Qualitative Evidence Synthesis Research Articles

Early childhood and primary school Teachers’ experiences and needs in working with trauma-impacted Children: A systematic review and thematic synthesis

BackgroundTrauma experienced during childhood can have deleterious impact on children’s social, emotional, and physical health. Teachers working in educational settings are uniquely positioned to respond to and support children impacted by trauma. ObjectiveThe aim of this systematic review and thematic synthesis is to explore the experiences and needs of early childhood and primary teachers in terms of their work with trauma-impacted children. MethodThis is a systematic review and qualitative evidence synthesis of primary studies. Systematic searching and screening were conducted following the PRISMA guidelines; an iterative three-stepped thematic synthesis procedure was followed in terms of coding and analysis. ResultsFourteen studies were included in the final synthesis, with three themes emerging across studies: (1) teachers lack training and support to work with trauma-impacted children, (2) dilemma of teachers’ roles, and (3) teachers need multifaceted support. Discussion and conclusionAn under-examination of early childhood teachers’ experiences and needs in working with trauma-impacted children was identified. Teachers are ill-prepared and lack confidence working with children impacted by trauma. They report multiple challenges, face several dilemmas and confusion relating to the boundaries of their role. Working with trauma-impacted children, without adequate preparation and support, can have a negative impact on teacher wellbeing. Multifaceted support, including training, collaboration with professionals with expertise in trauma, and trauma-informed organisational change is needed. Recommendations for future research and practices are discussed.

The Experiences of Foster Carers’ Birth Children of Living in Fostering Families: A Qualitative Evidence Synthesis

The task of foster care impacts all members of the fostering family, not least the birth children of foster carers. This systematic review provides a qualitative evidence synthesis of the experiences of birth children and adolescents of foster carers. Utilizing thematic synthesis, data from 15 identified studies were analyzed, with five analytical themes identified: “Responsibility and Power in the Fostering Task,” “Adaptations of the Family System,” “Buffering against the Challenges of Fostering,” “Shaped by the Realities of Fostering,” and “Collaborating with Others beyond the Family.” Themes are discussed in terms of existing research and implications for future research and practice.

Barriers and facilitators experienced in delivering alcohol screening and brief interventions in community pharmacy: a qualitative evidence synthesis.

Following increases in deaths due to alcohol during the COVID-19 pandemic, there have been renewed calls to increase resources in alcohol screening and brief intervention (SBI). Research has shown that community pharmacy could be a promising setting for SBI. This review aimed to investigate the barriers and facilitators to SBI delivery in community pharmacy to inform its further development. A systematic search of four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) was conducted in October 2021 to identify relevant published qualitative or mixed-method studies. Relevant qualitative data were extracted from the included studies and a framework synthesis was performed using the Capability-Opportunity-Motivation-Behaviour (COM-B) model. Two thousand two hundred and ten articles were screened and nine studies were included in the review (seven in the United Kingdom and two in Australia). Identified barriers and facilitators to delivering SBI corresponded to all components of the COM-B model. Facilitators included non-confrontational communication skills, aligning SBI with existing pharmacy services and pharmacist role legitimacy. Barriers included multiple demands on staff time, a lack of staff experience with screening tools, and staff concerns of causing offence. Using the Behaviour Change Wheel (BCW), we propose five elements of a pharmacy SBI to address identified barriers. Research into SBI in community pharmacy is limited in comparison to other healthcare settings and this review provides an understanding of the barriers and facilitators to the delivery of SBI in community pharmacy from a behavioural perspective. Through the use of COM-B and BCW, our findings could inform the development of future pharmacy-based SBI.

Perspectives of women living with type 1 diabetes regarding preconception and antenatal care: A qualitative evidence synthesis.

Pregnant women with type 1 diabetes may have an increased risk of complications for both the baby and themselves. Educational programmes, preconception planning, strict glycemic control and comprehensive medical care are some of the antenatal interventions that have been proposed to improve the outcomes of pregnant women with type 1 diabetes. While some evidence-based recommendations about antenatal care are included in clinical practice guidelines (CPGs), the views, and experiences of women with type 1 diabetes about these interventions are not well known. To understand and synthesize the perceptions of women with type 1 diabetes about the interventions before pregnancy. A qualitative evidence synthesis (QES) was carried out with a framework analysis guided by the Cochrane Qualitative and Implementation Methods Group approach. Three online databases (Medline, Embase and Web of Science) were searched. We included qualitative articles that were published from 2011 to 2021 and which were available in English or Spanish. Ten references met the inclusion criteria of the study and were included. Three main themes were identified: (a) acceptability of antenatal care, (b) feasibility and implementation consideration and (c) equity and accessibility difficulties. Continuity of care, coordination between health professionals and services, and a more holistic approach are the key aspects women say need to be considered for more acceptable, feasible and equitable preconception and antenatal care. This QES was carried out as part of the CPGs on diabetes mellitus type 1, carried out as part of the Spanish Network of Health Technology Assessment Agencies. In this CPG, the representatives of the patient associations are Francisco Javier Darias Yanes, from the Association for Diabetes of Tenerife, who has participated in all the phases of the CPG; Aureliano Ruiz Salmón and Julián Antonio González Hernández (representatives of the Spanish Diabetes Federation (FEDE) who have participated as collaborator and external reviewer, respectively.

Puncture Site Bleeding Complications of Peripheral Nerve Block in Patients Taking Antithrombotic and Anticoagulant Drugs: An Umbrella Review.

While there are multiple guidelines for the management of bleeding complications and hematoma if being treated with antithrombotic and anticoagulant drugs, these risks are not yet stratified for procedures with regional anesthesia. This study was an umbrella review of systematic studies and meta-analysis based on PRISMA guidelines in databases of Scopus, PubMed, Medline, Cochrane Library, and Web of Science databases. Due to heterogeneity in evaluated outcomes and methods of studies, only the qualitative evidence synthesis was performed. AMSTAR checklist was used to assess the risk of bias in included systematic reviews. After an extensive search of relevant studies, 971 primary cases were identified. Following a thorough screening process, 5 systematic reviews were selected. The evidence suggests that head and neck punctures generally do not result in bleeding complications, except for rare cases of hematoma associated with Infraclavicular brachial plexus block. A deep cervical plexus block is not recommended. Interscalene blocks have varying findings, with some studies reporting hematoma incidence and spinal injury, while others consider them low risk. Supraclavicular brachial plexus block might be associated with hemothorax and infraclavicular blocks are not favored by reviews. Axillary brachial plexus blocks have a minor incidence of hematoma. Abdomen blocks, TAP blocks, ilioinguinal blocks, and rectus sheath blocks carry a higher risk of hematoma. Pectoral nerve (PECS) blocks have a relatively high risk, while paravertebral and intercostal blocks are considered high risk, but further research is needed regarding paravertebral blocks. The available evidence from systematic reviews and studies suggests varying levels of risk for different blocks and procedures that should be considered before decision-making.

Imaging findings and clinical relevance of 68Ga-Pentixafor PET in atherosclerosis: a systematic review

ObjectiveWe aimed to perform a qualitative synthesis of evidence on the role of 68Ga-Pentixafor PET in atherosclerosis.MethodsA systematic search of the PubMed and Embase databases for studies reporting the evaluation of atherosclerotic lesions by 68Ga-Pentixafor PET was performed with a search time frame from database creation to 2022-12-26. The diagnostic test evaluation tool QUADAS-2 was used to evaluate the quality of the included literature and to perform descriptive analyses of relevant outcome indicators.ResultsA total of 6 studies with 280 patients were included. One study reported only imaging outcome metrics, while the other five studies reported imaging outcome metrics and clinical correlation metrics. For imaging outcomes, three studies reported imaging results for 68Ga-Pentixafor PET only, and the other three studies reported imaging results for comparative analysis of 68Ga-Pentixafor PET with 18F-FDG PET. For clinical correlation, three studies reported the correlation between tracer uptake and cardiovascular risk factors, one study reported the correlation between tracer uptake and plaque calcification, and one study reported the correlation between all three: tracer uptake, cardiovascular risk factors, and plaque calcification.Conclusion68Ga-Pentixafor PET has a good imaging effect on atherosclerotic lesions, and it is a promising imaging modality that may replace 18F-FDG PET for atherosclerosis imaging in the future. In patients with atherosclerosis, there is a clear clinical correlation between cardiovascular risk factors, tracer uptake, and plaque calcification.

Stakeholders’ perceptions of factors influencing uptake, delivery, and commissioning of health checks

Abstract Background General health checks are offered through national programs and commercial providers in many healthcare systems. Despite their popularity, it has been argued that health checks have little or no impact on population morbidity and mortality. The aim of the qualitative evidence synthesis was to identify factors that influence the uptake, delivery, and commissioning of general health checks from the perspective of stakeholders. Methods We searched Medline and CINAHL for relevant studies up to 20 January 2022. We dually selected abstracts and fulltexts according to predefined criteria and sampled studies using a maximum variation. We developed a logical model representing individual, intervention, and contextual factors which guided data extraction and synthesis. Results A total of 110 studies met the inclusion criteria, and we selected 37 as sample. Individual factors identified were awareness of the existence of general health checks, personal risk perception, social factors, patient-doctor relationship, financial and time resources, experience during examination and fears regarding outcomes, feedback on health status as impetus for lifestyle changes. Intervention factors included information and invitation systems, discussions about the components and impact of general health checks, modalities of follow-up care, staff qualifications, framework conditions, logistical aspects, and setting. The contextual factors included cultural differences in the perception of disease and prevention, effects of general health checks on morbidity, mortality and social inequality, accessibility, and political climate. Conclusions The results show a variety of perceptions regarding factors that influence the uptake, delivery, and commissioning of general health checks. They shed light on the debate about general health checks as a preventive measure in the health care system and highlight the limitations of the evidence regarding effectiveness. Key messages • Clients, providers and commissioners may define the “effectiveness” of general health checks not merely on the grounds of population-wide morbidity and mortality reduction. • Clients, providers and commissioners might seek in general health checks the fulfillment of individual needs that are context dependent.

"Can't live willingly": A thematic synthesis of qualitative evidence exploring how early marriage and early pregnancy affect experiences of pregnancy in South Asia.

In South Asia, early marriage has been associated with a range of adverse outcomes during pregnancy and infancy. This may partly be explained by early marriage leading to a younger maternal age, however it remains unclear which other factors are involved. This review aimed to synthesise the qualitative evidence on experiences of pregnancy following early marriage or early pregnancy in South Asia, to inform our understanding of the mechanisms between early marriage and adverse pregnancy outcomes. We searched MEDLINE, EMBASE, Scopus, Global Index Medicus, CINAHL, PsycINFO, Web of Science, and grey literature on 29/11/2022 to identify papers on experiences of pregnancy among those who married or became pregnant early in South Asia (PROSPERO registration number: CRD42022304336, funded by an MRC doctoral training grant). Seventy-nine papers from six countries were included after screening. We appraised study quality using an adapted version of the Critical Appraisal Skills Programme tool for qualitative research. Reporting of reflexivity and theoretical underpinnings was poor. We synthesised findings thematically, presenting themes alongside illustrative quotes. We categorised poor pregnancy experiences into: care-seeking challenges, mental health difficulties, and poor nutritional status. We identified eight inter-connected themes: restrictive social hierarchies within households, earning social position, disrupted education, social isolation, increased likelihood of and vulnerability to abuse, shaming of pregnant women, normalisation of risk among younger women, and burdensome workloads. Socioeconomic position and caste/ethnic group also intersected with early marriage to shape experiences during pregnancy. While we found differences between regions, the heterogeneity of the included studies limits our ability to draw conclusions across regions. Pregnancy experiences are largely determined by social hierarchies and the quality of relationships within and outside of the household. These factors limit the potential for individual factors, such as education and empowerment, to improve experiences of pregnancy for girls married early.

Women's views and experiences of pregnancy yoga. A qualitative evidence synthesis

BackgroundPregnancy yoga is a holistic practice to support the physiological and psychological changes women experience in pregnancy, with the potential to be offered by mainstream maternity services. Evidence suggests benefits of pregnancy yoga are reduced anxiety and stress, enhanced mood and sleep, with reported improvements in physical and overall wellbeing. Women report that yoga in pregnancy assists in their birth preparation and self-efficacy in labour, with improved labour and birth experience. To date, a Qualitative Evidence Synthesis (QES) of qualitative studies of women's experiences of pregnancy yoga has not been undertaken and accordingly, the literature lacks a high-level synthesis of women's first-hand accounts. MethodsThis qualitative systematic review aims to synthesise and present new evidence about women's views and experiences of pregnancy yoga. Qualitative studies reporting women's views and experiences of practising pregnancy yoga as a sole intervention, were eligible for inclusion. Systematic searches of eight academic databases, AMED, ASSIA, CINAHL, EMBASE, MEDLINE, MIDIRS, PsycInfo and Web of Science, accompanied by extensive searches of Grey Literature, and evidence libraries, took place in May 2022. The methodological quality of included studies was formally evaluated, independently, by two reviewers using an adapted quality assessment tool. Data extraction followed and thematic synthesis, using the Thomas and Harden 2008 framework, was the validated method for the development of six analytical themes. ResultsSeven studies, providing the experiences of 92 pregnant women, were included in the review. The methodological quality of the studies was mixed, with three of the seven scoring highly and two scoring medium for weight of evidence. The three key synthesised themes were: Equilibrium; Personal Autonomy in Healthcare; and Connection. There were six analytical subthemes: intuitive knowing, embedding the practice of yoga practice, practical toolkit, holistic care, baby bonding and peer social support. ConclusionSynthesis of pregnant women's voices identified what women want - easy access to the holistic benefits of pregnancy yoga; what they recommend - pregnancy yoga provided as mainstream maternity support and what should be provided – pregnancy yoga for all women, not only those who can afford to pay; Paying attention to what women identify as important, brings us closer to a woman-centred maternity service.

Understanding the influence of ethnicity on adherence to antidiabetic medication: Meta-ethnography and systematic review.

A high prevalence of diabetes and diabetes-related complications in people from minority ethnic communities in high income countries is of significant concern. Several studies have indicated low adherence rates to antidiabetic medication in ethnic minority groups. Poor adherence to antidiabetic medication leads to a higher risk of complications and potential mortality. This review aims to qualitatively explore the barriers to and facilitators of adherence to antidiabetic medication among ethnic minority groups in high-income countries. A comprehensive search of MEDLINE, Embase, CINAHL, PsycINFO, and Global Health databases for qualitative studies exploring the barriers to or facilitators of adherence to antidiabetic medication in minority ethnic groups was conducted from database inception to March 2023 (PROSPERO CRD42022320681). A quality assessment of the included studies was conducted using the Critical Appraisal Skills Programme (CASP) tool. Key concepts and themes from relevant studies were synthesised using a meta-ethnographic approach. The Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach was used to assess the Confidence in the review findings. Of 13,994 citations screened, 21 studies that included primary qualitative studies were selected, each of which involved people from minority ethnic communities from eight high income countries. This qualitative evidence synthesis has identified three overarching themes around the barriers to and facilitators of adherence to antidiabetic medication among ethnic minority groups.: 1) cultural underpinnings, 2) communication and building relationships, and 3) managing diabetes during visiting home countries. Based on the GRADE-CERQual assessment, we had mainly moderate- and high-confidence findings. Multiple barriers and facilitators of adherence to antidiabetic medication among people from minority ethnic communities in high-income countries have been identified. A medication adherence intervention focusing on identified barriers to adherence to antidiabetic medication in these communities may help in improving diabetes outcomes in these groups.

A qualitative evidence synthesis (QES) exploring the barriers and facilitators to screening in emergency departments using the theoretical domains framework

BackgroundValidated screening tools can be utilised to detect early disease processes and risk factors for disease and adverse outcomes. Consequently, identifying individuals in need of early intervention and targeted assessment can be achieved through the implementation of screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review will assist in the identification of barriers and facilitators to screening in the ED using a QES to underpin implementation processes. Healthcare workers engage in screening in the ED routinely. Consequently, this review focused on synthesizing the experience of healthcare workers (HCWs) who are involved in this process. This synthesis is informed by a QES protocol published by the lead author in 2021 (Barry et al., HRB Open Res 3:50, 2021).MethodologyA comprehensive literature search, inclusive of grey literature sources, was undertaken. Initially, an a priori framework of themes was formed to facilitate the interpretation and organisation of search results. A context specific conceptual model was then formulated using “Best fit” framework synthesis which further assisted in the interpretation of data that was extracted from relevant studies. Dual blind screening of search results was undertaken using RAYYAN as a platform. Thirty studies were identified that met the inclusion criteria. Dual appraisal of full text articles was undertaken using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively. FindingsThis is the first known synthesis of qualitative research on HCW’s experiences of screening in the ED. Predominantly, the findings illustrate that staff experience screening in the ED as a complex challenging process. The barriers and facilitators identified can be broadly categorised under preconditions to screen, motivations to screen and knowledge and skills to screen. Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were clear facilitators.Trial registrationPROSPERO: CRD42020188712 05/07/20.

The experience of healthcare professionals implementing recovery-oriented practice in mental health inpatient units: A qualitative evidence synthesis.

WHAT IS KNOWN ON THE SUBJECT?: The principles of personal recovery are primarily applied in outpatient and community settings as these settings provide continuity of care and recovery-based community programs supporting consumers' recovery journey. A range of healthcare professionals are involved in the care of people within mental health in-patient units, including nurses, psychiatrists, psychologists, occupational therapists and social workers. The integration of recovery-oriented care in mental health inpatient units may be impaired by a lack of confidence among mental health professionals. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Developing hope and a safe place is an integral part of recovery-oriented practice within mental health inpatient units. Instilling connectedness is a relevant recovery principle; however, there may be greater barriers in mental health settings which traditionally prioritise safety and risk mitigation practices to prevent perceived harmful behaviours. Staff workload and inadequate understanding of recovery concepts present challenges to promoting recovery-oriented care in everyday practice. Using strength-based practice is critical in promoting a safe space for consumers by providing psychosocial interventions and person-centred care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The provision of recovery-oriented practice requires adopting a collaborative approach that places a strong emphasis on the involvement of consumers and their families. Empowering mental health professionals to believe that recovery-oriented practice is possible in mental health inpatient units is crucial. Mental health professionals need to create a safe environment and positive relationships through respect and empathy for consumers and their family members. ABSTRACT: Introduction Recovery-oriented practice underpins an individual's personal recovery. Mental health nurses are required to adopt a recovery-oriented approach. Globally, a paucity of literature exists on mental health professionals' experience of recovery-oriented practice in mental health inpatient units. Aim The aim of this synthesis was to explore the experiences of healthcare professionals regarding recovery-oriented care in mental health inpatient units by appraising and synthesising existing qualitative research. Method Three databases, including MEDLINE, PsycINFO and CINAHL were searched between 2000 and 2021. Data were extracted and synthesised using thematic integrative analysis. The quality of included studies was assessed with the CASP Critical Appraisal Checklist. Results Ten qualitative research projects met the inclusion criteria. Four themes were identified (i) developing a safe and hopeful space, (ii) promoting a healing space, (iii) instilling connectedness and (iv) challenges to realising recovery-oriented care. Discussion Mental healthcare professionals perceived the principles of recovery-oriented care to be positive and include: therapeutic space, holistic care and person-centred care. Nevertheless, findings revealed limited knowledge and uncertainty of the recovery concept to be key barriers that may hinder implementation into practice. Implications for Practice Recovery-oriented practice must underpin consumer and family engagement, treatment choices and continuity of care to facilitate consumer's personal recovery.

A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments.

A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments.

Student nurses' experiences of remote learning during Covid-19 pandemic: A qualitative evidence synthesis.

To systematically synthesize undergraduate student nurses' experience of online, blended or distance learning during Covid-19 pandemic. A qualitative evidence synthesis (QES). A QES. Themes were organized using the 'best fit' framework approach. Methodological limitations and confidence in the review findings were informed by GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). Qualitative literature from five databases including CINAHL, PubMed, Medline, Education Full Text (H.W. Wilson) and ERIC were searched from March 2020 to November 2021. Nine qualitative and two mixed method studies were included in this 'best fit' framework using Chickering and Gamson's Seven Principles for Good Practice in Undergraduate Education. Importance of the social presence of the teacher through effective communication and interpersonal relationships is highlighted. Clinical placement and in-person practical skills training are needed for effective nursing education. This review highlighted that online content can be developed into efficient and high-quality learner-centred education within blended undergraduate nursing programmes incorporating essential face-to-face and practical components. Various supporting measures are required for both students and faculty. We suggest an adaptation of a 'Blending with Purpose: The Multimodal Model' with key considerations for undergraduate nursing programmes where pedagogical objectives and activities drive the approaches to achieve intended learning outcomes and student satisfaction. Well-designed online programmes using digital tools that support interaction and teamwork are required for undergraduate nursing education. Blended learning approaches offer more flexibility than online learning alone which leads to improved student engagement. Clinical placement and in-person practical skills training are needed for effective nursing education. REPORTING METHOD: 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) for QES. No Patient or Public Contribution.

Changing mobility practices. Can meta-ethnography inform transferable and policy-relevant theory?

Social practice theories have attracted attention for their potential insights into how to change transport systems towards “healthier” states. However, most evidence is from small-scale qualitative case studies. We explored whether a synthesis of qualitative evidence on mobility practices in one country, informed by meta-ethnography and a Bourdieusian approach to practice, could produce theory that is of sufficient abstraction to be transferable, yet also capable of informing intervention planning. The synthesis identified three third order constructs: mobility practices result from habitus plus capital in fields; specific configurations of local mobility practices are shaped, but not determined, by material infrastructures and social structures; and changes in practice happen across a number of scales and temporalities. This body of evidence as a whole was then interpreted as an integrative “storyline”: Mobility systems are complex, in that outcomes from interventions are neither unilinear nor necessarily predictable from aggregations of individual practice changes. Infrastructure changes may be a necessary, but not sufficient, condition for change. Moving systems towards “healthier” states requires changing habitus such that “healthier” practices align with fields, and that interventions take sufficient account of the power relations that materially and symbolically constrain or enable attachments to and changes in mobility practices. Meta-ethnography is a useful approach for integrating qualitative evidence for informing policy.

Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis

BackgroundCaesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use.MethodsWe re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success.ResultsWe found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components.ConclusionWe identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.

Stakeholders'perspectives and experiences of patient and public involvement (PPI) in clinical trials in maternal and neonatal healthcare: protocol for a qualitative evidence synthesis.

Patient and public involvement (PPI) has the potential to improve the relevance of trial outcomes and improve participant recruitment within clinical trials. However, the literature on PPI approaches, outcomes, and attitudes towards PPI in specific clinical research areas is limited. We are interested to know the current approaches to and views of PPI within maternal and neonatal clinical trials, from the perspective and experience of involved stakeholders. A qualitative evidence synthesis (QES) of stakeholders' perspectives and experiences of PPI will be conducted. Stakeholders will include any individual involved in maternal or neonatal clinical trials with experience of PPI in the area or who expresses their views on PPI. The electronic bibliographic databases CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science and the Maternity and Infant Care (OVID) will be searched from inception. Qualitative studies, mixed-methods studies where the qualitative data can be extracted independently, and surveys with open-ended qualitative questions, will be included. The QES seeks to explore stakeholders', including PPI contributors, trial participants and guardians, and trial researchers, perspectives and experiences of PPI in maternal and neonatal clinical trials. THE QES will provide an understanding of how PPI is understood, operationalised and experienced by stakeholders in maternal and neonatal clinical trials, with the aim of identifying good practice and areas for improvement. PROSPERO registration: CRD42023383878 (2 nd March 2023).

205 Exploring stakeholder experiences of Comprehensive Geriatric Assessment in community and out-patient settings: a qualitative evidence synthesis

Abstract Background Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary process that addresses an older adult’s bio-psycho-social capabilities to create an integrated and co-ordinated plan of care. While there is established quantitative evidence that demonstrates the positive impacts of CGA on clinical and process outcomes, less is known about how older adults and service providers experience CGA. This study aimed to systematically review and synthesise qualitative studies reporting the experiences of CGA of community-dwelling older adults, caregivers and healthcare professionals in the community and Out-Patient Department (OPD) setting. Methods This qualitative evidence synthesis involved a systematic search across 5 databases targeting qualitative or mixed methods studies that reported qualitative findings on stakeholder experiences of CGA. The protocol was registered with the PROSPERO database (Registration: CRD42021283167). The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Results were synthesised according to Noblit and Hare’s seven-step approach to meta-ethnography. Results Fourteen studies were included where CGA was completed in the home, general practice, out-patient setting in acute hospitals and in hybrid models across the community and acute OPD settings. Synthesis identified four key themes: (1) CGA is experienced as a holistic process (2) The home environment enhances CGA (3) Time, the prevailing healthcare model and interprofessional communication influenced the success of CGA in the community (4) Conflicting perspectives on the meaningful involvement of older adults, carers and family in the CGA process. Conclusion The findings demonstrate that CGA in a home-based setting allows for a more holistic approach to care while increasing patient satisfaction and accessibility to healthcare. Although potential barriers to the delivery of CGA include current fragmented health service structures and a lack of understanding of CGA, factors such as enhanced communication, carer and older adult involvement in the CGA process are potential facilitators to its implementation.

336 Exploring the barriers and facilitators to screening in Emergency Departments (ED): a qualitative evidence synthesis using the theoretical domains framework

Abstract Background Validated screening tools, such as the Identification of Seniors At-Risk tool, can be utilised to detect early disease processes, risk factors and the risk of adverse outcomes. Identifying individuals in need of early intervention and targeted assessment can be achieved by implementing screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review identified barriers and facilitators to screening in the ED to underpin implementation processes. Furthermore, this review focused on synthesising the experience of healthcare workers who are routinely involved in this process. Methods A rigorous search strategy was employed and reported using PRISMA. Subsequently, an a-priori framework of themes was formulated to facilitate the interpretation of search results. A conceptual model was then formed using ‘Best fit’ framework synthesis, this assisted in the organisation of data from relevant studies during data extraction. Dual blind screening of results was undertaken using RAYYAN as a platform. Thirty studies met the inclusion criteria. Dual appraisal of full text articles was completed using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively. Results This is the first known synthesis of qualitative research, focused on screening in the ED. Predominantly, the findings illustrate that screening in the ED is perceived as a complex and challenging process. The barriers and facilitators identified can be broadly categorised as identifying preconditions to screen, recognising motivations to screen and acknowledging the required knowledge and skills to screen. Conclusion Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were facilitators.

49 Older adults’ experience of transition to the community from the Emergency Department: a qualitative evidence synthesis

Abstract Background Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes on discharge. 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 systematically reviewed and synthesised qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods A systematic literature search of six databases was completed in March 2022 and updated in March 2023. Nine studies were included following full text review representing the experiences of over 490 older adults from five countries. Findings from included studies were synthesised as a meta-ethnography. Results Older adults often reported un-resolved symptoms on discharge (theme 1) which negatively affected transition home and return to daily life. Unresolved symptoms were also a major driver of ED re-attendance shortly after discharge (theme 2). Although older adults wanted a planned discharge home with organised transport (theme 4) however, this was not often achieved. Fragmented care at the point of transition home (theme 3) was a reoccurrence experience for older adults alongside inadequate healthcare provider communication/instructions on ED discharge (theme 5). Conclusion Study findings identified key areas for consideration in service development and intervention development for older adult’s care when transitioning from the ED to the community. ED healthcare providers should consider adapting their communication to meet the needs of older adults. Healthcare providers need to explicitly address expectations about symptom resolution during discharge planning as a collaborative process with older adults. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication from providers and desire to return to daily life.