Qualitative Evidence Syntheses Within Cochrane Effective Practice and Organisation of Care: Developing a Template and Guidance

A growing number of researchers are preparing systematic reviews of qualitative evidence, often referred to as ‘qualitative evidence syntheses’. Cochrane published its first qualitative evidence synthesis in 2013 and published 27 such syntheses and protocols by August 2020. Most of these syntheses have explored how people experience or value different health conditions, treatments and outcomes. Several have been used by guideline producers and others to identify the topics that matter to people, consider the acceptability and feasibility of different healthcare options and identify implementation considerations, thereby complementing systematic reviews of intervention effectiveness.Guidance on how to conduct and report qualitative evidence syntheses exists. However, methods are evolving, and we still have more to learn about how to translate and integrate existing methodological guidance into practice. Cochrane’s Effective Practice and Organisation of Care (EPOC) (www.epoc.org) has been involved in many of Cochrane’s qualitative evidence syntheses through the provision of editorial guidance and support and through co-authorship. In this article, we describe the development of a template and guidance for EPOC’s qualitative evidence syntheses and reflect on this process

Cochrane Effective Practice and Organisation of Care (EPOC) Qualitative Evidence Syntheses, Differences From Reviews of Intervention Effectiveness and Implications for Guidance

Systematic reviews of qualitative research (‘qualitative evidence syntheses’) are increasingly popular and represent a potentially important source of information about people’s views, needs and experiences. Since 2013, Cochrane has published qualitative evidence syntheses, and the Cochrane Effective Practice and Organisation of Care group has been involved in the majority of these reviews. But more guidance is needed on how to prepare these reviews in an environment that is more familiar with reviews of quantitative research. In this paper, we describe and reflect on how Cochrane qualitative evidence syntheses differ from reviews of intervention effectiveness and how these differences have influenced the guidance developed by the EPOC group. In particular, we discuss how it has been important to display to end users, firstly, that qualitative evidence syntheses are carried out with rigour and transparency, and secondly, that these quality standards need to reflect qualitative research traditions. We also discuss lessons that reviews of effectiveness might learn from qualitative research

Factors influencing obesogenic behaviours of adolescent girls and women in low- and middle-income countries: A qualitative evidence synthesis

This systematic review synthesized the qualitative evidence on factors influencing obesogenic behaviours in adolescent girls and women of reproductive age in low- and middle-income countries (LMICs). This qualitative evidence synthesis followed the framework synthesis approach to extract, analyse and synthesize data. Electronic searches were conducted in the Web of Science, SCOPUS, CABI Abstracts, MEDLINE, PsycINFO and Google Scholar. Studies were eligible if they were conducted in LMICs, of qualitative nature, and reported obesogenic behaviours of female adolescents (10-19 years of age) or women of reproductive age (15-49 years of age). The review resulted in 71 included studies from 27 different countries. Thirty-two studies focused on dietary behaviours, 17 on physical activity and 22 on both behaviours. Gender norms and failures to recognize the importance of healthy behaviours across the life cycle were important factors. The abundance and promotion of affordable but unhealthy food, food safety concerns, taste preferences and social desirability of foods drive consumption of unhealthy foods. Busy lives and limited exercise spaces keep girls and women from being physically active. Obesogenic behaviours of adolescent girls and women of reproductive age are influenced by factors at individual, social, physical and environmental levels and require diverse solutions to address these factors in LMICs

Dental caries in primary and permanent teeth in children's worldwide, 1995 to 2019: a systematic review and meta-analysis

Background: Early childhood caries (ECC) is a type of dental caries in the teeth of infants and children that is represented as one of the most prevalent dental problems in this period. Various studies have reported different types of prevalence of dental caries in primary and permanent teeth in children worldwide. However, there has been no comprehensive study to summarize the results of these studies in general, so this study aimed to determine the prevalence of dental caries in primary and permanent teeth in children in different continents of the world during a systematic review and meta-analysis. Methods: In this review study, articles were extracted by searching in the national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, ScienceDirect, Scopus, PubMed, and Web of Science (ISI) between 1995 and December 2019. Random effects model was used for analysis and heterogeneity of studies was evaluated by using the I2 index. Data were analyzed by using the Comprehensive Meta-Analysis (Version 2) software. Findings: In this study, a total of 164 articles (81 articles on the prevalence of dental caries in primary teeth and 83 articles on the prevalence of dental caries in permanent teeth) were entered the meta-analysis. The prevalence of dental caries in primary teeth in children in the world with a sample size of 80,405 was 46.2% (95% CI: 41.6–50.8%), and the prevalence of dental caries in permanent teeth in children in the world with a sample size of 1,454,871 was 53.8% (95% CI: 50–57.5%). Regarding the heterogeneity on the basis of meta-regression analysis, there was a significant difference in the prevalence of dental caries in primary and permanent teeth in children in different continents of the world. With increasing the sample size and the year of study, dental caries in primary teeth increased and in permanent teeth decreased. Conclusion: The results of this study showed that the prevalence of primary and permanent dental caries in children in the world was found to be high. Therefore, appropriate strategies should be implemented to improve the aforementioned situation and to troubleshoot and monitor at all levels by providing feedback to hospitals

Factors associated with the salt intake behaviors in women in a high-salt intake setting

Purpose The high prevalence of hypertension is a significant concern worldwide. A decrease in salt intake is a well-known strategy to control hypertension and reduce the risk of cardiovascular diseases. Little is known about the factors influencing salt intake behaviors in settings such as Iran where consumption of salt is higher than the recommended amount. The purpose of this study was to find out what factors affect three salt intake behaviors among women: adding salt when cooking, adding salt to prepared food at the table and purchasing salty foods. Design/methodology/approach A community-wide cross-sectional survey of 516 women was conducted in Ilam, Iran. Participants were recruited using the cluster random sampling method. The survey included behaviors and variables of an expanded theory of planned behavior. The hypothesized relationships were investigated using structural equation modeling. Findings Perceived behavioral control (PBC) (p < 0.001) and habit (p = 0.01) appeared to be significant factors of adding salt when cooking. Determinants of adding salt to food at the table were intention (p < 0.001), PBC (p < 0.001), habit (p < 0.001). Also, PBC (p < 0.001), intention (p < 0.001), habit (p < 0.001) were identified as predictors of the purchase of salty foods. The results did not support the moderating role of Hedonic feeling to salt on the relation between intention and behaviors. Originality/value This study would be applicable to develop salt reduction interventions. Because altering the hedonic response to food is difficult, the lack of its moderating role could be a promising finding for developing salt reduction interventions

Factors associated with the salt intake behaviors in women in a high-salt intake setting

Purpose The high prevalence of hypertension is a significant concern worldwide. A decrease in salt intake is a well-known strategy to control hypertension and reduce the risk of cardiovascular diseases. Little is known about the factors influencing salt intake behaviors in settings such as Iran where consumption of salt is higher than the recommended amount. The purpose of this study was to find out what factors affect three salt intake behaviors among women: adding salt when cooking, adding salt to prepared food at the table and purchasing salty foods. Design/methodology/approach A community-wide cross-sectional survey of 516 women was conducted in Ilam, Iran. Participants were recruited using the cluster random sampling method. The survey included behaviors and variables of an expanded theory of planned behavior. The hypothesized relationships were investigated using structural equation modeling. Findings Perceived behavioral control (PBC) (p < 0.001) and habit (p = 0.01) appeared to be significant factors of adding salt when cooking. Determinants of adding salt to food at the table were intention (p < 0.001), PBC (p < 0.001), habit (p < 0.001). Also, PBC (p < 0.001), intention (p < 0.001), habit (p < 0.001) were identified as predictors of the purchase of salty foods. The results did not support the moderating role of Hedonic feeling to salt on the relation between intention and behaviors. Originality/value This study would be applicable to develop salt reduction interventions. Because altering the hedonic response to food is difficult, the lack of its moderating role could be a promising finding for developing salt reduction interventions

Factors associated with the salt intake behaviors in women in a high-salt intake setting

Purpose The high prevalence of hypertension is a significant concern worldwide. A decrease in salt intake is a well-known strategy to control hypertension and reduce the risk of cardiovascular diseases. Little is known about the factors influencing salt intake behaviors in settings such as Iran where consumption of salt is higher than the recommended amount. The purpose of this study was to find out what factors affect three salt intake behaviors among women: adding salt when cooking, adding salt to prepared food at the table and purchasing salty foods. Design/methodology/approach A community-wide cross-sectional survey of 516 women was conducted in Ilam, Iran. Participants were recruited using the cluster random sampling method. The survey included behaviors and variables of an expanded theory of planned behavior. The hypothesized relationships were investigated using structural equation modeling. Findings Perceived behavioral control (PBC) (p < 0.001) and habit (p = 0.01) appeared to be significant factors of adding salt when cooking. Determinants of adding salt to food at the table were intention (p < 0.001), PBC (p < 0.001), habit (p < 0.001). Also, PBC (p < 0.001), intention (p < 0.001), habit (p < 0.001) were identified as predictors of the purchase of salty foods. The results did not support the moderating role of Hedonic feeling to salt on the relation between intention and behaviors. Originality/value This study would be applicable to develop salt reduction interventions. Because altering the hedonic response to food is difficult, the lack of its moderating role could be a promising finding for developing salt reduction interventions

Developing and Testing an Instrument to Measure the Factors Affecting the Salt Restriction Benaviors among Women

Background: High salt intake is considered as one of the most important causes of hypertension and cardiovascular diseases. Measuring and identifying factors contributing to people's salt intake behaviors is important to evaluate effectiveness of interventions focusing on salt reduction behaviors. The purpose of this study was to develop and test a new theory of planned behavior (TPB)- based instrument to measure factors influencing three different salt intake behaviors (adding salt during cooking, at the table, purchasing salty food) among women. Study design: A mixed-method study. Methods: After the face and content validity of developed instrument were established, a representative sample of women (N= 300, age (SD):42.82(12.10)) were recruited to assess the construct validity using Partial Least Square confirmatory factor analysis. Coefficient alpha and composite reliability (CR) were used to establish reliability of instrument. The content validity index (CVI) and content validity ratio (CVR) were used to assess the content validity. Results: Assessing validity and reliability of instrument led to 56-item questionnaire. CVI was more than 0.70 and CVR more than 0.56. Internal consistency as assessed by Cronbach's alpha was acceptable. Convergent and discriminant validity were established. The GOF index for behavior one was 0.250, for behavior two was 0.414 and behavior three was 0.374. The results of confirmatory factor analysis indicate that TPB model has an acceptable fit with data. Conclusion: Our instrument provides a validated and reliable tool for assessing different aspects of salt intake behaviors in women to evaluate effectiveness of interventions focusing on salt reduction behaviors

Effect of TQM educational interventions on the management policy standard of health promoting hospitals

The purpose of this study was to manage total quality management (TQM) to increase the standard of management policy and contribute to achieve the standards for health promotion hospitals (HPHs). This was a quasi-experimental intervention study. A total of 35 managers participated in this study were selected in the census. Based on the TQM components, educational items were provided as lectures, posters and pamphlets. The TQM questionnaire and HPHs checklist used to collect data in three different periods: before the interventions, immediately after the interventions and 3 months after the interventions (follow-up). The data analysis was done by means of SPSS software (version 23). The results showed that the average difference of the components of the qualitative groups (p 0.05). Based on the findings of this study, the educational interventions had a positive effect on quality management and management policy. Therefore, educational interventions should be accompanied by changes in the culture and management policies of the hospital to meet HPH standards. © 2020 The Author(s). Published by Oxford University Press. All rights reserved