Systematic Mixed Studies Review Research Articles

Clinical ethics support services in paediatric practice: protocol for a mixed studies systematic review on structures, interventions and outcomes

IntroductionClinical ethics support services (CESS) have been developing worldwide with growing interest in evaluating their quality. Paediatric-specific CESSs (p-CESS) have received little attention, and evidence from adult services might not...

Mental health outcomes in formerly incarcerated Black men: A systematic mixed studies review.

The aim of this review was to evaluate the current state of scientific knowledge describing the mental health of Black men who have experienced incarceration. This systematic mixed studies review employed a sequential explanatory design integrating quantitative and qualitative published research. PubMed, CINAHL, PsycINFO, Social Work and Criminal Justice databases were searched using search terms addressing core constructs of mental health, Black men, incarceration and re-entry, January 2010 through October 2021. Articles identified through a search protocol were screened for inclusion as: peer-reviewed original research, published in English and relevant to the mental health of formerly incarcerated Black men in the United States. Twenty-three articles met inclusion criteria. Quantitative findings demonstrated significant associations between incarceration history and poor mental health, including higher levels of psychological distress, increased severity of depressive and PTSD symptoms, and delayed mental health treatment. Discrimination, negative police encounters, solitary confinement and difficulty finding employment were associated with the relationship between incarceration and mental health outcomes. Four themes were identified from the qualitative synthesis: (1) Social Determinants of Mental Health (2) Pushing Through Emotional Despair (3) Challenges to Healthcare Engagement and (4) Gender, Race and Intersections between Social Identities. The United States has the highest rate of incarceration in the world and disproportionately incarcerates Black men. This review contextualizes the relationship between incarceration history and mental health in the lived experiences and perspectives of formerly incarcerated Black men. Findings indicate the need for interventions to support mental health needs and prevent downstream health consequences in this population. Mental health concerns are pervasive in formerly incarcerated Black men; to address key gaps in current scientific understandings future research should focus on how Black men navigate help-seeking experiences and use mental health services in the context of an incarceration history.

A Systematic Mixed Studies Review and Framework Synthesis of Mental Health Professionals’ Experiences of Violence Risk Assessment and Management in Forensic Mental Health Settings

ABSTRACT Violence risk assessment and management is at the forefront of the work of mental health professionals in forensic mental health settings. Staff working in these settings are presented with many challenges. This review explores how mental health professionals working in forensic mental health settings experience the violence risk assessment and management process. A systematic mixed studies review utilizing PRISMA guidelines was conducted. Sixteen studies were identified for inclusion. Data from qualitative, quantitative, and mixed-methods studies were analyzed together using a data-based convergent synthesis design. Using a best-fit framework synthesis approach, existing data was built upon to allow for a comprehensive qualitative overview of mental health professionals’ experiences. The themes which emerged were: The Patient as a Person; The Caring Relationship; Multidisciplinary Working; and Reliance on Clinical Intuition. Results, clinical implications, and future research directions are discussed.

Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review

BackgroundGlobally, the number of forcibly displaced women is growing. Refugee and displaced women have poorer health outcomes compared to migrant and host country populations. Conflict, persecution, violence or natural disasters and under-resourced health systems in their country of origin contribute to displacement experiences of refugee and displaced women. Poor health outcomes are further exacerbated by the migration journey and challenging resettlement in host countries. Preventive sexual and reproductive health (SRH) needs of refugee and displaced women are poorly understood. The aim was to synthesise the evidence about access to preventive SRH care of refugee and displaced women.MethodsA systematic review of qualitative, quantitative and mixed methods studies of women aged 18 to 64 years and health care providers' (HCPs’) perspectives on barriers to and enablers of SRH care was undertaken. The search strategy was registered with PROSPERO in advance of the search (ID CRD42020173039). The MEDLINE, PsycINFO, Embase, CINAHL, and Global health databases were searched for peer-reviewed publications published any date up to 30th April 2020. Three authors performed full text screening independently. Publications were reviewed and assessed for quality. Study findings were thematically extracted and reported in a narrative synthesis. Reporting of the review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.ResultsThe search yielded 4083 results, of which 28 papers reporting 28 studies met inclusion criteria. Most related to contraception and cervical or breast cancer screening. Three main themes and ten subthemes relating to SRH care access were identified: interpersonal and patient encounter factors (including knowledge, awareness, perceived need for and use of preventive SRH care; language and communication barriers), health system factors (including HCPs discrimination and lack of quality health resources; financial barriers and unmet need; HCP characteristics; health system navigation) and sociocultural factors and the refugee experience (including family influence; religious and cultural factors).ConclusionsImplications for clinical practice and policy include giving women the option of seeing women HCPs, increasing the scope of practice for HCPs, ensuring adequate time is available during consultations to listen and develop refugee and displaced women’s trust and confidence, strengthening education for refugee and displaced women unfamiliar with preventive care and refining HCPs’ and interpreters’ cultural competency. More research is needed on HCPs’ views regarding care for refugee and displaced women.

Nurses' competency in electrocardiogram interpretation in acute care settings: A systematic review.

Identify and synthesize evidence of nurses' competency in electrocardiogram interpretation in acute care settings. Systematic mixed studies review. Cumulative Index to Nursing and Allied Health Literature, Medline, Scopus and Cochrane were searched in April 2021. Data were selected using the updated Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. A data-based convergent synthesis design using qualitative content analysis was adopted. Quality appraisal was undertaken using validated tools appropriate to study designs of the included papers. Forty-three papers were included in this review. Skills and attitudes were not commonly assessed, as most studies referred to 'competency' in the context of nurses' knowledge in electrocardiogram interpretation. Nurses' knowledge levels in this important nursing role varied notably, which could be partly due to a range of assessment tools being used. Several factors were found to influence nurses' competency in electrocardiogram interpretation across the included studies from individual, professional and organizational perspectives. The definition of 'competency' was inconsistent, and nurses' competency in electrocardiogram interpretation varied from low to high. Nurses identified a lack of regular training and insufficient exposure in electrocardiogram interpretation. Hence, regular, standard training and education are recommended. Also, more research is needed to develop a standardized and comprehensive electrocardiogram interpretation tool, thereby allowing educators to safely assess nurses' competency. This review addressed questions related to nurses' competency in electrocardiogram interpretation. The findings highlight varying competency levels and assessment methods. Nurses reported a lack of knowledge and confidence in interpreting electrocardiograms. There is an urgent need to explore opportunities to promote and maintain nurses' competency in electrocardiogram interpretation.

Factors that influence parent recruitment into prevention programs in early childhood: A mixed studies systematic review

The objective of this study is to identify the factors that influence the recruitment of parents of at-risk families into prevention programs targeting behavior problems in early childhood. A mixed studies systematic review was performed and the level of evidence for each influencing factor was determined according to the quality of the studies and to the consistency of the results across research. All evidence from the quantitative-, qualitative-, and mixed-design studies were identified (n = 28) using a convergent qualitative synthesis design. The factors that influence parent recruitment were grouped into five broad dimensions, namely, the child, the parent, parent-practitioner interactions, organizational decisions and actions, and policies, which confirms the ecological vision of recruitment. The review highlights the shared responsibility for the recruitment process, some factors being specific not only to the family, but also to the actors involved in the practice. The study demonstrates that certain influencing factors should be further promoted to increase the chances of reaching at-risk families during the early childhood period.

Implementation of Safety Leadership in Nursing Management: A Systematic Mixed Studies Review

Background: Safety leadership positively influence safety compliance amongst employees in health care. It is necessary to understand how far nursing management has played its roles in attaining safety leadership.
 Objective: This study is aimed to explore the safety leadership implemented by nursing management in enhancing the health care system.
 Methods: This study conducted a systematic mixed studies review of current literature focusing on nursing managerial and safety leadership. Five key terms, safety leadership and head nurse or headward, first-line nurse manager, nurse leader, or nurse administrator, were used to retrieve relevant articles. Potential articles were found in seven extensive databases (EBSCO, Sage Publication, Scopus, JSTOR, Wiley online, ProQuest and Emerald). We included English research articles or review papers, available full-text, and published from September 2010 to September 2020. Irrelevant and redundant articles were excluded. Two data extractors analyzed the relevant reports.
 Results: The search yielded 40 articles. But, after duplicates were removed, eleven full-text articles involving 5361 respondents were reviewed. The review papers included qualitative studies (n = 3), cross-sectional survey (n = 6), and (quasi) experiments (n = 2). The most significant proportion (40%) of the study was conducted in the American region. Four themes were generated, including role of safety leadership, development of safety leadership, support, and barriers. The review highlights that the nurse leaders play essential role in the development and implementation of safety leaderships in the hospital wards though they face challenges which need supporting team works, professionals, and standards.
 Conclusion: Adopting safety leadership as a part of nursing management requires support from policymakers, institutions, and nursing leaders. The leaders should understand the complexities of the institutional structures and functional relationships in the health care system to meet patient safety standards

Stroke survivors' perspectives on recovering in rural and remote Australia: A systematic mixed studies review.

Stroke survivors recovering in rural and remote locations often have little or no access to rehabilitation services. The purpose of this study was to review the literature on recovering in rural and remote Australia, from the perspective of stroke survivors. Use of technology to support recovery was also explored. A systematic mixed studies review was conducted and reported according to the ENTREQ and PRISMA statements. MEDLINE (Ovid), CINAHL (EBSCOhost), Scopus, PsycINFO (ProQuest), Cochrane Library and Google Scholar were searched from inception to May 2021 for studies investigating stroke survivors' perspectives on recovering in rural or remote Australia. Qualitative, quantitative or mixed methods studies were included. Methodological quality was assessed using the Mixed Methods Appraisal Tool. Studies were not excluded or weighted according to methodological quality. To review the perspectives of stroke survivors on recovering, findings of included studies were mapped to the Living My Life framework and integrated using a convergent qualitative synthesis. The review protocol was registered on PROSPERO (CRD42017064990). Eight studies met the inclusion criteria: six qualitative, one quantitative and one mixed methods. Methodological quality of the small number of studies ranged from low to high, indicating further high-quality research is needed. Included studies involved 152 stroke survivors in total. Review findings indicated that recovering was driven by working towards what mattered to stroke survivors, in ways that matched their beliefs and preferences and that worked for them in their world, including use of technology. Stroke survivors recovering in rural and remote locations want to live their life by doing what matters to them, despite the challenges they face. They want support in ways that work for them in their environment. Further research is required to tailor support for stroke survivors that is specific to their life in rural and remote locations.

Systematic Reviews of Systematic Quantitative, Qualitative, and Mixed Studies Reviews in Healthcare Research: How to Assess the Methodological Quality of Included Reviews?

Conducting a review of systematic reviews can be challenging, especially when combining systematic quantitative, qualitative and mixed studies reviews. In this methodological discussion paper, we propose (a) a typology for categorizing various types of review of reviews and (b) an exploration of criteria pertaining to three existing critical appraisal tools (ROBIS, AMSTAR 2, and MMSR) to identify those that could be adapted for qualitative and mixed studies reviews. Further work has to be done to develop methodological guidance in conducting, interpreting, and reporting reviews of reviews that combine qualitative and quantitative data.

The role of health literacy in cancer care: A mixed studies systematic review.

BackgroundPatients diagnosed with cancer face many challenges and need a good understanding of their diagnosis and proposed treatments to make informed decisions about their care. Health literacy plays an important role in this and low health literacy has been associated with poorer outcomes. The aims of this review are to identify which outcomes relate to health literacy in patients with cancer, and to combine this through a mixed studies approach with the patient experience as described through qualitative studies.MethodsFour electronic databases were searched in January 2021 to identify records relating to health literacy and patients with cancer. Records were independently screened then assessed for inclusion by two reviewers according to the following criteria: patients aged ≥18 years with cancer, English language publication AND health literacy measured with validated tool and measured outcome associated with health literacy OR qualitative study exploring the role of health literacy as patients make decisions about health. Quality was independently assessed by two reviewers. A narrative synthesis was performed, and findings integrated through concept mapping. This systematic review was registered with PROSPERO, entry CRD42020166454.Results4441 records were retrieved. Following de-duplication, 2496 titles and abstracts were screened and full texts of 405 papers were reviewed for eligibility. 66 papers relating to 60 studies met the eligibility criteria. Lower health literacy was associated with greater difficulties understanding and processing cancer related information, poorer quality of life and poorer experience of care. Personal and situational influences contributed to how participants processed information and reached decisions about their care.ConclusionThis review highlights the important role of health literacy for patients with cancer. Outcomes are poorer for those who experience difficulties with health literacy. Further efforts should be made to facilitate understanding, develop health literacy and support patients to become more involved in their care.

Arts and Humanities Interventions for Flourishing in Healthy Adults: A Mixed Studies Systematic Review

The arts and humanities have enriched human life in various ways throughout history. Yet, an analysis of empirical research into the effects of arts and humanities engagement remains incomplete, calling for a systematic and integrative understanding of the role of arts and humanities in promoting human flourishing. The present study used a mixed studies systematic review approach to integrating recent evidence from 27 intervention studies on the effectiveness of arts and humanities interventions on psychological flourishing of healthy adults. Our final dataset both represented quantitative and qualitative data on real-world interventions that encompassed a range of arts and humanities domains, including music, theater, visual arts, and integrative arts. A separate quantitative and qualitative data synthesis on study characteristics and psychological flourishing outcomes and a meta-integration of both types of evidence were conducted. Overall, arts and humanities interventions were associated with positive changes in a range of psychological flourishing outcomes, with overlapping quantitative and qualitative evidence for emotional, social, and sense of self outcomes. A secondary analysis explored key contextual and implementation features that contributed to effectiveness. Recommendations for future research and practice are provided based on our review.

Barriers and Facilitators Affecting the HIV Care Cascade for Migrant People Living with HIV in Organization for Economic Co-Operation and Development Countries: A Systematic Mixed Studies Review.

Migrants in countries affiliated with the Organization for Economic Co-operation and Development (OECD) have a higher risk of acquiring HIV, experience delayed HIV diagnosis, and have variable levels of engagement with HIV care and treatment when compared to native-born populations. A systematic mixed studies review was conducted to generate a multilevel understanding of the barriers and facilitators affecting HIV Care Cascade steps for migrant people living with HIV (MLWH) in OECD countries. Medline, Embase, Scopus, CINAHL, and the Cochrane Library were searched on March 25, 2020. Screening, critical appraisal, and analysis were conducted independently by two authors. We used qualitative content analysis and the five-level Socio-Ecological Model (i.e., individual, interpersonal, organizational, community, and policy) to categorize barriers and facilitators. Fifty-nine studies from 17 OECD countries were included. MLWH faced similar barriers and facilitators regardless of their host country, ethnic and geographic origins, or legal status. Most barriers and facilitators were associated with the individual and organizational levels and centered around retention in HIV care and treatment. Adapting clinical environments to better address MLWH's competing needs via multidisciplinary models would address retention issues across OECD countries.

A systematic mixed studies review of patient experiences in the ED

BackgroundUnderstanding patient experiences is crucial to evaluating care quality in EDs. However, while previous reviews describe the determinants of ED patient experiences (ie, factors that influence patient experiences), few have...

Mental health and psychological wellbeing in the early stages of doctoral study: a systematic review

ABSTRACT As concerns about poor mental health and psychological wellbeing (wellbeing) in doctoral students grow, the early stage of doctoral study could be a prime opportunity for early intervention and prevention strategies. To inform the development of such strategies, it is important and timely to understand what is known about doctoral student mental health and wellbeing in the early stages. The aim of this systematic mixed studies review was to synthesise published research on mental health and wellbeing in early-stage doctoral students (ESDS). After conducting electronic searches on 10 databases and manual searches, 26 studies matching the eligibility criteria were identified. Thematic synthesis revealed there is limited evidence regarding the prevalence of mental health and wellbeing concerns and the effects of the transition to doctoral study on mental health and wellbeing. More promisingly, the synthesis generated understanding of factors related to mental health and wellbeing in ESDS. Finally, a single mental health and/or wellbeing intervention in ESDS was identified. The review underscores the need for more high-quality research to allow more robust conclusions to be drawn about mental health and wellbeing in ESDS.

Advantages and Challenges in Using Telehealth for Home-Based Palliative Care: Protocol for a Systematic Mixed Studies Review.

BackgroundGiven the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients’ experiences of the advantages and challenges of telehealth for home-based palliative care.ObjectiveThe aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients’ use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients.MethodsThis article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data, and assess methodological quality. The data will then be analyzed using thematic synthesis.ResultsWe describe the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021.ConclusionsFollowing the ethos of patient-centered palliative care, this systematic mixed studies review could lead to recommendations for practice and policy, enabling the development and implementation of telehealth applications and services that align with patients’ preferences and needs at home.International Registered Report Identifier (IRRID)PRR1-10.2196/22626

Illness perceptions of adults with eczematous skin diseases: a systematic mixed studies review

BackgroundEczematous skin diseases, e.g., atopic dermatitis or contact dermatitis, are associated with a high disease burden, a significant impact on quality of life and a higher risk for anxiety and depression. Therefore, coping strategies are of interest. In order to understand coping processes, it is necessary to examine the patients’ perspectives on their illness. The aim of this systematic mixed studies review is to investigate the illness perceptions of patients with eczematous skin diseases to get a better understanding of their coping processes.MethodsWe performed a systematic literature search in PubMed, The Cochrane Library, PsycInfo, PSYNDEX, CINAHL, Web of Science, and Scopus until February 20, 2019. Both qualitative and quantitative studies were included in the review. Two independent reviewers conducted data extraction and carried out a narrative synthesis. We assessed study quality with the Mixed Methods Appraisal Tool.ResultsThree qualitative and four quantitative studies were included in the systematic review. We found different methodological approaches for investigating illness perceptions: guided interviews, focus group interviews as well as standardized questionnaires, e.g., the Brief Illness Perception Questionnaire. All studies report suspected causes of the skin disease, such as endogenous and exogenous causes (namely, psychological or occupational factors). We found long timeline beliefs as well as various perceived and experienced social, economic, and psychological consequences. Our analysis reveals complex emotional representations in patients with eczematous skin diseases, in particular impairment of emotional well-being, and feelings of shame or helplessness. Qualitative and quantitative data were predominantly complementary and convergent.ConclusionPatients with eczematous skin diseases have complex illness representations regarding their disease. These representations interrelate with the coping behavior of patients. Therefore, medical professionals should consider them for counseling and treatment.Systematic review registrationPROSPERO 2018 CRD42018109217.

Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review

BackgroundCountries around the world have committed in policy to transforming their mental health services towards a recovery orientation. How has mental health recovery been implemented into services for adults, and what factors influence the implementation of recovery-oriented services?MethodsThis systematic mixed studies review followed a convergent qualitative synthesis design and used the best-fit framework synthesis method. Librarians ran searches in Ovid- MEDLINE, Ovid-EMBASE, Ovid-PsycInfo, EBSCO-CINAHL Plus with Full Text, ProQuest Dissertations and Theses, Cochrane Library, and Scopus. Two reviewers independently screened studies for inclusion or exclusion using DistillerSR. Qualitative, quantitative, and mixed methods peer-reviewed studies published since 1998 were included if they reported a new effort to transform adult mental health services towards a recovery orientation, and reported findings related to implementation experience, process, or factors. Data was extracted in NVivo12 to the 38 constructs of the Consolidated Framework for Implementation Research (CFIR). The synthesis included a within-case and a cross-case thematic analysis of data coded to each CFIR construct. Cases were types of recovery-oriented innovations.ResultsSeventy studies met our inclusion criteria. These were grouped into seven types of recovery-oriented innovations (cases) for within-case and cross-case synthesis. Themes illustrating common implementation factors across innovations are presented by CFIR domain: Intervention Characteristics (flexibility, relationship building, lived experience); Inner Setting (traditional biomedical vs. recovery-oriented approach, the importance of organizational and policy commitment to recovery-transformation, staff turnover, lack of resources to support personal recovery goals, information gaps about new roles and procedures, interpersonal relationships), Characteristics of Individuals (variability in knowledge about recovery, characteristics of recovery-oriented service providers); Process (the importance of planning, early and continuous engagement with stakeholders). Very little data from included studies was extracted to the outer setting domain, and therefore, we present only some initial observations and note that further research on outer setting implementation factors is needed.ConclusionThe CFIR required some adaptation for use as an implementation framework in this review. The common implementation factors presented are an important starting point for stakeholders to consider when implementing recovery-oriented services.

Centering Race in Mixed and Multi-Method Research on Implicit Bias: A Systematic Review

Understanding how we form and maintain implicit racial biases can help identify how to disrupt them. With this goal in mind, mixed and multi-method research approaches offer researchers the ability to combine various methodological approaches to explore the formation, experiences, and impact of implicit racial bias. This article therefore provides a critical descriptive systematic review of empirical mixed and multi-method studies on implicit bias and race. This review is based on the following research questions: (a) What are the theoretical and methodological features among empirical studies on race and implicit bias that use mixed or multi-method approaches? and (b) what are the opportunities for theoretical and/or methodological expansion in this literature? The criteria for inclusion in the review are the use of a multi-method (e.g., qualitative and quantitative) or mixed method (e.g., integrating qualitative and quantitative) approach in an empirical study, implicit racial bias is the main or one of the main concepts being studied, and the work (published or unpublished) was dated 1995-2019. The studies in this review often had no theoretical framework or one that did not center race. This is noteworthy because race-specific theoretical frameworks can be used to contextualize the study of implicit bias and race in racism, to define race, and to align with the following important features of mixed and multi-method studies: substantiating the use of multiple methods, prioritizing one or more methodological approaches, analyzing and integrating data, and reflecting on the researcher’s own positionality.

Characterising generalism in clinical practice: a systematic mixed studies review protocol.

BackgroundGeneralist physician care is associated with improved patient outcomes. Despite initiatives to promote generalism in educational settings, recruitment to generalist disciplines remains less than required to serve societal needs. Increasingly this impacts not just general practice but also generalist specialties such as internal medicine, surgery, and paediatrics. One potential factor for this deficit is a lack of explicit attention to generalism as a praxis, including clarifying key aspects of generalist expertise.AimTo examine empirical clinical literature on generalism, and characterise how generalism is described and delivered by physicians in primary and secondary care.Design & settingA systematic mixed studies review (SMSR) including quantitative, qualitative, mixed-methods studies, and systematic reviews of physician generalist practice.MethodMEDLINE, Psycinfo, SocINDEX, Embase, Ovid HealthSTAR, Scopus, and Web of Science will be searched for English language studies from 1999 to present, using a structured search. Given study heterogeneity, quality appraisal will not be performed. Two reviewers will perform study selection for each study. Data extraction will focus on how generalism is defined and characterised, including the clinical care provided by generalists and patient experiences of generalist care. Quantitative and qualitative data will be summarised in tabular and narrative form. Convergent synthesis design will then be used to synthesise quantitative and qualitative data.ConclusionFindings will characterise generalism and generalist practice from a grassroots clinical perspective. By identifying similarities and differences across generalist disciplines, this work will inform more focused educational initiatives on generalism at undergraduate and postgraduate level, including collaborations between generalist disciplines.

Crowdsourcing citation-screening in a mixed-studies systematic review: a feasibility study

BackgroundCrowdsourcing engages the help of large numbers of people in tasks, activities or projects, usually via the internet. One application of crowdsourcing is the screening of citations for inclusion in a systematic review. There is evidence that a ‘Crowd’ of non-specialists can reliably identify quantitative studies, such as randomized controlled trials, through the assessment of study titles and abstracts. In this feasibility study, we investigated crowd performance of an online, topic-based citation-screening task, assessing titles and abstracts for inclusion in a single mixed-studies systematic review.MethodsThis study was embedded within a mixed studies systematic review of maternity care, exploring the effects of training healthcare professionals in intrapartum cardiotocography. Citation-screening was undertaken via Cochrane Crowd, an online citizen science platform enabling volunteers to contribute to a range of tasks identifying evidence in health and healthcare. Contributors were recruited from users registered with Cochrane Crowd. Following completion of task-specific online training, the crowd and the review team independently screened 9546 titles and abstracts. The screening task was subsequently repeated with a new crowd following minor changes to the crowd agreement algorithm based on findings from the first screening task. We assessed the crowd decisions against the review team categorizations (the ‘gold standard’), measuring sensitivity, specificity, time and task engagement.ResultsSeventy-eight crowd contributors completed the first screening task. Sensitivity (the crowd’s ability to correctly identify studies included within the review) was 84% (N = 42/50), and specificity (the crowd’s ability to correctly identify excluded studies) was 99% (N = 9373/9493). Task completion was 33 h for the crowd and 410 h for the review team; mean time to classify each record was 6.06 s for each crowd participant and 3.96 s for review team members. Replicating this task with 85 new contributors and an altered agreement algorithm found 94% sensitivity (N = 48/50) and 98% specificity (N = 9348/9493). Contributors reported positive experiences of the task.ConclusionIt might be feasible to recruit and train a crowd to accurately perform topic-based citation-screening for mixed studies systematic reviews, though resource expended on the necessary customised training required should be factored in. In the face of long review production times, crowd screening may enable a more time-efficient conduct of reviews, with minimal reduction of citation-screening accuracy, but further research is needed.