Children of extremist parents: Insights from a specialized clinical team.

BACKGROUND: Data on children who grow up with parents adhering to violent extremism is scant. This makes it extremely delicate to inform policies and clinical services to protect such children from potential physical and psychological harm. OBJECTIVE: This paper explores the predicament of children whose caretakers were referred to a specialized clinical team in Montreal (Canada) because of concerns about risks or actual involvement in violent extremism processes. METHODS: This paper uses a mixed methods concurrent triangulation design. Quantitative data was obtained through a file review (2016-2020). Qualitative data was collected through semi-structured interviews and a focus group with the team practitioners. RESULTS: Clinicians reported the presence of stereotypes in the health and social services network frequently representing religious extremist parents as potentially dangerous or having inappropriate parenting skills while minimizing the perception of risk for parents adhering to political extremism. Children displayed high levels of psychological distress, mainly related to family separation, parental psychopathology, and conflicts of loyalty stemming from familial or social alienation. CONCLUSIONS: Training practitioners to be aware of their own personal and institutional bias may help them to understand the predicament of extremist parents' children and implement systemic, trauma and attachment informed interventions.

Collective case formulation in situations of violent radicalization: A critical perspective in training.

Case formulation is used in clinical training to weave together theoretical perspectives and support a shared plan of action. Although a cornerstone of clinical practice, critical social theorists have highlighted the risks of depoliticizing political struggles and of reifying and fixing subjects when using psychopathology and case formulation to address situations of injustice. In the field of violent radicalization, this risk is increased by the extreme affects evoked by terror in practitioners and in societies. This article explores the challenges of training clinicians in the field of violent radicalization. It does so by analyzing a Community of Practice (CoP) that was developed to support practitioners involved in this domain of practice in Quebec, Canada. Four focus groups with CoP participants and participant observation of nine CoP meetings were conducted. Thematic and narrative analyses were used to explore the training potential of the CoP and to identify the discursive processes and group dynamics associated with this modality. Results indicate that the diversity of professional perspectives and social positionalities in the group plays a central role in helping participants become aware of their biases and in developing more complex understandings of cases and of their social embedding. Results also suggest that the collective holding of risk is key to preserve practitioners' investment in patients involved with violent radicalization. The sensitive issue of partnership between health and social services and security agencies is also addressed. Results suggest that CoPs with strong leadership allow for experiential training to enhance clinical and critical thinking.

The challenges of decolonising participatory research in indigenous contexts: the Atautsikut community of practice experience in Nunavik.

Historically, research involving Indigenous peoples has been the scene of power imbalances between Indigenous communities and researchers. Indigenous peoples have often been put in the position of passive subjects of research rather than participants or collaborators with agency, a situation that the current movement of decolonisation of research and practices in the field of Indigenous health aims to counteract. Participatory research seeks a better balance of input, decision-making and power between research participants and research teams and values participants' knowledges. As such, it is a particularly relevant approach for researchers to involve community members and support self-determination of Indigenous people. Yet, if its explicit intentions are aiming at a decolonising approach, the socio-structural context of participatory research initiatives in Indigenous communities brings obstacles to the approach's success. The development and implementation of the participatory project Atautsikut: A Community of Practice in Youth Mental Health and Wellness in Nunavik, has been an occasion to document certain barriers that take place in participatory research. This article describes Atautsikut as a starting point for a reflection on the challenges of decolonising participatory research. It discusses how, despite intentions, structural barriers, blind spots and unexpected contextual elements may challenge the journey towards decolonising research.

Intercultural Training in Tense Times: Cultural Identities and Lived Experiences Within a Community of Practice of Youth Mental Health Care in Montréal.

This article presents an analysis of the lived experiences of youth mental health practitioners taking part in Transcultural Interinstitutional and Interdisciplinary Case Discussion Seminars (TIICDS), an intercultural training initiative developed in Montréal (Québec, Canada), while considering the current context of increasing social polarizations. Using insights from the community of practice (CoP) framework and drawing on the analysis of 21 seminar sessions and 26 semi-structured individual interviews, this article examines the relation between the local sociopolitical context, the participants' verbalization about their identities, and the affect and cognition evoked by the training. Results indicate that TIICDSs present several features of a CoP and that intercultural training needs to build on both theoretical and experiential knowledge, while considering local contextual elements. These include historical and contemporary social representations and power differentials between groups, the cultural identities of trainees, and the institutions and sociopolitical structures in which clinical practices take place. These elements, we argue, are sensitive and potentially conflictual but can be addressed through supportive and reflexive group-based initiatives such as CoPs that bring together practitioners on a regular basis and provide them with a 'culturally safe enough' space in which they can learn to complexify their understanding of clinical situations.

Egyptian and Roma Adolescents' Perspectives on Their Developmental Assets in Albania During the COVID-19 Pandemic.

This mixed-method study explores the accessibility of developmental assets among Egyptian and Roma minority youth in Albania during the COVID-19 pandemic. Six focus groups were conducted in August 2020 with Egyptian (n = 16) and Roma (n = 15) adolescents (14-20 years, Mage  = 16.71; SDage  = 2.00; 14 girls and 17 boys). In addition, adolescents rated how much they experienced each developmental asset. Descriptive and thematic analyses highlighted: (1) low developmental assets and barriers to accessing resources, (2) mental health concerns and coping strategies, (3) the role of proximal contexts of life, and (4) experiences within the society in terms of discrimination, integration, and contribution to society. Inter-sectoral community-based interventions are urgently needed to mitigate the impact of the pandemic on minority youth.

[Migrant Families' Engagement in Youth Mental Health Collaborative Care: Clinical Spaces Anchored within their Institutional and Sociopolitical Context]. / L'engagement dans les soins en collaboration en santé mentale jeunesse pour les familles migrantes : des lieux cliniques ancrés dans leurs contextes institutionnel et sociopolitique.

Objective This article aims at filling some gaps in the literature regarding conditions conducive to high-quality collaborative care in youth mental health (YMH) for migrant families. It focuses on the factors that are susceptible to foster the engagement of migrant families in the services, by examining the clinical encounter, as well as sociopolitical and institutional dimensions. Methods Using a multiphase mixed methods design, it sequentially follows qualitative and quantitative results regarding migrant families within the different projects of a research program on collaborative care in YMH in culturally and socioeconomically diverse neighborhoods, done in Montreal during the last decade. These results come from data collected through questionnaires, semi-structured interviews, focus groups, participatory observation and documentation, with research participants being children, adolescents and parents from migrant families, clinicians and managers. Results The results suggest that the sociopolitical and macro institutional system finds its way into the clinical space by influencing the process of care. In particular, successive reforms of the health system challenge institutions and YMH teams in their capacity to create a favourable environment for continuity of care and interinstitutional partnership and interprofessional collaboration, factors associated with families' engagement into care. This engagement is also dependent on the representations of mental health and services that migrant families hold. These representations are shaped by their experience of the services, but also by what their sociocultural environment and the public discourses allow them to imagine of these services. This calls for the integration of cultural and sociopolitical dimensions within the concept of engagement. Finally, results also suggest that schools are playing an important role to foster engagement in mental health care. Conclusion The quality of mental health care for migrant children and adolescent relies on the engagement of families, as well as on the mutual engagement of clinicians and of their institutions. Political contexts where tensions between majority and minority groups are present can also act as barriers to the care. Given that migrant families are engaging less in the services compared to non-migrant families, these considerations call for an important review of avenues to facilitate engagement of migrant families into collaborative care YMH services. This article suggests certain avenues to promote this engagement.

Interdisciplinary case discussions as a training modality to teach cultural formulation in child mental health.

The DSM-5 Cultural Formulation Interview (CFI) may become an important tool to help operationalize culture in the clinical realm. However, challenges exist in teaching its use to avoid the risk of stereotyping and oversimplification, which could result in misunderstanding and stigma. The aim of this article is to document whether the CFI can be taught using regular Interdisciplinary Case Discussion Seminars (ICDSs), proposed as continuing education in child mental health and as part of clinical rotations for new trainees. During a two-year evaluative research project, ICDSs were held monthly in three different primary care settings servicing recent immigrants in Montreal, Canada. ICDSs were recorded and analyzed to examine their effect on the cultural formulation process and focus groups were conducted to explore the subjective experience of the participant trainees and professionals. Results suggest that ICDSs are a helpful way to teach the use of the CFI. The group discussions helped participants to better capture the complexity of the cultural and social experience of the child and family by moving away from simple identity assignations, supporting an inquiry into structural dimensions, and considering stigma and inequality in their formulation. The multiple levels of diversity (individual, disciplinary, and interinstitutional) represented in the discussion groups helped clinicians to understand the cultural formulation as situated in a specific relational context and a particular moment and, in so doing, helped trainees to avoid cultural formulations that essentialize culture.

Learning from partnership tensions in transcultural interdisciplinary case discussion seminars: A qualitative study of collaborative youth mental health care informed by game theory.

Although collaborative care was adopted in several countries, including Canada, to improve the health and social services system, partnerships are often experienced as challenging. In many cases, transformative partnership remains a political rhetoric rather than a practical reality. This article presents an analysis of partnership relationships in youth mental health (YMH) using insights from game theory and a qualitative analysis of interactions during transcultural interinstitutional and interdisciplinary case discussion seminars (TIICDSs). Drawing on the analysis of 40 seminar sessions and six focus groups with seminar participants conducted in Montréal (Canada) between October 2013 and April 2015, this article interrogates the conditions and processes present in TIICDSs that contribute to building and strengthening YMH partnerships, examining how tensions among TIICDS participants are attended to. Research results indicate that TIICDSs can be seen as a game operating under different rules than real-life clinical work. They are characterized by the establishment of a climate of trust and respect, a high value placed on diversity and creativity, a concern for affects and power dynamics, a process of inclusive dialogue and negotiation, and a consideration for continuity. The game rules allow participants to safely apprehend a situation from a different perspective, a key competence in intercultural and collaborative YMH care. Results also indicate that participants complexify their representations by playing with divergent perceptions of people and situations and that enhanced case formulations are collective game outcomes. In light of our findings, tensions in collaborations can be seen as constituting both obstacles that can be counterproductive if not attended to, as well as powerful and useful learning tools that, under certain conditions, can support the clinical process and contribute to partnership building. Some clinical and partnership impasses may be overcome through clinical case discussions that allow partners to address these tensions and negotiate power relationships.

Collaborative youth mental health service users, immigration, poverty, and family environment.

BACKGROUND: This article examines the association between immigration, poverty and family environment, and the emotional and behavioral problems reported by youth and their family receiving mental health (MH) services within a collaborative care model in a multiethnic neighborhood. METHOD: Participants in this study were 140 parent-child dyads that are part of an ongoing longitudinal project looking at the association between individual, familial, social and organizational factors, and outcomes of youth receiving MH services in local health and social service organizations in the Montreal area. Measures included in this study were collected at the initial phase of the longitudinal project (Time 0). Parents completed a sociodemographic questionnaire and the Family Environment Scale (FES), and both parents and children completed the Strength and Difficulties questionnaire (SDQ). RESULTS: Results suggest that the family environment, especially family conflicts, has a significant role in the MH problems of children seeking help in collaborative MH services. In this specific population, results also show a trend, but not a statistically significant association, between poverty or immigration and emotional and behavioral problems. They suggest as well that boys show more MH problems, although this could be a contamination effect (parents' perspective). CONCLUSIONS: The results support the importance of interventions that not only target the child symptomatology but also address family dynamics, especially conflicts. Collaborative care models may be particularly well suited to allow for a coherent consideration of family environmental factors in youth mental health and to support primary care settings in addressing these issues.

Perception of Interprofessional Collaboration and Co-Location of Specialists and Primary Care Teams in Youth Mental Health.

OBJECTIVES: Interprofessional collaboration is a cornerstone of youth mental health collaborative care models. This article presents quantitative results from a mixed-methods study. It analyses the organizational predictors of the perception of interprofessional collaboration of professionals comparing two models of services within recently constituted youth mental health collaborative care teams. METHODS: Professionals (n=104) belonging to six health and social services institutions completed an online survey measuring their perceptions of interprofessional collaboration through a validated questionnaire, the PINCOM-Q. RESULTS: Results suggest that the integrated model of collaborative care in which specialized resources are co-located with the primary care teams is the main significant predictor of positive perception of interprofessional collaborations in the youth mental health team. CONCLUSION: More research on the relation between service delivery models and interprofessional relations could help support the successful implementation of collaborative care in youth mental health.

OBJECTIF: La collaboration interprofessionnelle est un pilier des modèles de soins en collaboration en santé mentale des adolescents. Cet article présente les résultats quantitatifs d'une étude à méthodes mixtes. Il analyse les prédicteurs organisationnels de la perception de la collaboration interprofessionnelle de professionnels en comparant deux modèles de services au sein d'équipes de soins en collaboration récemment constituées en santé mentale des adolescents. MÉTHODE: Les professionnels (n = 104) qui appartenaient à six institutions de services sociaux et de santé ont répondu à un sondage en ligne mesurant leurs perceptions de la collaboration interprofessionnelle à l'aide d'un questionnaire validé, le PINCOM-Q. RÉSULTATS: Les résultats suggèrent que le modèle intégré des soins en collaboration dans lequel les ressources spécialisées cohabitent avec les équipes des soins de première ligne est le principal prédicteur significatif de la perception positive des collaborations interprofessionnelles dans l'équipe de santé mentale des adolescents. CONCLUSION: Plus de recherche sur la relation entre les modèles de prestation des services et les relations interprofessionnelles pourrait contribuer à soutenir la réussite de la mise en oeuvre des soins en collaboration en santé mentale des adolescents.

Perspectives of Migrant Youth, Parents and Clinicians on Community-Based Mental Health Services: Negotiating Safe Pathways.

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12-15 years old), one of their parents and their primary care therapist (N = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values.

[Youth mental health at the cross roads of service organization]. / La santé mentale jeunesse: un domaine à la croisée des chemins.

The importance of children and youth mental health is increasingly recognized. This rapidly developing field cannot be conceptualized as an extension of adult services to a younger age group and its developmental and organizational specificities are the object of debate. Reviewing recent literature in this domain and some preliminary information about the Quebec Mental Health Plan implementation, this paper addresses some of the questions which structure this debate in Quebec.Quebec mental health plan has put at the forefront collaboration among disciplines and partnership among institutions. In spite of having produced significant improvement in the field, discontinuities in services, which interfere with an ecosystemic model of care, persist. Recent studies suggest that the organisational climate which surrounds youth mental health services has a direct impact on the quality of services and on youth health outcomes. A flexible management structure, which engages clinicians and health workers, favors empowerment, minimizes work stress and facilitates partnership, is needed to foster successful interdisciplinary and intersectorial collaboration. This collaboration is the cornerstone of youth mental health services.

Development and content validation of the information assessment method for patients and consumers.

BACKGROUND: Online consumer health information addresses health problems, self-care, disease prevention, and health care services and is intended for the general public. Using this information, people can improve their knowledge, participation in health decision-making, and health. However, there are no comprehensive instruments to evaluate the value of health information from a consumer perspective. OBJECTIVE: We collaborated with information providers to develop and validate the Information Assessment Method for all (IAM4all) that can be used to collect feedback from information consumers (including patients), and to enable a two-way knowledge translation between information providers and consumers. METHODS: Content validation steps were followed to develop the IAM4all questionnaire. The first version was based on a theoretical framework from information science, a critical literature review and prior work. Then, 16 laypersons were interviewed on their experience with online health information and specifically their impression of the IAM4all questionnaire. Based on the summaries and interpretations of interviews, questionnaire items were revised, added, and excluded, thus creating the second version of the questionnaire. Subsequently, a panel of 12 information specialists and 8 health researchers participated in an online survey to rate each questionnaire item for relevance, clarity, representativeness, and specificity. The result of this expert panel contributed to the third, current, version of the questionnaire. RESULTS: The current version of the IAM4all questionnaire is structured by four levels of outcomes of information seeking/receiving: situational relevance, cognitive impact, information use, and health benefits. Following the interviews and the expert panel survey, 9 questionnaire items were confirmed as relevant, clear, representative, and specific. To improve readability and accessibility for users with a lower level of literacy, 19 items were reworded and all inconsistencies in using a passive or active voice have been solved. One item was removed due to redundancy. The current version of the IAM4all questionnaire contains 28 items. CONCLUSIONS: We developed and content validated the IAM4all in partnership with information providers, information specialists, researchers and representatives of information consumers. This questionnaire can be integrated within electronic knowledge resources to stimulate users' reflection (eg, their intention to use information). We claim that any organization (eg, publishers, community organizations, or patient associations), can evaluate and improve their online consumer health information from a consumers' perspective using this method.

Number needed to benefit from information (NNBI): proposal from a mixed methods research study with practicing family physicians.

PURPOSE: We wanted to describe family physicians' use of information from an electronic knowledge resource for answering clinical questions, and their perception of subsequent patient health outcomes; and to estimate the number needed to benefit from information (NNBI), defined as the number of patients for whom clinical information was retrieved for 1 to benefit. METHODS: We undertook a mixed methods research study, combining quantitative longitudinal and qualitative research studies. Participants were 41 family physicians from primary care clinics across Canada. Physicians were given access to 1 electronic knowledge resource on handheld computer in 2008-2009. For the outcome assessment, participants rated their searches using a validated method. Rated searches were examined during interviews guided by log reports that included ratings. Cases were defined as clearly described searches where clinical information was used for a specific patient. For each case, interviewees described information-related patient health outcomes. For the mixed methods data analysis, quantitative and qualitative data were merged into clinical vignettes (each vignette describing a case). We then estimated the NNBI. RESULTS: In 715 of 1,193 searches for information conducted during an average of 86 days, the search objective was directly linked to a patient. Of those searches, 188 were considered to be cases. In 53 cases, participants associated the use of information with at least 1 patient health benefit. This finding suggested an NNBI of 14 (715/53). CONCLUSION: The NNBI may be used in further experimental research to compare electronic knowledge resources. A low NNBI can encourage clinicians to search for information more frequently. If all searches had benefits, the NNBI would be 1. In addition to patient benefits, learning and knowledge reinforcement outcomes are frequently reported.

An online knowledge resource and questionnaires as a continuing pharmacy education tool to document reflective learning.

OBJECTIVE: To assess the use of an electronic knowledge resource to document continuing education activities and reveal educational needs of practicing pharmacists. METHODS: Over a 38-week period, 67 e-mails were sent to 6,500 Canadian Pharmacists Association (CPhA) members. Each e-mail contained a link to an e-Therapeutics+ Highlight, a factual excerpt of selected content from an online drug and therapeutic knowledge resource. Participants were then prompted to complete a pop-up questionnaire. RESULTS: Members completed 4,140 questionnaires. Participants attributed the information they learned in the Highlights to practice improvements (50.4%), learning (57.0%), and motivation to learn more (57.4%). CONCLUSIONS: Reading Highlight excerpts and completing Web-based questionnaires is an effective method of continuing education that could be easily documented and tracked, making it an effective tool for use with e-portfolios.

Do family physicians retrieve synopses of clinical research previously read as email alerts?

BACKGROUND: A synopsis of new clinical research highlights important aspects of one study in a brief structured format. When delivered as email alerts, synopses enable clinicians to become aware of new developments relevant for practice. Once read, a synopsis can become a known item of clinical information. In time-pressured situations, remembering a known item may facilitate information retrieval by the clinician. However, exactly how synopses first delivered as email alerts influence retrieval at some later time is not known. OBJECTIVES: We examined searches for clinical information in which a synopsis previously read as an email alert was retrieved (defined as a dyad). Our study objectives were to (1) examine whether family physicians retrieved synopses they previously read as email alerts and then to (2) explore whether family physicians purposefully retrieved these synopses. METHODS: We conducted a mixed-methods study in which a qualitative multiple case study explored the retrieval of email alerts within a prospective longitudinal cohort of practicing family physicians. Reading of research-based synopses was tracked in two contexts: (1) push, meaning to read on email and (2) pull, meaning to read after retrieval from one electronic knowledge resource. Dyads, defined as synopses first read as email alerts and subsequently retrieved in a search of a knowledge resource, were prospectively identified. Participants were interviewed about all of their dyads. Outcomes were the total number of dyads and their type. RESULTS: Over a period of 341 days, 194 unique synopses delivered to 41 participants resulted in 4937 synopsis readings. In all, 1205 synopses were retrieved over an average of 320 days. Of the 1205 retrieved synopses, 21 (1.7%) were dyads made by 17 family physicians. Of the 1205 retrieved synopses, 6 (0.5%) were known item type dyads. However, dyads also occurred serendipitously. CONCLUSION: In the single knowledge resource we studied, email alerts containing research-based synopses were rarely retrieved. Our findings help us to better understand the effect of push on pull and to improve the integration of research-based information within electronic resources for clinicians.

A participatory approach to understanding and measuring patient satisfaction in a primary care teaching setting.

BACKGROUND: Patient satisfaction is a complex, multidimensional concept that is difficult to measure. However, there is agreement that understanding the expectations of a patient community or "what is important to them" is an essential consideration. We chose a participatory approach to address patient satisfaction in the context of a primary care teaching clinic. OBJECTIVES: The objectives of this project were to use a participatory research team of patients staff and researchers to (1) adapt an existing patient satisfaction questionnaire (PSQ) to the specific cultural and organizational elements ofa primary care teaching clinic, (2) administer the revised questionnaire and use the findings as a tool for organizational improvement, with the ultimate goal of increasing patient satisfaction, and (3) ensure that all decision making involved patients and staff to empower them in the process of organizational change. METHODS: We used an iterative, mixed methods approach to conduct this project. An interdisciplinary committee composed of members of the patient community, clinical and administrative staff, and researchers worked together as the primary decision making body. RESULTS: We modified a preexisting questionnaire to address the unique care delivery model of the clinic, issues of cultural sensitivity, and the need for simplified language and response format. Patient dissatisfaction was found to center on continuity and access to care. CONCLUSIONS: The participatory approach was critical to our success in understanding and measuring patient satisfaction from the patients' perspective. The involvement of the interdisciplinary committee and the high level of joint decision making in this project represents a unique contribution to assessing primary care patient satisfaction.

Evaluation of email alerts in practice: Part 2. Validation of the information assessment method.

RATIONALE AND OBJECTIVE: The information assessment method (IAM) permits health professionals to systematically document the relevance, cognitive impact, use and health outcomes of information objects delivered by or retrieved from electronic knowledge resources. The companion review paper (Part 1) critically examined the literature, and proposed a 'Push-Pull-Acquisition-Cognition-Application' evaluation framework, which is operationalized by IAM. The purpose of the present paper (Part 2) is to examine the content validity of the IAM cognitive checklist when linked to email alerts. METHODS: A qualitative component of a mixed methods study was conducted with 46 doctors reading and rating research-based synopses sent on email. The unit of analysis was a doctor's explanation of a rating of one item regarding one synopsis. Interviews with participants provided 253 units that were analysed to assess concordance with item definitions. RESULTS AND CONCLUSION: The content relevance of seven items was supported. For three items, revisions were needed. Interviews suggested one new item. This study has yielded a 2008 version of IAM.

A scoring system for appraising mixed methods research, and concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed Studies Reviews.

UNLABELLED: A new form of literature review has emerged, Mixed Studies Review (MSR). These reviews include qualitative, quantitative and mixed methods studies. In the present paper, we examine MSRs in health sciences, and provide guidance on processes that should be included and reported. However, there are no valid and usable criteria for concomitantly appraising the methodological quality of the qualitative, quantitative and mixed methods studies. OBJECTIVE: To propose criteria for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies or study components. DESIGN: A three-step critical review was conducted. DATA SOURCES: 2322 references were identified in MEDLINE, and their titles and abstracts were screened; 149 potentially relevant references were selected and the full-text papers were examined; 59 MSRs were retained and scrutinized using a deductive-inductive qualitative thematic data analysis. This revealed three types of MSR: convenience, reproducible, and systematic. REVIEW METHODS: Guided by a proposal, we conducted a qualitative thematic data analysis of the quality appraisal procedures used in the 17 systematic MSRs (SMSRs). RESULTS: Of 17 SMSRs, 12 showed clear quality appraisal procedures with explicit criteria but no SMSR used valid checklists to concomitantly appraise qualitative, quantitative and mixed methods studies. In two SMSRs, criteria were developed following a specific procedure. Checklists usually contained more criteria than needed. In four SMSRs, a reliability assessment was described or mentioned. While criteria for quality appraisal were usually based on descriptors that require specific methodological expertise (e.g., appropriateness), no SMSR described the fit between reviewers' expertise and appraised studies. Quality appraisal usually resulted in studies being ranked by methodological quality. CONCLUSION: A scoring system is proposed for concomitantly appraising the methodological quality of qualitative, quantitative and mixed methods studies for SMSRs. This scoring system may also be used to appraise the methodological quality of qualitative, quantitative and mixed methods components of mixed methods research.

Many family physicians will not manually update PDA software: an observational study.

BACKGROUND: In a prospective study to explore connections between clinical information delivery and information retrieval, 41 Canadian family physicians searched an electronic knowledge resource (EKR) as needed for practice. Research software, called the Information Assessment Method (IAM), prompted family physicians to report on the situational relevance, perceived cognitive impact and application of their retrieved information hits. Both the IAM and the EKR needed periodic updating to properly address our research questions. OBJECTIVE: To determine the frequency of software updating when manual or semi-automatic approaches are used by family physicians. METHODS: Each family physician received a handheld computer (PDA) that ran the Windows Mobile 6 operating system. For technical reasons, both the IAM and the EKR were accessed offline on PDA. To update the EKR and the IAM, family physicians were asked to synchronize their PDA to their PC. Updating the IAM was a manual process, whereas updating the EKR was semi-automatic. RESULTS: We found: (1) about 25% of family physicians never or rarely updated PDA software on their own, (2) a large number of software updates were never installed and (3) the semi-automatic method was associated with a small increase in the proportion of installed software updates (58.9% versus 48.6% for the manual method). CONCLUSIONS: When a wireless internet connection is not used to update PDA software, sociotechnical issues complicate mobile data collection and data transfer.