For our scoping review we will follow the methodological framework initially set out by Arskey and O’Malley (12); with further enhancements by Levac (13) and Colquhoon (14); which has culminated in an approach to the conduct of scoping reviews laid out in the Joanna Briggs Institute reviewer’s manual (15) (see appendix 1).
We will report the findings in accordance with the reporting guidance provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol – Extension for Scoping Reviews (PRISMA-ScR) checklist (16).
The above process of performing a scoping review will involve the following stages:
-
Define the research question.
-
Identify relevant published literature.
-
Select which studies to analyse.
-
Extract and chart the data collected from these studies.
-
Report and disseminate the results.
1. Research question
‘What is known about educational interventions for children with asthma to facilitate the mastery of inhaler technique?’
However, due to the iterative nature of a scoping review, the research question or the search terms may alter following a piloting process.
2. Identifying relevant published literature
Under the guidance of the Queen’s University Belfast medical librarian, the search will include a range of terms and keywords related to the research question. The following search terms will be used:
Asthma or wheeze.
Children or paediatrics or pediatrics.
Inhaler technique or inhaler management or inhaler method.
Educational intervention or training or education.
An initial pilot exercise will be undertaken using the online database Medline before proceeding to a complete search of all available databases. We plan to review 10 publications of varying styles from this initial piloting exercise. The purpose of the pilot is to ensure that we have chosen the most suitable search terms by considering the different concepts that each of these articles could be mapped to.
Once the pilot is complete and consideration of new search terms is made, a full search of MEDLINE will be completed followed by a full search of the subsequent chosen online databases (Embase, Scopus, Web of Science, CINAHL and the Cochrane library). These databases will provide a comprehensive list of the appropriate literature across a range of interdisciplinary fields. A search of the grey literature and discussion with a group of paediatric asthma specialists will also be undertaken to handpick any further highly relevant studies. At this point, we will record the total number of citations yielded by these search terms from each of the databases.
3. Selecting studies
Eligibility criteria
We will include studies published since the year 1956 (when the pressurised metered-dose inhaler (pMDI) was first introduced to clinical practice (17)). In order to consider a full breath of knowledge in this subject area we will include all publication types for review (including conference abstracts, presentations and scholarly information that has not necessarily been peer reviewed). Studies of children which also involved (but not exclusively) patients above the age of 18 years will also be included.
Publications not in English will be excluded.
Screening
Selection of studies will then be performed in two stages. There will be an initial screening of all publications based on the title with further screening based on the abstract, to ensure they fulfill the eligiblity criteria (P McCrossan). Documents not meeting eligibility criteria will be excluded from full text analysis.
The remaining publications will then be read by two reviewers, from the research team (P McCrossan, O Mallon and D O’Donoghue). These two reviewers will independently analyse the content included in full text articles. If there is any case of uncertainty, the text will be re-evaluated by a third independent reviewer (MD Shields). The final search results will be exported into EndnoteTM at which point all duplicates will be detected and eliminated.
A flow diagram in keeping with PRISMA (18) (see appendix 2) will be used to report the searches and inclusion/exclusion pathway.. Data will be stored and charted using a Microsoft Excel spreadsheet.
3. Extracting and charting the data
This involves a logical and descriptive summary of the results that align to the objectives of the review. A draft charting table (see appendix 3) has been developed to record the characteristics of the included studies and the key information relevant to the review question. This data charting form may be refined following a review of this process with the first 2 or 3 studies; purposively chosen as diverse (in keeping with the iterative nature of the scoping review methodlogy)(15).
At intervals during the data extraction and charting process, charted data will be compared and discussed to ensure consistency between reviewers and to enable iterative reflection on emerging themes and categories.
During the review process, any amendments to the protocol deemed necessary by the team will be recorded in the master protocol document with the reason for amendment noted on file.
4. Reporting results
The results of this scoping review will produce an outcome that refers to teaching the skill of inhaler technique to children. We will consider the meaning of these findings, as they relate to the overall purpose of the study i.e implications for future research, practice and policy. We will present these results as a ‘map’ of this data in a logical and diagrammatic form by classifying them under main conceptual categories.
The results of this scoping review will be disseminated through peer reviewed publications and presented at international conferences targeting an audience interested or involved in paediatric asthma.
Limitations
We acknowledge that this study will be limited to those publications in the English language; however, the broad nature of the research question will still allow us to capture a significant proportion of the available literature.
For our scoping review we will follow the methodological framework initially set out by Arskey and O’Malley (12); with further enhancements by Levac (13) and Colquhoon (14); which has culminated in an approach to the conduct of scoping reviews laid out in the Joanna Briggs Institute reviewer’s manual (15) (see appendix 1).
We will report the findings in accordance with the reporting guidance provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol – Extension for Scoping Reviews (PRISMA-ScR) checklist (16).
The above process of performing a scoping review will involve the following stages:
- Define the research question.
- Identify relevant published literature.
- Select which studies to analyse.
- Extract and chart the data collected from these studies.
- Report and disseminate the results.
1.Research question
‘What is known about educational interventions for children with asthma to facilitate the mastery of inhaler technique?’ However, due to the iterative nature of a scoping review, the research question or the search terms may alter following a piloting process.
2. Identifying relevant published literature
Under the guidance of the Queen’s University Belfast medical librarian, the search will include a range of terms and keywords related to the research question. The following search terms will be used:
Asthma or wheeze or childhood asthma or childhood wheeze.
Children or paediatrics or pediatrics.
Inhaler technique or inhaler management or inhaler method or metered dose inhaler technique or dry powder inhaler technique.
Educational intervention or training or education.
An initial pilot exercise will be undertaken using the online database Medline before proceeding to a complete search of all available databases. We plan to review 10 publications of varying styles from this initial piloting exercise. The purpose of the pilot is to ensure that we have chosen the most suitable search terms by considering the different concepts that each of these articles could be mapped to.
Once the pilot is complete and consideration of new search terms is made, a full search of MEDLINE will be completed followed by a full search of the subsequent chosen online databases (Embase, Scopus, Web of Science, CINAHL and the Cochrane library). These databases will provide a comprehensive list of the appropriate literature across a range of interdisciplinary fields. A search of the grey literature and discussion with a group of paediatric asthma specialists will also be undertaken to handpick any further highly relevant studies. At this point, we will record the total number of citations yielded by these search terms from each of the databases.
3. Selecting studies
Eligibility criteria
We will include studies published since the year 1956 (when the pressurised metered-dose inhaler (pMDI) was first introduced to clinical practice (17)). We will include randomised control trials, case control studies, cohort studies and retrospective studies which investigate methods used to teach inhaler technique to children. In order to consider a full breadth of knowledge in this subject area we will include conference abstracts, presentations and scholarly information that has not necessarily been peer reviewed. We will include studies in which the teaching of inhaler technique was provided by doctors, nurses, pharmacists and physiotherapists. We do not wish to be ‘device specific’ and so will include studies of metered-dose inhalers and dry powder inhalers (DPI), with and without the use of spacer devices. We will include studies which have taken place in the emergency department, the out-patient department, the hospital ward and/or the community as these are all areas where inhaler technique teaching occurs.
We will exlude studies of the use of nebulised therapies as this involves a different technique and is a more passive procedure. Studies which involve adult participants only will be excluded. We will include studies which include adults and children only if the children’s data has been presented seperately and can therefore be reviewed as a study of children with asthma. Publications not in English will be excluded.
Screening
Selection of studies will then be performed in two stages. There will be an initial screening of all publications based on the title with further screening based on the abstract, to ensure they fulfill the eligiblity criteria (P McCrossan). Documents not meeting eligibility criteria will be excluded from full text analysis.
The remaining publications will then be read by two reviewers, from the research team (P McCrossan, O Mallon and D O’Donoghue). These two reviewers will independently analyse the content included in full text articles. If there is any case of uncertainty, the text will be re-evaluated by a third independent reviewer (MD Shields). The final search results will be exported into EndnoteTM at which point all duplicates will be detected and eliminated.
A flow diagram in keeping with PRISMA (18) (see appendix 2) will be used to report the searches and inclusion/exclusion pathway.. Data will be stored and charted using a Microsoft Excel spreadsheet.
3.Extracting and charting the data
This involves a logical and descriptive summary of the results that align to the objectives of the review. A draft charting table (see appendix 3) has been developed to record the characteristics of the included studies and the key information relevant to the review question. The main outcome measures within this charting table include; the methodology of the studies, the measured outcomes of those studies, the intervention type used in the study to provide inhaler technique training, who was providing the inhaler training in the study and then a group consensus of what the overal ‘concept’ of each study was. This data charting form may be refined following a review of this process with the first 2 or 3 studies; purposively chosen as diverse (in keeping with the iterative nature of the scoping review methodlogy)(15).
At intervals during the data extraction and charting process, charted data will be compared and discussed to ensure consistency between reviewers and to enable iterative reflection on emerging themes and categories.
During the review process, any amendments to the protocol deemed necessary by the team will be recorded in the master protocol document with the reason for amendment noted on file.
4.Reporting results
We will present these results as a ‘map’ of the data in a logical and diagrammatic form by classifying them under main conceptual categories. We will not attempt to interpret the effectiveness of each intervention but will describe each of the different methods that have been used to teach inhaler technique to children and how those investigators determined its effectiveness. This will form a base to uncover potential new ideas which have not yet been fully studied or to decide which methods seem to have been feasbile (not necessarily effective) in other centres practice.
We will also perform a subgroup analysis between pre-school and school age children as these are often distinct in the literature with regards phenotype but also present different challenges with regards inhaler technique compliance (19).
The results of this scoping review will be disseminated through peer reviewed publications and presented at international conferences targeting an audience interested or involved in paediatric asthma.
Limitations
We acknowledge that this study will be limited to those publications in the English language; however, the broad nature of the research question will still allow us to capture a significant proportion of the available literature.