Systematic review / synthesis of qualitative evidence – issues

After #PHTwitJC 10 which considered a systematic review of qualitative evidence, some participants  expressed an interest in exploring this methodology further.

This is an area that I have been exploring over the past couple of years. I am interested in qualitative research methodology generally; my interest in systematic review /synthesis was sparked by advice that MSc students could now submit a qualitative systematic review (QSR) as their dissertation. I found that we didn’t have much guidance for supervisors or students, on how to approach this. Since then, I’ve supervised two QSR dissertations to successful completion and developed discussions and training for supervisors, although I still have not completed my own QSR.

Although it is a methodology  that many are unfamiliar with, there is a substantial literature around that provides both examples of QSR and methodological discussion. It is a contentious area; even agreement about what to call such studies is lacking. Although I have plumped for the shorthand ‘QSR’ as an umbrella term, some would object to inclusion of the phrase ‘systematic review’ and prefer terms such as ‘metasynthesis’ (and there are a number of other labels out there).

Key areas for consideration are both practical and philosophical, and include:

  • Philosophical /epistemological debates – e.g. does aggregating study results  actually generate ‘better’ evidence / insights;  is secondary analysis ‘authentic’ enough to the situational aspects of the original study…; should positivist assumptions about ‘rigour’ be imposed upon qualitative research (e.g. via the use of critical appraisal tools)..?
  • Limitations of journal articles in terms of quantity of qualitative data ( + findings) presented –often offer  just a flavour of, or a selection of overall themes, from wider study;
  • Size:  how ‘big’ or wide ranging should the research /search question be;  at what stage can this be delimited or expanded? How many studies can be included –   do one or two make a review; is it possible to include, say, 100 studies for thematic synthesis?
  •   Quality appraisal: there are ‘checklists’ for appraising published qualitative studies; however not all qualitative researchers agree that these represent a benchmark for good qualitative reporting. Certainly, the presentation of qualitative research is much less standardised than that of, for example,  clinical research reports).

I’ve identified a modest (!) selection of sources below. Happy reading!

Selected further reading references:

About qualitative metasynthesis /QSR

Dixon-Woods, M. (2006) Critical interpretive synthesis: a brief introduction [PowerPoint presentation] . ESRC Research Methods Festival , Oxford, 17-20 July 2006.

Downe, S. (2008) Metasynthesis: a guide to knitting smoke, Evidence Based Midwifery 6(1): 4-8 Excellent discussion of practical & philosophical issues

Noblit, G. & Hare, R. (1988) Meta-Ethnography: Synthesising qualitative studies. London: Sage. A classic text – note ‘meta-ethnography’ does not necessarily involve systematic review/searching.

Sandelowski, M., Docherty, S. & Emden, C. (1997) Qualitative Metasynthesis: issues and techniques. Research in Nursing and Health 1997, 20, 365–371

 Thorne S, Jensen L, Kearney M, Noblit G, Sandelowski M. (2004) Qualitative metasynthesis: reflections on methodological orientation and ideological agenda. Qualitative Health Research 14(10): 1342-56.  [not open access]

 Examples of studies

Atkins, S. et al (2008) Conducting a meta-ethnography of qualitative literature: Lessons learnt  BMC Medical Research Methodology 2008, 8:21 Study of TB treatment adherence; also discusses methodological issues.

Attree, Pamela (2004) Growing up in disadvantage: a systematic review of the qualitative evidence. Child: Care, Health & Development 30, 6: 979-89 [not open access]

Baxter, S. et al (2010) Factors relating to the uptake of interventions for smoking cessation among pregnant women: A systematic review and qualitative synthesis Nicotine and Tobacco Research 12 (7): 685-694. [not open access]

Harden, A., Brunton, G., Fletcher, A. And Oakley, A. (2009) Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies. BMJ, 2009;339:b4254 doi:10.1136/bmj.b4254 [integrative review – mixed trials + qual studies]

McDermott, E., Graham, H. & Hamilton, V. (2004) Experiences of being a teenage mother in the UK: a report of a systematic review of qualitative studies. Glasgow: SHPSU.

O’Connell, R. And Downe, S. (2009)  A metasynthesis of midwives’ experience of hospital practice in publicly funded settings: compliance, resistance and authenticity Health (London) 2009 13: 589 [not open access]

Williamson Lisa M, et al (2009) Limits to modern contraceptive use among young women in developing countries: a systematic review of qualitative research. Reproductive Health 2009, 6:3

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4 Responses to Systematic review / synthesis of qualitative evidence – issues

  1. Kate Thomson says:

    Reblogged this on Health and Policy and commented:

    This post was written for Public Health Twitter Journal Club. It reflects a scholarly interest of mine – currently drafting a paper about it.

  2. Sunil Bhopal says:

    Thanks, very interesting. Are there some guidelines on how to write qualitative papers in order to allow for easier sythesis in the future?

  3. Thanks Kate – very helpful!

  4. Pingback: » Jompy Boiler creating clean water

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