A Literature Review to Determine How Bereavement Support or Grief Recovery Programs are Evaluated

Purpose: For every death, four people on average grieve the loss of that person. With nearly 60 million deaths taking place each year now worldwide, this indicates that around 240 million global citizens begin a grief journey each year. However, as acute grief can last as long as two years, and as some mourners develop chronic or permanent grief, the number of people worldwide who are experiencing grief at this point in time is clearly much higher than 240 million. Moreover, and despite the common view that grief is a naturally occurring and frequently experienced life event, and that grief is something that most people successfully recover from, the health of grieving people can be seriously affected (Masterson et al., 2015). Some become so ill that they require cardiac care and some die after the loss of a beloved family member or friend (Eckerd, Barnett, & Jett-Dias, 2016). As such, grief should be considered one of the most prevalent “ailments” in existence today, with major implications for individual as well as population health. Most people recover from their grief over time with emotional support from family and friends, while some go to bereavement programs for grief recovery assistance (Wilson et al., 2018). A wide range of bereavement programs are often available (Wilson & Playfair, 2016). All programs may be beneficial to the people who access them, but it is also possible that some mourners instead will be harmed (Neimeyer, 2010). For instance, their grief could be sustained or increased by the planned grief recovery activities and through contact with other grieving persons. Moreover, their grief could be sustained or increased by uninformed or ineffectual bereavement service providers. Evaluations of these programs is therefore essential.

Methods: Since there is no standard evaluation requirement or evaluation methods, a scoping literature review of bereavement support or grief recovery program evaluations was undertaken to identify and assess evaluation methods. Scoping literature reviews are a type of systematic literature review, where all types of mixed method, qualitative and quantitative research reports are reviewed to assess the amount of research existing on a topic or question and determine existing evidence or evidence gaps on that topic or question. In scoping reviews, research articles are not eliminated from review when research methodological or other quality concerns are identified. For this review, research articles published in the years 2000 through 2018 that described the evaluation of one or more bereavement support or grief recovery programs were sought in the Directory of Open Access Journals and the EBSCO Discovery Service. The keywords/MeSH terms “bereavement or grief program or service” combined with “evaluation” or “quality improvement” and then also “research” were used to identify articles. The findings were limited to relevant English-language research report articles appearing in peer-review journals. The results were also limited to articles containing an abstract and information on the data collection and analysis methods.

Results: Only eight research articles were identified. The references listed in these 8 research articles and 6 review articles were searched, with 34 more articles identified for the review. All 42 were systematically searched for information by one reviewer who drafted a table of findings, with this information checked for accuracy by a second team member. After some corrections, the findings were subject to content analysis, a process by the two reviewers to identify key findings and then group these findings into categories. The 42 articles reveal interest exists in many, although primarily developed, countries about the efficacy of bereavement programs. A wide range of bereavement programs were evaluated, including group counselling or support, one-on-one counselling or support, education, memorial activities, and social activities. These programs were described as having been designed for a single group of mourners such as adults, parents, or children or for a number of different mourner groups, such as parents, children, and grandparents. Considerable variance in evaluation methods was evident. Multiple methods were most often used to collect evaluation data (64.3%). A self-devised questionnaire or survey tool was commonly used to collect evaluation data (57.1%), followed by qualitative interviews (38.1%) and the use of existing standardized data collection instruments such as grief inventories or depression scales (38.1%). Evaluation data were most often collected at only one point in time (81.0%), typically upon completion of the bereavement program or at an unspecified time soon after program completion. The study subjects or participants also varied, with 97.6% of studies collecting data from program recipients and 28.6% from program staff, with 3 studies (7.1%) only collecting data from program staff.

Conclusion: Considerable insight into bereavement program evaluation methods was gained through this review, but bereavement program evaluation was determined to be an underdeveloped science. Research is needed now to ensure that bereavement support or grief recovery programs are effectively evaluated so they are beneficial to the participants.