INTRODUCTION Midwifery care meets the triple aims of health system improvement, i.e. good health outcomes, high client satisfaction, and low per capita costs. Scaling up access to midwifery care is a global priority yet the growth and sustainability of the profession is threatened by high levels of burnout and attrition. This scoping review provides a comprehensive review of the existing literature on burnout in midwifery, with a focus on prevalence, associated factors and potential solutions. METHODS Four electronic databases were searched to locate relevant literature up to July 2019. A total of 1034 articles were identified and reduced to 27 articles that met inclusion criteria. We summarize sample sizes, settings, study designs, burnout measures, prevalence of burnout, associated factors and potential solutions, and recommendations. RESULTS Prevalence of burnout was highest among Australian, Western Canadian and Senegalese midwives and lowest among Dutch and Norwegian midwives. Midwives working in caseload/continuity models reported significantly lower burnout compared to midwives working in other models. We identified 26 organizational and personal factors that were significantly associated with burnout, such as high workload, exposure to traumatic events, and fewer years in practices. Organizational support to improve work-life balance and emotional well-being, as well as more continuing education to raise awareness about burnout and how to cope with it, emerged as common strategies to prevent and address burnout. CONCLUSIONS Burnout is a serious and complex occupational phenomenon. More qualitative research is needed in this area, to better understand the lived experience of burnout. AFFILIATION

Background This review seeks to identify (a) the various components and process outcomes of type 2 diabetes peer support (PS) interventions and (b) the measures implemented to monitor intervention fidelity and evaluate outcomes in these studies. Methods The MEDLINE, PubMed, EMBASE (Excerpta Medica Database), CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases were searched from inception to May 2019. Two reviewers independently screened and extracted data from eligible articles via the Template for Intervention Description and Replication (TIDieR) checklist (why, what, who provided, how, where, when and how much, tailoring, modifications, and how well). Results Twenty‐three trials were included. The total number of participants was 7178. Most interventions were in primary care. Although face‐to‐face was the most common modality of contact, rates of contact were highest for telephone. Potential peer leaders (PLs) were identified primarily through recommendations from health professionals, based on their communication skills, glycosylated hemoglobin (HbA1c), and coaching interest. PLs were mostly female, university educated, and had a long history of diabetes (≥ 10 years). PL training varied significantly in length and content; the two most frequent topics were communication skills and diabetes knowledge. Although several studies implemented methods to evaluate “intervention fidelity,” only few rigorously assessed the two key components of fidelity, “adherence” and “competence,” through audio‐ and video‐taping or direct observations. Conclusions The impact of PS on participants' health outcomes is well investigated; however, the implementation and evaluation strategies vary significantly across these studies. In the present review, we define the various components of PS interventions and propose suggestions for enhancing the implementation and evaluation of future PS models.

Due to lack of high-quality, consistent research on the effects of exercise for persons with vertebral fractures, no definitive conclusions can be drawn from this systematic review. Positive trends were identified with regard to improvements in strength and balance, with no increase in pain following exercise protocols. Future research is needed in this area.

This is the first study to report that diabetes distress is a serious concern for South Asian Canadians with type 2 diabetes. Given that depression and diabetes distress are linked, studies recruiting a larger and more diverse sample of South Asian Canadians should be conducted to better understand the psychological issues that may impact diabetes self-management in this community.

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Objective To explore the experiences of peer leaders with respect to delivering core components of a 12‐month, telephone‐based peer support intervention in type 2 diabetes within a tertiary‐care setting. Methods Seventeen peer leaders were recruited and interviewed. Interviews lasted approximately 20 to 45 min, were audio‐taped, and transcribed verbatim. The transcripts were analysed by two team members using the qualitative descriptive approach. Findings Peer leaders reported mutually beneficial and reciprocal relationships with participants. They encountered challenges in maintaining regular contact with participants and in motivating them to make lifestyle changes. To improve the programme, peer leaders suggested having more frequent – but shorter – training sessions and reducing the diabetes education component of the training programme. To enhance the intervention fidelity and retention rate, they recommended matching peer leaders to participants on more meaningful variables (e.g. diabetes‐related commonalities, personality, life experiences, etc.) beyond just gender, geographic proximity and availability. They also requested more frequent face‐to‐face contacts with participants (Modality of Contact), and additional ongoing support from the research team. Conclusion Peer leaders were satisfied with the intervention design. However, future studies may consider more comprehensive peer leader‐matching algorithms and increased opportunities for in‐person communication modalities. ClinicalTrials.gov Identifier: NCT02804620.

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