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To describe a sequential mixed methods review method that prioritized synthesized qualitative evidence from primary studies to explain the complexities of older persons with multiple chronic conditions’ unplanned readmission experiences.
Background
Segregated mixed methods review studies frequently prioritize quantitative evidence synthesis to examine the effectiveness of interventions; utilizing qualitative evidence to explain quantitative data. There is a lack of guidance about how to prioritize qualitative evidence.
Results
Five procedural steps were developed to prioritize qualitative evidence synthesis. In Step 1, research questions were developed. In Step 2, databases were searched, studies were mapped to their method (qualitative or quantitative) and appraised. In Step 3, meta-synthesis and applied thematic analysis were used to synthesize extracted qualitative evidence about the psychosocial processes and factors that influenced unplanned readmission. In Step 4, quantitative evidence was synthesized using vote counting to determine the factors influencing unplanned readmission. In Step 5, a matrix was used to compare, determine the agreement between the qualitative and quantitative evidence, juxtapose findings, and uphold validity. Factors were mapped to the model of psychosocial processes and analytic themes.
Conclusion
Prioritizing qualitative evidence synthesis in a mixed methods review study prioritizes participants’ experiences, perspectives, and voices to understand complex clinical problems from participants who experienced the event. Synthesizing and integrating evidence facilitates the construction of holistic new understandings about phenomenon and expands mixed methods systematic review methods.
Implications
Prioritizing patients’ perspectives is useful for developing new client-centered interventions, establishing best practices for future reviews, generating theories, and expanding research methods.
Fibromyalgia presents a challenge to both the patients experiencing symptoms and the staff aiming to treat them. This qualitative review aimed to synthesise how patients and practitioners experience primary care consultations, develop a rounded picture of how they perceive each other, the challenges to primary care consultation and how they might be tackled.
Methods:
CINAHL, Embase, CENTRAL and Medline were searched from inception to November 2021. Qualitative studies were included if they explored the perspectives and experiences of either fibromyalgia patients or primary care practitioners. Quantitative data, studies not published in English, not set in primary care or that did not distinguish the type of patient or clinician were excluded. Included studies were analysed using thematic synthesis and their quality assessed.
Results:
In total, 30 studies met the inclusion criteria. Thematic synthesis identified three overarching themes: (1) life turned upside down – exploring the chaos experienced by patients as they seek help; (2) negative cycle – highlighting how patient and practitioner factors can create a detrimental cycle; and (3) breaking the cycle – validating patient–doctor relationships underpinned by clear communication can help break the negative cycle.
Conclusions:
Fibromyalgia patients experience uncertainty and chaos that can clash with the attitudes of GPs and the help they can feasibly provide. Difficult consultations in which neither the GP nor patient are satisfied can easily occur. Promoting supportive, reciprocal and open patient–doctor relationships is essential. Future research is required to further explore GP attitudes and to develop an intervention that could improve consultations, patient outcomes and GP satisfaction.
Humanitarian emergencies can impact people's psychosocial well-being and mental health. Providing mental health and psychosocial support (MHPSS) is an essential component of humanitarian aid responses. However, factors influencing the delivery MHPSS programmes have yet to be synthesised. We undertook a systematic review on the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies in low- and middle-income countries.
Methods.
A comprehensive search of 12 bibliographic databases, 25 websites and citation checking was undertaken. Studies published in English from 1980 onwards were included if they contained evidence on the perspectives of adults or children who had engaged in or programmes providers involved in delivering, MHPSS programmes in humanitarian settings. Thirteen studies were critically appraised and analysed thematically.
Results.
Community engagement was a key mechanism to support the successful implementation and uptake of MHPSS programmes. Establishing good relationships with parents may also be important when there is a need to communicate the value of children and young people's participation in programmes. Sufficient numbers of trained providers were essential in ensuring a range of MHPSS programmes were delivered as planned but could be challenging in resource-limited settings. Programmes need to be socially and culturally meaningful to ensure they remain appealing. Recipients also valued engagement with peers in group-based programmes and trusting and supportive relationships with providers.
Conclusion.
The synthesis identified important factors that could improve MHPSS programme reach and appeal. Taking these factors into consideration could support future MHPSS programmes achieve their intended aims.
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