Meta-synthesis Of Qualitative Studies Research Articles

Factors Influencing the Self-management of Breast Cancer-Related Lymphedema: A Meta-synthesis of Qualitative Studies.

Patients with breast cancer have an estimated 14% to 60% risk of developing lymphedema after treatment. Self-management behavior strategies regarding lymphedema are essential in preventing and alleviating the severity of lymphedema. The aim of this study was to evaluate qualitative research evidence on the potential influencing factors for self-management behaviors of lymphedema in patients with breast cancer. A systematic search of 10 electronic databases was conducted to identify qualitative studies on patient experience of lymphedema self-management. The following databases were included and appraised using the Joanna Briggs Institute Critical Appraisal Checklist: Cochrane Library, PubMed, EMBASE, Web of Science, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, Wanfang Med Online, and Chinese Biomedical Database. The literature search yielded 5313 studies, of which only 22 qualitative studies fulfilled the eligibility criteria. Five synthesized findings were derived encompassing personal characteristics, personal knowledge and experience, personal health beliefs, self-regulation skills and abilities, and social influences and support. Patients with breast cancer are confronted with many challenges when performing self-management of lymphedema. Therefore, it is important to recognize potential facilitators and barriers to further offer practical recommendations that promote self-management activities for lymphedema. Healthcare professionals should receive consistent training on lymphedema management. On the basis of individual patient characteristics, tailored education and support should be provided, including transforming irrational beliefs, and improving related knowledge and skills, with the aim to promote self-management behaviors with respect to lymphedema.

Perspectives of patients in relation to the role of the general practice pharmacist: a systematic review and meta-synthesis of qualitative studies

Abstract Introduction The integration of general practice pharmacists (GPPs) into general practice across the United Kingdom (UK) and internationally has been tested and supported through different initiatives.[1] The intention of this integration was to address issues relating to primary care workforce and workload.[1] However, there is limited evidence available on the views of patients about the GPP role.[1] Aim To synthesise qualitative research evidence on patients’ views of the GPP role in general practice. Methods A systematic, qualitative meta-synthesis was undertaken. A search of six electronic databases (Medline, Embase, Scopus, Web of Science, IPA and CINAHL) was conducted from the date of inception to May 2023; reference lists of included studies were also reviewed. Inclusion criteria were peer-reviewed studies which addressed the views of patients about the GPP role in general practice, in the English language, had used qualitative methods for data collection and analysis; no date restrictions were applied. Findings and verbatim quotes relevant to patients’ views were extracted. This was followed by applying the thematic synthesis approach of Thomas and Harden to the extracted data.[2] The Critical Appraisal Skills Programme (CASP) checklist was used to assess quality of the included studies.[2] The review protocol was registered with PROSPERO (CRD42023423623). Results Eight qualitative studies were included, of which five were conducted in the UK and three in Australia. Most studies used interviews to collect data (n=6). The total number of participants was 139 and sample sizes across studies ranged from 7 to 34. Two main analytical themes were generated. The first theme related to perceptions of the GPP role such as benefits (patients believed the GPP increased their knowledge and adherence to medications, rationalised drug therapy, and improved health outcomes) and challenges (patients felt that because GPPs were only available for specific hours every week and on certain days, this was a disadvantage) for patients. The second theme related to attitudes towards the GPP role such as acceptance (acceptability levels of the GPP and their role in general practice among patients were high and no objections were reported when patients were asked to meet with the GPP) and disappointment (some patients were not happy about the way in which medication review was conducted or its outcome). Overall, included studies demonstrated high methodological quality, meeting all or at least seven of the 10 criteria of the CASP checklist.[2] Conclusion The findings have shown that there were benefits and challenges associated with the GPP role, along with acceptance and disappointment. The method adopted (i.e. qualitative meta-synthesis) is considered an essential technique for informing practice, policy, and research in healthcare and pharmacy, and has highlighted patients’ views in this study. However, our searches only retrieved studies published in English. Thus, it is possible that there are relevant studies in other languages which have not been identified. Further work is needed to assess patients’ views on the role of the GPP and how this relationship can be developed.

Influential factors in the adoption of clinical decision support systems in hospital settings: a systematic review and meta-synthesis of qualitative studies

PurposeAdoption of Clinical Decision Support Systems (CDSS) is a crucial step towards the digital transition of the healthcare sector. This review aims to determine and synthesise the influential factors in CDSS adoption in inpatient healthcare settings in order to grasp an understanding of the phenomenon and identify future research gaps.Design/methodology/approachA systematic literature search of five databases (Medline, EMBASE, PsycINFO, Web of Science and Scopus) was conducted between January 2010 and June 2023. The search strategy was a combination of the following keywords and their synonyms: clinical decision support, hospital or secondary care and influential factors. The quality of studies was evaluated against a 40-point rating scale.FindingsThirteen papers were systematically reviewed and synthesised and deductively classified into three main constructs of the Technology–Organisation–Environment theory. Scarcity of papers investigating CDSS adoption and its challenges, especially in developing countries, was evident.Practical implicationsThis study offers a summative account of challenges in the CDSS procurement process. Strategies to help adopters proactively address the challenges are: (1) Hospital leaders need a clear digital strategy aligned with stakeholders' consensus; (2) Developing modular IT solutions and conducting situational analysis to achieve IT goals; and (3) Government policies, accreditation standards and procurement guidelines play a crucial role in navigating the complex CDSS market.Originality/valueTo the best of the authors’ knowledge, this is the first review to address the adoption and procurement of CDSS. Previous literature only addressed challenges and facilitators within the implementation and post-implementation stages. This study focuses on the firm-level adoption phase of CDSS technology with a theory refining lens.

Family members’ experiences of bereavement in the emergency department: A meta-synthesis of qualitative studies

The emergency department (ED) is one of the places where patient deaths frequently occur. Understanding family members’ experiences of bereavement would help provide individualized bereavement care. We conducted a meta-synthesis to synthesize family members’ experiences of bereavement in the ED and assess the impact of bereavement on their lives. We searched seven international electronic databases. Five studies were selected and critically appraised. Thematic analysis was employed. Five themes (with 13 subthemes) were derived: suffering sudden changes and are severely impacted, multiple feelings and needs of waiting, final farewell, personal and family difficulties after leaving the ED, and journey through grief. Family members endured agonizing waits to see and learn more about their family members’ condition. Family members reported the need for effective follow-up resources. Findings revealed that it would be helpful if the EDs could provide sensitive and respectful care to family members.

Older Adults’ Experiences of Using Strategies to Maintain and Foster Social Participation: A Systematic Review with Metasynthesis of Qualitative Studies

Social participation is positively associated with older adults’ health. Health-care services, therefore, need to empower older adults to adapt to the social changes that accompany aging. This systematic review, with a metasynthesis of qualitative studies, aimed to describe and develop an understanding of home-dwelling older adults’ (65 yrs+) experiences of using strategies to maintain and foster their social participation. The main search was performed in March 2022 using the PubMed, CINAHL, PsycINFO, and AMED databases and included peer-reviewed articles published between 2012 and 2022. A total of 35 full-text articles from 15 different countries were included and assessed for quality by the assessment tool for qualitative studies provided by the Critical Appraisal Skills Programme (CASP). The metasynthesis resulted in the main theme: strategically creating routines that foster social participation and two main categories: inward-looking strategies for social participation and outward-looking strategies for social participation. Each main category contained three subcategories. The findings suggest that for perceiving social participation, it is important for older adults to create routines with patterns of activities and to be able to engage in these activities. The findings further reflect that older adults use earlier experiences of social participation to facilitate the making of routines. This indicates that health-care interventions supporting older adults’ social participation must be applied early and with a health-promotive focus. Conclusively, researchers need to develop interventions that support older adults in healthy activity patterns by raising awareness of how to use inward-looking and outward-looking strategies to create routines for social participation. The findings further suggest that older adults’ possibilities for social participation could be supported by designing accessible venues that facilitate spontaneous meetings and encourage older adults’ own choices and initiatives for social participation.

Experiences of financial toxicity among caregivers of cancer patients: a meta-synthesis of qualitative studies.

The purpose of this study was to explore the experience of financial toxicity among caregivers of cancer patients and to provide recommendations for subsequent intervention strategies. Computer searches of PubMed, EmBase, The Cochrane Library, Web of Science, CINAHL (EBSCO), CNKI, Wanfang database, and SinoMed for qualitative studies experience of financial toxicity among caregivers cancer patients. The search time frame was from the establishment of the database to May 2023. The quality of included studies was assessed using the Qualitative Research Checklist from the Joanna Briggs Institute (JBI) Reviewer's Manual. The meta-synthesis was integrated following the meta-aggregation method proposed by the Joanna Briggs Institute (JBI) and reported following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. A total of nine studies were included, distilling 25 qualitative findings into nine new categories and synthesizing three synthesized findings: caregivers have strong negative experiences that affect their family relationships, daily work and life; caregivers use different strategies to cope with financial toxicity; needs and expectations of caregivers coping with financial toxicity. Financial toxicity among caregivers of cancer patients affects their daily lives. Receiving timely recognition of this financial burden and providing assistance to enhance their coping skills are crucial in mitigating its impact. Healthcare professionals should focus on the financial toxicity experienced by caregivers of people with cancer, address their supportive needs, and develop a comprehensive support system to improve caregivers' coping abilities and quality of life.

Meta-synthesis of qualitative studies on patient perceptions and requirements during the perioperative period of robotic surgery.

This research undertakes a comprehensive evaluation and amalgamation of patient experiences and requirements during the perioperative period of robot-assisted surgery (RS), with the goal of enriching clinical practice with patient-centered insights. A meta-synthesis was performed and reported according to the preferred reporting Items for systematic reviews and meta-analyses and the enhancing transparency in reporting the synthesis of qualitative research statement. A rigorous literature search was conducted across multiple Chinese and English databases, namely PubMed, CINAHL (EBSCO), Embase, Web of Science, Scopus, China Biomedical Literature Database (CBLD), China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Information. This study incorporated ten qualitative studies, the outcomes were classified into three overarching themes: personalized patient requirements related to RS; the psychological and physiological experiences of patients; and the divergent perceptions of male and female patients regarding RS. Greater emphasis needs to be placed on patient comprehension of RS, augmenting focus on patient psychological experiences, recognizing unique patient needs at various stages of RS, and providing patients with specialized knowledge and technical support.

Experiences of cancer survivors returning to work decision-making: a meta-synthesis of qualitative studies.

Return to work for cancer survivors (CSs) may be challenging, and there is a research gap in integrating the relevant experiences of the return-to-work decision-making process for CSs. Our aim was to synthesize existing qualitative research that integrates the dynamic experiences of CSs in the return-to-work decision-making process and highlights the factors influencing the return-to-work decisions of CSs. We retrieved qualitative studies on a relevant theme published in the PubMed, EBSCO, Scopus, Web of Science, Cochrane Library, and CINAHL databases since construction to December 2023. Literature screening, quality evaluation, and data analysis followed the PRISMA, Joanna Briggs Institute Critical Appraisal Tool (2016), and thematic analysis methods to ensure study reliability. The study was registered on PROSPERO (registration number: CRD42023429623). Ten articles were included, and six key outcomes were identified based on Social Cognitive Career Theory (SCCT) integration: points of concern for individuals, sense of self-efficacy, outcome expectations, work perception and belonging, medical advice and guidance, and effects of the external reactions. The decision-making process for CSs to return to work is affected by various personal and external factors. Effectively addressing personal appearance, financial, and emotional issues can enhance self-efficacy of CSs. Improving external perceptions of cancer patients and enhancing social support in the workplace and medical settings can help CSs make informed decisions regarding their return to work. The decision of CSs to return to work is a result of integrating personal, job, and medical care considerations. These findings contribute to the development of future interventions for CSs' return-to-work decisions that target an array of potential factors.

The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence.

The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence is not well understood. To address this we conducted a systematic review and meta-synthesis of qualitative studies. Our search strategy included electronic searches of 18 databases and grey literature, citation tracking and reference list screening. Studies were eligible if they presented qualitative data from racially and/or ethnically minoritised women or girls, who had experienced sexual violence at any age and described their experiences of receiving treatment from statutory mental health and/or substance use services. Studies were analysed using meta-ethnography. Fourteen papers based on 12 individual studies were included. Analysis developed three main themes: (1) understanding minoritised women holistically, (2) processing the trauma and beginning the healing and (3) the need for social connectedness and empowering relationships. For minoritised women to benefit from treatment, mental health and substance use services need to challenge the dynamics of the multiple traumas minoritised women experience. Knowledge and understanding of the racial trauma minoritised women experience is limited and many are subjected to further harm from racist practices occurring in some treatment services. Offering culturally safe, trauma-informed care which promotes anti-racist practices may help improve mental health and substance use service responses to minoritised women who have experienced sexual violence.

Sexuality in Women with Fibromyalgia Syndrome: A Metasynthesis of Qualitative Studies.

Metasynthesis of qualitative studies. The search included articles published between 2000 and June 2023 on the PubMed, WOS, CINAHL, SCOPUS, and SCIELO databases. 450 articles were found through the initial search, of which, only nine fulfilled the criteria and were included in the thematic synthesis. From this analysis, three main themes emerged: (1) "I want to, but I can't": FMS causes a shift in feminine sexuality. (2) Resetting sex life and intimacy. (3) Taking charge of a "new sexuality." Women with FMS suffer from limitations of their sexuality that affect their partner. Pain, stiffness and a loss of desire make sexual encounters difficult. Becoming aware of this and striving not to lose their sexuality is key to coping with this problem. Women and their sexual partners can change roles and encourage communication, games, foreplay or touching. The use of lubricants, physical exercise and complementary therapies, along with social, professional and partner support, are key to coping with FMS.

Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis

BackgroundTelemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology.MethodA meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease).ResultsSearches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used.ConclusionMost studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.

Perception of eHealth Programs for Cardiovascular Health: Qualitative Systematic Review and Meta-synthesis.

Despite emerging evidence on the effectiveness of eHealth interventions in improving cardiovascular health, little is known about the perception of use and efficacy of these interventions and real-world application. We sought to develop an in-depth understanding of the perceptions of eHealth interventions in improving cardiovascular health. This is a systematic review and meta-synthesis of qualitative studies. A comprehensive search of multiple databases and a manual search of the references list were conducted. Meta-synthesis of qualitative data was performed to review and interpret the findings. The study report followed the ENTREQ checklist. Four themes emerged regarding perceptions of eHealth interventions: preferred eHealth intervention design features, enabling healthcare professionals' support, eHealth engagement for health benefits, and barriers to eHealth engagement. Intervention design features should integrate motivational elements, use an eHealth literacy lens, and enhance cultural relevance. Healthcare professionals appreciated these new working methods but voiced concern about competency building. Real-world usage initiation was driven by perceived needs and usefulness, whereas persistent engagement was inspired by intrinsic motivation in participants. eHealth interventions were appreciated as a valuable opportunity for providing alternative/supplementary cardiac care for health optimization. Participants commented on the need for more explicit and accurate health information presentation, and they appreciated the motivational elements in empowering them with self-determination over daily self-care behaviors. Professionals raised the need for specific guidance to enhance competency and intervention fidelity when delivering eHealth care.

Experiences of nurse practitioners working during the COVID-19 pandemic: A metasynthesis of qualitative studies.

The impact of the COVID-19 pandemic forced global changes to how nurses practice. Nurse practitioners deviated from their scope, changed how they delivered their service, and worked with limited resources. For some services, patient access was also compromised. To synthesize, combine, and present current evidence on the experiences of nurse practitioners working during the COVID-19 pandemic. CINAHL, Embase, and MEDLINE electronic databases were used to perform a structured search strategy. During the COVID-19 pandemic, health care services had to leverage their workforce skills to accelerate COVID-19 identification, treatment, and care. Nurse practitioners rapidly found themselves at the forefront and were concerned about infecting others. They also identified the need for support and were able to adapt to the changing environment. Nurse practitioners also recognized the impact on their well-being. Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning. Understanding how they coped will help with critical preparedness and response actions to other health care crises. Having insight into nurse practitioner's experiences during the pandemic is valuable for future health care workforce planning because, as we know, the nurse practitioner workforce is one of the most rapidly growing professions in primary health care. Any future work in this space will help inform future nurse practitioner education and also help by informing critical preparedness and response actions to future health care crises, whether global or local or clinical or nonclinical.

Experiences of nurse practitioners working during the COVID-19 pandemic: A meta-synthesis of qualitative studies.

Journal of the American Association of Nurse Practitioners 35(6):p 357-358, June 2023. | DOI: 10.1097/JXX.0000000000000887

Experiences and perspectives of healthcare professionals implementing advance care planning for people suffering from life-limiting illness: a systematic review and meta-synthesis of qualitative studies

BackgroundLife-limited patients may lose decision-making abilities during disease progression. Advance care planning can be used as a discussion method for healthcare professionals to understand patients’ future care preferences. However, due to many difficulties, the participation rate of healthcare professionals in advance care planning is not high.AimTo explore the facilitators of and barriers to healthcare professionals’ provision of advance care planning to life-limited patients to better implement it for this population.MethodsWe followed ENTREQ and PRISMA to guide this study. We conducted a systematic search of PubMed, Web of Science, Embase, CINAHL, PsycINFO, CNKI, and SinoMed to include qualitative data on the experiences and perspectives of healthcare professionals in different professional fields in providing advance care planning for life-limited patients. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies.ResultsA total of 11 studies were included. Two themes were identified: unsupported conditions and facilitative actions. Healthcare professionals regarded cultural concepts, limited time, and fragmented record services as obstacles to implementation. They had low confidence and were overly concerned about negative effects. They needed to possess multiple abilities, learn to flexibly initiate topics, and facilitate effective communication based on multidisciplinary collaboration.ConclusionHealthcare professionals need an accepting cultural environment to implement advance care planning, a sound legal system, financial support, and a coordinated and shared system to support them. Healthcare systems need to develop educational training programs to increase the knowledge and skills of healthcare professionals and to promote multidisciplinary collaboration to facilitate effective communication. Future research should compare the differences in the needs of healthcare professionals in different cultures when implementing advance care planning to develop systematic implementation guidelines in different cultures.

Interaction in Distance Education: Meta-Synthesis of Qualitative Studies

Interaction in distance education processes; It has a very important place in the learner's academic performance, attitude and motivation, participation in the lesson and the acquisition of instructional goals and behaviors. According to the data obtained as a result of the analysis in this study, in which the interaction in synchronous and asynchronous distance education processes was investigated by qualitative meta-synthesis method; In the synchronous and asynchronous distance education processes, themes emerged about the purposes for which interactions are established, which features and functions can increase interactions in distance education, and which factors negatively affect this process while the interactions are established. According to these themes, which also constitute the aims of the research, interactions in distance education processes are established for cognitive, affective and collaborative purposes. Cognitively oriented interactions; ask questions-answer, asking for and expressing opinions, feedback, making explanations, sharing knowledge and experience, participating in discussions, suggesting solutions, directing, while affectively focused; encouragement and support, sharing personal information, cooperation and emotional support, collaborative interactions; It is established for the purpose of determining group qualifications (members and work area), coordination among group members, distribution of tasks within the group (expertise), group work processes. The categories on how to increase interactions were examined as learner-teacher, learner-learner, learner-content and multiple interaction. Teaching strategies that encourage peer consultation for learning, course contents with detailed and explanatory demonstrations, the learner's sense of belonging and commitment to the group, reducing social and psychological distance with a quick reply to the e-mail sent by the learner, the learner's questions and There is in-depth and explanatory feedback on the students' comments, and asynchronous student-teacher interaction using alternative web resources. Among the factors that negatively affect the interaction process are; during the process, there are negative experiences, slow connection or disconnection, conflict between learners, insufficient online course time to interact due to the intensity of the content, the dominant student being at the forefront when the teacher cannot manage the interaction process, and pedagogical inadequacy that negatively affects the cooperation between learners.

The Relationship Between Fathers and Children with Anorexia and Bulimia Nervosa: a Systematic Review and Meta-synthesis of Qualitative studies

The Relationship Between Fathers and Children with Anorexia and Bulimia Nervosa: a Systematic Review and Meta-synthesis of Qualitative studies

Colorectal cancer survivors’ experiences of return-to-work: A meta-synthesis of qualitative studies

This review is to explore the relevant experience of colorectal cancer survivors' return-to-work, reintegrating and analyzing the promoting factors and obstacles of colorectal cancer survivors' return-to-work. This review followed PRISMA List. Databases including the Cochrane Library, PubMed, Web of Science, EM base, CINAHL, APA PsycInfo, Wangfang Database, CNKI and CBM from inception to October 2022 were searched to collect qualitative studies in the experience of colorectal cancer survivors' return-to-work. Article selection and data extraction were conducted by two researchers used the Joanna Briggs Institute Critical Appraisal Tool for qualitative researches (2016) in Australia. Seven studies were included, the thirty-four themes distilled from the literature were grouped into eleven new categories and summed into two integrated findings: (1) facilitators to return-to-work for colorectal cancer survivors: desire and expectation for return-to-work and social dedication, economic needs, support and tolerance from employers and colleagues, work suggestions provided by professionals, health insurance policy of the workplace. (2) obstacles to return-to-work for colorectal cancer survivors: physical problems, psychological barriers, lack of family support, negative attitudes of employers and colleagues, limited information and resources available from professionals, Imperfection of related policies. This study shows that colorectal cancer survivors' return-to-work is influenced by many factors. We should pay attention to and avoid obstacles, help colorectal cancer survivors recover their physical functions and maintain a positive psychological state, improve the social support for colorectal cancer survivors to return-to-work, so as to achieve comprehensive rehabilitation as soon as possible.

Towards an Enhanced Implementation of Printed Modular Distance Learning in the Philippines: A Meta-Synthesis

Implementing modular distance learning (MDL) in the Philippines remains problematic. We review studies on printed MDL to create themes for its enhanced implementation. A meta-synthesis of qualitative studies was executed, and a comprehensive search in Google Scholar was conducted. A thematic synthesis was performed, revealing the four presences to enhance the implementation of printed MDL, such as: structural; community; intervention; and quality assurance. The structural presence underscores module designs that can capture students' interests and learning, as well as module content that can articulate curricular learning competencies and students' context, needs, and situations. The community presence highlights that education in the MDL is not the sole responsibility of students. Contrary to the common idea that MDL is about providing modules for students to study independently, MDL is everyone's responsibility. The family members and teachers, as well as community members and sectors, have roles to play and must work together to produce more desirable learning outcomes. The intervention presence emphasizes instructional and socio-emotional support to help students overcome academic and personal difficulties and foster a positive and supportive learning atmosphere. Quality assurance presence highlights the systematic actions in the planning, development, implementation, monitoring, and evaluation processes to ensure the MDL's quality implementation and continuous improvement. The provision of quality includes meeting stakeholders' needs and conforming to desired outcomes or standards. Hence, education officials may adopt the identified presences for the orientation and training activities to enhance the implementation of MDL.

A Multipath Development Framework for Inter-Organizational Relationships: A Metasynthesis of Qualitative Studies

Abstract Purpose This review paper identifies and compares models of inter-organizational relationship development that have evolved in qualitative studies and then proposes an original, situational framework for the evolution of inter-organizational relationships over time. Design/methodology/approach Methodologically, this paper follows a systematic approach and uses metasynthesis of prior qualitative research as a reviewing technique. Findings The analysis of prior qualitative investigations reveals the lack of consistency among authors referring to the number and specificity of phases, with no agreement about the trajectory of relationship development (its linearity, looping of phases, dynamics, start and end points). Originality/value As its main theoretical contribution, this paper offers a multipath framework covering four phases of relationship development: (1) initiation and initial development, (2) development, (3) maintenance, and (4) dissolution, with three possible subphases to each of them (active, passive, and re-activated). From the managerial perspective, the developed framework may broaden managers’ understanding and awareness of the different approaches to modeling the trajectory of the inter-organizational relationship life cycle and configuration of its particular phases.