Application of Kolcaba's Comfort Theory in healthcare promoting adults' comfort: a scoping review

Abstract

Background: Comfort is a primary goal of healthcare. Theory-informed interventions and measurement are essential for comfort enhancement.

Objectives: To categorise and synthesise the international literature on the application of Kolcaba's Comfort Theory in research and practice aiming to promote adults' comfort.

Eligibility criteria: Papers reporting the application of Kolcaba's Comfort Theory on adult participants published in English and Chinese.

Sources of evidence: MEDLINE, CINAHL, APA PsycInfo, Embase, AMED, Web of Science, Scopus, The Cochrane Library, JBI EBP Database, CNKI, Wan Fang; grey literature of Google Scholar, Baidu Scholar and The Comfort Line were searched from January 1991 to January 2024.

Chart methods: Following the Joanna Briggs Institute guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, two reviewers selected papers and extracted data independently using a standardised chart embedded in NVivo software. A thematic synthesis and a descriptive analysis were provided.

Results: The review included 359 papers. Approximately two-thirds (n=216, 60.2%) had been published since 2017. The majority of papers (n=316, 88.0%) originated from China, the USA, Turkey, Brazil and Portugal. The use of Kolcaba's Comfort Theory was dominated in a range of hospital settings (n=263) and with participants suffering neoplasms (n=55). Seven categories of theory application were identified: (I) interventions underpinned by Comfort Theory as the theoretical framework, (II) interventions evaluated by instruments derived from Comfort Theory, (III) descriptive or observational studies of services or practices underpinned by Comfort Theory, (IV) surveys using questionnaires derived from Comfort Theory, (V) questionnaires development or adaption based on Comfort Theory, (VI) qualitative studies interpreted by Comfort Theory and (VII) literature reviews and discussion about Comfort Theory use. The most commonly evaluated interventions included music therapy (n=31), position intervention (n=20) and massage (n=19), and the most commonly used questionnaire was General Comfort Questionnaire (n=109).

Conclusions: Kolcaba's Comfort Theory has been largely used in interventions and assessments across a wide range of contexts, providing a set of options for practitioners. However, quantifying evidence is needed through further systematic reviews, and continuous development of Comfort Theory is warranted based on the categorisation by this review.

Keywords: Adult palliative care; Complementary Medicine; Pain Management; Systematic Review.

Figure 1. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews flow chart.

Figure 2. Number of publications per year (n=358). One included paper’s year of publication was unknown. Each blue bar shows the number of publications (on the top of bar, vertical axis) in a year between 1992 and 2023 (horizontal axis). The dotted curved line is an exponential trendline showing the number of publications rose at increasingly higher rates.

Figure 3. Number of publications by country (n=359). The blue bar shows the number of publications (vertical axis) in each country (horizontal axis) ranking from high to low, corresponding to the size of bubble summing up the number of publications in different countries within each region on the world map according to WHO regions system.

Figure 4. Number and percentage of papers in seven categories of Comfort Theory application (n=359).