Barriers and Facilitators to Implementing Evidence in African Health Care: A Content Analysis With Implications for Action.

BACKGROUND: Culture- and context-specific issues in African countries such as those related to language, resources, technology, infrastructure and access to available research may confound evidence implementation efforts. Understanding the factors that support or inhibit the implementation of strategies aimed at improving care and health outcomes specific to their context is important. AIMS: The aim of this study was to determine barriers and facilitators to evidence implementation in African healthcare settings, based on implementation projects undertaken as part of the Joanna Briggs Institute (JBI) Clinical Fellowship program. METHODS: Reports of implementation projects conducted in Africa were obtained from the JBI database and printed monographs associated with the fellowship program. A purpose-built data extraction form was used to collect data from individual reports. Data were analysed using content analysis. RESULTS: Eleven published and nine unpublished implementation reports were reviewed. The most frequently reported barriers to evidence implementation operate at the health organization or health practitioner level. Health organization-level barriers relate to human resources, material resources and policy issues. Health practitioner-level barriers relate to practitioners' knowledge and skills around evidence-based practice, and attitudes to change. Barriers at the government and consumer levels were uncommon. Only a few facilitators were identified and were related to health practitioners' attitudes or support from the organization's management. LINKING EVIDENCE TO ACTION: The study identified a core set of barriers and facilitators in African healthcare settings, which are common to other low- and middle-income countries. These can be used to develop a method by which implementation programs can systematically undertake barrier or facilitator analysis. Future research should aim to develop a process by which these barriers and facilitators can be prioritised so that a structured decision support procedure can be established.

Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach.

BACKGROUND: Scoping reviews are a relatively new approach to evidence synthesis and currently there exists little guidance regarding the decision to choose between a systematic review or scoping review approach when synthesising evidence. The purpose of this article is to clearly describe the differences in indications between scoping reviews and systematic reviews and to provide guidance for when a scoping review is (and is not) appropriate. RESULTS: Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions. CONCLUSIONS: Scoping reviews are a useful tool in the ever increasing arsenal of evidence synthesis approaches. Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. Our hope is that with clear guidance available regarding whether to conduct a scoping review or a systematic review, there will be less scoping reviews being performed for inappropriate indications better served by a systematic review, and vice-versa.

Characteristics of Indigenous primary health care service delivery models: a systematic scoping review.

BACKGROUND: Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. METHOD: This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. RESULTS: Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community participation, continuous quality improvement, culturally appropriate and skilled workforce, flexible approach to care, holistic health care, and self-determination and empowerment. CONCLUSION: While the eight characteristics were clearly distinguishable within the review, the interdependence between each characteristic was also evident. These findings were used to develop a new Indigenous PHC Service Delivery Model, which clearly demonstrates some of the unique characteristics of Indigenous specific models.

Access to primary health care services for Indigenous peoples: A framework synthesis.

BACKGROUND: Indigenous peoples often find it difficult to access appropriate mainstream primary health care services. Securing access to primary health care services requires more than just services that are situated within easy reach. Ensuring the accessibility of health care for Indigenous peoples who are often faced with a vast array of additional barriers including experiences of discrimination and racism, can be complex. This framework synthesis aimed to identify issues that hindered Indigenous peoples from accessing primary health care and then explore how, if at all, these were addressed by Indigenous health care services. METHODS: To be included in this framework synthesis papers must have presented findings focused on access to (factors relating to Indigenous peoples, their families and their communities) or accessibility of Indigenous primary health care services. Findings were imported into NVivo and a framework analysis undertaken whereby findings were coded to and then thematically analysed using Levesque and colleague's accessibility framework. RESULTS: Issues relating to the cultural and social determinants of health such as unemployment and low levels of education influenced whether Indigenous patients, their families and communities were able to access health care. Indigenous health care services addressed these issues in a number of ways including the provision of transport to and from appointments, a reduction in health care costs for people on low incomes and close consultation with, if not the direct involvement of, community members in identifying and then addressing health care needs. CONCLUSIONS: Indigenous health care services appear to be best placed to overcome both the social and cultural determinants of health which hamper Indigenous peoples from accessing health care. Findings of this synthesis also suggest that Levesque and colleague's accessibility framework should be broadened to include factors related to the health care system such as funding.

Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project.

OBJECTIVE: To assess falls prevention practices in Australian hospitals and implement interventions to promote best practice. DESIGN: A multi-site audit using eight evidence-based audit criteria. Following a baseline audit, barriers to compliance were identified and targeted. Two follow-up audit cycles assessed the sustainability of practice change. SETTING: Nine acute care hospitals around Australia, including a mix of public and private. One medical ward and one surgical ward from each hospital were involved. PARTICIPANTS: A clinical leader from each hospital, trained in evidence implementation, conducted the audits and implementation strategies in their setting. INTERVENTIONS: Multi-component falls prevention interventions were utilized, designed to target specific barriers to compliance identified at each hospital. Common interventions involved staff and patient education. MAIN OUTCOME MEASURE: Percentage compliance with falls prevention audit criteria and change in compliance between baseline and follow-up audits. Fall rate data were also analysed. RESULTS: Mean overall compliance at baseline across all hospitals was 50.4% (range 30.8-76.6%). At the first follow-up, this had increased to 74.5% (range 59.4-87.4%), which was sustained at the second follow-up (74.1%, range 48.6-84.4%). There were no statistically significant differences between compliance rates in medical versus surgical wards or in private versus public hospitals. Despite sustained practice improvement, reported fall rates remained unchanged. The focus on staff education possibly led to improved reporting of falls, which may explain the apparent lack of effect on fall rates. CONCLUSIONS: Clinical audit and feedback is an effective strategy to promote quality improvement in falls prevention practices in acute hospital settings.

Improving communication between health-care professionals and patients with limited English proficiency in the general practice setting.

Quality service provision and patient safety and satisfaction in encounters with health-care professionals relies on effective communication between the practitioner and patient. This study aimed to identify effective practices for improving communication between clinical staff in general practice and patients with limited English proficiency, and to promote their implementation in general practice. Effective interventions and strategies were identified from a review of international research. Experiences with their use in practice were explored via focus group discussions with general practitioners and practice nurses. The results suggest that, wherever possible, communication in the patient's primary language is preferable; use of a qualified medical interpreter should be promoted, and practices should have a standardised and documented procedure for accessing interpreter services. General practice staff must increase their awareness about services that are available to facilitate communication with patients with limited English proficiency, and also develop attitudes, both individual and organisational, that will maximise the effectiveness of these strategies. These findings were used to develop brief, evidence-based practice guidelines that were disseminated to focus group participants for evaluation of utility and general feedback. This evidence-based guidance is now available to assist clinical and administrative general practice staff across regional and metropolitan South Australia.

Early enteral nutrition support for patients with acute pancreatitis in the inpatient setting: a best practice implementation project.

INTRODUCTION: Acute pancreatitis is a major disease that endangers the health and lives of people. Historically, clinical therapy has recommended. that patients with acute pancreatitis remain nil by mouth. As one of the therapies recommended in recent guidelines, early enteral nutrition support reduces the incidence of infectious complications and reduces the risk of severe conditions. However, early enteral nutrition support has not been optimally implemented within clinical practice for acute pancreatitis inpatients. OBJECTIVES: This evidence implementation project aimed to increase compliance with best practice recommendations for early enteral nutrition support, while standardizing the enteral nutrition support process and reducing the incidence of delayed enteral nutrition. METHODS: The project was guided by the JBI Evidence Implementation Framework, which is grounded in the audit and feedback process, as well as a seven-stage structured approach to identifying and managing barriers to compliance with recommended practices. RESULTS: In the baseline audit, compliance rates were low for all evidence-based audit criteria. Four of the eight criteria showed 0% compliance. However, after implementation, all eight criteria achieved a minimum compliance rate of 60%, with Site 2 achieving 90% to 100% compliance. In addition, nurses improved their knowledge and skills in early enteral nutrition support. The incidence of delayed enteral nutrition also fell from 86.2% to 20.7% at both study sites. The implementation strategy included a training program, psychological interventions, and financial and human resource support. CONCLUSION: This project not only significantly improved early enteral nutrition support for acute pancreatitis patients, but also increased nurses' knowledge and practice skills, standardized the process of enteral nutrition support, and reduced the incidence of delayed enteral nutrition. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A177.

Pelvic floor muscle training for urinary incontinence in older adults: a best practice implementation project.

OBJECTIVES: This project aimed to implement best practices for pelvic floor muscle training to manage urinary incontinence among older women in long-term care in Kerala, India. INTRODUCTION: Urinary incontinence is a prevalent and distressing condition that affects a significant proportion of older adults and is characterized by involuntary loss of urine, leading to social embarrassment, decreased quality of life, and increased health care costs. It is more prevalent in women and is associated with dementia, limited mobility, and other comorbidities in long-term care. Pelvic floor muscle training is a first-line treatment option for urinary incontinence in older adults, given its potential to improve quality of life and reduce health care costs. METHODS: This project was based on the JBI Evidence Implementation Framework. A baseline audit was conducted to evaluate current practice against best practices. After identifying barriers and implementing strategies, follow-up audits were conducted after 3 and 6 months. RESULTS: The baseline audit showed 0% compliance with all best practices. Barriers such as lack of knowledge and practice of pelvic floor exercises for urinary incontinence among participants and nurses; unknown cognitive status; and health emergencies were identified. Strategies including video-assisted training of pelvic floor muscle exercises, training calendars, and flip charts with instructions. The follow-up audits showed significant improvements in compliance. CONCLUSIONS: This project reduced urinary incontinence in the participants. Although two of the audit criteria did not reach 100% compliance by the end of 6 months, the stakeholders of the long-term care facility understood the importance of pelvic floor muscle training, which will be beneficial for future residents with urinary incontinence. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A211.

Methods for developing quality indicators for evidence implementation: a scoping review protocol.

OBJECTIVE: The aim of this scoping review is to locate, identify, and understand the extent and type of evidence in relation to the development of quality indicators within evidence implementation health care programs. INTRODUCTION: Health care organizations evaluate care using quality improvement initiatives, which are based on quality indicators that are clearly defined and measure what they are intended to, based on structures, processes, or outcomes of care. However, the development of quality indicators is an area plagued by inconsistency and issues in terms of their pragmatic use in the health care context. Inconsistency when using terminology related to quality improvement has highlighted issues with distinct definitions, and many terms appear to be used interchangeably. This leads to confusion and a lack of clarity in what these terms are actually describing with regard to measures of quality in health care. INCLUSION CRITERIA: The proposed review will consider studies, guidelines, manuals, evidence syntheses, and other relevant literature that examine the key concepts, terms, or definitions used in the development of quality indicators and that identify the methods or frameworks used in the development approaches across the international health care setting. METHODS: The search strategy will aim to locate both published and unpublished documents, using a 3-step search strategy. Results of the search, study inclusion, data extraction, and analysis and presentation of results will be conducted by 2 independent reviewers, in accordance with JBI's methodology for conducting scoping reviews.Findings will be presented in tables or visual charts, accompanied by a narrative summary. DETAILS OF THIS REVIEW PROJECT ARE AVAILABLE AT: Open Science Framework https://osf.io/54q8j.

JBI's approach to evidence implementation: a 7-phase process model to support and guide getting evidence into practice.

ABSTRACT: In this paper, we provide an overview of JBI's approach to evidence implementation and describe the supporting process model that aligns with this approach. The central tenets of JBI's approach to implementing evidence into practice include the use of evidence-based audit and feedback, identification of the context in which evidence is being implemented, facilitation of any change, and an evaluation process. A pragmatic and practical seven-phased approach is outlined to assist with the 'planning' and 'doing' of getting evidence into practice, focusing on clinicians as change agents for implementing evidence in clinical and policy settings. Further research and development is required to formally evaluate the robustness of the approach to better understand the complex nature of evidence implementation.

Providing a scaffold for considering theoretical frameworks in evidence implementation projects: the JBI approach to evidence implementation.

ABSTRACT: There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.

Facilitation in evidence implementation - experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review.

INTRODUCTION: Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness. METHODS: A systematic review of qualitative studies was conducted using the JBI methodology. RESULTS: A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators. CONCLUSION: To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the "implementers" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior. REVIEW REGISTRATION NUMBER: PROSPERO CRD42023402496.

Experiences of health professionals in screening for postpartum depressive symptoms: a qualitative systematic review protocol.

OBJECTIVE: This review will assess and synthesize the available qualitative evidence on the experiences of health professionals in screening for postpartum depression. INTRODUCTION: Postpartum depression is a significant public health problem. Clinical screening is essential to develop appropriate interventions to meet the needs of women and their families. The findings of this review will have important implications for decision-making and policy development for continuous professional development programs that promote evidence-based postpartum depression screening. INCLUSION CRITERIA: This review will consider studies that explore the experiences of health professionals who screen for postpartum depression in any geographic location at any health care level (primary, secondary, or tertiary). The review will focus on qualitative data, including methods such as phenomenology, grounded theory, ethnography, action research, and feminist research. METHODS: The review will follow a 3-step search strategy, in line with the JBI methodology for systematic reviews of qualitative evidence. The databases to be searched will include MEDLINE, CINAHL, Embase, Scopus, LILACS, ScienceDirect, PsycINFO, Index Psi Periódicos, and PePsic. Unpublished studies will be searched for in Google Scholar, Cybertesis, Dart-E, EthOS, and OATD. Two independent reviewers will evaluate the included studies for methodological quality and extract data using the JBI data extraction and synthesis tools. There will be no language or date limitations. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021253792.

JBI series paper 2: tailored evidence synthesis approaches are required to answer diverse questions: a pragmatic evidence synthesis toolkit from JBI.

Evidence synthesis is critical in evidence-based healthcare and is a core program of JBI. JBI evidence synthesis is characterised by a pluralistic view of what constitutes evidence and is underpinned by a pragmatic ethos to facilitate the use of evidence to inform practice and policy. This second paper in this series provides a descriptive overview of the JBI evidence synthesis toolkit with reference to resources for 11 different types of reviews. Unique methodologies such as qualitative syntheses, mixed methods reviews, and scoping reviews are highlighted. Key features include standardised and collaborative processes for development of methodologies and a broad range of tailored resources to facilitate the conduct of a JBI evidence synthesis, including appraisal and data extraction tools, software to support the conduct of a systematic review and an intensive systematic review training program. JBI is one of the leading international protagonists for evidence synthesis, providing those who want to answer health-related questions with a toolkit of resources to synthesize the evidence.

Facilitation as a component of evidence implementation: a multinational perspective.

BACKGROUND: Facilitation is a key component of JBI's approach to evidence implementation along with context analysis and evaluation of process and outcomes. Although the role of facilitation is recognized as a critical component of evidence implementation, what constitutes effective facilitation is poorly understood. AIM: This article presents a descriptive exploration of facilitation as it occurs in evidence implementation initiatives conducted in various healthcare and geographical contexts. All projects used the JBI approach to evidence implementation. METHODS: To provide a multinational perspective on how facilitation was operationalized to promote positive changes in clinical practice and health outcomes, five case studies of evidence implementation projects are presented. RESULTS: The cases highlighted that facilitation is a multifaceted process that can be met through a variety of roles that address aspects of education and capacity building, partnerships, action planning, problem solving and evaluation. Facilitation in all cases appeared to be collaborative, with multiple 'players' within and outside of the health organization being involved in the process. Although there are similarities in activities, facilitation involved some level of local contextualization where there were unique or additional activities performed to accommodate the local needs and requirements of the health organization involved in each case. Numerous contextual factors influenced the success of the implementation initiative. CONCLUSION: The cases emphasized the complex nature of facilitation as a strategy for evidence implementation, indicating that contextual attributes and features define the range of knowledge, skills, and activities that should take place in order for facilitation to be effective. Although there appears to be some core components, tailoring and adaptation of the facilitation process (or roles) is required.

JBI series paper 3: The importance of people, process, evidence, and technology in pragmatic, healthcare provider-led evidence implementation.

In this paper, we describe and discuss evidence implementation as a venture in global human collaboration within the framework of "people, process, evidence, and technology" as a roadmap for navigating implementation. At its core implementation is not a technological, or theoretical process, it is a human process. That health professionals central to implementation activities may not have had formal training in implementation, highlights the need for processes and programs that can be integrated within healthcare organization structures. Audit with feedback is an accessible implementation approach that includes the capacity to embed theory, frameworks, and bottom-up change processes to improve the quality of care. In this third paper in the JBI series, we discuss how four overarching principals necessary for sustainability (Culture, Capacity, Communication, and Collaboration) are combined with evidence, technology, and resources for evidence-based practice change. This approach has been successfully used across hundreds of evidence implementation projects around the globe for over 15 years. We present healthcare practitioner-led evidence-based practice improvement as sustainable and achievable in collaborative environments such as the global JBI network as a primary interest of the practicing professions and provide an overview of the JBI approach to evidence implementation.

Rapid reviews and the methodological rigor of evidence synthesis: a JBI position statement.

ABSTRACT: The demand for rapid reviews has exploded in recent years. A rapid review is an approach to evidence synthesis that provides timely information to decision-makers (eg, health care planners, providers, policymakers, patients) by simplifying the evidence synthesis process. A rapid review is particularly appealing for urgent decisions. JBI is a world-renowned international collaboration for evidence synthesis and implementation methodologies. The principles for JBI evidence synthesis include comprehensiveness, rigor, transparency, and a focus on applicability to clinical practice. As such, JBI has not yet endorsed a specific approach for rapid reviews. In this paper, we compare rapid reviews versus other types of evidence synthesis, provide a range of rapid evidence products, outline how to appraise the quality of rapid reviews, and present the JBI position on rapid reviews. JBI Collaborating Centers conduct rapid reviews for decision-makers in specific circumstances, such as limited time or funding constraints. A standardized approach is not used for these cases;instead, the evidence synthesis methods are tailored to the needs of the decision-maker. The urgent need to deliver timely evidence to decision-makers poses challenges to JBI's mission to produce high-quality, trustworthy evidence. However, JBI recognizes the value of rapid reviews as part of the evidence synthesis ecosystem. As such, it is recommended that rapid reviews be conducted with the same methodological rigor and transparency expected of JBI reviews. Most importantly, transparency is essential, and the rapid review should clearly report where any simplification in the steps of the evidence synthesis process has been taken.

Circulating leptin levels in patients with myalgic encephalomyelitis, chronic fatigue syndrome or fibromyalgia: a systematic review protocol.

OBJECTIVE: The objective of the review is to evaluate circulating levels of leptin in people diagnosed with myalgic encephalomyelitis chronic fatigue syndrome or fibromyalgia syndrome and to investigate the differences compared with healthy controls. INTRODUCTION: Myalgic encephalomyelitis chronic fatigue syndrome is a condition that has major symptoms, including self-reported fatigue, post-exertional malaise, and unexplained pain across the body. The widespread pain is measured in a systematic way and is often referred to as fibromyalgia. The two disorders have many similarities, but their association with leptin has indicated that leptin may affect the role of pro-inflammatory cytokines and symptom severity. INCLUSION CRITERIA: This review will consider observational studies of varying study designs including prospective and retrospective cohort studies, case-control studies, time-series, and analytical cross-sectional studies that include both cases and healthy comparators. Cases will include a diagnosis of myalgic encephalomyelitis, chronic fatigue syndrome, and/or fibromyalgia. Controls are people without this diagnosis, usually healthy participants. Only studies published in English will be included due to limited resources for translation. METHODS: This protocol will be reported based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist and will follow the JBI methodology for systematic reviews of etiology and risk. A comprehensive search strategy will include PubMed, Embase, Scopus, Science Direct, and PsycINFO. Two reviewers will screen, critically appraise eligible articles, and extract data using a standardized data extraction tool informed by JBI SUMARI. The authors will complete a quantitative analysis that synthesizes findings across studies using pooled effect sizes and confidence intervals of the measures provided. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020169903.

Women's experiences of their interactions with health care providers during the postnatal period in Australia: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to explore and evaluate women's experiences of interactions with health care providers during their postnatal period. INTRODUCTION: The postnatal period is a transformative time for women. Women experience significant change and adaptation, which could impact upon parenting confidence, health, and psychological outcomes during this time. The interaction women have with their health care providers during the postnatal period plays an integral role in improving these health outcomes. INCLUSION CRITERIA: This qualitative review will explore the experiences of primiparous and multiparous women during the postnatal period with a key focus on evaluating the interactions they have with health care providers. It will include all studies that utilize qualitative methods (such as interviews and focus groups). Articles that explore the postnatal care experiences of women who have endured a pregnancy loss, given birth to a baby with complex needs, or those that solely focus on describing the neonatal and intensive care experiences, will not be included. METHODS: PubMed, CINAHL, Embase, Emcare, and PsycINFO will be searched. Studies published from 2000 onwards and written in English will be assessed for inclusion. Studies that are selected initially will be assessed for methodological quality by two independent reviewers utilizing the JBI critical appraisal instrument for qualitative research. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020186384.

Effectiveness of photobiomodulation therapy for nipple pain or nipple trauma in lactating women: a systematic review protocol.

OBJECTIVE: The objective of this protocol is to evaluate the effectiveness of photobiomodulation therapy for the treatment of nipple pain or nipple trauma in women during the breastfeeding period. INTRODUCTION: One approach that has been reported on the management of nipple pain or nipple trauma in lactating women is the use photobiomodulation therapy to heal the injury or to decrease pain intensity. However, studies have achieved different results, due to variations in the treatment protocol, such as the source of light used, the application mode, the irradiation, or the light dose parameters, leading to varying outcomes. INCLUSION CRITERIA: This review will consider studies that evaluate photobiomodulation therapy for the treatment of nipple pain or nipple trauma in lactating women in the postpartum period that compare the intervention to standard care, placebo, or other type of treatment. The following outcomes will be considered: intensity of nipple pain, healing of nipple trauma, exclusive breastfeeding rate, quality of life, and satisfaction of the women with treatment. There will be no publication time limit, and studies published in any language will be considered for inclusion. METHODS: This review will be conducted in accordance with JBI methodology for systematic reviews of effectiveness. The search strategy will search both published and unpublished studies, and the process of study selection, critical appraisal, data extraction, and data synthesis will be performed in accordance to the JBI approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019147401.