Critical Interpretive Synthesis Research Articles

Justice for Women After Sexual Assault: A Critical Interpretive Synthesis.

Justice after sexual assault is often understood and enacted through the criminal legal system such that the outcomes are binary (i.e., justice is achieved or not achieved). Previous research indicates that survivors have specific wants and needs following an assault in order to experience justice, which may or may not align with current practices. We conducted a critical interpretive synthesis of 5 databases to create a sampling frame of 4,203 records; the final analysis included 81 articles, book chapters, and policy documents. Results indicate that justice is an individualized and dynamic process which may include the experience of voice, connectedness, participating in a process, accountability, and prevention. The experiences of safety and control are central to each of these domains. Survivors may seek and enact these justice domains through several avenues, including the criminal justice and legal systems, restorative justice, medical/mental health spaces, activism, art, and social media. Existing actors within currently available justice systems, including legal, medical, and mental health personnel should encourage survivors to identify and define their own experience of justice, including locating helpful behaviors rooted in safety and control, and resist a binary model of justice. Extant systems should therefore be flexible and accessible to help survivors realize their preferred modes of justice.

Creating or destroying value for users? Lessons about activation from qualitative studies in Norway and Denmark

ABSTRACT This article contributes to a growing stream of research on service co-creation and users’ experiences and use of activation services. In public management research, the idea of a public service logic has gained increasing prominence. A key point is that a better understanding of what a service genuinely is, has implications for how to develop more user-centric and efficient services. This article applies a public service logic in a critical interpretive synthesis of qualitative research findings regarding users’ experiences with activation services in Denmark and Norway. It shows that activation services are necessarily co-created, as users contribute resources to co-create services. Only users can transform these services into individual value, helping them in their process towards work. Services made by utilizing users’ resources but not answering to users’ needs may destroy individual value. Some activation services tend to contribute more to individual value creation than other services, but most services can contribute to both value creation and destruction, depending on users’ needs and circumstances. Public services must also create public value. Services users are obliged to participate in co-creating and which give priority to the creation of public value, such as clarifying eligibility for long term benefits often lead to the destruction of individual value. Taking users’ co-creation of service as a starting point in the design of and research on activation services will contribute to provide more user-centric services, increase the priority given to creation of individual over public value and thereby improve the outcome of activation policy.

Malnutrition, sarcopenia and cachexia: exploring prevalence, overlap, and perceptions in older adults with cancer.

Older adults with cancer are a growing population requiring tailored care to achieve optimum treatment outcomes. Their care is complicated by under-recognised and under-treated wasting disorders: malnutrition, sarcopenia, and cachexia. We aimed to investigate the prevalence, overlap, and patients' views and experiences of malnutrition, sarcopenia, and cachexia, in older adults with cancer. Mixed-methods study with cross-sectional study and qualitative interviews. Interviews were thematically analysed through a phenomenological lens, with feedback loop analysis investigating relationships between themes and findings synthesised using modified critical interpretative synthesis. n = 30 were screened for malnutrition, sarcopenia, and cachexia, n = 8 completed semi-structured interviews. Eighteen (60.0%) were malnourished, 16 (53.3%) sarcopenic, and 17 (56.7%) cachexic. One or more condition was seen in 80%, and all three in 30%. In univariate analysis, Rockwood clinical frailty score (OR 2.94 [95% CI: 1.26-6.89, p = 0.013]) was associated with sarcopenia, reported percentage meal consumption (OR 2.28 [95% CI: 1.24-4.19, p = 0.008]), and visible wasting (OR 8.43 [95% CI: 1.9-37.3] p = 0.005) with malnutrition, and percentage monthly weight loss (OR 8.71 [95% CI: 1.87-40.60] p = 0.006) with cachexia. Screening tools identified established conditions rather than 'risk'. Nutritional and functional problems were often overlooked, overshadowed, and misunderstood by both patients and (in patients' perceptions) by clinicians; misattributed to ageing, cancer, or comorbidities. Patients viewed these conditions as both personal impossibilities, yet accepted inevitabilities. Perceptions, identification, and management of these conditions needs to improve, and their importance recognised by clinicians and patients so those truly 'at risk' are identified whilst conditions are more remediable to interventions.

Unraveling Gender and Non-Accidental Violence in Women’s Gymnastics Research: A Critical Interpretive Synthesis

ABSTRACT Non-accidental violence in women’s gymnastics has gained significant attention, and is a sport where gender is clearly differentiated. Despite the volume of gymnastics research on these themes it seemingly had little impact in preventing harm. We conducted a critical interpretative synthesis of 45 articles to reexamine the literature for understanding of, and connections between, gender and violence. We found that where gender viewed as a structure was explicit, violence was not. Conversely where violence was explicit, gender was implicit and viewed in individualist terms. Only one article explicitly connected gender and violence recognizing violence as a gendered outcome. We encourage researchers to incorporate gender as a structure in analytical inquiries and identify the wider contexts and associated mechanisms through which gender intersects with violence. Doing so can help to develop prevention measures that align with international definitions of gender-based violence.

Music-related wellbeing as a teaching objective? A critical interpretive synthesis

Music-related wellbeing as a teaching objective? A critical interpretive synthesis

Ethical, legal, social, and policy issues of ovarian tissue cryopreservation in prepubertal girls: a critical interpretive review.

Despite the increasing number of childhood cancer survivors, significant advances in ovarian tissue cryopreservation (OTC) technique and medical societies' recommendations, fertility preservation (FP) and FP discussions are not always offered as a standard of care in the pediatric context. The aim of this literature review is to understand what ethical, legal, social, and policy issues may influence the provision of FP by OTC in prepubertal girls with cancer. A critical interpretive review of peer-reviewed papers published between 2000 and January 2023 was conducted, guided by the McDougall's version of the critical interpretive synthesis (Dixon-Woods), to capture recurring concepts, principles, and arguments regarding FP by OTC for prepubertal girls. Of 931 potentially relevant papers, 162 were included in our analysis. Data were grouped into seven thematic categories: (1) risks of the procedure, (2) unique decision-making issues in pediatric oncofertility, (3) counseling, (4) cultural and cost issues, and (5) disposition of cryopreserved reproductive tissue. This first literature review focusing on ethical, legal, social, and policy issues surrounding OTC in prepubertal girls highlights concerns in the oncofertility debate. Although OTC is no longer experimental as of December 2019, these issues could limit its availability and the child's future reproductive autonomy. This review concludes that specific actions must be provided to enable the offer of FP, such as supporting families' decision-making in this unique and complex context, and providing pediatric patients universal and full access to free or highly subsidized OTC.

Autistic sociality: challenging representations of autism and human-animal interactions

Purpose The objective of this synthesis research was to explore representations of autism and human-animal interactions (HAI) in the health sciences literature and the implications for autistic children and their families. Methods Guided by critical interpretive synthesis methods proposed by Dixon-Woods et al. (2006), we synthesized and examined how autism and HAI were described in the health sciences literature and explored assumptions and goals underlying HAI as an intervention. Results Across 47 reviewed articles, animals were represented as therapeutic objects whose purpose from a biomedical perspective was to address “problematic” behaviours and “deficits” in social functioning and development. HAI was employed as a therapy to address improvements in these problematic behaviours in the majority of studies. Relational and social aspects of HAI were present but not explicitly discussed. An alternative perspective proposed by Olga Solomon positioned autistic sociality as one form of diverse human socialities that can be embraced, rather than held problematic and in need of being normalized. Conclusions Implications for HAI in rehabilitation include recognizing the multiple purposes of animals in a child’s life, not only the therapeutic goal of normalizing functioning.

Can Community Music Contribute to More Equitable Societies? A Critical Interpretive Synthesis

AbstractThis article presents outcomes from a critical interpretive synthesis inquiry exploring whether community music can contribute to more equitable societies. Drawing on 74 cross-disciplinary articles, we identify equity-related outcomes across three key categories: outcomes to improve the immediate wellbeing and life trajectories for individuals experiencing disadvantage; outcomes relating to the development of skills, knowledge and understandings empowering individual participants to enact positive social change within their communities; and outcomes with the potential to affect the root causes of social inequity. This review provides a solid foundation for further conceptual and theoretical development within and beyond the fields of social justice research and community music. Our findings will also be helpful for translating the creative and cultural benefits that community music practice could bring to addressing social justice issues in a wide range of complex contexts.

Bridging the gap: Implementation science, knowledge translation, and innovation for advancing maternal health sustainable development goals

Background: Maternal health remains a critical global concern, with sustainable development goal 3 aiming to reduce the maternal mortality ratio and ensure universal access to reproductive healthcare by 2030. According to a 2023 report, a woman dies from preventable causes related to pregnancy and childbirth every 2 minutes, and almost 70% of maternal deaths occur in sub-Saharan Africa. The reduction of maternal mortality and promotion of maternal health and well-being are complex tasks.  Objective: To understand how a synergistic approach integrating complex interventions’ research, implementation science principles, knowledge translation, and innovative solutions can be leveraged to achieve sustainable improvements in maternal health outcomes in different contexts. Methods: This study employed sequential and iterative critical interpretive synthesis (CIS), integrative literature (ILR) review with multiscale analysis of extant literature on maternal health starting with the landmark Lancet series on “Maternal Survival” 2006 (5 papers); 2016 “Maternal Health” series (6 papers); the 2023 Series – “Maternal health in Perinatal period and Beyond” (4 papers); and health sector strategic plans.  Results: Despite knowledge that healthcare is a complex adaptive system (CAS), whereas interventions for maternal health are considered complex interventions, the predominant implementation approaches assume a linear cause-effect approach, leading to the observed stagnation in maternal health.  Conclusion: The effectiveness of complex interventions and their success in reaching relevant populations is critically influenced by their implementation in each context.  A linear understanding of evidence translation, from ‘bench to bedside’, is naïve. This is because those who deliver, manage, and receive healthcare, negotiate multiple forms and sources of evidence, which complement and compete within a complex system of institutional logics.

Prospective policy analysis-a critical interpretive synthesis review.

Most policy analysis methods and approaches are applied retrospectively. As a result, there have been calls for more documentation of the political-economy factors central to health care reforms in real-time. We sought to highlight the methods and previous applications of prospective policy analysis (PPA) in the literature to document purposeful use of PPA and reflect on opportunities and drawbacks. We used a critical interpretive synthesis (CIS) approach as our initial scoping revealed that PPA is inconsistently defined in the literature. While we found several examples of PPA, all were researcher-led, most were published recently and few described mechanisms for engagement in the policy process. In addition, methods used were often summarily described and reported on relatively short prospective time horizons. Most of the studies stemmed from high-income countries and, across our sample, did not always clearly outline the rationale for a PPA and how this analysis was conceptualized. That only about one-fifth of the articles explicitly defined PPA underscores the fact that researchers and practitioners conducting PPA should better document their intent and reflect on key elements essential for PPA. Despite a wide recognition that policy processes are dynamic and ideally require multifaceted and longitudinal examination, the PPA approach is not currently frequently documented in the literature. However, the few articles reported in this paper might overestimate gaps in PPA applications. More likely, researchers are embedded in policy processes prospectively but do not necessarily write their articles from that perspective, and analyses led by non-academics might not make their way into the published literature. Future research should feature examples of testing and refining the proposed framework, as well as designing and reporting on PPA. Even when policy-maker engagement might not be feasible, real-time policy monitoring might have value in and of itself.

Staff‐based measurement instruments of person‐centredness in settings of care for older people: A systematic review

AbstractBackgroundPerson‐centred care is widely endorsed as a promising approach for delivering high‐quality care to older people. However, the multitude of existing definitions and measurement tools, coupled with the continuous emergence of new tools, can create confusion and hinder precision in assessing this concept. This review was undertaken with a recognition of the crucial role that assessment quality plays in evaluations and improvements, particularly within the context of person‐centred care for older people.ObjectivesThis study aimed to systematically review staff‐based measures of person‐centredness in settings of care for older people. More specifically, the objectives were to provide description, methodological evaluation and synthesis of diverse conceptual understandings of person‐centredness encapsulated in these measurement tools.MethodsWe systematically searched the Cinahl, PsycInfo, PubMed, Scopus and Web of Science databases for English peer‐reviewed journal articles between 2000 and 2021. These articles discussed the creation of staff‐based questionnaires designed to assess the extent of person‐centred care. We excluded questionnaires meant for clients, patients or families, as well as non‐questionnaire scales. The measures were described, and their interpretations of person‐centred care were synthesised through a critical interpretive synthesis method. We evaluated methodological quality using a condensed COSMIN risk of bias checklist and adhered to PRISMA guidelines.ResultsThe review identified a total of 14 staff‐based measures. These measures exhibited varying levels of comprehensiveness, encompassing anywhere between 2 and 17 components. Furthermore, the number of items within the measures ranged from 11 to 62, and the sample sizes exhibited significant diversity, spanning from 58 to 1428. In terms of the components scrutinised by the scales regarding person‐centred care, our synthesis revealed the emergence of four distinct conceptual categories: care process, supportive care environment, relations and communication, and knowledge and attitudes. As for the methodological quality of the scales, it exhibited a notable degree of variation (i.e. from inadequate to very good).ConclusionsDiverse measures of person‐centredness vary in terms of comprehensiveness, aspects covered and methodological quality. Synthesising the concept through staff‐based measures offers a novel approach for researchers and practitioners, illuminating nuanced perspectives in person‐centred care.Implications for practiceThe synthesis enriches academic discussions and practical applications by dissecting components, ultimately enhancing care quality assessment and improvement. Further, this review is a valuable resource for unit managers and quality coordinators working in settings of care for older people, empowering them to make informed decisions tailored to their specific needs from a diverse array of available person‐centred care measures.

A critical interpretive synthesis of interprofessional education interventions

ABSTRACT Interprofessional practice can look quite different depending on a number of dynamics. Interprofessional education interventions may or may not orient toward this range of practice possibilities. This literature review explores: (1) how interprofessional education interventions relate to different kinds of interprofessional practice and (2) the range of interprofessional practices assumed by interprofessional education interventions. Four databases were searched for articles published between 2011–2021 describing pre-licensure level interprofessional education interventions, resulting in a dataset of 110 articles. Our analysis involved (1) descriptive summaries of the articles, and (2) content analysis of the rationale and description of the intervention. Of the articles, 93% (102/110) of interprofessional education interventions were designed and/or evaluated using the concept of interprofessional education competencies. “Teamwork” was the most relied upon competency. Most articles were not explicit about the different kinds of interprofessional practices that these competencies might be oriented toward. Our study substantiates earlier claims that interprofessional education literature tends to focus on competencies and orient toward undifferentiated understandings of “teamwork.” This analysis is particularly important as interprofessional teams are engaging in increasingly complex, fluid, and distributed forms of interprofessional practice that may not be captured in an undifferentiated approach to “teamwork.”

A critical literature review: deconstructing narratives of trauma in art therapy with young people

ABSTRACT Background This paper addresses the need for critical reflection on how art therapists position themselves and represent their work in the context of diverse frameworks for understanding young people’s adverse life experiences, particularly in relation to the prevalence of trauma discourses. Aims The study examined how art therapists have represented in the literature their practice and research with young people (12-18 years old) experiencing adversity, from 2000 to 2019. Methods Employing Critical Interpretive Synthesis (Dixon-Woods et al., 2006), 26 theoretically-sampled articles were systematically reviewed through an interpretive, inductive and recursive process. Results Art therapists commonly use trauma as a lens to conceptualise young people’s diverse adverse life experiences, with variations based on their theoretical and philosophical orientations. These variations influence how they perceive young people’s needs and art therapy aims. The study also highlights varying levels of creativity and self-agency that young people express in art therapy, emphasising the importance of art therapists’ flexible and tailored approaches. Conclusions The importance of art therapists’ critical awareness when framing and working with young people’s complex life experiences and presentations to avoid stigmatisation and disempowerment is underscored. Implications for practice/policy/future research The study suggests that art therapists’ critical awareness that can enable collaborative practice and researchwith young people with adverse life experiences. It encourages more research into and cultivating art therapists’ conscious awareness of their choice of theoretical alignment and its implications. Additionally, it encourages future research to understand young people’s own conceptualisations of their lived experiences and their perspectives on the ongoing relevance and meaning of art therapy. Plain-language summary This study sought to present the key findings of a critical review of art therapy literature. The main focus of the review was to examine how art therapists represented their work and if there were dominant understandings of trauma influencing art therapists. Using a Critical Interpretive Synthesis method developed by Dixon-Woods et al. (2006), 26 peer-reviewed journal articles published between 2000-2019 were selected based on their relevance to this study. The selected articles described art therapy practice and research with young people (12-18 years old) who had various adverse life experiences. These articles were thoroughly reviewed and analysed through a cyclic process of re-examination and interpretation. Findings indicated that while young people’s diverse adverse life experiences were often labelled as trauma, art therapists’ conceptualisations of trauma varied depending on their theoretical and philosophical orientations. Intriguingly, how art therapists perceived the meaning of adverse life experiences influenced how they formulated young people’s needs and the aims of art therapy. Findings also highlighted young people’s creativity and expression of self-agency in their art therapy programmes and the importance of art therapists’ flexible and tailored approaches. Overall, this study highlights the importance of art therapists’ critical awareness when framing and working with young people’s complex life experiences and presentations to avoid stigmatisation and disempowerment. It recommends further exploring and cultivating art therapists’ conscious awareness of what theoretical concepts they align with and the implications of their choice. Additionally, future art therapy practice and research should actively explore the perspectives of young people with adverse life experiences to inform the ongoing relevance and meaning of art therapy.

The challenges and solutions of technology integration in rural schools: A systematic literature review

The digital divide between urban and rural schools challenges efforts to promote technology integration in education, and contributes to growing educational inequity in many contexts. Using the most current version of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020), we identified and extracted 36 articles and conference papers on the use of technology in rural schools from the Scopus and Web of Science databases. We used Critical Interpretive Synthesis to identify the challenges and solutions involved in integrating technology in rural schools. The analysis revealed 29 challenges, which were categorized using the framework of the ecological perspective into macro level, meso level, and micro level challenges. The analysis also identified solutions to the challenges discussed in these studies. By focusing on the challenges and proposed solutions at different contextual levels, this review is intended to identify what constitutes good practices when integrating technology in rural schools. Future research should focus on factors which facilitate the use of technology and how the integration of technology impacts students’ learning experiences and achievement in rural schools.

Music in medical education: A critical interpretive synthesis.

While many have championed the value of music in medical education, research specific to how and why music has been offered in medical education is sparse and there have been few attempts to synthesise the literature. A Critical Interpretive Synthesis (CIS) of 56 texts including published articles, correspondence, abstracts and one thesis published between 1977 and 2022 was undertaken to explore the evidence basis for offering music in medical education. A total of 52 music-focused programmes/activities were described, encompassing both curricular and extra-curricular, receptive and participatory music activities and a wide range of musical genres. Inductive analysis of data extracted from texts revealed a variety of rationales for the use of music in medical education, which could be grouped within seven interrelated themes: well-being; supportive learning environment; affective engagement; teaching and learning; developing skills for clinical practice; humanism in medicine; and creative expression (identity). The results of this synthesis demonstrate that there remains a gap between what is claimed about the affordances of music and what has been explicitly addressed in medical education research. Despite a paucity of research in this area, the available data support that the affordances of music are 'multiple' and may not be well represented by linear models. Evidence that engagement with music is beneficial for medical students is strongest in relation to the affordances of music for well-being, facilitating a supportive learning environment, affective engagement, memorisation and creative expression (identity). That engagement with music might enhance humanism, including developing skills for clinical practice, requires further investigation. Accounting for student agency and the 'multiple' affordances of music will ensure that future teaching and research are best positioned to benefit medical students' well-being and personal and professional development.

Meta-synthesis As an Original Method to Synthesize Qualitative Literature in Chronic Diseases: A Narrative Review

Context: The recent growth of research and the vast amount of knowledge available highlight the necessity for synthesizing existing research in a reliable and high-quality manner. The substantial body of qualitative meta-synthesis studies on chronic diseases indicates the need for a deeper understanding of this methodology. Therefore, the purpose of this paper was to explain the process of meta-synthesis in qualitative research. Methods: This was a narrative review with predefined inclusion and exclusion criteria, followed by a web search using relevant keywords. Initially, 980 relevant articles were selected. Subsequently, the titles, abstracts, and full texts were assessed for eligibility using the Critical Appraisal Skills Program checklist. Finally, 21 articles were included in this study. Results: Various approaches have been adopted to address the meta-synthesis of qualitative studies. Common types of qualitative meta-synthesis include meta-narrative, critical interpretive synthesis, meta-study, meta-ethnography, grounded formal theory, thematic synthesis, textual narrative synthesis, framework synthesis, and ecological triangulation. However, concerning chronic diseases, the most commonly used methods were ethnography and Sandelowski and Barroso’s method. Conclusions: Meta-synthesis is a method for integrating the results of studies, re-understanding the findings, and ultimately interpreting them to generate new insights beyond what is obtained from individual studies. Given the extensive body of qualitative research on chronic diseases, it is recommended to conduct this type of research to develop new knowledge based on the findings of previous studies.

A Critical Interpretive Synthesis of the Role of Arecoline in Oral Carcinogenesis: Is the Local Cholinergic Axis a Missing Link in Disease Pathophysiology?

Arecoline is the primary active carcinogen found in areca nut and has been implicated in the pathogenesis of oral squamous cell carcinoma (OSCC) and oral submucous fibrosis (OSF). For this study, we conducted a stepwise review process by combining iterative scoping reviews with a post hoc search, with the aim of identifying the specific mechanisms by which arecoline initiates and promotes oral carcinogenesis. Our initial search allowed us to define the current trends and patterns in the pathophysiology of arecoline-induced OSF and OSCC, which include the induction of cell proliferation, facilitation of invasion, adhesion, and migration, increased collagen deposition and fibrosis, imbalance in immune and inflammatory mechanisms, and genotoxicity. Key molecular pathways comprise the activation of NOTCH1, MYC, PRDX2, WNT, CYR61, EGFR/Pl3K, DDR1 signaling, and cytokine upregulation. Despite providing a comprehensive overview of potential pathogenic mechanisms of OSF, the involvement of molecules functioning as areca alkaloid receptors, namely, the muscarinic and nicotinic acetylcholine receptors (AChRs), was not elucidated with this approach. Accordingly, our search strategy was refined to reflect these evidence gaps. The results of the second round of reviews with the post hoc search highlighted that arecoline binds preferentially to muscarinic AChRs, which have been implicated in cancer. Consistently, AChRs activate the signaling pathways that partially overlap with those described in the context of arecoline-induced carcinogenesis. In summary, we used a theory-driven interpretive review methodology to inform, extend, and supplement the conventional systematic literature assessment workflow. On the one hand, the results of this critical interpretive synthesis highlighted the prevailing trends and enabled the consolidation of data pertaining to the molecular mechanisms involved in arecoline-induced carcinogenesis, and, on the other, brought up knowledge gaps related to the role of the local cholinergic axis in oral carcinogenesis, thus suggesting areas for further investigation.

Evaluating mental health decision units in acute care pathways (DECISION): a quasi-experimental, qualitative and health economic evaluation.

People experiencing mental health crises in the community often present to emergency departments and are admitted to a psychiatric hospital. Because of the demands on emergency department and inpatient care, psychiatric decision units have emerged to provide a more suitable environment for assessment and signposting to appropriate care. The study aimed to ascertain the structure and activities of psychiatric decision units in England and to provide an evidence base for their effectiveness, costs and benefits, and optimal configuration. This was a mixed-methods study comprising survey, systematic review, interrupted time series, synthetic control study, cohort study, qualitative interview study and health economic evaluation, using a critical interpretive synthesis approach. The study took place in four mental health National Health Service trusts with psychiatric decision units, and six acute hospital National Health Service trusts where emergency departments referred to psychiatric decision units in each mental health trust. Participants in the cohort study (n = 2110) were first-time referrals to psychiatric decision units for two 5-month periods from 1 October 2018 and 1 October 2019, respectively. Participants in the qualitative study were first-time referrals to psychiatric decision units recruited within 1 month of discharge (n = 39), members of psychiatric decision unit clinical teams (n = 15) and clinicians referring to psychiatric decision units (n = 19). Primary mental health outcome in the interrupted time series and cohort study was informal psychiatric hospital admission, and in the synthetic control any psychiatric hospital admission; primary emergency department outcome in the interrupted time series and synthetic control was mental health attendance at emergency department. Data for the interrupted time series and cohort study were extracted from electronic patient record in mental health and acute trusts; data for the synthetic control study were obtained through NHS Digital from Hospital Episode Statistics admitted patient care for psychiatric admissions and Hospital Episode Statistics Accident and Emergency for emergency department attendances. The health economic evaluation used data from all studies. Relevant databases were searched for controlled or comparison group studies of hospital-based mental health assessments permitting overnight stays of a maximum of 1 week that measured adult acute psychiatric admissions and/or mental health presentations at emergency department. Selection, data extraction and quality rating of studies were double assessed. Narrative synthesis of included studies was undertaken and meta-analyses were performed where sufficient studies reported outcomes. Psychiatric decision units have the potential to reduce informal psychiatric admissions, mental health presentations and wait times at emergency department. Cost savings are largely marginal and do not offset the cost of units. First-time referrals to psychiatric decision units use more inpatient and community care and less emergency department-based liaison psychiatry in the months following the first visit. Psychiatric decision units work best when configured to reduce either informal psychiatric admissions (longer length of stay, higher staff-to-patient ratio, use of psychosocial interventions), resulting in improved quality of crisis care or demand on the emergency department (higher capacity, shorter length of stay). To function well, psychiatric decision units should be integrated into the crisis care pathway alongside a range of community-based support. The availability and quality of data imposed limitations on the reliability of some analyses. Psychiatric decision units should not be commissioned with an expectation of short-term financial return on investment but, if appropriately configured, they can provide better quality of care for people in crisis who would not benefit from acute admission or reduce pressure on emergency department. The systematic review was registered on the International Prospective Register of Systematic Reviews as CRD42019151043. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/49/70) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 25. See the NIHR Funding and Awards website for further award information.

Advancing the communication of genetic risk for cardiometabolic diseases: a critical interpretive synthesis

BackgroundGenetics play an important role in risk for cardiometabolic diseases—including type 2 diabetes, cardiovascular disease and obesity. Existing research has explored the clinical utility of genetic risk tools such as polygenic risk scores—and whether interventions communicating genetic risk information using these tools can impact on individuals’ cognitive appraisals of disease risk and/or preventative health behaviours. Previous systematic reviews suggest mixed results. To expand current understanding and address knowledge gaps, we undertook an interpretive, reflexive method of evidence synthesis—questioning the theoretical basis behind current interventions that communicate genetic risk information and exploring how the effects of genetic risk tools can be fully harnessed for cardiometabolic diseases.MethodsWe obtained 189 records from a combination of database, website and grey literature searches—supplemented with reference chaining and expert subject knowledge within the review team. Using pre-defined critical interpretive synthesis methods, quantitative and qualitative evidence was synthesised and critiqued alongside theoretical understanding from surrounding fields of behavioural and social sciences.FindingsExisting interventions communicating genetic risk information focus predominantly on the “self”, targeting individual-level cognitive appraisals, such as perceived risk and perceived behavioural control. This approach risks neglecting the role of contextual factors and upstream determinants that can reinforce individuals’ interpretations of risk. It also assumes target populations to embody an “ascetic subject of compliance”—the idea of a patient who strives to comply diligently with professional medical advice, logically and rationally adopting any recommended lifestyle changes. We developed a synthesising argument—“beyond the ascetic subject of compliance”—grounded in three major limitations of this perspective: (1) difficulty applying existing theories/models to diverse populations, (2) the role of familial variables and (3) the need for a life course perspective.ConclusionsInterventions communicating genetic risk information should account for wider influences that can affect individuals’ responses to risk at different levels—including through interactions with their family systems, socio-cultural environments and wider health provision.Protocol registrationPROSPERO CRD42021289269

Components of Outpatient Child and Youth Concurrent Disorders Programs: A Critical Interpretive Synthesis: Composantes des programmes de troubles concomitants des enfants et des jeunes ambulatoires : une synthèse interprétative critique.

Co-occurring mental health and substance use disorders (concurrent disorders) lead to significant morbidity in children and youth. Programs for integrated treatment of concurrent disorders have been developed; however, there exists little guidance outlining their structure and activities. Our objective was to synthesize available information on outpatient child and youth concurrent disorders programs and produce a comprehensive framework detailing the components of such programs. We used a four-stage critical interpretive synthesis design: (1) systematic review of published and grey literature, (2) data abstraction to identify program components and purposive sampling to fill identified gaps, (3) organization of components into a structured framework, (4) feedback from programs. We employed an iterative process by which programs reviewed data abstraction and framework development and provided feedback. Through systematic review (yielding 1,408 records total and 7 records eligible for inclusion) and outreach strategies (yielding an additional 7 eligible records), we identified 11 programs (4 American, 7 Canadian) and 2 theoretical models from which data could be abstracted. Program activities were categorized into 12 overarching constructs that make up the components of the framework: accessibility, engagement, family involvement, integrated assessment, psychotherapy for patients, psychotherapy for families, medication management, health promotion, case management, vocational support, recreation and social support, and transition services. Program components are informed by the philosophical orientation of the program and models of care. This framework considers health system factors, clinical service factors, program development, and community partnership that impact program structure and activities. Multidisciplinary teams provide care and include addiction medicine, psychiatry, psychology, nursing, social work, occupational therapy, recreation therapy, peer support, and program evaluation. We developed a comprehensive framework describing components of child and youth outpatient concurrent disorders programs. This framework may assist programs currently operating, and those in development, to reflect on their structure and activities.