate the experience of dementia on partner/spousal relationships through a synthesis of pertinent qualitative literature.

METHOD

A systematic literature search for qualitative research papers was undertaken in November 2013. Five databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES and PsycINFO) were searched using terms for dementia, partner and qualitative data analysis. Meta-synthesis was conducted on the data within the found papers.

RESULTS

A line-of-argument synthesis of 10 studies yielded four overarching themes, which highlight couples' efforts to maintain their sense of togetherness; shifts in balance and power within their relationship which can impact upon both partners' sense of identity; the empathy and sensitive attunement between couples as they work to protect each other's sense of role and identity; and the resilience couples demonstrate in the face of great fear, uncertainty and hopelessness.

CONCLUSION

Findings have important implications for both research and practice, particularly the need for services to support couples' efforts to enhance couplehood in spite of dementia. Ultimately, this review adds further weight to arguments to refocus dementia care on relationships in addition to individuals.

Experiences and unmet needs of lesbian, gay, and bisexual people with cancer care: A systematic review and meta-synthesis

OBJECTIVES

To explore the cancer care experiences and unmet needs of people who identify as a sexual or gender minority.

METHODS

A qualitative systematic review and meta-synthesis was undertaken based on a registered protocol. Following literature searching and study selection, study quality was examined by using the Critical Appraisal Skill Programme Checklist. Qualitative data were extracted verbatim from included studies and synthesized by using thematic analysis.

RESULTS

Fifteen studies that included lesbian, gay, and bisexual (LGB) people living with or beyond cancer were included in the review. Studies including gender minorities were not identified. Most of the study participants were sexual minority women with breast cancer or sexual minority men with prostate cancer. Meta-synthesis of 106 individual findings generated 6 overarching themes pertaining to sexual orientation disclosure, experiences and fear of homophobia, positive and negative health-care professional behaviors, heterocentric systems and care, inadequacy of available support groups, and unmet needs for patient-centered care and LGB-specific information. Lesbian, gay, and bisexual people often reported feelings of anxiety, invisibility, isolation, and frustration throughout the cancer care continuum.

CONCLUSIONS

Analysis of the experiences of LGB people with cancer care shows that LGB people face numerous challenges due to their sexual orientation and receive care that does not adequately address their needs. Training and education of health-care professionals are strongly recommended to address some of these challenges and practice gaps. Culturally appropriate care includes avoiding heterosexual assumptions, use of inclusive language, the provision of tailored information, and involving partners in care.

Overweight and obese adolescents: what turns them off physical activity?

A systematic review of qualitative studies was undertaken to understand the barriers to physical activity experienced by adolescents who were overweight or obese. From a search of electronic databases and 'grey' literature, published between 1950 and 2009, 15 studies met the inclusion criteria. Bronfenbrenner's model of human development provided an ecological lens for identifying and synthesising barriers to physical activity. Two reviewers appraised study quality. Miles and Huberman's cross-case analysis was integrated with thematic networking to synthesize the individual, interpersonal and environmental level barriers for boys and girls of different ethnicities and socioeconomic status, across school settings and generalised context. Thirty-five barriers were identified, 13 of which occurred in physical activity situations in the school setting, 18 were not linked to a specific setting, and the remainder were common across both contexts. The fact that these barriers emerged from studies that focused on topics such as victimisation and mental health is particularly poignant and reflects the potentially pervasive influence of adolescent's excessive weight not only in relation to physical activity situations but other aspects of their lives. Furthermore, socioeconomic status and ethnicity was poorly considered, with only one study linking these participant characteristics to quotations and discussing the potential implications. At present, there are few qualitative studies with sufficiently thick description or interpretive validity that provide insight into this vulnerable group of adolescents, and give them a voice to influence policy and practice.

Women's experiences of fear of childbirth: a metasynthesis of qualitative studies

Purpose: Women's experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women's experiences of fear of childbirth.Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers.Results: The main results demonstrate a deepened understanding of women's experiences of fear of childbirth interpreted through the metaphor "being at a point of no return". Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear.Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth.Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other's experiences will not happen to them.

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

BACKGROUND

Understanding patient experiences of detention under mental health legislation is crucial to efforts to reform policy and practice.

AIMS

To synthesise qualitative evidence on patients' experiences of assessment and detention under mental health legislation.

METHOD

Five bibliographic databases were searched, supplemented by reference list screening and citation tracking. Studies were included if they reported on patient experiences of assessment or detention under mental health legislation; reported on patients aged 18 years or older; collected data using qualitative methods; and were reported in peer-reviewed journals. Findings were analysed and synthesised using thematic synthesis.

RESULTS

The review included 56 papers. Themes were generally consistent across studies and related to information and involvement in care, the environment and relationships with staff, as well as the impact of detention on feelings of self-worth and emotional state. The emotional impact of detention and views of its appropriateness varied, but a frequent theme was fear and distress during detention, including in relation to the use of force and restraint. Where staff were perceived as striving to form caring and collaborative relationships with patients despite the coercive nature of treatment, and when clear information was delivered, the negative impact of involuntary care seemed to be reduced.

CONCLUSIONS

Findings suggest that involuntary in-patient care is often frightening and distressing, but certain factors were identified that can help reduce negative experiences. Coproduction models may be fruitful in developing new ways of working on in-patient wards that provide more voice to patients and staff, and physical and social environments that are more conducive to recovery.

DECLARATION OF INTEREST

None.

Older Adults' Experiences With Using Wearable Devices: Qualitative Systematic Review and Meta-synthesis

BACKGROUND

Older adults may use wearable devices for various reasons, ranging from monitoring clinically relevant health metrics or detecting falls to monitoring physical activity. Little is known about how this population engages with wearable devices, and no qualitative synthesis exists to describe their shared experiences with long-term use.

OBJECTIVE

This study aims to synthesize qualitative studies of user experience after a multi-day trial with a wearable device to understand user experience and the factors that contribute to the acceptance and use of wearable devices.

METHODS

We conducted a systematic search in CINAHL, APA PsycINFO, PubMed, and Embase (2015-2020; English) with fixed search terms relating to older adults and wearable devices. A meta-synthesis methodology was used. We extracted themes from primary studies, identified key concepts, and applied reciprocal and refutational translation techniques; findings were synthesized into third-order interpretations, and finally, a "line-of-argument" was developed. Our overall goal was theory development, higher-level abstraction, and generalizability for making this group of qualitative findings more accessible.

RESULTS

In total, we reviewed 20 papers; 2 evaluated fall detection devices, 1 tested an ankle-worn step counter, and the remaining 17 tested activity trackers. The duration of wearing ranged from 3 days to 24 months. The views of 349 participants (age: range 51-94 years) were synthesized. Four key concepts were identified and outlined: motivation for device use, user characteristics (openness to engage and functional ability), integration into daily life, and device features. Motivation for device use is intrinsic and extrinsic, encompassing many aspects of the user experience, and appears to be as, if not more, important than the actual device features. To overcome usability barriers, an older adult must be motivated by the useful purpose of the device. A device that serves its intended purpose adds value to the user's life. The user's needs and the support structure around the device-aspects that are often overlooked-seem to play a crucial role in long-term adoption. Our "line-of-argument" model describes how motivation, ease of use, and device purpose determine whether a device is perceived to add value to the user's life, which subsequently predicts whether the device will be integrated into the user's life.

CONCLUSIONS

The added value of a wearable device is the resulting balance of motivators (or lack thereof), device features (and their accuracy), ease of use, device purpose, and user experience. The added value contributes to the successful integration of the device into the daily life of the user. Useful device features alone do not lead to continued use. A support structure should be placed around the user to foster motivation, encourage peer engagement, and adapt to the user's preferences.

The District Health Information System (DHIS2): A literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries

BACKGROUND

Health information systems offer many potential benefits for healthcare, including financial benefits and for improving the quality of patient care. The purpose of District Health Information Systems (DHIS) is to document data that are routinely collected in all public health facilities in a country using the system.

OBJECTIVE

The aim of this study was to examine the strengths and operational challenges of DHIS2, with a goal to enable decision makers in different counties to more accurately evaluate the outcomes of introducing DHIS2 into their particular country.

METHOD

A review of the literature combined with the method of meta-synthesis was used to source information and interpret results relating to the strengths and operational challenges of DHIS2. Databases (Embase, PubMed, Scopus and Google Scholar) were searched for documents related to strengths and operational challenges of DHIS2, with no time limit up to 8 April 2017. The review and evaluation of selected studies was conducted in three stages: title, abstract and full text. Each of the selected studies was reviewed carefully and key concepts extracted. These key concepts were divided into two categories of strengths and operational challenges of DHIS2. Then, each category was grouped based on conceptual similarity to achieve the main themes and sub-themes. Content analysis was used to analyse extracted data.

RESULTS

Of 766 identified citations, 20 studies from 11 countries were included and analysed in this study. Identified strengths in the DHIS were represented in seven themes (with 21 categories): technical features of software, proper management of data, application flexibility, networking and increasing the satisfaction of stakeholders, development of data management, increasing access to information and economic benefits. Operational challenges were identified and captured in 11 themes (with 18 categories): funds; appropriate communication infrastructure; the need for the existence of appropriate data; political, cultural, social and structural infrastructure; manpower; senior managers; training; using academic potentials; definition and standardising the deployment processes; neglect to application of criteria and clinical guidelines in the use of system; data security; stakeholder communications challenges and the necessity to establish a pilot system.

CONCLUSION

This study highlighted specific strengths in the technical and functional aspects of DHIS2 and also drew attention to particular challenges and concerns. These results provide a sound evidence base for decision makers and policymakers to enable them to make more accurate decisions about whether or not to use the DHIS2 in the health system of their country.

Barriers and facilitators to health care professionals discussing child weight with parents: A meta-synthesis of qualitative studies

INTRODUCTION

Childhood obesity is one of the most serious global public health challenges. However, obesity and its consequences are largely preventable. As parents play an important role in their children's weight-related behaviours, good communication between parents and health care professionals (HCPs) is essential. This systematic review provides a meta-synthesis of qualitative studies exploring the barriers and facilitators experienced by HCPs when discussing child weight with parents.

METHODS

Searches were conducted using the following databases: MEDLINE (OVID), Psych INFO (OVID), EMBASE (OVID), Web of Knowledge and CINAHL. Thirteen full-text qualitative studies published in English language journals since 1985 were included. Included studies collected data from HCPs (e.g., nurses, doctors, dieticians, psychologists, and clinical managers) concerning their experiences of discussing child weight-related issues with parents. An inductive thematic analysis was employed to synthesize findings.

FINDINGS

Emerging subthemes were categorized using a socio-ecological framework into intra/interpersonal factors, organizational factors, and societal factors. Perceived barriers and facilitators most commonly related to intra/interpersonal level factors, that is, relating to staff factors, parental factors, or professional-parent interactions. HCPs also attributed a number of barriers, but not facilitators, at the organizational and societal levels.

CONCLUSION

The findings of this review may help to inform the development of future weight-related communication interventions. Whilst intra/interpersonal interventions may go some way to improving health care practice, it is crucial that all stakeholders consider the wider organizational and societal context in which these interactions take place. Statement of contribution What is already known on the subject? Childhood obesity is one of the United Kingdom's most serious current public health challenges. Health care professionals are in a prime position to identify child weight issues during routine consultations. However, they often feel unable or unequipped to raise the topic and provide information on child weight management. What does this study add? To our knowledge, this is the first review to synthesize barriers and facilitators to discussing child weight. This review interprets key barriers and facilitators in the context of the socio-ecological model. Supports the development of interventions matched to the appropriate level of the socio-economic model.

Living with complexity; marshalling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity

BACKGROUND

Multimorbidity poses a major health burden worldwide yet most healthcare is still orientated towards the management of single diseases. Literature on the experience of living with multimorbidity is accumulating but has not yet been synthesised in a manner conducive to informing the design of self-management interventions for this population. This study aimed to systematically review and synthesise findings from published, in-depth qualitative studies about the experience of multimorbidity, with a view to identifying the components and motivation for successful self-management in this population.

METHODS

Systematic review of and meta-synthesis of qualitative studies that evaluated patient experience of living with and/or self-managing mental and/or physical multimorbidity. MEDLINE, Embase, PsycINFO, CINAHL, and ASSIA along with reference lists of existing reviews and content pages of non-indexed specialists comorbidity journals were searched.

RESULTS

Nineteen studies from 23 papers were included. A line of argument synthesis was articulated around three third-order constructs: 1) Encounters with complexity; 2) Marshalling medicines, emotions, and resources; and 3) Self-preservation and prevention. Our interpretation revealed how mental and physical multimorbidity is experienced as moments of complexity rather than mere counts of illnesses. Successful self-management of physical symptoms was contingent upon the tactical use of medicines, whilst emotional health was more commonly managed by engaging in behavioural strategies, commonly with a social or spiritual component. Motivations for self-management were underpinned by a sense of moral purpose to take responsibility for their health, but also by a desire to live a purposeful life beyond an immediate context of multimorbidity.

CONCLUSIONS

Understanding how people experience the complexities of mental and physical multimorbidity may be crucial to designing and delivering interventions to support successful self-management in this population. Future self-management interventions should aim to support patients to exert responsibility and autonomy for medical self-management and promote agency and self-determination to lead purposeful lives via improved access to appropriate social and psychological support.

The nurse-patient relationship as a story of health enhancement in community care: A meta-ethnography

AIM

To explore and improve our understanding of how nurse-patient relationships can enhance patients' health by synthesizing knowledge from published qualitative studies from both patients' and nurses' perspectives in community care.

BACKGROUND

While primary research showing the health benefits of the nurse-patient relationship has been reported, this knowledge has not previously been synthesized.

DESIGN

Meta-ethnography.

DATA SOURCES

A comprehensive search of five relevant databases, without year limitation, was completed. Inclusion criteria were: peer-reviewed studies exploring patient and/or nurse perspectives in community care settings, using a qualitative approach and published in English in any country.

REVIEW METHOD

Noblit and Hare's meta-ethnographic approach.

RESULTS

Ten primary studies published between 1997 - 2014 met the research objective and inclusion criteria and were appraised as high quality using CASP. Included studies reported similar findings and reciprocal translational analysis was possible. Six core themes were identified: entering the patient's world; trusting and telling; identifying different needs and uncovering change; patients becoming masters of their own health; patients experiencing health in illness; and nurses going the distance. The core themes were synthesized into a metaphor of "the nurse-patient relationship as a story of health enhancement", which illustrates the meaning of the "common story" they create together.

CONCLUSION

The findings help us better understand how the nurse-patient relationship may enhance the patient's health, not only with regard to illness, physical condition and treatment but also physical, emotional, mental and social well-being. The nurse-patient relationship also has the potential to strengthen the patient's own resources towards maintaining health.

Positive but variable effects of crop diversification on biodiversity and ecosystem services

Ecological theory suggests that biodiversity has a positive and stabilizing effect on the delivery of ecosystem services. Yet, the impacts of increasing the diversity of cultivated crop species or varieties in agroecosystems are still under scrutiny. The available empirical evidence is scattered in scope, agronomic and geographic contexts, and impacts on ecosystem services may depend on the type of diversification strategy used. To robustly assess the effects of crop diversification in agroecosystems, we compiled the results of 95 meta-analyses integrating 5156 experiments conducted over 84 experimental years and representing more than 54,500 paired observations on 120 crop species in 85 countries. Overall, our synthesis of experimental data from across the globe shows that crop diversification enhances not only crop production (median effect +14%) but also the associated biodiversity (+24%, i.e., the biodiversity of non-cultivated plants and animals), and several supporting and regulating ecosystem services including water quality (+51%), pest and disease control (+63%) and soil quality (+11%). However, there was substantial variability in the results for each individual ecosystem service between different diversification strategies such as agroforestry, intercropping, cover crops, crop rotation or variety mixtures. Agroforestry is particularly effective in delivering multiple ecosystem services, that is, water regulation and quality, pest and diseases regulation, associated biodiversity, long-term soil productivity and quality. Variety mixtures, instead, provide the lowest benefits, whereas the other strategies show intermediate results. Our results highlight that while increasing the diversity of cultivated crop species or varieties in agroecosystems represents a very promising strategy for more sustainable land management, contributing to enhanced yields, enhanced biodiversity and ecosystem services, some crop diversification strategies are more effective than others in supporting key ecosystem services.

Women's Experiences of Seeking and Receiving Psychological and Psychosocial Interventions for Postpartum Depression: A Systematic Review and Thematic Synthesis of the Qualitative Literature

INTRODUCTION

Postpartum depression (PPD) is a serious maternal disorder that can have adverse effects on maternal and infant health. The importance of offering effective and acceptable treatments is well recognized, particularly given the numerous barriers women in many settings face in accessing interventions for PPD. The aim of this systematic review was to synthesize qualitative research exploring women's experiences of professional psychological and psychosocial support for PPD.

METHODS

A systematic review of the literature was conducted in April 2017 by searching 5 electronic databases (CINAHL, MEDLINE, PubMed, Ovid, and Web of Science). Qualitative research studies published in English that explored women's experiences of professional psychosocial support for PPD were included, whereas studies exploring women's experiences of antidepressant medication only were excluded. Seventeen articles met inclusion criteria and were appraised for methodologic quality. Data were synthesized using the interpretive thematic synthesis method.

RESULTS

Four main themes were identified: the process of help-seeking, barriers to seeking and accepting support, valued aspects of support, and outcomes. Women found the process of seeking help difficult, with several barriers preventing them from both seeking and accepting professional support. Despite this, women described the support received as beneficial and particularly valued the therapeutic relationship. Women reported 1) feeling more positive and confident after receiving a psychological and/or psychosocial intervention and 2) experiencing better relationships with their infant and other family members.

DISCUSSION

Although seeking and accepting professional support for PPD was a difficult process, women highly valued mental health care support and perceived it as beneficial. Clinical services should aim to address the barriers women face in accessing mental health care and empower women to feel in control throughout the process, offering interventions appropriate to each woman's personal circumstance.

User Experience and Care Integration in Transitional Care for Older People From Hospital to Home: A Meta-Synthesis

This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence.

Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review

AIMS AND OBJECTIVES

To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care.

BACKGROUND

Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period.

DESIGN

A systematic review and meta-synthesis.

METHODS

A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied.

RESULTS

The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home.

CONCLUSIONS

Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care.

RELEVANCE TO CLINICAL PRACTICE

Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.

The Experience of Caregivers Living with Cancer Patients: A Systematic Review and Meta-Synthesis

The objectives of this meta-synthesis were to: (1) explore the experience of caregivers who were caring for cancer patients, including their perceptions and responses to the situation; and (2) describe the context and the phenomena relevant to the experience. Five databases were used: CINAHL, MEDLINE, Academic Search, Science Direct, and a Thai database known as the Thai Library Integrated System (ThaiLIS). Three sets of the context of the experience and the phenomena relevant to the experience were described. The contexts were (1) having a hard time dealing with emotional devastation; (2) knowing that the caregiving job was laborious; and (3) knowing that I was not alone. The phenomenon showed the progress of the caregivers’ thoughts and actions. A general phenomenon of the experience—balancing my emotion—applied to most of the caregivers; whereas, more specific phenomenon—keeping life as normal as possible and lifting life above the illness—were experienced by a lesser number of the caregivers. This review added a more thorough explanation of the issues involved in caregiving for cancer patients. A more comprehensive description of the experience of caregiving was described. The findings of this review can be used to guide clinical practice and policy formation in cancer patient care.

A meta-synthesis on parenting a child with autism

BACKGROUND

The lifelong nature of autism in a child has deep implications on parents as they are faced with a range of challenges and emotional consequences in raising the child. The aim of this meta-synthesis was to explore the perspectives of parents in raising a child with autism in the childhood period to gain an insight of the adaptations and beliefs of parents toward autism, their family and social experiences, as well as their perceptions toward health and educational services.

METHODS

A systematic search of six databases (PubMed, EMBASE, PsychInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects [DARE]) was conducted from inception up to September 30, 2014. Full-text English articles of qualitative studies describing parents' perceptions relating to the care of children younger than 12 years of age and diagnosed with a sole disorder of autism were included.

RESULTS

A total of 50 eligible articles were appraised and analyzed, identifying four core themes encompassing all thoughts, emotions, and experiences commonly expressed by parents: 1) The Parent, 2) Impact on the Family, 3) Social Impact, and 4) Health and Educational Services. Findings revealed that parents who have a child with autism experienced multiple challenges in different aspects of care, impacting on parents' stress and adaptation.

CONCLUSION

Health care provision should be family centered, addressing and supporting the needs of the whole family and not just the affected child, to ensure the family's well-being and quality of life in the face of a diagnosis of autism.