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Aims and objectives: To systematically review and synthesise qualitative data from studies exploring the experiences of hospital staff who care for people living with dementia (Plwd). Background: In hospital, the number of Plwd continues to rise; however, their experiences of care remain problematic. Negative experiences of care are likely to contribute to poorer mental and physical health outcomes for Plwd while in hospital and after discharge. Experiences of the hospital staff who care for Plwd can also be poor or unrewarding. It is important to understand the experiences of staff in order to improve staff well‐being and ultimately the experience of care for Plwd while in hospital. Design: Systematic review and evidence synthesis of qualitative research. Data sources: We searched 16 electronic databases in March 2018 and completed forward and backward citation chasing. Methods: Eligible studies explored the experiences of paid and unpaid staff providing care in hospital for Plwd. Study selection was undertaken independently by two reviewers, and quality appraisal was conducted. We prioritised included studies according to richness of text, methodological rigour and conceptual contribution. We adopted approaches of meta‐ethnography to analyse study findings, creating a conceptual model to represent the line of argument. Findings: Forty‐five studies reported in 58 papers met the inclusion criteria, and of these, we prioritised 19 studies reported in 24 papers. The line of argument was that Institutions can improve staff experiences of care for Plwd by fostering person‐centred care (PCC). PCC aligned with staff perceptions of 'good care'; however, staff often felt prevented from providing PCC because of care cultures that prioritised tasks, routines and physical health. Staff experienced conflict over the care they wanted to give versus the care they were able to give, and this caused moral distress. When staff were able to provide PCC, this increased experiences of job satisfaction and emotional well‐being. Conclusions: Person‐centred care not only has the potential to improve the experience of care for Plwd and their carers, but can also improve the experiences of hospital staff caring for Plwd. However, without institutional‐level changes, hospital staff are often unable to provide PCC even when they have the experience and knowledge to do so. Implications for practice: Institutional‐level areas for change include the following: training; performance indicators and ward cultures that prioritise psychological needs alongside physical needs; adequate staffing levels; inclusive approaches to carers; physical environments that promote familiarisation, social interaction and occupation; systems of documentation about individual needs of Plwd; and cultures of sharing knowledge across hierarchies. [ABSTRACT FROM AUTHOR]

The incorporation of evidence derived from multiple research designs into one single synthesis can enhance the utility of systematic reviews making them more worthwhile, useful, and insightful. Methodological guidance for mixed‐methods synthesis continues to emerge and evolve but broadly involves a sequential, parallel, or convergent approach according to the degree of independence between individual syntheses before they are combined. We present two case studies in which we used novel and innovative methods to draw together the findings from individual but related quantitative and qualitative syntheses to aid interpretation of the overall evidence base. Our approach moved beyond making a choice between parallel, sequential, or convergent methods to interweave the findings of individual reviews and offers three key innovations to mixed‐methods synthesis methods: The use of intersubjective questions to understand the findings of the individual reviews through different lenses,Immersion of key reviewers in the entirety of the evidence base, andCommencing the process during the final stages of the synthesis of individual reviews, at a point where reviewers are developing an understanding of initial findings. Underlying our approach is the process of exploration and identification of links between and across review findings, an approach that is fundamental to all evidence syntheses but usually occurs at the level of the study. Adapting existing methods for exploring and identifying patterns and links between and across studies to interweave the findings between and across reviews may prove valuable. [ABSTRACT FROM AUTHOR]

Background: An increasingly high number of patients admitted to hospital have dementia. Hospital environments can be particularly confusing and challenging for people living with dementia (Plwd) impacting their wellbeing and the ability to optimize their care. Improving the experience of care in hospital has been recognized as a priority, and non-pharmacological interventions including activity interventions have been associated with improved wellbeing and behavioral outcomes for Plwd in other settings. This systematic review aimed at evaluating the effectiveness of activity interventions to improve experience of care for Plwd in hospital.Methods: Systematic searches were conducted in 16 electronic databases up to October 2019. Reference lists of included studies and forward citation searching were also conducted. Quantitative studies reporting comparative data for activity interventions delivered to Plwd aiming to improve their experience of care in hospital were included. Screening for inclusion, data extraction and quality appraisal were performed independently by two reviewers with discrepancies resolved by discussion with a third where necessary. Standardized mean differences (SMDs) were calculated where possible to support narrative statements and aid interpretation.Results: Six studies met the inclusion criteria (one randomized and five non-randomized uncontrolled studies) including 216 Plwd. Activity interventions evaluated music, art, social, psychotherapeutic, and combinations of tailored activities in relation to wellbeing outcomes. Although studies were generally underpowered, findings indicated beneficial effects of activity interventions with improved mood and engagement of Plwd while in hospital, and reduced levels of responsive behaviors. Calculated SMDs ranged from very small to large but were mostly statistically non-significant.Conclusions: The small number of identified studies indicate that activity-based interventions implemented in hospitals may be effective in improving aspects of the care experience for Plwd. Larger well-conducted studies are needed to fully evaluate the potential of this type of non-pharmacological intervention to improve experience of care in hospital settings, and whether any benefits extend to staff wellbeing and the wider ward environment. [ABSTRACT FROM AUTHOR]

In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The initial programme theory was developed from these sources in an iterative process between researchers and stakeholders (service users, practitioners, commissioners) involving four activities: articulation of 442 explanatory statements systematically developed using realist methods; debate and consensus; communication; and interrogation. We refute two criticisms of theory-driven evaluation of complex interventions. We demonstrate how the process of initial theory-building made a meaningful contribution to our complex intervention in five ways. Although time-consuming, it allowed us to develop an internally coherent and well-documented intervention. This study and the lessons learnt provide a detailed resource for other researchers wishing to build theory for theory-driven evaluation. [ABSTRACT FROM AUTHOR]

Evaluation of recovery-focused interventions for people with psychosis may be enhanced by the use of Interpersonal Process Recall (IPR). The aim of this study was to examine whether the inclusion of IPR alongside semi-structured interviews in the formative evaluation of a novel collaborative care intervention increased understanding about both practitioner and service user experiences. It also explored the impact of the IPR process on participants. Four service users and the practitioner delivering the intervention participated in semi-structured interviews and an adapted IPR process. The themes identified from different data sources were systematically compared using framework analysis. Semi-structured interviews indicated that the intervention was operating as intended but IPR data revealed exceptions. Practitioner IPR interviews identified practitioner barriers to delivery and fostered critical self-reflection. Service user IPR interviews facilitated critical feedback but also caused some distress. Interviews gave more information about organisational level contextual factors. IPR increased understanding of how the intervention was being delivered and experienced. IPR should be used alongside other forms of qualitative data collection. The potential of IPR to impact on intervention delivery should be taken into account. Further research is needed to establish for whom IPR is likely to be most effective. [ABSTRACT FROM AUTHOR]

Non‐pharmacological interventions for attention‐deficit/hyperactivity disorder are useful treatments, but it is unclear how effective school‐based interventions are for a range of outcomes and which features of interventions are most effective. This paper systematically reviews randomised controlled trial evidence of the effectiveness of interventions for children with ADHD in school settings. Three methods of synthesis were used to explore the effectiveness of interventions, whether certain types of interventions are more effective than others and which components of interventions lead to effective academic outcomes. Twenty‐eight studies (n = 1807) were included in the review. Eight types of interventions were evaluated and a range of different ADHD symptoms, difficulties and school outcomes were assessed across studies. Meta‐analyses demonstrated beneficial effects for interventions that combine multiple features (median effect size g = 0.37, interquartile range 0.32, range 0.09–1.13) and suggest some promise for daily report card interventions (median g = 0.62, IQR = 0.25, range 0.13–1.62). Meta‐regression analyses did not give a consistent message regarding which types of interventions were more effective than others. Finally, qualitative comparative analysis demonstrated that self‐regulation and one‐to‐one intervention delivery were important components of interventions that were effective for academic outcomes. These two components were not sufficient though; when they appeared with personalisation for individual recipients and delivery in the classroom, or when interventions did not aim to improve child relationships, interventions were effective. This review provides updated information about the effectiveness of non‐pharmacological interventions specific to school settings and gives tentative messages about important features of these interventions for academic outcomes. [ABSTRACT FROM AUTHOR]

This paper describes the mixed methodology evaluation of the Own‐Voice Intensive Phonics (OVIP) programme with 33 secondary students with persistent literacy difficulties. The evaluation involved a quasi‐experimental evaluation in which 33 students in years 7–9 in four schools used OVIP over an 8 week period and were monitored at three times for their word reading, phonic decoding and phonological skills. Students, teaching assistants and teachers involved were also interviewed about the use of OVIP, the perceived processes and outcomes. Assessment results showed that OVIP was associated with greater gains in word reading than these students' usual teaching/intervention approaches. Those interviewed also experienced benefits associated with using OVIP. It was further found that word reading gains were not related to a measure of being at risk of significant literacy difficulties. Participants identified the use of their own voice, the student's agency and working at their own pace as key factors relevant to how OVIP worked. These factors aligned with a working OVIP programme theory. The findings are discussed in terms of further development and research related to an own voice approach to addressing persistent literacy difficulties. [ABSTRACT FROM AUTHOR]

Background: The benefits of end‐user involvement in health‐care research are widely recognized by research agencies. There are few published evaluations of end‐user involvement in systematic reviews. Objectives: (i) Describe end‐user involvement in a complex mixed‐methods systematic review of ADHD in schools, (ii) reflect on the impact of end‐user involvement, (iii) highlight challenges and benefits experienced and (iv) provide suggestions to inform future involvement. Methods: End‐users were involved in all stages of the project, both as authors and as members of an advisory group. In addition, several events were held with groups of relevant end‐users during the project. Results: End‐user input (i) guided the direction of the research, (ii) contributed to a typology of interventions and outcomes, (iii) contributed to the direction of data analysis and (iv) contributed to the robustness of the syntheses by demonstrating the alignment of interim findings with lived experiences. Challenges included (i) managing expectations, (ii) managing the intensity of emotion, (iii) ensuring that involvement was fruitful for all not just the researcher, (iv) our capacity to communicate and manage the process and (v) engendering a sense of involvement amongst end‐users. Conclusions: End‐user involvement was an important aspect of this project. To minimize challenges in future projects, a recognition by the project management team and the funding provider that end‐user involvement even in evidence synthesis projects is resource intensive is essential to allow appropriate allocation of time and resources for meaningful engagement. [ABSTRACT FROM AUTHOR]

This systematic review and synthesis of qualitative research explored contextual factors relevant to non-pharmacological interventions for attention deficit hyperactivity disorder (ADHD) in schools. We conducted meta-ethnography to synthesise 34 studies, using theories of stigma to further develop the synthesis. Studies suggested that the classroom context requiring pupils to sit still, be quiet and concentrate could trigger symptoms of ADHD, and that symptoms could then be exacerbated through informal/formal labelling and stigma, damaged self-perceptions and resulting poor relationships with staff and pupils. Influences of the school context on symptoms of ADHD were often invisible to teachers and pupils, with most attributions made to the individual pupil and/or the pupil’s family. We theorise that this ‘invisibility’ is at least partly an artefact of stigma, and that the potential for stigma for ADHD to seem ‘natural and right’ in the context of schools needs to be taken into account when planning any intervention. [ABSTRACT FROM PUBLISHER]

School-based non-pharmacological interventions are an important part of the treatment of attention-deficit/hyperactivity disorder (ADHD). We aimed to systematically review qualitative literature relating to the experience of and attitudes towards school-based non-pharmacological interventions for ADHD. Systematic searches of 20 electronic databases were undertaken. Reviewers screened titles, abstracts and full reports of studies, before extracting data and critically appraising 33 included papers. Studies were synthesised using meta-ethnographic methods. Four-key interrelated themes were identified: (1) individualising interventions, (2) structure of interventions, (3) barriers to effectiveness, (4) perceived moderators and impact of interventions. The perceived effectiveness of interventions used in school settings is reported to vary. Therefore, flexible, tailored interventions ought to hold potential. However, highly individualised interventions may negatively affect children with ADHD. Findings point to the need for school-based interventions to take into account the wider school context, as well as core symptoms of ADHD. [ABSTRACT FROM AUTHOR]

Exclusion from school is associated with adverse outcomes for young people. There is limited research that explores parents’ perspectives, particularly in relation to the exclusion of primary school aged children. The present study used semi-structured interviews with 35 parents of 37 children aged 5–12 years from the Southwest of England. Parents experiences were captured in a conceptual model through three main themes. Exclusion was described as part of a complex journey of difficulties reflected by a continuum of coping. The child’s place on the continuum was determined by an interaction between the child, family, and school with communication a key determinant. The study also highlighted the wider implications of exclusion, including emotional and functional impacts on the child and parent and highlighted the importance of the parents voice in the identification and support of their child’s needs. It also presents many complexities surrounding exclusion from school and limited support parents felt their child was offered. [ABSTRACT FROM PUBLISHER]

Educational policy and the school effectiveness movement often involve rhetoric about the benefit of parent involvement in schools, but high-quality relationships between parents and teachers are not always straightforwardly achieved, and this may be particularly true in the case of parents of children presenting with academic problems and/or social, emotional and behavioural difficulties. A systematic review of qualitative research was conducted to explore the school-related experiences of parents of pupils diagnosed with attention deficit hyperactivity disorder ( ADHD). Six studies reported in seven papers met the inclusion criteria. High-quality parent-teacher relationships were found to be the exception, with mothers feeling silenced and criticised. Findings show commonalities with wider research about parents, but identify additional grounds for conflict resulting from parental blame for pupils' disruptive behaviour, and the ambivalent nature of the concept of ADHD. [ABSTRACT FROM AUTHOR]

The concept of moderate learning difficulties (MLD) is not clearly understood in its definition and in its general use. Nevertheless, as a distinct area of special educational needs (SEN) this category has constituted about a quarter of all of those pupils identified as having SEN in England. This paper reports the analysis of findings from an ongoing research project in an attempt to improve understanding of the MLD category. Pupils (aged 12–14 years) identified as having MLD were compared with others in the same classes identified as having either specific learning difficulties or low attainments in terms of literacy, reasoning and dispositional measures. The paper shows that the label of MLD is often used in an over-generalised way in schools and that although there are some differences in reasoning and literacy abilities between those identified as having MLD and those who have not, no such differences were found in learner self-concept and in pupils’ attitudes to education and learning questioning the current definition of MLD which includes associated low self-esteem. Reasons for lack of clarity in the definition/category of MLD are discussed, as are implications for future use of the term. [ABSTRACT FROM PUBLISHER]

A six-year-old child was independently assessed by three licensed educational (school) psychologists and one interdisciplinary team in the UK. All but one of these practitioners believed their assessment to be the first. The aim was to compare the practice of assessors and their conclusions especially in diagnostic categorisation. The methods of assessment and conclusions of the four resulting reports were compared using thematic analysis. There was agreement about the child's specific learning difficulties, intellectual abilities and need for additional support. However, there were extensive differences in the methods of assessment and notable differences in three sets of conclusions, especially in the use of diagnostic terms: one practitioner identified the child's difficulties as dyslexic in nature, the second one identified them as primarily dyspraxic and the third one reported a ‘borderline probability of Asperger's Syndrome’. The diagnosis, therefore, remained uncertain from initial assessment, exposing inherent overlap between diagnostic categories. The disparities in conclusions are discussed in terms of differing contexts and methods of assessment. The validity of diagnostic categories as discrete is questioned. Even where practitioners describe uncertainty, the use of diagnostic terms may be interpreted unambiguously by other actors. [ABSTRACT FROM PUBLISHER]

It is highly likely that teachers' abilities in dealing with different forms of learning difficulties will be affected by their knowledge about and attitudes towards those difficulties. Ajzen's Theory of Planned Behaviour (TPB) provides a useful framework within which to explore such attitudes and was used as the starting point for investigating trainee teachers' attitudes towards aspects of dyslexia. It is assumed that new teachers will enter the profession with a set of intentions according to personal beliefs, normative views within the teaching profession and the sense of competence and power they feel in dealing with dyslexic difficulties. The purpose of this study was to probe student teachers' attitudes at a prestigious School of Education in the Southwest of England. Four hundred and eight primary and secondary Post Graduate Certificate in Education (PGCE) students responded to a survey asking about their attitudes toward dyslexia. The student teachers expressed strongly positive attitudes toward the construct of dyslexia, with the majority expressing confidence in their ability to support dyslexic pupils. Females held significantly more positive attitudes toward dyslexia than males, but there were no significant differences according to PGCE course subject. Students who took the survey before and after teaching practice demonstrated some small but significant changes in attitude scores over that time. It is proposed that a new breed of teachers may be entering the teaching profession with positive beliefs about their ability to help dyslexic pupils, but who remain unclear as to how this can be accomplished. Some implications for action and suggestions for future research are provided. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Patient and Public Involvement (PPI) in research is a growing field of work, incorporating experiential knowledge within research processes. Co-production is a more recent PPI approach that emphasises the importance of power-sharing to promote inclusive research practices, valuing and respecting knowledge from different sources, and relationship building. Applying co-production principles in research trials can be difficult, and there are few detailed worked examples or toolkits. This paper explores the successes and challenges encountered by one research team. Methods: Our paper is written by a team of 21 people working on PARTNERS2, led by a smaller co-ordinating group. Using a co-operative style inquiry, the authors have reflected on and written about their experiences; analysis of the resulting 15 accounts provided examples of how PPI and co-production were delivered in practice. Results: We reveal varied and complicated experiences as we developed our collaborative approach across the entire research programme. Four main themes emerge from reflective accounts which describe aspects of this process: (1) recognising the importance of 'emotional work'; (2) developing safe spaces to create and share knowledge; (3) some challenges of using our personal identities in research work; and (4) acknowledging power-sharing within the research hierarchy. We also found continual relationship building, how different forms of expertise were valued, and stigma were central to shaping what work was possible together. Other important practices were transparency, particularly over decision making, and clear communication. Conclusions: Our work provides one example of the 'messy' nature of collaborative research in practice. The learning we surface was contextual, generated within a large-scale research programme, but applicable to other studies. We found for success there needs to be an acknowledgement of the importance of emotional work, creating safe spaces to co-produce, transparency in decision making and reflection on the difficulties of using personal identities in research work including for service user researchers. These elements are more important than existing guidelines suggest. Implementation of actions to support emotional work, will require changes within individual teams as well as institutions. Introducing reflective practice in teams may be helpful in identifying further improvements to inclusive research practice. [ABSTRACT FROM AUTHOR]

Background: Many people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care. Primary care practitioners may not be well equipped to meet their needs and there is often poor communication with secondary care. Collaborative care is a promising alternative model but has not been trialled specifically with this service user group in England. Collaborative care for other mental health conditions has not been widely implemented despite evidence of its effectiveness. We carried out a formative evaluation of the PARTNERS model of collaborative care, with the aim of establishing barriers and facilitators to delivery, identifying implementation support requirements and testing the initial programme theory. Methods: The PARTNERS intervention was delivered on a small scale in three sites. Qualitative data was collected from primary and secondary care practitioners, service users and family carers, using semi-structured interviews, session recordings and tape-assisted recall. Deductive and inductive thematic analysis was carried out; themes were compared to the programme theory and used to inform an implementation support strategy. Results: Key components of the intervention that were not consistently delivered as intended were: interaction with primary care teams, the use of coaching, and supervision. Barriers and facilitators identified were related to service commitment, care partner skills, supervisor understanding and service user motivation. An implementation support strategy was developed, with researcher facilitation of communication and supervision and additional training for practitioners. Some components of the intervention were not experienced as intended; this appeared to reflect difficulties with operationalising the intervention. Analysis of data relating to the intended outcomes of the intervention indicated that the mechanisms proposed in the programme theory had operated as expected. Conclusions: Additional implementation support is likely to be required for the PARTNERS model to be delivered; the effectiveness of such support may be affected by practitioner and service user readiness to change. There is also a need to test the programme theory more fully. These issues will be addressed in the process evaluation of our full trial. Trial registration: ISRCTN95702682, 26 October 2017. [ABSTRACT FROM AUTHOR]