You are here

  • Home
  • Archive
  • Volume 10, Issue 6
  • Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis—protocol

Article Text

Article menu

Download PDFPDF

XML
Evidence based practice
Protocol
Barriers towards organ donor registration and consent among people of Indian origin living globally: a systematic review and integrative synthesis—protocol
  1. Britzer Paul Vincent1,
  2. Gurch Randhawa1,
  3. Erica Cook2
  1. 1 Institute for Health Research, University of Bedfordshire, Faculty of Health and Social Sciences, Luton, UK
  2. 2 Department of Psychology, University of Bedfordshire, Luton, UK
  1. Correspondence to Dr Gurch Randhawa; gurch.randhawa{at}beds.ac.uk

Abstract

Introduction The need for organs is comparatively higher among people of Indian origin due to the higher prevalence of end-stage organ failure. In spite of the higher need, they have a lower number of organ donors. Studies have been carried out among people of Indian origin living globally to understand the reasons for the low donation rate, but there has been no systematic review that has integrated all of these studies to synthesise the current literature. Therefore, the purpose of this review is to examine the barriers towards organ donor registration and consent among Indians living globally.

Methods and analysis A systematic search will be conducted using the following relevant databases namely CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Grey literature. Studies from 1994 that satisfy our inclusion criteria will be included. Two reviewers will conduct the screening, data extraction and quality assessment of the studies; in event of any disagreement between the two reviewers at any stage, the third reviewer will reconcile any disagreements and consensus will be made.

Ethics and dissemination As this study includes only secondary data, ethical approval for secondary data usage has been sought. This study will use Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to report and the study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various non-governmental organisations globally which are working with this particular community; following which further research can be developed based on this evidence and also helps in building a culturally competent strategy.

PROSPERO registration number CRD42019155274.

  • protocols & guidelines
  • medical ethics
  • public health
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-035360

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Strengths and limitations of the study

    • Using integrative synthesis is one of the strengths of this systematic review as it gives the power to combine both quantitative and qualitative studies to have a better understanding of the research question.

    • Relevant quality appraisal adds strength to this study to generate a strong and high-quality outcome.

    • Review with other authors helps in the consistency of the outcomes in the study.

    • Limiting articles to only written in English may serve as a drawback to this study.

    Introduction

    The need for an organ transplant is mainly due to the end-stage organ failure majorly caused by non-communicable diseases (NCD) such as diabetes and hypertension.1 2 This is highly prevalent among people of Indian origin.3–5 The higher prevalence of NCD such as diabetes and hypertension among people of Indian origin gives them a greater likelihood on the need for organs.6 This high need for organs is contrasted with poor donation rates within the same community. In India, 220 000 of the population suffer from end-stage renal failure and wait for an organ, but only 15 000 of these people receive one, others die while waiting or become unfit for a transplant and it is a similar situation with the liver, where an estimation of 100 000 of the population suffers from end-stage liver disease and requires an organ transplant, but only less than 1000 of these people ever receive one.7 This shows the gap between demand and supply. Also, the shortage of organs is high in India similar to the other parts of the world.8 9 The national organ donation rate (ODR) is 0.8 per million population (pmp) ranging from 41.69 pmp to 0.04 pmp across the country.9

    Interestingly, a similar pattern can be observed in many other countries, such as the UK, where people of Indian origin are disproportionately over-represented on the transplant waiting list and less likely to become organ donors or be present on the organ donor register.10 This shows the similarity that exists between people of Indian origin living in India and the UK in the context of organ donation. Given the ethnic diversity of the UK population, it is important to seek culturally competent solutions.11

    In countries where there is an opt-in system for procuring organs, either the deceased should have registered to donate organs or the next of kin should give consent to retrieve organs after the death has occurred. These countries require a good level of information regarding organ donation among the public, since they can donate only if they are aware of organ donation and have a positive attitude which ultimately helps in the improvement of the ODR in this community.12 13

    There have been many studies conducted on organ donation among varied communities within people of Indian origin.14–36 However, to date, there has been no integration of these studies (searched the following databases such as CINHAL, MEDLINE, PsycINFO, Scopus, Web of Science, PubMed Central, Global Health and Google Scholar using the search string (“Organ Donation” AND “India*” AND “Systematic Review” OR “Scoping Review”)). Therefore, this systematic review would help in collecting and collating all of the studies on this topic to understand the barriers towards organ donor registration and consent among people of Indian origin living globally.

    A systematic review was proposed as there are many studies available,14–36 specific research question, transparent and explicit methods to critically appraise the individual studies,37 more systematic and rigour protocols followed, attempts to validate all the studies that meet the eligibility criteria and also validate the findings of the study through quality appraisal,38 better quality conclusions can be made on this topic when compared with a scoping review,39 a clear understanding and strong evidence can be generated that will be useful for the stakeholders involved in this field.38

    This systematic review will be conducted on studies undertaken among the people of Indian origin living globally. This study will map the evidence on the barriers towards organ donor registration and consent. Hence, through this systematic review, the literature/evidence present on this topic will be critically appraised and some informative conclusions can be made, based on which further research can be carried out by identifying the gaps and can be used by stakeholders to make evidence-based policy decisions to inform culturally competent organ donation information initiatives. This study will also generate information that will help governments, policymakers, non-governmental organisation (NGO) and research groups working towards the improvement of ODR among people of Indian origin.

    Research question

    What are the barriers towards organ donor registration and consent among people of Indian origin living globally?

    Methods and analysis

    Protocol

    The protocol for this systematic review is designed as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Protocol.40 The reporting of this systematic review will follow PRISMA guidelines41 in order to ensure high calibre of this review.

    Patient and public involvement

    No patients and public were involved in the design of the protocol.

    Inclusion criteria

    The inclusion criteria for this systematic review are

    1. Population: this review will include people of Indian origin living globally of aged 18 years or older.

    2. Settings: studies conducted in any settings such as public, educational institutes (both healthcare and non-healthcare related), hospital, NGO, workplace, religious community and any public gathering will be included.

    3. Study design: this review will include cross-sectional studies and qualitative studies; commentary articles that address the aim.

    4. Type of donation: this review will include studies related to deceased organ donation.

    5. Language of publication: the language of the articles should be in English.

    6. Outcome: any barriers that may include knowledge: on organ donation/law/waiting list/registration; attitude: willingness to be a donor/willingness to talk with family members/conversation on organ/worries and concerns towards organ donation; religious views/cultural practices/norms towards organ donation/political framework/manpower/organogram or others that serve to be barriers will be included.

    7. This review will include studies from 1994 to 31 December 2019. This time period has been chosen as 1994 appears to be the year when the first studies regarding organ donation and people of Indian origin started to get published.

    Exclusion criteria

    1. Studies conducted among other Indian ethnic group such as America’s native Indians or Red Indians

    2. Any studies with participants not to be considered relating to the country India.

    3. Articles not peer reviewed.

    4. Interventional studies in regards to organ donation.

    Search strategy

    The search words that will be used for capturing the studies include the following related terms: organ tissue donation, Consent, India*, barrier*, facilitat*, knowledge, awareness, attitude, perception, practice, cultur*, religio*, brain death. Relevant truncation commands, Boolean and proximity operators will be used while searching with the help of a librarian expert. The final search strategy will be documented and the number of articles included in each level will be recorded. The search strategy has been tested for replicability. This will also be altered in relevance to the database. The search strategy in respect to PubMed for this protocol can be found in the online supplementary file 1 (see additional file 1).

    Supplemental material

    Information sources

    The following databases such as CINHAL, MEDLINE, PsycINFO, Scopus, Global Health, Web of Science and PubMed Central will be used for a comprehensive literature search. Additional literature will be gathered from Indian Journal of Transplantation and individually contacting the relevant authors and experts in the field of organ donation for published and peer-reviewed manuscripts.

    Data management and selection process

    Using the above-mentioned databases, the literature will be exported to RefWorks (https://refworks.proquest.com/). For further scrutiny for eligibility, excel sheets will also be used to manage literatures and filter the studies based on each stage. Two reviewers will work independently to screen the title and abstracts based on the inclusion criteria (stage 1). Any missed duplicates will also be identified and excluded. In case of abstract absence in any studies, studies will be excluded only if a strong decision can be made only based on the title of the study. After the selection of the studies based on the title and abstract, full text will be obtained. Two reviewers will independently assess the full text in order to examine whether they satisfy the inclusion criteria and answer the research question (stage 2). Before proceeding forward, if there are any disagreements between the two reviewers, a third reviewer will reconcile any disagreements and consensus will be made on the inclusion or exclusion of the respective studies. The PRISMA flow diagram will be used to define the process of studies included and excluded.41

    Data collection process

    A predesigned form in excel format will be used for data extraction. Two reviewers will extract the data independently from the studies included for review finally. The form will also be pilot tested to ensure whether it captures the data that it is intended for. Any disagreements on the data extracted by the two reviewers will be reconciled by the third reviewer. The following information will be extracted from the study included for review: author name, year of publication, study site, setting of the study (in terms of rural/urban/slums/college/hospital, etc), participant socioeconomic status (if available), journal name, DOI number, study design (type of the study, study tool, sample size, sampling technique and inclusion/exclusion criteria), main findings as explained in the Data synthesis section below, limitations and other comments will be extracted.

    Quality assessment

    Joanna Briggs Institute’s critical appraisal tools will be used to assess the quality for quantitative studies. This enables us to assess the quality of all types of research published including both quantitative and qualitative methods.42 Two reviewers will undertake the quality assessment using the tools mentioned above independently. If there are any disagreements over the quality of the study, it would be referred to the third author and consensus would be made. The quality of the paper will be classified as thin, moderate and strong. The emphasis will be given based on the quality of the study. The thin-quality studies will be included but emphasis will be very minimal in regards to such studies. Also the quality assessment of the final paper included for review will be displayed.

    Data synthesis

    Data synthesis will be based on narrative synthesis developed by Popay et al.43 The synthesis will follow the method of narrative synthesis that has four steps, namely: (1) systematic search and quality appraisal, (2) grouping and clustering of included studies, (3) developing a textual summary of the data and (4) assessment and interpretation. Narrative synthesis is a flexible approach giving freedom to include both quantitative and qualitative studies. Initially, the synthesis will be separate for quantitative and qualitative studies after which they would be integrated. For quantitative studies, the findings will be tabulated and indexed in terms of types of barriers. Later each study will be compared across to learn how they are related. This will produce a descriptive synthesis of quantitative studies. For qualitative studies, a similar approach will be taken where the synthesis will be descriptive, where the data would be coded and themes will be generated. The data captured from quantitative studies will be identified and provided for the initial framework, and the data from qualitative studies will be used to elaborate and develop explanation descriptively.44 45

    Discussion

    This will be the first systematic review that will synthesise the barriers towards organ donor registration and consent among people of Indian origin living globally. The strength of this study is the combination of quantitative and qualitative studies using the narrative synthesis as proposed by Popay et al.43 This will enable a better understanding of the low organ donation rate problem, based on the available research.

    This will be an important step forward in collectively understanding this population that will help identify any research gaps and inform future research. Through this systematic review, we will also be able to gather evidence to aid policymakers to frame culturally competent strategy according to the need of this particular population.

    The limitation of this review is the heterogeneity of the studies and settings. Also, this study does not aim to generalise the outcome of the studies but will present the available knowledge regarding the barriers towards organ donor registration and consent among this population.

    Ethics and dissemination

    The study is approved by the Institute for Health Research Ethics Committee (IHREC), University of Bedfordshire, UK (IHREC931). It is expected to be completed by the end of June 2020. The study outcomes will be disseminated through a relevant peer-review publication, related conferences and also to various NGOs globally working with this community with a view to showing the barriers among people of Indian origin living globally; following which further research can be developed based on this evidence and also help in building a culturally competent strategy.

    Acknowledgments

    We would like to thank our librarian Mr David Abdy from the Institute for Health Research, University of Bedfordshire for his guidance with the development of the search strategy.

    References

    1. ↵
      2. Ritz E ,
      3. Rychlík I ,
      4. Locatelli F , et al
      . End-Stage renal failure in type 2 diabetes: a medical catastrophe of worldwide dimensions. Am J Kidney Dis 1999;34:795–808.doi:10.1016/S0272-6386(99)70035-1 pmid:http://www.ncbi.nlm.nih.gov/pubmed/10561134
      OpenUrlCrossRefPubMedWeb of Science
    2. ↵
      2. Weisstuch JM ,
      3. Dworkin LD
      . Does essential hypertension cause end-stage renal disease? Kidney Int Suppl 1992;36:S33–7.pmid:http://www.ncbi.nlm.nih.gov/pubmed/1614065
      OpenUrlPubMed
    3. ↵
      2. Dornhorst A ,
      3. Paterson CM ,
      4. Nicholls JS , et al
      . High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med 1992;9:820–5.doi:10.1111/j.1464-5491.1992.tb01900.x pmid:http://www.ncbi.nlm.nih.gov/pubmed/1473322
      OpenUrlPubMedWeb of Science
    4. ↵
      2. Beckles GL ,
      3. Miller GJ ,
      4. Kirkwood BR , et al
      . High total and cardiovascular disease mortality in adults of Indian descent in Trinidad, unexplained by major coronary risk factors. Lancet 1986;1:1298–301.doi:10.1016/S0140-6736(86)91221-3 pmid:http://www.ncbi.nlm.nih.gov/pubmed/2872431
      OpenUrlCrossRefPubMedWeb of Science
    5. ↵
      2. Cruickshank JK ,
      3. Beevers DG ,
      4. Osbourne VL , et al
      . Heart attack, stroke, diabetes, and hypertension in West Indians, Asians, and whites in Birmingham, England. Br Med J 1980;281:1108.doi:10.1136/bmj.281.6248.1108 pmid:http://www.ncbi.nlm.nih.gov/pubmed/7427603
      OpenUrlFREE Full Text
    6. ↵
      2. Platt JL
      . New directions for organ transplantation. Nature 1998;392:11–17.doi:10.1038/32023 pmid:http://www.ncbi.nlm.nih.gov/pubmed/9579856
      OpenUrlCrossRefPubMedWeb of Science
    7. ↵
      2. Navin S ,
      3. Shroff S ,
      4. Niranjan S
      . ‘Deceased Organ Donation in India’. Available: < http://www.mohanfoundation.org/organ-donation-transplant-resources/organ-donation-in-india.asp> [Accessed 14 Nov 2018].
    8. ↵
      2. Rudge C ,
      3. Matesanz R ,
      4. Delmonico FL , et al
      . International practices of organ donation. British journal of anaesthesia, 108(suppl_1) 2012 pp.:i48–55.
    9. ↵
      1. Mohan Foundation
      . ‘National Deceased Donor Transplantation’, 2017. Available: https://www.mohanfoundation.org/deceased-organ-donation-in-india.asp [Accessed 22 Nov 2018].
    10. ↵
      1. NHSBT
      . Organ donation and transplantation data for black, Asian and minority ethnic (BamE) communities. Report for 2017/2018. Available: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/12048/bame-organ-donation-and-transplantation-data-2017-18.pdf [Accessed 21 Oct 2019].
    11. ↵
    12. ↵
      2. Nordfalk F ,
      3. Olejaz M ,
      4. Jensen AMB , et al
      . From motivation to acceptability: a survey of public attitudes towards organ donation in Denmark. Transplant Res 2016;5:5.doi:10.1186/s13737-016-0035-2 pmid:http://www.ncbi.nlm.nih.gov/pubmed/27222709
      OpenUrlPubMed
    13. ↵
      2. Saunders B
      . Opt-out organ donation without presumptions. J Med Ethics 2012;38:69–72.doi:10.1136/medethics-2011-100039 pmid:http://www.ncbi.nlm.nih.gov/pubmed/21828226
      OpenUrlAbstract/FREE Full Text
    14. ↵
      2. Annadurai K ,
      3. Mani K ,
      4. Ramasamy J
      . A study on knowledge, attitude and practices about organ donation among college students in Chennai, Tamil Nadu-2012. Prog Health Sci 2013;3.
    15. ↵
      2. Guleria K ,
      3. Singh AK ,
      4. Kumar B , et al
      . Trends of organ donation and awareness in Ernakulam, Kerala. BMC Proc 2012;6:48.doi:10.1186/1753-6561-6-S4-P48
    16. ↵
      2. Randhawa G
      . An exploratory study examining the influence of religion on attitudes towards organ donation among the Asian population in Luton, UK. Nephrol Dial Transplant 1998;13:1949–54.doi:10.1093/ndt/13.8.1949 pmid:http://www.ncbi.nlm.nih.gov/pubmed/9719146
      OpenUrlCrossRefPubMedWeb of Science
    17. ↵
      2. Vincent BP ,
      3. Kumar G ,
      4. Parameswaran S , et al
      . Barriers and suggestions towards deceased organ donation in a government tertiary care teaching hospital: qualitative study using socio-ecological model framework. Indian J Transplant 2019;13.
    18. ↵
      2. Vincent BP ,
      3. Kumar G ,
      4. Parameswaran S , et al
      . Knowledge, attitude, and perception on organ donation among undergraduate medical and nursing students at a tertiary care teaching hospital in the southern part of India: a cross-sectional study. J Educ Health Promot 2019;8:161.doi:10.4103/jehp.jehp_439_18 pmid:http://www.ncbi.nlm.nih.gov/pubmed/31544126
      OpenUrlPubMed
    19. ↵
      2. Morgan M ,
      3. Kenten C ,
      4. Deedat S , et al
      . Increasing the acceptability and rates of organ donation among minority ethnic groups: a programme of observational and evaluative research on donation, transplantation and ethnicity (donate). Programme Grants for Applied Research 2016;4:1–196.doi:10.3310/pgfar04040
      OpenUrl
    20. ↵
      2. Ahlawat R ,
      3. Kumar V ,
      4. Gupta AK , et al
      . Attitude and knowledge of healthcare workers in critical areas towards deceased organ donation in a public sector hospital in India. The National Med J India 2013;26:322–6.
      OpenUrl
    21. ↵
      2. Wig N ,
      3. Gupta P ,
      4. Kailash S
      . Awareness of brain death and organ transplantation among select Indian population. J Assoc Physicians India 2003;51:455–8.pmid:http://www.ncbi.nlm.nih.gov/pubmed/12974425
      OpenUrlPubMed
    22. ↵
      2. Panwar R ,
      3. Pal S ,
      4. Dash NR , et al
      . Why are we poor organ donors: a survey focusing on attitudes of the lay public from northern India. J Clin Exp Hepatol 2016;6:81–6.doi:10.1016/j.jceh.2016.04.001 pmid:http://www.ncbi.nlm.nih.gov/pubmed/27493454
      OpenUrlPubMed
    23. ↵
      2. Balajee KL ,
      3. Ramachandran N ,
      4. Subitha L
      . Awareness and attitudes toward organ donation in rural Puducherry, India. Ann Med Health Sci Res 2016;6:286–90.doi:10.4103/amhsr.amhsr_63_15 pmid:http://www.ncbi.nlm.nih.gov/pubmed/28503345
      OpenUrlPubMed
    24. ↵
      2. Jothula KY ,
      3. D. S ,
      4. Sreeharshika D
      . Study to assess knowledge, attitude and practice regarding organ donation among interns of a medical college in Telangana, India. Int J Community Med Public Health 2018;5:1339–45.doi:10.18203/2394-6040.ijcmph20180950
      OpenUrl
    25. ↵
      2. Vijayalakshmi P ,
      3. Sunitha TS ,
      4. Gandhi S , et al
      . Knowledge, attitude and behaviour of the general population towards organ donation: an Indian perspective. Natl Med J India 2016;29:257.pmid:http://www.ncbi.nlm.nih.gov/pubmed/28098078
      OpenUrlPubMed
    26. ↵
      2. Mithra P ,
      3. Ravindra P ,
      4. Unnikrishnan B , et al
      . Perceptions and attitudes towards organ donation among people seeking healthcare in tertiary care centers of coastal South India. Indian J Palliat Care 2013;19:83.doi:10.4103/0973-1075.116701 pmid:http://www.ncbi.nlm.nih.gov/pubmed/24049347
      OpenUrlPubMed
    27. ↵
      2. Sam N ,
      3. Ganesh R ,
      4. Indrapriyadarshini V , et al
      . Awareness, knowledge, and attitude regarding organ donation among final year students of medical, dental, engineering, and arts and science colleges in Thiruvallur and Chennai City, India. Indian J Transplant 2018;12.
    28. ↵
      2. Krishnaiah S ,
      3. Kovai V ,
      4. Nutheti R , et al
      . Awareness of eye donation in the rural population of India. Indian J Ophthalmol 2004;52:73.pmid:http://www.ncbi.nlm.nih.gov/pubmed/15132388
      OpenUrlPubMed
    29. ↵
      2. Manojan KK ,
      3. Raja RA ,
      4. Nelson V , et al
      . Knowledge and attitude towards organ donation in rural Kerala. AMJI 2014;2:25–7.
      OpenUrl
    30. ↵
      2. Sarveswaran G ,
      3. Sakthivel MN ,
      4. Krishnamoorthy Y , et al
      . Knowledge, attitude, and practice regarding organ donation among adult population of urban Puducherry, South India. J Educ Health Promot 2018;7:117.doi:10.4103/jehp.jehp_44_18 pmid:http://www.ncbi.nlm.nih.gov/pubmed/30271802
      OpenUrlPubMed
    31. ↵
      2. Mani G
      . Perceptions and practices related to organ donation among a rural population of Kancheepuram district, Tamil Nadu, India Geetha Mani1, Raja Danasekaran1, Kalaivani Annadurai1. J Compr Health 2016;4.
    32. ↵
      2. Dasgupta A ,
      3. Shahbabu B ,
      4. Sarkar K , et al
      . Perception of organ donation among adults: a community based study in an urban community of West Bengal. Scholars J Appl Med Sci 2014;6:2016–21.
      OpenUrl
    33. ↵
      2. Bharambe VK ,
      3. Arole VU ,
      4. Puranam V , et al
      . Knowledge and attitude toward organ donation among people in Lanja: a rural town in India. Saudi J Kidney Dis Transpl 2018;29:160.doi:10.4103/1319-2442.225209 pmid:http://www.ncbi.nlm.nih.gov/pubmed/29456223
      OpenUrlPubMed
    34. ↵
      2. Balwani M ,
      3. Pasari A ,
      4. Aziz F , et al
      . Knowledge regarding brain death and organ donation laws among medical students. Transplantation 2018;102:S812.doi:10.1097/01.tp.0000543851.64997.1b
    35. ↵
      2. Balwani MR ,
      3. Gumber MR ,
      4. Shah PR , et al
      . Attitude and awareness towards organ donation in Western India. Ren Fail 2015;37:582–8.doi:10.3109/0886022X.2015.1007820 pmid:http://www.ncbi.nlm.nih.gov/pubmed/25656835
      OpenUrlPubMed
    36. ↵
      2. Bharambe VK ,
      3. H. R ,
      4. M. PV , et al
      . Awareness regarding body and organ donation amongst the population of an urban City in India. Journal of Health and Allied Sciences NU 2015;5:051–7.doi:10.1055/s-0040-1703935
      OpenUrl
    37. ↵
      2. Briner RB ,
      3. Denyer D
      . Systematic review and evidence synthesis as a practice and scholarship tool. In: Handbook of evidence-based management companies, classrooms and research, 2012: 112–29.
    38. ↵
      2. Bearman M ,
      3. Smith CD ,
      4. Carbone A , et al
      . Systematic review methodology in higher education. Higher Education Research & Development 2012;31:625–40.doi:10.1080/07294360.2012.702735
      OpenUrl
    39. ↵
      2. Rousseau DM ,
      3. Manning J ,
      4. Denyer D
      . 11 Evidence in Management and Organizational Science: Assembling the Field’s Full Weight of Scientific Knowledge Through Syntheses. Acad Manag Ann 2008;2:475–515.doi:10.5465/19416520802211651
      OpenUrl
    40. ↵
      2. Moher D ,
      3. Shamseer L ,
      4. Clarke M , et al
      . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015;4:1.doi:10.1186/2046-4053-4-1 pmid:http://www.ncbi.nlm.nih.gov/pubmed/25554246
      OpenUrlCrossRefPubMed
    41. ↵
      2. Moher D ,
      3. Liberati A ,
      4. Tetzlaff J , et al
      . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336–41.doi:10.1016/j.ijsu.2010.02.007 pmid:http://www.ncbi.nlm.nih.gov/pubmed/20171303
      OpenUrlCrossRefPubMed
    42. ↵
      1. JBI
      . JBI critical appraisal tools. Available: https://joannabriggs.org/critical_appraisal_tools [Accessed 19 Oct 2019].
    43. ↵
      2. Popay J ,
      3. Roberts H ,
      4. Sowden A
      . Guidance on the conduct of narrative synthesis in systematic reviews.A product from the ESRC methods programme version. 1, 2006.
    44. ↵
      2. Morgan M ,
      3. Kenten C ,
      4. Deedat S , et al
      . Attitudes to deceased organ donation and registration as a donor among minority ethnic groups in North America and the U.K.: a synthesis of quantitative and qualitative research. Ethn Health 2013;18:367–90.doi:10.1080/13557858.2012.752073 pmid:http://www.ncbi.nlm.nih.gov/pubmed/23249284
      OpenUrlCrossRefPubMed
    45. ↵
      2. Harden A
      . Mixed-Methods systematic reviews: integrating quantitative and qualitative findings. Focus 2010:1–8.

    Footnotes

    • Contributors BPV drafted the protocol. The protocol was then reviewed and revised in consultation with GR and EC. All authors have read and approved the protocol. The corresponding author guarantees the paper and that the statement of authorship is correct.

    • Funding This work is a part of the PhD studentship research funded by the Global Challenges Research Fund at the University of Bedfordshire.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.