Effectiveness of home-based interventions in improving loneliness and social connectedness among older adults: a systematic review and meta-analysis.

OBJECTIVES: To evaluate the effectiveness of home-based interventions in improving loneliness and social connectedness (primary outcomes), and depressive symptoms (secondary outcome) among older adults. METHODS: Eight electronic databases were searched from inception dates to February 2022. Meta-analyses were conducted using a random-effect model. Heterogeneity was assessed using I2 statistics and Cochran's Q chi-squared test. The Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) was used to appraise the included studies. RESULTS: Fourteen randomized controlled trials were included. Home-based interventions were found to significantly increase older adults' social connectedness (social support and social engagement) and reduce their loneliness and depressive symptoms. Subgroup analyses suggested that interventions which lasted more than three months and were delivered using mixed platforms were more favorable. Both professional-led and volunteer-led interventions showed favorable results. CONCLUSIONS: Future studies could be conducted in varied geographical regions and consider carrying out follow-up assessments. Home-based interventions could be improved by being more than months, delivered by mixed personnel, and using mixed platforms. Considering the low-quality rating by the GRADE approach, future research is needed to confirm current findings.

KEY POINTSOlder adults can be at higher risk for loneliness and home-based interventions may help to address this issue.This review consolidated the available evidence regarding the effectiveness of home-based interventions in improving loneliness, social connectedness, and depressive symptoms among older adults.Home-based interventions could significantly increase older adults' social connectedness (social support and social engagement), and reduce their loneliness and depressive symptoms.Future research would be needed to ascertain the sustainability of home-based programs' effect on older adults.

Experiences of Patients and Their Caregivers Admitted to a Hospital-at-Home Program in Singapore: a Descriptive Qualitative Study.

BACKGROUND: Hospital at Home (HaH) programs have been shown to improve clinical outcomes, quality of care, and patient satisfaction. However, how Asian patients experience HaH remained underexplored. OBJECTIVE: To explore the perceptions and experiences of patients and caregivers admitted to a hospital-at-home program in Singapore. DESIGN: Descriptive qualitative study design. PARTICIPANTS: Purposive sampling was used to conduct 36 interviews with 13 patients, nine Legally Acceptable Representatives (LARs), and 14 caregivers until data saturation was achieved. INTERVENTIONS: NUHS@Home is a HaH program providing care through a multi-disciplinary team, enabled by remote vital signs monitoring through a tablet and wireless blood pressure and oxygen meters. APPROACH: This study used in-depth semi-structured individual interviews. Interviews were transcribed and thematically analyzed using Braun and Clark's six-step inductive approach. KEY RESULTS: The overarching theme identified was "Enablers, difficulties, and improvements to the HaH experiences" which was supported by three key themes: (1) Perceived better care at home, (2) Importance of social support, and (3) Organizational structures required to support HaH. Participants described overall HaH experiences around factors contributing to their impeding engagement, overall satisfaction, and quality of care. CONCLUSIONS: Although HaH is unfamiliar to the Singapore population, most of the participants in this study had an overall positive experience. The key challenges found in this paper were the stress and inconvenience caused to caregivers. The enablers for positive HaH experiences were (1) consideration of patient's family members as key participants in the patients' therapeutic alliance; (2) the HaH care team must be accessible, approachable, and reassuring, and communicate frequently and timely with patients and their families; and (3) financing strategies to ensure HaH out-of-pockets costs remain affordable which are critical to keeping HaH as an option for patients and families.

Perceptions, Experiences, and Needs of Adolescents About School-Based Sexual Health Education: Qualitative Systematic Review.

Adolescents are particularly vulnerable to poor sexual health outcomes such as sexually transmitted diseases, sexually transmitted infections, human immunodeficiency virus, and unintended pregnancy. While school-based sexual health education (SBSHE) can address adolescents' needs, they are often insufficient. Hence, their perception of SBSHE should be explored to improve current education. This review aims to consolidate the available evidence on perceptions, experiences, and needs of adolescents about SBSHE. Six electronic databases were searched from their inception date till June 2022. The included studies were assessed using the method of the Critical Appraisal Skills Program tool, and findings were meta-synthesized using Sandelowski and Barroso (2007). This review was registered via the International Prospective Register of Systematic Reviews. Overall, 51 studies were included, and three themes were identified: (1) teachings of SBSHE and its impact, (2) adolescents' preferred approach to SBSHE, and (3) importance of engaging and safe SBSHE. In conclusion, adolescents had mixed reactions toward SBSHE. They expressed the need for inclusivity (gender identity and racial, ethnic, and cultural groups). Having a "safe space," well-trained educators, and interactive approaches were important and hence should also be considered. More qualitative studies from different geographical regions are needed. Diverse topics (e.g., mutual consent, sexual abuse, and violence) should also be discussed. The use of multiple educators (e.g., schoolteachers, specialist teachers, and peers) should also be deliberated in future SBSHE research. Findings from this review should be triangulated by evaluating the perceptions of various stakeholders (e.g., educators, adolescents, and SBSHE administrators).

Perceptions of Hospital-at-Home Among Stakeholders: a Meta-synthesis.

BACKGROUND: Hospital-at-home (HaH) provides acute healthcare in patients' homes as an alternative to traditional hospital inpatient care. HaH has been shown to improve clinical outcomes, increase patient satisfaction, and reduce hospitalization costs. Despite its effectiveness, the uptake of HaH remains slow and little is known about factors that impact the quality and transferability of HaH. This review aimed to qualitatively synthesize existing literature to examine the perspectives of stakeholders to identify areas of improvement in this model of care. METHODOLOGY: Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from inception date until 3 February 2021. The included studies were assessed for quality using the Critical Appraisal Skills Program tool. This review was registered on the International Prospective Register of Systematic Reviews. The meta-synthesis was completed according to Sandelowski and Barroso's guidelines. RESULTS: Sixteen articles met the inclusion criteria. The overarching synthesized theme was "the intricacies of developing HaH," and the four main themes were (1) factors influencing patient selection, (2) advantages of HaH, (3) challenges of HaH, and (4) enablers for HaH development. CONCLUSION: Overall, high levels of satisfaction were expressed by various stakeholders. Continuity of care remains an important factor for patient-centeredness in HaH. Caregivers should be involved in the decision-making process and supported throughout the HaH duration to prevent caregiver burnout. Collaboration and coordination among healthcare professionals are vital and can be strengthened through training and technological advancements of remote patient monitoring. Institutional and organizational support for stakeholders may make HaH a viable solution to modern healthcare challenges.

Experiences of men undergoing assisted reproductive technology: A qualitative systematic review.

BACKGROUND: Many infertile couples undergo assisted reproductive technology (ART) to increase pregnancy chances, with many of them experiencing psychosocial distress. Although research has been performed on women's experiences of ART, there is limited focus on men. OBJECTIVE: This systematic review consolidated and synthesized men's experiences with ART to better understand their needs and challenges to support them. SEARCH STRATEGY: Nine electronic databases were searched from the inception date until November 2022. SELECTION CRITERIA: This review included published and unpublished primary studies with qualitative methodologies exploring men's experiences with ART. DATA COLLECTION AND ANALYSIS: The screening of studies, methodological assessment, data extraction, and analysis were conducted by two reviewers independently. The data were thematically synthesized. MAIN RESULTS: Fifteen studies were included. An overarching theme of "despair to destiny" was identified, with four synthesized themes: (1) "the roller coaster ride," (2) "what made it from bad to worse?", (3) "what kept men going?", and (4) "hopeful for the future." CONCLUSION: Men undergoing ART experienced struggles, a transition of emotions, and a need for support as they attempted to cope with unknowns while remaining hopeful for future outcomes. There is a need for health care interventions and policies to address the issue to improve the well-being of male ART patients. Interventions should be tailored to the specific support groups that cater to the emotional and informational needs of male ART patients. Future research should focus on the influence of cultural sensitivities on men's ART experiences, to tailor support programs to address their psychological needs during ART.

Content and characteristics of evidence in the use of standardized patients for advanced practice nurses: A mixed-studies systematic review.

OBJECTIVES: The use of Standardized Patients (SPs) as a supplement to traditional clinical experience is of interest in the advanced practice nursing curriculum. Yet, evidence exploring this area is limited. This systematic review aims to consolidate and synthesize findings on the available evidence of using standardized patients (SPs) on advanced practice nurse (APN) students' learning and assessment experiences. DESIGN: Mixed-studies systematic review. DATA SOURCES: PubMed, EMBASE, Cochrane Library, CINAHL, Scopus, PsycINFO, and ProQuest Dissertations and Theses from the inception of each database to May 2022. REVIEW METHODS: Quantitative, qualitative, and mixed-method studies involving the use of SPs for education and assessments among APN students were included in this review. RESULTS: Twenty studies were included. Three themes were identified through thematic synthesis: (1) Benefits associated with standardized patients, (2) Uniqueness of standardized patient experience, and (3) Preference and way forward. Overall, these students benefited from refining knowledge, clinical skills, and communication skills, and perceived a boost in confidence in their nursing competencies through SP simulations. More studies with rigorous methodology are needed to ascertain the causal relationships between SP simulations and APN students. Future studies should evaluate the cost-effectiveness of SP, especially in low-income countries. Inter-professional SP simulations and hybrid simulations should be explored further. Considerations for improvements include allocating more sessions for multisource feedback, offering dyadic or group support, and providing assessments that are more formative during simulations. CONCLUSIONS: SP simulation can complement traditional clinical experience in providing APN students with the knowledge, clinical skills, and communication skills in the real-world context.

Use of telelactation interventions to improve breastfeeding outcomes among mothers: A mixed-studies systematic review.

BACKGROUND: Breastfeeding has multiple positive impacts on infants, mothers, and the economy. PROBLEM: However, the global breastfeeding rates fall short of the World Health Organization's recommendations. Telelactation interventions have been shown to improve breastfeeding outcomes, yet this field has not been systematically reviewed. AIM: This mixed-studies systematic review aims to consolidate and synthesize findings on the available evidence of telelactation interventions on breastfeeding outcomes, uptake of these interventions, and provide recommendations for future lactation interventions. METHODS: A literature search was conducted in six electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Cochrane, and Scopus) and one gray literature (Mednar) from their inception date to October 2021. Thirteen articles met the selection criteria, and thematic synthesis was conducted to consolidate and synthesize findings from the included studies. FINDINGS: Three themes and nine subthemes were identified: (1) Attributes and receptivity of telelactation interventions, (2) Benefits associated with telelactation interventions, and (3) Recommendations and improvement opportunities. DISCUSSION: Telelactation interventions were well-received by stakeholders (mothers, fathers, and healthcare providers), and receptivity was found to be influenced by primiparity and the perceived usefulness of telelactation consultations (extrinsic motivation). These interventions showed promising improvement in the provider-user relationship and breastfeeding outcomes. Future studies should make telelactation user-friendly, secure their telelactation platforms, increase communication options and built-in functions, and improve care continuity. CONCLUSION: This review highlighted the advantages, recommendations, and future considerations for telelactation interventions. More research is needed to pilot telelactation interventions in various regions and obtain longitudinal data with different time points.

Experiences of patients and their caregivers in a Virtual Ward in Singapore: A descriptive qualitative study.

BACKGROUND: The experiences of COVID-19 patients admitted to Virtual Wards and their caregivers are underexplored in Asian communities. A COVID-19 Virtual Ward (CVW) was recently established in Singapore. AIM: This study aims to describe the experiences of high-risk COVID-19 patients admitted to a Virtual Ward and their caregivers in a multi-racial Asian community. METHODS: A descriptive qualitative study was conducted from November 2021 to March 22 among high-risk COVID-19 patients and their caregivers who had been admitted to a CVW. The CVW involved teleconsultation whereby patients submitted their vital signs via a chatbot on their mobile phone and were supported remotely by a team of allied health professionals. In-depth interviews were conducted with patients and their caregivers and analyzed thematically. Findings The findings were supported by three themes. First, CVW admissions were perceived to be safe and effective. The second emerging theme related to the benefits and burdens of receiving care at home. The benefits of CVW were perceived comfort and familiarity with the home environment, while burdens included ensuring discipline in submitting health data and self-isolating from other household members. Last, the role of external factors such as informal support, paid domestic workers, and work arrangements was highlighted by the participants. Overall, key enablers for a successful CVW experience were the availability of social support, timely care from the care team, and 24/7 access to the team. CONCLUSION: In conclusion, CVW was perceived as a safe and effective strategy to manage high-risk patients at home. We recommend that Virtual Wards should be further developed to expand bed capacity in both pandemic and non-pandemic settings.

Nurses and nursing students' experiences on pediatric end-of-life care and death: A qualitative systematic review.

BACKGROUND: End-of-Life care and experiencing death of infants, children, and teenagers remain one of the most difficult and traumatic events for nurses and nursing students, potentially leading to personal and professional distress. Although efforts have been made to alleviate stressors in these settings, improvements remain slow. Understanding nurses and nursing students' experiences of pediatric End-of-Life care and death in multiple care settings may direct interventions to better support quality of care and healthcare professionals in these areas. OBJECTIVE: This review aimed to qualitatively synthesize existing literature to examine the nurses and nursing students' experiences of providing End-of-Life care to children and the death of pediatric patients. DESIGN: The qualitative systematic review was conducted using Sandelowski and Barroso's guidelines. The included studies were appraised using the Critical Appraisal Skill Program. DATA SOURCES: This qualitative systematic review was registered with the International Prospective Register of Systematic Reviews. Six electronic databases (Cumulative Index of Nursing and Allied Health Literature, PubMed, Embase, PsychINFO, Scopus, and Mednar) were searched from the database inception date through May 2021. RESULTS: Thirty articles were included to form three key themes: (1) Emotional impact of pediatric End-of-Life care and death, (2) Perspective of delivering optimal care: What works and what does not, and (3) The complex role of nurses in pediatric End-of-Life care. Overall, the findings suggested that in an emotionally taxing environment, clinical and emotional support were paramount. Furthermore, there is a need to examine nurses' role in End-of-Life decision making and provide more discussion on professional boundaries. CONCLUSION: This review offered nurses' and nursing students' perceptions of pediatric End-of Life care and death in the nursing profession. Findings can provide useful insights towards the planning of educational programs and institutional changes that supports nurses and nursing students in these settings.

Perceptions of Stakeholders Toward "Hospital at Home" Program in Singapore: A Descriptive Qualitative Study.

OBJECTIVE: Hospital at Home (HaH) programs have been shown to improve quality of care and patient satisfaction, and reduce bed occupancy rate in hospitals. Despite the prevalence of HaH in Western countries, studies in Asia are limited and the perception of HaH remains underexplored in Asian context. Understanding the perceptions of stakeholders is vital before implementing HaH in any new settings. Thus, the aim of this study is to explore the perceptions of referring physicians, care providers, patients, and caregivers on HaH programs in a multiracial country such as in Singapore. METHODS: This study used a descriptive qualitative design. Participants from 2 tertiary hospitals in Singapore, including 13 referring physicians, 10 care providers, 15 patients, and 3 caregivers, were interviewed between June 2020 and September 2020. Data were analyzed using inductive thematic analysis. RESULTS: The overarching theme titled "The stakeholders' perception on HaH" was pillared by 4 main themes: (1) patients suitable for HaH; (2) perceived advantages and benefits of HaH; (3) perceived risks, anxiety, and concerns about HaH; and (4) potential enablers of HaH. Overall, the findings reported that most of the stakeholders embraced HaH. Timely medical interventions and support from care providers were reportedly important factors to maintain patient safety and quality of care. The importance of having adequate resources and sound financing mechanisms to develop a successful HaH program was also highlighted. CONCLUSIONS: This study offered insights into HaH from the perspectives of stakeholders in Singapore and facilitate the planning of future HaH pilot programs in multiracial Singapore and other Asian countries.

Parents' perceptions of antenatal educational programs: A meta-synthesis.

BACKGROUND: Contents and mode of delivery of antenatal educational programs differed considerably. Yet there is a lack of high-level evidence about the delivery of these programs. OBJECTIVE: We aimed to understand the experiences and needs of parents who have attended antenatal educational programs. DESIGN: Six databases were searched from each database. Included studies were appraised using the Critical Appraisal Skills Program tool. Qualitative data were meta-summarized and meta-synthesized. FINDINGS: Seventeen studies were included, and three themes were developed: (1) Contradicting views on antenatal educational programs, (2) Feeling 'well prepared' after attending the antenatal educational programs, and (3) Parents' expectations and way forward for the antenatal educational programs. DISCUSSION: Findings revealed that the description of contents of antenatal educational programs needed to be more specific. Mindfulness strategies were well-received by parents in the included studies. Educators should take into account inclusivity and increase educational resources related to individual, cultural and community needs. Learning needs can be assessed before and after classes. Parents with specific needs that were not addressed should be identified and referred to the relevant professionals for continued support. More deliberate actions were needed during the programs to foster social and professional networks for attendees to support them throughout antenatal and postnatal periods. CONCLUSION: We consolidated the experiences and needs of parents who have attended antenatal educational programs. Findings can help refine policies related to antenatal care to improve pregnancy, birth and parenthood experiences for both mothers and fathers.