Paper one is a metasynthesis of studies exploring mothers' experiences of recovery from postnatal mental illness. Four databases were systematically searched using key words and index terms to identify the qualitative literature exploring mothers' experiences of recovery from postnatal mental illness. Fourteen studies met the inclusion criteria and were critically appraised and synthesised. These papers reported the views of 395 women's experiences of recovery from postnatal mental illness. Five core themes emerged from the synthesis to describe four key processes that facilitate recovery. This experience begins with recognising the problem through crisis and relational distress. Women then go through the process of seeking help which consists of subthemes of accepting help and help to access help. The next process in the in the journey is achieving recovery which includes subthemes of sharing with others like me, coping strategies and noticing recovery. The final process of maintaining recovery consists of incorporating coping strategies into daily life; acquiring a different model of motherhood and processing the experience. The role of the family was interwoven through each stage of recovery. Recommendations were made for professionals who come into contact with this group of women and their families. The review highlighted gaps in the existing evidence and made recommendations for future research. The findings and limitations were discussed with reference to the existing literature. Paper two explored the role of the baby in 12 mothers' experiences of recovery from psychosis after childbirth. A thematic analysis of the data identified three core themes that described the role of the baby in the mothers' recovery. Findings revealed that the baby was central to women's recovery and could be experienced as both helpful and unhelpful. The baby interacted with the mother; increasing self efficacy and reducing emotional distress. The baby could act as a barrier to recovery by increasing the women's emotional distress and hindering access to help and self care. The findings recommended that women receive specialist treatment in mother and baby units where they can access interventions that support parent-infant interactions. The findings of the study add to the existing evidence base on recovery from psychosis after childbirth and highlighted areas for future research. Paper three is a critique of the research carried out in Papers one and two. This paper discussed the rationale for the research design in both papers. Approaches to data sampling and data analysis are reviewed with reference to researcher reflexivity. The search strategy and critical appraisal of techniques of the metasynthesis are also critiqued. Paper three closes with personal reflections and conclusions drawn from both papers.

Background: Gestational diabetes mellitus (GDM) poses risks to maternal and neonatal health, yet screening approaches vary in Europe. Cultural, socioeconomic, psychological, and healthcare factors impact adherence to the essential dietary management of GDM. This study aims to explore these factors to enhance dietary adherence among women with GDM in Europe. Aim: To investigate the factors promoting and hindering adherence to a healthy diet among women diagnosed with GDM or at risk of developing GDM in Europe. Methodology: A qualitative meta-synthesis with a meta-ethnographic analysis design (Noblit & Hare, 1988) was used in this study. 18 qualitative articles focusing on diet adherence experiences and perceptions of women with GDM risk or diagnosis in Europe were analyzed. Results: Five main themes were identified: Beliefs and Perceptions, Psychological impact and Coping, Environmental and Social Factors, Healthcare Services and Support and Knowledge and Awareness. The sub-themes included: beliefs about illness, beliefs about health, beliefs about healthcare, preliminary psychological impact, stigma, coping and building resilience, social and economic stressors, family life and domestic duties, service provision, relational interactions, understanding of GDM and awareness of future diabetes risks. Conclusion: The study underscores the complex interplay of socio-cultural, psychological, and healthcare factors affecting women with GDM or at risk in Europe. Adherence to a healthy diet is influenced by women's beliefs, emotional responses, financial constraints, social support, and healthcare experiences. Positive healthcare encounters enhance adherence, while knowledge gaps highlight the need for improved education and guidance. Holistically addressing these factors is crucial for effective dietary management in GDM.

Patient influence for women giving birth in Caseload midwifery Background: According to the Patent Safety Act, a patient must be provided with expert and caring health care that meets certain requirements. The patient must be shown care and respect and the care is designed with and carried out in consultation with the patient, in that the patient has influence over their care. Person-centered, here women-centered, is about meeting the patient's need for coordination, continuity and with the participation of the patient. Motive: There are no studies done regarding patient-influence in caseload midwifery, which is so far the most women-centered model this author has found.Aim: To, based on previous research, describe and interpret women's experience of patient influence when they give birth to children in Caseload midwifery. Method: A search for qualitative articles using the PubMed and CINAHL databases was performed to make a metasynthesis. Inclusion criteria was articles were published from 2010 onwards in English and peer reviewed. Quality review was performed using SBU's protocol for review of qualitative studies, which resulted in sex articles. Results: Five themes that all showed that Caseload contributed to an increased patient influence. Continuity in the relationship, Consent to and be inclusive of, Empowerment and decision-making, Ownership and being in the moment and Alteration and normality.Conclusion: Continuity in the relationship by being remembered helped the woman to focus, on things that were important to her. This increased the woman's self-confidence, she got a sense of context and felt prepared for the birth. Participation in informed decisions about her pregnancy and childbirth, gave her empowerment. The woman experienced control and got an active role in the birth, they owned their birth. Childbirth as a philosophy gave women additional perspectives on childbirth as a normal phenomenon but at the same time as a transforming process of becoming a mother. The summary of this meta-synthesis is that all experiences flow together and are interdependent of each other, patient influence is complex. The synthesis of the six qualitative studies showed that Caseload midwifery contributed to an increased patient influence.

Thesis advisor: Brinton Lykes / This study used a systematic meta-synthesis methodology to explore and expand upon the field of youth participatory action research (YPAR) through synthesizing findings for a change-oriented audience interested in how YPAR has been and can be leveraged to support youth outcomes reported in current and future YPAR academic literature. With that in mind, I screened, coded, and synthesized studies using both inductive and deductive processes to support my meta-synthesis. This included defining, and systematically searching databases for keywords, screening the academic literature, assessing the quality of the literature, and extracting and presenting the formal data before undergoing detailed thematic analysis and validation. Of the 153 non-duplicated English-language US-based YPAR sources read and analyzed for fit, 20 distinct studies were included in the final sample. These studies were coded for documented reports of youth-led research activities and youth-directed change. A description and analysis of YPAR principles, project and contextual characteristics, study methods, and reported youth outcomes are included. Analyses confirmed that this YPAR literature emphasized youth leadership in problem-posing and data collection contexts, with fewer studies involving youth in leading the data analysis and reporting the academic findings. Moreover, while thereare many studies that report a change as part of the desired action, there are fewer that explicitly explore how the youth understand the change as being aligned with their interests ‒ or that show the youth seeing the change through to the end of their involvement with the project. While most common outcomes associated with participation in YPAR were related to the discussion of youth leadership, followed by academic or social changes, interpersonal outcomes were also explored through discussions about the importance of youth involvement in YPAR. Additionally, more recent research has tended to emphasize the role of change (also called “action” or “impact”) and youth’s protagonism in exploring if the actions that the YPAR studies initiated are beneficial to the youth’s own goals, versus more general goals or outcomes. This meta-synthesis provided increasing support for the role of YPAR in fostering some of the skills and competencies youth wish to acquire and that their teachers, mentors, etc. seek for them. This dissertation offers a methodological discussion on YPAR that can provide greater evidence of YPAR’s contributions to youth outcomes, where youth’s protagonism is explored as a contributing factor for the shifts in intrapersonal, relational, and contextual outcomes. Throughout the dissertation, this meta-synthesis offers suggestions as to implications for research, practice, and policy. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Lynch School of Education. / Discipline: Counseling, Developmental and Educational Psychology.