RAMESES publication standards: meta-narrative reviews

PMCID: PMC3558334This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach

BACKGROUND: Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions. METHODS: Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories. RESULTS: Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food insecurity. While peer advice was familiar, meaningful, and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning. CONCLUSIONS: 'Behaviour change' interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural 'choices' are made

How does grazing relate to body mass index, self-compassion, mindfulness and mindful eating in a student population?

Contemporary research investigating obesity has focused on grazing (i.e. an uncontrolled and repetitive consumption of small amounts of food). Meanwhile, constructs such as mindfulness, mindful eating and self-compassion have received much attention in assisting individuals with eating behaviours and weight regulation. The association between those constructs and grazing, however, has not been explored. In a cross-sectional study, university students ( n  = 261) were recruited to explore the relationship of mindfulness, mindful eating and self-compassion with current weight and grazing. Results indicated that all constructs were negatively related to grazing, but only mindful eating related negatively to current weight. In addition, mindful eating mediated the relationship between grazing and current weight. Possible explanations and future directions are discussed further with an emphasis on the need for more empirical work

Computer-mediated support group intervention for parents

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldPurpose: The purpose of this study was to evaluate the feasibility of a computer-mediated support group (CMSG) intervention for parents whose children had been diagnosed with cancer. Design and Methods: An evaluative one-group, before-and-after research design. A CMSG, an unstructured listserve group where participants used their E-mail for communication, was conducted over a 4-month period. Participation in the CMSG was offered to parents in Iceland whose children had completed cancer treatment in the past 5 years. Outcome measures were done: before the intervention (Time 1), after 2 months of intervention (Time 2) and after 4 months of intervention (Time 3) when the project ended. Measures included: demographic and background variables; health related vulnerability factors of parents: anxiety, depression, somatization, and stress; perceived mutual support; and use of the CMSG. Data were collected from November 2002 to June 2003. Twenty-one of 58 eligible parents participated in the study, with 71% retention rate for both post-tests. Findings: Mothers' depression decreased significantly from Time 2 to Time 3 (p<.03). Fathers' anxiety decreased significantly from Time 1 to Time 3 (p<.01). Fathers' stress decreased significantly from Time 2 to Time 3 (p<.02). To some extent, mothers and fathers perceived mutual support from participating in the CMSG. Both mothers and fathers used the CMSG by reading messages. Messages were primarily written by mothers. Conclusions:Study findings support further development of CMSGs for parents whose children have been diagnosed with cancer. Clinical Relevance: Using computer technology for support is particularly useful for dispersed populations and groups that have restrictions on their time. Computer-mediated support groups have been shown to be a valuable addition to, or substitute for, a traditional face-to-face mutual support group and might suit both genders equally

‘Good’ evidence for improved policy making: from hierarchies to appropriateness

Within the field of public health, and increasingly across other areas of social policy, there are widespread calls to increase or improve the use of evidence for policy making. Often these calls rest on an assumption that improved evidence utilisation will be a more efficient or effective means of achieving social goals. Yet, a clear elucidation of what can be considered ‘good evidence’ for policy use is rarely articulated. Many of the current discussions of best practice in the health policy sector derive from the evidence-based medicine (EBM) movement, embracing the ‘hierarchy of evidence’ in framing the selection of evidence – a hierarchy that places experimental trials as preeminent in terms of methodological quality. However, there are a number of difficulties associated with applying EBM methods of grading evidence onto policy making. Numerous public health authors have noted that the hierarchy of evidence is a judgement of quality specifically developed for measuring intervention effectiveness, and as such it cannot address other important health policy considerations such as affordability, salience, or public acceptability (Petticrew and Roberts, 2003). Social scientists and philosophers of knowledge have illustrated other problems in the direct application of the hierarchy of evidence to guide policy. Complex or structural interventions are often not conducive to experimental methods, and as such, a focus on evidence derived from randomised trials may shift policy attention away from broader structural issues (such as addressing the social determinants of health (Solar and Irwin, 2007)), to disease treatment or single element interventions. Social and behavioural interventions also present external validity problems to experimental methods and meta-analyses, as the mechanisms by which an intervention works in one social context may be very different or produce different results elsewhere (Cartwright, 2011). In these cases, policy makers may be better advised to look for evidence about the mechanism of effect, and evidence of local contextual features (Pawson et al., 2005). We argue that rather than adhering to a single hierarchy of evidence to judge what constitutes ‘good’ evidence for policy, it is more useful to examine evidence through the lens of appropriateness. It is important to utilise evidence to improve policy outcomes, yet the form of that evidence should vary depending on the multiple decision criteria at stake. Policy makers must therefore start by articulating their decision criteria in relation to a given problem or policy, so that the appropriate forms of evidence can be drawn on – from both epidemiological and clinical experiments (e.g. for questions of treatment effect), as well as from social scientific, social epidemiological, and multidisciplinary sources (e.g. for questions of complex causality, acceptability, human rights, etc.). Following this selection of types of evidence on the basis of appropriateness, the rigour and quality of the research can be assessed according to the evidentiary best practice standards of the discipline within which the evidence was produced. This approach speaks to calls to improve the use of evidence through ensuring rigour and methodological quality, yet recognises that good evidence is dictated by specific public health or social policy goals

The Clinic Narrative: A Multiple Case Study of Integrated Knowledge Translation and Equity-Oriented Primary Health Care

Understanding how PHC organizations implement changes to achieve equity-oriented care will add to the knowledge base regarding primary care renewal. Implementation science or knowledge translation (KT) has emerged, with the goal of enhancing evidence-based practice by implementing strategies of knowledge mobilization. Questions in this qualitative multiple case study were: 1) How does a new knowledge product, a ‘clinic narrative’, co-created by the researchers and the clinic leads, influence practices in the clinic specific to equity-oriented care?, 2) What facilitates or constrains the use of the narrative? and, 3) What are the novel uses of the narrative for organizational goals? The Consolidated Framework for Implementation Research and Integrated Knowledge Translation were used to guide data collection and analysis. Results indicate that the clinics perceived the intervention positively with multiple uses. The results of this study will help researchers and other decision makers understand how an evidence-based knowledge synthesis tool can assist PHC organizations in improving equity-oriented care

Synthetic Social Support: Theorizing Lay Health Worker Interventions

Levels of social support are strongly associated with health outcomes and inequalities. The use of lay health workers (LHWs) has been suggested by policy makers across the world as an intervention to identify risks to health and to promote health, particularly in disadvantaged communities. However, there have been few attempts to theorize the work undertaken by LHWs to understand how interventions work. In this article, the authors present the concept of 'synthetic socialsupport' and distinguish it from the work of health professionals or the spontaneous social support received from friends and family. The authors provide new empirical data to illustrate the concept based on qualitative, observational research, using a novel shadowing method involving clinical and non-clinical researchers, on the everyday work of 'pregnancy outreach workers' (POWs) in Birmingham, UK. The service was being evaluated as part of a randomized controlled trial. These LHWs provided instrumental, informational, emotional and appraisal support to the women they worked with, which are all key components of social support. The social support was 'synthetic' because it was distinct from the support embedded in spontaneous social networks: it was non-reciprocal; it was offered on a strictly time-limited basis; the LHWs were accountable for the relationship, and the social networks produced were targeted rather than spontaneous. The latter two qualities of this synthetic form of social support may have benefits over spontaneous networks by improving the opportunities for the cultivation of new relationships (both strong and weak ties) outside the women's existing spontaneous networks that can have a positive impact on them and by offering a reliable source of health information and support in a chaotic environment. The concept of SSS can help inform policy makers about how deploying lay workers may enable them to achieve desired outcomes, specify their programme theories and evaluate accordingly. [Abstract copyright: Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Behavior change interventions: the potential of ontologies for advancing science and practice

A central goal of behavioral medicine is the creation of evidence-based interventions for promoting behavior change. Scientific knowledge about behavior change could be more effectively accumulated using "ontologies." In information science, an ontology is a systematic method for articulating a "controlled vocabulary" of agreed-upon terms and their inter-relationships. It involves three core elements: (1) a controlled vocabulary specifying and defining existing classes; (2) specification of the inter-relationships between classes; and (3) codification in a computer-readable format to enable knowledge generation, organization, reuse, integration, and analysis. This paper introduces ontologies, provides a review of current efforts to create ontologies related to behavior change interventions and suggests future work. This paper was written by behavioral medicine and information science experts and was developed in partnership between the Society of Behavioral Medicine's Technology Special Interest Group (SIG) and the Theories and Techniques of Behavior Change Interventions SIG. In recent years significant progress has been made in the foundational work needed to develop ontologies of behavior change. Ontologies of behavior change could facilitate a transformation of behavioral science from a field in which data from different experiments are siloed into one in which data across experiments could be compared and/or integrated. This could facilitate new approaches to hypothesis generation and knowledge discovery in behavioral science

An Innovation Platform for Diffusing Public Health Practices across a Global Network

Hospitals and health systems in high-income countries (HIC) develop the capacities of peer healthcare organizations around the world by diffusing clinical, quality, and public health improvement practices in lower and middle-income countries (LMIC). In turn, these HIC healthcare institutions are exposed to innovative approaches developed and used by global communities to advance care despite resource constraints in the LMIC contexts. Attention has been growing in recent years to the potential these innovations can have to improve care delivery, lower costs, and drive quality within resource constrained communities in HIC. Often referred to as ‘reverse innovations,’ the identification, adaptation, and diffusion of these practices face challenges in uptake related to limited evidence, perceptions of poor quality or irrelevance, and a complicated regulatory and policy environment. This paper suggests the development of a knowledge platform to support diffusion of innovative health practices along a global community continuum and illustrates its potential use