More than a third of people over the age of 65 years fall each year. Falling can lead to a reduction in quality of life, mortality, and a risk of prolonged hospitalisation. Reducing and preventing ...falls has become an international health priority. To help understand why research evidence has often not been translated into changes in clinical practice, we undertook a systematic review and synthesis of qualitative research in order to identify what factors serve as barriers and facilitators to the successful implementation of fall-prevention programmes.
We conducted a review of literature published between 1980 and January 2012 for qualitative research studies that examined barriers and facilitators to the effective implementation of fall-prevention interventions among community-dwelling older people and healthcare professionals. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality according to predefined criteria. Findings were synthesised using meta-ethnography.
Of the 5010 articles identified through database searching, 19 were included in the review. Analysis of the 19 studies revealed limited information about the mechanisms by which barriers to implementation of fall-prevention interventions had been overcome. Data synthesis produced three overarching concepts: (1) practical considerations, (2) adapting for community, and (3) psychosocial. A line of argument synthesis describes the barriers and facilitators to the successful implementation of fall-prevention programmes. These concepts show that the implementation of fall-prevention programmes is complex and multifactorial. This is the first systematic review and synthesis of qualitative studies to examine factors influencing the implementation of fall-prevention programmes from the perspectives of both the healthcare professional and the community-dwelling older person.
The current literature on barriers and facilitators to the implementation of fall-prevention programmes examines a variety of interventions. However, the ways in which the interventions are reported suggests there are substantial methodological challenges that often inhibit implementation into practice. We recommend that successful implementation requires individuals, professionals, and organisations to modify established behaviours, thoughts, and practice. The issues identified through this synthesis need to be fully considered and addressed if fall-prevention programmes are to be successfully implemented into clinical practice.
Flame retardants are chemical substances that are intended to mitigate fire safety risks posed by a range of goods including furniture, electronics, and building insulation. There are growing ...concerns about their effectiveness in ensuring fire safety and the potential harms they pose to human health and the environment. In response to these concerns, on 13 June 2022, a roundtable of experts was convened by the UKRI Six Clean Air Strategic Priorities Fund programme 7. The meeting produced a Consensus Statement that summarises the issues around the use of flame retardants, laying out a series of policy recommendations that should lead to more effective fire safety measures and reduce the human and environmental health risks posed by these potentially toxic chemicals.
•Marine exposure and human health research in Europe is patchy but expanding.•Foci include marine-derived fats, chemical & microbial pollution, the oil industry.•Climate change and wellbeing research ...remains less well developed.•Knowledge gaps and scope for evidence syntheses highlighted toward informing policy.•Understanding of synergistic exposures needed for effective Blue Growth strategies.
Globally, there is increasing scientific evidence of critical links between the oceans and human health, with research into issues such as pollution, harmful algal blooms and nutritional contributions. However, Oceans and Human Health (OHH) remains an emerging discipline. As such these links are poorly recognized in policy efforts such as the Sustainable Development Goals, with OHH not included in either marine (SDG14) or health (SDG3) goals. This is arguably short-sighted given recent development strategies such as the EU Blue Growth Agenda.
In this systematic map we aim to build on recent efforts to enhance OHH in Europe by setting a baseline of existing evidence, asking: What links have been researched between marine environments and the positive and negative impacts to human health and wellbeing?
We searched eight bibliographic databases and queried 57 organizations identified through stakeholder consultation. Results include primary research and systematic reviews which were screened double blind against pre-defined inclusion criteria as per a published protocol. Studies were limited to Europe, US, Australia, New Zealand and Canada. Data was extracted according to a stakeholder-defined code book. A narrative synthesis explores the current evidence for relationships between marine exposures and human health outcomes, trends in knowledge gaps and change over time in the OHH research landscape. The resulting database is available on the website of the Seas, Oceans and Public Health in Europe website (https://sophie2020.eu/).
A total of 1,542 unique articles were included in the database, including those examined within 56 systematic reviews. Research was dominated by a US focus representing 50.1% of articles. A high number of articles were found to link: marine biotechnology and cardiovascular or immune conditions, consumption of seafood and cardiovascular health, chemical pollution and neurological conditions, microbial pollution and gastrointestinal or respiratory health, and oil industry occupations with mental health. A lack of evidence relates to direct impacts of plastic pollution and work within a number of industries identified as relevant by stakeholders. Research over time is dominated by marine biotechnology, though this is narrow in focus. Pollution, food and disease/injury research follow similar trajectories. Wellbeing and climate change have emerged more recently as key topics but lag behind other categories in volume of evidence.
The evidence base for OHH of relevance to European policy is growing but remains patchy and poorly co-ordinated. Considerable scope for future evidence synthesis exists to better inform policy-makers, though reviews need to better incorporate complex exposures. Priorities for future research include: proactive assessments of chemical pollutants, measurable impacts arising from climate change, effects of emerging marine industries, and regional and global assessments for OHH interactions. Understanding of synergistic effects across multiple exposures and outcomes using systems approaches is recommended to guide policies within the Blue Growth Strategy. Co-ordination of research across Europe and dedicated centres of research would be effective first steps.
Although mental health difficulties can severely complicate the lives of children and young people (CYP) with long-term physical conditions (LTCs), there is a lack of evidence about the effectiveness ...of interventions to treat them.
To evaluate the clinical effectiveness and cost-effectiveness of interventions aiming to improve the mental health of CYP with LTCs (review 1) and explore the factors that may enhance or limit their delivery (review 2).
For review 1, 13 electronic databases were searched, including MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Science Citation Index. For review 2, MEDLINE, PsycINFO and CINAHL were searched. Supplementary searches, author contact and grey literature searches were also conducted.
The first systematic review sought randomised controlled trials (RCTs) and economic evaluations of interventions to improve elevated symptoms of mental ill health in CYP with LTCs. Effect sizes for each outcome were calculated post intervention (Cohen's
). When appropriate, random-effects meta-analyses produced pooled effect sizes (
). Review 2 located primary qualitative studies exploring experiences of CYP with LTCs, their families and/or practitioners, regarding interventions aiming to improve the mental health and well-being of CYP with LTCs. Synthesis followed the principles of metaethnography. An overarching synthesis integrated the findings from review 1 and review 2 using a deductive approach. End-user involvement, including topic experts and CYP with LTCs and their parents, was a feature throughout the project.
Review 1 synthesised 25 RCTs evaluating 11 types of intervention, sampling 12 different LTCs. Tentative evidence from seven studies suggests that cognitive-behavioural therapy interventions could improve the mental health of CYP with certain LTCs. Intervention-LTC dyads were diverse, with few opportunities to meta-analyse. No economic evaluations were located. Review 2 synthesised 57 studies evaluating 21 types of intervention. Most studies were of individuals with cancer, a human immunodeficiency virus (HIV) infection or mixed LTCs. Interventions often aimed to improve broader mental health and well-being, rather than symptoms of mental health disorder. The metaethnography identified five main constructs, described in an explanatory line of argument model of the experience of interventions. Nine overarching synthesis categories emerged from the integrated evidence, raising implications for future research.
Review 1 conclusions were limited by the lack of evidence about intervention effectiveness. No relevant economic evaluations were located. There were no UK studies included in review 1, limiting the applicability of findings. The mental health status of participants in review 2 was usually unknown, limiting comparability with review 1. The different evidence identified by the two systematic reviews challenged the overarching synthesis.
There is a relatively small amount of comparable evidence for the effectiveness of interventions for the mental health of CYP with LTCs. Qualitative evidence provided insight into the experiences that intervention deliverers and recipients valued. Future research should evaluate potentially effective intervention components in high-quality RCTs integrating process evaluations. End-user involvement enriched the project.
This study is registered as PROSPERO CRD42011001716.
The National Institute for Health Research (NIHR) Health Technology Assessment programme and the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Aims
The aim of this study was to provide guidance to improve the completeness and clarity of meta‐ethnography reporting.
Background
Evidence‐based policy and practice require robust evidence ...syntheses which can further understanding of people's experiences and associated social processes. Meta‐ethnography is a rigorous seven‐phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta‐ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta‐ethnography reporting guidance is needed to improve reporting quality.
Design
The eMERGe study used a rigorous mixed‐methods design and evidence‐based methods to develop the novel reporting guidance and explanatory notes.
Methods
The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta‐ethnography conduct and reporting; (2) a review and audit of published meta‐ethnographies to identify good practice principles; (3) international, multidisciplinary consensus‐building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes.
Findings
Recommendations and good practice for all seven phases of meta‐ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance.
Conclusion
The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta‐ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta‐ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta‐ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho‐oncology, Review of Education, and BMC Medical Research Methodology.
There is some evidence to suggest that animal-assisted interventions can have beneficial impact for residents in long-term care, but the focus of the evidence has largely been on behavioural and ...psychosocial measured outcomes. Animals, either as companion animals or in the form of pet/animal-assisted therapy, may provide benefits in the form of social contact, as well as opportunities for sensory experiences and meaningful engagement not picked up by outcome tools. This review aimed to create a state-of-knowledge synthesis, bringing together qualitative and quantitative findings, on the impact of animal-human interaction on care home residents and care home staff.
Fourteen databases were searched from inception to July 2020. Forward and backward citation chasing of included articles was conducted. Screening was undertaken independently by a team of reviewers. Thematic synthesis and meta-analysis were used to synthesise the qualitative and quantitative data.
Thirty-four studies, published in 40 articles (20 qualitative and 20 quantitative) were included. Five themes relating to resident wellbeing were identified in the qualitative evidence synthesis. These were animals as 'living beings', reminiscence and storytelling, caring (as 'doing' and 'feeling'), respite (from loneliness, institutionalisation, and illness), and sensory engagement. A sixth theme related to staff perceptions and wellbeing, and a seventh to animal health and wellbeing. Maintaining identity was identified as an overarching theme. The majority of randomised trials had small sample sizes and were rated as low quality, mostly showing no evidence of beneficial effect. There was, however, limited evidence of a positive effect of pet/animal interaction on outcomes of loneliness, anxiety and depression, supporting the themes of respite and sensory engagement.
The presence of animals can significantly impact the health and wellbeing of some care home residents. Residents had meaningful relationships with animals and derived pleasure and comfort from them. Interacting with animals offered residents a way to maintain a sense of self in the care homes, and with support, residents with dementia could also express their identities. Facilitating residents to interact with animals as part of person-centred care may also help residents to feel 'at home' in the care home.
PROSPERO registration no: CRD42017058201.
We considered the relationship between street trees and mental health with the aim of developing systems thinking-informed hypotheses to improve the implementation and evaluation of this popular ...nature-based solution (NBS). We integrated qualitative and quantitative evidence using causal loop diagraming (CLD), and then further analyzed and extended these diagrams with the aid of systems archetypes to identify key system structures. From these CLDs, we identified three systems thinking-informed hypotheses: 1) although there are many ways in which street trees may improve mental health, tree health is critical in realizing many of these benefits and minimizing dis-benefits; 2) communities which have benefited from street trees in the past are more likely to be able to advocate for additional trees, further entrenching historical inequities in street tree distribution; and 3) efforts to address these inequities through new tree planting initiatives may ultimately fail or even exacerbate existing challenges if they do not include sustained resources for tree maintenance, with direct and indirect impacts on inequities in mental health. Using a systems thinking lens was a useful way to deeply consider a purported but under-theorized co-benefit of a popular nature-based solution and identify policy-relevant hypotheses to guide future research.
Abstract
Background
Global policy initiatives and international conservation organizations have sought to emphasize and strengthen the link between the conservation of natural ecosystems and human ...development. While many indices have been developed to measure various social outcomes to conservation interventions, the quantity and strength of evidence to support the effects, both positive and negative, of conservation on different dimensions of human well-being, remain unclear, dispersed and inconsistent.
Methods
We searched 11 academic citation databases, two search engines and 30 organisational websites for relevant articles using search terms tested with a library of 20 relevant articles. Key informants were contacted with requests for articles and possible sources of evidence. Articles were screened for relevance against predefined inclusion criteria at title, abstract and full text levels according to a published protocol. Included articles were coded using a questionnaire. A critical appraisal of eight systematic reviews was conducted to assess the reliability of methods and confidence in study findings. A visual matrix of the occurrence and extent of existing evidence was also produced.
Results
A total of 1043 articles were included in the systematic map database. Included articles measured effects across eight nature conservation-related intervention and ten human well-being related outcome categories. Linkages between interventions and outcomes with high occurrence of evidence include resource management interventions, such as fisheries and forestry, and economic and material outcomes. Over 25 % of included articles examined linkages between protected areas and aspects of economic well-being. Fewer than 2 % of articles evaluated human health outcomes. Robust study designs were limited with less than 9 % of articles using quantitative approaches to evaluate causal effects of interventions. Over 700 articles occurred in forest biomes with less than 50 articles in deserts or mangroves, combined.
Conclusions
The evidence base is growing on conservation-human well-being linkages, but biases in the extent and robustness of articles on key linkages persist. Priorities for systematic review, include linkages between marine resource management and economic/material well-being outcomes; and protected areas and governance outcomes. Greater and more robust evidence is needed for many established interventions to better understand synergies and trade-offs between interventions, in particular those that are emerging or contested.
Registration
CEE review 14-012
We conducted a systematic review of qualitative evidence to improve understanding of the processes and outcomes of redress and reconciliation following a life-changing event from the perspectives of ...individuals experiencing the event and their families.
We searched six bibliographic databases for primary qualitative evidence exploring the views of individuals who have experienced a life-changing event, and/or their family or carers, of redress or reconciliation processes. This was supplemented with targeted database searches, forward and backward citation chasing and searches of Google Scholar and relevant websites. Title and abstract and full-text screening were undertaken independently by two reviewers. Data extraction and quality appraisal were conducted by one reviewer and checked by a second. We used a best-fit framework synthesis approach, drawing upon procedural and restorative justice concepts.
Fifty-three studies (61 papers) were eligible for inclusion. Forty-one studies (47 papers) were included in the synthesis, from which we identified four themes. Three themes 'Transparency', 'Person-centered' and 'Trustworthy' represent the procedural elements required to support a fair and objective process. The fourth, 'Restorative justice' encapsulates how a fair process feels to those who have experienced a life-changing event. This theme highlights the importance of an empathic relationship between the different parties involved in the redress-reconciliation process and the significance of being able to engage in meaningful action.
Our findings highlight the procedural aspects and context of redress-reconciliation processes required to ensure that the process and outcomes are experienced as fair. These criteria may be applied to the processes used to investigate both recent and historical patient safety events.
One member of the public affiliated with the Exeter Policy Research Programme Evidence Review Facility helped develop the review protocol. Two people with experience of medically life-changing events provided insight which corroborated our findings and identified important limitations of the evidence included in this review.
Abstract
Background
UNESCO biosphere reserves (BRs) have historically aimed to play a crucial role in contributing to sustainable development by bringing about win–win outcomes for both biodiversity ...and socio-economic development. However, recent studies show the need for a more thorough understanding of how conservation activities impact on and are affected by socio-economic development.
Method
We built this systematic review on a systematic map by Eales et al. 14 adding studies from further academic database and grey literature searches specifically designed for this systematic review. Because studies were not sufficiently homogeneous in their outcomes to warrant a valid meta-analysis, we used narrative synthesis to explore the studies’ findings.
Results
We assessed 10,053 titles and abstracts from database searches and Google Scholar. 343 articles were screened at full text and 16 studies were included in our review. Of the 16 studies, 3 were assessed as having overall high validity, 8 having moderate validity and 3 having low validity of evidence. 2 studies did not provide sufficient information for validity categorisation (unclear validity). Effects on economic living standards, reported in 11 studies, were in both desired and undesired directions, though most high validity studies reported no significant difference, and most others did not test for significance. Most studies reported that BR interventions were associated with positive impacts on material living standards. In general, studies reported good relations between local people and local enforcement/government following interventions in BRs. BR interventions may both reduce or cause social conflict, though the higher validity studies showed results in the desired direction. In one study, there was a positive impact on population family planning outcomes, when a reproductive health intervention was implemented with conservation efforts. There was no clear impact in either direction regarding education. Across two studies the overall message is positive for the subjective wellbeing of local people.
Conclusions
With 727 BRs worldwide, the BR model has been accepted and developed as an approach to facilitate the implementation of the UN's SDGs. However, our work shows that interventions implemented in UNESCO BRs can bring about impacts in quite diverse ways: positive, negative, unchanged, and may often present both positive and negative impacts in the same situation. This reconfirms that the expected win–win outcomes of UNESCO BR model in terms of biodiversity and socio-economic development should be more carefully considered. We suggest some main points for consideration, particularly when developing management mechanisms for UNESCO biosphere reserves and/or managing activities in biosphere reserves. We also highlight the need for further research to explore the socio-economic impacts of the UNESCO biosphere reserves in Southeast Asia, especially on the domains of freedom of choice and action, security and safety, and culture and spirituality. Moreover, it is vital to have research projects that measure long-term impacts of biosphere reserves, which have been lacking in previous work. Finally, the potential impact of external factors should be considered in programme and monitoring design.
PDF
