review
Global scoping review Review protocol development Submission of review protocol to HREC
24 Source: Author
Part 1: Scoping review
The first phase of this research was to conduct a scoping review. Scoping reviews are frequently used as a precursor to systematic reviews as they are helpful instruments in understanding the depth and breadth of the existing literature (Munn et al. 2018). “True to their name, scoping reviews are an ideal tool to determine the scope or coverage of a body of literature on a given topic and give clear indication of the volume of literature and studies available as well as an overview (broad or detailed) of its focus” (Munn et al., 2018, p.
1440). By reviewing the existing literature broadly, scoping reviews identify research gaps, key concepts, and inform the researcher on the variety and forms of evidence available (Pham et al. 2014). As described above in Table 8 scoping findings enabled the formation of a research question, search terms, a data extraction sheet, and relevant inclusion and exclusion criteria (Arksey and O'Malley 2005; Tricco et al. 2016).
To initiate the scoping review, keyword searches in PubMed, Scopus, EBSCOhost, and Google Scholar were conducted. These four databases were selected to ensure a broad coverage of literature necessary to conduct a rigorous scoping review (Arksey and O'Malley 2005). While Google Scholar features less bibliometric tools, use of this database was critical in ensuring a comprehensive overview of both academic and non-academic findings such as grey literature encompassing conference proceedings, government reports, or theses (Mingers and Meyer 2017). Additionally, to ensure broad coverage of literature reviewed, further searches for grey literature were also conducted on institutional databases like the World Bank (https://openknowledge.worldbank.org/) and WHO (https://www.who.int/en/).
As described in Table 9 below, search terms included ‘’dignity,” ‘health systems,” and later “LMIC.” Search terms included relevant linguistic variations and combinations formed through Boolean operators of AND,”
“OR,” and “NOT”. Initially, only “dignity” and “health systems” were used as the main search terms. As familiarity with the literature increased; however, there appeared to be a geographical deficit on research concerning dignity in LMIC health systems. Considering this finding, the geographically bound search term of LMIC was included as the third key search term to elicit findings from the region. According to Arksey and O’Malley (2005), scoping reviews are an iterative process. As such, the amendment or addition of search terms is common practice in the scoping review processes because as a researcher’s familiarity with the literature increases so does the identification of research gaps and thus the inclusion, adjustment, or optimization of key search terms (Arksey and O'Malley 2005). Given these reasons, the decision to include the third search term was a permissible action according to the scoping review methodology. Though it was permissible to
Part 2:
Systematic review
Qualitative systematic review data collection Qualitative systematic data extraction and analysis Draft journal manuscript
Final edits and review of whole thesis Submission of thesis for examination
25 include additional search terms to the scoping review, key to the scoping review process is typically to limit literature inclusion criteria (Arksey and O'Malley 2005). As such, to ensure a comprehensive overview and scope of evidence during this initial scoping, no date restrictions were applied. However, due to resource constraints, only literature published in English was included.
Table 9: Examples of scoping review search Main term Variations
Dignity “Dignity;” “dignified”; “non-dignified”; “not dignified”; undignified”; “dignified care”; “dignified treatment”; “dignified health”; “dignity in health”; “dignified health”; “dignity and respect”;
“undignified”; “dignity and friendliness”; “dignity and non-discrimination”; “dignity and privacy”;
“dignity and confidentiality”; “dignity and involvement”; “dignity and care environment”
Health systems “Health systems;” “health care system”; “health service”; “health service delivery”; “health”;
“health care”; “health care delivery”; “health systems research;” “public health”; “public health system”; “public health service”; “health facility”; “health systems strengthening”;
“responsiveness”
LMIC countries30 and related- phrases
“Afghanistan”; “Algeria”; “Angola”; “Bangladesh“; “Belize“; “Benin”; “Bhutan“; “Bolivia”;
“Burkina Faso”; “Burundi”; “Cabo Verde”; “Cambodia”; “Cameroon“; “Central African Republic”;
“Chad”; “Congo, Dem. Rep“; “Comoros“; “Congo, Rep.”; “Côte d'Ivoire“; “Djibouti“; “Egypt, Arab Rep. “; “El Salvador“; “Eritrea“; “Eswatini“; “Ethiopia“; “Gambia”; “Ghana“; “Guinea“; “Guinea- Bissau“; “Haiti“; “Honduras”; “India“; “Indonesia“; “Iran, Islamic Rep“; “Kiribati“; “Korea, Dem.
People's Rep“; “Kenya”; “Kyrgyz Republic“; “Lao PDR”; “Lesotho“; “Liberia”; “Madagascar”;
“Malawi“; “Mali” ; “Mauritania”; “Micronesia, Fed. Sts“; “Mongolia”; “Morocco“;
“Mozambique“; “Myanmar”; “Nepal“; “Nicaragua“; “Niger”; “Nigeria“; “Pakistan“; “Papua New Guinea“ “Philippines”; “Rwanda”; “Samoa“; “São Tomé and Principe“; “Senegal“; “Sierra Leone“;
“Solomon Islands“; “Somalia“; “South Sudan“; “Sri Lanka“; “Sudan”; “Syrian Arab Republic”;
“Tajikistan“; “Tanzania“; “Timor-Leste”; “Togo”; “Tunisia“; “Uganda”; “Ukraine“; “Uzbekistan“;
“Vanuatu“; “Vietnam“; “West Bank and Gaza“; “Yemen, Rep.” “Zambia“; “Zimbabwe“; “Low- income country;” “middle income country”; “developing country”; “less developed”; “middle income economics”; “poor countries”; “under- developed countries”; “underdeveloped economies”
Source: Author
Based on the organized scoping review findings, we established our research question, formulated the data extraction sheet, identified and optimized key words and search terms, and confirmed the relevance of inclusion and exclusion criteria (Tranfield et al. 2003; Munn et al. 2018).
Anticipated budget
This research project is being undertaken in South Africa (the primary author’s country of residence) and is being conducted in partial fulfilment of the requirements for a Master’s in Public Health. This research project is self-funded and apart from the items listed below (see table 11 for research budget), there are no direct costs associated with conducting research activities. The primary author declares no conflict of interests.
Table 11: Anticipated research project budget
Item Total Cost
Pens R 100.00
Pencils R100.00
Highlighters R90.00
Notebooks R110.00
30Low – and Lower-Middle Incomes (LMIC) countries identified as per the World Bank classification as of August 2021 (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519)
26 Miscellaneous printing including a final hard copy of dissertation for editing purposes R3400.00
Total R3,800
Source: Author
Communication of findings
The findings from this study will be shared in thesis format and in the format of a journal manuscript. The thesis format will be shared with the University of Cape Town’s open access research database. Additionally, the findings will be communicated in the format of a journal manuscript intended for publication in a relevant journal read by key public health professionals, researchers, and health system stakeholders. Lastly, findings from this study will be disseminated on the primary author’s social media accounts which have some relevant health system related followers.
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