Effectiveness of text message reminders on paediatric appointment adherence: a systematic review and meta-analysis.

Attending health appointments is important for the paediatric population, as it allows for earlier detection of health issues and subsequent necessary treatments. It also ensures timely immunisations while also allowing patients or their parents to raise health concerns. Hence, it is crucial to take steps to ensure that such medical appointments are attended. To evaluate the effectiveness of text message reminders (TMRs) in improving paediatric patients' adherence to their appointments. A systematic review and meta-analysis were conducted. The search spanned across eight online databases from their inception dates to January 2024. The random-effects model was utilised to conduct the meta-analysis, where risk ratio was used as the effect measure. Subgroup analyses were conducted for age, number of TMRs sent, and type of appointments attended. In total, 13 studies were included. Compared to standard care (involving non-text message reminders or no reminders), TMRs were significantly more effective in improving appointment attendance among the paediatric population. Significant subgroup differences were found in the type of appointments attended, where TMRs were more effective for medical appointments compared to vaccination appointments. No differences in adherence to appointments were found across age groups or the number of TMRs sent.   Conclusion: Sending TMRs can be a potentially cost-effective way to improve the attendance rate of paediatric medical appointments, given the ease of implementation and the extensive mobile phone usage globally. Future studies should compare TMRs to other modes of automated reminders such as telephone messages or emails, to identify the most optimal method of delivery.   Trial registration: PROSPERO (CRD42023464893).

Healthy siblings' perspectives about paediatric palliative care: A qualitative systematic review and meta-synthesis.

BACKGROUND: Siblings of children requiring palliative care are often forgotten and overlooked, as the focus tends to be on the ill child and their parents. Limited knowledge of non-bereaved siblings' perspectives makes it challenging to provide appropriate support for them. A review of existing literature is thus needed to better understand the experiences of these siblings and to identify research gaps that may require further examination. AIM: To consolidate the available qualitative evidence on the perspectives of non-bereaved healthy siblings regarding paediatric palliative care. DESIGN: A qualitative systematic review using a meta-synthesis approach was conducted. DATA SOURCES: Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until October 2022. The search included qualitative and mixed-method studies that reported the perceptions and associations of siblings of patients receiving paediatric palliative care. Data were synthesised using thematic analysis. RESULTS: Eleven studies were included. The overarching theme of the review would be 'A walking shadow: Living in the darkness shaped by the dying sibling', and three key themes and nine subthemes were identified from the included articles: (1) Changing family dynamics; (2) Impact on school and socialisation and (3) Psychological impact and coping. CONCLUSION: Siblings demonstrated negative psychological impacts and were affected by changing family structure and relationships. However, socialisation with society, and varied coping skills such as cognitive coping and using distraction techniques, were significant for siblings to go through this journey and even led to some positive outcomes for them.

Primary care physicians' perspectives on the identification and management of postnatal mental health problems.

BACKGROUND: Postnatal mental health problems (PMHPs) are prevalent and negatively affect mothers, children, and society. International and local guidelines recommend that Singapore primary care physicians (PCP) screen, assess, and manage mothers with PMHPs. However, little is known about their experiences and views. METHODS: We conducted semi-structured interviews with 14 PCPs in Singapore. Interview questions elicited perspectives on the identification and management of mothers with PMHPs. The interview guide was developed from a conceptual framework incorporating the knowledge-attitudes-practices, self-efficacy, and socio-ecological models. Interviews were audio-recorded and transcribed. Thematic analysis was used to identify emergent themes. RESULTS: Singapore PCPs viewed themselves as key providers of first-contact care to mothers with PMHPs. They believed mothers preferred them to alternative providers because of greater accessibility and trust. In detection, they were vigilant in identifying at-risk mothers and favoured clinical intuition over screening tools. PCPs were confident in diagnosing common PMHPs and believed that mothers not meeting diagnostic criteria must be readily recognized and supported. In managing PMHPs, PCPs expressed varying confidence in prescribing antidepressants, which were viewed as second-line to supportive counselling and psychoeducation. Impeding physician factors, constraining practice characteristics and health system limitations were barriers. Looking forward, PCPs aspired to leverage technology and multidisciplinary teams to provide comprehensive, team-based care for the mother-child dyad. CONCLUSION: Singapore PCPs are key in identifying and managing mothers with PMHPs. To fully harness their potential in providing comprehensive care, PCPs need greater multidisciplinary support and technological solutions that promote remote disclosure and enhanced preparation for their role.

Psychometrics of the breastfeeding self-efficacy scale and short form: a systematic review.

BACKGROUND: The Breastfeeding Self-Efficacy Scale and its short-form were developed in Canada and have been used internationally among numerous maternal populations. However, the psychometric properties of the scales have not been reviewed to confirm their appropriateness in measuring breastfeeding self-efficacy in culturally diverse populations. The purpose of this research was to critically appraise and synthesize the psychometric properties of the scales via systematic review. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Three databases (EMBASE, MEDLINE, and PsycINFO) were searched from 1999 (original publication of the Scale) until April 27, 2022. The search was updated on April 1, 2023. Studies that assessed the psychometric properties of the BSES or BSES-SF were included. Two researchers independently extracted data and completed the quality appraisals. RESULTS: Forty-one studies evaluated the psychometrics of the BSES (n = 5 studies) or BSES-SF (n = 36 studies) among demographically or culturally diverse populations. All versions of the instrument demonstrated good reliability, with Cronbach's alphas ranging from .72 to .97. Construct validity was supported by statistically significant differences in mean scores among women with and without previous breastfeeding experience and by correlations between the scales and theoretically related constructs. Predictive validity was demonstrated by statistically significant lower scores among women who ultimately discontinued breastfeeding compared to those who did not. CONCLUSION: The BSES and BSES-SF appear to be valid and reliable measures of breastfeeding self-efficacy that may be used globally to (1) assess women who may be at risk of negative breastfeeding outcomes (e.g., initiation, duration and exclusivity), (2) individualize breastfeeding support, and (3) evaluate the effectiveness of breastfeeding interventions.

Parents' Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot-A Digital Healthcare Assistant): Qualitative Process Evaluation.

BACKGROUND: Parents experience many challenges during the perinatal period. Mobile app-based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. OBJECTIVE: This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app-based intervention with an in-built chatbot titled Parentbot-a Digital Healthcare Assistant (PDA). METHODS: A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50%; intervention group: 10/20, 50%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. RESULTS: Three themes with 10 subthemes describing parents' perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. CONCLUSIONS: Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users' experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents.

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.

Perceptions of game-based education among parents during the perinatal period: A mixed studies review.

BACKGROUND: Experiential education, particularly through game-based approaches, has gained recognition for effectively addressing the myriad challenges faced by expectant parents. AIM: To consolidate and synthesize the available evidence regarding expectant parents' experiences of game-based perinatal education. DESIGN: A mixed studies review. DATA SOURCES: Six electronic databases were searched from their inception until March 2024: PubMed, Embase, CINAHL, Web of Science, Scopus, ProQuest Dissertations and Theses Global. METHODS: This review observed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was guided by Pluye and Hong's (2014) framework for mixed studies review. Quality appraisal of included studies was conducted using the Mixed Methods Appraisal Tool. A convergent qualitative synthesis design for mixed studies review was adopted to analyse all findings and thematic analysis was conducted. FINDINGS: Three themes and 10 subthemes were generated from the eight included studies. The main themes were: (1) Exploring novel frontiers to deliver perinatal education, (2) Empowerment through play: Unveiling key insights and (3) Insights and recommendations. CONCLUSION: The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills in an engaging and immersive manner to navigate the challenging perinatal period. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The findings suggest that game-based education holds promise as a valuable tool for equipping expectant parents with the necessary knowledge and skills to navigate the challenging perinatal period. Nurses should consider incorporating or developing a game-based curriculum to supplement current educational classes to encourage parental participation and enhance learning for perinatal education. REPORTING METHOD: This study adhered to the PRISMA reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. TRIAL AND PROTOCOL REGISTRATION: A protocol was submitted to PROSPERO (CRD42023447527).

Effectiveness of educational interventions in reducing the stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta-analysis.

AIM: To examine the effectiveness of educational interventions in reducing stigma among healthcare professionals and students towards people with mental illness. DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs) and cluster RCTs. DATA SOURCES: Articles published from database inception to October 2023 were systematically searched from seven databases (CINAHL, Embase, ProQuest Dissertations and Theses Global, PsycINFO, PubMed, Scopus, Web of Science), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS: Random-effect meta-analyses were conducted. Heterogeneity was evaluated using the I2 statistics and Cochran's Q chi-squared test. A quality appraisal conducted at the study level used the Cochrane risk of bias tool and an outcome-level quality assessment utilized the Grades of Recommendation, Assessment, Development and Evaluation Approach. Publication bias was assessed using the funnel plot. RESULTS: Twenty-five articles were included in this review. Meta-analysis reported statistically significant medium and small effect sizes for attitudes towards mental illness and attitudes towards people with mental illness respectively, showing the association between educational interventions and improved attitudes among healthcare professionals and students. However, a statistically non-significant effect was reported for knowledge of mental illness. Subgroup analyses indicated that face-to-face and contact-based interventions were particularly effective at reducing stigma. Notably, single-session interventions were just as effective as multiple sessions, suggesting a potential for resource-efficient approaches. CONCLUSION: Educational interventions demonstrate promise in fostering more positive attitudes towards mental health issues. Future research should aim to determine the long-term effects of these interventions and include patient feedback on the stigmatizing behaviours of healthcare professionals and students, to holistically evaluate the effect of interventions. NO PATIENT OR PUBLIC CONTRIBUTION: This study is a secondary review and does not require relevant contributions from patients or the public. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Face-to-face contact-based educational sessions have proven to be the most effective. Reinforcing learning may be achieved through a series of repeated single-session interventions.

Strength Amidst Struggles: A Descriptive Qualitative Study of Maternal Experiences of Low Socioeconomic Status Mothers in the Third Month Postpartum.

AIM: To explore the experiences, expectations and needs of mothers from low socioeconomic status at 3 months postpartum. DESIGN: Descriptive qualitative. METHODS: Mothers aged 21 years old and above, from low socioeconomic status (monthly household income is less than Singapore Dollar [SGD] $4300), and irrespective of their parity were invited to participate in one-to-one in-depth interviews at 3 months postpartum from September 2022 to June 2023. A semistructured guide was used in the interviews, which were conducted until data saturation. A trained researcher conducted the interviews that were audio recorded, transcribed verbatim and analysed thematically. Written informed consent was obtained and voluntary participation was reinforced. RESULTS: Twenty mothers participated in this study and four themes were identified: (1) difficult trade-offs; (2) help-seeking behaviours and (3) 'But if?' Concerns about Emergencies. CONCLUSION: This study explored the difficult circumstances that mothers from low socioeconomic status face in their third month postpartum, and how wider societal inequalities exacerbated these circumstances. Current policies and practices need to be relooked, reframed, and reformed to address the unique needs of this community. IMPLICATIONS FOR PATIENT CARE: Nurses should keep mothers' struggles in balancing employment and childcare in consideration and explore other ways of supporting the low socioeconomic status mothers such as online modes in providing patient education and peer support. IMPACT: Mothers from low socioeconomic status are less likely to seek formal help from healthcare professionals, external organizations and the government. These mothers need flexible, affordable and accessible childcare options to return to work. More targeted family-oriented policies that create empowering and understanding workplaces in Singapore could help ease the stress on mothers returning to employment postpartum. Online peer support groups consisting of mothers of similar socioeconomic backgrounds could help engage and retain this hard-to-reach yet vulnerable population. REPORTING METHOD: COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Cradling disparities: A descriptive qualitative study of maternal experiences of mothers from low-socioeconomic status in the first month postpartum.

AIM: To explore the experiences, expectations and needs of mothers from low-socioeconomic status at 1 month postpartum. DESIGN: Descriptive qualitative. METHODS: Mothers from low-socioeconomic status and irrespective of their parity were invited to participate in one-to-one interviews at 1 month postpartum. Semi-structured interviews were conducted until data saturation. Interviews were audio recorded, transcribed verbatim and analysed thematically. Written informed consent was obtained. RESULTS: Twenty mothers participated and six themes were identified: (1) No choice but to find meaning; (2) Father as a major pillar of support; (3) 'Kampung' Spirit; (4) Trials and Tribulations of Transition to Motherhood; (5) Shame, guilt and internalized stigma and (6) Reclaiming the power. CONCLUSION: This study reflected the unique struggles of mothers from low-socioeconomic status with pregnancy, childbirth and early postpartum and the wider health inequities within Singapore's maternal health system. To provide much-needed support and improved care, the stakeholders within government, healthcare providers and social organizations should consider the niche needs of this community. IMPLICATIONS FOR PATIENT CARE: Nurses need to reflect on their own biases and ensure consistent care delivery regardless of socioeconomic status. When delivering patient education, patient-centred and sincere advice rooted in personal experience can help to establish rapport. IMPACT: This study is the first to explore the experiences of mothers from low-socioeconomic status in the Singapore context. Low-socioeconomic status mothers experienced less autonomy over their health, the care they received and their childcare options. As mothers adjusted to their new roles, they struggled to cope. However, as they were wary of the stigma surrounding poverty and their guilt of not being a 'good mother', they preferred to seek informal support from their family, friends and self-help through learning from social media, as compared to formal, external help. REPORTING METHOD: COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nurturing networks: A prospective longitudinal study of factors influencing help-seeking behaviours among mothers from low socioeconomic status.

AIM: To explore the factors influencing help-seeking behaviours amongst mothers with low socioeconomic status at pregnancy, 1 month postpartum and 3 months postpartum. METHODS: A prospective cohort study was conducted from September 2022 to August 2023. A total of 209 mothers aged 21 years and above, with low socioeconomic status and irrespective of parity, were recruited from a local hospital using convenience sampling. Self-administered questionnaires were used to collect data at (1) third trimester of pregnancy, (2) 1 month postpartum and (3) 3 months postpartum. Multiple regression analysis was used to identify significant factors influencing help-seeking behaviour at 3 months postpartum. Sub-analyses were conducted between primiparous mothers and multiparous mothers. General linear model repeated measures were used to identify longitudinal trends in outcomes of help-seeking behaviour. RESULTS: Help-seeking behaviour at pregnancy and 1 month postpartum, sources of social support at 3 months postpartum, birth order of the child, attendance of antenatal classes, paternal involvement in feeding and changing diapers and mode of delivery significantly predicted mothers' help-seeking behaviour at 3 months postpartum. Amongst primiparous mothers, help-seeking behaviour at pregnancy at 1 month, social support at 3 months postpartum, employment in part-time jobs and exclusively breastfeeding their infant were significant factors in influencing their help-seeking behaviours at 3 months postpartum. For multiparous mothers, help-seeking behaviour at pregnancy and 1 month postpartum, number of hours of antenatal class attended, Malay ethnicity, educational background, parental satisfaction at 3 months postpartum and infant bonding at both time points were significant factors influencing their help-seeking behaviours at 3 months postpartum. CONCLUSION: Primiparous mothers with low socioeconomic status who underwent caesarean section exhibited less help-seeking behaviours. Attendance of antenatal classes and greater paternal involvement in infant care encouraged mothers with low socioeconomic status to help-seeking behaviours. A tailored approach is needed to support mothers with low socioeconomic status by providing additional support in improving the accessibility of antenatal classes and involving fathers in infant care. IMPACT: What Problem Did the Study Address? Mothers with low socioeconomic status tend to exhibit lower help-seeking behaviours due to limited support and access to care services. What Were the Main Findings? First-time mothers who underwent caesarean section, did not attend antenatal classes, and had husbands uninvolved in feeding and diaper changing were significantly less likely to seek help in the third month postpartum. One and 3 months postpartum are crucial time points when mothers with low socioeconomic status could benefit from additional support. Hospitals should explore online informational resources, forums, teleconsultations and virtual antenatal classes as possible alternative options to improve accessibility for mothers with low socioeconomic status. Where and on Whom Will the Research Have an Impact? Mothers with low socioeconomic status and healthcare providers of mothers with low socioeconomic status will benefit from the findings of this research. This study was conducted within the Singapore context. Findings could be generalizable to other cultural contexts with similar multi-ethnic populations. REPORTING METHOD: STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

'Been there, experienced that': A qualitative study on the experiences and perceptions of online peer volunteers in supporting Singaporean mothers at risk of depression.

BACKGROUND: Online peer support is a useful source of support for parents during the perinatal period, associated with improved psychological outcomes. Past research has found that peer support providers themselves gain from providing peer support as well, making it mutually beneficial. As current maternity care services are insufficient to meet the support needs of parents, the Supportive Parenting App (SPA) intervention was developed to offer them informational, appraisal and emotional support during the perinatal period. It consists of mobile health application-based educational support and online peer support provided by trained peer volunteers, to prevent the development of postnatal depression. OBJECTIVE: To explore the experiences of peer volunteers with providing online peer support to parents during the perinatal period, as well as to identify areas of improvement for the SPA intervention. METHODS: A qualitative descriptive design was adopted. This study took place from October 2020 to August 2021 in two tertiary public healthcare institutions in Singapore. A total of 18 peer volunteers were invited for individual semi-structured interviews. The interviews were audio recorded and transcribed verbatim, and thematic analysis was used to analyse the data. RESULTS: Four themes were emerged as follows: (1) 'Being there': Reminiscing about and healing of own postnatal depression experience; (2) Building rapport with parents; (3) Parents in mind: Mutual sharing of knowledge and how to support new parents better; (4) Ensuring good quality peer support. CONCLUSIONS: The peer volunteers felt that their experience was fulfilling and healing. Frequent contact, sharing of SPA resources and self-disclosure were found to help engage the new parents and build rapport between peer volunteers and parents. Challenges described by the peer volunteers have identified possible areas in which the SPA intervention can be improved. IMPLICATIONS FOR CARE: Communication between peer program facilitators, managers and peer volunteers can be enhanced to ensure that peer volunteers are more sensitive and precise when providing support or information. This can improve rapport building between parents and peer volunteers, which will in turn maximize the benefits that parents can reap through online peer-to-peer support. IMPACT: This study explored the perceptions of peer volunteers who provided online peer support to parents across the perinatal period. Peer volunteers felt that the SPA intervention was meaningful and that providing peer support was a healing experience. They were able to learn about the experiences of other mothers with postpartum depression while sharing their own past experiences. Thus, both parents and peer volunteers can benefit from engaging in online peer support programs. Technology-based interventions like the Supportive Parenting App (SPA) can be a suitable complement to maternity care services by providing parents access to medically accurate information and social support. Additionally, more experienced mothers can engage in fulfilling experiences through volunteering for new mothers who may benefit from informational, appraisal and emotional support. REPORTING METHOD: This study follows the reporting guidelines as stated by the Consolidated criteria for reporting qualitative research (COREQ) checklist. PATIENT OR PUBLIC CONTRIBUTION: Parents and peer volunteers contributed ideas that aided with the design of the mobile app. Many topics added to the educational materials were suggested by these parents as well. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study showed that sufficient training can be provided to lay peer volunteers to help them support other parents, buffering the pressure exerted on the healthcare industry due to the rising demand for healthcare services. The provision of such support is also beneficial for the peer volunteers themselves, as they find it meaningful and educational. Program developers of parenting and peer volunteering interventions can draw on the findings of this study to improve the effectiveness of these programs.

A qualitative systematic review of adolescent's perceptions of sleep: Awareness of, barriers to and strategies for promoting healthy sleep patterns.

AIMS: To consolidate adolescents' perspectives regarding various aspects of sleep and offer insights to promote healthier sleep habits during their critical developmental years. METHODS/DATA SOURCES: Six electronic databases (PubMed, CINAHL, Embase, Scopus, PsycINFO and Web of Science) were searched from their inception dates to June 2023. Data were extracted and meta-summarised using Sandelowski and Barroso's approach and synthesised using Thomas and Harden's thematic analysis framework. RESULTS: Meta-synthesis from 11 peer-reviewed published studies identified four main themes: (1) Awareness and understanding of sleep's significance, (2) The shadows and radiance of slumber, (3) Traversing the sleepscape: trouble bubbles and (4) Illuminating the path: Guiding lights to enhanced sleep. CONCLUSION/IMPLICATIONS: Our review findings suggest a lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Identified barriers to adequate sleep encompass various factors, including overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. Strategies to improve adolescents' sleep health involve multiple sleep strategies, including sleep education, workshops/seminars, parental involvement, incorporating digital well-being practices, the promotion of relaxation techniques and the provision of essential resources. Prioritising sleep health and implementing targeted interventions are key steps to empower adolescents, create supportive environments and shape a healthier future generation. Future research endeavours should focus on evaluating the effectiveness of interventions and exploring the influence of cultural factors. IMPACT: There exists a notable lack of awareness and guidance regarding the significance of sleep and the cultivation of good sleep habits among adolescents. Barriers to achieving adequate sleep among adolescents include overthinking, poor habits, family/environmental influences, extensive technology use, peer pressure, the fear of missing out, academic demands and involvement in extracurricular activities. The collaboration between healthcare institutions, professionals and educational institutions is crucial to facilitate (1) the implementation of sleep education workshops/seminars targeting adolescents, (2) increased parental involvement and role-modelling to instil good sleep practices among adolescents and (3) enhanced integration of digital well-being practices, the promotion of relaxation techniques and accessibility to essential sleep hygiene resources. REPORTING METHOD: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. TRIAL AND PROTOCOL REGISTRATION: This review was registered on the Prospective Register of Systematic Reviews (CRD42023403775).

Navigating Uncharted Waters: A Mixed Studies Systematic Review of Elective Female Fertility Preservation for Women.

AIM: This study aimed to review studies exploring the experiences and perceptions of healthcare students and providers regarding their personal choices for elective female fertility preservation and their recommendations of the same to patients. DESIGN/METHODS: Employing Pluye and Hong's convergent qualitative synthesis approach, a mixed-studies review was conducted. The appraisal of studies was performed using the Mixed Methods Appraisal Tool and data analysis utilised Thomas and Harden's thematic synthesis approach. DATA SOURCES: Six electronic databases (PubMed, Embase, CINAHL, PsycINFO, Scopus and Web of Science) were searched from their inception till November 2023. RESULTS: About 24 studies were reviewed, uncovering four major themes: varied personal perspectives, knowledge gaps and role ambiguities, perceived temporal and financial constraints and apprehensions related to fear and stigma. CONCLUSION/IMPLICATION: This review underscored the challenges faced by healthcare professionals and students in their personal pursuit of elective fertility preservation. Addressing these challenges demands the implementation of fertility navigators, culturally and religiously sensitive public health campaigns and staff training. Moreover, standardised guidelines, transparent cost and process reporting, evidence-based education, counselling on risks and success rates and governmental support in the form of subsidies can mitigate barriers, enhance cost-effectiveness and promote equitable access to care. Collaboration among stakeholders is imperative to ensure equitable access and maintain quality care in elective female fertility preservation. REPORTING METHOD: This mixed studies review followed the reporting guidelines in the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. TRIAL REGISTRATION: This review has been registered on the Prospective Register of Systematic Reviews (PROSPERO) database (CRD42023395406).

Effectiveness of psychosocial interventions on the psychological outcomes of parents with preterm infants: A systematic review and meta-analysis.

BACKGROUND: Parents of preterm infants are often thrown unexpectedly into the care of their vulnerable infant, causing them to be stressed and overwhelmed. Social support has been previously highlighted as a crucial factor in helping parents cope with stress. Several psychosocial interventions have thus been developed to support parents of preterm babies, which warrant further investigations. OBJECTIVES: To evaluate the effectiveness of psychosocial interventions in reducing stress (primary outcome), anxiety, depression, pediatric medical traumatic stress (PMTS) and increasing social support among parents with preterm infants. METHODS: A systematic-review and meta-analysis were conducted. Eight electronic databases were searched for relevant studies from their respective inception dates till September 2023. Meta-analysis was performed with RevMan, using the random-effects model. Heterogeneity was investigated using Cochran Q and I2 tests, and publication bias was assessed using funnel plots. Subgroup analyses were conducted for follow-up measurement, gender of parent, type of intervention provider, and setting. FINDINGS: Eighteen studies were included in this review, and all studies were meta-analysed. Participants who received psychosocial interventions reported significantly lower stress and depression in comparison to control group participants. Psychosocial interventions delivered by psychologists and trained researchers were more effective compared to the nurses. The GRADE assessment indicated that the certainty of evidence for all outcomes were very low. CONCLUSION: Psychosocial interventions effectively reduce stress and depression levels in parents with preterm infants. Our findings encourage the implementation of psychosocial interventions to improve parental psychological wellbeing. Future higher quality trials are needed to measure psychological outcomes among parents, especially fathers.

Development of the Paternal Involvement in Early Infancy Scale (PEACE) for fathers in Singapore.

OBJECTIVES: To develop and validate a psychometrically sound self-reported Paternal involvement in Early InfAnCy ScalE (PEACE) for Asian fathers with infants aged 0-12 months old. METHODS: This study comprised of three phases: (1) Pilot test among 100 fathers, (2) Exploring and confirming the PEACE's multidimensional structure using exploratory factor analysis (EFA) (n = 200 fathers) and confirmatory factor analysis (CFA) (n = 200 fathers), and (3) Assessing one-month test-retest reliability of PEACE among 30 fathers. Data was collected from August 2022 to August 2023. The EFA was conducted using principal axis factoring and varimax rotation. The CFA confirmed the factor structure via goodness-of-fit statistics. To assess the PEACE's concurrent validity, paternal involvement was measured using a previously validated paternal involvement scale. Convergent validity was established by examining correlations between PEACE and theoretically related measures of parenting self-efficacy, parent-child bonding, parenting satisfaction, and depression. Test-retest reliability was examined using the intra-class correlation coefficient. RESULTS: The EFA and CFA results supported the five-factor 25-item PEACE. The five subscales were: i) Providing Tangible Support, ii) Meeting Basic Needs, iii) Bonding with Baby, iv) Decision-Making for Baby, and v) Sense of Responsibility and Accomplishment. All subscales reported good internal consistency and weak to moderate one-month test-retest reliability. Correlation coefficients between the PEACE and other scales supported the concurrent and convergent validity of the PEACE. CONCLUSION: This study provided sufficient evidence to establish the initial reliability and validity of the five-factor 25-item PEACE. IMPLICATIONS TO PRACTICE: The PEACE could be used to quantitatively assess paternal involvement in infant care.

Experiences of paediatric terminal oncology patients and their parents in palliative care: A qualitative systematic review.

PROBLEM: The terminal phase of childhood cancer poses profound physical and mental challenges for children, simultaneously influencing parents and rendering them particularly susceptible to psychosocial issues. ELIGIBILITY CRITERIA: This review included studies exploring the experiences of either: (1) paediatric terminal oncology patients aged under 18 years, (2) parents with a child facing terminal cancer undergoing palliative care, or (3) parents with a child who had undergone palliative care and died. English language, qualitative journal studies or grey literature of any care settings, geographical locations and publication years were included. Studies exploring the experiences of (1) paediatric terminal oncology not receiving palliative care from qualified healthcare professionals, and (3) non-biological parents or non-parental family members, were excluded. SAMPLE: A total of 22 studies were included, published between January 2000 and December 2023. Seventy-two children (aged between 5 and 18 years old) and 236 parents (aged between 24 and 57 years old) participated across all studies. Palliative care settings mostly comprised oncology centres, hospitals and homes. RESULTS: Two themes were identified from the 22 included studies: (1) Navigating rough waters and enduring hardships, and (2) Preparing for end-of-life amidst the looming threat of death. CONCLUSIONS: This review underscored the importance of integrating palliative childhood cancer care in a holistic, age-specific, family-centred, person-centred and timely manner. IMPLICATIONS: Paediatric oncology nurses should attend to physical and psychosocial needs of children and parents, fostering familial and social ties while recognising cultural and spiritual needs. Future research could recruit participants of varying ages, genders, and cultures.

Complex journeys of adolescents after induced abortion: A qualitative systematic review.

PROBLEM: Adolescents face unique challenges in accessing sexual healthcare, particularly regarding induced abortion experiences. Prior research, often quantitative or biased towards young adults, overlooks this. This review aims to address adolescents' specific post-abortion experiences to inform comprehensive reproductive healthcare needs. ELIGIBILITY CRITERIA: Qualitative and mixed-methods studies exploring the experiences of adolescents following induced abortion were included. Studies reporting these experiences from third-person perspectives were excluded. SAMPLE: Five electronic databases (CINAHL, PubMed, PsycINFO, Web of Science, and Embase) were searched from the databases' inception through March 2024. Of the 2834 articles retrieved, 45 studies were included in this review. RESULTS: Using a meta-synthesis approach combining Sandelowski & Barroso's qualitative metasummary with Braun & Clarke's thematic analysis, three main themes emerged: Post-abortion experiences and emotions, Social dynamics and support, and Life post-abortion and future perspectives. CONCLUSIONS: Adolescents who underwent abortion faced physical and emotional challenges, adopted various coping strategies, and had mixed experiences with social support and healthcare providers. To address these challenges, the provision of comprehensive reproductive health information, access to safe and legal abortion options, and support for their physical, social, and emotional well-being is necessary. Healthcare providers must ensure that adolescents are equipped with necessary skills to navigate their reproductive health journeys with informed choices and confidence. IMPLICATIONS: Future research exploring adolescents' experiences, considering cultural beliefs, involving multiple stakeholders, and conducting longitudinal studies, is warranted. Healthcare providers should implement practice changes, including providing accurate information, offering tailored mental health support, and undergoing adolescent-friendly training, to enhance care for adolescents.

Fathers' experiences with supportive parenting interventions: A qualitative systematic review.

Despite proven efficacy, fatherhood interventions face challenges in attracting and retaining participants. This qualitative systematic review aims to inform the future design of fatherhood interventions by consolidating and synthesizing the evidence around fathers' experiences with interventions aimed at enhancing their involvement and relationships with their children. Following PRISMA guidelines, we analyzed 10 studies from a search of six electronic databases. Our analysis coalesced into three pivotal themes: (a) creating a sense of belonging: facilitating participation; (b) transformative takeaways; and (c) challenges of negotiating expectations of masculinity. Our findings indicate that group-based, culturally sensitive programs are advantageous but also reveal that fathers grapple with reconciling evolving fatherhood roles with societally entrenched expectations of masculinity. This review offers actionable insights for the future development, evaluation, and implementation of fatherhood interventions, particularly those utilizing qualitative research methodologies.

Application of the Stanford Biodesign Framework in Healthcare Innovation Training and Commercialization of Market Appropriate Products: A Scoping Review.

The Stanford Biodesign needs-centric framework can guide healthcare innovators to successfully adopt the 'Identify, Invent and Implement' framework and develop new healthcare innovations products to address patients' needs. This scoping review explored the application of the Stanford Biodesign framework for healthcare innovation training and the development of novel healthcare innovative products. Seven electronic databases were searched from their respective inception dates till April 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations, and Theses Global. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews and was guided by the Arksey and O'Malley's scoping review framework. Findings were analyzed using Braun and Clarke's thematic analysis framework. Three themes and eight subthemes were identified from the 26 included articles. The main themes are: (1) Making a mark on healthcare innovation, (2) Secrets behind success, and (3) The next steps. The Stanford Biodesign framework guided healthcare innovation teams to develop new medical products and achieve better patient health outcomes through the induction of training programs and the development of novel products. Training programs adopting the Stanford Biodesign approach were found to be successful in improving trainees' entrepreneurship, innovation, and leadership skills and should continue to be promoted. To aid innovators in commercializing their newly developed medical products, additional support such as securing funds for early start-up companies, involving clinicians and users in product testing and validation, and establishing new guidelines and protocols for the new healthcare products would be needed.