Synthesising qualitative findings - PowerPoint Presentation

Slide1

Synthesising qualitative findings

An interpretive perspective

Janet Harris

K U Leuven QES Workshop 4 – 6 June 2012Slide2

Acknowledgements

These power points build on the materials presented by Angela Harden in the systematic review workshop at

K U Leuven, 6

th

to 8

th

May 2011Slide3

What is synthesis?

‘The process or result of building up separate elements, especially ideas, into a connected whole, especially a theory or system’

(Oxford English Dictionary) Slide4

What is synthesis?

“..the product of activity where some set of parts is combined or integrated into a whole…..[synthesis] involves some degree of conceptual innovation, or employment of concepts not found in the characterisation of the parts and a means of creating the whole”

Strike and Posner (1983) Slide5

Synthesis starts with an epistemological assumption

Subjective idealism: there is no shared reality

independent of

multiple alternative human constructions

Objective idealism

: there is a world of

collectively shared

understandings

Critical realism

: knowledge of reality is mediated

by our

perceptions and beliefsScientific realism: it is possible for knowledge to approximate closely an external reality

Spencer et al, 2003Slide6

Mapping qualitative synthesis methods

Meta-narrative

CIS*

Meta-study

Meta-ethnography

Grounded theory

Thematic synthesis

Textual narrative synthesis

Framework synthesis

Ecological triangulation

Subjective idealism

Subjective idealism

Subjective idealism

Objective idealism

Objective idealism

Critical realismCritical realismCritical realismScientific realism

*Critical interpretive synthesis Barnett-Page and Thomas (2009)

Idealist Realist

Discrepancy preserves complexity of multiple views

Convergence on a definite answer

Commonalities across accounts produce greater explanatory powerSlide7

Type of question

Extent of iterationQuality assessment

Going beyond primary studies

Problematizing the literature

The synthetic product

Idealist RealistSlide8

The review method is related to the aim of the review and the literature that exists

A synthesis can aim to:

Bring together separate findings into an interpretive explanation that is greater than the sum of the parts (Meta ethnography)

Produce theories or models that are based on phenomena involving processes of contextualised understanding and action (Grounded theory)

Review need for an intervention, it’s appropriateness, acceptability and effectiveness (Thematic analysis)

Enable exploration of study heterogeneity by context, characteristics and findings (Textual narrative synthesis)

Look at how social, historical and ideological contexts influence the knowledge that is produced (Meta-study)

Bring together research of widely different designs and paradigms (Meta-narrative)Slide9

Approaches to qualitative evidence synthesis

Noyes &

Lewin

, 2010

http

://cqrmg.cochrane.org/supplemental-handbook-guidance

Interpretive approachesSlide10

Extent of iteration

Meta-narrative

CIS

Meta-study

Meta-ethnography

Grounded theory

Thematic synthesis

Textual narrative synthesis

Framework synthesis

Ecological triangulation

Subjective idealism

Subjective idealism

Subjective idealism

Objective idealism

Objective idealism

Critical realismCritical realismCritical realismScientific realismIteration throughout

Iteration at searching

Iteration at synthesis

Iteration at synthesis

Iteration at synthesis

Iteration not mentioned

Iteration at searching

Iteration not mentioned

Idealist RealistSlide11

Approaches to inclusion

Meta-narrative

CIS

Meta-study

Meta-ethnography

Grounded theory

Thematic synthesis

Textual narrative synthesis

Framework synthesis

Ecological triangulation

Subjective idealism

Subjective idealism

Subjective idealism

Objective idealism

Objective idealism

Critical realismCritical realismCritical realismScientific realism

Quality is important in terms of the end product - information to inform policy makers

Multi-method review

which includes RCTs

Multi-method review which includes RCTs

Multi-method review

which includes RCTs

Idealist Realist

Less emphasis on quality; more emphasis on utility and relevance

Specific approaches to quality assessmentSlide12

Context surrounding knowledge production

Meta-narrative

CIS

Meta-study

Meta-ethnography

Grounded theory

Thematic synthesis

Textual narrative synthesis

Framework synthesis

Ecological triangulation

Subjective idealism

Subjective idealism

Subjective idealism

Objective idealism

Objective idealism

Critical realismCritical realismCritical realismScientific realism

Idealist Realist

Examine the context in which the knowledge was produced (social, political, historical)

De-contextualised because phenomenon has an accepted definition in the literatureSlide13

Synthesis typologies

Integrative and interpretive

(e.g. Dixon-Woods et al. 2004;

Noblit

and Hare, 1988)

Aggregation and configuration

(e.g.

Sandelowski

, forthcoming)Slide14

A review of research about the experiences of motherhood for women with HIV*

45 studies

800 abstracted findings

Reduced to 93

Aggregation: effect sizes calculated for each finding

Concentration of findings in any one study

The frequency with which each of the 93 abstracted findings occurred

*Sandelowski M, Barroso J (2003) Creating metasummaries of qualitative findings

Nursing Research

52: 226-233Slide15

Frequency effect sizes for first 3 findings*

Abstracted findings (n=93)

No. of studies

Effect size

1. Children were the main reasons to live, fight, get off drugs, care for oneself, and avoid risky behaviors.

19

43%

2. Whether their children were in or out of their care or custody, being a mother was central to women’s lives: a source of self-esteem, strength, normalcy, inspiration, pride, hope, joy, sense of well-being, & sense of self as a whole woman.

15

31%

3. Children were important sources of physical, practical, emotional, and social support, and unconditional love to their mothers, buffering the negative effects of HIV.

7

18%

*Adapted from Sandelowski M, Barroso J (2003) Creating metasummaries of qualitative findings

Nursing Research

52: 226-233Slide16

An ‘interpretive’ synthesis method: meta-ethnography

Similar methods to those employed in the primary research it contains.

Products: new

interpretive

constructions, ‘translating the studies into one another’

Transferring ideas, concepts and metaphors across studies;

Data: interpretations and explanations of original authors;

Looking for reciprocal and

refutational

studies and lines of argument;

Role of quality and sampling varies.

Exact methods vary amongst the small number of studies reported so far

e.g. Britten N, Campbell R, Pope C, Donovan J, Morgan M, Pill R (2002) Using meta ethnography to

synthesise

qualitative research: a worked example.

J Health Serv Res Policy 7(4):209-215Slide17

This review was about…

Research question: How do the perceived meanings of medicines affect patients’ medicine taking behaviour and communication with health professionals?

Was not concerned with searching or assessing quality – it is an example of a method of synthesis.Slide18

Steps taken in the synthesis

The researchers looked across the papers for common and recurring concepts.Used Schutz’s notion of ‘first- and second-order constructs.

First order: everyday understandings of ordinary people

Second order: constructs of the social sciences

‘Third order interpretations’ were derived from a ‘line of argument’ based on 1

st

and 2

nd

order concepts.Slide19

Translating studies into one anotherSlide20

Meta-ethnographic synthesis

Adapted from Britten et al., 2002

CONCEPTS described in primary studies

Second order interpretations

Third order interpretations

Adherence/

compliance:

correct

and routine medicine taking

Self regulation:

problematic adherence; leaving off drugs

Aversion

:

eg

dislike of taking drugs; harmful side effects

Alternative coping strategies:eg Traditional remedies, self-helpa)Patients conduct cost-benefit analyses: weigh up risks vs benefitsb) Medicine taking influenced by cultural meanings and resourcesc)Self regulation includes the use of alternative coping strategiesSanctions: Drs talk severely about need to take tablets regularly; coercion from significant others, fear of coerciond) Self regulation is… inhibited by… the threat of social and professional sanctionse) Self regulation flourishes if sanctions are not severeSelective disclosure: patients don’t tell Dr of altered doses; manage info to psychiatristsf) Patients may not articulate views which they do not perceive as medically legitimatedg) Alternative coping strategies are not seen by patients as medically legitimateh) Fear of sanctions and guilt produce selective disclosureSlide21

Grounded theory synthesis

Developed by Eaves (2001) by combining steps used by grounded theorists

Charmaz

, Strauss & Corbin,

Chesler

)

Used with the aim of developing a substantive theory or model to explain a phenomenon

Starts with In-vivo codes: chunks of text containing the informant’s own words

SO

Relies upon articles containing thick descriptions for theory-buildingSlide22

Grounded theory synthesis stepsSlide23

Applying the synthesis

approach of

GT analysis to research data: a model

of rural

African American family

caregiving for

elderly stroke survivors

. Eaves, 1997 in Eaves 2001.Slide24

Which approach should you use?

What is the aim of the review?What sort of literature already exists?

How well defined are the concepts in the literature?

How contested are the concepts? Is there a variation in paradigms or definitions or conceptualisations?

What sort of expertise and resources do you have in your review team?