Dr Andrew Booth Caveat Reviewer Pandoras Box Confusing Terminology Variety of Choices Qualitative Systematic Review Qualitative MetaSynthesis Qualitative Research Synthesis Qualitative Evidence Synthesis ID: 418480
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Slide1
Choosing a Method of Qualitative Synthesis
Dr Andrew BoothSlide2
Caveat Reviewer: Pandora’s Box!Slide3
Confusing Terminology, Variety of Choices
Qualitative Systematic Review
Qualitative Meta-Synthesis
Qualitative Research Synthesis
Qualitative Evidence Synthesis
Qualitative Interpretive Meta-Synthesis
Best Fit Synthesis Critical Interpretive SynthesisFramework SynthesisMeta-AggregationMeta-EthnographyMeta-InterpretationMeta-NarrativeMeta-StudyMeta-SummaryNarrative SynthesisQualitative Meta-SynthesisRealist Synthesis 19. Rapid Realist SynthesisThematic SynthesisSlide4
Decisions, Decisions!
Novice
– Bewildering variety of methods of synthesis – compounded by choice of checklists, conflicting guidance etcetera
Experienced
-
Many authors stick to familiar methods rather than select most appropriate method to address question and type of evidenceMuch description of methods, little evaluation and critiqueMuch hiding behind “labels”, misuse of methodsSlide5
Caveat Reviewer:
TREAD
Carefully
T
ime/Timeframe
ResourcesExpertiseAudience & PurposeData – Quality, Quantity, Thickness, RichnessSlide6
T
ime/Timeframe
Most Time Consuming
Meta-ethnography –
interpretive approach
Realist Synthesis – Identification of theory and development of programme theoriesLeast Time ConsumingMeta-Aggregation –aggregating existing themesThematic Synthesis –
inductively coding themesFramework SynthesisBest Fit Framework Synthesis“Framework-based synthesis is an important advance in conducting reviews of qualitative synthesis. The 'best fit' strategy is a variant of this approach that may be very helpful when policymakers, practitioners or other decision makers need answers quickly, and are able to tolerate some ambiguity about whether the answer is the very best that could be given”. Dixon-Woods M. Using framework-based synthesis for conducting reviews of qualitative studies. BMC Med. 2011 Apr 14;9:39.Slide7
Seven steps for meta-ethnographySlide8
Process of Realist Synthesis
from:
McCormack, B., Wright, J., Dewar, B., Harvey, G., & Ballantine, K. (2007). A realist synthesis of evidence relating to practice development: findings from the literature analysis.
Practice Development in Health Care
,
6(1), 25-55.Slide9
R
esources
Most
Resource Intensive
Least Resource IntensiveSlide10
E
xpertise
Expertise in Qualitative Research Methods
(e.g. Grounded Theory; Framework Analysis, Thematic Analysis)
Expertise in Synthesis Methods
(incl. Searching, Data Extraction, Quality Assessment, Interpretation) Knowledge of Topic Area Slide11
A
udience & Purpose
“output of some methods… (
Thematic Synthesis
, textual
Narrative Synthesis, Framework Synthesis, and ecological triangulation) is more directly relevant to policymakers and designers of interventions than…methods with a more constructivist orientation (Meta-Study, Meta-Narrative, Meta-Ethnography, Grounded Theory, CIS)…generally more complex and conceptual” (Barnett-Page & Thomas, 2009)
Thematic Synthesis (including Meta-Aggregation) and Framework Synthesis produce findings that directly inform practitioners (Thomas & Harden, 2009)Interpretive approaches (e.g. CIS, Meta-Ethnography) produce a model that requires practitioners to interpret relevance and applicability to their own contextNarrative Synthesis or EPPI-Centre (matrix) methods may help to integrate and present quantitative/qualitative workSlide12
D
ata – Quality, Quantity, Thickness, Richness
Rich, Thick Data
Meta-ethnography
characterised
by data of high methodological quality, rich data and systematic presentation.Rich/“Thick” reports sustain Meta-Ethnography/Grounded Theory – may allow selective sampling/ theoretical saturation
Poor, Thin DataQualitative data from “thin” studies (or textual responses to surveys) will not sustain interpretive approachesLimited to Meta-Aggregation, Thematic Synthesis, Framework Synthesis, Meta-Summary Narrative Synthesis –type approachesNB. Is “Unit of Analysis” Individual Study (Meta-Aggregation, Thematic Synthesis) or “Body of Evidence” (e.g. Meta-Narrative or Critical Interpretive Synthesis approaches) or even Theory (Framework Synthesis/Best Fit Synthesis)? Slide13
Overview of Approaches
Gough D, Thomas J, Oliver S. Clarifying differences between review designs and methods.
Syst Rev
. 2012 Jun 9;1:28. doi: 10.1186/2046-4053-1-28.Slide14
Decision to conduct a qualitative evidence
synthesis
To interpret synthesised qualitative evidence and develop explanatory theory or models
Purpose of the additional
qualitative synthesis
or
Choice of Synthesis (Adapted from Noyes & Lewin, 2011)
To aggregate/ summarise/ integrate qualitative data to address questions in relation to a specific intervention review
Primarily to integrate and interpret qualitative and quantitative evidence within a single approach or integrated model. Can be used to develop explanatory theory.
Thematic analysis without theory generation
Meta-aggregation
Meta-summary
Product:
Aggregated findings from source papers
Meta-ethnography
Grounded theory
Thematic analysis with theory generation
Framework synthesis
Realist Review
EPPI Approach
Matrix Method
Narrative Synthesis
Bayesian Synthesis
Critical Interpretive synthesis
Product: Explanatory theory, analytical or conceptual framework or interpretative framework/mechanism
Best fit synthesisSlide15
Some ExamplesSlide16
The Scenario
HTA Report – Systematic Review, Modelling & Qualitative Synthesis on Group Therapy for Postnatal Depression (UK)
Stevenson
M, Scope A, Sutcliffe P, Booth
A,
et al. Group cognitive behavioural therapy for postnatal depression: a systematic review of clinical effectiveness, cost effectiveness and value of information analyses. Health Technol Assess 2010;14(44).
Scope, A., Booth, A. and Sutcliffe, P. (2012), Women’s perceptions and experiences of group cognitive behaviour therapy and other group interventions for postnatal depression: a qualitative synthesis. Journal of Advanced Nursing. doi: 10.1111/j.1365-2648.2012.05954Slide17
The Choice
Type of
Question
– Acceptability of Intervention
Extent of Description versus
Interpretation – Factors Making Group Therapy More or Less Acceptable (Descriptive) Role of Theory – No Theory – Trying to separate Group Effect from Therapy EffectType of Data – Very Thin Data, Small Number of Studies (n = 6) – Descriptive Case Study Accounts in Nursing Journals
Intended Output – Alongside Effectiveness Review & Cost Effectiveness Study – for ImplementationOther Considerations: Methodological Expertise in Team – Novice Reviewer Available Resources – Limited Time in Comparison to “Main” ReviewSlide18
Your Choice?
STSlide19
The Contribution
While Group Therapy is Acceptable
on Average
there are some for whom it is unfavourable because:
Group Comparison
– Some People are Getting Better Quicker than I amGroup Comparison – Ms. X has been Coming Here longer than I am and is still not any betterIdentified Key Issue: Identification of those Most Likely to Benefit.Slide20
The Scenario
Aim:
To analyse meaning
and motivation of the
Wish To Hasten Death
in patients with chronic illness or advanced diseaseMonforte-Royo C, Villavicencio-Chávez C, Tomás-Sábado J, Mahtani-Chugani V, Balaguer A (2012) What Lies behind the Wish to Hasten Death? A Systematic Review…. from
the Perspective of Patients. PLoS ONE 7(5): e37117. doi:10.1371/journal.pone.0037117Slide21
The Choice
Type of
Question
– Explanatory
Extent of Description versus
Interpretation – Factors that Help to Explain a Phenomenon (Interpretative) Role of Theory – Theory GenerationType of Data – Contextually Rich – Qualitative Research Reports – Thick Data [NB. 7 studies]Intended
Output – Stand Alone Research Report for EnlightenmentOther Considerations: Methodological Expertise in Team – Large Experienced Team with Qualitative Researcher Available Resources – Extant Funded ProjectSlide22
Your Choice?
E/MSlide23
The Contribution
Wish
to hasten death (WTHD) is
multifactorial
construct with
multiple meanings that do not necessarily imply genuine desire to hasten one's death or actually taking steps towards this. Wish to hasten death (WTHD) is a phenomenon that appears, among patients in advanced stages of illness, as response to extreme
suffering that affects all aspects of their human existence.Slide24
The Scenario
Aim:
To evaluate benefits and constraints of collaborative health-related
research by researchers and those affected by the issues under study
and/or those who would apply research results and to examine how variations in programme context and mechanisms influence the process and outcomes of collaborative health intervention research? Jagosh, J., Macaulay, A. C.,
Pluye, P., Salsberg, J., Bush, P. L., Henderson, J., ... & Greenhalgh, T. (2012). Uncovering the benefits of participatory research… Milbank Quarterly, 90(2), 311-346.Slide25
The Choice
Type of
Question
– Explanatory
Extent of Description versus
Interpretation – Factors that Help to Explain Variation in Outcomes Role of Theory – Theory ExplorationType of Data – Contextually Rich – Quantitative and Qualitative Research Reports – Thick Data [NB. Twenty-three PR partnerships described in 276 publications.]
Intended Output – Explanatory Report for Multiple FundersOther Considerations: Methodological Expertise in Team – Large Experienced International Team of Experienced Researchers Available Resources – Extant Funded ProjectSlide26
Your Choice?
S/RSlide27
The Contribution
Used
middle-range
theory of
partnership
synergy to demonstrate how PR can (1) ensure culturally and logistically appropriate research, (2) enhance recruitment capacity, (3) generate professional capacity and competence in stakeholder groups, (4) result in productive conflicts followed by useful negotiation, (5) increase quality of outputs and outcomes over time, (6) increase sustainability of project
goals, and (7) create system changes and new unanticipated projects and activities. Generated new insights into benefits of PR regarding conflicts and negotiation between stakeholders, program sustainability and advancement, unanticipated project activity, and generation of systemic change. Slide28
References - 1
Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review.
BMC Med Res
Methodol
.
2009 Aug 11;9:59.Booth, A, Papaioannou, D and Sutton, A J (2011). Systematic Approaches to a Successful Literature Review. SAGE publications Candy B, King M, Jones L, Oliver S. Using qualitative synthesis to explore heterogeneity of complex interventions. BMC Med Res Methodol
. 2011 Aug 26;11:124. Dixon-Woods M, Agarwal S, Young B, Jones D, Sutton A. (2004) Integrative approaches to qualitative and quantitative evidence. London: Health Development AgencyGough, D, Oliver, S, Thomas J (2012) An Introduction to Systematic Reviews. London: Sage Publications.Lorenc, T., Pearson, M., Jamal, F., Cooper, C. and Garside, R. (2012), The role of systematic reviews of qualitative evidence in evaluating interventions: a case study. Res. Synth. Method, 3: 1–10.Slide29
References - 2
Popay
J, Roberts H,
Sowden
A, Pettticrew M, Arai L, Rodgers M, Britten N: Guidance on the conduct of narrative synthesis in systematic reviews. http://www.lancs.ac.uk/fass/projects/nssr/2007 .Pope C, Mays N,
Popay J: Synthesizing Qualitative and Quantitative Health Evidence: a Guide to Methods. Maidenhead: Open University Press; 2007. Ring N., Ritchie K, Mandava L, Jepson R. (2011) A guide to synthesising qualitative research for researchers undertaking health technology assessment and systematic reviews. NHS Quality Improvement Scotland and University of Stirling, Edinburgh. Thomas J, Harden A (2009) Methods for the thematic synthesis of qualitative research in systematic reviews, BMC Medical Research Methodology 8:45