Family interventions for adults living with type 2 diabetes mellitus: A qualitative meta-synthesis

ObjectiveReview and synthesize qualitative research on family interventions for adults living with type 2 diabetes.MethodsA qualitative metasynthesis was conducted. Analysis used imported concepts from realist evaluation – context, mechanisms, and outcomes.ResultsSix studies met inclusion criteria in this qualitative systematic review. Powerful mechanisms were identified that occur outside the family intervention in the context of ethnic, racialized, and geographically defined groups. Many similarities were noted across contexts, such as low income. Mechanisms of interventions focused primarily on family member education. Outcomes were focused more on improving self-care behaviors, rather than family-oriented outcomes.ConclusionSystemic issues affecting social determinants of health set the context for family interventions for type 2 diabetes. When designing these interventions, intersectionality, scarcity, and family functioning may need to be considered.Practice implicationsEmphasis on education of family members may not be effective in improving diabetes outcomes, as many powerful mechanisms exist outside of these interventions.     

The pregnant male: a metasynthesis of first-time fathers’ experiences of pregnancy

Objective: To synthesise qualitative study findings in order to gain an understanding of fathers’ experiences of pregnancy. Background: As the transition to fatherhood can be challenging, awareness of the factors facilitating or hindering expectant fathers’ adjustment is important. Our aim was to better understand the experiences of men during this significant life cycle phase, and to use this knowledge to advise health care professionals on how best to support men during this transition. Methods: We used Noblit and Hare’s metasynthesis approach to review and synthesise 13 qualitative studies relating to expectant fathers’ experiences of pregnancy. Results: The synthesis revealed five super-ordinate themes, which captured the emotional, psychological and physiological experiences of the expectant fathers during pregnancy: (1) Reacting to early pregnancy; (2) On the outside looking in; (3) The pregnant male; (4) A journey of acceptance; and (5) Redefining self as a father. Conclusion: Possible clinical implications and limitations of the metasynthesis approach are discussed. Relevant recommendations on how health professionals and services can be more effectively supportive of men during this period are outlined.     

Stigma in HIV-Positive Women

PURPOSE: To present a metasynthesis of qualitative findings on stigma in HIV-positive women. METHOD: Metasummary and metasynthesis techniques were used to integrate findings on stigma in 93 reports of qualitative studies conducted between 1991 and 2002 with a total of 1,780 women, mostly from minority groups. FINDINGS: Both perceived and enacted stigma were pervasive in the lives of HIV-positive women. HIV-related stigma was intensified in women because they were women. Stigma management largely involved efforts to control information in the service of preserving social relations and maintaining moral identity. DISCUSSION: This metasynthesis reprises and clarifies the connections between recurring themes in primary quantitative studies and metastudies of HIV-positive people and of stigmatizing diseases and conditions. This work also shows how affected people's location on key axes of difference can both facilitate and complicate efforts to manage stigma. CONCLUSIONS: HIV-positive women experience stigmatization in relationships with others. HIV-related stigma is as much a reflection of these others as it is central to the experience of HIV-positive people themselves. Even those not infected with HIV are still affected by it and are thus appropriate targets for interventions to reduce its negative effects.     

Lay beliefs about hypertension: an interpretive synthesis of the qualitative research

PURPOSE: The purpose of this interpretive synthesis was to explore lay beliefs about high blood pressure and its treatment in order to develop a foundation for better partnering with clients. DATA SOURCES: Meta-interpretation was used to analyze 11 qualitative research studies published in the United States between 2000 and 2005. CONCLUSIONS: Professional and lay beliefs about hypertension are not congruent. Historical factors, lack of congruence between belief systems, and poor relationships with providers lead many clients, especially African Americans, to distrust providers and impede the effectiveness of treatment plans. The most problematic discrepancies were related to beliefs about (a) the presence of symptoms, (b) the need to take medications for the rest of life, and (c) race-specific treatment plans. The interactions between nurse practitioners and hypertensive clients have not been explored. IMPLICATIONS FOR PRACTICE: Professional-client interactions based on partnership models, with specific consideration for the above-stated discrepancies in beliefs, are necessary to improve hypertension control.     

Women’s Perceptions and Experiences of Breastfeeding Support: A Metasynthesis

Abstract: Background: Both peer and professional support have been identified as important to the success of breastfeeding. The aim of this metasynthesis was to examine women’s perceptions and experiences of breastfeeding support, either professional or peer, to illuminate the components of support that they deemed “supportive.” Methods: The metasynthesis included studies of both formal or “created” peer and professional support for breastfeeding women but excluded studies of family or informal support. Qualitative studies were included as well as large‐scale surveys if they reported the analysis of qualitative data gathered through open‐ended responses. Primiparas and multiparas who initiated breastfeeding were included. Studies published in English, in peer‐reviewed journals, and undertaken between January 1990 and December 2007 were included. After assessment for relevance and quality, 31 studies were included. Meta‐ethnographic methods were used to identify categories and themes. Results: The metasynthesis resulted in four categories comprising 20 themes. The synthesis indicated that support for breastfeeding occurred along a continuum from authentic presence at one end, perceived as effective support, to disconnected encounters at the other, perceived as ineffective or even discouraging and counterproductive. A facilitative approach versus a reductionist approach was identified as contrasting styles of support that women experienced as helpful or unhelpful. Conclusions: The findings emphasize the importance of person‐centered communication skills and of relationships in supporting a woman to breastfeed. Organizational systems and services that facilitate continuity of caregiver, for example continuity of midwifery care or peer support models, are more likely to facilitate an authentic presence, involving supportive care and a trusting relationship with professionals. (BIRTH 38:1 March 2011)     

The travesty of choosing after positive prenatal diagnosis

OBJECTIVE: To integrate the findings of qualitative studies of expectant parents receiving positive prenatal diagnosis. DATA SOURCES: Seventeen published and unpublished reports appearing between 1984 and 2001 and retrieved between December of 2002 and March of 2003. The electronic databases searched include Academic Search Elite, AIDS Information Online (AIDSLINE), Anthropological Index Online, Anthropological Literature, Black Studies, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Digital Dissertations, Dissertation Abstracts Index (DAI), Educational Resource Information Center (ERIC), MEDLINE, PsycInfo, Public Affairs Information Service (PAIS), PubMed, Social Science Abstracts (SocSci Abstracts), Social Science Citation Index, Social Work Abstracts, Sociological Abstracts (Sociofile), Women's Resources International, and Women's Studies. STUDY SELECTION: Qualitative studies involving expectant parents living in the United States of any race, ethnicity, nationality, or class who learned during any time in pregnancy of any fetal impairment by any means of diagnosis were eligible for inclusion. DATA EXTRACTION: Metasummary techniques, including the calculation of frequency effect sizes, were used to aggregate the findings. Metasynthesis techniques, including constant comparison analysis and the reciprocal translation of concepts, were used to interpret the findings. DATA SYNTHESIS: The topical emphasis in the findings is on the termination of pregnancy following positive diagnosis. The thematic emphasis is on the dilemmas of choice and decision making. Positive prenatal diagnosis was for couples an experience of chosen losses and lost choices. Couples managed information to minimize stigmatization and cognitive dissonance. CONCLUSIONS: Existing guidelines for caring for couples after perinatal losses must accommodate the chosen loss experientially defining positive prenatal diagnosis.     

Understanding How People with Mental Health Difficulties Experience Substance Use

Background: Quantitative studies dominate research exploring reasons for substance use and experiences of substance use by people with mental health difficulties. This limits the depth of understanding which can be gained about these experiences. Objectives: In the present article, we synthesized current qualitative research in this area to provide enhanced theoretical knowledge of these experiences. Methods: Following a systematic literature search, we identified 12 studies which explored how people with mental health difficulties experienced using substances, and which met additional inclusion criterion. We used Noblit and Hare's metaethnographic approach to qualitatively synthesize these studies. Results: Synthesis led to the development of two themes; “substance use mediates acceptance and social inclusion” and “substance use provides perceived opportunities for control and power.” Conclusions/Importance: The findings suggest that in the studies reviewed people's motivation for substance use was embedded in social and psychological contexts. It indicated that substance use could provide perceived benefits such as mediating the impact of mental health stigma, enabling the development of alternative identities, increasing their sense of power and providing opportunities for social inclusion. Mental health and substance use workers should therefore aim to develop alternative opportunities for people with co-occurring disorders to gain such benefits, and seek to challenge mental health stigma.