BACKGROUND: Virtual patients (VPs) are widely used in health professions education. When they are well integrated into curricula, they are considered to be more effective than loosely coupled add-ons. However, it is unclear what constitutes their successful integration. The aim of this study was to identify and synthesise the themes found in the literature that stakeholders perceive as important for successful implementation of VPs in curricula.
METHODS: We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern\'s six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool.
RESULTS: Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes.
CONCLUSIONS: The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.

BACKGROUND: Shared decision-making facilitates collaboration between patients and health care providers for informed health decisions. Our review identified interventions to support Indigenous Peoples making health decisions. The objectives were to synthesize evidence and identify factors that impact the use of shared decision making interventions.
METHODS: An Inuit and non-Inuit team of service providers and academic researchers used an integrated knowledge translation approach with framework synthesis to coproduce a systematic review. We developed a conceptual framework to organize and describe the shared decision making processes and guide identification of studies that describe interventions to support Indigenous Peoples making health decisions. We conducted a comprehensive search of electronic databases from September 2012 to March 2022, with a grey literature search. Two independent team members screened and quality appraised included studies for strengths and relevance of studies\' contributions to shared decision making and Indigenous self-determination. Findings were analyzed descriptively in relation to the conceptual framework and reported using guidelines to ensure transparency and completeness in reporting and for equity-oriented systematic reviews.
RESULTS: Of 5068 citations screened, nine studies reported in ten publications were eligible for inclusion. We categorized the studies into clusters identified as: those inclusive of Indigenous knowledges and governance (\"Indigenous-oriented\")(n = 6); and those based on Western academic knowledge and governance (\"Western-oriented\")(n = 3). The studies were found to be of variable quality for contributions to shared decision making and self-determination, with Indigenous-oriented studies of higher quality overall than Western-oriented studies. Four themes are reflected in an updated conceptual framework: 1) where shared decision making takes place impacts decision making opportunities, 2) little is known about the characteristics of health care providers who engage in shared decision making processes, 3) community is a partner in shared decision making, 4) the shared decision making process involves trust-building.
CONCLUSIONS: There are few studies that report on and evaluate shared decision making interventions with Indigenous Peoples. Overall, Indigenous-oriented studies sought to make health care systems more amenable to shared decision making for Indigenous Peoples, while Western-oriented studies distanced shared decision making from the health care settings. Further studies that are solutions-focused and support Indigenous self-determination are needed.

We conducted a systematic review of qualitative evidence to improve understanding of the processes and outcomes of redress and reconciliation following a life-changing event from the perspectives of individuals experiencing the event and their families.
We searched six bibliographic databases for primary qualitative evidence exploring the views of individuals who have experienced a life-changing event, and/or their family or carers, of redress or reconciliation processes. This was supplemented with targeted database searches, forward and backward citation chasing and searches of Google Scholar and relevant websites. Title and abstract and full-text screening were undertaken independently by two reviewers. Data extraction and quality appraisal were conducted by one reviewer and checked by a second. We used a best-fit framework synthesis approach, drawing upon procedural and restorative justice concepts.
Fifty-three studies (61 papers) were eligible for inclusion. Forty-one studies (47 papers) were included in the synthesis, from which we identified four themes. Three themes \'Transparency\', \'Person-centered\' and \'Trustworthy\' represent the procedural elements required to support a fair and objective process. The fourth, \'Restorative justice\' encapsulates how a fair process feels to those who have experienced a life-changing event. This theme highlights the importance of an empathic relationship between the different parties involved in the redress-reconciliation process and the significance of being able to engage in meaningful action.
Our findings highlight the procedural aspects and context of redress-reconciliation processes required to ensure that the process and outcomes are experienced as fair. These criteria may be applied to the processes used to investigate both recent and historical patient safety events.
One member of the public affiliated with the Exeter Policy Research Programme Evidence Review Facility helped develop the review protocol. Two people with experience of medically life-changing events provided insight which corroborated our findings and identified important limitations of the evidence included in this review.

OBJECTIVE: To identify how peer support interventions, for self-management of chronic pain, support basic psychological needs from a self-determination theory (SDT) perspective, using a systematic review.
METHODS: Ten databases were searched for studies reporting qualitative research about peer interactions in pain management interventions. \'Best fit\' framework synthesis methodology was applied to identify strategies that support the satisfaction of competence, autonomy and motivation. These were matched to definitions of strategies provided by standardised taxonomies.
RESULTS: 18 studies were selected for inclusion. The synthesis resulted in a conceptual model, identifying 12 peer strategies that support psychological needs for self-management of chronic pain; 10 overlapped with existing taxonomies.
CONCLUSIONS: This was the first known attempt to synthesise evidence about peer support strategies for people living with pain, using SDT as an a priori framework. The model demonstrates commonality between the motivation-promoting processes of peer support and those of other behaviour change interventions and identifies additional unique strategies provided by peers. This systematic classification of peer support strategies provides a means for future study of the efficacy and comprehensiveness of peer interventions.
CONCLUSIONS: The model could assist healthcare professionals and support groups to optimise the potential of peer processes.

Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a \'model of evidence-based, non-surgical OA care that has been implemented in a real-world setting\'. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE-CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.

Personal recovery, living a satisfying, hopeful life alongside symptoms, has become an increasingly valued aim across mental health care agendas internationally. However, there is little understanding of how people experience personal recovery alongside the mood challenges characteristic of a bipolar disorder diagnosis. Personal recovery frameworks have been developed for populations with mixed psychiatric diagnoses, predominantly psychotic disorders.
This systematic review of qualitative data used the widely adopted personal recovery processes Connectedness, Hope and optimism, Identity, Meaning and purpose, Empowerment (CHIME) in a \"best fit\" framework synthesis to understand personal recovery experiences in bipolar disorder. Included studies were coded with deductive framework analysis based on the CHIME processes and inductive thematic analysis for aspects beyond the a priori framework.
A comprehensive search of six literature databases led to inclusion of twelve articles published 2010-2020. Deductive coding supported the fit with the CHIME framework but revealed difficulties, losses, and tensions within and across recovery processes. The proposed framework for personal recovery in bipolar disorder, Purpose and meaning, Optimism and hope, Empowerment, Tensions, Identity, Connectedness (POETIC), organises all CHIME processes around these tensions.
Diversity among study participants was limited with majority middle-aged, female, Western participants.
The compact POETIC personal recovery framework tailored for bipolar disorder is directly applicable to clinical practice with personal recovery objectives. It highlights the need for professionals to introduce personal recovery in a realistic and balanced way to address recent criticism by service user organisations of personal recovery as overly optimistic.

The short time frame associated with rapid reviews can be challenging for researchers conducting qualitative evidence synthesis. In these circumstances a Best-Fit Framework Synthesis, drawing upon existing theory and/or research, may be conducted to rapidly make sense of qualitative evidence. This article discusses a \"Rapid Best-Fit\" approach to conducting Framework Synthesis within an 6-week rapid systematic review of qualitative evidence. In the absence of a suitable theoretical model to inform the synthesis, we drew upon our research objectives to structure a framework, and to identify the studies which contained the most relevant data. Themes from these studies were used to revise the initial framework before inductive thematic synthesis finalized theme content. This \"Rapid Best-Fit\" approach yielded results aligned with the needs of the commissioners of the review and is a useful addition to qualitative synthesis methods, allowing for the incorporation of diverse views and experiences into fast-paced decision making scenarios.

Framework synthesis is one systematic review method employed to address health care practice and policy. Adapted from framework analysis methods, it has been used increasingly, using both qualitative and mixed-method systematic review methods. This article demonstrates a spectrum of approaches to framework synthesis that are dependent on the extent to which theory is tentative, emergent, refined, or established; and that stakeholder involvement may help to understand the topic\'s complexity where theory is more nascent. The choice of approach depends on the degree of match with existing theories and, in the absence of existing theory, the scale and heterogeneity of the literature to be managed.

Within the health sciences, organizational participatory research (OPR) is defined as a blend of research and action, in which academic researchers partner with health organization members. OPR is based on a sound partnership between all stakeholders to improve organizational practices. However, little research on the evaluation of OPR health partnership exists. This systematic mixed studies review sought to produce a new theoretical model that structures the evaluation of the OPR processes and related outcomes of OPR health partnerships. Six bibliographic databases were searched together with grey literature sources for OPR health partnership evaluation questionnaires. Six questionnaires were included, from which a pool of 95 OPR health partnership evaluation items were derived. The included questionnaires were appraised for the quality of their origin, development and measurement properties. A framework synthesis was performed using an existing OPR framework by organizing questionnaire items in a matrix using a hybrid thematic analysis. This led to our proposed Organizational Participatory Research Evaluation Model (OPREM) that includes three axes, Trust, Collective Learning and Sustainability (with specific dimensions) and 95 items. This model provides information to help stakeholders comprehensively structure the evaluation of their partnerships and subsequent improvement; thus, potentially helping to improve health organization practices.

OBJECTIVE: To ascertain whether a new framework examining midwifery practice in perinatal mental health (PMH) is supported by the research literature.
BACKGROUND: The identification and care of women with PMH problems is increasingly considered part of midwifery practice. Research suggests that many midwives lack knowledge, skills and confidence. It would be useful to be able to determine barriers and facilitators to effective clinical practice. The authors propose a framework comprising five potentially measurable domains which have an impact on midwives\' ability to identify, assess and care for women with PMH problems.
METHODS: This mixed-methods review uses an innovative qualitative convergent design based on framework synthesis.
METHODS: Relevant electronic databases were searched for the period from January 2007-December 2016; 33 studies from nine countries met the inclusion criteria.
METHODS: Study quality was assessed using critical appraisal tools. Study findings were mapped onto the five domains of the framework: knowledge, confidence, attitudes, illness perception and infrastructure. Findings were then synthesized for each domain.
RESULTS: All five domains are substantially represented in the literature, thus supporting the proposed framework. Several sub-domains and relationships between domains were identified. Varying levels of knowledge, confidence, attitudes and illness perceptions were found; evidence suggests that midwives benefit from further training within these domains. Features of organizational infrastructure act as barriers or facilitators to effective care; these need to be addressed at organizational level.
CONCLUSIONS: The proposed framework was confirmed and can be used to inform practice, policy and research.