Meta-synthesis Of Qualitative Studies Research Articles

The vulnerable-empowered mother of academic food discourses: a qualitative meta-synthesis of studies of low-income mothers and food provisioning

ABSTRACTThe nutritional health and wellbeing of children, and by extension their weight, is a heated topic in contemporary discussions of food and health, particularly for low-income populations. Despite contrary understandings, there remains a dominant societal framing that parents – in particular low-income mothers – are solely responsible for the status of their children’s health and wellbeing. In this paper, we examine how low-income mothers are positioned within the academic literature to reveal where responsibility for children’s health and well-being is positioned. We present a meta-synthesis of 18 qualitative studies to identify how mothers’ food choices and feeding are positioned, and the recommendations that researchers identify for promoting child health within this discursive terrain. We found that low-income mothers faced multiple challenges relating to cost, convenience, concerns about health and wellbeing. However, many of the recommendations made by researchers focused extensively on behavioural interventions aimed at the vulnerable mother rather than structural interventions to support mothers’ feeding practices. We argue that discourses of low-income motherhood must recommend structural, and not just individual, change to counteract dominant constructions of the ‘vulnerable-empowered mother’.

Barriers and facilitators to participating in physical activity for adults with breast cancer receiving adjuvant treatment: A qualitative metasynthesis

Physical activity can improve the health and well-being of individuals receiving adjuvant treatment for breast cancer, but engagement in physical activity can be low. This review synthesises the barriers and facilitators to engaging with and participating in physical activity whilst receiving treatment. The metasynthesis of qualitative studies is reported in line with the PRISMA statement. We systematically searched eight databases (MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, British Library, OpenGrey, and Conference Proceedings Citation Index) from inception to November 30, 2017. A total of 1276 abstracts were retrieved and screened by two reviewers independently. Data from eligible studies were extracted and critically appraised. As this review concerns qualitative studies only, a CER-QUAL GRADE assessment was completed. A total of 13 studies were included. Four clear themes emerged (side effects of treatment, beliefs about physical activity, focus on health not illness, and social factors) each containing both barriers and facilitators. Key facilitators to participating in physical activity during adjuvant treatment included positive physical benefits, improvements in psychological well-being, and increased self-esteem and empowerment. Further, having a knowledgeable instructor, tailored information, and a supportive environment were important to women undergoing treatment. Main barriers included fatigue and pain, as well as work and caring responsibilities. Incorporating physical activity into treatment regimens is important. Focusing on being less sedentary and providing accurate, tailored information should be prioritised within future interventions. Having a supportive environment and accounting for the particular barriers or facilitators to engagement identified here should aid the success of future interventions.

Basic Needs of Mothers with Children Undergoing Hemodialysis: A Meta-synthesis of Qualitative Studies

Background: Mothers of children undergoing hemodialysis encounter severe changes in their daily lives. It is of utmost importance to raise the awareness of treatment teams about the needs of these specific groups of mothers and different problems they may experience. The reason is that it can help health care professionals to support the mothers to fulfill their roles as the primary caregivers of such children. Aim: This study aimed to identify basic needs in mothers of children undergoing hemodialysis. Method: This meta-synthesis review of qualitative studies investigating the needs and experience of mothers whose children had kidney disease and published from January 1997 to October 2017. The articles were searched in four databases, including Web of Science, EMBASE, PubMed, and ProQuest. The search process was accomplished using the keywords “chronic kidney disease,” “hemodialysis,” “children,” “mothers,” “parents,” “caregivers,” “needs,” “experiences,” “perspectives,” and “perceptions”. Finally, 7 articles were chosen out of 567 papers and theses. The MAXQDA software was used to facilitate data management. Results: The systematic review of the qualitative studies revealed three main themes, including the need for child care management skills, the need to maintain family cohesion, and the need for emotional–psychological support. Implications for Practice: Mothers of children under hemodialysis should be considered as nursing clients. Accordingly, a multidisciplinary team can empower mothers to take care of the children under hemodialysis and preserve family coherence, as well as supporting them emotionally and psychologically.

Barriers to accessing mental health services for women with perinatal mental illness: systematic review and meta-synthesis of qualitative studies in the UK

ObjectiveLack of access to mental health services during the perinatal period is a significant public health concern in the UK. Barriers to accessing services may occur at multiple points in...

Mutuality in psychotherapy: A meta-analysis and meta-synthesis.

This manuscript presents a systematic review of mutuality in psychotherapy, including meta-analysis of quantitative and meta-synthesis of qualitative studies. A search with specified keyword combinations yielded 21 studies, including 10 quantitative studies with 1,071 participants and 11 qualitative studies with 81 participants. Researchers calculated effect sizes, conducted homogeneity tests, and assessed potential variables moderating the relationship between mutuality and therapeutic variables from quantitative studies; they analyzed qualitative studies to identify and synthesize themes related to mutuality in psychotherapy. Meta-analysis showed a large weighted mean effect size with a statistically significant overall relationship between mutuality and therapeutic variables (r = 0.51, 95% CI [0.37; 0.66], p < 0.001). The relationship between mutuality and session quality was strongest of the six relationships analyzed (r = 0.70, 95% CI [0.43; 0.97], p < 0.001). Qualitative meta-synthesis of studies produced six themes: 1. Lack of mutuality/strategies for disconnection, 2. Co-created relational process, 3. Meta-communication and misunderstanding, 4. Therapist congruence/being real, 5. Mutual impact and client agency, and 6. Asymmetric role power and boundaries. These findings suggest that mutuality is worthy of further research in psychotherapy, particularly in relation to its strong relationship with session quality.

Development of a Core Outcome Set for Studies on Obesity in Pregnant Patients (COSSOPP): a study protocol

BackgroundMaternal obesity is a risk factor for adverse maternal, fetal, and neonatal events. Numerous clinical trials are currently exploring the effectiveness of antenatal and peripartum interventions in improving pregnancy outcomes that can in future inform clinical practice. However, the heterogeneity in outcome reporting limits our ability to compare outcomes across studies, and there is a lack of stakeholder representation in outcome choice. A pragmatic solution to this problem is the development of a core outcome set (COS) that defines the minimum criteria for outcome reporting in clinical trials undertaken in this population, arrived at by the involvement of relevant stakeholders.MethodsThe development of a COS for studies on obesity in pregnant patients (COSSOPP) will comprise five steps. First, a systematic review of published literature will identify the long list of outcomes, their definitions and measurements if applicable, and outcome reporting quality. This will be followed by a meta-synthesis of qualitative studies with patients, and qualitative interviews in Toronto with patients, clinicians, researchers, hospital administrators, and policy-makers, to identify novel outcomes that were not obtained through systematic review. Third, the long list of outcomes will be narrowed down through online Delphi surveys involving an international group of patients and relevant stakeholders. This will be followed by a face-to-face consensus meeting with representatives of all stakeholder groups to arrive at a consensus on the final COS. Finally, in order to determine how the identified core outcomes should be measured, we will conduct another literature review and Delphi process.DiscussionCOSSOPP will engage patients, clinicians, researchers, and other relevant stakeholders in determining the core set of outcomes that should be reported and measured in order to harmonize outcome reporting in studies evaluating the effectiveness of antepartum and peripartum interventions in obese pregnant women. This protocol provides a detailed overview of the steps involved in the development of a COS, to guide researchers in developing COS within their areas of specialization.COMET Core Outcome Set Registrationhttp://www.comet-initiative.org/studies/details/939.

Prevalence of and reasons for women's, family members', and health professionals' preferences for cesarean section in China: A mixed-methods systematic review.

BackgroundChina has witnessed a rapid increase of cesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and reasons for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs, which are those performed in the absence of medical indications.Methods and findingsWe conducted a mixed-methods systematic review and included longitudinal, cross-sectional, and qualitative studies in mainland China, Hong Kong, and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, and one Chinese database (CNKI) using a combination of the key terms ‘caesarean section’, ‘preference’, ‘choice’, ‘knowledge’, ‘attitude’, ‘culture’, ‘non-clinical factors’, and ‘health professionals-patient relations’ between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%–17%) and 21% in late pregnancy (95% CI 15%–26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%–20%), 22% in late pregnancy (95% CI 18%–25%), and 30% postpartum (95% CI 19%–40%). Women’s preferences for CS were found to rise as pregnancy progressed (preference change across longitudinal studies: mean difference 7%, 95% CI 1%–13%). One longitudinal study reported that the preference for CS among women’s partners increased from 8% in late pregnancy to 17% in the immediate postpartum period. In addition, 18 quantitative studies revealed that some pregnant women, ranging from 4% to 34%, did not have a straightforward preference for a mode of delivery, even in late pregnancy. The qualitative meta-synthesis found that women’s perceptions of CS as preferable were based on prioritising the baby’s and woman’s health and appeared to intensify through interactions with the health system. Women valued the convenience of bypassing labour because of fear of pain, antagonistic relations with providers, and beliefs of deteriorating quality of care during labour and vaginal birth, fostering the feeling that CS was the safest option. Health professionals’ preference for CS was influenced by financial drivers and malpractice fears. This review has some limitations, including high heterogeneity (despite subgroup and sensitivity analysis) in the quantitative analysis, and the potential for over-reporting of women’s preferences for CS in the qualitative synthesis (due to some included studies only including women who requested CS).ConclusionsDespite a minority of women expressing a preference for CS, individual, health system, and socio-cultural factors converge, contributing to a high CS rate in mainland China, Hong Kong, and Taiwan. In order to reduce unnecessary CSs, interventions need to address all these non-clinical factors and concerns.Systematic review registryProspero CRD42016036596.

Barriers and facilitators to dental care during pregnancy: a systematic review and meta-synthesis of qualitative studies.

Some barriers to dental treatment during pregnancy are poorly understood, especially those related to psychosocial factors, which are better explored in qualitative studies. The aim of this systematic review was to explore the barriers and facilitators to dental care during pregnancy through a thematic synthesis of qualitative studies. Qualitative or mixed-methods studies published in English, Portuguese, Spanish and French, from 2000 to 2016, were included. The search strategies were conducted in PubMed, Scopus, Web of Science, LILACS, BBO and CINAHL. To evaluate the quality of the studies, we used the Critical Appraisal Skills Programme tool. Thematic synthesis was performed in order to interpret and summarize the results. From 2,581 screened studies, ten were included in the synthesis. We found 14 analytical themes related to barriers and facilitators to dental care during pregnancy that interacted in complex ways: physiological conditions, low importance of oral health, negative stigma regarding dentistry, fear of/anxiety toward dental treatment, mobility and safety, financial barriers, employment, time constraints, social support, lack of information, health professionals' barriers, family and friends' advice, beliefs and myths about the safety of dental treatment. Myths and beliefs about oral health and dental treatment during pregnancy appear to be the most frequent barriers, both to pregnant women and to dentists or other health professionals. The findings of this review may support new studies, especially to test intervention protocols and to guide effective public policies for the promotion of oral health during pregnancy.

The Experiences of Gay and Bisexual Men Post-Prostate Cancer Treatment: A Meta-Synthesis of Qualitative Studies.

Studies suggest that gay and bisexual men are affected by the psychological aspects of prostate cancer treatment differently than that of heterosexual men; however the data have not yet been synthesized. The focus of this meta-synthesis is to explore gay and bisexual men’s experiences of prostate cancer posttreatment. Empirical research published in peer reviewed journals between January 1990 and January 2018 were identified in six databases: CINAHL, Cochrane, Medline, PsycINFO, PubMed, and Web of Science. Titles and abstracts were checked by two reviewers. The six studies that met the inclusion criteria were selected and reviewed for quality and the extracted data were then synthesized. The main themes that emerged were sexual impact, physical and psychological difficulties, challenges to intimacy, and support mechanisms. Gay and bisexual men can have specific sexual roles and developing prostate cancer and undergoing treatment may compromise their ability to perform their sexual role. The needs of heterosexual men were perceived to be accommodated more often than that of gay and bisexual men because of engrained heteronormativity in the health-care system. The review suggests that more support groups specifically for gay and bisexual men should be established, while urologists should cater to the sexual and masculine implications of treatment, and not frame problems for gay and bisexual men in heterosexual terms. By failing to address the salient needs and concerns of gay and bisexual men, health-care professionals are reinforcing invisibility and marginalization of gay and bisexual men with prostate cancer.

Meta-syntese af kvalitative studier

This article is written for students and PhD students in psychology. The article is in Danish. The purpose of this article is to introduce a special kind of review of existing literature known as meta-synthesis. In a meta-synthesis, qualitative studies are integrated or compared and, as a result, the essence of meta-synthesis is as a result an analytic generalization of findings in qualitative studies. Stages in meta-synthesis are outlined, especially emphasizing the interchange between research topic and aim, the systematic literature search and analysis of identified studies. An example of a meta-synthesis is used to illustrate the stages. Finally, the article includes a comparison of the knowledge derived from meta-analysis of quantitative studies and meta-synthesis of qualitative studies. The conclusion is that meta-synthesis is well suited for generating theory and may improve decision-making about intervention.

Flexible Work Arrangements and Work–Family Conflict: A Metasynthesis of Qualitative Studies Among Academics

Quantitative research has reported variable and inconsistent findings regarding the relationship between flexible work arrangements (FWA) and work–family conflict (WFC). In this article, we address this inconsistency through the lens of qualitative research. We synthesize the findings of 45 qualitative studies from a variety of disciplines that have explored work–family interface (WFI) among academics whose profession offers high levels of FWA by nature. Analyzing the findings of these qualitative studies, we developed six themes of which five could be translated to moderators of the relationship between FWA and WFC. These moderator variables are boundary management preferences, time management skills and approach, career/family stage, nature of an academic job, and workplace culture. Our findings have theoretical, methodological, and practical implications for work–family and human resource development (HRD) scholars and practitioners motivated to improve the quality of employees’ work–life through initiation of FWA interventions.

Protocol for a meta-integration: investigating positive aspects of caregiving in dementia

IntroductionThe current work describes the protocol for a meta-integration investigating the positive aspects of providing care to someone living with dementia. We aim to understand the position of positive aspects...

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

IntroductionChildhood obesity is one of the most serious global public health challenges. However, obesity and its consequences are largely preventable. As parents play an important role in their children's weight‐related behaviours, good communication between parents and health care professionals (HCPs) is essential. This systematic review provides a meta‐synthesis of qualitative studies exploring the barriers and facilitators experienced by HCPs when discussing child weight with parents.MethodsSearches were conducted using the following databases: MEDLINE (OVID), Psych INFO (OVID), EMBASE (OVID), Web of Knowledge and CINAHL. Thirteen full‐text qualitative studies published in English language journals since 1985 were included. Included studies collected data from HCPs (e.g., nurses, doctors, dieticians, psychologists, and clinical managers) concerning their experiences of discussing child weight‐related issues with parents. An inductive thematic analysis was employed to synthesize findings.FindingsEmerging subthemes were categorized using a socio‐ecological framework into intra/interpersonal factors, organizational factors, and societal factors. Perceived barriers and facilitators most commonly related to intra/interpersonal level factors, that is, relating to staff factors, parental factors, or professional–parent interactions. HCPs also attributed a number of barriers, but not facilitators, at the organizational and societal levels.ConclusionThe findings of this review may help to inform the development of future weight‐related communication interventions. Whilst intra/interpersonal interventions may go some way to improving health care practice, it is crucial that all stakeholders consider the wider organizational and societal context in which these interactions take place. Statement of contribution What is already known on the subject? Childhood obesity is one of the United Kingdom's most serious current public health challenges.Health care professionals are in a prime position to identify child weight issues during routine consultations.However, they often feel unable or unequipped to raise the topic and provide information on child weight management. What does this study add? To our knowledge, this is the first review to synthesize barriers and facilitators to discussing child weight.This review interprets key barriers and facilitators in the context of the socio‐ecological model.Supports the development of interventions matched to the appropriate level of the socio‐economic model.

Understanding families’ conceptions of school readiness in the United States: a qualitative metasynthesis

ABSTRACTThe call by policymakers, education stakeholders, and families for children to enter school ‘ready’ has led to numerous empirical studies that seek to identify how children and their families are or are not prepared for school. In the United States, this empirical work tends to identify particular children and their families ‘at-risk’ for school success and often seeks out ways to intervene so that such risks are addressed. Absent from this work is an understanding of how families conceptualise school readiness, and how those understandings influence their conceptions of whether or not their own children are ready for school. Such work could assist educators and other school personnel in supporting families and their children as they enter their programmes. This article examines this issue by presenting findings from a qualitative metasynthesis of studies that investigated how families conceptualised school readiness. Analysing, synthesising, and interpreting their conceptions of school readiness offers the chance to consider how early childhood stakeholders can be ready for families as they enter their programmes as well as support their efforts in readying their children for school.

How do informal information sources influence women\u2019s decision-making for birth? A meta-synthesis of qualitative studies

BackgroundWomen approach birth using various methods of preparation drawing from conventional healthcare providers alongside informal information sources (IIS) outside the professional healthcare context. An investigation of the forms in which these informal information sources are accessed and negotiated by women, and how these disconnected and often conflicting elements influence women’s decision-making process for birth have yet to be evaluated. The level of antenatal preparedness women feel can have significant and long lasting implications on their birth experience and transition into motherhood and beyond. The aim of this study was to provide a deeper understanding of how informal information sources influence women’s preparation for birth.MethodsSeven electronic databases were searched with predetermined search terms. No limitations were imposed for year of publication. English language studies using qualitative methods exploring women’s experiences of informal information sources and their impact upon women’s birth preparation were included, subject to a quality appraisal framework. Searches were initiated in February 2016 and completed by March 2016. Studies were synthesised using an interpretive meta-ethnographic approach.ResultsFourteen studies were included for the final synthesis from Great Britain, Australia, Canada and the United States. Four main themes were identified: Menu Birth; Information Heaven/Hell; Spheres of Support; and Trust. It is evident that women do not enter pregnancy as empty vessels devoid of a conceptual framework, but rather have a pre-constructed embodied knowledge base upon which other information is superimposed. Allied to this, it is clear that informal information was sought to mitigate against the widespread experience of discordant information provided by maternity professionals.ConclusionWomen’s access to the deluge of informal information sources in mainstream media during pregnancy have significant impact on decision making for birth. These informal sources redefine the power dynamic between women and maternal healthcare providers, simultaneously increasing levels of anxiety and challenging women’s pre-existing ideations and aspirations of personal birth processes. A lack of awareness by some professionals of women’s information seeking behaviours generates barriers to women-centred support, leaving an experience expectation mismatch unchecked.Trial registrationCRD42016041491 17/06/16.

End User and Implementer Experiences of mHealth Technologies for Noncommunicable Chronic Disease Management in Young Adults: Systematic Review.

BackgroundChronic noncommunicable diseases (NCDs) such as asthma, diabetes, cancer, and persistent musculoskeletal pain impose an escalating and unsustainable burden on young people, their families, and society. Exploring how mobile health (mHealth) technologies can support management for young people with NCDs is imperative.ObjectiveThe aim of this study was to identify, appraise, and synthesize available qualitative evidence on users’ experiences of mHealth technologies for NCD management in young people. We explored the perspectives of both end users (young people) and implementers (health policy makers, clinicians, and researchers).MethodsA systematic review and meta-synthesis of qualitative studies. Eligibility criteria included full reports published in peer-reviewed journals from January 2007 to December 2016, searched across databases including EMBASE, MEDLINE (PubMed), Scopus, and PsycINFO. All qualitative studies that evaluated the use of mHealth technologies to support young people (in the age range of 15-24 years) in managing their chronic NCDs were considered. Two independent reviewers identified eligible reports and conducted critical appraisal (based on the Joanna Briggs Institute Qualitative Assessment and Review Instrument: JBI-QARI). Three reviewers independently, then collaboratively, synthesized and interpreted data through an inductive and iterative process to derive emergent themes across the included data. External validity checking was undertaken by an expert clinical researcher and for relevant content, a health policy expert. Themes were subsequently subjected to a meta-synthesis, with findings compared and contrasted between user groups and policy and practice recommendations derived.ResultsTwelve studies met our inclusion criteria. Among studies of end users (N=7), mHealth technologies supported the management of young people with diabetes, cancer, and asthma. Implementer studies (N=5) covered the management of cognitive and communicative disabilities, asthma, chronic self-harm, and attention deficit hyperactivity disorder. Quality ratings were higher for implementer compared with end user studies. Both complementary and unique user themes emerged. Themes derived for end users of mHealth included (1) Experiences of functionality that supported self-management, (2) Acceptance (technical usability and feasibility), (3) Importance of codesign, and (4) Perceptions of benefit (self-efficacy and empowerment). For implementers, derived themes included (1) Characteristics that supported self-management (functional, technical, and behavior change); (2) Implementation challenges (systems level, service delivery level, and clinical level); (3) Adoption considerations for specific populations (training end users; specific design requirements); and (4) Codesign and tailoring to facilitate uptake and person-centered care.ConclusionsSynthesizing available data revealed both complementary and unique user perspectives on enablers and barriers to designing, developing, and implementing mHealth technologies to support young people’s management of their chronic NCDs.Trial RegistrationPROSPERO CRD42017056317; http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD 42017056317 (Archived by WebCite at http://www.webcitation.org/6vZ5UkKLp)

Mandated reporters’ experiences with reporting child maltreatment: a meta-synthesis of qualitative studies

ObjectiveTo systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters’ (MRs) experiences with reporting.DesignAs no studies assessing...

Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners

ObjectivesThe integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the...

Barriers and facilitators in accessing dementia care by ethnic minority groups: a meta-synthesis of qualitative studies

BackgroundIt is estimated that there are about 25,000 people from UK ethnic minority groups with dementia. It is clear that there is an increasing need to improve access to dementia services for all ethnic groups to ensure that everyone has access to the same potential health benefits. The aim was to systematically review qualitative studies and to perform a meta-synthesis around barriers and facilitators to accessing care for dementia in ethnic minorities.MethodsDatabases were searched to capture studies on barriers and facilitators to accessing care for dementia in ethnic minorities. Analysis followed the guidelines for meta-ethnography. All interpretations of data as presented by the authors of the included papers were extracted and grouped into new themes.ResultsSix hundred and eighty four papers were identified and screened. Twenty eight studies were included in the meta-synthesis. The analysis developed a number of themes and these were incorporated into two overarching themes: ‘inadequacies’ and ‘cultural habitus’.ConclusionsThe two overarching themes lend themselves to interventions at a service level and a community level which need to happen in synergy.Trial registrationThe review was registered with PROSPERO: CRD42016049326.

Juvenile Corrections in the Era of Reform: A Meta-Synthesis of Qualitative Studies.

In this article, the authors synthesize knowledge from select qualitative studies examining rehabilitation-oriented juvenile residential corrections and aftercare programs. Using meta-synthesis methodology, the authors extracted and coded content from 10 research studies conducted by five authors across criminology, sociology, and social welfare disciplines. The total number of published works based on those studies analyzed was 18. Collectively, these studies offer insight into three major components of the juvenile correctional experience: therapeutic treatment and evidence-based practices, the shaping of identities and masculinities, and preparation for reentry. This analysis is particularly important as the United States is currently in an era of reform during which policymakers are increasingly espousing the benefits of rehabilitation for youth offenders over punishment. These studies took place before, during, and after this era of reform, and yet, the findings are surprisingly consistent over time, raising key questions about the effectiveness of the reform strategies.