<p>Study design and review framework</p>
This systematic literature review was conducted according to the recommendations outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) state ment (Moher, Liberati, Tetzlaff, Altman, & Group, 2009).
A three-stage search strategy was used in this review. A limited search in Web of Science and Sco pus databases was initially conducted to identify key words and indexing terms used in the titles and abstracts of relevant articles. Thereafter, a second search using all identified key words and indexing terms was undertaken across all selected databases. The databases searched were MEDLINE (EBSCO), PsycINFO (EBSCO), SocINDEX (EBSCO), Web of Science core collection, Scopus, PubMed, ProQuest Social Services Abstracts, and African Journals Online. Medical Subject Headings (MeSH) term categories were applied across all index terms in the PubMed search to ensure that all relevant publications were identified. Some of the main keywords and MeSH terms and their combinations used were ‘family support’, ‘social support’, ‘social capital’, ‘intergenerational relations’, ‘intergenerational transfers’, ‘financial support’, ‘activities of daily living’, ‘caregiving’, ‘older adults’, ‘elderly’, and ‘sub-Saharan Africa’. Box 37.1 shows the complete list of the main key words and index terms applied across all databases in the review.
A search for unpublished studies and reports was undertaken in the World Health Organization library (WHOLIS), World Bank electronic library, ProQuest Dissertations and Theses Global, and HelpAge International. Searches were also conducted to retrieve unpublished works such as government reports, government white papers, reports of ministries of health, and reports of seminars and conference proceedings. All records identified were imported into Endnote and exported into an Excel file. Two authors (MAA, TCV) initially screened the titles and abstracts of all identified publications and thereafter independently carried out full-text assessment for eligibility and inclusion. Disagreements over eligibility and inclusion were resolved by a third author (HH). Finally, the reference lists of eligible publications were hand-searched for additional publications. Figure 37.1 shows the PRISMA flow diagram illustrating screening of studies for inclusion in the review.
Studies published in English and conducted among community-residing (or non-institution alized) older people living in SSA between January 2000 and May 2020 were included. All sub-Saharan African countries were included in the database searches. Studies of any design and methodology examining the association between intergenerational family support received by older adults on measures of their health and well-being were included: primary empirical quan titative, qualitative and mixed methods, theoretical studies, working papers, and reports. Studies that exclusively focussed on family support provided to older adults or received by older adults in the context of HIV/AIDS were excluded.
Intergenerational family support in this review was conceptualized as the provision of instrumental, emotional, and structural forms of support to older adults by family or kin. SSA region refers to countries south of the Sahara based on the United Nations’ classification of countries (UNDESA, 2019). Although older people in sub-Saharan Africa are defined as persons aged 60 years and older in line with the United Nations’ recommended cut-off for defining an older person globally, this review considers persons aged 50 and older as older people given the relatively short remaining life expectancy at age 50 (23 years) in the sub region (UNDESA, 2019; McIntyre, 2005). Moreover, most ageing studies in Africa but also other countries or regions focus on individuals aged 50 and older (Kunna, San Sebastian, & Stewart Williams, 2017). Therefore, focussing on studies that investigated older adults aged 50 and older was considered appropriate and ensured more studies met the eligibility criteria for the review.
Figure 37.1 PRISMA flow diagram illustrating screening of studies for inclusion in the review.
Family OR relative OR relations OR kin AND support OR social support OR emotional support OR material support OR monetary support OR financial support OR personal support OR instrumental support OR practical support OR health support OR activities of daily living OR instrumental activities of daily living OR intergenerational support OR intergenerational transfers OR financial transfer OR cash transfer OR intergenerational relation OR intergenerational reciprocity OR family support OR family network OR kin networks OR kin support OR social capi tal OR social networks OR caregiving OR care OR needs AND older people OR older adult OR older person OR seniors OR elderly person OR elderly OR geriatric OR later years OR later life AND Africa OR sub-Saharan Africa OR African country OR Western Africa OR Eastern Africa OR Central Africa OR Southern Africa
*UN-listed SSA countries: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Madagascar, Malawi, Mauritius, Mozambique, Rwanda, Seychelles, South Sudan, Somalia, Uganda, Tanzania, Zambia, Zimbabwe, Angola, Cameroon, Central African Republic, Chad, Congo, DRC, Equatorial Guinea, Gabon, Sao Tome and Principe, Botswana, Swaziland, Lesotho, Namibia, South Africa, Benin, Burkina Faso, Cape Verde, Côte d’Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo.
Data from eligible studies was extracted on authors, publication year, study country, study title, study design and population, research methods, support provided, findings on support received and association with indicators of health and well-being, and study limitations.
Assessment of the methodological quality of included studies was conducted based on the National Institute of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (NIH, 2014). This is an instrument that has 14 criteria and is used to critically appraise the internal validity of quantitative studies. The 14 criteria include: research question, study population, sample recruitment and eligibility criteria, sample size justification, exposure and outcome assessment, follow-up rate, and statistical analysis. Each criterion was rated ‘yes’, ‘no’, ‘cannot determine’, ‘not applicable’, or ‘not reported’. Using these criteria, we provide an overall quality rating (Good, Fair, Poor) for each study assessed. None of the studies that met all selection criteria used qualitative methods.
A narrative synthesis was used to summarize the findings of the included studies. It is the preferred method of quantitative data synthesis when statistical synthesis is not possible as was the case in our review given the heterogeneity of concepts and variables. A narrative synthesisnis a textual approach to synthesizing findings from included studies (Popay et al., 2006). Two authors (TCV, HH) cross-validated the synthesized findings.