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Introduction: Despite increased awareness of the detrimental relationship between homelessness and health, people experiencing homelessness remain an underserved population in health and social care research. Due to barriers affecting the accessibility of medicine and healthcare services, as well as reported competing priorities such as food and shelter, evidence has demonstrated that people experiencing homelessness are less likely to undergo routine examinations, receive diagnoses and adhere to prescribed medical treatments. To enhance service design and access for those experiencing homelessness, it is critical to better recognise, understand and address the barriers these individuals face. This meta‐ethnography aims to identify barriers, enablers and interventions to begin addressing this inequality gap. Methods: A systematic literature search was undertaken in October and re‐ran in December 2023 across four databases: MEDLINE, Embase, CINAHL and Scopus. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines and health service inequalities among populations experiencing homelessness. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta‐ethnographic approach, as outlined by Noblit and Hare. The review was registered on PROSPERO (CRD42024511502) and performed according to PRISMA guidelines. Results: This meta‐ethnographic systematic review synthesised data from eight studies across multiple countries. Three overarching third‐order constructs (termed 'themes') were developed through reciprocal translation and centred around: recognising and acknowledging the discrimination, stigma and barriers experienced when using current services; exploring safe and practical use of medicines and the promotion of general health education and appreciating strategies to tackle inequalities, namely community outreach programmes designed for homeless communities. Conclusion: This work highlighted the barriers, enablers and interventions that sought to address the inequalities affecting people experiencing homelessness in accessing medication and healthcare services. Future research should utilise lived‐experience narratives and co‐design to further explore ways to tackle wider healthcare accessibility inequalities for this minoritised population. Trial Registration: Not applicable, as this is a systematic review. Patient or Public Contribution: Public contributors (minority research champions and one public health research champion, H.K.G. and T.G.) informed and shaped this project during study design and conceptualisation. They helped to ensure that the study was conducted, and the findings were reported with sensitivity. [ABSTRACT FROM AUTHOR]

Background: The current research builds on a previous review of the literature which explored sexuality during gender transition. There has been increased attention toward TGNC people across academic, political, and healthcare fields since the previous review, as well as shifts in language use and health interventions, justifying a need for more contemporary understandings. Aim: The current systematic review explores the experience of sexuality during gender transition. Methods: A meta-ethnography was conducted on 16 papers that focused specifically on TGNC people's experiences of their sexualities. Results: The main findings were the intersection of gender and sexuality; the importance of re-writing labels around sexuality, bodies and relationships; (re)negotiating changes in sexual, romantic and/or physical relationships due to transitioning; and changes in a sense of community and belonging. Discussion: The results have implications for supporting TGNC people navigating their identities by recognizing the multiple and intersecting levels of influence within which they are situated. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The term 'complex emotional needs' (CEN) is used here to describe people with difficulties and needs that are often associated with the diagnostic label of 'personality disorder'.People with CEN might use out of hours services such as emergency departments and Crisis Resolution/Home Treatment (CRHT) teams more often when experiencing a mental health crisis.Very little is understood about the experiences of both those receiving, and those delivering care, for people with CEN within CRHT settings. What this paper adds to existing knowledge?: There are differences between priorities for those delivering and those receiving care within CRHT settings. CRHT staff members are likely to focus more upon those aspects of their role relating to risk issues. managing resources, anxieties and the expectations of others. Service users, meanwhile, focus upon the caring relationship, wanting staff to listen to them, and to feel supported and reassured.In the papers reviewed, service users experiencing CEN did not always feel 'listened to' or 'taken seriously' especially in relation to risk issues and decision‐making. What are the implications for practice?: Relating the findings to mental health nursing and CEN within the context of CRHT, to better understand the person experiencing a mental health crisis, mental health nurses need to focus more upon the person and when making decisions around their care and must be aware of the potential for power imbalances.Collaborative 'sense‐making' in relation to a person's risk behaviours may help. Background: A growing body of qualitative evidence focusing upon the experiences of care within Crisis Resolution/Home Treatment (CRHT) is emerging; however, a firm evidence base regarding both the giving and receiving of care for those with complex emotional needs (CEN) in this context is yet to be established. Objective: A qualitative evidence synthesis was used to develop a comprehensive understanding of how crisis care for people with CEN is experienced by both those giving and receiving care, within the context of CRHT. Method: Findings from 19 research papers considering both clinician and service users' experiential accounts of CRHT were synthesised using meta‐ethnography. Findings: Both the giving and receiving of care within a CRHT context was experienced across four related meta‐themes: 'contextual', 'functional', 'relational' and 'decisional'. Discussion: Service user accounts focused upon relational aspects, highlighting a significance to their experience of care. Meanwhile, clinicians focused more upon contextual issues linked to the management of organisational anxieties and resources. For those with CEN, a clinician's focus upon risk alone highlighted power differentials in the caring relationship. Conclusions: There is a need for nurses to connect with the experience of the person in crisis, ensuring a better balance between contextual issues and relational working. [ABSTRACT FROM AUTHOR]

This paper gathers 14 ethnographic studies in a meta-ethnographic research to generate knowledge on the possibilities of creative teaching practices with digital media from an ethnographic perspective to promote inclusive education in schools. It explores common details between the articles using cross-case aggregation, which allows to get to know how digital media is used inside pre-primary, primary and secondary classrooms in depth. This research followed the seven phases established by Noblit and Hare in 1988. The results reflect on how teachers are using digital media considering students' voices and interests, listening their voices through knowledge ownership, and promoting interaction between all. The articles also consider new ways of acting and developing from the opportunity that digital media provides in disadvantaged contexts. Studies show spaces mediated by digital media in which the students find their voices and give voice to their thoughts, feelings, and learnings. [ABSTRACT FROM AUTHOR]

Background: Female police officers are reported to encounter more bias, discriminatory practices, and inadequate support than their male counterparts and experience poorer health outcomes. This meta-ethnographic review looks beyond individual responsibilities to consider which aspects of policing impact the health and well-being of female police officers. Methods: Primary qualitative and mixed method studies published between 2000 and 2024 were included. ProQuest (all databases) and Ovid (Medline and Embase) were searched using terms related to health, wellbeing, females, police, and qualitative research. This was a cross-jurisdictional review, with no limit on country of study. In total, twenty-one papers met the inclusion criteria. A seven-phase inductive and interpretative meta-ethnographic technique was employed to synthesise, analyse, and interpret the data. Results: The data analysis revealed a distinct outcome that demonstrated a strong relationship and substantial impacts of organisational injustice on the health and well-being of female police officers. Our findings showed that organisational injustice, encompassing procedural, relational, distributive, and gendered injustice, significantly influences the health and well-being of female officers. Impacts on mental health were commonly discussed, followed by aspects influencing social health, workplace wellbeing, and physical health. Moreover, the effects of these four forms of organisational injustice and the associated cultural, systemic, and structural risk factors extend beyond the immediate health and wellbeing impacts on the individual female officer through impeding other aspects of their work life, such as career progression and work-life balance, that can further impact long-term health and well-being. Conclusion: This review highlights the importance of addressing organisational injustice and the cultural, systemic, and structural risk factors within policing to promote healthier and more inclusive workforces for female officers. Policymakers and practitioners should critically examine policies and practices that may appear gender neutral but disproportionately impact women, affecting the health and well-being of female police officers. By addressing these issues, transformative action can be taken to create safer, more supportive, and healthier working environments for female police officers. [ABSTRACT FROM AUTHOR]

Abstract Background Female police officers are reported to encounter more bias, discriminatory practices, and inadequate support than their male counterparts and experience poorer health outcomes. This meta-ethnographic review looks beyond individual responsibilities to consider which aspects of policing impact the health and well-being of female police officers. Methods Primary qualitative and mixed method studies published between 2000 and 2024 were included. ProQuest (all databases) and Ovid (Medline and Embase) were searched using terms related to health, wellbeing, females, police, and qualitative research. This was a cross-jurisdictional review, with no limit on country of study. In total, twenty-one papers met the inclusion criteria. A seven-phase inductive and interpretative meta-ethnographic technique was employed to synthesise, analyse, and interpret the data. Results The data analysis revealed a distinct outcome that demonstrated a strong relationship and substantial impacts of organisational injustice on the health and well-being of female police officers. Our findings showed that organisational injustice, encompassing procedural, relational, distributive, and gendered injustice, significantly influences the health and well-being of female officers. Impacts on mental health were commonly discussed, followed by aspects influencing social health, workplace wellbeing, and physical health. Moreover, the effects of these four forms of organisational injustice and the associated cultural, systemic, and structural risk factors extend beyond the immediate health and wellbeing impacts on the individual female officer through impeding other aspects of their work life, such as career progression and work-life balance, that can further impact long-term health and well-being. Conclusion This review highlights the importance of addressing organisational injustice and the cultural, systemic, and structural risk factors within policing to promote healthier and more inclusive workforces for female officers. Policymakers and practitioners should critically examine policies and practices that may appear gender neutral but disproportionately impact women, affecting the health and well-being of female police officers. By addressing these issues, transformative action can be taken to create safer, more supportive, and healthier working environments for female police officers.

Abstract Background Social prescribing is gaining traction internationally. It is an approach which seeks to address non-medical and health-related social needs through taking a holistic person-centred and community-based approach. This involves connecting people with and supporting them to access groups and organisations within their local communities. It is hoped that social prescribing might improve health inequities and reduce reliance on healthcare services. In the UK, social prescribing link workers have become core parts of primary care teams. Despite growing literature on the implementation of social prescribing, to date there has been no synthesis that develops a theoretical understanding of the factors that shape link workers’ experiences of their role. Methods We undertook a meta-ethnographic evidence synthesis of qualitative literature to develop a novel conceptual framework that explains how link workers experience their roles. We identified studies using a systematic search of key databases, Google alerts, and through scanning reference lists of included studies. We followed the eMERGe guidance when conducting and reporting this meta-ethnography. Results Our synthesis included 21 studies and developed a “line of argument” or overarching conceptual framework which highlighted inherent and interacting tensions present at each of the levels that social prescribing operates. These tensions may arise from a mismatch between the policy logic of social prescribing and the material and structural reality, shaped by social, political, and economic forces, into which it is being implemented. Conclusions The tensions highlighted in our review shape link workers’ experiences of their role. They may call into question the sustainability of social prescribing and the link worker role as currently implemented, as well as their ability to deliver desired outcomes such as reducing health inequities or healthcare service utilisation. Greater consideration should be given to how the link worker role is defined, deployed, and trained. Furthermore, thought should be given to ensuring that the infrastructure into which social prescribing is being implemented is sufficient to meet needs. Should social prescribing seek to improve outcomes for those experiencing social and economic disadvantage, it may be necessary for social prescribing models to allow for more intensive and longer-term modes of support.

Background: Synthesis studies are used for the retrieval, review, synthesis, analysis, and integration of the findings of original studies. The purpose of this review was to shed more light on how meta-ethnography works as a method of inductive and interpretative knowledge synthesis, and on its application and implementation in medical sciences.Methods: This was a narrative review study and the statistical population included all scholarly publications on the synthesis of qualitative studies and meta-ethnography published from 1998 to 2022. The search in international and domestic databases led to the extraction of 118 books and articles. After reviewing the titles, abstracts, and full texts of these publications, we included 2 books and 8 articles in the review.Results: Meta-ethnography is used for synthesizing the knowledge obtained from qualitative studies to re-conceptualize their findings. There are seven phases in the process of meta-ethnography: Getting started; Deciding on what is of initial interest; Reading the studies; Determining how the studies are related; Translating the studies to each other; Synthesizing the translations; and expressing the synthesis. The number of studies required to perform meta-ethnography has been recently suggested to be 40. Strategies for updating meta-ethnography include repeating the previous strategy and reformulating the strategy according to a new objective, a revised review question, or new inclusion criteria.Conclusion: Noblit and Hare introduced meta-ethnography in 1988 as a qualitative research method for the synthesis of educational ethnographies. Today, it is widely used in healthcare research.

Aims Design Methods Data Sources Results Conclusions Implications for the Profession and/or Patient Care Reporting Method To examine immigrant and minority parents' experiences of having a newborn infant in the neonatal intensive care unit and explore healthcare professionals' experiences in delivering care to immigrant and minority families.A meta‐ethnographic review informed by eMERGe guidelines.We conducted a systematic literature review. Studies were included if they explored immigrant or minority parent experiences in neonatal intensive care units and health professional experiences delivering care to immigrant and minority families in neonatal intensive care. Reporting followed ENTREQ guidelines.Database searches included CINAHL, MEDLINE, PubMed, PsycINFO, Scopus and Google Scholar. Boolean search strategies were used to identify qualitative studies. No limitations on commencement date; the end date was 23rd August 2022. PRISMA guidelines used for screening and article quality assessed using Joanna Briggs Institute criteria for qualitative studies.Initial search yielded 2468 articles, and nine articles met criteria for inclusion. Three overarching themes were identified: (1) Overwhelming Emotions, (subthemes: Overwhelming Inadequacy; Cultural Expressions of Guilt; Not Belonging), (2) Circles of Support, (subthemes: Individual Level‐Spirituality; External Level‐Connecting with Family; Structured Peer‐to‐Peer Support), (3) Negotiating Relationships with Healthcare Professionals (subthemes: Connecting; Disconnected; Linguistic Barriers). Interactions between healthcare professionals and immigrant and minority parents were the strongest recurring theme.There can be a mismatch between immigrant and minority families' needs and the service support provided, indicating improvements in neonatal intensive care are needed. Despite challenges, parents bring cultural and family strengths that support them through this time, and many neonatal intensive care staff provide culturally respectful care.Professionals should be encouraged to identify and work with family strengths to ensure parents feel supported in the neonatal intensive care unit. Findings can inform policy and practice development to strengthen health professionals capabilities to support immigrant and minority families in neonatal units.The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklists were used to report the screening process. [ABSTRACT FROM AUTHOR]

Introduction: Widening participation in education by including students from underrepresented groups has been recognized as important for the last decade. During the recent pandemic, the interest in how to make students from different backgrounds feel part of the university, and connected to their studies and peers, has become an even more widespread concern and therefore important to explore further. The aim of our study was to develop a conceptual model for educational design to support student engagement and participation, by exploring pedagogical aspects recognized as being valuable during widening participation initiatives. Methods: We used meta-ethnography following the recommended seven steps: getting started, developing a search strategy, reading and assessing the quality of the papers, analyzing how the different studies related to each other based on the interpretation of quotations of the informants (first order) and the researchers of the articles (second order), translating the meaning of the studies, developing a line of argument, and finally developing a conceptual model to express the synthesis. Three databases we used: PubMed, ERIC, and Scopus; the PRISMA workflow was used. Results: Six articles with a qualitative approach were included. A conceptual model was developed with the theme 'Scaffolding Strategies' and four sub-themes: Academic Support, Social Interaction, Processing Expectations and Clarifying Learning Progress. Conclusion: We developed a conceptual model from previous studies that entailed aspects of particular importance to support widening participation. By using scaffolding strategies in course design, teachers and students may collectively improve the learning environment to promote widening participation, through clear instructions and frequent interaction, communication and calibration of expectations, clarification of learning processes and progress, and support for academic-skills development. Furthermore, the importance of using academic support and social interaction between students and teachers early on, to encourage students to explore how to become an independent learner, is highlighted. [ABSTRACT FROM AUTHOR]

Public health nursing is grounded in public health ideologies and fundamental nursing values. Researchers have argued that ethical responsibility from the perspective of the nurse is an understudied phenomenon. This meta-ethnography provides in-depth knowledge of how public health nurses (PHNs) experience ethical responsibility when working to prevent injury and disease, and promote health and well-being in children, young people and their families. There are reciprocal findings across the 10 included studies. The findings reveal that these nurses often feel alone, have worries and uncertainties and are afraid of doing wrong. They describe unclear boundaries in their work, creating a heightened sense of responsibility. PHNs fight lonely battles. Yet they show courage and commitment and are ready to stand up and fight for children and families who do not receive adequate care. A line of argument is developed and the metaphorical phrase Chivalrous knights in moral armour is used to express the authors' overall interpretations of the findings. Reflection on the findings shows how the different dimensions of ethical responsibility are interconnected. The nurses' ethical sensitivity enables them to feel compassion for others and they show indignation when vulnerable others are not treated with dignity and respect. Indignation and compassion are interrelated, and when human life and dignity are threatened, the ethical demand to respond emerges. Indignation is a precursor to moral courage, and the nurses' moral sensitivity and respect for their clients emboldens them to stand up for vulnerable others. The findings also illustrate the paradoxical nature of freedom. Freedom of choice due to unclear boundaries heightens the nurses' sense of responsibility. This research is an important step in theory development and has implications for further research, education and practice. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods: We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings: We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion: Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem. [ABSTRACT FROM AUTHOR]

Point-of-care tests (POCTs) have become technological solutions for many global health challenges. This meta-ethnography examines what has been learned about the 'social lives' of POCTs from in-depth qualitative research, highlighting key social considerations for policymakers, funders, developers and users in the design, development and deployment of POCTs. We screened qualitative research examining POCTs in low- and middle-income countries and selected 13 papers for synthesis. The findings illuminate five value-based logics—technological autonomy, care, scalability, rapidity and certainty—shaping global health innovation ecosystems and their entanglement with health systems. Our meta-ethnography suggests that POCTs never achieve the technological autonomy often anticipated during design and development processes. Instead, they are both embedded in and constitutive of the dynamic relationships that make up health systems in practice. POCTs are often imagined as caring commodities; however, in use, notions of care inscribed in these devices are constantly negotiated and transformed in relation to multiple understandings of care. POCTs promise to standardize care across scale, yet our analysis indicates nonstandard processes, diagnoses and treatment pathways as essential to 'fluid technologies' rather than dangerous aberrations. The rapidity of POCTs is constructed and negotiated within multiple distinct temporal registers, and POCTs operate as temporal objects that can either speed up or slow down experiences of diagnosis and innovation. Finally, while often valued as epistemic tools that can dispel diagnostic uncertainty, these papers demonstrate that POCTs contribute to new forms of uncertainty. Together, these papers point to knowledge practices as multiple, and POCTs as contributing to, rather than reducing, this multiplicity. The values embedded in POCTs are fluid and contested, with important implications for the kind of care these tools can deliver. These findings can contribute to more reflexive approaches to global health innovation, which take into account limitations of established global health logics, and recognize the socio-technical complexity of health systems. [ABSTRACT FROM AUTHOR]

Background: Social prescribing is gaining traction internationally. It is an approach which seeks to address non-medical and health-related social needs through taking a holistic person-centred and community-based approach. This involves connecting people with and supporting them to access groups and organisations within their local communities. It is hoped that social prescribing might improve health inequities and reduce reliance on healthcare services. In the UK, social prescribing link workers have become core parts of primary care teams. Despite growing literature on the implementation of social prescribing, to date there has been no synthesis that develops a theoretical understanding of the factors that shape link workers' experiences of their role. Methods: We undertook a meta-ethnographic evidence synthesis of qualitative literature to develop a novel conceptual framework that explains how link workers experience their roles. We identified studies using a systematic search of key databases, Google alerts, and through scanning reference lists of included studies. We followed the eMERGe guidance when conducting and reporting this meta-ethnography. Results: Our synthesis included 21 studies and developed a "line of argument" or overarching conceptual framework which highlighted inherent and interacting tensions present at each of the levels that social prescribing operates. These tensions may arise from a mismatch between the policy logic of social prescribing and the material and structural reality, shaped by social, political, and economic forces, into which it is being implemented. Conclusions: The tensions highlighted in our review shape link workers' experiences of their role. They may call into question the sustainability of social prescribing and the link worker role as currently implemented, as well as their ability to deliver desired outcomes such as reducing health inequities or healthcare service utilisation. Greater consideration should be given to how the link worker role is defined, deployed, and trained. Furthermore, thought should be given to ensuring that the infrastructure into which social prescribing is being implemented is sufficient to meet needs. Should social prescribing seek to improve outcomes for those experiencing social and economic disadvantage, it may be necessary for social prescribing models to allow for more intensive and longer-term modes of support. [ABSTRACT FROM AUTHOR]

Purpose: Mentalization-based treatment (MBT) is a psychotherapeutic approach that aims to increase mentalizing capacity. The purpose of this meta-ethnography was to synthesize the available qualitative literature on MBT to allow for a more thorough understanding of the lived experience of those who have undergone this therapy. Design/methodology/approach: A systematic search of seven databases was carried out. The Critical Appraisal Skills Programme was used to appraise the papers suitable for inclusion. The data were synthesized using a meta-ethnographic approach in which the second-order constructs from each paper were translated and reinterpreted creating a line of argument synthesis. Findings: A total of 11 studies were included in the meta-ethnography. Three overarching themes were identified within the included papers which outlined that participant experience of MBT consisted of three different developmental stages. Navigating the therapeutic process describes the participant's experience of the therapeutic process of MBT. The processes of change in MBT outlined participant reports of mechanisms of change experienced in MBT. Mentalizing self and others described the experience of generalizing new knowledge and skills to the world outside of therapy and unveiled the impact that engaging in MBT had on participants. Originality/value: This meta-ethnography offers new insights into how clients experience MBT as a therapeutic process and offers suggestions for implementation in clinical practice as well as areas of focus for research of this therapeutic approach. [ABSTRACT FROM AUTHOR]

Aim: To synthesize and interpret existing qualitative research on the existential experiences of siblings of children with complex care needs. Design: Noblit and Hare's interpretive meta‐ethnography. Methods: The study has been registered in the international prospective register for systematic reviews (PROSPERO). Noblit and Hare's 7‐step procedure was followed and reciprocal translation was performed to analyse the data and develop a line of argument synthesis. Data Sources: A comprehensive systematic literature search of five databases, along with extensive manual searches, was completed in November 2022. The final sample comprised 18 studies published between 2010 and 2022. Results: A line of argument, expressed through an overarching metaphor, "balancing on life's ladder", illustrates the core findings of siblings' fluctuating experiences of existential well‐being, and encapsulates four third‐order themes: the emotional turmoil of siblings, interrupted family life, siblings strive to be themselves and siblings struggle to cope. Conclusion: Growing up with a sibling with complex care needs made children feel invisible, lonely and struggling to find the courage to cope. By adopting a lifeworld approach, nurses can become aware of healthy siblings' unmet needs. Future research is needed on how nurses can contribute to siblings' existential well‐being, in primary – and secondary health care settings. Implications: The study provides insight into siblings' existential experiences and factors improving their well‐being, enabling nurses to provide a more optimized lifeworld‐led clinical practice. Impact: Healthcare, nursing education and practice should be informed by the knowledge of existential issues. Nurses are well‐positioned to work alongside families to provide family‐centered care. Our findings have implications for health policies tailored to the needs of children with chronically ill siblings. Reporting Method: This review adheres to the Equator and improving reporting of meta‐ethnography (eMERGe) guidelines. Patient or Public Contribution: No patient or public contribution, because the data comprised previously published studies. [ABSTRACT FROM AUTHOR]

Background: Collaboration is a key factor influencing the quality and safety in patients transition between sectors. However, specific collaborative practices may give rise to conflict between hospital nurses and community nurses. Aims: To gain a deeper understanding of collaborative practices which have the potential to fuel tension in collaboration between hospital nurses and community nurses during discharge of older patients from hospital to homecare. Methods: A meta-ethnography approach was used in this study and a systematic literature search was conducted in 2022. Results: Five themes were identified in the analysis. These themes revealed how uncertainty, limited confidence in information and personal attitude in communication may fuel tension between hospital nurses and community nurses. Tensions arising from a negative loop emerged because of uncertainty, causing a growing rift between hospital nurses and community nurses, leaving them as opponents rather than collaborators. The authors suggest that policy makers and managers can break this loop by underpinning shared policies and awareness of common objectives. [ABSTRACT FROM AUTHOR]

As an engaging instructional approach, project-based learning has gained prominence as a means of adapting K-12 education to a changing world. However, research assessing the effectiveness of project-based learning has primarily focused on teachers, whereas studies on students' perceptions of project-based learning have been limited to isolated cases. This review aimed to provide a comprehensive synthesis of qualitative and mixed-approach studies that investigated K-12 students' perceptions of project-based learning. A metaethnography approach was employed to identify, evaluate, and combine the findings of the 14 peer-reviewed studies. These studies were selected based on an extensive search of databases such as Web of Science, ERIC, and ScienceDirect. Six themes were identified to reflect K-12 students' perceptions of project-based learning: enhancing 21st-century skills, enhancing enthusiastic engagement, fostering interdisciplinary integration, time consumption, evoking initial jitter, and content insufficiency. Additionally, two research gaps were identified, with the majority of studies conducted among senior high school students in Europe and Asia. In conclusion, this synthesis highlights the effectiveness of project-based learning in promoting essential contemporary skills. However, caution is advised regarding challenges, such as content insufficiency. Stakeholders should consider targeted support and resource adequacy to optimize project-based learning benefits for diverse students. [ABSTRACT FROM AUTHOR]

Some autistic people use strategies to hide autistic behaviour and appear more neurotypical. Previous research has linked this 'social camouflaging' with mental health difficulties. This review synthesised qualitative research to explore the relationship between camouflaging and mental health. Thirteen studies were systematically identified, appraised and synthesised using meta-ethnography. Four third-order concepts were developed, describing camouflaging as an attempt to cope with stressful social contexts which impact mental health. Many autistic people experienced unintended negative consequences of their camouflaging that increased stress. Potential mechanisms for the relationship between camouflaging and mental health related to the qualities of the strategies that were used. Camouflaging strategies that were superficially 'successful' involved high levels of self-monitoring, were highly cognitively demanding or highly habitual and appeared more linked to poor mental health. This should be investigated in future research and has potential implications for how clinicians support autistic people with mental health difficulties. Some autistic people describe trying to hide autistic behaviour and seem more neurotypical. Researchers called this 'social camouflaging' and have linked it with mental health difficulties. We used a step-by-step approach to identify research where autistic people talk about social camouflaging to explore the relationship between camouflaging and poor mental health. Thirteen studies were combined. The results describe how society negatively impacts autistic people's mental health, and camouflaging is a way to try and cope with this. Many autistic people find their camouflaging strategies have accidental negative consequences which also affect their mental health. Strategies which seemed 'successful' involved a lot of self-monitoring, were very mentally demanding or were very habitual and seemed to have more of an effect on mental health. This might be important for clinicians who support autistic people with mental health difficulties. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Despite increased awareness of the detrimental relationship between homelessness and health, people experiencing homelessness remain an underserved population in health and social care research. Due to barriers affecting the accessibility of medicine and healthcare services, as well as reported competing priorities such as food and shelter, evidence has demonstrated that people experiencing homelessness are less likely to undergo routine examinations, receive diagnoses and adhere to prescribed medical treatments. To enhance service design and access for those experiencing homelessness, it is critical to better recognise, understand and address the barriers these individuals face. This meta‐ethnography aims to identify barriers, enablers and interventions to begin addressing this inequality gap. Methods A systematic literature search was undertaken in October and re‐ran in December 2023 across four databases: MEDLINE, Embase, CINAHL and Scopus. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines and health service inequalities among populations experiencing homelessness. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta‐ethnographic approach, as outlined by Noblit and Hare. The review was registered on PROSPERO (CRD42024511502) and performed according to PRISMA guidelines. Results This meta‐ethnographic systematic review synthesised data from eight studies across multiple countries. Three overarching third‐order constructs (termed ‘themes’) were developed through reciprocal translation and centred around: recognising and acknowledging the discrimination, stigma and barriers experienced when using current services; exploring safe and practical use of medicines and the promotion of general health education and appreciating strategies to tackle inequalities, namely community outreach programmes designed for homeless communities. Conclusion This work highlighted the barriers, enablers and interventions that sought to address the inequalities affecting people experiencing homelessness in accessing medication and healthcare services. Future research should utilise lived‐experience narratives and co‐design to further explore ways to tackle wider healthcare accessibility inequalities for this minoritised population. Trial Registration Not applicable, as this is a systematic review. Patient or Public Contribution Public contributors (minority research champions and one public health research champion, H.K.G. and T.G.) informed and shaped this project during study design and conceptualisation. They helped to ensure that the study was conducted, and the findings were reported with sensitivity.

Abstract Aim Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods Six databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990). Findings Ten studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance. Discussion/ conclusion Key areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life.

ABSTRACTGlobally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare’s approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users’ needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries’ disaster mental health response and to invest in quality care, particularly for marginalized groups.

AbstractObjectiveMethodsResultsConclusionThis systematic review and meta-ethnography aimed to examine how children, adults and families cope with Tourette’s syndrome (TS).A systematic search of four databases was completed in October 2022. Sixteen papers met the inclusion criteria and were synthesised using Noblit and Hare’s (1988) meta-ethnographic approach.Three themes were constructed: redefining the self and social identity, controlling the visible presentation of Tourette’s syndrome, and challenging the narrative.Findings indicate that coping involves the need to integrate TS with identity, to exert control over tics and to challenge the misrepresentations of TS in wider society. A supportive environment provided by parents and friends enables individuals to feel proud that they can control their tics, and this allows for the positive integration of TS into identity. Raising awareness at a societal level through educational campaigns is important when aiming to improve coping with a stigmatised condition. Further research is recommended, for example, to understand how common co-occurring conditions, such as attention deficit hyperactivity disorder, impact coping. [ABSTRACT FROM AUTHOR]

Introduction: Portfolio with a collection of evidence has become popular in higher education, including dental education. It is valuable to study the experiences of the use and implementation processes. Meta‐ethnography can be a suitable method to analyse, synthesize and construct interpretations of qualitative research. Our aim was to explore experiences from the use of a portfolio/e‐portfolio in dental education, from the students' and teachers' perspectives. Materials and Methods: A systematic search in the databases PubMed, Scopus and ERC was performed, and the established seven steps of a meta‐ethnographic review were used. 278 papers were initially identified, and seven were included in the final analysis. Results: Two themes (Issues to Address and Consequences) and five subthemes (Purpose, Roles, Support and Structure, Challenges and Enablers, and Gains) were constructed. Discussion: Our synthesis reflects various challenges, yet the learning gains are recognized and expressed to be important once the students and teachers have overcome early thresholds. Beyond the conclusions drawn in each paper, our synthesis provides new perspectives on the complexity of an implementation process and the balance of not seeing the woods for the trees being overwhelmed by technical and other practical aspects, reducing the opportunity for learning. Conclusion: The portfolio implementation in undergraduate dental education should address clarification to all stakeholders of the purpose and role, presenting a purposeful portfolio structure and timely support. [ABSTRACT FROM AUTHOR]

Supporting children to be digitally resilient when facing online adversity is an increasingly important developmental task. However, conceptual knowledge underpinning digital resilience and how this operates among children and across their home, community and societal contexts is embryonic. A systematic review and meta-ethnography of research focusing on the understandings and experiences of digital resilience of children aged 8–12, their parents and educators identified 11 studies conducted since 2011 across 14 countries. Four main themes, 'Using connective technologies', 'Risky online experiences', 'Mediation strategies' (comprised of sub-themes 'Proactive coping' and 'Reactive coping'), and 'Risk and protective factors' were constructed from our translation of first- and second-order constructs, with the overarching theme ' Constant balancing ' cross-cutting these themes. We argue one cannot have risky online experiences without the potential to develop digital resilience and vice versa. Insofar as current conceptualisations of digital resilience underestimate the role played by wider contexts, important knowledge gaps are highlighted. [ABSTRACT FROM AUTHOR]

GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was developed to support the use of evidence from qualitative reviews within policy- and decision-making. To date, the approach has been applied predominantly to aggregative synthesis methodologies and descriptive review findings. GRADE-CERQual guidance recommends the approach be tested on more diverse review methodologies and outputs to support its evolution. This paper contributes to this evolution by reflecting on our experiences of applying GRADE-CERQual to findings that emerged from a recent Cochrane meta-ethnography on childhood vaccination. Specifically, we describe the similarities and differences, challenges and dilemmas we experienced applying the approach to more interpretive versus more descriptive review findings. We found that we were able to apply the core criteria and principles of GRADE-CERQual in ways that were congruent with the methodologies and epistemologies of a meta-ethnography and its findings. We also found that the practical application processes were similar across review finding types. The main differences related to the level of demand placed on the evidence and the level of complexity involved with the decisions. Compared to more descriptive findings, more interpretive findings required evidence that was richer, thicker, more contextually situated and methodologically stronger for us to have the same level of confidence in them. Making the assessments for these findings also involved more complicated forms of judgement. We provide practical examples to illustrate these complexities and how we approached them, which others applying GRADE-CERQual to more interpretive review findings could draw upon. We also highlight areas requiring further discussion, in the hope that this will offer a platform for engagement and the potential future refinement of the approach. Ultimately, this could enhance the usability of GRADE-CERQual for a larger range of qualitative review findings and in turn expand the kinds of knowledges that count within decision-making. [ABSTRACT FROM AUTHOR]

Breast cancer is associated with adverse physical and psychological consequences. Although research has identified the various benefits linked to psychosocial interventions, mixed results have been found in relation to peer support. The aim of the present systematic review and meta‐ethnography is to explore the qualitative evidence on the experience of breast cancer survivors in peer support. A systematic search of the literature was conducted until June 2023, and a meta‐ethnographic approach was used to synthesize the included papers. Eleven articles were included, collecting the experience of 345 participants. The following four core areas involved in peer support implementation were identified from the synthesis: Peer support can create understanding and a mutual therapeutic and emotional connection; peer support can facilitate an educational and supportive patient‐centered journey; peer support should monitor group members for unpleasant emotional experiences; peer support should have professional supervision of recruitment and training to prioritize quality. These results can be used as patient‐centered insights by healthcare professionals to provide evidence‐informed peer support programs and address current limitations in the field. [ABSTRACT FROM AUTHOR]

Objective: The objective of this review was to establish a modified meta-ethnography framework by integrating the traditional phases with methods from social constructivist grounded theory. The modified version was required to identify methods which can ensure analytic generalisability and honour critical inquiry. Method: A narrative synthesis review was undertaken using 4 electronic databases. Articles were located that described the methods and methodologies of meta-ethnography and social constructivist grounded theory. A synthesis was undertaken which integrated the methods of social constructivist grounded theory. Results: The meta-ethnography was undertaken in 5 phases: (1) The positionality of the researcher and the area of interest identified. (2) Identifying what is relevant. (3) Reading the included studies and determining how studies are related. (4) The iterative process of idea generation required for theory generation. And (5) Expression of the theory, model, or process. Conclusion: The current review has been able to create a social constructivist meta-ethnographic framework for reviewing empirical qualitative research. This framework will support the development of a substantive theory (a theory in one area) which can be used then to consider its application in other areas. This approach will help create new lines of research and aid the explanation of problems in other areas. [ABSTRACT FROM AUTHOR]

Background: Being subjected to or witnessing coercive measures in mental health services can have a negative impact on service users, carers and professionals, as they most often are experienced as dehumanising and traumatic. Coercion should be avoided, but when it does happen, it is important to understand how the experience can be processed so that its consequences are managed. Method: A systematic review and meta-ethnography was used to synthesise findings from qualitative studies that examined service users', staff's and relatives' experiences of recovery from being exposed to coercive measures in mental health care settings. We identified, extracted and synthesised, across 23 studies, the processes and factors that were interpreted as significant to process the experience. Results: Recovery from coercion is dependent on a complex set of conditions that support a sense of dignity and respect, a feeling of safety and empowerment. Being in a facilitating environment, receiving appropriate information and having consistent reciprocal communication with staff are the means through which these conditions can be achieved. People employ strategies to achieve recovery, both during and after coercion, to minimise its impact and process the experience. Conclusions: The findings point to the importance of mental health care settings offering recovery-oriented environments and mental health professionals employing recovery-oriented practices, that would empower service users to develop strategies for managing their mental distress as well as their experiences in mental health care in a way that minimises traumatisation and fosters recovery. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATIONTo identify and synthesize qualitative literature on the experiences of participants and key stakeholders in dance programs for people living with Parkinson’s disease. Synthesizing the available literature can generate new insights into participant experience to inform current and future programs.Qualitative and mixed methods studies were identified via a systematic search of six databases: CINAHL, Web of Science, Scopus, SPORTDiscus, PsycInfo, and MEDLINE. Articles were synthesized using the meta-ethnographic method developed by Noblit and Hare (1988). Key concepts across studies were related via reciprocal translation, ultimately forming a line-of-argument synthesis.26 articles met the inclusion criteria. Four interrelated, overarching themes were developed: (1) dance communities provide peer support and insight into living with Parkinson’s, (2) feeling safe, accepted, and included in the dance experience, (3) overcoming dance-based challenges contributes to sense of achievement, confidence, and connectedness, and (4) dance participation is an opportunity to re-imagine oneself.Participant experience is shaped by the instructor-participant relationship, the social environment of classes, and class difficulty level. In order to support participant experience, classes should be safe, supportive, and have an appropriate challenge-skill balance. These qualities facilitate creative immersion and the potential for personal and collective change.Physical activity can improve functional ability and quality of life in people living with Parkinson’s disease (PD).Dance is a safe, enjoyable form of physical activity for people with PD that creates opportunities for meaningful social engagement and artistic expression.The quality of the instructor-dancer relationship, the wider social environment, and the challenge-skill balance contribute to dancer experience.For a dance class for people with PD to be successful, it must be safe, socially accepting, and provide opportunities for dancers to experience positive growth and a sense of achievement.Physical activity can improve functional ability and quality of life in people living with Parkinson’s disease (PD).Dance is a safe, enjoyable form of physical activity for people with PD that creates opportunities for meaningful social engagement and artistic expression.The quality of the instructor-dancer relationship, the wider social environment, and the challenge-skill balance contribute to dancer experience.For a dance class for people with PD to be successful, it must be safe, socially accepting, and provide opportunities for dancers to experience positive growth and a sense of achievement. [ABSTRACT FROM AUTHOR]

Aim Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30days. Interventions to reduce older adults’ risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the efectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults’ experiences of transition to the community from the ED. Methods Six databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise fndings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990). Findings Ten studies were included, and synthesis led to the development of fve themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult’s ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance. Discussion/ conclusion Key areas for consideration in future service and intervention development are identifed in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults’ changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hospitals streamline treatment pathways to reduce the length of time older adults admitted for planned procedures spend in hospital. However patient perspectives have been poorly evaluated. This systematic review aimed to understand the experiences of older patients, carers, families and staff of multi‐component interventions intended to improve recovery following elective treatment. Research Design and Methods: Bibliographic databases searched in June 2021 included MEDLINE ALL, HMIC, CENTRAL, CINAHL, AMED and ProQuest Dissertations and Theses. We conducted citation searching and examined reference lists of reviews. Two reviewers independently undertook screening and data extraction, resolving disagreements through discussion. We used an adapted Wallace checklist for quality appraisal and meta‐ethnography to synthesise data. Clinician, carer and patient views were incorporated throughout the review. Results: Thirty‐five papers were included in the synthesis. Thirteen studies were conducted in the UK, with patient views the most frequently represented. We identified six overarching constructs: 'Home as preferred environment for recovery', 'Feeling safe', 'Individualisation of structured programme', 'Taking responsibility', 'Essential care at home' and 'Outcomes'. Discussion and Implications: Findings explore the support patients, families and carers need throughout hospital admission, and may inform commissioning of services to ensure patients and carers receive appropriate follow‐up support after hospital discharge. The findings may help hospital and community‐based health and social care staff provide person‐centred care based upon assessments of emotional and physical wellbeing of patients and family/carers. Research is needed to establish a core‐set of patient‐reported outcome measures which capture aspects of recovery which are meaningful to patients. [ABSTRACT FROM AUTHOR]

Background Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management. Objectives To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as ‘good’ pain management. Design Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies’ findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children’s chronic non-cancer pain. Results We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members’ well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children’s education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. Limitations There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals. Conclusions We developed the family-centred theory of children’s chronic pain management, integrating health and social care with community support. Future work Future research should explore families’ experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services. Study registration This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information. Plain language summary Chronic pain lasting 3 months or more affects at least 8% of children in the UK. It causes difficulties with many aspects of children’s lives including relationships, school attendance and use of National Health Services. In the UK, there are few specialist services and a lack of high-quality research for managing children’s chronic pain. Our study aimed to locate and pull together existing research on the experiences and views of children with chronic pain and their families. We wanted to find out how they think about and live with chronic pain, and their views and experiences of services and treatments, and what they want to achieve from them. We conducted this study alongside children with chronic pain and their families, charities, healthcare professionals and academic experts. They helped us to conduct the study and to ensure our findings are relevant to children, families and the National Health Service. We pulled together data from 43 studies that best answered our questions. We found that moderate and severe children’s chronic pain that was not well managed affected the whole family, including their relationships and social lives. Families found it difficult to get help and a diagnosis from health services. Most families wanted a medical cure for pain. Families had long waits for answers and treatment but gradually realised there may be no cure, so they focused on living well with pain or gave up hope. Children and families from ethnic minority groups or with a learning disability experienced discrimination. Few studies focused on children under 5 years old, children with learning disabilities or experiences of services. Families need a pain management approach tailored to the whole family’s needs involving schools, social care and health services. Our findings could improve treatment guidelines, training of health and social care professionals and service design and treatments. Scientific summary Background Chronic pain in childhood is widespread, affecting at least 8% of children and young people (CYP) in the UK. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on children’s lives and quality of life and leads to increased use of healthcare services and medication. Treating adolescent pain alone has an annual cost of around 4 billion pounds in the UK. Provision of, and access to, services for managing children’s chronic pain is limited. We also do not know which treatment outcomes children and families value. To design and deliver services and treatments, which meet the needs of patients and their families, it is vital that we understand how children with chronic non-cancer pain and their families experience chronic pain, pain treatments and services, and which outcomes are important to them. Qualitative research addressing these urgent, important issues exists but must be synthesised to interpret the body of evidence. Existing qualitative evidence syntheses have focused on either a narrow chronic pain population or topic and none produced a theory. Therefore, we conducted a qualitative evidence synthesis using meta-ethnography, which is ideal for synthesising the diverse contexts of children’s chronic pain research and developing theory. We refer to the meta-ethnography by the acronym ‘CHAMPION’ (Children And young people’s Meta-ethnography on Pain). The meta-ethnography was conceived as a Cochrane review to inform and supplement existing Cochrane reviews of intervention effectiveness for children’s chronic pain. Cochrane requires qualitative evidence syntheses to be integrated with intervention effects reviews to further understanding of patient experiences, acceptability and implementation of interventions, which outcomes are important to children and their families, and inform further intervention development. Aim To conduct a meta-ethnography on the experiences and perceptions of CYP with chronic pain, and their families, of chronic pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. Review questions How do children with chronic pain and their families conceptualise chronic pain? How do they live with chronic pain? What do they think of how health and social care services respond to and manage their/their child’s chronic pain? What do they conceptualise as ‘good’ chronic pain management and what do they want to achieve from chronic pain management interventions and services? Objectives Conduct comprehensive searches to identify qualitative research literature on the experiences and perceptions of children with chronic pain and their families to address review questions 1–4. Select and synthesise relevant studies using meta-ethnography. Ensure salience of findings via involvement of children with chronic pain and their families in study design, analysis and interpretation. Assess how much confidence can be placed in our synthesised findings using GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research) in order to facilitate use of our findings for NHS decision-making. Identify research gaps regarding review questions 1–4 in order to inform future research directions. Integrate our findings with existing relevant Cochrane treatment effectiveness reviews in order to determine if programme theories and outcomes of interventions match children and their families’ views. Inform the selection and design of patient-reported outcome measures for use in chronic pain studies and interventions and care provision to children and their families. Disseminate findings to academic, clinical, lay and policy audiences to influence childhood chronic pain policy and practice. Methods Design We conducted a meta-ethnography, a seven-phase interpretive methodology, which takes into account the contexts and meanings of the original studies. Patient and public involvement Patient and public involvement (PPI) of children with chronic non-cancer pain and their families was fundamental to all aspects of our meta-ethnography conduct from study inception to dissemination. We also worked with a Project Advisory Group of wider stakeholders. The groups approved the aim and design and search strategy. They participated in workshops to decide study inclusion and sampling criteria decisions, how to group studies for analysis, data interpretation, identification of research gaps and to develop outputs. They also informed and assisted with dissemination of findings. Review strategy We carried out comprehensive searches of 12 bibliographic databases including MEDLINE (medical literature analysis and retrieval system online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycInfo and 9 others, with iterative supplementary searches, including citation tracking. We searched for studies that had been published up to September 2022. Selection criteria To identify qualitative research studies with children aged 3 months to 18 years with chronic non-cancer pain, and their families, which focused on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with our PPI group. We included qualitative research studies of any design using recognisable qualitative methods of data collection, in any language, with no date restrictions. We did not include children with chronic pain related to cancer or end of life because they have distinct care pathways; Cochrane reviews of effects also synthesise non-cancer pain separately. Data collection and analysis Eligible studies were purposively sampled to ensure we could conduct an in-depth, synthesis of the data most relevant to answering our review questions. Sampling, organising studies for synthesis and analysis and interpretation involved our PPI group via two workshops and additional communication by teleconference, e-mail and social media. ‘Conceptually rich’ and ‘thick’ studies, that is, those with in-depth explanatory/interpretive findings and contextual details, were included. Sampling was guided by Cochrane Qualitative and Implementation Methods Group Guidance, and our advisory and involvement groups who agreed we should include non-UK studies and studies with moderately rich data to ensure a wider range of pain conditions were represented. We assessed methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus and characteristics into Microsoft Excel® and findings using NVivo software. We compared these study data to determine how studies related to one another and decided how to order and group them for synthesis. Stakeholders and our PPI group agreed we should group studies by pain condition. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Our PPI group clarified the meaning of ambiguous study findings and identified and addressed gaps in the data. We used the GRADE-CERQual approach to assess our confidence in each key review finding and used a matrix approach to integrate our findings with 14 existing Cochrane reviews on treatment effectiveness for children’s chronic non-cancer pain. Results One hundred and seventy studies met inclusion criteria. We sampled and synthesised 43 most relevant conceptually rich and thick studies, which had minor (n = 24) or moderate (n = 19) methodological limitations overall. Using GRADE-CERQual, we rated 36 descriptive-level review findings as high (n = 22) or moderate (n = 13) confidence with only one very low confidence. Twenty-three included studies were conducted in the UK, 17 in other high-income countries and 4 in low- to middle-income countries (there is a three-country study, so the total does not add to 43 studies). Included studies involved 325 CYP with chronic pain, most aged 10 years or older, and 308 family members, mostly mothers. The studies covered chronic pain conditions including complex regional pain syndrome, juvenile idiopathic arthritis, sickle cell disease, headache, migraine, abdominal pain, musculoskeletal pain, epidermolysis bullosa, dysmenorrhoea, neurological conditions such as cerebral palsy, unspecified chronic pain or a mix of conditions. Moderate and severe children’s chronic pain had profound adverse impacts on the whole family, family life and their wider social connections. Pain affected all aspects of an individual’s and a family’s functioning: family dynamics and relationships; family members’ emotions, well-being, autonomy and a sense of self-identity; parenting strategies; friendships and socialising; children’s education and future employment prospects; and parental employment. Families experienced difficulties in seeking and getting help and support from health services to manage their child’s pain and its impacts. Most pain management occurred outside of health services supervised by parents, especially mothers who were usually the main caregivers. Children and young people and their families were aware of the biopsychosocial (physical/biological, psychological and social) impacts of chronic pain on their lives. However, most CYP and parents understood the cause of chronic pain as having solely an underlying biological cause. This influenced their expectations of, and interactions with, health services. However, families’ conceptualisations of pain were dynamic and could change over time influenced by experiences of treatments, services and interactions with healthcare professionals. Interactions with healthcare professionals were frequently negative and stressful. CYP and parents, particularly mothers, felt they were not listened to and believed, and thus felt unsupported. For instance, CYP’s experiences of living with pain were ignored or their pain was disbelieved, and mothers felt blamed for their child’s pain. Parents of younger children and of children with communication difficulties, in particular, perceived that healthcare professionals did not always recognise their expertise in assessing their child’s pain. A key challenge for children and their families was that they found health services fragmented and very difficult to navigate. Consequently, it was difficult to achieve satisfactory pain management. Families often entered a lengthy cycle, which could last many years, of attending then reattending health services, and awaiting referral. In addition to these navigation challenges, CYP and their families, particularly CYP with sickle cell disease and those with chronic pain and learning disabilities, such as Down syndrome, experienced prejudice and discrimination in health services. We created a model of how families navigate chronic management with two key routes labelled Path A and B. On Path A, families seek a cure from services but often repeatedly seek services without pain resolution. When their expectations of services are not met, they try to deal with pain alone, often unsuccessfully, which can dominate family life. Psychological treatments are only used as a last option. Path B depicts effective communication and expectation management by healthcare professionals which can help families to shift their focus from a cure to trying to live well despite the pain. Families might also realise independently over time that a cure is unlikely. Families on Path B tend to be more receptive to biopsychosocial approaches for pain management, due to lack of other options. Families can move between the paths depending on input from services and if pain worsens. We developed new interpretive findings resulting in the family-centred theory of children’s chronic pain and its management, which incorporates how children and families conceptualise pain, their experiences of living with pain and of pain management services, and defines ‘good’ pain management and services. Our mid-range theory describes good pain management and services as holistic, biopsychosocial, family-centred pain management which acknowledges the impact of CYP’s chronic pain on all aspects of family life and their social relationships. In the theory, pain management strategies are tailored to the family’s needs. Schools, social services, social care and healthcare services function as inter-related aspects in a whole system approach. This approach aims to reduce service fragmentation making services more intuitive for families. Empathetic communication is a core component of this approach, and it is fundamental for building trust between families and services. The theory includes assessment of chronic pain and of families’ psychosocial needs to enable effective triage and trigger appropriate actions from/referrals to different services (schools, social care and health services). Cochrane systematic reviews of intervention effects and trials did not measure some outcomes important to children and families, including effects of chronic pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. Limitations There were few conceptually rich qualitative studies focusing on common pain conditions like migraine, headache, abdominal pain; some rarer conditions; children with learning disabilities and under 5 years old; siblings; boys with chronic pain; fathers; and experiences of treatments/services for chronic pain. Our findings may not well represent the experiences and perceptions of the poorly represented groups and there were gaps in the evidence regarding experiences and perceptions of treatments/services. Three per cent (n = 1) of our findings were assessed as very low confidence, none were low confidence and 36% (n = 13) were moderate confidence, using GRADE-CERQual. Additional evidence could increase our confidence in those findings. We excluded studies focusing on chronic cancer pain, end-of-life pain management and experiences of healthcare professionals. Conclusions Currently, children’s chronic pain management does not involve holistic, biopsychosocial health and social care tailored for children and integrated with support in the community, which considers the needs of the entire family and the impact on the family life. The theory and findings developed in this meta-ethnography have the potential to contribute to the development and updating of existing clinical guidelines on children’s chronic non-cancer pain; inform training of health and social care professionals regarding children’s chronic pain management; and inform service, treatment and intervention design and delivery. Ultimately, this could improve the care provided and thus the health and quality of life of children with chronic non-cancer pain and their families, which in turn could reduce the burden on health and social care services. Findings are being disseminated widely to academic, lay, clinical and policy audiences. Outputs include a short, animated film on YouTube for children (https://youtu.be/Oz5I7xKYf5o), academic journal articles, a webinar, a lay podcast, an infographic, a policy briefing and other social media outputs. In addition, we have delivered eight conference presentations. Future work Family-centred outcomes should be included in future trials of chronic pain interventions. Conceptually rich, primary qualitative studies are needed to explore families’ experiences of services and treatments, including pain management plans, pain assessment, opioid use in children and social care services; experiences of children with autism and learning disabilities, under 5 years old, and with certain common pain conditions, such as headache, migraine and abdominal pain and with some rarer conditions such as Ehlers–Danlos syndrome; experiences of siblings and fathers of children with chronic pain; and healthcare professionals’ experiences and perceptions of chronic pain management. A qualitative evidence synthesis on chronic pain management for children with cancer is needed. Development and testing of family-centred children’s chronic pain interventions, services and treatments are needed. Study registration This study is registered as PROSPERO, the International Prospective Register of Systematic Reviews (reference: CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (review number 623). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.

Abstract Background Communication between patients and healthcare providers, and effective interprofessional communication, are essential to the provision of high-quality care. Implementing a patient-centred approach may lead to patients experiencing a sense of comfort, validation, and active participation in own healthcare. However, home-dwelling older adults’ perspectives on interprofessional communication (IPC) are lacking. The aim is therefore to explore how home-dwelling older adults experience communication in connection with the delivery of integrated care. Methods The meta-synthesis was conducted in line with Noblit and Hare’s seven phases of meta-ethnography. A systematic literature search was conducted by two university librarians in seven databases using the search terms ‘older adults’, ‘communication’, ‘integrated care’ and ‘primary care’. All articles were reviewed by two authors independently. 11 studies were included for analysis. Results Older adults are aware of IPC and have preferences regarding how it is conducted. Three main themes were identified in the reciprocal analysis: (1) Inconsistent care perceived as lack of IPC, (2) individual preferences regarding involvement and awareness of IPC and (3) lack of IPC may trigger negative feelings. Conclusions This meta-ethnography shows the perspective of older adults on IPC as part of integrated care. Our study shows that older adults are concerned about whether healthcare personnel talk to each other or not and recognise IPC as fundamental in providing consistent care. The perspectives of older adults are relevant for clinicians and politicians, as well as researchers, when developing and implementing future integrated care services for home-dwelling older adults.

Abstract Background Barriers to accessing hospice and palliative care have been well studied. An important yet less researched area is why people approaching the end-of-life decline a referral when they are offered services. This review focused on synthesising literature on patients in the last months of life due to a cancer diagnosis who have declined a referral to end-of-life care. Methods Six academic databases were systematically searched for qualitative literature published between 2007 and 2021. Two researchers independently reviewed and critically appraised the studies. Using meta-ethnographic methods of translation and synthesis, we set out to identify and develop a new overarching model of the reasons patients decline end-of-life care and the factors contributing to this decision. Results The search yielded 2060 articles, and nine articles were identified that met the review inclusion criteria. The included studies can be reconceptualised with the key concept of ‘embodied decisions unfolding over time’. It emphasises the iterative, dynamic, situational, contextual and relational nature of decisions about end-of-life care that are grounded in people’s physical experiences. The primary influences on how that decision unfolded for patients were (1) the communication they received about end-of-life care; (2) uncertainty around their prognosis, and (3) the evolving situations in which the patient and family found themselves. Our review identified contextual, person and medical factors that helped to shape the decision-making process. Conclusions Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients’ end-of-life care decision-making, in particular estimating how much time one has left and patients’ embodied knowing about when the right time for end-of-life care is. The multiple and intersecting domains of health that inform decision-making, namely physical, mental, social, and existential/spiritual as well as emotions/affect need further exploration. The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients.

Abstract Background Comprehensive geriatric assessment (CGA) is considered the gold standard approach to improving a range of outcomes for older adults living with frailty admitted to hospital. To date, research has predominantly focused on quantitative syntheses of the international evidence with limited focus on qualitative synthesis of stakeholder perspectives. This review aims to resolve this research gap by identifying and synthesising qualitative studies reporting multiple stakeholders’ experiences of inpatient CGA. Methods A systematic search of five electronic databases was conducted. Qualitative or mixed methods studies that included qualitative findings on the experiences of CGA in an inpatient hospital setting from the perspective of healthcare professionals (HCP), older adults, and those important to them were included. The protocol was registered on PROSPERO (Registration: CRD42021283167) and the 10-item Critical Appraisal Skills Programme checklist was used to appraise the methodological quality of included studies. Results were synthesised as a meta-ethnography. Results Eleven studies, which reported on the experiences of 153 HCPs, 91 older adults and 57 caregivers were included. The studies dated from 2011 to 2021 and three key themes were identified: (1) HCPs, older adults and caregivers report conflicting views on CGA as a holistic process, (2) most HCPs, but only some older adults and caregivers view CGA goalsetting and care planning as collaborative, and (3) all stakeholders value care continuity during the transition from hospital to home but often fail to achieve it. Conclusion While HCPs, older adults, and caregivers’ values and ambitions related to CGA broadly align, their experiences often differ. The identified themes highlight organisational and relational factors, which positively and negatively influence CGA practices and processes in an inpatient hospital setting.

Abstract Introduction Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the overall quality of care. Despite its importance, there is limited knowledge regarding patient engagement in the transition from nondialysis‐dependent chronic kidney disease (CKD) to dialysis‐dependent treatment. This systematic review employs meta‐ethnography to synthesize findings from qualitative studies examining patients' experiences of engagement during this transition, with the aim of developing a comprehensive theoretical understanding of patient engagement in the transition from nondialysis‐dependent CKD to dialysis. Methods A systematic search of six databases, namely the Cochrane Library, PsycINFO, Scopus, Embase, PubMed and Web of Science was conducted to identify eligible articles published between 1990 and 2022. Meta‐ethnography was utilized to translate and synthesize the findings and develop a novel theoretical interpretation of ‘patient engagement’ during the transition to dialysis. Results A total of 24 articles were deemed eligible for review, representing 21 studies. Patient engagement during a transition to dialysis was found to encompass three major domains: psychosocial adjustment, decision‐making and engagement in self‐care. These three domains could be experienced as an iterative and mutually reinforcing process, guiding patients toward achieving control and proficiency in their lives as they adapt to dialysis. Additionally, patient engagement could be facilitated by factors including patients' basic capability to engage, the provision of appropriate education, the establishment of supportive relationships and the alignment with values and resources. Conclusions The findings of this review underscore the necessity of involving patients in transitional dialysis care, emphasizing the need to foster their engagement across multiple domains. Recommendations for future interventions include the provision of comprehensive support to enhance patient engagement during this critical transition phase. Additional research is warranted to explore the effects of various facilitators at different levels. Patient or Public Contribution The studies included in our review involved 633 participants (547 patients, 14 family members, 63 healthcare providers and 9 managers). Based on their experiences, views and beliefs, we developed a deeper understanding of patient engagement and how to foster it in the future.

Background: The expressions of a "wish to hasten death" or "wish to die" raise ethical concerns and challenges. These expressions are related to ethical principles intertwined within the field of medical ethics, particularly in end-of-life care. Although some reviews were conducted about this topic, none of them provides an in-depth analysis of the meanings behind the "wish to hasten death/die" based specifically on the ethical principles of autonomy, dignity, and vulnerability. The aim of this review is to understand if and how the meanings behind the "wish to hasten death/die" relate to and are interpreted in light of ethical principles in palliative care. Methods: We conducted a meta-ethnographic review according to the PRISMA guidelines and aligned with Noblit and Hare's framework. Searches were performed in three databases, Web of Science, PubMed, CINAHL, with no time restrictions. Original qualitative studies exploring the meanings given by patients, family caregivers and healthcare professionals in any context of palliative and end-of-life care were included. A narrative synthesis was undertaken. PROSPERO registration CRD42023360330. Results: Out of 893 retrieved articles, 26 were included in the analysis, accounting for the meanings of a total of 2,398 participants. Several factors and meanings associated with the "wish to hasten death" and/or "wish to die" were identified and are mainly of a psychosocial and spiritual nature. The ethical principles of autonomy and dignity were the ones mostly associated with the "wish to hasten death". Ethical principles were essentially inferred from the content of included articles, although not explicitly stated as bioethical principles. Conclusions: This meta-ethnographic review shows a reduced number of qualitative studies on the "wish to hasten death" and/or "wish to die" explicitly stating ethical principles. This suggests a lack of bioethical reflection and reasoning in the empirical end-of-life literature and a lack of embedded ethics in clinical practice. There is a need for healthcare professionals to address these topics compassionately and ethically, taking into account the unique perspectives of patients and family members. More qualitative studies on the meanings behind a wish to hasten death, their ethical contours, ethical reasoning, and implications for clinical practice are needed. [ABSTRACT FROM AUTHOR]

Background: Barriers to accessing hospice and palliative care have been well studied. An important yet less researched area is why people approaching the end-of-life decline a referral when they are offered services. This review focused on synthesising literature on patients in the last months of life due to a cancer diagnosis who have declined a referral to end-of-life care. Methods: Six academic databases were systematically searched for qualitative literature published between 2007 and 2021. Two researchers independently reviewed and critically appraised the studies. Using meta-ethnographic methods of translation and synthesis, we set out to identify and develop a new overarching model of the reasons patients decline end-of-life care and the factors contributing to this decision. Results: The search yielded 2060 articles, and nine articles were identified that met the review inclusion criteria. The included studies can be reconceptualised with the key concept of 'embodied decisions unfolding over time'. It emphasises the iterative, dynamic, situational, contextual and relational nature of decisions about end-of-life care that are grounded in people's physical experiences. The primary influences on how that decision unfolded for patients were (1) the communication they received about end-of-life care; (2) uncertainty around their prognosis, and (3) the evolving situations in which the patient and family found themselves. Our review identified contextual, person and medical factors that helped to shape the decision-making process. Conclusions: Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients' end-of-life care decision-making, in particular estimating how much time one has left and patients' embodied knowing about when the right time for end-of-life care is. The multiple and intersecting domains of health that inform decision-making, namely physical, mental, social, and existential/spiritual as well as emotions/affect need further exploration. The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients. [ABSTRACT FROM AUTHOR]

Background: Communication between patients and healthcare providers, and effective interprofessional communication, are essential to the provision of high-quality care. Implementing a patient-centred approach may lead to patients experiencing a sense of comfort, validation, and active participation in own healthcare. However, home-dwelling older adults’ perspectives on interprofessional communication (IPC) are lacking. The aim is therefore to explore how home-dwelling older adults experience communication in connection with the delivery of integrated care. Methods: The meta-synthesis was conducted in line with Noblit and Hare’s seven phases of meta-ethnography. A systematic literature search was conducted by two university librarians in seven databases using the search terms ‘older adults’, ‘communication’, ‘integrated care’ and ‘primary care’. All articles were reviewed by two authors independently. 11 studies were included for analysis. Results: Older adults are aware of IPC and have preferences regarding how it is conducted. Three main themes were identified in the reciprocal analysis: (1) Inconsistent care perceived as lack of IPC, (2) individual preferences regarding involvement and awareness of IPC and (3) lack of IPC may trigger negative feelings. Conclusions: This meta-ethnography shows the perspective of older adults on IPC as part of integrated care. Our study shows that older adults are concerned about whether healthcare personnel talk to each other or not and recognise IPC as fundamental in providing consistent care. The perspectives of older adults are relevant for clinicians and politicians, as well as researchers, when developing and implementing future integrated care services for home-dwelling older adults. [ABSTRACT FROM AUTHOR]

Interdisciplinarity and transdisciplinarity are collaborative research modes that help advance science dealing with grand societal challenges. However, many factors still act as obstacles to high-impact research, showing disconnections between practices and policies. We can reasonably question whether we are still incapable of applying the correct methods to grasp interdisciplinary and transdisciplinary heterogeneity. This article aims to deepen the discussion of the methodological options for critically studying interdisciplinarity and transdisciplinarity. By applying meta-ethnography to the inter- and transdisciplinary academic literature, the paper inquires about the suitability of the method to study bodies of knowledge on interdisciplinarity and transdisciplinarity. Meta-ethnography is a seven-phase literature review type of meta-synthesis aimed at creating new understandings and theories from a body of work. Applying an autoethnographic approach, I show how meta-ethnography allows for the reconceptualisation of a disparate and dispersed body of literature, advancing current discussions on inter- and transdisciplinarity and their roles in science and policy. The approach outlined in the article is innovative because it contributes to two related realms: (i) it helps advance the field of inter- and transdisciplinary research and policy because it refines the methods available to study these multidimensional practices, and (ii) it offers an example of the further adaptability of meta-ethnography to new topics, such as the investigation of collaborative settings. I analyse six challenges in light of the scientific literature and conclude by focusing on the value meta-ethnography has for studying interdisciplinary and transdisciplinary research and propose two methodological innovations. [ABSTRACT FROM AUTHOR]

Functional neurological disorder (FND) causes many neurological symptoms and significant disability. It is often misunderstood by medical professionals and the public meaning stigma is regularly reported. The aim of this review was to synthesise the qualitative findings in the literature to develop a more in-depth understanding of how people with FND experience stigma to inform future interventions. This review used a meta-ethnography approach. Five databases were searched (PsycINFO, Web of Science, CINAHL, MEDLINE, and EMBASE) in February 2021 and updated in July 2022 for qualitative papers in FND. Included papers were critically assessed using the critical appraisal skills programme (CASP) checklist. Data were analysed and synthesised utilising meta-ethnography. Sixteen papers were included in the final synthesis. Four major themes emerged: stigmatized by delegitimization; stigmatized by social exclusion and rejection; coping with stigma; and stigma and identity. The results identified negative, stigmatizing attitudes towards people experiencing FND symptoms in a variety of contexts including healthcare and other social institutions. The effects of stigma led to further exclusion for participants and appeared to trigger coping styles that led to additional difficulty. Stigma is a key part of the illness experience of FND and needs to be addressed. Functional neurological disorders can cause a significant degree of disability for those individuals who experience them. This experience appears to be compounded by stigma these people encounter as a result of their illness in their day-to-day lives as well as in their contact with institutions including education, workplaces, and healthcare. A potential strategy to reduce the impact of stigma is through raising awareness of the reality of this condition which may be achieved through education targeted towards healthcare providers. [ABSTRACT FROM AUTHOR]

Introduction: There is a requirement for health and care systems and services to work on an equitable basis with people who use and provide integrated care. In response, co-production has become essential in the design and transformation of services. Globally, an array of approaches have been implemented to achieve this. This unique review explores multi-context and multi-method examples of co-production in integrated care using an exceptional combination of methods. Aim: To review and synthesise evidence that examines how co-production with service users, unpaid carers and members of staff can affect the design and transformation of integrated care services. Methods: Systematic review using meta-ethnography with input from a patient and public involvement (PPI) co-production advisory group. Meta-ethnography can generate theories by interpreting patterns between studies set in different contexts. Nine academic and four grey literature databases were searched for publications between 2012-2022. Data were extracted, analysed, translated and interpreted using the seven phases of meta-ethnography and PPI. Findings: A total of 2,097 studies were identified. 10 met the inclusion criteria. Studies demonstrated a variety of integrated care provisions for diverse populations. Coproduction was most successful through person-centred design, innovative planning, and collaboration. Key impacts on service transformation were structural changes, accessibility, and acceptability of service delivery. The methods applied organically drew out new interpretations, namely a novel cyclic framework for application within integrated care. Conclusion: Effective co-production requires a process with a well-defined focus. Implementing co-delivery, with peer support, facilitates service user involvement to be embedded at a higher level on the 'ladder of co-production'. An additional step on the ladder is proposed; a cyclic co-delivery framework. This innovative and operational development has potential to enable better-sustained person-centred integrated care services. [ABSTRACT FROM AUTHOR]

Care in the postnatal period is a goal for all families with a newborn baby, and support from nurses might prevent long-term health problems and contribute to a positive postnatal experience. This meta-ethnography aims to integrate and synthesize qualitative studies that illuminate and describe nurses' perspectives on municipal postnatal health care in high-income countries. Systematic literature searches for qualitative studies were conducted and 13 articles were included. The analysis followed the seven phases of Noblit and Hare. Being a "warrior" to care for the new family was identified as an overarching metaphor accompanied by three main themes: Stretching human boundaries, Stretching system boundaries, and Stretching knowledge boundaries. The overarching metaphor offers a deeper understanding of the nurses as "warriors" who despite tight timeframes and heavy workloads are stretching toward a caring relationship with the families. Being a warrior continuously pushing system boundaries puts the nurses in risk of being overstretched, balancing between their ideals and the reality. As more knowledge and clearer policies and procedures regarding the inclusion of fathers and LGBTQ parents in municipal postnatal healthcare are needed, more focus placed on the father or non-birthing parent, different cultural traditions and family constellations in practice and education is suggested. [ABSTRACT FROM AUTHOR]

Background: Comprehensive geriatric assessment (CGA) is considered the gold standard approach to improving a range of outcomes for older adults living with frailty admitted to hospital. To date, research has predominantly focused on quantitative syntheses of the international evidence with limited focus on qualitative synthesis of stakeholder perspectives. This review aims to resolve this research gap by identifying and synthesising qualitative studies reporting multiple stakeholders' experiences of inpatient CGA. Methods: A systematic search of five electronic databases was conducted. Qualitative or mixed methods studies that included qualitative findings on the experiences of CGA in an inpatient hospital setting from the perspective of healthcare professionals (HCP), older adults, and those important to them were included. The protocol was registered on PROSPERO (Registration: CRD42021283167) and the 10-item Critical Appraisal Skills Programme checklist was used to appraise the methodological quality of included studies. Results were synthesised as a meta-ethnography. Results: Eleven studies, which reported on the experiences of 153 HCPs, 91 older adults and 57 caregivers were included. The studies dated from 2011 to 2021 and three key themes were identified: (1) HCPs, older adults and caregivers report conflicting views on CGA as a holistic process, (2) most HCPs, but only some older adults and caregivers view CGA goalsetting and care planning as collaborative, and (3) all stakeholders value care continuity during the transition from hospital to home but often fail to achieve it. Conclusion: While HCPs, older adults, and caregivers' values and ambitions related to CGA broadly align, their experiences often differ. The identified themes highlight organisational and relational factors, which positively and negatively influence CGA practices and processes in an inpatient hospital setting. [ABSTRACT FROM AUTHOR]

Aim: The aim of this meta-ethnography was to identify and synthesize qualitative studies focusing on older people's and registered nurses' interpretations of competence in home care. Methods: The meta-ethnography followed the six phases developed by Noblit and Hare (1988). Results: In Phase 6, the translation process of the included studies, three themes were identified: i) temporality--the feeling of being of value; ii) dignity--a person, not just a patient; and iii) mutuality of being--togetherness. A synthesis was developed, and the phrase "a becoming in the meeting" emerged. Conclusion: The sense of becoming includes progress, which means becoming something other than before in relation with others and refers to what constitutes the meeting between the older person and the registered nurse working in home care. Competence originates from becoming in the meeting, and registered nurses should therefore value what they do and hold on to this aspect of caring competence that centres on a caring relationship. It is important for registered nurses working in home care to be able to cultivate a caring relationship. [ABSTRACT FROM AUTHOR]

Introduction: Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the overall quality of care. Despite its importance, there is limited knowledge regarding patient engagement in the transition from nondialysis‐dependent chronic kidney disease (CKD) to dialysis‐dependent treatment. This systematic review employs meta‐ethnography to synthesize findings from qualitative studies examining patients' experiences of engagement during this transition, with the aim of developing a comprehensive theoretical understanding of patient engagement in the transition from nondialysis‐dependent CKD to dialysis. Methods: A systematic search of six databases, namely the Cochrane Library, PsycINFO, Scopus, Embase, PubMed and Web of Science was conducted to identify eligible articles published between 1990 and 2022. Meta‐ethnography was utilized to translate and synthesize the findings and develop a novel theoretical interpretation of 'patient engagement' during the transition to dialysis. Results: A total of 24 articles were deemed eligible for review, representing 21 studies. Patient engagement during a transition to dialysis was found to encompass three major domains: psychosocial adjustment, decision‐making and engagement in self‐care. These three domains could be experienced as an iterative and mutually reinforcing process, guiding patients toward achieving control and proficiency in their lives as they adapt to dialysis. Additionally, patient engagement could be facilitated by factors including patients' basic capability to engage, the provision of appropriate education, the establishment of supportive relationships and the alignment with values and resources. Conclusions: The findings of this review underscore the necessity of involving patients in transitional dialysis care, emphasizing the need to foster their engagement across multiple domains. Recommendations for future interventions include the provision of comprehensive support to enhance patient engagement during this critical transition phase. Additional research is warranted to explore the effects of various facilitators at different levels. Patient or Public Contribution: The studies included in our review involved 633 participants (547 patients, 14 family members, 63 healthcare providers and 9 managers). Based on their experiences, views and beliefs, we developed a deeper understanding of patient engagement and how to foster it in the future. [ABSTRACT FROM AUTHOR]