The present protocol has been registered within the Open Science Framework platform (osf.io/n7kcw).
The present study protocol is being reported in accordance with the reporting guidance provided in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement (12) and the PRISMA extension for Scoping Reviews (PRISMA-ScR) (13)(see PRISMA-P checklist in additional file 1). The scoping review conduct will be guided by methods and framework of Arksey and O’Malley (14), subsequently adapted by Levac (15) and Colquhoon (16) and the Joanna Briggs Institute guidelines (17). The reporting of methods and results of the scoping review will be presented using the PRISMA-ScR (13).
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.
Information sources and searches
An initial pilot exercise will be undertaken using the online database MEDLINE (see additional file 2 for details of search strategy) 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 electronic databases (Embase, Scopus, Web of Science, CINAHL and the Cochrane library) from inception onwards. These databases will provide a comprehensive list of the appropriate literature across a range of interdisciplinary fields. A search of other grey literature (including Google Scholar) 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 (18)). We will include randomised control trials, case control studies and cohort studies which investigate methods used to teach inhaler technique to children (patients under the age of 18). 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, 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 chart showing details of studies included and excluded at each stage of the study selection process will be provided.
3. Extracting and charting the data
A data extraction form will be designed (see additional file 3) and used to extract equivalent information from each study report. This data extraction 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)(17). Subsequently, each of the included studies will be abstracted by two reviewers, independently, and potential conflicts will be resolved through discussion. Authors of primary publications will be contacted for data clarifications or missing outcome data, as necessary. Information of interest will include the following:
• Study characteristics: study design, year of publication, journal, year (or period) of study conduct, sample size, country, setting, aim, and other fields to capture data relevant to the assessment of study methods.
• Participant characteristics: age (e.g. mean with standard deviation, range), gender (e.g. percentage of female participants), definitions of asthma (according to standard diagnostic criteria).
• Inhaler characteristics: name, design (pressurised metered-dose inhalers and dry powder inhalers) and use of inhaler adjunct devies such as spacers.
• Technique training characteristics: definitions of the educational intervention content and delivery (as described by study authors), including who was providing the inhaler training.
• Outcomes: outcome measures related to how the effectiveness of the technique training are evaluated.
- Concept: the research group will come to a consensus of what the overall ‘concept’ of each study was.
4. Data synthesis
The data will be summarised in a descriptive format (narrative synthesis), in visual format (mapping summary) and tabular form (numerical summary). The strategy for data synthesis entails the use of qualitative methods to categorise the educational interventions based on the treatment modality as well as subgroup diagnosis and age group e.g. preschoolers aged ≤ 5 years old, as they are often distinct in the literature with regards phenotype but also present different challenges with regards inhaler technique compliance (19). Any commonalities between studies will be synthesised and presented. A qualitative descriptive synthesis of data will be undertaken in mapping the intervention modalities.