Mixed-methods Synthesis Research Articles

Public perspectives on the benefits and harms of lung cancer screening: A systematic review and mixed-method integrative synthesis.

Screening for lung cancer with low dose computed tomography aims to reduce lung cancer mortality, but there is a lack of knowledge about how target populations consider its potential benefits and harms. We conducted a systematic review of primary empirical studies published in any jurisdiction since 2002 using an integrative meta-synthesis technique. We searched six health and social science databases. Two reviewers independently screened titles, abstracts, and potentially eligible full-text studies. Quantitative assessments and open-ended perspectives on benefits and harms were extracted and convergently integrated at analysis using a narrative approach. Study quality was assessed. The review included 26 quantitative, 18 qualitative, and 5 mixed methods studies. Study quality was acceptable. Lung cancer screening was widely perceived to be personally beneficial for early detection and reassurance. Radiation exposure and screening accuracy were recognised as harms, but these were frequently considered to be justified by early detection of lung cancer. Stigma, anxiety, and fear related to screening procedures and results were pervasive among current smokers. People with low incomes reported not participating in screening because of potential out-of-pocket costs and geographic access. Populations targeted for lung cancer screening tended to consider screening as personally beneficial and rationalised physical, but not psychological, harms. Screening programmes should be clear about benefits, use non-stigmatising design, and consider equity as a guiding principle.

The Offence of Abduction in Canon Law and Kidnapping in Polish Penal Law—Selected Issues

The article examines the issue of abduction and kidnapping in the modern world. This issue is analyzed in two legal systems: the canon law of the Latin Rite Catholic Church and Polish penal law. The choice of these two systems aims to highlight the consistency in understanding and penalizing the offence of abduction (kidnapping). A mixed-method approach, incorporating both analysis and synthesis, is employed in this study. The analysis is comprehensive and multifaceted, while the synthesis aids in organizing and integrating the findings on this topic.

Health professionals' attitudes towards traditional healing for mental illness: A systematic review protocol.

Mental illness is a global problem that receives less attention, particularly in developing countries. Integrating modern treatment with traditional healing approaches has been proposed as one way to address mental health problems, especially in developing countries. Despite health professionals' participation in traditional healing being crucial to integrative approaches, their participation is limited to date. This review protocol is designed to explore the attitudes of health professionals towards traditional healing practices in mental health services. The review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searching databases, including PubMed/Medline, PsychINFO, EMBASE, Scopus, and the Web of sciences will be conducted. Additionally, Google and Google Scholar will be searched for other information, including grey literature. Moreover, a manual search of identified articles' reference lists will also be conducted to help ensure all potential papers are included in the review. Qualitative, quantitative, and mixed study methods published in English between January 2014 and April 2024 will be included. The qualities of the included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018. A mixed-method synthesis will be used to synthesis the results. It is crucial for healthcare professionals to provide culturally sensitive care to empower people to manage their health. This systematic review will summarize the attitudes of health professionals towards the adoption and delivery of traditional healing approaches to people experiencing mental illness. Therefore, the findings of this review will support integration between traditional healers and modern mental health practitioners for the treatment of mental illness. Protocol registration number: CRD42024535136.

An evaluation of education videos for women experiencing domestic and family violence in healthcare settings: protocol for a mixed methods systematic review

BackgroundDomestic and family violence (DFV) is a significant public health issue that poses a high risk to women, globally. Women experiencing DFV have higher rates of healthcare utilisation than women not experiencing DFV. Healthcare services are therefore well placed to address DFV and deliver education and awareness interventions to women. Video interventions are a strategy to deliver education to women, while overcoming barriers such as language, literacy, lack of rapport with clinician, or unwillingness to disclose. The current review will aim to further understand the characteristics, methods of evaluation, and outcomes of DFV video education interventions for perinatal women.MethodsThe review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A systematic search will be conducted of the following databases: Medline, Embase, PsycINFO, PsycArticles, Scopus, and Web of Science Core Collection. Two independent reviewers will screen titles and abstracts against the inclusion criteria, followed by a full text screening of eligible articles. A third reviewer will resolve discrepancies. All study types will be included. Only studies published in English will be included. Risk of bias will be assessed using the Quality Assessment with Diverse Studies (QuADS) tool. Data will undergo an aggregate mixed method synthesis informed by The Joanna Briggs Institute, before being analysed using a thematic approach.DiscussionThis systematic review will provide evidence on best practice for the creation, delivery, and evaluation of DFV video interventions for women in the peripartum.Systematic review registrationPROSPERO registration number CRD42023475338.

What is known about adolescent dysmenorrhoea in (and for) community health settings?

Dysmenorrhoea affects many adolescents with significant impacts on education and well-being. In the UK, most of the adolescents who seek care (and many never do), will do so through general practice (primary care). Knowing how best to care for adolescents reporting menstrual pain is an area where UK general practitioners would like better guidance and resources. This mixed-methods narrative synthesis collates community and specialist evidence from 320 papers about adolescent dysmenorrhoea, with a UK general practice community health perspective. We report a narrative summary of symptoms, cause, consequences and treatments for adolescent dysmenorrhoea. We highlight areas of tension or conflicted evidence relevant to primary care alongside areas of uncertainty and research gaps identified through this synthesis with input from lived experience advisers. There is little evidence about primary care management of adolescent dysmenorrhoea or specific resources to support shared-decision making in general practice, although there are evidence-based treatments to offer. Primary care encounters also represent potential opportunities to consider whether the possibility of underlying or associated health conditions contributing to symptoms of dysmenorrhoea, but there is little epidemiological evidence about prevalence from within community health settings to inform this. The areas where there is little or uncertain evidence along the care journey for adolescent dysmenorrhoea, including at the interface between experience and expression of symptoms and potential underlying contributory causes warrant further exploration. https://www.crd.york.ac.uk/PROSPEROFILES/256458_STRATEGY_20210608.pdf, identifier (CRD42021256458).

The characteristics of eating, drinking and oro-pharyngeal swallowing difficulties associated with repaired oesophageal atresia/tracheo-oesophageal fistula: a systematic review and meta-proportional analysis

IntroductionEating, drinking and swallowing difficulties are commonly reported morbidities for individuals born with OA/TOF. This study aimed to determine the nature and prevalence of eating, drinking and oro-pharyngeal swallowing difficulties reported in this population.MethodA systematic review and meta-proportional analysis were conducted (PROSPERO: CRD42020207263). MEDLINE, EMBASE, CINAHL, Pubmed, Scopus, Web of Science databases and grey literature were searched. Quantitative and qualitative data were extracted relating to swallow impairment, use of mealtime adaptations and eating and drinking-related quality of life. Quantitative data were summarised using narrative and meta-proportional analysis methods. Qualitative data were synthesised using a meta-aggregation approach. Where quantitative and qualitative data described the same phenomenon, a convergent segregated approach was used to synthesise data.ResultsSixty-five studies were included. Six oro-pharyngeal swallow characteristics were identified, and pooled prevalence calculated: aspiration (24%), laryngeal penetration (6%), oral stage dysfunction (11%), pharyngeal residue (13%), nasal regurgitation (7%), delayed swallow initiation (31%). Four patient-reported eating/drinking difficulties were identified, and pooled prevalence calculated: difficulty swallowing solids (45%), difficulty swallowing liquids (6%), odynophagia (30%), coughing when eating (38%). Three patient-reported mealtime adaptations were identified, and pooled prevalence calculated: need for water when eating (49%), eating slowly (37%), modifying textures (28%). Mixed methods synthesis of psychosocial impacts identified 34% of parents experienced mealtime anxiety and 25% report challenging mealtime behaviours reflected in five qualitative themes: fear and trauma associated with eating and drinking, isolation and a lack of support, being aware and grateful, support to cope and loss.ConclusionsEating and drinking difficulties are common in adults and children with repaired OA/TOF. Oro-pharyngeal swallowing difficulties may be more prevalent than previously reported. Eating, drinking and swallowing difficulties can impact on psychological well-being and quality of life, for the individual and parents/family members. Long-term, multi-disciplinary follow-up is warranted.

May the 4th be with you: mixed-methods best-evidence synthesis on 4th-generation alumina-zirconia ceramic bearings in total hip arthroplasty.

To assess utility, benefits, and risks of 4th-generation alumina-zirconia ceramic pairings in elective total hip arthroplasty (THA). A comprehensive mixed-methods best-evidence synthesis using data from systematic reviews, randomized controlled trials (RCTs), prospective and retrospective cohort studies, as well as joint replacement registries, was conducted to estimate overall revision and survival rates, periprosthetic infection, bearing fractures, and noise phenomena with 4th-generation alumina-zirconia ceramic versus other tribological couplings in elective THA. The systematic review part across multiple databases was registered with PROSPERO (CRD42023418076), and individual study data were extracted for statistical re-analysis. Twenty overlapping systematic reviews, 7, 17, and 8 references from RCTs, cohort studies, and joint replacement registries form the basis of this work. According to current best evidence, it is (i) 15-33 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for audible noise, (ii) 38-85 times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than causing a revision for ceramic head fractures, and (iii) three to six times more likely that 4th-generation alumina-zirconia pairings avoid a revision for infection than cause a revision for ceramic liner fractures. Fourth-generation alumina-zirconia pairings in THA show a favorable benefit-risk ratio, with rare compound-specific adverse events and complications significantly outbalanced by long-term advantages, such as a markedly lower incidence of revision for infection.

Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement.

Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding. To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS. Evidence syntheses with stakeholder engagement. Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops. We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence. There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics. 'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK. Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies. This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/). This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.

Supported employment interventions with people who have severe mental illness: Systematic mixed-methods umbrella review.

Primary and review studies show that supported employment interventions showed promise in assisting people with severe mental illness (SMI) in achieving successful employment and health-related outcomes. This umbrella review synthesises evidence from across review studies on supported employment interventions for individuals with SMI, to identify key findings and implementation challenges in relation to five key outcomes: (1) employment, (2) quality of life, (3) social functioning, (4) clinical/service utilisation, and (5) economic outcomes. A systematic search of eleven databases and registers (CINAHL, Cochrane, EmCare, JBI EBP, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science, and Prospero and Campbell) was conducted to identify meta-analyses and systematic reviews on supported employment interventions for individuals with SMI, peer reviewed and published in English. Quality assessment and data extraction were performed using standardised Joanna Briggs Institute (JBI) tools. A mixed-methods synthesis approach was employed to integrate both quantitative and qualitative evidence. The synthesis of 26 review studies primarily focused on the Individual Placement and Support (IPS) model among various supported employment interventions. Overall, combining supported employment with targeted interventions such as neurocognitive therapy and job-related social skill training showed a positive effect on employment (including job retention) and non-employment outcomes (e.g., health, quality of life, social functioning) relative to standard forms of supported employment for people with SMI. Contextual factors (intervention fidelity, settings, systemic barriers) were important considerations for intervention implementation and effectiveness. Significant overlap of primary studies across 26 review studies exposed considerable variations in interpretation and conclusions drawn by authors, raising questions about their reliability. High volume of overlap reporting from the USA on IPS interventions in review studies is likely to have biased perceptions of effectiveness. There is no one-size-fits-all solution for supporting individuals with SMI in obtaining and maintaining employment. Tailoring strategies based on individual needs and circumstances appears crucial to address the complexity of mental health recovery. We propose creating centralised registries or databases to monitor primary studies included in reviews, thus avoiding redundancy. This umbrella study was registered with PROSPERO (No. CRD42023431191).

Where are services regarding sexual minorities and psychological therapies post-COVID in 2024? A mixed-method systematised review

PurposeSince COVID-19, many services have burgeoned within the UK, but what about sexual minorities? Since the last review, there are appropriate therapies, but there is often inadequate research. The purpose of this mixed-method review synthesis looking into the efficacy of psychological therapies for sexual minorities. Seven studies were found in total.Design/methodology/approachA mixed-method review synthesis, three studies looking into the efficacy of psychological therapies for sexual minorities and four studies addressing the experiences of sexual minorities partaking in psychological therapies were identified.FindingsThese included three quantitative and four qualitative studies. The minority stress hypothesis is used to formulate problems, but challenges remain to confidentiality and privacy in this context. Therapists still operate within the heteronormative framework, discounting intersectionality in therapy conversations.Research limitations/implicationsMost studies have had low retention rates since 2021. It shows that minority stress needs to be accounted for at the ethics committee and research delivery levels.Practical implicationsApplying a heteronormative framework to sexual minorities is not working. An alternative progress world view is needed.Social implicationsHealth-care clinicians strive for equitable care. Unfortunately, using an equitable health service scale adapted from Levesque et al. (2013), the rating is 3 out of 6. More work is needed to improve services.Originality/valueSome services are reporting much improvement post-pandemic. Sadly, this is not the case for sexual minorities. Individual and systemic barriers remain.

SGLT-2 Inhibitors and Their Correlation With Kidney Stones. A Systematic Review

Background: Sodium-glucose cotransporter-2 (SGLT-2) inhibitors have emerged as a valuable class of medications for managing Type 2 Diabetes Mellitus (T2DM) due to their efficacy in glycemic control and cardiovascular and renal benefits. However, concerns have been raised regarding their potential association with an increased risk of kidney stone formation. Objective: This systematic review aimed to comprehensively evaluate the existing literature to determine the association between SGLT-2 inhibitors and kidney stone formation, elucidate potential underlying mechanisms, and discuss implications for clinical practice. Methods: A systematic search of databases including PubMed, Google Scholar, Web of Sciences, Medline, and Scopus was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant research articles investigating the utilization of SGLT-2 inhibitors in humans and their potential correlation with kidney stones were included. Data extraction and quality assessment were performed, and a mixed-methods synthesis approach was used for data analysis. Results: The systematic review identified several studies examining the association between SGLT-2 inhibitors and kidney stones. Overall, SGLT-2 inhibitors were found to be associated with a potential protective effect against kidney stone formation. Mechanistically, SGLT-2 inhibitors promote glycosuria and natriuresis, leading to increased urine flow rate and enhanced urinary volume, which may help dilute and flush out stone-forming substances. However, certain limitations and considerations, including potential adverse events and variations in study designs, were also highlighted. Conclusion: This systematic review provides valuable insights into the potential correlation between SGLT-2 inhibitors and kidney stones. While the observed protective effect against kidney stone formation is promising, further research with longer follow-up durations and larger sample sizes is warranted to establish a more conclusive understanding of this relationship. Nonetheless, clinicians should remain vigilant in monitoring patients using SGLT-2 inhibitors and carefully assess individual risk factors when prescribing these medications.

Women's Experiences of Sexual Agency Under Constrained Choice: A Systematic Review

In Western societies, women are encouraged to present themselves in sexualized ways and are expected to experience this as a form of sexual agency. However, research on women's sexual agency is new and still developing, leading to inconsistent definitions and understandings. In addition, women's experiences of and resistance to violations of their sexual boundaries are frequently overlooked. The current systematic review answers research questions on how sexual agency has been conceptualized, how it has been studied in relation to sexual violence, and how women's social positionality influences sexual agency. A systematic strategy was used to search 10 health and social science databases and analyze 95 full-text articles. A feminist social constructionist framework guided this mixed-methods synthesis and provided a framework for addressing the research questions. The findings contribute to a deeper understanding of how society and researchers understand women's sexual agency and how intersectionality is largely ignored. Findings also identify an urgent need for future research to consider the relations between violence against women and women's perceptions of (or lack of) sexual agency. Future policymakers, researchers, and educators should move away from a one-size-fits-all approach in their work and instead, consider the diverse impact of societal expectations on women. By doing so, we can develop policies and programming that are specifically tailored to address the unique needs and challenges faced by women in society.

Experiences of Gender-Based Stigma in Health Care in North America: A Mixed-Methods Scoping Review and Synthesis of the Literature

Experiences of Gender-Based Stigma in Health Care in North America: A Mixed-Methods Scoping Review and Synthesis of the Literature

‘You can change your life through sports’—physical activity interventions to improve the health and well-being of adults experiencing homelessness: a mixed-methods systematic review

ObjectivesSystematically synthesise evidence of physical activity interventions for people experiencing homelessness (PEH).DesignMixed-methods systematic review.Data sourcesEMBASE, Web of Science, CINAHL, PubMed (MEDLINE), PsycINFO, SPORTDiscus and Cochrane Library, searched from inception to...

Definition, Frequency and Risk Factors for Intra-Operative Spinal Cord Injury: A Knowledge Synthesis.

Mixed-methods approach. Intra-operative spinal cord injury (ISCI) is a devastating complication of spinal surgery. Presently, a uniform definition for ISCI does not exist. Consequently, the reported frequency of ISCI and important risk factors vary in the existing literature. To address these gaps in knowledge, a mixed-methods knowledge synthesis was undertaken. A scoping review was conducted to review the definitions used for ISCI and to ascertain the frequency of ISCI. The definition of ISCI underwent formal review, revision and voting by the Guidelines Development Group (GDG). A systematic review of the literature was conducted to determine the risk factors for ISCI. Based on this systematic review and GDG input, a table was created to summarize the factors deemed to increase the risk for ISCI. All reviews were done according to PRISMA standards and were registered on PROSPERO. The frequency of ISCI ranged from 0 to 61%. Older age, male sex, cardiovascular disease including hypertension, severe myelopathy, blood loss, requirement for osteotomy, coronal deformity angular ratio, and curve magnitude were associated with an increased risk of ISCI. Better pre-operative neurological status and use of intra-operative neuromonitoring (IONM) were associated with a decreased risk of ISCI. The risk factors for ISCI included a rigid thoracic curve with high deformity angular ratio, revision congenital deformity with significant cord compression and myelopathy, extrinsic intradural or extradural lesions with cord compression and myelopathy, intramedullary spinal cord tumor, unstable spine fractures (bilateral facet dislocation and disc herniation), extension distraction injury with ankylosing spondylitis, ossification of posterior longitudinal ligament (OPLL) with severe cord compression, and moderate to severe myelopathy. ISCI has been defined as "a new or worsening neurological deficit attributable to spinal cord dysfunction during spine surgery that is diagnosed intra-operatively via neurophysiologic monitoring or by an intraoperative wake-up test, or immediately post-operatively based on clinical assessment". This paper defines clinical and imaging factors which increase the risk for ISCI and that could assist clinicians in decision making.

Self-care advice for patients after surgery for oesophageal cancer - a mixed-methods systematic review.

The aim of the literature review was to identify and synthesise research on self-care advice for oesophageal cancer survivors. A mixed-methods systematic review and synthesis of existing literature on the topic. Five databases were searched for studies providing information on self-care advice for survivorship after oesophageal cancer surgery, in English, with no time filter. The Critical Appraisal Skills Program was used to assess the risk of bias. Data were presented by textual descriptions and grouping of data. Among the 13 studies included in the review, five pieces of self-care advice were identified; reconstructing eating habits, bed-head elevation, health-promoting advice, monitoring symptoms and body functions, and involving family and friends. The self-care advice was experienced to be hard work, but worth the effort. They also provided reassurance and an increased understanding of bodily changes and social consequences of the disease and treatment. Thereare is little evidence-based self-care advice for oesophageal cancer survivors. However, the existing self-care advice was appreciated and contributed to an increased understanding of the situation. Comprehensible and easy-to-follow recommendations should be provided to all oesophageal cancer survivors. Evidence-based self-care advice helpful for the individual oesophageal cancer survivor may be imperative to cope with the consequences of oesophagectomy after hospital discharge.

Effective interventions for improving routine childhood immunisation in low and middle-income countries: a systematic review of systematic reviews

ObjectiveAn umbrella review providing a comprehensive synthesis of the interventions that are effective in providing routine immunisation outcomes for children in low and middle-income countries (L&MICs).DesignA systematic review of systematic...

1717 Interventions to Reduce Sedentary Behaviour in Community-Dwelling Older Adults: A Mixed Method Review

Abstract Introduction Sedentary behaviour has been associated with several deleterious health outcomes and older adults are the fastest-growing and most sedentary group in society. This review aimed to systematically review quantitative and qualitative studies examining interventions to reduce sedentary behaviour in community-dwelling older adults. Methods This mixed-method systematic review (PROSPERO registration number: CRD42021264954) considered quantitative articles (randomised-controlled trials (RCTs) and cluster RCTs), qualitative articles (semi-structured interviews and focus groups) and mixed-method studies that explored interventions to reduce sedentary behaviour in community-dwelling older adults. Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Cinahl, SportDiscus and PEDRO were searched from inception to March 2023. Articles were appraised using the Mixed Method Appraisal Tool. Quantitative evidence was meta-analysed, qualitative evidence was thematically synthesised and both were combined in a mixed-method synthesis. Results Forty-one studies (15 RCTs, 21 qualitative and 5 mixed-method studies) were included. Interventions were somewhat effective at reducing sedentary time (-29.10 mins/day, 95% CI -51.74, -6.46). Three analytical themes were identified (what sitting means to older adults, expectations of ageing and social influence in older adults). The mixed-method synthesis identified that existing interventions have been limited by a recruited sample that is not representative of the wider population of older adults, and outcome measurement and intervention content that is not consistent with older adults’ priorities. Conclusions Future research should focus on inclusive recruitment strategies to recruit under-represented populations (such as adults aged 75 years and above), incorporate outcome measures that are valued by older adults, and incorporate older adults’ preferences in intervention content.

Intervention components in the self-management of Parkinson’s: a mixed-methods synthesis of qualitative and quantitative evidence

IntroductionSelf-management interventions consist of multiple components to support people in the management of medical, emotional, and behavioural aspects of their condition, and aim to improve quality of life, function, and other outcomes. A systematic review of self-management interventions in Parkinson’s showed no conclusive evidence for effectiveness of specific self-management approaches in Parkinson’s to date but identified several potentially useful components.AimTo identify the key required components for self-management in people with Parkinson’s by synthesising evidence from a body of primary qualitative evidence and systematic reviews, and to explore which of these key components should be incorporated into trials of self-management in Parkinson’s.MethodA mixed-methods synthesis was conducted. We combined data from two primary qualitative studies and a systematic review of qualitative studies that focused on self-management in Parkinson’s to identify key intervention components. These were then mapped onto the results of a systematic review of Randomised Controlled Trials (RCTs) using matrices. First, data were extracted from the qualitative studies with people with Parkinson’s and healthcare professionals on the key self-management components in this population. Second, a matrix table was created to map the identified Parkinson’s specific self-management components against potential effectiveness from published RCTs of self-management interventions.ResultsSynthesis of qualitative data identified 15 potential self-management components. These 15 components included components needed to start self-managing (e.g., information, skill acquirement) and components needed to maintain self-managing (e.g., self-motoring, increasing motivation). From 18 RCTs, interventions varied in how many components were included (range 1–10). Trials reporting significant beneficial effects of their intervention included a higher number of components (4 or more self-management components) than trials without significant findings (1–3 self-management components).ConclusionFifteen key self-management components were identified that should be incorporated into interventions or programs of self-management in Parkinson’s. No current trial has incorporated all aspects, but a higher number of these key components appears to make trials of self-management interventions more likely to be successful.

Using qualitative comparative analysis as a mixed methods synthesis in systematic mixed studies reviews: Guidance and a worked example.

Qualitative comparative analysis (QCA) is a hybrid method designed to bridge the gap between qualitative and quantitative research in a case-sensitive approach that considers each case holistically as a complex configuration of conditions and outcomes. QCA allows for multiple conjunctural causation, implying that it is often a combination of conditions that produces an outcome, that multiple pathways may lead to the same outcome, and that in different contexts, the same condition may have a different impact on the outcome. This approach to complexity allows QCA to provide a practical understanding for complex, real-world situations, and the context of implementing interventions. There are guides for conducting QCA in primary research and quantitative systematic reviews yet, to our knowledge, no guidance for conducting QCA in systematic mixed studies reviews (SMSRs). Thus, the specific objectives of this paper are to (1) describe a step-by-step approach for novice researchers for using QCA to integrate qualitative and quantitative evidence, including guidance on how to use software; (2) highlight specific challenges; (3) propose potential solutions from a worked example; and (4) provide recommendations for reporting.