Primary Qualitative Studies Research Articles

Patient experiences of treatment-resistant depression (TRD): A systematic review and qualitative meta-synthesis

Treatment-resistant depression (TRD) occurs when depressive symptoms persist after a patient has tried at least two antidepressants at an appropriate dose for an adequate length of time, as judged by their clinician. Understanding what it is like to live with and seek care for TRD can inform treatment planning and contribute to health technology assessments for depression-related therapies. Our objective was to systematically review this evidence through an investigation of qualitative literature about the experiences of people who have TRD. We searched MEDLINE, CINAHL, PsycINFO, and the Web of Science Core Collection. Publications eligible for inclusion were English-language primary empirical qualitative studies or the qualitative component of mixed methods studies examining adults’ experiences with TRD or with specific treatment options for TRD. Two reviewers independently screened and extracted data, as well as critically appraised included studies using the Standards for Reporting Qualitative Research (SRQR) instrument. This review was guided by integrative meta-synthesis. Data analysis consisted of a staged coding process similar to grounded theory. The protocol was registered in PROSPERO prior to the search (record ID: CRD42022356813). Sixteen studies were included from screening 18,568 results. Two studies focused on the overall experience of TRD and 14 explored experiences of specific treatments such as ketamine. Patients described the depressive symptoms they experienced, a sense of futility and desperation to find an effective treatment, and their experiences with new, sometimes experimental, therapies including deriving benefits beyond the clinical. Overall, few studies have examined the patient experience of TRD, reflecting the clinical complexity of this patient population. As most literature coalesced around experiences of specific treatments, greater examination of the overall experience of TRD is needed to inform clinical practice, and administrative and funding policy decisions for interventions that may be effective for this patient population. PROSPERO registration number: CRD42022356813.

Leadership opportunities to mitigate challenges and barriers of precision health

Abstract Background Precision health, encompassing personalized and proactive health solutions, aims to address this gap by integrating genetic, behavioral, and environmental factors. However, challenges persist in its integration, necessitating new healthcare competencies, particularly in leadership, to expedite the transition. Our goal is to identify barriers and solutions for the implementation of precision health and build a core curriculum of leadership competencies to mitigate challenges and barriers for the implementation of precision health. Methods A systematic literature review of qualitative primary studies on barriers and facilitators to precision health implementation was conducted. Data extracted from included articles were analyzed thematically, adapting leadership competencies outlined in the CanMEDS Physician Competency Framework. This approach identified key leadership traits crucial for precision health implementation. Results 51 articles meeting inclusion criteria yielded 985 barriers and facilitators. Thematic analysis identified 9 primary leadership competencies essential for precision health implementation: application of quality improvement science (30%); fostering a culture of patient safety in data use (10%); advocacy for innovative data management (4%); resource allocation advocacy (9%); evidence-based cost management (4%); driving practice change (8%); prioritization and time management (11%); and optimization of healthcare workforce practices (14%). Discussion The synthesized leadership competencies provide a useful framework for addressing barriers and fostering precision health implementation among healthcare professionals. The high representation of competency related to quality improvement science is emblematic of how cultural elements specific to leadership and management in medicine could represent a strategic asset to foster the implementation of innovative solutions, like precision health, in healthcare. Key messages • Leadership skills are a crucial element in the curriculum of health professionals to support the implementation of precision health in clinical practice. • Incorporating elements of ‘quality improvement science’ in the healthcare professionals education emerged as essential to foster precision health implementation.

"I didn't really fit into any boxes": understanding the experiences of women affected by cancer in pregnancy and up to one-year postpartum-a mixed-method systematic review.

Little is known about women's experiences of cancer during pregnancy and up to one-year postpartum. As the incidence of gestational cancer rises parallel to increasing rates of early onset cancers there is an imperative need to understand their experiences. The aim of this research is to understand women's experiences of gestational cancer during pregnancy and up to one-year postpartum. This systematic integrative review followed the JBI methodology for mixed method systematic reviews (MMSR) which integrates empirical data from qualitative and quantitative primary studies. The search strategy included electronic databases, APA PsycINFO, CINHAL, Medline, Scopus, and the Web of Science Core Collection. The review has been reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive methodological quality assessment was undertaken using the Mixed Methods Appraisal Tool (MMAT). Thirteen studies were included, reporting on the experiences of 266 women. The findings represented the women's insight on the psychological impact of their gestational cancer, the impact on women's identity as a mother and a patient, and women's experiences of complex care. Gestational cancer reflects an emerging focus of clinical practice and an opportunity for much needed new research to explore woman-centered care exploring supportive care needs and models of maternity care. Women's experiences indicate that services are under-resourced to address the holistic and integrated supportive care needs of women affected by cancer across both maternity and cancer care teams.

Facilitators and Barriers in Palliative and End-of-Life Care in Prisons.

With an aging prison population facing various chronic diseases, the importance of palliative and end-of-life care (EOLC) in correctional facilities is heightened. This systematic review aimed to identify facilitators and barriers to palliative and EOLC in prisons. PubMed, Web of Science, Scopus, and Cochrane databases were searched for primary qualitative studies (January 2014 to December 2022) in English. Eligible studies focused on people in prison, health care professionals, administrators, and governors regarding palliative or EOLC provision within prison settings. Five studies were included, from Australia, France, the United Kingdom, and the United States, whose overall quality was moderate to high. Key facilitators included access to family, support from prison staff, specialized care availability, and cultural/spiritual support. Barriers encompassed discomfort, patient-clinician relationship constraints, time limitations, protocol uncertainty, restricted patient agency, negative attitudes, inequality, conflicting priorities, and lack of grief support. Addressing these barriers and leveraging facilitators will be crucial in ensuring equitable access to compassionate EOLC for individuals experiencing incarceration. Policymakers, health care providers, and correctional authorities must prioritize the enhancement of palliative care services within prisons, supported by further research and targeted interventions to address disparities and optimize care provision.

The Experiences and Perceptions of Telehealth in Patients Living With Advanced Chronic Obstructive Pulmonary Disease: A Qualitative Evidence Synthesis.

To systematically identify, appraise and synthesise qualitative research evidence which examined the impact of telehealth on the experiences and perceptions of patients living with advanced chronic obstructive pulmonary disease, to inform the development of patient-centred telehealth. Qualitative evidence synthesis. CINAHL, Cochrane, Embase, PUBMED, MEDLINE, EThOS, Web of Science, PsycINFO, Lenus, DART, RIAN and ProQuest were searched for primary qualitative studies undertaken between 2008 and 2023. A thematic synthesis of studies was undertaken to identify descriptive themes relating to patient views. Methodological quality was assessed using the Critical Appraisal Skills Programme framework, and confidence in review findings was assessed using the GRADE-CERQual approach. Nine studies met the inclusion criteria and were included in the final synthesis. Four analytical themes were generated (1) telehealth as a facilitator of independence, (2) the influence of patient and healthcare provider relationship on successful engagement with telehealth, (3) usability of telehealth to patients living with advanced chronic obstructive pulmonary disease and (4) trusting virtual health services and facilitating confidence in the patient/service user. Five descriptive themes emerged: (i) individualised telehealth chronic obstructive pulmonary disease care (ownership and control), (ii) managing chronic obstructive pulmonary disease exacerbations, (iii) being heard and feeling understood, (iv) telehealth as an education aid and (v) aging and virtual technology. Understanding the experiences of patients with chronic obstructive pulmonary disease and their engagement with telehealth is a necessary determinant of how best to utilise telehealth in this population and may serve to inform policymakers to further develop and implement telehealth into practice. Future research on patients and healthcare professionals' views on telehealth use in the palliative stage of this illness may also be valuable. Findings add value by providing healthcare providers with additional evidence to improve understanding of both telehealth complexity and human experiences and perceptions. It is anticipated that a deeper understanding of chronic obstructive pulmonary disease patients' experiences and perceptions will inform the development of strategies to maximise and enhance the application of patient-centred telehealth within the context of coping and living with a debilitating condition. No patient or public contribution was utilised in this study.

Addressing Nursing Resignation: Insights From Qualitative Studies on Nurses Leaving Healthcare Organisations and the Profession.

The aim of this study is to explore the experiences of nurses who resigned from healthcare organisations or abandoned the profession and explore the reasons behind them. A systematic review of qualitative studies and meta-summary. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase (Ovid), MEDLINE (Ovid), Social Science Citation Index (Web of Science), and Scopus. The search was conducted up to May 2024. Primary qualitative studies focused on nurses who had resigned or left the profession were included. The meta-summary was conducted using method: findings were extracted from the reports, edited, grouped, abstracted into key meta-findings, and finally, their frequency effect sizes were calculated. A total of 282 findings were extracted from 12 studies, generating 49 statements of findings that were aggregated into nine key meta-findings. Poor management practices presented a frequency effect size of 100%. Other key meta-findings included excessive workload, teamwork hurdles, health issues related to work shifts and difficulty in maintaining work-life balance, a lack of career growth opportunities and promotion chances, disillusionment with nursing, dissatisfaction due to salary, bullying and horizontal violence, and moral distress over ethical dilemmas. The findings can help support the development of targeted strategies and the implementation of effective policies aimed at reducing nursing turnover. The major impact of these findings is the recognition of rising factors that negatively affect nurses' quality of life, including workload pressures and poor management strategies, which significantly lower job satisfaction. To address these challenges, the profession should prioritise tools that value nurses in their roles, implement strategies to manage workloads more effectively and advocate for policies promoting flexible scheduling. Additionally, investing in professional development and fostering a supportive work environment can help retain skilled nurses and nurture the growth of new talent. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). No patient or public contribution.

Characteristics of advanced practice nurses’ clinical competence in primary healthcare settings: a scoping review protocol

Objective: This scoping review aims to identify the clinical competency characteristics, in terms of knowledge, skills, and attitudes, of advanced practice nurses in primary care settings. Introduction: Although much has been written about the competencies of advanced practice nurses, more detail about the skills, knowledge, and attitudes that inform their clinical competency in primary health care needs to be ascertained. This will promote the development, implementation, and evaluation of advanced nursing practice in contexts where it is unavailable. Inclusion criteria: Studies that address the clinical competency characteristics of advanced practice nurses in primary health care settings will be considered for inclusion. Methods: This review will be conducted according to JBI methodology for scoping reviews. A comprehensive search will be conducted in PubMed, CINAHL (EBSCOhost), Web of Science, Scopus, Virtual Health Library (VHL), Scientific Electronic Library Online (SciELO), Embase (Elsevier), Science Direct (Elsevier), Cochrane Library, and Google Scholar for primary and secondary qualitative, quantitative, and mixed methods studies on the topic of relevance. Gray literature will be searched in DART-E, TESES CAPES, CAUL (Australian Digital Theses), and Theses Canada Editorials. Letters, editorials, commentaries, conference abstracts, and documents published by advanced practice nurses’ associations will also be considered for inclusion. Two independent reviewers will screen the studies at title and abstract and full text. The same reviewers will extract relevant data using an instrument developed by the reviewers. These data will be presented in a narrative synthesis to facilitate the analysis of the evidence found. Review registration: Open Science Framework https://osf.io/tnrjz/

Influences on ethnic minority women’s experiences and access to contraception in the UK: a systematic qualitative evidence synthesis

BackgroundAccessible contraception is critical for promoting the health and well-being of women and their families. In the UK, contraception is free at the point of access, but only 55% of...

Nursing staff's attitudes towards the prevention of adverse events among hospitalized people with dementia: Protocol of qualitative systematic review and evidence synthesis.

People with dementia are more likely than people without dementia to be hospitalized and to experience in-hospital preventable adverse events, such as falls, skin injury, and infection, compared to other hospitalized groups. Negative attitudes towards people with dementia are common among acute healthcare workers and have been linked to a cascade of negative adverse events in this population. However, no qualitative systematic review has ever been conducted to synthesize the existing evidence in this area, which hampers the development of preventative measures. This is a protocol for a qualitative systematic review aimed at exploring and synthesizing existing qualitative evidence regarding the attitudes of nursing staff towards the prevention of adverse events among hospitalized people with dementia. Literature searches will be performed in PubMed, CINAHL, PsycINFO, Web of Science, Biblioteca Virtual de Salud, Scopus, The Cochrane Library, and Google Scholar. The references of eligible studies will be checked for eligibility. All primary qualitative or mixed-methods studies with a qualitative component published in peer-reviewed academic journals in English, Portuguese, or Spanish will be eligible. There will be no limitations to the date of publication. The selection process will be conducted independently by two researchers using the software Rayyan and then compared and discussed. Any disagreements regarding eligibility will be discussed among the entire research team and resolved via consensus. Methodological quality will be assessed using Cochrane's guidance. A meta-aggregative approach will be employed to extract and synthesize the evidence using the software package QARI from the JBI. The confidence in the findings will be graded using ConQual. This review will help identify and better understand specific attitudinal and psychosocial aspects that influence nursing care delivery for people with dementia in hospital settings. Such data can be used to generate novel explanatory models of nursing behaviors in dementia care, as well as capacity building and training to enhance hospital care for people with dementia globally.

Implementing Preceptorship in Baccalaureate Nursing Program in Middle-Low-Income Countries: A Scoping Review

BACKGROUND: Preceptorship is critical for developing the next generation of nurses to provide high-quality patient care. However, challenges in implementing preceptorship programs in low-middle-income countries (LMICs) exist, affecting the quality of nursing care provided to patients. OBJECTIVES: To (1) explore the extent of literature on key strategies for effective implementation of undergraduate preceptorship nursing education in LMICs and (2) identify existing evidence and gaps in the literature about the implementation of preceptorship in LMICs. METHOD: This scoping review followed Arksey and O’Malley’s (2005) methodological framework. We used the following databases: CINHAL, PubMed, MEDLINE, and ERIC to conduct a systematic search of articles in 2023. The search strategies were focused on the following aspects: “preceptorship,” “baccalaureate nursing program,” “implementation strategies,” and “Low-middle-income countries.” Criteria for including the studies were a) preceptorship in undergraduate/ baccalaureate nursing programs, b) primary quantitative and qualitative studies, and c) implementation of preceptorships in LMICs. RESULT: Twenty-three (n=23) studies met the inclusion criteria. Five themes were identified from the analysis of the data: 1) Setting clear guidelines for preceptorship, 2) Preceptor professional development, 3) Strengthening preceptor roles in the development of future nursing force, 4) Preceptorship experience in clinical placement environment, and 5) Collaborative approach to preceptorship. CONCLUSION: This scoping review highlighted the importance of structured guidelines for preceptorship programs in elevating the quality of nursing education in LMICs. There is a paucity of evidence on preceptor professional development related to integrating evidence-based pedagogy in student supervision.

Patient and public understanding of antimicrobial resistance: a systematic review and meta-ethnography.

To further develop an understanding of laypeople's (adult patients and public) beliefs and attitudes toward antimicrobial resistance (AMR) by developing a conceptual model derived from identifying and synthesizing primary qualitative research. A systematic search of 12 electronic databases, including CINAHL, MEDLINE, PsycINFO, PubMed and Web of Science to identify qualitative primary studies exploring patient and public understanding of AMR published between 2012 and 2022. Included studies were quality appraised and synthesized using Noblit and Hare's meta-ethnographic approach and reported using eMERGe guidance. Thirteen papers reporting 12 qualitative studies were synthesized. Studies reported data from 466 participants aged 18-90 years. Five themes were identified from these original studies: the responsible patient; when words become meaningless; patient-prescriber relationship; past experience drives antibiotic use; and reframing public perception. These themes supported the development of a conceptual model that illustrates the tension between two different assumptions, that is, how can antibiotics be used for the collective good whilst balancing the immediate needs of individual patients. Findings suggest that AMR is a distinct ethical issue and should not be viewed purely as a prescribing problem. The meta-ethnography-generated conceptual model illustrates many factors affecting the public's perception of AMR. These include laypeople's own knowledge, beliefs and attitudes around antibiotic use, the relationship with the healthcare provider and the wider context, including the overwhelming influence of the media and public health campaigns. Future research is needed to explore effective health messaging strategies to increase laypeople's baseline awareness of AMR as a public threat.

Assessing qualitative data richness and thickness: Development of an evidence‐based tool for use in qualitative evidence synthesis

AbstractBackgroundWell‐conducted qualitative evidence syntheses (QESs) can provide invaluable insights into complex phenomena. However, the development of an in‐depth understanding depends on the analysis of rich, thick data from the included primary qualitative studies. Sampling may be needed if there are too many eligible studies. Data richness and thickness are among several criteria that can be taken into consideration when sampling studies for inclusion. However, existing tools do not address explicitly the assessment of both data richness and thickness in the context of QES.MethodsTo address this gap, we have developed, piloted, and conducted initial user testing of a richness and thickness assessment tool. The tool has been in development since 2014. Three pilot versions from three review teams have been used in six Cochrane reviews. Key members from the original three review teams subsequently came together to create a consensus‐based definitive version 1 of the tool. Four review authors piloted the version 1 tool, which has been subject to initial user testing. The version 1 assessment tool consists of two components: assessing the thickness of contextual data and assessing the richness of conceptual data. The accompanying guidance emphasizes the importance of assessing data that addresses the review question.ResultsThe paper provides guidance on how to apply the tool, emphasizing the importance of reaching a consensus among review authors and fostering a shared understanding of what constitutes rich and thick data in the context of the review. The potential challenges related to the time and resource constraints of this additional review process are acknowledged.ConclusionVersion 1 of the tool represents a significant development in QES methodology, filling a critical gap and enhancing the transparency and rigor of the sampling process. The authors invite feedback from the research community to further test, refine and improve this tool based on wider user experiences.

Barriers and enablers to the implementation and sustainability of short-stay arthroplasty programs for elective primary total hip and knee replacement: A systematic review with qualitative evidence synthesis.

We aimed to systematically review contemporary evidence on the barriers and enablers to implementing and sustaining short-stay arthroplasty programs for elective primary total hip and knee replacement from the perspectives of patients, health professionals, carers, healthcare administrators, funders and policymakers and to map the findings to the Theoretical Domains Framework (TDF). Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and the Cochrane Central Register of Controlled Trials were searched (up to 19 August 2023). Primary qualitative or mixed-methods studies reporting on perspectives relating to the review aims that utilised a short-stay programme were eligible for inclusion. Study quality was assessed using the qualitative critical appraisal tool from the Joanna Briggs Institute. Data were analysed inductively. The final themes were mapped to the TDF. The confidence in the findings was assessed using GRADE CERQual. Fifteen studies were included. Twelve barrier themes and twelve enabler themes were identified. Three themes were graded with high confidence, 10 were graded with moderate confidence, three were graded with low confidence, and eight were graded with very low confidence. The most pertinent domains that the themes were mapped to for patients were beliefs about capabilities, reinforcement, and the environmental context and resources. Health professionals identified knowledge, environmental context and resources as important domains. Two domains were identified for carers: (1) social/professional role and identity and (2) memory, attention, and decision processes. We identified key barrier and enabler themes linked to the TDF that can be used to guide implementation initiatives and promote the sustainability of short-stay arthroplasty programs.

An ecosystem of accepting life with chronic pain: A meta-ethnography.

Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.

Knowledge, attitudes and practice on sudden infant death: study protocol of a scoping review

IntroductionSudden infant death syndrome (SIDS) is the unexpected death of an infant less than 1 year old, which occurs without presentation of any signs of mortality risk and it is...

A rapid review of the evidence on models of service delivery for correctional centre-based mothers and children’s units: does our approach need to change?

BackgroundIncarcerated mothers are a marginalised group who experience substantial health and social disadvantage and routinely face disruption of family relationships, including loss of custody of their children. To support the...

Perceptions of Patients and Nurses about Bedside Nursing Handover: A Qualitative Systematic Review and Meta-Synthesis.

Bedside nursing handover is a recognized nursing practice that involves conducting shift change communication at the patient's bedside to enhance communication safety. Understanding the perceptions of both patients and nurses regarding bedside handover is crucial in identifying the key principles for developing and implementing effective bedside handover protocols. However, there is currently a lack of comprehensive evidence that summarizes and evaluates studies focused on qualitative approaches for gaining insights into the perceptions of both nurses and patients. This meta-synthesis review aims to identify, synthesize, and evaluate the quality of primary qualitative studies on the perceptions of patients and nurses about bedside nursing handover. A meta-synthesis review was conducted to identify qualitative studies that reported patients and nurses' perceptions about bedside handover using seven electronic databases, including CINAHL, PsycINFO, Embase, Education Database (ProQuest), Web of Science, The Cochrane Library, and PubMed, from January 2013 to November 2023. The authors independently selected reviews, extracted data, and evaluated the quality of included studies using the 10-item JBI Qualitative Assessment and Review Instrument tool. A total of 871 articles were retrieved, of which 13 met the inclusion and exclusion criteria. These studies identified three main themes: (1) facilitators of bedside nursing handover, (2) barriers to bedside nursing handover, and (3) strategies to maintain confidentiality during bedside handover. This study systematically reviewed and integrated the perceptions of patients and nurses about bedside handover. Based on nurses' perceptions, the combined findings highlight the facilitators of bedside handover, including developing partnership interaction between nurses and patients, promoting professionalism, and enhancing emotional communication among nurses. From the patients' viewpoint, the synthesized findings emphasize the facilitators of bedside handover, including acknowledging the expertise, professionalism, and humanity of the nursing profession, ensuring a sense of safety, satisfaction, and confidence in the care received, as well as promoting individualized nursing care. In the context of barriers to bedside handover, both nurses and patients perceive breaches of confidentiality and privacy violations as significant barriers. When it comes to maintaining confidentiality during bedside handovers, it is important to consider patients' preferences. Patients often prefer handovers to take place in a private setting. From the nurses' perspective, it is important to inquire with patients about their preference for the presence of caregivers, and to conduct private handovers for sensitive issues away from the bedside. Relevance to Clinical Practice. Clinicians should carefully evaluate the barriers and facilitators in this meta-synthesis prior to implementing bedside handover. Study Registration. This study is registered in PROSPERO with Protocol registration ID: CRD42024514615.

Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries.

Objectives: We aimed to evaluate changes to measles-containing vaccine (MCV) provision and subsequent measles disease cases in low- and lower-middle income countries (LICs, LMICs) in relation to the COVID-19 pandemic. Methods: A systematic search was conducted of MEDLINE, OVID EMBASE and PubMed records. Primary quantitative and qualitative research studies published from January 2020 were included if they reported on COVID-19 impact on MCV provision and/or measles outbreak rates within LICs and LMICs. Results: 45 studies were included. The change in MCV1 vaccination coverage in national and international regions ranged -13% to +44.4% from pre-COVID time periods. In local regions, the median MCV1 and overall EPI rate changed by -23.3% and -28.5% respectively. Median MCV2 rate was disproportionally impacted in local areas during COVID-interruption time-periods (-48.2%) with ongoing disruption in early-recovery time-periods (-17.7%). 8.9% of studies reported on vaccination status of confirmed measles cases; from these, 71%-91% had received no MCV dose. Conclusion: MCV vaccination coverage experienced ongoing disruption during the recovery periods after initial COVID-19 disruption. Vaccination in local area datasets notably experienced longer-term disruption compared to nationally reported figures.

Factors that affect the health of immigrants: Qualitative meta synthesis.

Migration has challenged society. Most people who move do so for economic reasons, but others move for more tragic reasons. The proportion of female migrants was slightly higher than that of male migrants, partly due to the longer life expectancy of women and the higher demand for female migrants in care-related Jobs. The process may affect migrants' health, particularly in countries where healthcare is associated with high economic costs or insurance availability. A global systematic review of qualitative studies with meta-synthesis was conducted. The results can be used to support health policy and clinical practice. To describe how migrants perceive and experience the process of migrating and how it affects their health. Databases consulted were Medline, PsychInfo, Cuiden, Cinahl, WOS, Scopus, Social Science Database, and Epistemonikos. Thirty-four articles were selected for final meta-synthesis. All qualitative primary studies were included that describe the experiences or perceptions of migrants and refugees over 18 years that talk about their migration process and the impact on their health; written in English or Spanish between 2016 and 2021. Articles referring to second generations and those dealing with pathologies that pre-date the migration process were excluded. The COREQ and JBI templates were used as quality criteria. Studies mostly used a phenomenological methodology and in-depth interviews, both individual and group, were used for data collection and narrative synthesis. Uncertainty emerges as a main category. Three other interrelated themes have a direct impact on migrants' health: Language, Social Networks and Work. There are several conditions in each of these that have a positive or negative impact on health. The gender condition appears in both work and social networks, positively and negatively. Health would be improved by having a stable job, which would facilitate access to health resources. Social networks and language are facilitators of access to a better job, but not the only condition. From a gender perspective, social networks can become a source of health problems, especially for women. The process of migration places women in a position of vulnerability due to the difficulties of reconciling family and work life. Job insecurity, workload, loss of family life or social isolation increase hopelessness and anxiety, leading to health problems. As an academic review study, no patient contribution was required, and this study serves as a theoretical framework for more in-depth research that will work with migrant populations. As a public contribution, this work provides evidence of the need to improve access to health for some populations, in line with the Sustainable Development Goals (SDGs) set for 2030.

Designing a primary care pharmacist-led review for people treated with opioids for persistent pain: a multi-method qualitative study.

Opioids are frequently prescribed for persistent non-cancer pain despite limited evidence of long-term effectiveness and risk of harm. Evidence-based interventions to address inappropriate opioid prescribing are lacking. To explore perspectives of people living with persistent pain to understand barriers and facilitators in reducing opioids in the context of a pharmacist-led primary care review, and identify review components and features for optimal delivery. A multi-method qualitative study undertaken in the primary care setting in the UK. Adults with experience of persistent pain and taking opioids participated in semi-structured interviews (n = 15, 73% female) and an online discussion forum (n = 31). The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis, involving deductive analysis to TDF domains, inductive analysis within domains to generate sub-themes, and sub-theme comparison to form across-domain overarching themes. The behaviour change technique taxonomy (v1) and motivational behaviour change technique classification system were used to systematically map themes to behaviour change techniques to identify potential review components and delivery features. Thirty-two facilitator and barrier sub-themes for patients reducing opioids were identified across 13 TDF domains. These combined into the following six overarching themes: learning to live with pain; opioid reduction expectations; assuming a medical model; pharmacist-delivered reviews; pharmacist-patient relationship; and patient engagement. Sub-themes mapped to 21 unique behaviour change techniques, yielding 17 components and five delivery features for the proposed PROMPPT review. This study generated theoretically informed evidence for design of a practice pharmacist-led PROMPPT review. Future research will test the feasibility and acceptability of the PROMPPT review and pharmacist training.