Tag: meta-narrative mapping

Meta-narrative review

PLoSOneAs promised, here’s a post about a new paper from COCAPP, published last month in gold open access form in the journal PLOS ONE. Led by Aled Jones, this reports on our meta-narrative review of research into care planning and coordination in community mental health care. Meta-narrative reviews are a relatively new approach to literature reviewing, and aim to track the (potentially diverse) traditions of research found in a given field. Guidance on their production can be found here.

For those interested, here’s this new article’s abstract:

Context

In response to political and social factors over the last sixty years mental health systems internationally have endeavoured to transfer the delivery of care from hospitals into community settings. As a result, there has been increased emphasis on the need for better quality care planning and care coordination between hospital services, community services and patients and their informal carers. The aim of this systematic review of international research is to explore which interventions have proved more or less effective in promoting personalized, recovery oriented care planning and coordination for community mental health service users.

Methods

A systematic meta-narrative review of research from 1990 to the present was undertaken. From an initial return of 3940 papers a total of 50 research articles fulfilled the inclusion criteria, including research from the UK, Australia and the USA.

Findings

Three research traditions are identified consisting of (a) research that evaluates the effects of government policies on the organization, management and delivery of services; (b) evaluations of attempts to improve organizational and service delivery efficiency; (c) service-users and carers experiences of community mental health care coordination and planning and their involvement in research. The review found no seminal papers in terms of high citation rates, or papers that were consistently cited over time. The traditions of research in this topic area have formed reactively in response to frequent and often unpredictable policy changes, rather than proactively as a result of intrinsic academic or intellectual activity. This may explain the absence of seminal literature within the subject field. As a result, the research tradition within this specific area of mental health service delivery has a relatively short history, with no one dominant researcher or researchers, tradition or seminal studies amongst or across the three traditions identified.

Conclusions

The research findings reviewed suggests a gap has existed internationally over several decades between policy aspirations and service level interventions aimed at improving personalised care planning and coordination and the realities of everyday practices and experiences of service users and carers. Substantial barriers to involvement are created through poor information exchange and insufficient opportunities for care negotiation.

It’s taken far longer than it should have done to get this paper into print. PLOS ONE’s peer review and editorial processes moved at glacial pace, and we’ve agreed as a team not to submit to this journal again. As it happens, this week another COCAPP paper completed its journey through peer review, and has been accepted for publication in the  International Journal of Integrated Care. This has been a much better managed publishing experience, and once this article – which reports on what care coordinators do when they coordinate care – appears online I’ll post something here about it.

#MHNR2018 scientific committee and more

img_0567-1Today I’ve been at this year’s meeting of the International Mental Health Nursing Research Conference scientific committee. This convened at the Royal College of Nursing headquarters in London. We had a good range of abstract submissions to deliberate over, and people can expect emails soon informing them of our decisions. We’re also pleased to have been able to identify our annual Mental Health Nurse Academics UK Lecturer for 2018. I dare not make an announcement on this front in this post, and shall wait for official communications to be made first.

Hopefully #MHNR2018, which takes place in Manchester in the middle of September, will be a lively and well-attended affair. There is, it has to be said, space for the conference committee to receive and deliberate over a larger number of conference abstracts than it did today. For #MHNR2019, my early request is: spread the word, and get writing. And for #MHNR2018, for people who missed the abstract submission date: do consider, if possible, participating as a delegate anyway.

Elsewhere, having been stuck in the PLOSONE editorial and peer review system for a spectacularly long period, this week’s good news on the mental health research front includes the acceptance for publication of a paper reporting the COCAPP metanarrative review of care planning and coordination. This has been lead authored by Aled Jones, and once it becomes available in the public domain I’ll post a link. Also accepted for publication this week is a paper lead authored by Jane Davies, derived from her PhD which I supported as a supervisor with Danny Kelly. Jane’s study was an investigation into choice and control in young people with cancer, and this article accepted by the European Journal of Oncology Nursingreports some of Jane’s main findings.

Talking of publications, later this week I head into a meeting of the Cardiff University Press editorial board. Up to now I haven’t written much on this site about the Press, which has been around since 2014 and supports journal publishing in diamond open access form. The Press is in the process of extending into monograph publishing, too, having struck an agreement with Ubiquity. For people looking to move their existing journal titles, or to found new ones, the Press is a good place to go and information on opportunities of this type can be found here.

Synthesising evidence

evidenceToday, returning to this blog after something of a gap, I find reason to reflect on the many flavours of evidence review which now exist.

In the RiSC project we’ve been using the EPPI-Centre approach, developed by people working at the Institute of Education in London. This framework has a number of desirable features, including the combination of a phase 1 mapping with a more in-depth phase 2 involving quality appraisal. Deciding the focus of phase 2 in an EPPI-Centre review involves discussion with stakeholding collaborators. That’s all to the good, proving that in evidence syntheses, as in primary data-generating studies, it is possible for researchers to work jointly with service user, carer and practitioner colleagues.

Last week, with other members of the Wales chapter of the COCAPP team, I spoke on our meta-narrative mapping of care planning and care coordination at a Swansea University seminar. Amongst other things meta-narrative mapping traces the different research traditions found within a given field. And, today, I mock-examined a delightful doctoral thesis containing a scoping review, which lays out what’s there but does not include formal quality appraisal. Then there are realist syntheses, where reviewers look across multiple studies for evidence of the generative mechanisms underpinning change in policy, services or practice. The list goes on, encompassing thematic literature reviews and, of course, Cochrane-style systematic reviews. This latter approach has been very important in driving the evidence-based practice movement, but personally I’ve always been a little disappointed at its insistence on hierarchies with randomised trials as the gold standard.

So how might decisions be made on selecting one approach over another? Practical considerations have a bearing, but perhaps more important are commitments to certain intellectual or other principles. We chose the EPPI-Centre approach in RiSC because we valued user, carer, practitioner and manager perspectives and wanted a way of hearing these and using them to inform our project. Realist reviewers sign up to particular sets of ideas on how programmes work, and meta-narrative mappers embrace the idea, and seek out examples, of paradigmatic differerence. Perhaps the key thing is to be aware of, and articulate, these in justifying the choices which inevitably have to be made.