Qualitative Evidence Synthesis Research Articles

Family Involvement in the Care of Hospitalized Older Adults: Protocol for a Qualitative Evidence Synthesis.

Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature. This study aimed to better understand how families are involved in the care of hospitalized older adults and develop a conceptual model describing the phenomenon of family involvement in the care of hospitalized older adults. We describe the protocol of a qualitative evidence synthesis (QES), a systematic review of qualitative studies. We chose to focus on qualitative studies given the complexity and multifaceted nature of family involvement in care, a type of topic best understood through qualitative inquiry. The protocol describes our process of developing a research question and eligibility criteria for inclusion in our QES based on the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool. It describes the development of our search strategy, which was used to search MEDLINE (via Ovid), Embase (via Elsevier), PsycINFO (via Ovid), and CINAHL Complete (via EBSCO). Title and abstract screening and full-text screening will occur sequentially. Purposive sampling may be used depending on the volume of studies identified as eligible for inclusion during our screening process. Descriptive data regarding included individual studies will be extracted and summarized in tables. The results from included studies will be synthesized using qualitative methods and used to develop a conceptual model. The conceptual model will be presented to community members via engagement panels for further refinement. As of September 2023, we have assembled a multidisciplinary team including physicians, nurses, health services researchers, a librarian, a social worker, and a health economist. We have finalized our search strategy and executed the search, yielding 8862 total citations. We are currently screening titles and abstracts and anticipate that full-text screening, data extraction, quality appraisal, and synthesis will be completed by summer of 2024. Conceptual model development will then take place with community engagement panels. We anticipate submitting our manuscript for publication in the fall of 2024. This paper describes the protocol for a QES of family involvement in the care of hospitalized older adults. We will use identified themes to create a conceptual model to inform further intervention development and policy change. PROSPERO 465617; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023465617. PRR1-10.2196/53255.

Barriers and facilitators of adherence to low-dose aspirin during pregnancy: A co-produced systematic review and COM-B framework synthesis of qualitative evidence.

Women at increased risk of developing pre-eclampsia are advised to take a daily low-dose of aspirin from 12 weeks of pregnancy to reduce their risks. Despite the well-established prophylactic effect of aspirin, adherence to this therapy is low. This systematic review aimed to summarise evidence on the barriers and facilitators of adherence to low-dose aspirin to inform intervention development to support decision making and persistence with aspirin use for pre-eclampsia prevention. A systematic review and meta-synthesis of qualitative research was co-produced by representatives from charities, and public, clinical and academic members. Eight electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, Scopus, EMBASE, Prospero, OpenGrey), archives of charities and professional organisations were searched (between October and November 2023 and re-run in August 2023) using predefined search terms. Studies containing qualitative components related to barriers and facilitators of adherence to low-dose aspirin during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. A combination of the COM-B framework with phases of adherence process as defined by international taxonomy was used as the coding framework. Co-production activities were facilitated by use of 'Zoom' and 'Linoit'. From a total of 3377 papers identified through our searches, five published studies and one dissertation met our inclusion criteria. Studies were published from 2019 to 2022 covering research conducted in the USA, Canada, UK, Netherlands and Australia. Barriers and facilitators to adherence were mapped to six categories of the COM-B for three phases of adherence: initiation, implementation, and discontinuation. The discontinuation phase of adherence was only mentioned by one author. Four key themes were identified relating to pregnancy: 'Insufficient knowledge', 'Necessity concerns balance', 'Access to medicine', 'Social influences', and 'Lack of Habit'. The COM-B framework allowed for detailed mapping of key factors shaping different phases of adherence in behavioural change terms and now provides a solid foundation for the development of a behavioural intervention. Although potential intervention elements could be suggested based on the results of this synthesis, additional co-production work is needed to define elements and plan for the delivery of the future intervention. PROSPERO CRD42022359718. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359718.

Nurses' experiences and perceptions of unfinished nursing care: a qualitative systematic review protocol.

The aim of this review is to synthesize the findings of qualitative studies about the experiences and perceptions of nurses regarding unfinished nursing care. The issue of unfinished nursing care is a widespread challenge globally, causing detrimental effects to both patients and health care practitioners. Despite its prevalence, there is a dearth of qualitative evidence synthesis summarizing the reasons for unfinished nursing care, as well as the experiences of nurses. This review will include studies exploring registered nurses' and nurse managers' experiences and perceptions of unfinished nursing care, utilizing qualitative methods. Our approach to qualitative methodology will be unrestricted, allowing for various designs, such as phenomenology, ethnography, grounded theory, action research, and feminist research. Only articles published in English or Chinese from 2001 onward will be included. Our search will encompass the following electronic databases for published and unpublished literature: MEDLINE (PubMed), PsycINFO (APA PsycNET), CINAHL (EBSCOhost), Web of Science, Embase, ScienceDirect, ProQuest Dissertations and Theses, GreyNet International, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Biomedicine Literature Database (CBM). To ensure thoroughness, manual searches of reference lists and citations of included studies will also be conducted. Two reviewers will extract relevant information, and quality validation will be conducted using the JBI critical appraisal checklist for qualitative research. Similar findings will be categorized through meta-aggregation to establish synthesized findings. Finally, each synthesized finding will be graded according to the JBI ConQual approach. PROSPERO CRD42022368041.

P104 Exploring patient activation and self-management experiences in adults with fibromyalgia: A qualitative evidence synthesis

Abstract Background/Aims Fibromyalgia Syndrome (FMS) is a chronic pain condition that impacts daily functioning, including self-care and household responsibilities. Effective self-management strategies are essential for managing FMS; however, success depends on an individual’s readiness and capacity to adopt health-promoting behaviours. This qualitative evidence synthesis explored the experiences of adults in their self-management, focusing on understanding the barriers and facilitators influencing patient activation (PA) and effective self-management in the context of FMS. Methods A qualitative evidence synthesis was undertaken. An electronic search was conducted across several databases, including AMED, PubMed, CINAHL, Science Direct, and PsycINFO. Eligibility criteria were applied to screen studies for relevance. Quality assessment was conducted using established tools, including the Critical Appraisal Skills Programme (CASP) questionnaire for qualitative studies and the Consolidated Criteria for Reporting Qualitative Research Checklist (COREC). Findings from the selected papers underwent a three-stage thematic synthesis process to identify common themes. Results Nine studies, comprising a total of 130 participants, were included in the synthesis. Four analytical themes were identified: legitimising FMS, the value of medical support, receiving peer and social support, and learning to self-manage. These themes highlight the multifaceted nature of self-management in FMS. The first theme of legitimising FMS shows how people living with FMS validate their condition, seeking acknowledgement and understanding from healthcare providers and their social support network. The second theme of the value of medical support was important in FMS management, with empathy, education, and personalised guidance from clinicians playing a crucial role in empowering patients to self-manage effectively. The third theme of receiving peer and social support shows that people with FMS found relief and empowerment through interactions with peers and social networks. This shared experience and communal support served as a catalyst for adopting health-promoting behaviours. Finally, the theme of learning to self-manage shows that active involvement in their health is a key component to living well with FMS. People living with FMS embark on a self-management journey, navigating various strategies and interventions to identify what works for them. Conclusion This qualitative synthesis shows that the self-management of FMS requires active involvement from people living with FMS. It illuminates the pivotal role of healthcare providers, peer support, and social networks in enabling individuals to navigate the challenges of FMS. The findings encourage a holistic approach to FMS care, emphasising the need for healthcare professionals to provide medical expertise, empathy, education, and personalised support. Disclosure K. Yung: None. D. Jadhav: None. C. Ma: None. S. Majgaonkar: None. E. Manai: None. J. Pearson: None.

Partners' Experiences of Chronic Pain: A Qualitative Evidence Synthesis.

This systematic review of qualitative studies synthesised evidence on the experience chronic pain from the perspective of romantic partners. Medline via Ovid, Embase via Ovid, CINAHL via EBSCO, APA PsycInfo via Ovid, Scopus, and Web of Science databases were searched. Studies exploring the impact of chronic pain from partners' perspectives using qualitative data collection methods were eligible for inclusion. Thematic synthesis was conducted, and confidence in the review findings was assessed using GRADE CERQual criteria. A total of 198 participants were represented from 15 primary studies. Four interconnected analytical themes were developed: 'life is different', 'internal conflict between two worlds', 'togetherness vs separateness', and 'coping in the longer term'. Out of 27 review findings, 9 were assessed as high confidence, 12 as moderate confidence, 4 as low confidence, and 2 as very low confidence. Socially isolated partners, those in strained relationships, and partners who continually sacrificed their own needs were more likely to experience distressing emotions. Greater recognition of partners' needs is needed within pain management services.

Pregnant and postpartum women’s experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

BackgroundPregnant and postpartum women’s experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic.MethodsA qualitative evidence synthesis of studies relating to women’s experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings.ResultsSixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment.ConclusionsThe findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

[Introduction to qualitative evidence synthesis - Variants and application].

Qualitative evidence syntheses (QES) are still uncommon in German rehabilitation research, although robust syntheses of qualitative evidence may lead to more strongly scientifically based decisions in health care. This article introduces the topic of qualitative evidence synthesis by describing three different synthesis methods - thematic synthesis, meta-ethnography, and grounded theory synthesis - and illustrating them with examples from rehabilitation research. This is followed by guidance on selecting the appropriate QES-method and reflections on the challenges of QES that are associated with the literature search and quality assessment of the studies to be included in the synthesis. Likewise considerations on quality criteria and their application are taken into account. GRADE-CERQual provides guidance for assessing confidence of findings from QES. Finally the value of QES for rehabilitation research is discussed.

Use of qualitative research in World Health Organisation guidelines: a document analysis

BackgroundGuidelines depend on effect estimates, usually derived from randomised controlled trials, to inform their decisions. Qualitative research evidence may improve decisions made but where in the process and the methods to do this have not been so clearly established. We sought to describe and appraise how qualitative research has been used to inform World Heath Organization guidance since 2020.MethodsWe conducted a document analysis of WHO guidelines from 2020 to 2022. We purposely sampled guidelines on the topics of maternal and newborn health (MANH) and infectious diseases, as most of the qualitative synthesis to date has been conducted on these topics, likely representing the ‘best case’ scenario. We searched the in-built repository feature of the WHO website and used standardised search terms to identify qualitative reporting. Using deductive frameworks, we described how qualitative evidence was used to inform guidelines and appraised the standards of this use.ResultsOf the 29 guidelines, over half used qualitative research to help guide decisions (18/29). A total of 8 of these used qualitative research to inform the guideline scope, all 18 to inform recommendations, and 1 to inform implementation considerations. All guidelines drew on qualitative evidence syntheses (QES), and five further supplemented this with primary qualitative research. Qualitative findings reported in guidelines were typically descriptive, identifying people’s perception of the benefits and harms of interventions or logistical barriers and facilitators to programme success. No guideline provided transparent reporting of how qualitative research was interpreted and weighed used alongside other evidence when informing decisions, and only one guideline reported the inclusion of qualitative methods experts on the panel. Only a few guidelines contextualised their recommendations by indicating which populations and settings qualitative findings could be applied.ConclusionsQualitative research frequently informed WHO guideline decisions particularly in the field of MANH. However, the process often lacked transparency. We identified unmet potential in informing implementation considerations and contextualisation of the recommendations. Use in these areas needs further methods development.

Why do people sell their kidneys? A thematic synthesis of qualitative evidence.

Globally, demands for the kidneys have surpassed supply both living and deceased donors. High demands relative to the availability have made the kidney one of the most saleable human organs. The main objective was to explore the drivers of kidney selling. Literature related to kidney selling and its drivers was explored in three databases including MEDLINE (PubMed), Scopus (Elsevier), and JSTOR covering the period from 1987 to 2022. A total of 15 articles were selected, which underwent thematic analysis. Investigators independently assessed the articles for relevance and study quality to synthesize the data. The thematic analysis involved a critical approach to understanding the reasons for kidney selling by examining power disparities and social inequities. Kidney selling and the underlying reasons for it showed similarities across various geographic regions. Several factors were identified which increased individuals' vulnerability for kidney selling. At the micro level, poverty and illiteracy emerged as significant factors. Lack of financial safety nets obliged family to resort to kidney selling which helped to alleviate poverty, resolve debt, and other urgent financial issues. Nonetheless, the revenues from kidney selling were also used to purchase luxury items (diverting away from investing in livelihood expenses) such as buying motorbikes, mobile phones and televisions. Family, and gender responsibilities also played roles in kidney selling such as obligations related to paying dowry made parents particularly vulnerable. Surprisingly, a few victims of kidney selling later adopted kidney brokering role to support their livelihood. Kidney selling was further fostered by lack of stringent policy to regulate and monitor background checks for kidney transplantation. There were myriad factors that affected individual's vulnerability to kidney selling which stemmed from micro (poverty, illiteracy), meso (weak legal system, lacking stringent institutional policy, regulatory framework) and macro (social inequalities, corruption, organ shortage, insufficient health infrastructure) levels.

Constraints to agricultural finance in underdeveloped and developing countries: a systematic literature review

ABSTRACT Agricultural finance plays a pivotal role in facilitating the modernization and commercialization of farming practices and bolstering global food security. However, the provision of sustainable financial services in remote regions poses a significant challenge within the developing and underdeveloped countries. Consequently, farmers often grapple with inadequate access to formal credit sources and essential productive assets due to diverse constraints. Although, several studies have investigated constraints to agriculture finance; the literature is divergent and a holistic framework of constraints to agriculture finance is missing. Therefore, this research explores the constraints to agriculture finance in 31 developing and underdeveloped countries using systematic review approach, and synthesizes a holistic framework of the constraints using Qualitative Evidence Synthesis (QES) method that can be used as dependable framework for conceptualization and policy formation. Moreover, it describes the interplay and mutual reinforcement between the challenges faced by different stakeholders to elaborate how they influence each other in complex ways. Additionally, this study suggests a collective and multi-faceted approach for overcoming barriers to agricultural financing, and highlights the limitations and unintended consequences of agricultural credit and its implications for agricultural sustainability.

Understanding How Patients With Lumbar Radiculopathy Make Sense of and Cope With Their Symptoms.

Lumbar radiculopathy, characterized by pain radiating along a nerve root, significantly diminishes the quality of life due to its neuropathic nature. Patients' understanding of their illness and the coping strategies they employ directly influence how they manage their condition. Understanding these illness representations from the patient's perspective is crucial for healthcare providers seeking to optimize treatment outcomes. This study adopted a qualitative interpretive/constructive paradigm to explore this dynamic. A qualitative evidence synthesis approach, utilizing best-fit framework synthesis for data extraction, was applied to analyze primary qualitative studies focused on patient experiences with lumbar radiculopathy. Using SPiDER(Sample, Phenomenon of interest, Design, Evaluation, Research type) to guide the search strategy, extracted data was mapped against the Common-Sense Model of Self-Regulation (CSM) framework. Sixteen studies, with moderate to minor methodological quality concerns, were included in the analysis. Data mapping across CSM domains generated 14 key review findings. Results suggest that patients with high-threat illness representations often exhibit maladaptive coping behaviors (e.g., activity avoidance) driven by emotional responses. In contrast, problem-solving techniques appear to contribute to positive outcomes (e.g., exercise adherenceand effective self-management) in patients who perceive their condition as less threatening. These findings highlight the potential benefits of interventions designed to reduce perceived threat levels and enhance self-efficacy in patients with lumbar radiculopathy, leading to improved self-management and ultimately better health outcomes.

Association of serum galectin-3 levels with mortality and cardiovascular disease outcomes in hemodialysis patients: a systematic review and dose-response meta-analysis.

Galectin-3 has been proposed as a candidate marker for cardiovascular risk stratification, although its role in kidney failure is unclear. The aim of this systematic review was to assess the association of serum galectin-3 levels with overall survival and cardiovascular outcomes among hemodialysis patients. Medline, Scopus, Web of Science and CENTRAL were systematically searched from inception till Aug 20, 2023. Observational studies evaluating the association of serum galectin-3 with mortality, cardiovascular disease and arterial stiffness in hemodialysis patients were included. The exposure-response relationship between galectin-3 and mortality was explored by dose-response meta-analysis using restricted cubic splines in a one-stage approach. Overall, 13 studies were included (9 cohort and 4 cross-sectional), comprising 6025 hemodialysis individuals. Increasing galectin-3 values were associated with greater all-cause mortality risk (χ2: 18.71, p-value < 0.001) and an insignificant trend toward higher cardiovascular mortality risk (χ2: 5.06, p-value: 0.079). Compared to a reference galectin-3 value of 10ng/ml, all-cause mortality risk was significantly higher with levels of 20ng/ml (Hazard ratio-HR: 2.62, 95% confidence intervals-CI: 1.66-4.15), 30ng/ml (HR: 3.78, 95% CI: 2.05-6.97) and 40ng/ml (HR: 4.01, 95% CI: 2.14-7.52). Qualitative synthesis of evidence indicated that serum galectin-3 may be linked to abdominal aortic calcification severity and progression, as well as to left ventricular systolic and diastolic dysfunction. This study suggests that high serum galectin-3 levels are associated with greater all-cause mortality risk among patients on maintenance hemodialysis. Preliminary cross-sectional evidence indicates that serum galectin-3 may be associated with arterial stiffness and left ventricular dysfunction.

PROTOCOL: Factors influencing the implementation of non-pharmacological interventions for behaviours and psychological symptoms of dementia in residential aged care homes: Asystematic review and qualitative evidence synthesis.

This is a protocol for a Cochrane Review. The objectives are as follows.This paper aims to describe a protocol for a systematic review that will synthesise the qualitative evidence regarding factors influencing the implementation of non-pharmacological interventions (NPIs) for behavioural and psychological symptoms of dementia (BPSD) management in residential aged care homes (RACHs). The planned systematic review aims to answer the research question: 'What are the factors influencing the implementation of NPIs in the management of BPSD at RACHs?'. Additionally, the planned systematic review also aims to generate recommendations to guide stakeholders (e.g., clinicians and aged care staff) and policymakers in the implementation of NPIs for managing BPSD at RACHs.

Patient’s and healthcare provider’s experiences with Opioid Maintenance Treatment (OMT): a qualitative evidence synthesis

BackgroundOpioid Maintenance Treatment (OMT) is the gold standard for people with opioid dependence. However, drop-out rates are high, and many patients do not reach desired outcomes. Understanding patients’ and healthcare providers’ experiences with the treatment can provide valuable information to improve the quality of OMT and to increase acceptability and accessibility of services. The aim of this systematic review is to explore and synthesise the experiences of OMT among persons with opioid dependence and health care providers, to inform policy makers and practitioners on how to improve OMT outcomes.MethodsWe conducted a qualitative evidence synthesis. We systematically searched in electronic databases (CINAHL, Embase, MEDLINE, and nordic databases) and searched for grey literature. As we identified many studies that met our inclusion criteria, we purposively sampled a manageable number of studies to include in this review. Two researchers independently extracted and coded data from the included studies and used the Andersen’s healthcare utilization model to organize and develop codes. We assessed the methodological limitations of the studies, and our confidence in the findings using GRADE CERQual.ResultsWe retrieved 56 relevant studies and purposively sampled 24 qualitative studies of patients’ and healthcare providers’ experiences with OMT. Our analyses resulted in six main themes: (1) External stigma prevents engagement and retention in treatment, (2) Being identified as in OMT contributed to an increased experience of stigma (3) Inadequate knowledge and expertise among healthcare providers affected patients’ treatment experiences, (4) Quality of communication between personnel and patients impacts patients’ engagement with treatment and treatment outcomes, (5) Patients wanted help with many aspects of their lives not just medication, and (6) Balancing positive expectations of OMT with treatment stigma. We found that stigma was an overarching theme across these themes.ConclusionOur findings suggest that OMT could be more beneficial for patients if treatment programs prioritize efforts to diminish societal and OMT provider stigma and find strategies to better address patient needs. Initiatives should focus on improving treatment knowledge among providers, encouraging the use of client perspectives, considering the context of family members, and establishing a more holistic and flexible treatment environment.

Elimination of restrictive practices from acute adult mental health care services: A qualitative evidence synthesis of the lived experience literature.

The calls to eliminate restrictive practices (e.g., seclusion and physical restraint) from mental health care services have been gaining momentum over time and have been one of the many issues at the forefront of international mental health care systems. Whilst it is known that restrictive practices are often harmful and traumatic for the mental health service user, there is a lack of synthesis of the factors that are influencing restrictive practices’ ultimate reduction and elimination from the perspective of mental health service users and practitioners. The aim of this research was to conduct a qualitative evidence synthesis of the literature regarding the perceptions and experiences of mental health service users and practitioners about restrictive practices in mental health care services. A systematic search and inclusion strategy identified 44 relevant articles for review. Inductive thematic synthesis resulted in five themes across the articles: (1) Meaning and emotional experience, (2) Re-traumatisation and dehumanisation, (3) Professional competencies and varying experiences, (4) Balancing safety versus care, and (5) Alternatives to restrictive practices. Discussion of these themes highlighted the many layered and often uncomfortable nature of restrictive practices which can pervade mental health facilities across the world.

Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis

AimOlder adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED.MethodsSix databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990).FindingsTen studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance.Discussion/ conclusionKey areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life.

Increased Stigma, and Physical and Sexual Violence Against Men Who Have Sex with Men and Transgender Women in Sub-Saharan Africa: A Qualitative Evidence Synthesis Analyzing Social and Structural Barriers to HIV Testing and Coping Behaviors

ABSTRACT In sub-Saharan Africa, accessing HIV testing services is a significant challenge for men who have sex with men (MSM) and transgender women (TGW). In this qualitative evidence synthesis, our aim is to understand social and structural barriers and how they hinder MSM’s and TGW’s access to HIV testing services in sub-Saharan African countries. We searched four selective databases (PubMed, Web of Science and CINAHL complemented with Google Scholar) for qualitative studies, published in English between January 2005 and December 2023, generated 1507 articles, of which 22 were included. Thematic synthesis was conducted for data synthesis. This led to five barriers that hinder HIV test uptake among MSM and TGW, which included: non-availability of tailored HIV testing services, stigma, lack of trust among service providers, sexual and physical violence, and criminalization of same sex relationship. To navigate these social and structural barriers and cope with fears of discrimination and criminalization, MSM and TGW engaged into riskier behaviors, including avoiding HIV testing, non-disclosure, or relying on informal or alternative sources of HIV testing. Decriminalization of same-sex relationship and peer-led HIV testing services were noted to address structural barriers, including stigma and poor access, and subsequently increase the participation in HIV testing services.

Experiences of music therapy in paediatric palliative care from multiple stakeholder perspectives: A systematic review and qualitative evidence synthesis

Background: Children and young people with life-limiting conditions and their families need physical and emotional support to manage the challenges of their lives. There is a lack of synthesised qualitative research about how music therapy is experienced by children, young people and their families supported by paediatric palliative care services. Aim: To systematically identify and synthesise qualitative research on experiences of music therapy in paediatric palliative care from stakeholder perspectives. Design: A Qualitative Evidence Synthesis was conducted using Thematic Synthesis. The review protocol was registered in PROSPERO (registration number: CRD42021251025). Data sources: Searches were conducted with no dates imposed via the electronic databases PsycINFO, MEDLINE, EMBASE, AMED and CINAHL in April 2021 and updated in April 2022. Studies were appraised for quality using the Critical Appraisal Skills Programme tool (CASP). Results: A total of 148 studies were found, 5 studies met the eligibility criteria reporting the experiences of 14 mothers, 24 family members and 4 staff members in paediatric palliative care. There were five overarching themes: emotional and physical reprieve, opportunity for normalised experiences, thriving despite life limited condition, enhance family wellbeing and therapeutic relationship central to outcomes. Conclusion: Music therapy provides unique benefits for this paediatric population particularly in supporting child and family wellbeing. The therapeutic relationship, interpersonal skills of the therapist and experience in paediatric palliative care are perceived as central to these positive outcomes.

Barriers and enablers of quality high-acuity neonatal care in sub-Saharan Africa: protocol for a synthesis of qualitative evidence

IntroductionNeonatal intensive care unit (NICU) in sub-Saharan Africa face limited resources and systemic challenges, resulting in poorer quality care, higher infant mortality, and dissatisfaction among both patients and healthcare workers....

Community health workers for health systems resilience during COVID-19: protocol for qualitative evidence synthesis

IntroductionCOVID-19 exposed the fragility of health systems, where even the most basic health services in high-income and low-income and middle-income nations could not withstand the health systems shock due to...