Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Nov 21, 2012; 18(43): 6240-6249
Published online Nov 21, 2012. doi: 10.3748/wjg.v18.i43.6240
Understanding the health and social care needs of people living with IBD: A meta-synthesis of the evidence
Karen Kemp, Jane Griffiths, Karina Lovell
Karen Kemp, Jane Griffiths, Karina Lovell, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, United Kingdom
Karen Kemp, Department of Gastroenterology, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
Author contributions: Kemp K designed the metasynthesis, conducted the search strategy, undertook the quality appraisal of included studies, conducted the main synthesis and data interpretation, and drafted the manuscript; Griffiths J and Lovell K contributed to the quality appraisal of studies to be included in the synthesis, contributed to the main synthesis and data interpretation, and contributed significantly to the draft of the manuscript; all three authors read and approved the final manuscript.
Correspondence to: Karen Kemp, NIHR Doctorate Research Training Fellow, Lecturer (research), Nurse Practitioner Gastroenterology, School of Nursing, Midwifery and Social Work, University of Manchester, Manchester M13 9PL, United Kingdom. karen.kemp@manchester.ac.uk
Telephone: +44-161-3067775 Fax: +44-161-3067894
Received: June 5, 2012
Revised: June 25, 2012
Accepted: September 19, 2012
Published online: November 21, 2012
Abstract

AIM: To undertake a metasynthesis of qualitative studies to understand the health and social needs of people living with inflammatory bowel disease (IBD).

METHODS: A systematic search strategy identified qualitative studies exploring the phenomenon of living with inflammatory bowel disease. Databases included MEDLINE, PsychInfo, EMBASE, CINAHL and the British Nursing Index via the OVID platform. Qualitative search filters were adapted from Hedges database (http://www.urmc.rochester.edu/hslt/miner/digital_library/tip_sheets/Cinahl_eb_filters.pdf). Qualitative empirical studies exploring the health and social needs of people living with inflammatory bowel disease were selected. Study eligibility and data extraction were independently completed using the Critical Appraisal Skills Programme for qualitative studies. The studies were analysed and synthesised using metasynthesis methodology. The themes from the studies allowed for common translations into a new interpretation of the impact of living with inflammatory bowel disease.

RESULTS: Of 1395 studies, six published studies and one unpublished thesis fulfilled the inclusion criteria. First iteration of synthesis identified 16 themes, 2nd iteration synthesised these into three main 2nd order constructs: “detained by the disease”; “living in a world of disease” and “wrestling with life”. “Detained by the disease” is the fear of incontinence, the behaviour the patients display due to the fear, and the impact this has on the individual, such as social isolation and missing out on life events. All of these serve to “pull” the patient back from normal living. “Living in a world of disease” is the long term effects of living with a long term condition and the fear of these effects. “Wrestling with life” is the continued fight to thrive, the “push” to continue normal living.

CONCLUSION: The metasynthesis provides a comprehensive representation of living with IBD. The unmistakeable burden of incontinence is exposed and its ongoing effects are demonstrated. The combined overall impact of living with IBD is the tension these patients live with: “Pushed and pulled: a compromised life”, people living with IBD experience a constant conflict throughout their lives, they push to be normal but IBD pulls them back. The impact of the fear of incontinence and behaviour of the individual as a result, requires further qualitative enquiry.

Keywords: Inflammatory bowel disease; Metasynthesis; Qualitative; Incontinence