scholarly journals Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039809
Author(s):  
Sharon Dixon ◽  
Claire Duddy ◽  
Gabrielle Harrison ◽  
Chrysanthi Papoutsi ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Grey Literature ◽  
Relevant Literature ◽  
Theory Development ◽  
Realist Review ◽  
Primary Outcome Measure ◽  
Mandatory Reporting ◽  
Programme Theory ◽  
Genital Mutilation ◽  
The Impact

ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

scholarly journals Understanding the role of the paramedic in primary care: a realist review

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Georgette Eaton ◽  
Geoff Wong ◽  
Stephanie Tierney ◽  
Nia Roberts ◽  
Veronika Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Supervision ◽  
Formal Education ◽  
Grey Literature ◽  
Realist Review ◽  
Evidence Base ◽  
Programme Theory ◽  
Primary Care Workforce ◽  
The Impact ◽  
Insight Into

Abstract Background Since 2002, paramedics have been working in primary care within the United Kingdom (UK), a transition also mirrored within Australia, Canada and the USA. Recent recommendations to improve UK NHS workforce capacities have led to a major push to increase the numbers of paramedics recruited into primary care. However, gaps exist in the evidence base regarding how and why these changes would work, for whom, in what context and to what extent. To understand the ways in which paramedics impact (or not) the primary care workforce, we conducted a realist review. Methods A realist approach aims to provide causal explanations through the generation and articulation of contexts, mechanisms and outcomes. Our search of electronic databases was supplemented with Google and citation checking to locate grey literature including news items and workforce reports. Included documents were from the UK, Australia, Canada and the Americas—countries within which the paramedic role within primary care is well established. Results Our searches resulted in 205 included documents, from which data were extracted to produce context-mechanism-outcome configurations (CMOCs) within a final programme theory. Our results outline that paramedics are more likely to be effective in contributing to primary care workforces when they are supported to expand their existing role through formal education and clinical supervision. We also found that unless paramedics were fully integrated into primary care services, they did not experience the socialisation needed to build trusting relationships with patients or physicians. Indeed, for patients to accept paramedics in primary care, their role and its implications for their care should be outlined by a trusted source. Conclusions Our realist review highlights the complexity surrounding the introduction of paramedics into primary care roles. As well as offering an insight into understanding the paramedic professional identity, we also discuss the range of expectations this professional group will face in the transition to primary care. These expectations come from patients, general practitioners (family physicians) and paramedics themselves. This review is the first to offer insight into understanding the impact paramedics may have on the international primary care workforce and shaping how they might be optimally deployed.

scholarly journals Caregiver-mediated interventions to support self-regulation among infants and young children (0–5 years): a protocol for a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e046078
Author(s):  
Amy Finlay-Jones ◽  
Jetro Emanel Ang ◽  
Elaine Bennett ◽  
Jenny Downs ◽  
Sally Kendall ◽  
...  
Keyword(s):  
School Readiness ◽  
Working Group ◽  
Protective Factor ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Self Regulation ◽  
Realist Review ◽  
Programme Theory ◽  
Review Team ◽  
The Impact

IntroductionSelf-regulation is a modifiable protective factor for lifespan mental and physical health outcomes. Early caregiver-mediated interventions to promote infant and child regulatory outcomes prevent long-term developmental, emotional and behavioural difficulties and improve outcomes such as school readiness, educational achievement and economic success. To harness the population health promise of these programmes, there is a need for more nuanced understanding of the impact of these interventions. The aim of this realist review is to understand how, why, under which circumstances and for whom, early caregiver-mediated interventions improve infant and child self-regulation. The research questions guiding this review were based on consultation with families and community organisations that provide early childhood and family services.Methods and analysisRealist reviews take a theory-driven and iterative approach to evidence synthesis, structured around continuous refinement of a programme theory. Programme theories specify context-mechanism-outcome configurations to explain what works, for whom, under which circumstances and how. Our initial programme theory is based on prior work in this field and will be refined through the review process. A working group, comprising service users, community organisation representatives, representatives from specific populations, clinicians and review team members will guide the evidence synthesis and interpretation, as well as the development and dissemination of recommendations based on the findings of the review. The review will involve searching: (i) electronic databases, (ii) connected papers, articles and citations and (iii) grey literature. Decisions to include evidence will be guided by judgements about their contribution to the programme theory and will be made by the research team, with input from the working group. Evidence synthesis will be reported using the Realist and MEta-narrative Evidence Synthesis: Evolving Standards guidelines.Ethics and disseminationEthical approval is not required as this is a review. Findings will be disseminated to our working group and through peer-reviewed publications and conference presentations.Review registration numberThe protocol is registered with Open Science Framework https://osf.io/5ce2z/registrations.

scholarly journals Protocol for the impact of paramedics in NHS primary care: application of realist approaches to improve understanding and support intelligent policy and future workforce planning

2019 ◽  
Vol 4 (3) ◽  
pp. 35-42 ◽  
Author(s):  
Georgette Eaton ◽  
Veronika Williams ◽  
Geoff Wong ◽  
Nia Roberts ◽  
Kamal R. Mahtani
Keyword(s):  
Primary Care ◽  
Life Support ◽  
Evidence Synthesis ◽  
Workforce Planning ◽  
Advanced Life Support ◽  
Realist Review ◽  
Professional Associations ◽  
Realist Evaluation ◽  
Programme Theory ◽  
The Impact

Introduction: In the United Kingdom, changing demands on ambulance services has caused a change in what is expected of a paramedic. As well as advanced life support, paramedics now need to be skilled in managing a range of urgent case presentations, with emphasis on treat-at-scene. The change in the scope of work paramedics can undertake has established their role within primary care. However, as paramedics transition to roles within primary care, their knowledge and skillset will undoubtedly need to change. The current opportunities for paramedics’ employment in primary care require careful evaluation. In order to contribute to patients’ and the NHS’ primary care agenda, evidence must be generated to show how and why these changes would work, for whom, in what context and to what extent.Methods and analysis: The purpose of this research is to produce findings that will improve our understanding of the ways in which (i.e. how, why and in what contexts) paramedics impact on the primary care workforce. A theory-driven approach to evidence-synthesis will be conducted in a realist review, to produce a programme theory. This programme theory will be tested using empirical data collected through a realist evaluation. Survey and interview data will be collected from paramedics working in primary care, general practitioners and patients to assess under which contexts, and by which mechanisms, paramedics are working in primary care, and thus test the programme theory. Based on the findings, we will be able to highlight the role of paramedics in primary care, as well as how they operate and under what conditions.Ethics and dissemination: Formal ethics review is not required for the review, as it is secondary research, but will be sought for the evaluation. Findings will be disseminated in a peer-reviewed journal, at national and international conferences and to relevant professional associations.

scholarly journals Upskilling health and care workers with augmented and virtual reality: protocol for a realist review to develop an evidence-informed programme theory

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e050033
Author(s):  
Norina Gasteiger ◽  
Sabine N van der Veer ◽  
Paul Wilson ◽  
Dawn Dowding
Keyword(s):  
Virtual Reality ◽  
Grey Literature ◽  
Healthcare Providers ◽  
Realist Review ◽  
Relevant Information ◽  
Care Providers ◽  
Programme Theory ◽  
Clinical Educators ◽  
Continued Learning ◽  
Search Quality

IntroductionAugmented reality (AR) and virtual reality (VR) are increasingly used to upskill health and care providers, including in surgical, nursing and acute care settings. Many studies have used AR/VR to deliver training, providing mixed evidence on their effectiveness and limited evidence regarding contextual factors that influence effectiveness and implementation. This review will develop, test and refine an evidence-informed programme theory on what facilitates or constrains the implementation of AR or VR programmes in health and care settings and understand how, for whom and to what extent they ‘work’.Methods and analysisThis realist review adheres to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards and will be conducted in three steps: theory elicitation, theory testing and theory refinement. First, a search will identify practitioner, academic and learning and technology adoption theories from databases (MEDLINE, Scopus, CINAHL, Embase, Education Resources Information Center, PsycINFO and Web of Science), practitioner journals, snowballing and grey literature. Information regarding contexts, mechanisms and outcomes will be extracted. A narrative synthesis will determine overlapping configurations and form an initial theory. Second, the theory will be tested using empirical evidence located from the above databases and identified from the first search. Quality will be assessed using the Mixed Methods Appraisal Tool (MMAT), and relevant information will be extracted into a coding sheet. Third, the extracted information will be compared with the initial programme theory, with differences helping to make refinements. Findings will be presented as a narrative summary, and the MMAT will determine our confidence in each configuration.Ethics and disseminationEthics approval is not required. This review will develop an evidence-informed programme theory. The results will inform and support AR/VR interventions from clinical educators, healthcare providers and software developers. Upskilling through AR/VR learning interventions may improve quality of care and promote evidence-based practice and continued learning. Findings will be disseminated through conference presentations and peer-reviewed journal articles.

scholarly journals Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e043091
Author(s):  
Rikke Siersbaek ◽  
John Alexander Ford ◽  
Sara Burke ◽  
Clíona Ní Cheallaigh ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Healthcare Access ◽  
Grey Literature ◽  
Realist Review ◽  
Access To Healthcare ◽  
Staff Retention ◽  
Programme Theory ◽  
Eligibility Criteria ◽  
Ovid Medline ◽  
High Level

ObjectiveThe objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.DesignA realist review.Data sourcesOvid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019.Eligibility criteria for selecting studiesThe purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer-reviewed articles were identified through a systematic search, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.AnalysisInductive and deductive coding was used to generate context–mechanism–outcome configurations, which were refined and then used to build several iterations of the overarching programme theory.ResultsSystematic searching identified 330 review articles, of which 24 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation. Additional purposive searching of grey literature yielded 50 records, of which 12 were included, for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma, generating trusting relationships between patients and staff/practitioners. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention.ConclusionsWith homelessness on the rise internationally, healthcare systems should focus on high-level factors such as funding stability, building inclusive cultures and setting goals which encourage and support staff to provide flexible, timely and connected services to improve access.

scholarly journals O4B.3 The impact of income support systems on healthcare quality and functional capacity in workers with LBP: a realist review

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A34.3-A35
Author(s):  
Michael Di Donato ◽  
Ross Iles ◽  
Tyler Lane ◽  
Alex Collie
Keyword(s):  
Functional Capacity ◽  
Work Disability ◽  
Support Systems ◽  
Grey Literature ◽  
Healthcare Quality ◽  
Realist Review ◽  
Current Evidence ◽  
Income Support ◽  
Context Dependent ◽  
The Impact

BackgroundLow back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers’ compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little evidence as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality and functional capacity of people with work disability and LBP.MethodsWe performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether or not they do. Five initial theories about the mechanisms of the relationship were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented by grey literature searching for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare, and LBP.ResultsIncome support systems influence healthcare quality through healthcare funding restrictions, healthcare provider administrative burden, and allowing an employer to select healthcare providers. Income support systems influence worker functional capacity through the level of participation and share of income support funding required of employers, and through certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition.ConclusionIncome support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory, and administrative mechanisms. Future policy design and research efforts should consider how income support systems may indirectly influence workers with LBP via the workplace.

scholarly journals Understanding the impact of delegated home visiting services accessed via general practice by community-dwelling patients: a realist review protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024876 ◽  
Author(s):  
Ruth Abrams ◽  
Geoffrey Wong ◽  
Kamal Ram Mahtani ◽  
Stephanie Tierney ◽  
Anne-Marie Boylan ◽  
...  
Keyword(s):  
Home Visiting ◽  
Hospital Admissions ◽  
Evidence Synthesis ◽  
Realist Review ◽  
Professional Associations ◽  
Community Dwelling ◽  
Mixed Method Research ◽  
Programme Theory ◽  
Registration Number ◽  
The Impact

IntroductionIn western countries, early visiting services (EVS) have been proposed as a recent intervention to reduce both general practitioner workload and hospital admissions among housebound individuals experiencing a healthcare need within the community. EVS involves the delegation of the patient home visits to other staff groups such as paramedics or nursing staff. However, the principles of organising this care are unknown and it remains unclear how different contexts, such as patient conditions and the processes of organising EVS influence care outcomes. A review has been designed to understand how EVS are enacted and, specifically, who benefits, why, how and when in order to provide further insight into the design and delivery of EVS.Methods and analysisThe purpose of this review is to produce findings that provide explanations of how and why EVS contexts influence their associated outcomes. Evidence on EVS will be consolidated through realist review—a theory-driven approach to evidence synthesis. A realist approach is needed as EVS is a complex intervention. What EVS achieve is likely to vary for different individuals and contexts. We expect to synthesise a range of relevant data such as qualitative, quantitative and mixed-method research in the following stages: devising an initial programme theory, searching evidence, selecting appropriate documents, extracting data, synthesising and refining the programme theory.Ethics and disseminationA formal ethics review is not required as this study is secondary research. Findings will be disseminated in a peer-reviewed journal, at national and international conferences and to relevant professional associations.PROSPERO registration numberCRD42018096518.

scholarly journals Does mental fatigue affect skilled performance in athletes? A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258307
Author(s):  
He Sun ◽  
Kim Geok Soh ◽  
Samsilah Roslan ◽  
Mohd Rozilee Wazir Norjali Wazir ◽  
Kim Lam Soh
Keyword(s):  
Systematic Review ◽  
Executive Functions ◽  
Grey Literature ◽  
Relevant Literature ◽  
Mental Fatigue ◽  
Cognitive Tasks ◽  
Table Tennis ◽  
Negative Effects ◽  
Skilled Performance ◽  
The Impact

Background Mental fatigue is a psychobiological state induced by a prolonged duration of demanding cognitive tasks. The effects of mental fatigue on physical performance have been well investigated in the literature. However, the effect of mental fatigue on skilled performance in sports remains unclear. Objective This study aimed to report a comprehensive systematic review investigating the carryover effects of mental fatigue on skilled performance among athletes. Methods A thorough search was conducted on PubMed, Web of Science, EBSCOhost (CENTRAL, SPORTDicus), and Scopus to select relevant literature, as well as on Google Scholar and sources of reference for grey literature. The selected literatures are centred on a mental fatigue protocol in which cognitive tasks are performed prior to athletic tasks. Only studies that used an experimental design to test two conditions, namely mental fatigue and non-mental fatigue, were selected. Results Eleven articles were chosen based on the selection criteria. Mental fatigue affects skilled performance in three sports: soccer, basketball, and table tennis. A decline in skilled performance (decreased accuracy, increased performing time etc) is relevant to impaired executive functions. Seven studies focus on offensive skills, whereas only two studies are associated with defensive skills. Conclusion Mental fatigue has a negative effect on various sports skills of high-level athletes, including their technical and decision-making skills; however, the impact is greater on offensive skills than that of defensive skills in terms of the role of athletes. Impaired executive functions may be responsible for the negative effects of mental fatigue on skilled performance.

scholarly journals The Role of Trust and Hope in Antipsychotic Medication Reviews in Primary Care Settings: A Realist Review. 

2021 ◽  
Author(s):  
Lisa Marie Grünwald ◽  
Claire Duddy ◽  
Richard Byng ◽  
Nadia Crellin ◽  
Joanna Moncrieff
Keyword(s):  
Primary Care ◽  
Antipsychotic Medication ◽  
Perceived Risk ◽  
Secondary Care ◽  
Realist Review ◽  
Service Users ◽  
Programme Theory ◽  
Primary Care Settings ◽  
Low Expectations ◽  
Medication Reviews

Abstract Background: Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support.Aim: To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health inputDesign & Setting: Realist review in general practice settings. Method: A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia and/or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews.Results: Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to carrying out meaningful reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, and perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. Conclusions: The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.

scholarly journals Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

2020 ◽  
Author(s):  
Rikke Siersbaek ◽  
John Ford ◽  
Sara Burke ◽  
Clíona Ní Cheallaigh ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Access ◽  
Grey Literature ◽  
Realist Review ◽  
Access To Healthcare ◽  
Staff Retention ◽  
Programme Theory ◽  
Eligibility Criteria

Abstract Objective: The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.Design: A realist review.Data sources: Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies: The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer reviewed articles were first identified through a systematic search, grey literature searching, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.Analysis: Inductive coding was used to generate Context-Mechanism-Outcome configurations which were refined and then used to build several iterations of the overarching programme theory.Results: Searching identified 330 review articles, of which 24 were included. Additional searching of grey literature yielded 50 records of which 12 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma generating trusting relationships between patients and staff/providers. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention. Conclusions: With homelessness on the rise internationally, this study will inform health systems policy-making and implementation. It contributes to our understanding how healthcare systems can be more accessible for populations experiencing homelessness by providing long-term stable funding, promoting inclusive cultures and limiting stigma. Health systems should be flexible, timely and connected.

Sign in / Sign up

Export Citation Format

Share Document