To guide the collection and analysis of data, as well as the synthesis and presentation of results (33), the scoping review will follow the Cadre de référence ministériel d’évaluation de la performance du système public de santé et de services sociaux à des fins de gestion (19) as its primary conceptual framework. This framework identifies and outlines performance factors that can influence management within the public health care setting, which will be evaluated in the context of LTCFs in this scoping review. It includes three main dimensions of performance: the accessibility of services, the quality of services, and the optimization of resources. This framework has been slightly modified, through the addition and adaptation of certain sub concepts, to further enhance its pertinence to the specific topic of the scoping review. After examining the descriptors of the CINAHL database and discovering that the definition of reactivity provided did not correspond to the definition of reactivity from the MSSS framework, the sub concept of reactivity was replaced with adaptability and satisfaction. This replacement avoids a discrepancy that would have resulted from the lack of consistency between the MSSS framework’s definition of performance and some of the articles found in our searches. In addition, the definitions of the descriptor terms adaptability and satisfaction from the CINAHL database were found to better correspond to the MSSS framework definition, thus, adaptability and satisfaction will be used in all database searches. For the same reason, this process also resulted in the MSSS sub concept of viability being replaced with the CINAHL descriptors resource management and resource mobilization. Additionally, whenever synonyms of the MSSS sub concepts were found within the CINAHL descriptors, they were added as sub concepts to capture all relevant articles. This led to the sub concepts of effectiveness and safety being added to the quality of services dimensions within our adapted framework, as they are synonyms of efficacy and security, respectively.
Considering that the MSSS framework is not specifically structured to consider infection prevention and control, and that the context of this review is the COVID-19 pandemic, the authors wanted to ensure the proper consideration of IPC measures within the conceptual evaluation of performance used. This led to the fusion of information from the La prévention et le contrôle des infections nosocomiales (PCI) guideline, which was also developed by the Ministry of Health and Social Services of Québec, into the existing MSSS framework. The PCI guideline, which is centered around the prevention and control of infections, considers organizational and physical elements of the environment of care, and focuses on how resources, the physical layout, and the structural elements (including personnel members) of a health care setting can directly or indirectly affect the quality of health care when it comes to infection prevention and control (34). This modified version of the MSSS conceptual framework (represented in Fig. 1) will help to better capture the complex, interconnected elements that all help to explain the performance of LTCFs in the context of the COVID-19 pandemic.
Data Sources and Research Strategy
This scoping review protocol was registered with the Research Registry (researchregistry7026: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/6109a98e7fdaf6001ecffe67/ ). Articles will be selected from the scientific literature. Five online databases will undergo electronic searches in the fall of 2021 for this review: CINAHL, MEDLINE (Ovid), CAIRN, ScienceDirect, and Web of Science. A summarized search strategy for the CINAHL database has been included as an additional file (see Additional File 3). The articles that will be included in the review will discuss the review’s population (LTCFs), concept (dimensions of performance, i.e., accessibility of services, quality of services, optimization of resources, and quality of care), context (COVID-19), as well as facilitators and barriers affecting the performance of LTCFs. Included articles will have been published in a peer-reviewed journal in either English or French, between January 1st, 2020, and December 31st, 2021.
- Research published in any language other than English or French
- Research focusing on infections other than COVID-19
- Research focusing on care contexts other than LTCFs
- Research focusing on pharmaceutical research examining treatments received by LTCF residents during the pandemic
- Research focusing on COVID-19 vaccination rates within LTCFs.
The databases will be searched using descriptors with the Boolean operators ‘AND’ and ‘OR’, using our search strategy which was developed and defined in collaboration with all review team members. Searches of the chosen databases will be conducted by two of the authors (JL, EB), independently, after which results will be compared for consistency. Articles found in the searches will then be imported into the EndNote software, at which point all duplicates will be removed.
All articles will be imported into the Rayyan web platform (35) for the article selection process. Authors will independently complete the article selection process, using a screening algorithm (see Fig. 2) previously developed by members of the research team involved in this review (3). Prior to beginning the official selection process, a pilot test will occur, to ensure the reliability of the algorithm screening tool and the article selection process itself. All authors of the review will screen the titles and abstracts of the first 10% of articles found for eligibility and will then compare results in a group meeting to discuss the presence of any discrepancies and subsequent potential modifications to the screening algorithm or screening process. The official selection process will then take place, which will involve all the articles being divided among the co-authors, with each article being examined by at least two authors. Half of the articles will be reviewed by two of the authors (JL, EB), while the other half of the articles will be split between all the other authors involved in the review. The reviewers will first screen the titles and abstracts of the articles for relevancy. If both reviewers classify an article as relevant, it will be included in the review. If one of the reviewers questions the relevancy of an article, a third reviewer (another co-author) will independently review the title and abstract of the article in question and cast the deciding vote. An article will not be included in the review if two of the three reviewers deem it to be non-relevant. Subsequently, three or four of the selected articles will then be read in their entirety by every member of the review team to determine their relevance to the review, after which a meeting will occur to examine the consistency in screening full articles. All the articles will then be read in full by at least two of the authors (JL, EB), at which point an article will be included in the final scoping review if it is found to satisfy the review’s criteria. The research strategy and selection process for this review have also been represented visually using a PRISMA flow chart (see Fig. 3) (31).
All full text articles that satisfy the selection process and are chosen to be included in the scoping review will undergo data extraction. A structured data charting form will be created by the investigators, combining general elements from a template provided by the JBI as well as specific elements from the adapted MSSS framework which are directly related to the topic of the review. The extracted data will include the following information: title and abstract, author, year of publication, publication type, full citations, country of origin, study purpose, type of LTCF, population size (if applicable), study design, performance factors discussed in the articles, facilitators and barriers to performance identified in the article. Prior to the data extraction process, the data charting form will be pilot tested by the investigators, in a similar manner to the article screening algorithm. All team members will extract data from three or four articles using the charting form and then compare results in a group meeting to examine consistency among the results and discuss subsequent potential modifications to the data extraction form. After confirmation of the extraction form, the data from all articles will be extracted by one author (EB) and then reviewed by the principal investigator (JL).
Analysis and presentation of the evidence
Several categories of results related to the selected articles for this review will be presented both narratively and with visual aids. First, a completed PRISMA flowchart will be provided, as Fig. 3 shown above will be updated to reflect the total number of records and reports found and included in each stage of the review. Second, characteristics of the included articles will be analyzed, specifically sociodemographic information, the region of origin, and the type of study/study design. This information will be synthesized and presented in tabular form, to assess the frequency of certain study characteristics among the sample. Third, the dimension(s) of performance found in each article, as well as the relative frequency of each dimension among all the selected articles, will also be presented. Furthermore, articles will be specifically analyzed for factors that act as facilitators or barriers to the management of LTCFs during the pandemic and the relative frequency of those factors within the sample will also be presented. This information will be shared through mapping and will follow the review’s conceptual framework for performance.
The principal author of this scoping review (JL) is a registered nurse and a post-doctoral fellow in the field of nursing sciences, with specific expertise in the prevention and control of infections, the analysis of performance within a nursing organization, and the evaluation of factors contributing to infection outbreak. This author’s expertise is also supported by the experience of several professors (ENT, DS, IB) who are experts in the completion of scoping reviews within the field of nursing sciences. The review team also includes research professionals (EB, SR, KK), and a nurse who is a doctoral student in the field of nursing sciences (MJ), who are proficient in searching databases and in the article selection process, as well as in the preparation and writing of academic articles.
In April of 2021, prior to beginning the initial steps of this scoping review, two of the authors (JL, ENT) consulted with two professors (DS, IB) who possess expertise in completing scoping reviews within the field of nursing sciences. After this consultation to aid in the development of an initial search strategy, the two professors subsequently became co-authors of the review.