Fathers' experiences, views and perspectives of childbirth attendance: A qualitative evidence synthesis protocol

Aim

To provide a protocol for a QES that will synthesise the available qualitative evidence on fathers’ experiences, views, and perspectives of childbirth attendance.

To ensure transparency and methodological rigor, the proposed QES has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023470902, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=470902). The protocol report adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines (Supplementary file 1: https://osf.io/9wscm/).

Inclusion criteria

The inclusion criteria were defined using the SPIDER acronym (Cooke et al., 2012). Studies will be considered for inclusion if they report on:

Sample: Cis-gender male fathers above 18 years of age.

The QES will include all fathers regardless of their previous experience of attending childbirth. The sample population is limited to Cis-gender males to enable the application of the findings into the context of the wider study within Bahrain. Bahrain, being a culturally Islamic country, by law only recognises parenthood within a heterosexual marriage.

Phenomenon of Interest: All studies reporting on fathers’ experiences, views or perspectives of father attendance during labour and birth will be included.

Design: All published and unpublished studies using qualitative methodologies such as focus groups, interviews or narrative research, irrespective of date conducted, or country of origin will be included.

Evaluation of outcomes: Themes derived from the qualitative or narrative data that are representative of fathers’ views, perspectives, and experiences of childbirth attendance.

Research type: Primary qualitative studies (e.g., grounded theory, phenomenology, qualitative descriptive studies) that use recognised methods of qualitative data collection (e.g., interviews) and qualitative data synthesis methods. Survey designs with free-text response options will also be considered for inclusion if the available qualitative data provides sufficient depth and has been analysed formally using a structured approach (e.g. thematic analysis, content analysis, etc.). In case of mixed method studies, the qualitative component of the study where the participants' experiences are reported separately, will be included. Opinion pieces and commentaries from fathers on childbirth will be considered for inclusion if there is qualitative data of sufficient depth to contribute to data synthesis.

Search strategy

Guided by SPIDER, search strings were developed for retrieving relevant literature. Within string search terms are combined using the OR Boolean operand, and each complete string combined then using the AND operand (Table 1).

A systematic search of the databases MEDLINE, CINAHL, PsycINFO, MIDIRS, Web of Science, and Google Scholar will be conducted from the database date of inception to the date the search is implemented. The search strings will be adapted for controlled vocabulary across the databases (Supplementary file 2: https://osf.io/9wscm/). Grey literature sources will include Open Grey, ProQuest Dissertations & Theses Abstract & Index, and Trinity's Access to Research Archive (TARA). The reference lists of included studies will be screened to identify potentially relevant additional studies that may not have been captured by the search of all other sources. To enhance methodological rigor, the search strategy was independently assessed by a topic expert not involved in the review using the Peer Review of Electronic Search Strategies (PRESS) checklist (Supplementary file 3: https://osf.io/9wscm/).

While the initial search will be conducted with no restrictions on language, only studies published in English will be included in the QES. The purpose of including non-English publications in the search is to identify the extent of potentially relevant studies that are not in English and whether this may lead to language bias and thus a potential limitation of the QES.

Study selection

All the citations retrieved from the search will be uploaded to Covidence which is a proprietary software, an open access similar to this software could be used- Rayyan, a web-based software specifically designed to streamline the screening process for reviews. Duplicates will be identified and removed automatically by Covidence. Using AMSTAR 2 guidance stands for "A Measurement Tool to Assess Systematic Reviews" version 2. It's a widely used tool designed to critically evaluate the methodological quality of systematic reviews especially in healthcare (Shea et al., 2007), two reviewers will initially pilot screen 10% of retrieved records on title and abstract independently to ensure a consistent application of the inclusion criteria. If agreement on include or exclude is more than 80% one reviewer will proceed to further complete the screening by title and abstract. Full-text articles of relevant studies will be independently screened by two reviewers. Any disagreement or conflicts will be resolved through discussion and consensus, involving a third reviewer if necessary. The PRISMA flowchart will be used to report the screening and inclusion process (Moher et al., 2009).

Quality appraisal of included studies

The methodological quality of studies included will be appraised by using the Critical Appraisal Skills Programme (CASP) quality assessment tool specifically designed for qualitative research. This assessment tool consists of 10 questions based on three key aspects (i) clarity and validity of research papers (ii) the methodology used, and (iii) the relevance and presentation of the findings. Two reviewers will independently appraise the included studies to assess their overall quality.

Data extraction and synthesis

Data will be extracted from the included studies through a purposively designed data extraction form (Appendix 4.) developed for the QES based on the aim of the review. The form will be initially piloted by two reviewers independently on the first three included studies to ensure its suitability; if required amendments will be made to the format and documented in the QES. To ensure the robustness of the process, one reviewer will extract the data, and a second reviewer will independently verify the extracted data. Data extracted will include study aim, study design, source and type of publication (journal paper, unpublished thesis, conference proceeding, abstract, etc.), location and year of study, description of participants, sampling and study settings, method (s) of data collection and analysis, and findings related to the views, experiences and perspectives of fathers on childbirth attendance.

Findings from the included studies will be synthesised using Thomas and Harden’s (2008) three-stage thematic synthesis approach. The extracted ‘findings’ data from included studies will be coded (line by line coding). These codes will then be grouped into descriptive themes, and, from these themes, analytical themes will be developed.

Assessing the confidence of the QES findings

A systematic assessment of the confidence of the QES findings will be conducted using the Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) framework. The framework focuses primarily on four components: (i) Methodological limitations, (ii) Coherence (iii) Adequacy of data, and (iv) Relevance of the findings (Booth et al., 2018). To ensure consistency and transparency, a pre-defined set of criteria aligned with the GRADE-CERQual framework will be established prior to commencing the review. Two reviewers will independently evaluate each study and assign confidence ratings. The confidence ratings are categorized into four levels: very low, low, moderate, and high confidence, based on the four primary components. Any discrepancies will be discussed and resolved by consensus.