Meta-synthesis Of Qualitative Studies Research Articles

What matters to women in the postnatal period: A meta-synthesis of qualitative studies.

The postnatal period is an underserved aspect of maternity care. Guidelines for postnatal care are not usually informed by what matters to the women who use it. This qualitative systematic review was undertaken to identify what matters to women in the postnatal period, to inform the scope of a new World Health Organization (WHO) postnatal guideline. We searched MEDLINE, CINAHL, PsycINFO, POPLINE, Global Index Medicus, EMBASE, LILACS, AJOL, and reference lists of eligible studies published January 2000-July 2019, reporting qualitative data on women's beliefs, expectations, and values relating to the postnatal period. Author findings were extracted, coded and synthesised using techniques derived from thematic synthesis. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting findings was assessed using GRADE-CERQual. We included 36 studies from 15 countries, representing the views of more than 800 women. Confidence in most results was moderate to high. What mattered to women was a positive postnatal experience where they were able to adapt to their new self-identity and develop a sense of confidence and competence as a mother; adjust to changes in their intimate and family relationships, including their relationship to their baby; navigate ordinary physical and emotional challenges; and experience the dynamic achievement of personal growth as they adjust to the 'new normal' of motherhood and parenting in their own cultural context. This review provides evidence that what matters to women in the postnatal period is achieving positive motherhood (including maternal self-esteem, competence, and autonomy), as well as fulfilling adaptation to changed intimate and family relationships, and (re)gaining health and wellbeing for both their baby, and themselves. Where this process is optimal, it also results in joy, self-confidence, and an enhanced capacity to thrive in the new integrated identity of 'woman and mother'.

중도입국청소년의 교육 경험에 대한 질적 메타분석: 위험요인과 보호요인을 중심으로

중도입국청소년의 교육 경험에 대한 질적 메타분석: 위험요인과 보호요인을 중심으로

Fatigue: The Misunderstood Symptom of Heart and Lung Disease

Fatigue is a common symptom experienced by patients with chronic heart and lung failure that can lead to adverse health outcomes, such as frailty. To better understand the nature of fatigue in heart and lung failure, a meta-synthesis of qualitative studies was conducted to explore patients' experiences of fatigue while living with heart failure (HF) or chronic obstructive pulmonary disease (COPD). Understanding the nature and impact of fatigue in these chronic conditions can guide the evaluation and management of fatigue and inform future development of therapeutic interventions to decrease fatigue and improve quality of life. Three databases (Embase, PubMed, CINAHL) were searched for qualitative studies published in the last ten years that describe fatigue in patients with HF or COPD. Studies with descriptions of fatigue, either as the primary focus or as a component to a symptom profile, were synthesized, integrated, and interpreted. 13 studies describing the experience of fatigue in HF and COPD across 444 participants were identified and included in the analysis. Across studies, fatigue was described as an all-consuming experience of lethargy, lack of energy, and physical weakness that was refractory to rest and worsened over time. Fatigue was deeply disruptive to daily life, impacting both physical and social activities, and leading to a loss of independence and isolation. This disruption had significant physical and psychological consequences, which further emerged in two sub-themes; co-occurrence of symptoms (e.g. sleep disturbances, anxiety and depression, reduced appetite, and impaired cognition), and feeling that the extent of their suffering and capabilities were either under recognized or misunderstood by both loved ones and clinicians. Findings highlight the pervasive experiences of fatigue in chronic heart failure and COPD. Fatigue deeply impacts physical, psychological, and social domains and decreases quality of life. Fatigue is commonly under recognized or misunderstood by family, friends, and clinicians. Assessment and management of fatigue needs to be incorporated in routine clinical care of patients with heart and lung failure. Themes of commonly occurring co-symptoms highlight key physical and psychological elements that mediate or exacerbate fatigue, and may serve as targets in future interventional studies.

The Experiences of Women Living With Cervical Cancer in Africa: A Metasynthesis of Qualitative Studies.

Cervical cancer is the fourth most common cancer in women worldwide. However, developing countries bear 85% of the burden, with Africa sharing the highest incidence with Melanesia. The aims of this study were to explore the experiences of women living with cervical cancer in Africa and to inform others of the extent of the work done in this field of study by synthesizing the findings of qualitative research. The work of Sandelowski and Barroso guided the study, and 6 databases were searched to identify relevant studies using the key words Africa, cervical cancer, and experiences. A total of 13 studies (n = 13) met the inclusion criteria, and their findings were synthesized. The studies originated primarily from South Africa and focused on the period from diagnosis to 1 year after completing curative treatment. One overarching core theme living a life of suffering, 2 main themes, architects of suffering and mediators of suffering, and 9 subthemes were identified. Women living with cervical cancer in Africa live a life of suffering, which starts when they experience the first symptom of cervical cancer and continues well after completing treatment. The facilitators of suffering outweighed the mediators and could not be guaranteed, as it did not relieve the suffering of all. Nurses practicing in Africa should be acutely aware of cervical cancer and do their utmost within their limited resources to prevent and detect the disease in its earliest stage. Religious and support interventions could be used to lessen the suffering of these women.

A metasynthesis of qualitative studies on girls' and women's labeling of sexual violence

Abstract Many women do not label their unwanted sexual experiences as rape or sexual violence, but rather use various labels that suggest a different understanding of the events. This metasynthesis provides new insights and empirical evidence of how girls and women discuss their unwanted sexual experiences, and identifies factors that impede or promote such labeling. Qualitative data of 9 studies were synthetized using Noblit and Hare's (1988) framework. Results show that victims can frame sexual violence within rape scripts that may lead to minimization, normalization, self-blame or rationalization of the event. Some participants hold an ambivalent discourse, which suggests that labeling is a fluctuating process. Finally, seeking social support, or receiving educational information seem to facilitate the labeling of sexual violence. The implications for intervention and sexual violence prevention programs are discussed.

Working with patients suffering from chronic diseases can be a balancing act for health care professionals - a meta-synthesis of qualitative studies

BackgroundThe number of patients with long-term chronic diseases is increasing. These patients place a strain on health care systems and health care professionals (HCPs). Presently, we aimed to systematically review the literature on HCPs’ experiences working with patients with long-term chronic diseases such as type 2 diabetes, chronic obstructive pulmonary disease (COPD), and chronic kidney disease (CKD).MethodA systematic search of papers published between 2002 and July 2019 was conducted in the Embase, AMED, PsycINFO, MEDLINE, CINAHL, and COCHRANE databases to identify studies reporting qualitative interviews addressing HCPs’ experiences working with adults with COPD, CKD or type 2 diabetes. An interdisciplinary research group were involved in all phases of the study. With the help of NVivo, extracts of each paper were coded, and codes were compared across papers and refined using translational analysis. Further codes were clustered in categories that in turn formed overarching themes.ResultsOur comprehensive search identified 4170 citations. Of these, 20 papers met our inclusion criteria. Regarding HCPs’ experiences working with patients with COPD, CKD, or type 2 diabetes, we developed 10 sub-categories that formed three overarching main themes of work experiences: 1) individualizing one’s professional approach within the clinical encounter; 2) managing one’s emotions over time; 3) working to maintain professionalism. Overall these three themes suggest that HCPs’ work is a complex balancing act depending on the interaction between patient and professional, reality and professional ideals, and contextual support and managing one’s own emotions.ConclusionFew qualitative studies highlighted HCPs’ general working experiences, as they mainly focused on the patients’ experiences or HCPs’ experiences of using particular clinical procedures. This study brings new insights about the complexity embedded in HCPs’ work in terms of weighing different, often contrasting aspects, in order to deliver appropriate practice. Acknowledging, discussing and supporting this complexity can empower HCPs to avoid burning out. Leaders, health organizations, and educational institutions have a particular responsibility to provide HCPs with thorough professional knowledge and systematic support.Trial registrationPROSPERO number: CRD42019119052.

Physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions: a systematic review and metasynthesis of qualitative studies.

Clinical practice guidelines recommend a biopsychosocial approach for the management of musculoskeletal pain conditions, but physiotherapists have reported feeling inadequately trained and lacking in confidence to deal with psychosocial issues. Although a growing number of studies are exploring physiotherapists' perceptions of biopsychosocial training, the results have not been synthesized. Therefore, the aim of this systematic review and metasynthesis of qualitative studies was to explore physiotherapists' perceptions of learning and implementing a biopsychosocial intervention to treat musculoskeletal pain conditions. A search of the electronic databases: MEDLINE, EMBASE, CINAHL, ERIC, PsycInfo, SportDiscus, and Sociological abstracts identified eligible studies. We included full-text qualitative and mixed-methodology studies published in English, which investigated physiotherapists' perceptions of learning and implementing biopsychosocial interventions. Twelve studies involving 113 participants met the inclusion criteria, and a thematic synthesis was conducted. The quality of the included studies was appraised using the Clinical Appraisal Screening Program. Four main themes emerged from the data: changed understanding and practice, professional benefits, clinical challenges, and learning requirements. The results of this study indicate that although the physiotherapists reported a shift towards more biopsychosocial and person-centered approaches, the training interventions did not sufficiently help them feel confident in delivering all the aspects. Planning future implementation interventions and training physiotherapists through a biopsychosocial approach should focus on adequate training and individualized mentoring related to psychosocial factors, and discussion of role boundaries, patient expectations, and organizational factors such as time constraints and referral pathways.

Knowledge, beliefs, and concerns about bone health from a systematic review and metasynthesis of qualitative studies.

BackgroundPatients with low bone density or osteoporosis need information for effective prevention or disease management, respectively. However, patients may not be getting enough information from their primary care providers or other sources. Inadequate disease information leaves patients ill-informed and creates misconceptions and unnecessary concerns about the disease.ObjectiveWe systematically reviewed and synthesized the available literature to determine patient knowledge, beliefs, and concerns about osteoporosis and identify potential gaps in knowledge.MethodsA systematic search was conducted for full-text qualitative studies addressing understanding, literacy, and/or perceptions about osteoporosis and its management, using Medline, EMBASE, Web of Science, Cochrane Library, CINAHL, ERIC, PsychINFO, Psyc Behav Sci Collec, and PubMed, from inception through September 2016. Studies were selected by two reviewers, assessed for quality, and themes extracted using the Joanna Briggs Institute data extraction tool. Thematic analysis was used to identify themes and subthemes.ResultsTwenty-five studies with a total of 757 participants (including 105 men) were selected for analysis out of 1031 unique citations. Selected studies were from Australia, Canada, Denmark, Norway, the United Kingdom, and the United States. Four main themes emerged: inadequate knowledge, beliefs and misconceptions, concerns about osteoporosis, and lack of information from health care providers. Participants had inadequate knowledge about osteoporosis and were particularly uninformed about risk factors, causes, treatment, and prevention. Areas of concern for participants included diagnosis, medication side effects, and inadequate information from primary care providers.ConclusionAlthough there was general awareness of osteoporosis, many misconceptions and concerns were evident. Education on bone health needs to reinforce areas of knowledge and address deficits, misconceptions, and concerns.

The quality of life of family health professionals: a systematic review and meta-synthesis.

to perform a systematic review and meta-synthesis of qualitative studies about the work-related quality of life of Family Health Strategy professionals. this systematic review was developed to answer the following PVO question: "Which factors (variables) are associated with the work-related quality of life (outcome) of Family Health Strategy professionals (population)?" The PubMed, Scopus, Embase, SciELO, Web of Science, LILACS, Science Direct, OpenThesis, OpenGrey, and OATD databases were selected. The meta-synthesis analyzed the main codes and secondary codes of all included studies. the database search resulted in 1,744 reports; six were considered eligible for the meta-synthesis. Four factors were considered for the quality of work life: working conditions; work processes; interpersonal relationships; and personal aspects. although this study confirms the adequacy of aspects commonly related to the quality of work life, other factors are important in the case of FHS professionals, especially work context.

Family Experiences Prior to the Initiation of Care for First-Episode Psychosis: A Meta-Synthesis of Qualitative Studies.

This study systematically reviewed existing qualitative evidence of family members' experiences prior to the initiation of mental health services for a loved one experiencing their first episode of psychosis (FEP). A meta-synthesis review of published peer-reviewed qualitative studies conducted between 2010 and 2019 were included. Keyword searches were performed in four electronic databases and the reference lists of primary manuscripts. Two independent reviewers used the Critical Appraisal Skills Programme (CASP) qualitative checklist to assess methodological quality of each study. A total of 365 articles were initially identified and 9 were articles identified in a secondary review and literature search. A total of 21 met inclusion criteria. Of those included in this review 169, mothers were the primary family to recall experiences. The meta-synthesis identified four major themes related to family member experiences prior to the initiation of mental health services for FEP: the misinterpretation of signs, the emotional impact of FEP on family members, the effect of stigma on family members, and engaging with resources prior to mental health services for FEP. Additional research is needed to develop healthy communication strategies that effectively deliver educational information about psychosis. This meta-synthesis also identified the need to understand help-seeking behaviors among families of those with FEP in effort to reduce the duration of untreated psychosis and improve pathways to care often initiated by a family member.

The impact of home enteral feeding on the daily lives of people with head and neck cancer: a metasynthesis of qualitative studies.

Home enteral feeding (HEF) may have a wider impact on peoples' daily lives beyond influencing their nutritional and clinical status. This metasynthesis aimed to determine the impact of HEF on peoples' daily lives. Qualitative studies were included with adults, who had been diagnosed with head and neck cancer and had finished their cancer treatment, with a feeding tube in place. Medline, PubMed and Cinahl were searched (August 2009 to August 2019). Thematic synthesis was conducted to interpret findings from the included studies. The 'Confidence in the Evidence from Reviews of Qualitative research' (GRADE-CERQual) approach was used to assess the level of confidence associated with each review finding. Seven qualitative studies met the eligibility criteria. Four overarching themes were identified. 'Loss of life as they once knew it' encompassed loss of normality. 'Developing personal coping strategies works towards restoring a sense of normality' encapsulated active adjustment and acceptance of the feeding tube. 'Navigating the hurdles when transitioning back to eating' comprised the trials and tribulations of returning to oral intake. Overall, participants recognised that they could not have managed without the feeding tube and this is encapsulated in 'Feeding tube valued'. In many cases, initial feelings of change and loss as a result of HEF were replaced with empowerment, adaptation and acceptance following a period of adjustment. Despite the challenges associated with HEF, participants acknowledged its purpose as being functional, as well as reassuring. Future research should explore barriers and facilitators to self-management and patient empowerment amongst those receiving HEF.

Self-management support preferences of people with asthma or chronic obstructive pulmonary disease: A systematic review and meta-synthesis of qualitative studies.

To synthesise findings from qualitative studies on the preferences of people with asthma or chronic obstructive pulmonary disease (COPD) for self-management support. A thematic synthesis of literature was carried out. Six databases (ASSIA, CINAHL, MEDLINE, PsycINFO, Psychology and the Behavioural Sciences and SSCI) were used to search for qualitative studies eliciting perspectives of adults with asthma and/or COPD on self-management support, published between May 2008 and April 2018. A total of 968 articles were retrieved across databases, with 15 articles included in the synthesis. Three themes were identified: Types of Support described the range of supports valued by participants in the studies, particularly education provided by competent healthcare professionals; The Support Relationship highlighted the importance of a collaborative relationship with one's healthcare professional which was characterised by communication, trust and continuity over time and Accessibility identified the considerations of participants relating to physically accessible, prompt support which is provided in a format preferred by the individual. Increased understanding of patients' preferences may provide insight which can be used to enhance engagement with self-management support. Further research needs to examine self-management support preferences outside the context of evaluating interventions for people with asthma/COPD and needs to address the optimal means of enhancing accessibility.

A Meta-synthesis of qualitative studies on early prevention and operating experience of interventions for delirium

Objective To study the experience of medical staff in conducting the interventions for delirium focusing on the promoting and hindering factors. Methods Databases including Wanfang, CNKI, VIP, SinoMed, PubMed, EBSCO, Springer, CINAHL, EMBASE, Web of Science were searched and relevant qualitative studies were included and synthesized and analyzed after quality evaluation. Results Totally 23 relevant articles were included and categorized into 8 themes based on research results: complex measure, psychological conflicts, heavy workload, fear and afraid, hopeless and helpless, pessimistic attitude, partners' support, organizational support. Conclusions During the process of applying the early prevention and intervention for delirium, due to the complexity of the intervention measures, the workload increased and hinders the compliance of medical staff in the application of intervention for delirium. However, with the support from partners or the organization, the medical staff expressed their willingness to carry out the intervention measures. Hospital administrators should make full use of the promoting factors and actively overcome the obstacles so that the medical staff can effectively carry out the prevention and intervention measure for delirium and hence improve the nursing care quality for the patients. Key words: Delirium; Meta analysis; Interventions; Operating experience; Qualitative study

Eating Disorder Recovery: A Metaethnography.

BACKGROUND: Eating disorders seriously affect both physical health and psychosocial functioning. Breaking the confines of an eating disorder requires engagement in a multifaceted recovery process. OBJECTIVE: This article provides a synthesis of 12 qualitative research studies with various eating disordered populations (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, and other specified feeding and eating disorders) to elucidate the recovery process from the perspective of those who have overcome the disease. METHOD: A metasynthesis of qualitative studies was conducted using Noblit and Hare's metaethnographic methodology. RESULTS: Five overarching themes emerged from the data: (1) the eating disorder as a life jacket, (2) drowning: recognizing consequences, (3) treading the surface: contemplating recovery, (4) swimming: the path toward recovery, and (5) reaching recovery: a sense of freedom. CONCLUSIONS: Eating disorder treatment often entails a cycle of transitions before recovery occurs. Synthesizing the experiences from the perspective of individuals who have overcome an eating disorder presents a unique understanding of the treatment and recovery process.

Emotional development in eating disorders: A qualitative metasynthesis.

Emotions are considered to be an important feature in eating disorders. The present study aimed to conduct a systematic review and metasynthesis of qualitative studies, which considered the role of emotions in eating disorders in order to gain further insight on how these individuals experience various emotions and the strategies they use to manage them. Databases including Web of Science, PsychInfo, EMBASE, Medline, and the Cochrane library were searched for qualitative studies. The search identified 16 relevant studies. Meta‐ethnography was used to synthesize the data, which involved identifying the key findings and concepts of the studies and creating metaphors. The synthesis involved reciprocal translations and lines of argument approaches being applied to the present data. Results of the synthesis identified four second‐order themes and one third‐order theme relating to the emotional experiences of such individuals. The second‐order themes were (a) negative emotional environments, (b) interpersonal vulnerability, (c) the experience of negative emotions in social contexts, and (d) the management of emotions. The third‐order theme was the emotional self within a social environment. This is the first metasynthesis on emotions and eating disorders, and our synthesis highlights the important role that emotions play in the development and maintenance of eating disorders. Our model demonstrates how poor emotional development whilst growing up results in development of poor socioemotional bonds and the inability to handle negative emotions. The most significant finding of the review is that individuals use their eating disorder to manage negative emotions.

A Qualitative Meta-synthesis of Studies on Children's Place Experiences

A Qualitative Meta-synthesis of Studies on Children's Place Experiences

Children’s and caregivers’ perspectives about mandatory reporting of child maltreatment: a meta-synthesis of qualitative studies

ObjectiveTo systematically synthesise qualitative research that explores children’s and caregivers’ perceptions of mandatory reporting.DesignWe conducted a meta-synthesis of qualitative studies.Data sourcesSearches were conducted in Medline, Embase, PsycINFO, Cumulative Index to...

Factors and challenges of driving reduction and cessation: A systematic review and meta-synthesis of qualitative studies on self-regulation

Introduction: Older adults are at a greater risk of injury and death in a motor-vehicle accident. While the ability to drive safely can be challenging with aging, the concept of self-regulation and associated support system have attracted more attention in recent years, especially in developed countries. This review describes the mechanism and summarizes the potential factors that influenced self-regulation of driving amongst older adults to provide new insights into a broader framework for transportation and safe mobility. Methods: We systematically searched 12 online databases for qualitative studies exploring the experiences of older adults aged 60 years and above on their decision to self-regulate their driving. Thematic synthesis was performed to identify elements influencing driving reduction and cessation. The confidence profile of each findings from the meta-synthesis was appraised using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool. Results: A total of 17 studies representing views of 712 older adults from four countries were included. Three major themes were identified with each representing a transition phase that can either facilitate or hinder older drivers from ceasing completely or reducing their driving, when transitioning from pre-decision phase to post-cessation phase. Conclusions: Our findings suggest that there is a mismatch between the current traffic collation prevention measures, such as age-specific mandatory license renewal system and travel needs of older adults. As such, it is time for the authorities, researchers, and public from various fields and perspectives to collaborate, sustain, and improve safety and mobility in older adults. Practical applications: Adequate regulations and guidelines from the medical community and legal authorities are warranted to assist older adults and caregivers. Social support (e.g., feedback, assurance, or transportation support) from family members, friends, and healthcare professionals are crucial for a smooth transition. Provision of alternative transportations in rural areas are needed and future interventions should focus on engaging and educating older adults to consider alternative transportation modes for mobility. Age-specific mandatory license renewal procedure can be useful in screening for at-risk groups.

Healing from Childhood Sexual Abuse: A Meta-Synthesis of Qualitative Studies

ABSTRACTAlthough the global prevalence of childhood sexual abuse (CSA) is very high, the experience of healing after such abuse has not been well documented. The goal of this study was to characterize the healing experience among CSA survivors presented in the literature. Metaethnography was used to synthesize an integrative literature review. The CINAHL, PubMed, PsycINFO, and Web of Science databases were used as data sources. Eight articles that explored healing experiences from CSA, published between 2007 and 2017, were included in the analysis. After performing a quality assessment, line-of-argument synthesis was used to construct the integrating scheme of healing experiences from CSA. CSA healing experiences included dissociating oneself from the memories of CSA, finding peace by creating a comfort zone, disclosure as the start of healing, attempting to establish identity through ongoing self-reflective activities, feeling comfort by sharing experiences and connecting with CSA survivors, and accepting CSA as part of the life history and stepping forward. Healing experiences from CSA synthesized from the analysis focused on personal growth, supporting previous theory on CSA health in the broader literature. A tailored care plan could be developed for CSA survivors who are at varying stages of healing.

Crises in Caring for Dying Patients Regarding Cancer Within Iranian Cultural Backgrounds: A Systematic Review of Qualitative Studies

Context: Peaceful death is a primary goal in the philosophy of palliative care. However, there are some distressing situations that can cause this unachievable that are termed “dying process crises”. The leading causes are interrelated to cultural and religious backgrounds of different societies. Objectives: The main causes of end of life crises are sought from integration of viewpoints of health care providers and extracted results are discussed as priorities for a future implication on a cancer end of life framework. Data Sources: A literature search for was performed published English qualitative studies that measured challenges or crises of end of life care in dying patients in perspective of health care providers by interview-based content analysis approaches from January 2008 to March 2018 via PubMed, MedLine, Google Scholar, ScienceDirect, and PsycINFO databases. Study Selection: Studies related to death in acute or non-hospital settings, hastened death, and structural or modeled studies were excluded. At the end, 8 articles were entered in the Meta-synthesis of qualitative studies. Data Extraction: The selected articles were repeatedly read and related themes to research question were extracted. Then, overarching themes were synthesized among descriptive themes of each article. Results: The identified overarching themes were poorly controlled symptoms, unexpected death, time and facility constrains, lack of education or knowledge, weak coping skills, communication barriers, family conflicts, and systematic issues. By discussion on the cultural aspects and isolated palliative care framework of Iran, important priorities to prevent death crises were symptom management and appropriate communication skills. Conclusions: Regarding the themes in priority, planning educational programs for family meetings directed to the Iranian cultural and religious context, besides developing high quality cancer palliative services, are in a real necessity.