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Can Qualitative Metasynthesis Make a Contribution to Evidence-Based Practice?: Issues and Challenges in an Era of Research Integration

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Title: Can Qualitative Metasynthesis Make a Contribution to Evidence-Based Practice?: Issues and Challenges in an Era of Research Integration


1
Can Qualitative Metasynthesis Make a
Contribution to Evidence-Based Practice?
Issues and Challenges in an Era of Research
Integration 
Panel Presentation for Advances in Qualitative
Methods   AcademyHealth Seattle
June 26/2006
Sally Thorne, RN, PhD University of British
Columbia
2
Why Qualitative Metasynthesis?
  • Proliferation of qualitative research in the
    health sciences and practice disciplines
  • New turn to evidence-based practice and
    systematic reviews of research
  • Inadequate methodologies for conducting
    systematic reviews of qualitative research
  • Under-utilization of qualitative findings in
    health service/policy

3
Transforming Findings into Evidence?
4
General Definition
  • An interpretive integration of qualitative
    findings (i.e.., phenomenologies, ethnographies,
    grounded theories, and other integrated and
    coherent descriptions or explanations of
    phenomena, events, or cases) that are themselves
    interpretive syntheses of data.
  • Accommodates all findings, crafting them into a
    novel interpretation using an inclusive logic.

5
Terminological Context
  • Social Sciences
  • Meta-Ethnography (Noblit Hare, 1988)
  • Meta-Theorizing (Ritzer, 1991)
  • Metatheory, Metamethod, Meta-data-analysis
    (Zhao, 1996)
  • Health Sciences
  • Aggregating Qualitative Findings (Estabrooks,
    Field Morse (1994)
  • Qualitative Meta-Analysis (Schreiber, Crooks
    Stern (1997)
  • Meta-Study (Paterson, Thorne, Canam Jillings,
    2001)
  • Qualitative Metasummary (Sandelowski Barroso,
    2003)

6
What Metasynthesis is Not
  • Conventional narrative reviews of qualitative or
    quantitative research
  • Quantitative meta-analyses of qualitative
    research
  • Secondary analyses pooled case comparisons of
    qualitative data
  • Critical integrative literature review

7
Inherent Complexity of the Challenge
  • Multiple methods
  • Multiple disciplines
  • Multiple epistemologies

8
Challenges Across Metasynthesis Approaches
  • Finding reports of qualitative studies
  • Appraising qualitative research reports
  • Finding the findings in research reports
  • Integrating findings

9
Finding the findings
  • Defining findings
  • Locating them
  • Classifying findings
  • Extracting them

10
From Sandelowski Barroso (2003
11
Integrating qualitative findings
  • Preserving the case imperatives of qualitative
    research
  • Preventing paralytic immersion in data
  • Accounting for varying sample sizes
  • Differentiating idiographic nomothetic
    generalization

12
Methodological VariationsPossible approaches to
qualitative metasynthesis
  • Qualitative meta-study
  • Qualitative research integration

13
Meta-Study
  • remapping the cognitive status
  • of a changing field of study by considering
    its theoretical, methodological, and
    epistemological bases within a historical and
    sociocultural context. (Zhao, 1991, p. 381)
  •  

14
Components of Meta-study
  • Meta-Data-Analysis analysis of analyses or an
    analysis of the data analyses available in
    reports about primary qualitative research
    studies
  •  
  • Meta-Method study of the rigor, epistemological
    soundness, and fruitfulness of the research
    methods used in the research studies
  •  
  • Meta-Theory uncovering underlying structures of
    extant theory as the theoretical framework and/or
    emergent theory that is grounded in the research
    findings

15
Meta-Study Products
  • Historical critical analysis of a field,
    including diversities, patterns and
    methodological imperfections
  • Complexity of the final synthesis

16
Qualitative Research Integration
  • Empirical studies directed toward the combination
    of research findings in reports of qualitative
    studies.
  • Aimed at systematically judiciously appraising
    reports of completed qualitative studies in a
    target research domain
  • Creating conclusions about knowledge (however
    provisional and fallible) in a specified field

17
Metasummary a quantitatively oriented
aggregation of qualitative findings that are
topical or thematic summaries or surveys.versus
Qualitative Metasynthesis - Interpretive
syntheses of data in primary qualitative studies

18
Research integration vs. meta-study
Research Integration Meta-study
Focus Study findings Study studies
Primary data Findings Various elements of of reports
Orientation to data Empirical findings are indices of target events Discursive reports are socio-historical constructions
Method examples Qual metasummary Qual metasynthesis Meta-theory, -method Citation analysis Discourse analysis
Product examples Evidence synthesis Research hypotheses Critique Intellectual history
19
Critical Caveats in Qualitative MetaSynthesis
  • Orthe importance of humility in making claims
  • Experience thrice-removed
  • The problem of representation
  • Discursive readings as correctives to empirical
    claims

20
Critical Caveats continued
  • Choices judgments
  • Methodological groundings
  • Homogenizing variation
  • Reproducing bias
  • Objectifying meaning

21
Health service/policy research implications CDM
Example
  • Assumptions underlying acute/compliance model
  • Role of insider experience research in reshaping
    analysis
  • Single disease vs broad based CD analysis
  • Patterns themes across disease experience
    contexts

22
Moving Forward?
  • Finding appropriate balance between descriptive
    and normative empirical knowledge forms
    (including social construction).
  • Creating language within the qualitative health
    research community to account for probable
    truths and pragmatic generalizations

23

  • Slowing momentum toward meta-synthesis until we
    have a strong foundation of theoretically sound
    approaches
  • Strengthening quality criteria for qualitative
    health research, larger (more population based)
    studies
  • Nurturing a culture
    of complexity, not
    simplicity, in the
    presentation of

    qualitative findings

24

For Further Reference Paterson, B., Thorne, S..
Canam, C. Jillings, C. (2001). Meta-study of
Qualitative Research A Practical Guide to
Meta-analysis and Meta-Synthesis. Thousand Oaks,
CA Sage Publications. Thorne, S., Jensen, L,
Kearney, M.H., Noblit, G., Sandelowski, M.
(2004) Reflections on the methodological and
ideological agenda in qualitative meta-synthesis.
Qualitative Health Research, 14, 1342-1365.
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