Jamie L. Crandell

Mapping the Mixed Methods–Mixed Research Synthesis Terrain:

Mixed methods–mixed research synthesis is a form of systematic review in which the findings of qualitative and quantitative studies are integrated via qualitative and/or quantitative methods. Although methodological advances have been made, efforts to differentiate research synthesis methods have been too focused on methods and not focused enough on the defining logics of research synthesis—each of which may be operationalized in different ways—or on the research findings themselves that are targeted for synthesis. The conduct of mixed methods–mixed research synthesis studies may more usefully be understood in terms of the logics of aggregation and configuration. Neither logic is preferable to the other nor tied exclusively to any one method or to any one side of the qualitative/quantitative binary.

The impact of miscarriage and parity on patterns of maternal distress in pregnancy.

The purpose of the current study was to examine patterns of state anxiety and pregnancy-specific distress across pregnancy in a diverse sample of women with (n = 113) and without (n = 250) prior miscarriage. For both groups, state anxiety and pregnancy-specific distress were highest in the first trimester and decreased significantly over the course of pregnancy. Compared to women without prior miscarriage, women with prior miscarriage experienced greater state anxiety in the second and third trimesters. Having a living child did not buffer state anxiety in women with a prior miscarriage. Attention to patterns of distress can contribute to delivery of appropriate support resources to women experiencing pregnancy after miscarriage and may help reduce risk for stress-related outcomes.

Outcomes of an Uncertainty Management Intervention in Younger African American and Caucasian Breast Cancer Survivors

PURPOSE/OBJECTIVES To determine whether breast cancer survivors (BCSs) who received an uncertainty management intervention, compared to an attention control condition, would have less uncertainty, better uncertainty management, fewer breast cancer-specific concerns, and more positive psychological outcomes. DESIGN A 2 × 2 randomized block, repeated-measures design, with data collected at baseline and two other points postintervention, as well as a few days before or after either a mammogram or oncologist visit. SETTING Rural and urban clinical and community settings. SAMPLE 313 female BCSs aged 50 or younger; 117 African Americans and 196 Caucasians. METHODS Participants were blocked on ethnicity and randomly assigned to intervention or control. The intervention, consisting of a scripted CD and a guide booklet, was supplemented by four scripted, 20-minute weekly training calls conducted by nurse interventionists. The control group received the four scripted, 20-minute weekly training calls. MAIN RESEARCH VARIABLES Uncertainty in illness, uncertainty management, breast cancer-specific concerns, and positive psychological outcomes. FINDINGS BCSs who received the intervention reported reductions in uncertainty and significant improvements in behavioral and cognitive coping strategies to manage uncertainty, self-efficacy, and sexual dysfunction. CONCLUSIONS The intervention was effective as delivered in managing uncertainties related to being a younger BCS. IMPLICATIONS FOR NURSING The intervention can realistically be applied in practice because of its efficient and cost-effective nature requiring minimal direct caregiver involvement. The intervention allows survivors who are having a particular survival issue at any given point in time to access information, resources, and management strategies. KNOWLEDGE TRANSLATION Materials tested in CD and guide booklet format could be translated into online format for survivors to access as issues arise during increasingly lengthy survivorship periods. Materials could be downloaded to a variety of electronic devices, fitting with the information needs and management styles of younger BCSs.

Predictors of depression among older African American cancer patients.

Background: Depression is becoming an increasing concern in cancer patients because of its impact on quality of life. Although risk factors of having depression have been examined in the literature, there has been no research examining these factors in older African American cancer patients. Objective: This study explores the demographic and illness-related risk factors in older African American cancer patients. Methods: Two hundred eighty-three patients were recruited from outpatient oncology clinics. These older African American patients completed a questionnaire that included the Geriatric Depression Scale as well as sociodemographic characteristics and medical information. χ2 Tests, trend tests, and logistic regression were used to identify the demographic and illness-related factors that predict depression in the sample. Results: The overall prevalence of depression in the sample was 27.2%. Younger age (<65 years), employment status, proximity to family, and multiple symptoms due to cancer or treatment were independent predictors of depression. Conclusion: This study represents the first attempt to describe the risk factors of depression within older African American cancer patients. Findings indicate a high prevalence of depression in African American cancer patients which can be attributed to identifiable risk factors. Implications for Practice: An understanding of the risk factors associated with depression can be used to identify those cancer patients at risk for depression and initiate early interventions to improve psychological outcomes and lessen the potential burden of cancer on these patients.

Implementation of antiretroviral therapy adherence interventions: a realist synthesis of evidence.

AIM This paper is a report of a synthesis of evidence on implementation of interventions to improve adherence to antiretroviral therapy. BACKGROUND Evidence on efficacy must be supplemented with evidence on how interventions were implemented in practice and on how that implementation varied across populations and settings. DATA SOURCES Sixty-one reports were reviewed of studies conducted in the United States of America in the period 2001 to December 2008. Fifty-two reports were included in the final analysis: 37 reporting the effects of interventions and 15 reporting intervention feasibility, acceptability, or fidelity. REVIEW METHODS An adaptation of Pawsons realist synthesis method was used, whereby a provisional explanatory model and associated list of propositions are developed from an initial review of literature. This model is successively refined to the point at which it best explains empirical findings from the reports reviewed. RESULTS The final explanatory model suggests that individuals with HIV will be more likely to enroll in interventions that protect their confidentiality, to attend when scheduling is responsive to their needs, and both to attend and continue with an intervention when they develop a strong, one-to-one relationship with the intervener. Participants who have limited prior experience with antiretroviral therapy will be more likely to continue with an intervention than those who are more experienced. Dropout rates are likely to be higher when interventions are integrated into existing delivery systems than when offered as stand-alone interventions. CONCLUSION The explanatory model developed in this study is intended to provide guidance to clinicians and researchers on the points in the implementation chain that require strengthening.

Transforming Verbal Counts in Reports of Qualitative Descriptive Studies Into Numbers

Reports of qualitative studies typically do not offer much information on the numbers of respondents linked to any one finding. This information may be especially useful in reports of basic, or minimally interpretive, qualitative descriptive studies focused on surveying a range of experiences in a target domain, and its lack may limit the ability to synthesize the results of such studies with quantitative results in systematic reviews. Accordingly, the authors illustrate strategies for deriving plausible ranges of respondents expressing a finding in a set of reports of basic qualitative descriptive studies on antiretroviral adherence and suggest how the results might be used. These strategies have limitations and are never appropriate for use with findings from interpretive qualitative studies. Yet they offer a temporary workaround for preserving and maximizing the value of information from basic qualitative descriptive studies for systematic reviews. They show also why quantitizing is never simply quantitative.

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys.

OBJECTIVES Adoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11-12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys. METHODS We targeted parents and providers of 9-13 year old boys in a 13 county NC region. The 3-month intervention included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers; two radio PSAs; and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9-13 year old boys increased during the intervention period in targeted counties compared to control counties (n=15) with similar demographics. To compare with other adolescent vaccines, similar models were fit for HPV vaccination in girls and meningococcal and Tdap vaccination of boys in the same age range. Moderating effects of age, race, and Vaccines for Children (VFC) eligibility on the intervention were considered. RESULTS The Cox model showed an intervention effect (β=0.29, HR=1.34, p=.0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p<.0001 for all). HPV vaccination rates were highest in the 11-12 year old boys. Overall, three of every four clinic visits for Tdap and meningococcal vaccines for preteen boys were missed opportunities to administer HPV vaccination simultaneously. CONCLUSIONS Social marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.

Reliability and Validity of the Perspectives of Support From God Scale

Background:Existing spiritual support scales for use with cancer survivors focus on the support believed to come from a religious community, clergy, or health care providers. Objective:The objective of this study was to evaluate the reliability and validity of a new measure of spiritual support believed to come from God in older Christian African American cancer survivors. Methods:The Perceived Support From God Scale was administered to 317 African American cancer survivors aged 55-89 years. Psychometric evaluation involved identifying underlying factors, conducting item analysis and estimating reliability, and obtaining evidence on the relationship to other variables or the extent to which the Perceived Support From God Scale correlates with religious involvement and depression. Results:The Perceived Support From God Scale consists of 15 items in two subscales (Support From God and Gods Purpose for Me). The two subscales explained 59% of the variance. Cronbachs &agr; coefficients were .94 and .86 for the Support From God and Gods Purpose for Me subscales, respectively. Test-retest correlations were strong, supporting the temporal stability of the instrument. Pearsons correlations to an existing religious involvement and beliefs scale were moderate to strong. Subscale scores on Support From God were negatively correlated to depression. Discussion:Initial support for reliability and validity was demonstrated for the Perceived Support From God Scale. The scale captures a facet of spirituality not emphasized in other measures. Further research is needed to evaluate the scale with persons of other racial/ethnic groups and to explore the relationship of spirituality to other outcome measures.

Combining adjusted and unadjusted findings in mixed research synthesis

RATIONALE, AIMS AND OBJECTIVES Finding ways to incorporate disparate types of evidence into research syntheses has the potential to build a better evidence base for clinical practice and policy. Yet conducting such mixed research synthesis studies is challenging. Researchers have to determine whether and how to use adjusted and unadjusted quantitative findings in combination with each other and with qualitative findings. METHODS Among quantitative findings, adjustment for confounding, either via study design or statistical analysis, can be a considerable source of heterogeneity. Yet there is no consensus about the best way to synthesize findings resulting from different methods for addressing confounding. When synthesizing qualitative and quantitative findings, additional considerations include determining whether findings are amenable to synthesis by aggregation or configuration, which, in turn, depends on the degree of interpretive transformation of findings. RESULTS Qualitative survey findings appear similar in form to unadjusted or minimally adjusted quantitative findings and, when addressing the same relationship, can be summed. More interpreted qualitative findings appear similar in form to adjusted findings found in, for example, structural equation models specifying the relationship among a host of latent variables. An option for synthesis of conceptually similar models is reciprocal translation. CONCLUSIONS These decisions will ultimately be judged on the meaningfulness of their results to practice or policy.

Text‐in‐context: a method for extracting findings in mixed‐methods mixed research synthesis studies

AIM Our purpose in this paper is to propose a new method for extracting findings from research reports included in mixed-methods mixed research synthesis studies. BACKGROUND International initiatives in the domains of systematic review and evidence synthesis have been focused on broadening the conceptualization of evidence, increased methodological inclusiveness and the production of evidence syntheses that will be accessible to and usable by a wider range of consumers. Initiatives in the general mixed-methods research field have been focused on developing truly integrative approaches to data analysis and interpretation. DATA SOURCE The data extraction challenges described here were encountered, and the method proposed for addressing these challenges was developed, in the first year of the ongoing (2011-2016) study: Mixed-Methods Synthesis of Research on Childhood Chronic Conditions and Family. DISCUSSION To preserve the text-in-context of findings in research reports, we describe a method whereby findings are transformed into portable statements that anchor results to relevant information about sample, source of information, time, comparative reference point, magnitude and significance and study-specific conceptions of phenomena. IMPLICATIONS FOR NURSING The data extraction method featured here was developed specifically to accommodate mixed-methods mixed research synthesis studies conducted in nursing and other health sciences, but reviewers might find it useful in other kinds of research synthesis studies. CONCLUSION This data extraction method itself constitutes a type of integration to preserve the methodological context of findings when statements are read individually and in comparison to each other.