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Systematic Reviews of Qualitative Literature

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Systematic Reviews of Qualitative Literature Catherine Francis-Baldesari UK Cochrane Centre Oxford Objectives Discuss the purpose and characteristics of meta-synthesis. – PowerPoint PPT presentation

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Title: Systematic Reviews of Qualitative Literature


1
Systematic Reviewsof Qualitative Literature
  • Catherine Francis-Baldesari
  • UK Cochrane Centre
  • Oxford

2
Objectives
  • Discuss the purpose and characteristics of
    meta-synthesis.
  • Become familiar with the concepts and general
    processes to conduct a meta-synthesis.

3
What Meta-Synthesis is Not
  • Not a systematic literature review.
  • Not a collation or codifying of studies.
  • Not an aggregation or summing of outcomes.
  • Not a concept analysis.

Finfgeld, D.L. (2003). Metasynthesis
The state of the art- so far. Qualitative Health
Research, 13 (7), 893-904
4
Purpose
  • Meta-analysis aggregating data to reach
    statistical power for detection of cause and
    effect between treatment and outcomes.
  • Meta-synthesis integrating data to reach a new
    theoretical or conceptual level of understanding
    and development.
  • Thorne, S., Jensen, L., Kearney, M.H., Noblit,
    G., Sandelowski, M. (2004). Qualitative
    metasynthesis
  • Reflections on methodological orientation and
    ideological agenda. Qualitative Health Research,
    14 (10), 1342-1365.
  • ,

5
Concept of Integration
  • More than the sum of parts.
  • Inferences derived from findings as a whole.
  • New higher-order interpretations created.
  • Thorne, S., Jensen, L., Kearney, N.H., Noblit,
    G., Sandelowski, M. (2004). Qualitative
    metasynthesis Reflections on methodological
    orientation and ideological agenda. Qualitative
    Health Research, 14 (10), 1342-1365.

6
Achieving Integration
  • Comprehensive consideration of data
  • Inclusion vs. exclusion
  • Commonalities and differences
  • Sensitivity to patterns
  • Intuitive and logical
  • Theoretical reconstruction of concepts
  • Silverman, D. (2001). Interpreting Qualitative
    Data Methods for Analysing Talk, Text and
    Interaction (2nd ed.). Thousand Oaks, CA Sage
    Publications, Inc.

7
Characteristics of Process
  • Inductive and interpretive in design.
  • Deconstruction and examination of findings from a
    sample of studies.

Mays, N., Pope, C., Popay, J. (2005). Details of
approaches to synthesis A methodological
appendix to the paper. Systematically
reviewing qualitative and quantitative evidence
to inform management and policy making in the
health field. http//www.chsrf.ca/funding_opportun
ities/commissioned_research/ projects/pdf/msynth_a
ppendix_e.pdf - 115.5KB
8
  • Translation of studies into one another.
  • Transformation of parts into whole.
  • Development of theory to explain the range of
    findings encountered.

9
How Do We Evaluate Outputs of Qualitative
Research?
  • Conceptual themes
  • Contributory
  • Defensible in design
  • Rigorous in conduct
  • Credible in claim

Spencer, L., Ritchie, J., Lewis, J.,
Dillon, L. (2003). Quality in Qualitative
Evaluation A framework for assessing research
evidence. Government Chief Social Researchers
Office, Cabinet Office, United Kingdom.
10
  • Contributory
  • In advancing wider knowledge or understanding
    about policy, practice, theory or a particular
    substantive field.
  • Defensible in design
  • By providing a research strategy that can address
    the evaluative questions posed.

11
  • Credible in claim
  • Through offering well-founded and plausible
    arguments about the significance of the evidence
    generated.
  • Rigorous in conduct
  • Through the systematic and transparent
    collection, analysis and interpretation of
    qualitative data.

12
Evaluating Qualitative Studies
  • Qualitative
  • Credibility
  • Confirmability
  • Transferability
  • Dependability
  • Quantitative
  • Internal validity
  • Objectivity
  • Generalisability
  • External validity

Malterud, K. 2001. Qualitative research
standards, challenges, and guidelines. The
Lancet, 358, 483-488.
13
Theory and Philosophy
  • "Application of nursing theory in practice
    depends on nurses having knowledge of the
    theoretical works as well as an understanding of
    how philosophies, models, and theories can relate
    to each other.
  • Van Sell, S.L. Kalofissudis, I.A. (2002). The
    Evolving Essence of the Science of Nursing
    Complexity Integration Nursing Theory. E-Book
    retrieved on January 16, 2006 from
    http//www.nursing.gr/Complexitytheory.pdf

14
Philosophical Framework
  • Determines how reality is explained, the source
    of knowledge, and the perspective taken in
    research and practice.
  • Monti, E. J. Tingen, M.S. (1999). Multiple
    Paradigms of Nursing Science Nursing Theory for
    the 21st Century. Advances in Nursing Science,
    21(4), 64-80.

15
Theoretical Framework
  • Influences how research questions are generated,
    studies are conducted, data are analysed,
    findings are understood, and results are used.
  • Alderson, P. (1998). Theories in health care and
    research The importance of theories in health
    care.
  • BMJ, 317 1007-1010.

16
Conceptual Framework
  • Brings theory into practice by organizing themes
    to form models, and operationalizing findings of
    synthesis.
  • Enables experience, reflection and wisdom as
    praxis, allowing practice to drive theory.
  • Warelow, P.J. (1997). A nursing journey through
    discursive practice. Journal of Advanced Nursing,
    26, 1020-1027.

17
Person-Centred Practice with Older People
  • Hermeneutic philosophy guided development of
    theoretical and conceptual framework.
  • Theoretical framework of authentic consciousness.
  • McCormack, B. (2003). Conceptual framework
    for person-centred practice with older people.
    International Journal of Nursing Practice, 9(3)
    202-209.

18
  • Conceptual framework of person-centredness
    addressed patient's and nurse's values within the
    context of a care environment.
  • Integration of conversation analysis and
    reflective conversation for data collection and
    analysis.
  • Findings suggest nurses need to perceive the
    patient as an individual and articulate the
    mutual understanding and expectations in the
    relationship.

19
Why Do Meta-Synthesis?
  • Theory building
  • Theory explication
  • Theoretical development

Schreiber, R., Crooks, D.,Stern, P. N. (1997).
Qualitative meta-analysis. In J. M. Morse (Ed.),
Completing a qualitative project (pp 311-326).
Thousand Oaks, CA Sage.
20
Quantitative Viewpoint
  • Determine best practices.
  • Maximize outcomes with minimal expenditures.
  • Achieve best outcomes in the shortest amount of
    time at the lowest cost possible.

21
Concept of ComplianceNewton (2004)
  • At risk populations for low rates of
    breastfeeding include poorly educated,
    poverty-stricken, young African-American women.
    Unfortunately, the understanding of why these
    populations are noncompliant is rudimentary.

Newton, E.R. (2004). The Epidemiology of
Breastfeeding. Clinical Obstetrics Gynecology,
47(3)613-23.
22
Qualitative Viewpoint
  • Strengthen the role of qualitative studies in
    health sciences research.
  • Improve applicability of qualitative research
    findings in clinical practice.
  • Build on a qualitative body of knowledge to
    inform theory, practice, research, and policy.

23
Concept of Self-Regulation Conrad (1985)
  • Re-frames the medically defined problem of
    noncompliance.
  • Allows the modification of medication practice
    for asserting some clinical control over
    epilepsy.

Barbour, R.S. (2000). The role of
qualitative research in broadening the evidence
base' for clinical practice. Journal of
Evaluation in Clinical Practice, 6 (2), 155163.
24
  • Theoretically generalizable understanding of
    apparently illogical behaviour in a wide range of
    clinical and non-clinical contexts.
  • Childhood immunizations, observance of safer sex,
    and daily management of asthma and diabetes.

25
Steps in Meta-Synthesis
  • 1. Getting started. Identification of
    intellectual interest that qualitative research
    might inform.
  • 2. Deciding what is relevant to initial interests
    and inclusion criteria for studies.

26
  • 3. Reading the studies. Not a one-time event. As
    the synthesis develops, studies are read and
    reread to check relevant metaphors and
    interpretations.

27
  • 4. Determining how the studies are related. Lists
    of key metaphors, phrases, ideas, or concepts and
    their relationships from each study and
    juxtaposed with those of other studies.
  • This phase is complete when an initial
    assumption about the relationship between studies
    can be made.

28
  • 5. Translation. Treating accounts in studies as
    analogies.
  • Translation maintains central metaphors and
    concepts in each study related to other metaphors
    or concepts in the same study.
  • Compares them to relevant metaphors and
    concepts from other studies in the form of
    analogy.

29
  • 6. Synthesizing translations.
  • Translations compared to determine if some
    metaphors and concepts encompass those from other
    studies.
  • If so, another level of synthesis is possible
    analyzing competing interpretations and
    translating them into each other.

30
  • 7. Expressing the synthesis.
  • Meta ethnography must be translated into the
    language of intended audiences.
  • Clarity and transparency.
  • Concise and straightforward.

Noblit, G.W. Hare, R.D. (1988).
Meta-Ethnography Synthesizing Qualitative
Studies. Newbury Park, CA Sage Publications,
Inc.
31
Metasummary
  • Extraction of findings from all studies in
    review.
  • Generation of comprehensive inventory of findings
    across studies.
  • Findings reduced to parsimonious list.
  • Frequency effect sizes calculated.

Sandelowski, M. Barroso, J. (2003). Creating
Metasummaries of Qualitative Findings. Nursing
Research, 52(4), 226-233.
32
Analysis
  • Content analysis from meta findings used to
    identify patterns and themes common across
    studies.
  • Constant comparison analysis clarifies distinct,
    shared meanings.
  • Empirical results become foundation for
    metasynthesis.

33
Meta-Ethnography
  • Critical thinking and conceptual analysis occur
    simultaneously with insight, creativity and
    intuition.
  • Analogies and metaphors formed during
    interpretation become new knowledge and
    understanding.
  • Dynamic and real time self-awareness of the
    synthesis process is essential.

34
Types of Meta-Ethnography
  • Reciprocal
  • Refutational
  • Line of argument

35
Reciprocal
  • Translations directly comparable.
  • Iterative process studies translated into each
    other.
  • Metaphors, themes, concepts, and organizers
    translated across studies.

36
Refutational
  • Interpretation designed to argue against another
    interpretation.
  • Explanation not of findings but significance of
    findings.
  • Exhibits beliefs and ways of arguing.
  • Promotes individual reflexivity.
  • Enriches critical discourse.

37
Line of Argument
  • Concerned with clinical inference and grounded
    theorizing.
  • Construction of an interpretation.
  • Involves two steps
  • translation of studies into one another
  • development of grounded theory, putting
    similarities and differences between studies into
    an interpretive order

38
Summary
  • Meta-synthesis is needed to build on the
    qualitative body of literature in healthcare.
  • Different philosophical and theoretical
    approaches result in different designs, analysis,
    and results.
  • Diversity in approaches to meta-synthesis is
    important for enlarging discourse.

39
  • Generalization of theory across clinical
    situations and relationships is critical.
  • Bringing theory to practice, and practice to
    theory is possible.
  • Nursing is uniquely situated to pursue this
    methodological paradigm.

40
Questions?
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