This particular integrative review was steered by Whittemore and Knafl's (Whittemore & Knafl, 2005) comprehensive methodology review outline, which combined both quantitative and qualitative study findings on targeted topics and provides a comprehensive understanding of the review issues. The framework includes five stages, such as identification of the research problem, articles retrieval, evaluation of the data retrieved, analysis of the retrieved data, and the presentation of the findings (Noonan, Doody, Jomeen, O’Regan, & Galvin, 2018).
Identification of the problem
The purpose of the study is to examine whether there is any significant evidence that social capital in the form of social networking groups and other forms of social groups have any positive impact on the acceptance and the effectiveness of family doctors' contractual services. It also seeks to recommend any practical learning suggestions that can be applied to medical management projects, such as the family doctor services policy development in China.
Objectives
The main purpose of this integrative review is to thoroughly identify, select, evaluate/examine critically, and synthesize articles on social capital which can positively affect the effect of family doctor's contract services.
Literature search
Presently, the family doctors in China are mainly composed of GPs, so the definitions of these two kinds of subjects are similar. From January 2009 to October 2019, healthcare management topic titles (about family doctors and social capital), precise database titles, keywords and thesaurus were used to search the electronic database together by the use of truncation, synonyms and Boolean operators, (Table 1). The database searched include Medline, Web of Science, Science Direct and PubMed. Research on qualitative, quantitative and hybrid methods published in peer-reviewed journals on the social capital role in the process of contract service for family doctors was eligible for inclusion. In view of the increasing attention paid to the contract service effect of family doctors during this period, a 10-year time scale was selected to ensure full coverage of relevant literature in the same period.
Table 1: Terms used for the literature search
Article Search Terms
|
“family doctor” OR “family physician” OR “general practice” OR “general practitioner” OR “family practice” OR “social capital” OR “social network” OR “family doctor” AND “social capital” OR “primary care” AND “social capital” OR “family physician” AND “social capital” OR “service form for family doctor” OR “service results for family doctor”
|
In total, 809 articles were determined in the database retrieval results which were downloaded and transferred to the Mendeley reference application software. Repeated articles (353) were deleted after which all the authors reviewed the copies of the papers and discussed their differences until a consensus was reached. After deliberation, 456 articles were further deleted. Article titles and their summaries were examined by XX and HAA for their importance based on the exclusion and inclusion criteria. After the screening, the two authors discussed their outcome with the other authors and 31 articles were selected for full-text assessment. On this basis, the authors further screened the above-mentioned articles around the research topic and objectives and forwarded 12 papers for analysis (figure 1).
Data extraction and evaluation
The assessment of the 12 full-text articles composed of 2 level evaluations.
- The first stage evaluation involved the exclusion of studies using the layout for the exclusion and inclusion criteria rules. In this level, 12 articles were selected based on the inclusion criteria. These comprise of 1 qualitative and 11 quantitative studies as indicated in (Fig. 1). Data were extracted on the study objectives, sampling strategy, sample size, study design, data collection technique, strengths and limitations, key findings, and analytical approach of the studies (Table 2).
The evaluation of the second level involved the critical appraisal (XX, ZLL, HAA, and JOM) to determine the methodological quality of the included studies. Due to the variety of methodologies and designs, two method-specific tools were identified to assess the quality of evidence. For qualitative studies, the Critical Appraisal Skills Programme (CASP) (“Critical Appraisal Skills Programme. Available from: https://casp-uk.net/wp- content/uploads/2018/01/CASP-Qualitative-Checklist.pdf. Accessed 12 2019.,” n.d.) tool was used (Table 3) and the Rees et. al. (Rees, Beecroft, & Booth, 2015a) survey checklist (Table 4) was utilized for cross-sectional studies. Each criterion was recorded as “Yes” or “No” or “Clear” or “Unclear” and results of appraisal were discussed between XX, ZLL, HAA and JOM with discrepancies resolved by consensus. Overall studies were found to be of good methodological quality with the only qualitative study recording nine out of the ten appraisal criteria (Table 3) and quantitative studies recording between 11 and 14 of the total appraisal score (Table 4). All the studies have determined the research objectives, proved the appropriateness of the design, used a clear sampling strategy, made a clear statement of the research results, and outlined the value of its research. In terms of the quantitative studies, response rates varied between 65.5% (Pasgaard et al., 2018) to 97.75% (Shang et al., 2019) and only a study attempted to contact non-responders (Pasgaard et al., 2018). Most of the studies were limited to the purposive sampling method (Table 4). Four studies did not provide sufficient information to appraise the reliability of the measurement items (Table 4). Five of the quantitative studies were unclear regarding ethical approval or informed consent from an ethical committee (Table 4). Similarly, the conclusions of all quantitative studies are supported by data used for analysis, and the objectives of the study are described (Table 4). Qualitative research is valuable and provides details that fully consider the relationship between researchers and participants (Table 3).
Retrieved Data Analysis
In light of the heterogeneity of the literature contained, the results of each study were examined (Braun & Clarke, 2006), because conclusions can be drawn based on common factors (Lucas, Baird, Arai, Law, & Roberts, 2007). Procedures which were used to carry out the thematic examination were guided by Smith et al. (V. Smith, Begley, Clarke, & Devane, 2012), and Lucas et. al. (Lucas et al., 2007).
Findings Presentation
The summary of the findings from the 12 studies included in the review is depicted in Table 2. The selected papers were mainly research works conducted in the USA (Gage-Bouchard, 2017; Yeo & Lee, 2019), Denmark (Due, Sandholdt, & Waldorff, 2017; Pasgaard et al., 2018), Canada (Bataineh, Devlin, & Barham, 2019; Devlin & Rudolph-Zbarsky, 2014), China (Jing et al., 2015b; Shang et al., 2019; Zhou, Verdery, Margolis, & Chen, 2018), UK (Greenwood, MacKenzie, Habibi, Atkins, & Jones, 2010), Germany (Dinkel, Schneider, Schmutzer, Brähler, & Häuser, 2016), and Italy (Calciolari, González-Ortiz, & Lega, 2017). Out of the eleven quantitative studies; seven of them were cross-sectional in nature (Calciolari et al., 2017; Devlin & Rudolph-Zbarsky, 2014; Dinkel et al., 2016; Due et al., 2017; Greenwood et al., 2010; Shang et al., 2019; Zhou et al., 2018); two were based on data extracted from a cohort studies (Dinkel et al., 2016; Pasgaard et al., 2018) and the other two studies were based on longitudinal data (Bataineh et al., 2019; Yeo & Lee, 2019). The sample size of these studies varied from 78 to 4682 respondents. A study reported that Social capital may affect the ability of a General Practitioner to achieve his/her goals (Calciolari et al., 2017). Another study also reported social capital playing a significant role in the relationship between financial well-being and life satisfaction of the elderly (Yeo & Lee, 2019). The influencing factors of patients' contract behaviour of studies conducted in China were; age, education, social interaction of social capital, acceptance of the first contact in the community, year of investigation, and exposure to the public (Jing et al., 2015b; Shang et al., 2019; Zhou et al., 2018). Studies retrieved from Canada also reported that there was evidence of a positive link between social support, especially a sense of belonging and the presence of regular family doctors (Bataineh et al., 2019; Devlin & Rudolph-Zbarsky, 2014). The low level of social participation affected family doctor services while higher social participation was associated with lower loneliness in studies conducted in Denmark (Due et al., 2017; Pasgaard et al., 2018). The study from Germany linked the frequent visit of family doctors to their lower-income level (Dinkel et al., 2016). The sample size of the qualitative study was 80 participants, including 59 women and 21 men (Gage-Bouchard, 2017). This particular article reported on the examination of “how social support operated as a flexible resource that might help people navigate their health care system in their locality”. The study used to interview and observational methods for data collection. The study also combined in-depth interviews and direct clinical interactions observations among families and their medical doctors. Descriptive and qualitative data were analyzed with the statistical software, NVivo version 8 (Gage-Bouchard, 2017). The results from this study reported having improved the understanding of the mechanism that inspire the expansion and the distribution of the policies for steering the health care system. It further highlights the impact of social network support as a flexible resource that helped people met their organizational prospects for suitable involvement in health care (Gage-Bouchard, 2017).
[ Please Insert Table 2 Here]
Table 3: Methodological quality of qualitative studies
Study
|
1
|
2
|
3
|
4
|
5
|
6
|
7
|
8
|
9
|
10
|
Total Scores
|
E. Gage-Bouchard, (2017)
|
Yes
|
Yes
|
Yes
|
Yes
|
Yes
|
Yes
|
Unclear
|
Yes
|
Yes
|
Clear
|
9/10
|
Keys: “1. Is there a clear statement of the purpose of the study?; 2. Whether the qualitative method is appropriate?; 3. Whether the research design is suitable for the research purpose?; 4. Whether the recruitment strategy is suitable for the purpose of research?; 5. Can data collection methods solve research problems?; 6. Whether the relationship between researchers and participants is fully considered?; 7. Whether moral issues are taken into consideration?; 8. Is data analysis rigorous enough?; 9. Whether there are clear findings?; 10. How valuable is this research?”
Table 4: Methodological quality of quantitative studies
Study
|
1a
|
2a
|
2b
|
2c
|
2d
|
3a
|
3b
|
3c
|
4a
|
4b
|
5a
|
6a
|
7a
|
8a
|
Total Scores
|
Jing et. al. (2015
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Unclear
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
12/14
|
Pasgaard et. al. (2018)
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
14/14
|
Devlin et. al. (2014),
|
Y
|
Y
|
Y
|
N
|
N
|
Y
|
Y
|
Unclear
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
11/14
|
Bataineh et. al. (2019)
|
Y
|
Y
|
Y
|
N
|
N
|
Y
|
Y
|
Unclear
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
11/14
|
X. Shang et. al. (2019)
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
13/14
|
Greenwood et al. (2010)
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
13/14
|
Calciolari et. al. (2017)
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
13/14
|
Due, T. D., et. al. (2017)
|
Y
|
Y
|
Y
|
N
|
N
|
Y
|
Y
|
Unclear
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
11/14
|
A. Dinkel et. al. (2016)
|
Y
|
Y
|
Y
|
Y
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
13/14
|
Z. Zhou et. al. (2018)
|
Y
|
Y
|
Y
|
N
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
12/14
|
J. Yeo and Y. Lee, (2019)
|
Y
|
Y
|
Y
|
N
|
N
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Y
|
Clear
|
12/14
|
Key:
Y – for Yes, N – for No. “A. Is the result valid? 1. Objectives: 1a. Is the research objective clear? 2.Design:2a. Whether the study design is suitable for the target? 2b. Does this theme represent all interested groups? 2c. Whether it has obtained moral/ethical recognition? 2d. Whether to take measures to contact non-responders? 3. Measurement and observation; 3a. Whether it is clear what has been measured, how to measure and what the result is? 3b. Is the measurement valid? 3c. Is the measurement result reliable? B What are the results; Presentation of results; 4a. Whether the basic data is fully described? 4b. Whether the results are clear, objective and detailed enough for the readers to make their own judgment? Analysis; 5a. Is the method used suitable for the collected data? C Will the results help locally? 6Discussion; 6a Is the outcome of the discussion related to the existing knowledge about the discipline and research objectives? 7Interpretation; 7a. Is the author's conclusion confirmed by the data? 8Implementation; 8a Can any necessary changes be implemented in practice?” Rees et al. (Rees, Beecroft, & Booth, 2015b)