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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, and Commencing 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., (© 2019 The Authors. Research Synthesis Methods published by John Wiley & Sons Ltd.)

Background: 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., Objectives: 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)., Data Sources: 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., Review Methods: 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 d ). When appropriate, random-effects meta-analyses produced pooled effect sizes ( d ). 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., Results: 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., Limitations: 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., Conclusions: 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., Study Registration: This study is registered as PROSPERO CRD42011001716., Funding: 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., Competing Interests: Roz Shafran is on the Health Technology Assessment Mental, Psychological and Occupational Health Panel and Stuart Logan is on the Open Call Assessment Board – Medicines for Children.

School attendance problems are associated with a range of adverse consequences, and educational practitioners play a role in identifying and responding to attendance problems. This qualitative study explored educational practitioners' experiences of working with students with attendance problems and interventions to address them. Focus groups were conducted with sixteen practitioners across three secondary schools. Data were analysed using thematic analysis. Attendance problems were considered resource-intensive and emotionally challenging. Practitioners expressed difficulty understanding causes, although individual/family factors were emphasised over school factors. A range of interventions were described, including adaptations to school context and providing emotional support. Views on punitive approaches were mixed. Individualised interventions implemented at the first sign of problems, and a team approach, were considered important. Findings highlight the important role of educational practitioners in identifying attendance problems and implementing interventions. Recommendations include early intervention, team-work, and emotional support for students with, and staff responding to, attendance problems.

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.

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.

Background: Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity and/or impulsivity. Young people with ADHD have poorer educational and social outcomes than their peers. We aimed to better understand educational experiences of young people with ADHD in the UK, and make actionable recommendations for schools. Methods: In this secondary analysis of qualitative data, we used Thematic Analysis to analyse information relating to experiences of education from 64 young people with ADHD and 28 parents who participated in the Children and adolescents with ADHD in Transition between Children's services and adult Services (CATCh‐uS) study. Emerging patterns within and across codes led to organization of the data into themes and subthemes through an iterative process. Results: Two main themes were generated. The first described young people's early experiences of education, often within a mainstream setting; we labelled this the problematic provision loop, as this was a negative cycle that was repeated several times for some participants. The second theme described young people's more positive progression through education once they progressed out of the problematic loop. Conclusions: Educational experiences for young people with ADHD are often negative and fraught with complication. Young people with ADHD often found themselves on a more positive trajectory after they were placed in an alternative form of education provision (mainstream or otherwise), or where they were able to study topics that interest them and play to their strengths. We make recommendations that commissioners, local authorities and schools could consider in order to better support those with ADHD. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore Marriage and Family Therapy students' perspectives regarding food addiction and associated eating disorders, as a clinical treatment issue. In a standard addictions course housed in a Marriage and Family Therapy program approved by the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), 20 students completed a qualitative survey where they reflected on the topic of food addiction, Binge Eating Disorder, and Bulimia Nervosa, within the context of individual, couple, and family relationships. In the study four major themes emerged, which included (1) Defining Food Addiction, (2) Perceptions of Eating Disorders, (3) Conceptualizing Systemic Treatment, and (4) Experiences in clinical training. Clinical implications, recommendations for MFT education, clinical practice, and future research are discussed. Findings suggest that while MFT students in the study were well versed in conceptualized systemic treatment, it was of a general treatment and understanding using MFT theory, and not in relation to or specifically concerning food addictions and their connection or distinction from Binge Eating Disorder and/or other eating disorders found in the Diagnostic and Statistical Manual, potentially impacting the level of skillfully and appropriately working with clients. [ABSTRACT FROM AUTHOR]

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]

School staff have an important role to play in identifying and assisting pupils who require additional support to regularly attend school, but their beliefs about risk factors might influence their decisions regarding intervention. This qualitative study investigated educational practitioners' beliefs about risk factors for attendance problems. Sixteen practitioners from three secondary schools were interviewed via focus groups. Data were analysed using thematic analysis. Practitioners identified risk factors related to the individual, their family, peers and school. Poor mental health was identified as a risk factor, but practitioners primarily focused on anxiety rather than other mental health problems like depression or behavioural disorders. The overall perception was that school factors were less important than individual, family and peer factors. Implications include a need for increased awareness of the role of school factors in attendance problems, focus on promoting positive peer and pupil-teacher relationships, and collaborative working between young people, families and schools. [ABSTRACT FROM AUTHOR]

In Chinese societies, such as those in Taiwan, Hong Kong, mainland China, Malaysia, and Singapore, same-sex sexual behaviors have been pathologized, resulting in increased minority stress among Chinese gay men (CGM). Therefore, we attempted to understand CGM's potential clinical issues. Twelve CGM were interviewed and a basic interpretive qualitative methodology was used to analyze the data. Overall, the study separated their clinical issues to individual, couple, family, community, and environmental aspects. We suggest that counselors apply person-centered and Gestalt approaches to create a non-judgmental therapeutic environment and to improve CGM's holistic awareness. We also suggest they undergo relevant training to increase cultural competencies regarding CGM. [ABSTRACT FROM AUTHOR]

Background: Children and young people with long‐term physical health conditions are at increased risk of experiencing mental health and well‐being difficulties. However, there is a lack of research that explores the experiences of and attitudes towards interventions aiming to improve their mental health and well‐being. This systematic review seeks to address this gap in the literature by exploring what children and young people with long‐term conditions, their caregivers, and health practitioners perceive to be important aspects of interventions aiming to improve their mental health and well‐being. Methods: An information specialist searched five academic databases using predefined criteria for qualitative evaluations of interventions aiming to improve the mental health or well‐being of children with long‐term physical conditions. Reviewers also performed supplementary citation and grey literature searches. Two reviewers independently screened titles, abstracts, and full texts that met the inclusion criteria and conducted data extraction and quality assessment. Meta‐ethnography was used to synthesize the findings. Results: Screening identified 60 relevant articles. We identified five overarching constructs through the synthesis: (a) Getting In and Staying In, (b) Therapeutic Foundation, (c) Social Support, (d) A Hopeful Alternative, and (e) Empowerment. The line of argument that links these constructs together indicates that when interventions can provide an environment that allows young people to share their experiences and build empathetic relationships, it can enable participants to access social support and increase feelings of hope and empowerment. Conclusion: These findings may provide a framework to inform the development of mental health interventions for this population and evaluate existing interventions that already include some of the components or processes identified by this research. Further research is needed to establish which of the constructs identified by the line of argument are most effective in improving the mental well‐being of young people living with long‐term conditions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore Marriage and Family Therapy students’ experiences attending Overeaters Anonymous (OA). Utilizing a qualitative survey administered in an addictions course at an institution located in a rural area of the United States, 18 marriage and family therapy (MFT) graduate students reflected on their participation in both online and telephone meetings. In this study, MFT students provided their perspectives regarding the feasible utilization of Overeaters Anonymous in clinical treatment, with an emphasis on the consideration of social support for clients who may reside in rural areas. Three major themes emerged which included (1) enlightenment through exposure; (2) OA as a viable adjunct to therapy; and (3) convenience and comfort. The study addressed recommendations for MFT education, clinical implications, and future research. [ABSTRACT FROM AUTHOR]

School attendance problems are associated with a range of adverse consequences, and educational practitioners play a role in identifying and responding to attendance problems. This qualitative study explored educational practitioners’ experiences of working with students with attendance problems and interventions to address them. Focus groups were conducted with sixteen practitioners across three secondary schools. Data were analysed using thematic analysis. Attendance problems were considered resource-intensive and emotionally challenging. Practitioners expressed difficulty understanding causes, although individual/family factors were emphasised over school factors. A range of interventions were described, including adaptations to school context and providing emotional support. Views on punitive approaches were mixed. Individualised interventions implemented at the first sign of problems, and a team approach, were considered important. Findings highlight the important role of educational practitioners in identifying attendance problems and implementing interventions. Recommendations include early intervention, team-work, and emotional support for students with, and staff responding to, attendance problems. [ABSTRACT FROM AUTHOR]

Addressing problems associated with malnutrition in care home residents has been prioritized by researchers and decision-makers. This review aimed to better understand factors that may contribute to malnutrition by examining the attitudes, perceptions and experiences of mealtimes among care home residents and staff. Five databases were searched from inception to November 2015: Medline, Embase, PsychINFO, AMED, and the Cochrane Database. Forward and backward citation checking of included articles was conducted. Titles, abstracts, and full texts were screened independently by two reviewers and quality was assessed using the Wallace criteria. Thematic analysis of extracted data was undertaken. Fifteen studies were included in the review, encompassing the views and opinions of a total of 580 participants set in nine different countries. Four main themes were identified: (1) organizational and staff support, (2) resident agency, (3) mealtime culture, and (4) meal quality and enjoyment. Organizational and staff support was an over-arching theme, impacting all aspects of the mealtime experience. Mealtimes are a pivotal part of care home life, providing structure to the day and generating opportunities for conversation and companionship. Enhancing the mealtime experience for care home residents needs to take account of the complex needs of residents while also creating an environment in which individual care can be provided in a communal setting. PROSPERO Registration: CRD42015025890. [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 study explores the experiences of 20 men who have had bariatric surgery, focusing on their couple or marital relationships. The researcher concentrates on men's perspectives regarding relationship satisfaction, sexual intimacy, and social support after surgical intervention. Phenomenology and family systems theory were used to guide the study from which emerged three themes: (a) Unintended consequences (unpredicted problems occurring within intimate relationships); (b) Intimacy as bittersweet (experiencing increasing levels of intimacy, while still desiring more); and (c) Inconsistent social support (experiencing instances where social support is provided, while simultaneously experiencing other areas where social support is not provided). The study includes a rich description of the data, critical analysis, and discussion of clinical implications for therapists and other healthcare professionals. [ABSTRACT FROM AUTHOR]

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]

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]