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Library of Congress Cataloging-in-Publication Data

Synthesizing qualitative research : choosing the right approach / edited by Karin Hannes, Craig Lockwood.

p.; cm.

Includes bibliographical references and index.

ISBN 978-0-470-65638-9 (pbk.)

1. Qualitative research. 2. Medicine–Research–Methodology. 3. Biology–Research–Methodology.

I. Hannes, Karin. II. Lockwood, Craig, 1971-

[DNLM: 1. Qualitative Research. 2. Biomedical Research–methods. 3. Meta-Analysis as Topic. W 20.5]

R853.Q34S96 2011

610.72′1–dc23

2011022676

This book is published in the following electronic formats: ePDF 9781119959816; Wiley Online Library 9781119959847;

ePub 9781119959823

This book is dedicated to the future of synthesis science; a disparate field with rich potential for further methodological development. We trust that this book makes both a useful, practical contribution to what is known here and now and enables the next generation of students, academics, theorists, and researchers to draw upon some of today's best synthesis scientists for tomorrow's methodology.

List of contributors

Nicky Britten, PhD
Professor of Applied Health Care Research
Peninsula Medical School
University of Exeter
Exeter, Devon, UK

Fiona Campbell
Research Associate
School of Health and Related Research
University of Sheffield
Sheffield, UK

Jamie L. Crandell, PhD
Research Assistant Professor
University of North Carolina at Chapel Hill, NC
USA

Kate Flemming, PhD RN
Research Fellow
Department of Health Sciences
The University of York
York, UK

Karin Hannes, PhD
Doctor-Assistant
Centre for Methodology of Educational Research
Faculty of Psychology and Education, K.U. Leuven
Belgium

Centre for Evidence-Based Medicine
Belgian Branch of the Cochrane Collaboration
Belgium

Angela Harden, PhD
Professor of Community and Family Health
Institute for Health and Human Development
School of Health and Biosciences
University of East London
London, UK

Josephine Kavanagh, BA, MA
Research Officer
EPPI-Centre
Social Science Research Unit
Institute of Education
University of London
London, UK

Nathan Manning, PhD
Systematic Reviewer
Kleijnen Systematic Reviews and Adjunct Research Fellow
The Joanna Briggs Institute
The University of Adelaide
Australia

Elizabeth McInnes, PhD
Deputy Director
Nursing Research Institute – Australian Catholic University and St Vincents and Mater Health Sydney
National Centre for Clinical Outcomes Research (NaCCOR)
St Vincent's Hospital
Darlinghurst, NSW
Australia

Barbara L. Paterson, PhD RN
Professor & Dean
Thompson Rivers University
School of Nursing
Kamloops BC
Canada

Alan Pearson, AM
Executive Director
The Joanna Briggs Institute
Faculty of Health Sciences
The University of Adelaide
Australia

Catherine Pope, PhD
Professor of Medical Sociology
University of Southampton
Southampton, UK

Margarete Sandelowski, PhD RN
Cary C. Boshamer Distinguished Professor
University of North Carolina at Chapel Hill
Chapel Hill, NC
USA

James Thomas, PhD
Reader in Social Policy
EPPI-Centre
Social Science Research Unit
Institute of Education
University of London
London, UK

Corrine I. Voils, PhD
Associate Professor of Medicine
Durham Veterans Affairs Medical Center and Duke University Medical Center
Durham, NC
USA

Geoff Wong, MD(Res)
Senior Lecturer in Primary Health Care and GP Principal
Healthcare Innovation and Policy Unit
Centre for Health Sciences
Blizard Institute
Barts and The London School of Medicine and Dentistry
London, UK

Preface

The growth in qualitative evidence synthesis methods, and the increasing number of reviews that are published using these methods, is a clear indicator that what was once a field for the “interested few” is becoming mainstream practice. There are now large numbers of published qualitative synthesis papers, as well as a growing body of academic and theoretical work to further inform the conduct of qualitative reviews, and to further stimulate methodological development. It is within the last few years that the majority of methodological development has occurred, and within this timeframe, good theorists have enhanced and refined their methods, as is evident in the quality of published qualitative synthesis reports seen in mainstream journals to date. The majority of methodological guidance though is buried in websites or published in specialized journals. The few books available tend to have a limited focus on a particular methodology, or are theoretical rather than practical. Methodology papers in journals serve to flag issues or ideas, but limitations prevent the level of depth and explanation possible in a book. The word limit of journal articles prevents many authors from comprehensively describing their full methods, and providing appropriate illustration or exemplars is also problematic in most journals.

Writing about synthesis methods included the process of choosing between different approaches, selecting what would be appropriate for this particular book and what would be put into the drawer until a new opportunity for writing arose. Although first intended as a compendium of all qualitative evidence synthesis methods, we decided to focus this book on six commonly used methodologies for qualitative evidence synthesis. We opted to portray those synthesis approaches that have particularly been developed by and for researchers involved in systematically reviewing literature. Our choice has been influenced by previously published overviews of approaches from colleague methodologists, personal knowledge, and connections and the conversations that occur in our respective fields internationally. We have focused on methods that have been developed with the aim of synthesizing primary studies, providing the reader with a detailed stepwise description on how to move from original research texts to a review of qualitative literature. We believe that these approaches will generate interest from the international community of researchers, practitioners and policymakers currently involved in qualitative evidence synthesis.

The book is meant to be a guide to reviewers and users from any discipline, although most of the worked examples are situated in the field of healthcare. It is not a penultimate book of methods for qualitative synthesis, neither will everyone agree with our particular selection and how we have categorized them. Approaches that have been used in practice but are not covered in our book include narrative summary, thematic analysis, grounded theory, meta-study, cross-case techniques, content analysis, case survey, and qualitative comparative analysis methods. Some of these methods have drawn upon the principles of basic research designs. These adapted versions of basic research methods for the purpose of synthesis are promising, but currently lack the transparency important to a community of researchers involved in systematic reviewing. They offer little guidance on particular aspects such as search strategies, critical appraisal, and sampling of primary studies, neither do they discuss why these should or should not be done. Furthermore, they lack clarity of the particular features of the synthesis approach as compared to other synthesis methods and have not yet formally been subject to an evaluation of their appropriateness in the context of systematically reviewing literature.

The methods included here are some of the better developed and used approaches available at this point in time; yet no single text has brought them together before, nor provided the diverse and high quality example syntheses that the authors, and in some chapters, originators of the methodology have conducted. Some of the synthesis methods presented are meant to build theory and deepen understanding, while others have been created to develop lines of action for policy and practice or to provide the current state of the art on a particular topic. We feel it is most important that those engaging in a qualitative or mixed method evidence synthesis have a clear understanding of what particular approaches intend to do and which method best fits a researcher's goal and epistemological position.

Most researchers publishing qualitative or mixed-method syntheses do not successfully answer the question of why, among other approaches, they have opted for a particular method. Generally authors state that their choice was influenced by what fits their particular school of thought or by what others have successfully used in the past. The latter is particularly the case for meta-ethnography, currently a very commonly used approach and one of the few that has published methodological guidance. This is a substantive limitation though which offers future reviewers limited opportunities to critique or gain insights from such decision-making processes. This book not only offers to guide readers and potential users in how to apply a particular approach, it also guides general readers through the considerations as to why they should opt to choose a certain approach for their research project. Through the presentation of worked examples of different approaches, it brings more balance and a more insightful perspective to the options available to researchers. The book does not simply resort to technical reporting of method, but rather focuses on illustrating the challenges users of an approach are likely to come across. These challenges are often hidden or only partly addressed in published articles, where the main interest is to present the content of the work rather than the methodology.

In summary, we believe this book provides a detailed and integrated resource for readers who would otherwise have to piece together methodology from a disparate range of journal articles and other resources. We do not see this book as an end point, since much remains to be learned and written within the field of qualitative and mixed-method synthesis. Instead, we hope to stimulate further pragmatic, intellectual, and methodological curiosity in the richly rewarding field of qualitative evidence synthesis.

Karin Hannes
Craig Lockwood

Acknowledgements

We would not do justice to the hard work of the contributing authors on each of their worked examples, if we were not to put them first on our list of people to acknowledge. For some of them the production of their chapters coincided with serious life events, including very positive experiences but also more challenging issues, on a personal or a professional level. Therefore, a special thank you for the commitment and dedication that finally led us to the publication of this book is appropriate. We sincerely thank all academics that have assisted us in completing the initial peer review of the included chapters; Wim Van den Noortgate, Patrick Onghena and Mieke Heyvaert from the Centre for Methodology of Educational Research at K.U. Leuven, and Nathan Manning, former employee of the Joanna Briggs Institute. We also thank the staff members from both our hosting institutes for enthusiastically following up on the progress of the book. In addition, conversations and debates on approaches to qualitative evidence synthesis with methodological experts worldwide and colleague researchers from other research institutes have inspired us to embark on this particular journey, not least the Cochrane Qualitative Research Methods Group, whose convenors have been a wonderful forum for discussion and truly enriched our understanding of evidence synthesis.

We are most grateful for permission given to reproduce extracts from the following:

Figure 2.1 Reproduced with permission from the Joanna Briggs Institute, Reviewers' Manual, 2008.

Figures 2.3 to 2.6 Reproduced from Hannes K, Goedhuys J & Aertgeerts B. Obstacles to implementing Evidence-Based Practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines. Acta Clinica Belgica (in press), with permission from Acta Clinica Belgica.

Figures 3.1 and 3.2 Reproduced from Pound et al. Resisting Medicines: a synthesis of qualitative studies of medicine taking. Social Science & Medicine 2005; 61(1): 133–155, 2005, with permission from Elsevier.

Figure 4.1 and Tables 4.2, 4.4 and 4.5 Reproduced from Flemming K. ‘Synthesis of quantitative and qualitative research: an example using Critical Interpretive Synthesis’, Journal of Advanced Nursing 2010; 66(1):201–217, 2010, with permission from John Wiley & Sons Ltd.

Table 4.3 Reproduced from Flemming K. ‘Synthesis of quantitative and qualitative research: an example using Critical Interpretive Synthesis’, Journal of Advanced Nursing 2010; 66(1):201–217, 2010, (using data from Hawker et al 2002), with permission from John Wiley & Sons Ltd.

Figure 6.1 Reproduced from Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, Oakley A, Applying systematic review methods to studies of people’s views: an example from public health, Journal of Epidemiology and Community Health 58: 794–800, 2004, with permission from BMJ Publishing Group Ltd.

Figure 6.2 Reproduced from Campbell F, Johnson M, Messina J, et al. Behavioural interventions for weight management in pregnancy: A systematic review of quantitative and qualitative data. BMC Public Health 2011, 11:491 doi:10.1186/1471–2458–11–491

Table 7.1 and Figure 7.1 Adapted from Voils et al. 2009 with permission from the Royal Society of Medicine Press, London.