The mixed-methods approach will be employed in this systematic review. The Joanna Briggs Institute (JBI) reviewer’s manual, with a focus on mixed methods systematic reviews, will be utilized . The mixed-methods approach to research, which is among the first three widely used research approaches, has gained popularity due to its ability to analyze data obtained from quantitative, qualitative, and primary mixed-methods research papers [14,15]. The mixed-methods approach is also appropriate to permit data triangulation to enhance the study validity . In addition to this benefit, the use of mixed-methods has proven to be useful in comparing and contrasting quantitative and qualitative research findings. This results in either the quantitative findings supporting the qualitative findings or vice versa . To ensure that findings that have the highest recognizable strength are obtained at the end of the systematic review, the role of the mixed-methods approach in this review is important . This critical appraisal and synthesis is registered with Open Science Framework and can be accessed through https://doi.org/10.17605/OSF.IO/EYHF2 and will commence in July 2020.
Population of interest
The population of interest is women who are 18 years of age or above. The review will include research papers that involve women who are 18 years of age or above as part of the study population. In addition to the description of the interest population (women who are 18 years and above), the features of women in included studies will not be restricted to cultural/sub-cultural backgrounds and geographical locations.
The phenomena of interest for this review is the awareness of women on prostate cancer. Therefore, this review will involve studies that evaluated the knowledge of women aged 18 years and above on prostate cancer.
Context of interest
The context of interest will include but not limited to all studies conducted in women of all cultural/sub-cultural backgrounds and geographical locations.
The review will consider research papers that have the knowledge of women on the signs and symptoms, causes and risk factors, and screening recommendations of prostate cancer as the outcome measures.
Types of studies to be included
This critical appraisal and synthesis would involve primary research papers that are qualitative, quantitative, and mixed-methods in nature. Focused group discussions (FGD), observation of study subjects (follow-up studies), in-depth interviews, and other forms of interviews will constitute the qualitative studies to be included in this systematic review without ignoring other studies that meet the criteria of qualitative studies. Quantitative studies will constitute descriptive studies, descriptive cross-sectional studies, and other studies that meet the requirements of quantitative studies. Studies that combined qualitative and quantitative designs will constitute the mixed-methods arm of this study on a condition that the qualitative and quantitative data can be explicitly extracted. This review will also include studies that have been published in the English language. To be able to map up current evidence, studies dating January 1999 - December 2019 will be included in this review.
The following will be grounds for excluding papers for this review:
- Studies that were published before January 1999 or after December 2019.
- Studies that were not published in the English language.
- Studies that include women below the age of 18 years.
- Studies in which the age of included women cannot be established.
- Studies that did not indicate the number of included women.
- Studies that exclusively included male without any female gender (18 years and above).
- Studies conducted amongst women who were previously given education on prostate cancer.
- Studies involving lesbian, gay, bisexual, transsexual/transgender, and queer/questioning (LGBTQ) participants.
- Studies that included healthcare professionals.
- Studies that included healthcare and college/university students.
- Studies that do not include the outcome of interest.
- Book chapters.
- Reviews and overviews.
- Abstracts and conference papers.
- Dissertations and thesis.
- Commentaries and letters to editors.
- Studies published without abstracts.
Information sources and search strategy
A comprehensive search strategy will be developed by the primary author (EW) to identify various publications related to the study. The following databases will be searched; MEDLINE (EBSCOhost), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Web of Science, and EMBASE (Ovid). The searched period will be from January 1999 to December 2019.
A triple stage approach to searching published literature will be adopted in developing the preliminary search strategy . Firstly, MEDLINE (EBSCOhost) will be searched for articles relevant to this review. Subject terms (identified from the title and abstract of the relevant papers) and free text terms (identified from the description of the relevant papers) will be employed in the development of the preliminary search strategy. The preliminary search strategy, using MEDLINE (EBSCOhost), has been affixed (Appendix 1). Secondly, the preliminary search strategy will be adopted in the search for relevant studies from CINAHL (EBSCOhost), PsycINFO (EBSCOhost), Web of Science, and EMBASE (Ovid), respectively. The citation list of the selected studies for the review will be scanned for additional studies. Search findings, which will be in the English language, will be compiled independently by two authors (EW and KBM).
The total search findings of EW and KBM will be compiled and duplicate papers, removed with the help of the EndNote X8 software, to generate a final list of search findings for the review.
Screening and selection of studies
The final list of search findings will be independently screened by two reviewers (EW and KBM). The titles and abstracts of the selected studies will initially be screened for inclusion and exclusion in the review. Studies that are selected after the screening of the titles and abstract will undergo full-text reading by the same independent reviewers. The selection for data extraction will be done by a careful comparison of papers that successfully passed the screening stage to the established inclusion and exclusion criteria. Search findings that present disagreements between the independent reviewers, during the screening and selection stages, will be resolved through discussions with the third reviewer (ABBM). Cohen’s kappa will be used to measure inter-rater agreement between the two independent reviewers in each screening phase. Reference management will be done by EW.
The JBI quantitative and qualitative data extraction tools, appendix 2 [17-19] will be adopted to extract data from search findings. The convergent segregated approach to data synthesis and data integration recommends using separate data extraction tools for this review . Data that will be extracted from the included studies will not be restricted to the study title, principal investigator (lead author), year of publication, the country in which the study was conducted, the study sample size, the study design, ethnic background of study participants, key discoveries of the study, the limitations of the study and conclusions made by authors. Two reviewers (EW and KBM) will independently extract both quantitative and qualitative data. The outcome of the individual data extracted by these two authors will be merged to generate a final pool of data for the review. Disagreements that may arise when building the final pool of data will be resolved through discussions with ABBM.
Assessment of methodological quality
The quality assessment of the review will adopt and adapt a quality appraisal tool employed in a review conducted by Mensah et al, appendix 3 . The tool has 5 general quality assessment criteria and 3 specific quality assessment criteria to be scored over 100%. The design of the tool will permit the comparison of scores obtained by individual literature to the scoring benchmark of weak (0 – 33.9%), moderate (34% – 66.9%), and strong (67% – 100%) (20). This quality appraisal stage will be done independently by two authors (EW and KBM). It is recommended that a minimum of two reviewers be involved in the appraisal of the quality of studies to be considered for data extraction and subsequent synthesis [19,21]. Hence, the need for EW and KBM to independently conduct a quality assessment of search findings that passed the screening and selection stage of the review. The results obtained from the quality assessment stage will inform the final inclusion or exclusion of a research paper in the review. Disagreements arising from the results of EW and KBM will be addressed through discussions with ABBM.
Data synthesis and integration
The convergent segregated approach will be employed in data synthesis and integration . Quantitative data and qualitative data will be synthesized separately. The evidence that will be generated from the separate synthesis of quantitative and qualitative data will be integrated .
Quantitative and Qualitative data synthesis
The synthesis of quantitative data will be done through a meta-analysis or narrative synthesis depending on the feasibility of the pool of data to be analyzed statistically .
The findings from the pool of qualitative data will undergo meta-synthesis through findings assembly and categorization based on shared meanings . These categorized findings will undergo further analysis in an attempt to generate a wealth of evidence that will be easy to comprehend and will also be a true reflection of the awareness of women on prostate cancer concerning the underpinned review objectives .
In the event of the inability to perform a textual pooling, a narrative will be generated . The synthesis by narrative will be performed according to the following approach; the findings obtained from the selected studies will undergo preliminary synthesis, the compiled data will be explored for linkages and the synthesizing process will be assessed for robustness .
Integration of quantitative evidence and qualitative evidence
The evidence from the individual analysis of quantitative and qualitative data will undergo configuration . The inability of evidence configuration will result in the narrative presentation of evidence .