Mixed Methods Systematic Review Research Articles

A Mixed Methods Systematic Review of the Effectiveness, Acceptability, and Feasibility of Advanced Care Plans for Older Adults Without Life-Limiting Conditions

Context: Advance care planning (ACP) is a comprehensive procedure aimed at helping individuals understand and articulate their values, life goals, and preferences concerning future medical treatment. Despite extensive research on ACP in populations with terminal illnesses, dementia, and those in long-term care, there is a lack of focus on its impact among older adults without life-limiting conditions. Objectives: To investigate the effectiveness, acceptability, and feasibility of ACP for older adults without life-limiting conditions. Methods: We searched 11 electronic databases, spanning from inception to November 2023, complemented by extensive grey literature and reference searches. Rigorous quality assessments were conducted using the Mixed Methods Appraisal Tool (MMAT). Our approach adopted a dynamic convergent mixed-methods design, incorporating thematic and narrative synthesis. Findings: From over 12,600 citations, a total of 16 studies, comprising four randomised controlled trials (RCTs), nine qualitative studies, and three mixed methods studies met the inclusion criteria. Limited findings indicate that ACP interventions are generally effective in improving document completion rates and reducing hospital readmissions. Acceptability and feasibility of these interventions were high, although significantly influenced by cultural and religious factors. Limitations: Evidence supporting the effectiveness, acceptability, and feasibility of ACP in reducing unplanned hospital admissions in older adults without life-limiting conditions was limited. We excluded observations based on unwell older people, though some material with unclear distinctions may have been included. Quality assessments revealed that one of four RCTs had a high risk of bias, three had unclear risks; all nine qualitative studies had low risk; and one of three mixed methods studies had low risk while two had unclear risks. Implications: Further targeted research is necessary to assess the intervention’s value for this population. Rigorous real-world evidence studies involving older adults without life-limiting conditions and their proxies is crucial to enabling providers to tailor ACPs to diverse populations, whilst respecting individuals’ religious and cultural beliefs.

Communicating blood test results in primary care: a mixed methods systematic review.

Background Test result communication is important for patient-centred care, patient safety and primary care workload. Evidence is needed to ensure that test results are communicated safely and efficiently to patients in primary care. Aim To summarize existing evidence for blood test result communication between primary care providers and their patients and carers. Design and setting Mixed-methods systematic review Methods Medline, Embase, PsycINFO (Ovid); CINAHL (ESCOHost); and the Cochrane Library were searched from 2013 to September 2023. Primary studies of any design that provided information on the communication of blood test results by primary care staff to adult patients and carers were eligible for inclusion. Results There were 71 included studies, including 10 experimental studies and no randomized controlled trials. Study quality was mostly poor and risk of bias was high, partly due to a lack of reported information. Patients want more information about their blood test results, particularly in terms of 'what next', and prefer results to be provided quickly. Electronic methods such as online access or text messages were generally well accepted but not by everyone, and not for all results. Clinicians' opinions were mixed as to whether more information and direct release of test results to patients without clinician input was beneficial or could cause problems, such as increased workload. Conclusions We have identified a range of evidence on patient and clinician preferences, barriers and facilitators to test communication, which is particularly important in the current NHS context of a move towards patient online access.

A systematic review of attachment interventions for people with intellectual disability and their caregivers.

The current mixed-methods systematic review evaluated available literature to find out which attachment-based interventions have been implemented for people with intellectual disability and whether they are efficacious and acceptable. Five databases were searched (in July 2023 and April 2024), using terms related to intellectual disability and attachment-based interventions. The search yielded 793 papers; 15 papers (13 studies) met inclusion criteria. Relevant data was extracted from each study. Paper quality was appraised using the Mixed Methods Appraisal Tool. Findings were synthesised in an integrative review. Of the included studies, 7 had people with intellectual disability as participants and 6 had their caregivers. Interventions included education, psychotherapy, technology assisted therapy, video interaction guidance/feedback and circle of security. Research methods varied. Evidence for efficacy and acceptability of interventions was mixed but promising. Most studies had limited generalisability. Therefore, further research is required. Pre-registration with PROSPERO [351287].

Coaching to develop leadership of healthcare managers: a mixed-methods systematic review

IntroductionCoaching is commonly used to facilitate leadership development among healthcare managers. However, there is limited knowledge of the components of coaching interventions and their impacts on healthcare managers’ leadership development. This mixed-methods systematic review aimed to synthesize evidence of coaching to develop leadership among healthcare managers.MethodsThe authors conducted a mixed-methods systematic review using a convergent synthesis design where quantitative and qualitative evidence was collected and analyzed concurrently using a matrix synthesis method. They reviewed studies published in English or Chinese by searching databases including MEDLINE (Ovid), CINAHL, Embase, Cochrane Library, Nursing & Allied Health Premium, Scopus, Wanfang, CNKI, SinoMed, and VIP databases from their inception to August 10, 2023, and updated the search again on July 9, 2024. Articles were screened and assessed for eligibility. First, from eligible studies, the qualitative data were extracted to describe intervention components, the perceived impact of coaching, and participants’ perceptions of being involved in coaching intervention. Second, quantitative data analysis was conducted to describe the impact of coaching interventions and the frequency of each theme evolved in the data. Third, qualitative and quantitative data were synthesized using the matrix synthesis method.ResultsA total of 13 studies were included in the analysis. Three qualitative studies were assessed as having ‘no or few limitations’, three case series studies were scored between five and eight out of 10 points, two quasi-experimental studies showed ‘moderate’ overall bias, and the five mixed-methods studies scored from 40 to 60% (out of 100%). For Objective 1, which covers the component of coaching (aims, ingredients, mechanism, and delivery), the typical aim of coaching interventions was to develop the leadership skills of middle management managers. The ingredients of coaching encompassed three distinct coaching categories and seven specific procedures. The mechanisms of most coaching interventions were based on theory and empirical evidence. The average delivery time was approximately four months. Overall, coaching positively impacts outcomes for managers, organizations, and staff (Objective 2). Perceptions of the participants toward coaching interventions were divided into six categories: barriers, facilitators, effective components, attitudes, satisfactory aspects, and suggestions for designing high-quality coaching interventions to improve leadership (Objective 3).ConclusionsThe components of coaching interventions varied across different studies. The impact of coaching on leadership development was positive across three levels (manager, organization, and staff). Therefore, we recommend coaching as an intervention for healthcare managers aiming to enhance their leadership level. Future coaching interventions may achieve greater effectiveness if they are specifically aligned with the participants’ perceptions identified in our study.

Pharmacy stakeholders' views and experiences of the credentialing of advanced or specialist pharmacist practice: A mixed methods systematic review

BackgroundCredentialing of advanced and specialist pharmacist practice (ASPP) provides essential quality assurance for ASPP, which is significantly different to entry-level practice and is developing worldwide. Several credentialing models are in place or under development internationally. Synthesis of the views and experiences of pharmacists and other relevant stakeholders on credentialing is an important research gap. Objective(s)To determine pharmacy stakeholders' views and experiences of ASPP credentialing and to explore facilitators and barriers to credentialing implementation and uptake. MethodsThe Joanna Briggs Institute convergent integrated approach for mixed methods systematic reviews was followed. The review protocol was pre-registered with PROSPERO. Five electronic databases (Medline, CINAHL, Embase, Web of Science, Google Scholar) were searched from inception to August 2022 for qualitative, quantitative, or mixed methods studies that reported the views and experiences of pharmacy stakeholders on ASPP credentialing. The Mixed Methods Appraisal Tool was used to quality appraise included studies. Thematic synthesis was undertaken to analyse and integrate data from included studies. All screening and data analysis steps were performed by two reviewers independently, with additional author input where required. ResultsSixty studies were included, after screening titles and abstracts (n = 9055) and full texts (n = 228). Studies represented the views of pharmacists, pharmacy managers/employers and professional/representative bodies in hospital, community pharmacy, general practice/primary care, and academic sectors, from 40 countries. Four analytical themes were generated describing the factors, including facilitators and barriers, to be considered when developing or optimising ASPP credentialing: I. Drivers of credentialing, II. Developing ASPP competence, III. Optimising credentialing implementation, and IV. Enhancing credentialing uptake. ConclusionsThis systematic review is the first to synthesise pharmacy stakeholders' views and experiences of ASPP credentialing. A conceptual framework highlights contextual factors, facilitators, barriers, and inter-relationships which should be considered by pharmacists, policymakers, and other key stakeholders when implementing ASPP credentialing.

Cross-disciplinary working between gynaecologists and mental healthcare professionals: a mixed-methods systematic review protocol

IntroductionReproductive hormone transitions (menstrual cycle, post partum and menopause) can trigger mental disorders in a subset of women. Gynaecological diseases, such as endometriosis and polycystic ovary syndrome, can also elevate...

Impact of the degree of synergy between patient and nurse perceptions on the clinical outcome of pressure injury prevention: a mixed-methods systematic review protocol

IntroductionPressure injuries are a common and significant concern in clinical practice, often serving as a vital quality indicator. While (clinical) practice guidelines have been established to offer recommendations for mitigating...

Psychological Aspects of and Support for Survivors Attempting to Conceive During or After Cancer Treatments: A Mixed-Methods Systematic Review.

Advances in medical technology are expected to increase the possibilities for pregnancy for women during and after cancer treatment. We aimed to clarify the psychological dimensions of cancer diagnosis for patients hoping for a pregnancy (their own or their spouse/partner's) during or post-treatment and identify ways to improve support for these survivors and their families. A systematic literature review was conducted in May 2023 using six electronic databases: PubMed, Web of Science, Cochrane Library, PsycINFO, Ichushi-Web, and CINAHL. The search targeted English and Japanese studies with English abstracts published between January 1, 2001, and May 10, 2023. Search terms related to cancer, pregnancy, and psychological aspects were included. The initial search identified 1328 potentially relevant studies after removing duplicates. Subsequently, two reviewers screened article titles and abstracts to exclude studies with no data, those unrelated to pregnancy, and so on, and identified 44 potentially relevant studies. Two reviewers then reviewed the full text of each study, and 20 articles finally met the inclusion criteria. Several studies indicated that trying to conceive negatively impacts survivors' finances, their relationships with their spouses/partners, and their mental health. Although many participants required fertility counseling, few received such opportunities. When cancer survivors try to conceive, they experience physical, psychological, and social burdens; moreover, many report a lack of access to fertility counseling or sufficient information about reproductive health care. Health care professionals should provide patients with updated and more accurate information on reproductive medicine and fertility counseling to enhance pregnancy support during the survivorship phase.

The effects of parent and child participation in visual art activities on the attachment and well-being of young children: A mixed-methods systematic review.

The effects of parent and child participation in visual art activities on the attachment and well-being of young children: A mixed-methods systematic review.

Factors influencing the reporting of medication errors and near misses among nurses: A systematic mixed methods review.

This study aimed to systematically review empirical evidence on factors influencing nurses to report medication errors and near misses. There is underreporting of medication errors among nurses, in particular among novice and beginner nurses. To improve quality of care, factors influencing the reporting of medication errors and near misses should be documented. A systematic mixed methods review was conducted. CINAHL, Cochrane Collaboration, Embase, Medline, PsycINFO and Web of Science databases were explored and analysed from December 1990 to December 2023. Two reviewers independently selected and extracted data using a standardized data extraction grid. Data were analysed using thematic analysis based on the adapted theory of planned behaviour. Forty-two studies met the eligibility criteria. Principal factors influencing the reporting of medication errors and near misses among nurses were associated with perceived behavioural control, subjective norm and attitude. Few studies examined factors influencing reporting medication errors and near misses among novice and beginner nurses, and sociodemographic and professional factors. To understand factors influencing reporting of medication errors and near misses, further studies should be conducted to investigate sociodemographic and professional factors.

121 The effectiveness and acceptability of physical activity interventions amongst older adults from socioeconomically deprived groups: A mixed methods systematic review

121 The effectiveness and acceptability of physical activity interventions amongst older adults from socioeconomically deprived groups: A mixed methods systematic review

The Risks for HIV and Sexually Transmitted Infections Among Men Who Have Sex with Men Who Engage in Chemsex in Low- and Middle-Income Countries: A Mixed Methods Systematic Review and Meta-Analysis.

Chemsex, the use of drugs during and/or prior to sex, has been found to increase the risk of HIV and sexually transmitted infections (STI) among men who have sex with men (MSM). Many studies and reviews on chemsex were focused among MSM in high-income countries (HIC), with less attention given to understanding chemsex in low- and middle-income countries (LMIC). We estimated the prevalence of chemsex and its association with sexual risk behaviors, HIV, and STI among MSM in LMIC. We searched MEDLINE, Embase, GlobalHealth, PsychINFO, and CINAHL for quantitative, qualitative, and mixed-methods studies describing chemsex and its association with sexual risk behaviors, HIV, and STI among MSM in LMIC, published January 1, 2000-October 15, 2023. We used the Mixed Methods Appraisal Tool to assess study quality. We developed a narrative review and performed meta-analysis using a random effects model and the DerSimonian and Laird approach (PROSPERO #CRD42022339663). Thirty-two studies from LMIC, particularly from Asia, Africa, Latin America, and the Middle East, were included. MSM who engaged in chemsex had higher prevalence of condomless anal intercourse, group sex, having multiple sexual partners, and of HIV and STI compared to MSM who did not. We estimated a pooled prevalence for recent chemsex (≤ 12 months) of 16% (95% CI 11%-22%, τ = 0.01, I2 = 99.07%, p < 0.01). Chemsex and its associated behaviors are associated with HIV and STI among MSM in LMIC. Integration of harm reduction and sexual health services and structural changes could prevent HIV and STI prevention among MSM who engage in chemsex in LMIC.

Erratum to: Oral hygiene care and the management of oral symptoms in patients with cancer in palliative care: a mixed methods systematic review protocol.

Erratum to: Oral hygiene care and the management of oral symptoms in patients with cancer in palliative care: a mixed methods systematic review protocol.

A mixed-methods systematic review of offence-related shame and/or guilt in violent offenders

A mixed-methods systematic review of offence-related shame and/or guilt in violent offenders

The impact of bridging education programs on internationally educated nurses becoming registered nurses in high-income countries: A mixed-methods systematic review.

To synthesize the current literature on the impact of bridging education programs for internationally educated nurses (IENs) from low- and middle-income countries (LMICs) seeking to become registered nurses (RNs) in high-income countries (HICs). The issue of qualification pathways for IENs through bridging programs has garnered significant attention in contemporary discourse. The growing population of IENs in HICs has made it imperative to streamline the qualification process to facilitate their integration into the healthcare system. Utilizing a structured review method, we sourced data between January 2023 and April 2024 from the CINAHL, Scopus, and MEDLINE databases with no year limitations. Out of 817 studies, eight were included. The mixed-methods systematic review was carried out by two authors who adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. We employed a qualitative content analysis from a feminist standpoint to assess the impact of bridging programs on the transition of IENs to become RNs. Eight studies were included (mixed methods=1, quantitative=3, qualitative=4). Three themes revealed important key findings. Language proficiency emerged as a critical factor influencing success in bridging programs, with IENs needing to attain a certain level of proficiency in the local language required for licensure. Enhancing nursing competence highlighted skepticism and the need for tailored educational approaches. Transitioning into the workplace emphasized cultural challenges, highlighting the importance of targeted support for continuous integration. Our findings revealed that despite previous higher education attainment in nursing and nursing experience in the home countries from LMICs, bridging programs aided IENs in transitioning and assimilating into the host country's healthcare employment sector. It is essential for policymakers in the education sector to integrate language instruction, cultural sensitivity training, and adapted educational approaches into bridging programs to enhance IENs' readiness for efficient healthcare delivery.

Oral health knowledge, attitudes, and practices of people living with mental illness: a mixed-methods systematic review

People living with mental illness experience poorer oral health outcomes compared to the general population, yet little is known about their oral health knowledge, attitudes, and practices. The aim of this mixed-methods systematic review was to synthesise evidence regarding oral health knowledge, attitudes, and practices of people living with mental illness to inform preventative strategies and interventions. Database searches were conducted in PubMed, MEDLINE, PsycINFO, CINAHL, ProQuest, and Scopus with no limitations placed on the year of study. All studies available in the English language, that explored the oral health knowledge, attitudes, and/or practices of people with a mental illness were included. Articles were excluded if they primarily pertained to intellectual disability, behavioural and psychological symptoms of dementia, drug and alcohol or substance use, or eating disorders. A thematic synthesis was undertaken of 36 studies (26 high-moderate quality), resulting in 3 themes and 9 sub-themes. Study participants ranged from n = 7 to n = 1095 and aged between 15–83 years with most having a diagnosis of schizophrenia, schizoaffective, or bipolar affective disorder. People diagnosed with a mental illness were found to have limited oral health knowledge, particularly regarding the effects of psychotropic medication. Various barriers to oral health care were identified, including high dental costs, the negative impact of mental illness, dental fears, lack of priority, and poor communication with dental and health care providers. Study participants often displayed a reduced frequency of tooth brushing and dental visits. The findings highlight the potential for mental health care providers, oral health and dental professionals, mental health consumers, and carers to work together more closely to improve oral health outcomes for people with mental illness. The systematic review protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO), (registration ID CRD42022352122).

Exploring community- and systemic-level gender-based violence in visible minority women across five countries from an intersectionality lens: protocol for a mixed-methods systematic review.

The intersection of sexism with racism and xenophobia disproportionately exposes visible minority women to gender-based violence (GBV) at the community and systemic levels. This study aims to understand the knowledge strengths and gaps on GBV against visible minority women with an intersectional lens, revealing systemic barriers to accessing support and how these barriers intensify GBV and its effects. It will also identify effective and ineffective policies and practices in the literature to develop strategies addressing the root causes of GBV and supporting survivors. We will conduct a mixed-methods systematic review using a convergent integrated approach to examine current literature on community- and systemic-level GBV against visible minority women. We will follow Joanna Briggs Institute's guidelines to converge data from both qualitative and quantitative studies to obtain an integrated qualitative synthesis on GBV in five countries: Canada, the USA, the UK, Australia and New Zealand. This analysis will be conducted following Thomas and Harden's thematic synthesis guidelines. Community members with lived experience of GBV will actively contribute to improving the relevance and interpretation of results, following a community-engaged research approach. Themes are expected to unveil various aspects of community- and systemic-level GBV due to the intersection of racism, xenophobia and sexism, alongside barriers in addressing GBV and research gaps. Since this study does not involve primary data collection or the use of identifiable human data, no ethical approval will be needed. Results will be disseminated through integrated knowledge translation, involving collaboration with participants who have lived experience of GBV. The findings will be used to identify specific areas of policy intervention, including adopting culturally sensitive approaches, improving school and workplace policies and promoting rights of visible minority women.

What influences the implementation of clinical guidelines related to enteral nutrition in the intensive care unit: A mixed-methods systematic review.

To systematically evaluate and analyse literature concerning the factors influencing the implementation of clinical practice guidelines related to enteral nutrition in the adult intensive care unit. Guidelines serve as crucial tools for guiding clinical practice. However, a significant gap persists between current clinical practice and guidelines pertaining to enteral nutrition. It is essential to identify the reasons behind this disparity to foster clinical transformation. A mixed-methods systematic review. A systematic search was conducted across PubMed, Embase, Medline, Cochrane, PsycINFO and CNKI databases to identify impediments and facilitators to the implementation of ICU clinical practice guidelines related to enteral nutrition. The types of studies included quantitative, qualitative and mixed-methods studies. The search spanned from January 2003 to January 2024 and was updated in May 2024. The quality assessment of the included literature was conducted using the Mixed-Methods Study Evaluation Tool (MMAT). Data analysis was performed using a data-based convergent integration approach. The protocol for this study was prospectively registered (PROSPERO2023, CRD42023483287). Twenty papers were finally included, and 65 findings were extracted, integrating a total of three categories, Category 1: healthcare provider factors, including three sub-themes: knowledge of guideline-related knowledge and awareness of guideline application; social/professional roles and identity domains; beliefs, attitudes and self-efficacy; collaboration, Category 2: practice environments, including two sub-themes: environmental factors and resource areas; systems and behavioural norms, Category 3: patient values and nutritional support preferences including two sub-themes: patient disease status and value orientation. Healthcare professionals should analyse obstacles and facilitators to guideline implementation from multiple perspectives, strengthen healthcare collaboration, improve education and training systems, correct misperceptions and increase awareness of evidence-based practice.

Leaving No One Behind- Teacher Peer Mentoring Before and After the Pandemics: A Mixed-Methods Systematic Review of Spanish and English Literature

&lt;p style="text-align:justify"&gt;This paper examines how peer mentoring strengthens teaching practices in Regular Basic Education considering the changes undertaken since the COVID-19 pandemics. Peer mentoring is an in-service teacher training strategy that includes mutual collaboration, learning and monitoring. In this systematic review, we retrieved 24 articles since 2020 from Scopus (8), Web of Science (8), Dialnet (5), Google Scholar (2) and SciELO (1) to find out about the benefits of peer mentoring. Our review was guided by the PRISMA criteria. We found that educational companionship has a positive impact on reducing knowledge gaps regarding new technologies through the exchange of experiences, promotes openness to criticism, as well as the interest in learning and unlearning, supporting learning self-regulation, and guarantees consultation, reflection, and agreement between members of the teaching communities. We conclude that peer mentoring fulfilled, to a large extent, its purpose of improving teacher performance as one of the keys to educational quality.&lt;/p&gt;

Parents' and healthcare providers' perceptions, experiences, knowledge of, and attitudes toward kangaroo care of preterm babies in hospital settings: Mixed-methods systematic review.

Kangaroo care is an effective intervention to increase survival and improve the health and development of preterm infants. Despite this, implementation of kangaroo care globally remains low. The objectives of this review were to: (a) synthesize evidence on parents' and healthcare practitioners' perceptions, experiences, knowledge of, and attitudes toward kangaroo care of preterm babies in hospital settings; and (b) establish parents' satisfaction with kangaroo care. Studies of any design were included if they focused on parents' or healthcare practitioners' perceptions, experiences, knowledge of, and attitudes to kangaroo care of preterm babies, or reported parents' satisfaction, and were conducted in hospital settings. The search of seven electronic databases, African Journals Online, World Health Organization regional databases, and a gray literature search was conducted in April/May 2020, and updated in January 2024. Study selection was undertaken by two independent reviewers. Quality assessment using the Mixed Method Appraisal Tool and data extraction were completed by one reviewer with a 10% check by a second reviewer. Data were synthesized narratively using a parallel results convergent integrated design. Thirty-seven studies, 19 quantitative, 16 qualitative, and 2 mixed methods, were included. The findings suggested that while healthcare practitioners generally demonstrated knowledge about kangaroo care, there was a notable minority with insufficient understanding among those who received training. Parents' knowledge, particularly among fathers, was limited. Both healthcare practitioners and parents appeared to have positive attitudes to kangaroo care. Little is known about parental satisfaction with kangaroo care. Most healthcare practitioners were knowledgeable about kangaroo care, but parents had limited knowledge. This review findings suggest a need to enhance parental knowledge of kangaroo care before neonatal unit admission, and training is needed for HCPs to implement kangaroo care consistently.