Qualitative synthesis and systematic review in health professions education

Context  Formal qualitative synthesis is the process of pooling qualitative and mixed-method research data, and then drawing conclusions regarding the collective meaning of the research. Qualitative synthesis is regularly used within systematic reviews in the health professions literature, although such use has been heavily debated in the general literature. This controversy arises in part from the inherent tensions found when generalisations are derived from in-depth studies that are heavily context-dependent.Methods  We explore three representative qualitative synthesis methodologies: thematic analysis; meta-ethnography, and realist synthesis. These can be understood across two dimensions: integrative to interpretative, and idealist to realist. Three examples are used to illustrate the relative strengths and limitations of these approaches.Discussion  Against a backdrop of controversy and diverse methodologies, readers must take a critical stand when reading literature reviews that use qualitative synthesis to derive their findings. We argue that notions of qualitative rigour such as transparency and acknowledgment of the researchers’ stance should be applied to qualitative synthesis.

On the effectiveness of supplemental instruction: a systematic review of supplemental instruction and peer-assisted study sessions literature between 2001 and 2010

Supplemental instruction (SI)—variously known as peer-assisted learning, peer-assisted study sessions, and other names—is a type of academic support intervention popular in higher education. In SI sessions, a senior student facilitates peer learning between undergraduates studying a high-risk course. This article presents a systematic review of the literature between 2001 and 2010 regarding the effectiveness of SI. Twenty-nine studies met the inclusion criteria. Due to methodological heterogeneity and lack of consistency defining the SI treatment, qualitative synthesis methods were applied. For seven included studies, however, an effect size of SI participation on final grades was calculated, ranging from d = 0.29 to d = 0.60. The findings of the review are consistent with claims validated by the U.S. Department of Education in the 1990s that participation in SI is correlated with higher mean grades, lower failure and withdrawal rates, and higher retention and graduation rates.

The effectiveness of mobile-health behaviour change interventions for cardiovascular disease self-management: a systematic review

BACKGROUND: Mobile wireless devices (mHealth) have been used to deliver cardiovascular disease self-management interventions to educate and support patients in making healthy lifestyle changes. This systematic review aimed to determine the effectiveness of mHealth interventions on behavioural lifestyle changes and medication adherence for cardiovascular disease self-management. METHODS: A comprehensive literature search was conducted from inception through to 3 March 2015 using MEDLINE, PubMed, PsycINFO, EMBASE and The Cochrane Library. Eligible studies used an experimental trial design to determine the effectiveness of an mHealth intervention to change lifestyle behaviours in any cardiovascular disease population. Data extracted included intervention and comparison group characteristics with a specific focus on the use of behaviour change techniques. RESULTS: Seven studies met our inclusion criteria and were included in the qualitative synthesis. All interventions were delivered in part by mobile phone text messaging. Three studies were effective at improving adherence to medication and two studies increased physical activity behaviour. No effects were observed on dietary behaviour or smoking cessation, measured in one study each. Simple text messaging interventions appeared to be most effective; however, no clear relationships were found between study findings and intervention dose, duration or behaviour change techniques targeted. CONCLUSIONS: Our review found mHealth has the potential to change lifestyle behaviour. Results are still limited to a small number of trials, inconsistent outcome measures and ineffective reporting of intervention characteristics. Large scale, longitudinal studies are now warranted to gain a clear understanding of the effects of mHealth on behaviour change in the cardiovascular disease population.

Purposeful sampling in qualitative research synthesis

Informed decisions about sampling are critical to improving the quality of research synthesis. Even though several qualitative research synthesists have recommended purposeful sampling for synthesizing qualitative research, the published literature holds sparse discussion on how different strategies for purposeful sampling may be applied to a research synthesis. In primary research, Patton is frequently cited as an authority on the topic of purposeful sampling. In Patton’s original texts that are referred to in this article, Patton does not make any suggestion of using purposeful sampling for research synthesis. This article makes a unique contribution to the literature by examining the adaptability of each of Patton’s 16 purposeful sampling strategies to the process of qualitative research synthesis. It illuminates how different purposeful sampling strategies might be particularly suited to constructing multi-perspectival, emancipatory, participatory and deconstructive interpretations of published research.

Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: protocol of a systematic review and meta-synthesis of qualitative studies.

INTRODUCTION: Low back pain is the highest ranked condition contributing to years lived with disability, and is a significant economic and societal burden. Evidence-based clinical practice guidelines are designed to improve quality of care and reduce practice variation by providing graded recommendations based on the best available evidence. Studies of low back pain guideline implementation have shown no or modest effects at changing clinical practice. OBJECTIVES: To identify enablers and barriers to adherence to clinical practice guidelines for the management of low back pain. METHODS AND ANALYSIS: A systematic review and meta-synthesis of qualitative studies that will be conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines. Eight databases will be searched using a priori inclusion/exclusion criteria. Two independent reviewers will conduct a structured review and meta-synthesis, and a third reviewer will arbitrate where there is disagreement. This protocol has been registered on PROSPERO 2014. ETHICS AND DISSEMINATION: Ethical approval is not required. The systematic review will be published in a peer-reviewed journal. The review will also be disseminated electronically, in print and at conferences. Updates of the review will be conducted to inform and guide healthcare translation into practice. TRIAL REGISTRATION NUMBER: PROSPERO 2014:CRD42014012961. Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014012961.

Barriers to primary care clinician adherence to clinical guidelines for the management of low back pain: a systematic review and meta-synthesis of qualitative studies

INTRODUCTION: Despite the availability of evidence-based guidelines for the management of low back pain that contain consistent messages, large evidence-practice gaps in primary care remain.

OBJECTIVES: To perform a systematic review and meta-synthesis of qualitative studies that have explored primary care clinicians' perceptions and beliefs about guidelines for low back pain, including perceived enablers and barriers to guideline adherence.

METHODS: Studies investigatingperceptions and beliefs about low back pain guidelines were included if participants were primary care clinicians and qualitative methods had been used for both data collection and analysis. We searched major databases up to July 2014. Pairs of reviewers independently screened titles and abstracts, extracted data, appraised method quality using the CASP checklist, conducted thematic analysis and synthesized the results in narrative format.

RESULTS: Seventeen studies, with a total of 705 participants, were included. We identified three key emergent themes and eight subthemes: (1) guideline implementation and adherence beliefs and perceptions; (2) maintaining the patient-clinician relationship with imaging referrals; (3) barriers to guideline implementation. Clinicians believed that guidelines were categorical, prescriptive and constrained professional practice; however popular clinical practices superseded the guidelines. Imaging referrals were used to manage consultations and to obtain definitive diagnoses. Clinicians' perceptions reflected a lack of content knowledge and understanding of how guidelines are developed.

DISCUSSION: Addressing misconceptions and other barriers to uptake of evidence-based guidelines for managing low back pain is needed to improve knowledge transfer and close the evidence-practice gap in the treatment of this common condition.

Self-practice and self-reflection in training of psychological interventions and therapist skills development: A qualitative meta-synthesis review

© 2015 Australian Psychological Society. Objective: The use of self-practice and self-reflection has been proposed as an efficacious strategy in the training of therapists. It has been argued to enhance therapist skills, and a key factor in the development of expertise. This systematic literature review investigated the effect of self-practice and self-reflection on therapist skills development. Method: Studies were identified through Medline, Academic Search Complete, PsychINFO, PsycARTICLES, Proquest, ISI, CINAHL, Cochrane, and Scopus databases. Additional studies were identified through lateral searches of relevant papers' reference lists and direct correspondence with authors of unpublished material. The selection criteria were studies that investigated the effect of self-practice and/or self-reflection on therapist skill development. There was no restriction on sample sizes, design of studies, dates of publication, or peer-reviewed papers. All studies were published in English. Results: Ten studies were included in this review. A thematic analysis was undertaken to analyse qualitative data. Due to inconsistency in the variables investigated across the quantitative studies, quantitative results were not subject to a meta-analysis but simply reported. Finally, qualitative and quantitative data were juxtaposed in a meta-synthesis. Conclusion: The meta-synthesis revealed inconsistencies between the qualitative and quantitative literature and a gap in relation to declarative knowledge. Methodological limitations across studies are discussed and recommendations for future research provided.

How new graduate nurses experience patient death : a systematic review and qualitative meta-synthesis

Background

Patient death is an emotional and demanding experience for nurses, especially for new graduate nurses who are unprepared to deliver end-of-life care. Understanding new graduate nurses’ experience of death and dying will inform the design of training programs and interventions for improvements in the quality of care and support of new graduates.

Objective

To summarize new graduate nurses’ experience with patient death by examining the findings of existing qualitative studies.

Design

Systematic review methods incorporating meta-synthesis were used.

Methods

A comprehensive search was conducted in 12 databases from January 1990 to December 2014. All qualitative and mixed-method studies in English and Chinese that explored new graduate nurses’ experience of patient death were included. Two independent reviewers selected the studies for inclusion and assessed each study quality. Meta-aggregation was performed to synthesize the findings of the included studies.

Results

Five primary qualitative studies and one mix-method study met inclusion and quality criteria. Six key themes were identified from the original findings: emotional experiences, facilitating a good death, support for family, inadequacy on end-of-life care issues, personal and professional growth and coping strategies. New graduate nurses expressed a variety of feelings when faced with patient death, but still they tried to facilitate a good death for dying patients and provide support for their families. The nurses benefited from this challenging encounter though they lacked of coping strategies.

Using meta-synthesis to support application of qualitative methods findings in practice: a discussion of meta-ethnography, narrative synthesis, and critical interpretive synthesis

Meta-synthesis refers to a range of approaches by which existing qualitative studies in healthcare can bereviewed and compared. There is increasing use of meta-synthesis to ensure the clinical applicability offindings from qualitative studies, in healthcare generally, and in the creative arts therapies specifically.Qualitative method research can sometimes lack immediate clinical relevance, as such studies usuallyfocus on the experiences of a small number of participants. Additionally, the results are often presented ingreat detail; finely elaborated, and described conceptually. Findings reported in this way can be engaging,and even emotionally compelling, however the utility of these outcomes for clinical practice can belimited. Meta-synthesis of multiple studies aims to ensure that findings from qualitative methods studiescan be more easily, and effectively, applied in health and social care programs. Three approaches to metasynthesisare briefly presented here; meta-ethnography, narrative synthesis, and critical interpretivesynthesis. A procedure for presentation of meta-synthesis reviews is provided.

Using meta-synthesis to facilitate evidence-based practice

In a previous column, Fineout-Overholt et al. (2008) discussed the use of systematic reviews in decision making for clinical practice, focusing primarily on the quantitative studies, such as randomised controlled trials. Narrative reviews were included but in less detail; this was intentional because the synthesis of qualitative evidence is a complex process and has evoked significant discussion over the past 5 years. Consequently, this column addresses some of the process issues surrounding qualitative evidence synthesis, or meta-synthesis as it is more commonly known, and offers ideas for how evidence arising from these can be used to inform education, teaching, and practice.

Meta-analysis and research synthesis in education

This bibliography begins with this introduction followed by a general overview of meta-analysis and research synthesis methods in education. The third section cites references to illustrate how the concept of statistical integration of research findings dates back to early 20th century. Citations in the fourth section highlight early calls from educational researchers to recognize the process of synthesizing research as a scholarly endeavor in its own right. As evident from the citations in the fifth section, it was in the 1980s when monographs exclusively devoted to research synthesis methods started to be published. Since then, a number of books have been published on research synthesis methods. The sixth section cites some of the most comprehensive books on research synthesis methods and includes contributions from key players of meta-analysis current at the time. The citations in the seventh section illustrate how meta-analysis has become very popular over time. Several large organizations have been set up and software developed to support systematic reviews of research. These are cited in the eighth section. Citations in the ninth section illustrate critiques of systematic reviews. As qualitative research is becoming popular in education, sophisticated discussions of issues associated with synthesizing qualitative research have also been published, some of which are cited in the tenth section. The eleventh section presents a methodologically inclusive account of current developments in research synthesis methods. The final section cites examples of journals exclusively devoted to publishing research reviews and exemplary research synthesis with different methodologies. Individual methods of research synthesis are discussed chronologically as they became popular in educational research. Accordingly, this bibliography starts with a discussion of statistical methods of integrating research that parallels the dominance of quantitative research in education until the 1970s. As the popularity and diversity of qualitative research methods have been increasing in educational research, more methodologically inclusive discussions of research synthesis methods are becoming popular as described in the later sections of this bibliography.

Advancements in research synthesis methods: From a methodologically inclusive perspective

The dominant literature on research synthesis methods has positivist and neo-positivist origins. In recent years, the landscape of research synthesis methods has changed rapidly to become inclusive. This article highlights methodologically inclusive advancements in research synthesis methods. Attention is drawn to insights from interpretive, critical, and participatory traditions for enhancing trustworthiness, utility, and/or emancipatory potential for research syntheses. Also noted is a paucity of the literature that builds connections between methodologically diverse segments of the literature on research synthesis methods. Salient features of a methodologically inclusive research synthesis (MIRS) framework are described. The MIRS framework has been conceptualized by distilling and synthesizing ideas, theories, and strategies from the extensive literatures on research synthesis methods and primary research methods. Rather than prescribe how a research synthesis should be conducted or evaluated, this article attempts to open spaces, raise questions, explore possibilities, and contest taken-for-granted practices.

Epistemological pluralism in research synthesis methods

The purpose of research synthesis is to produce new knowledge by making explicit connections and tensions between individual study reports that were not visible before. Every effort of synthesizing research is inevitably premised on certain epistemological assumptions. It is crucial that research synthesists reflect critically on how their epistemological positioning enables them to pursue certain purposes while preventing them from pursuing other purposes. The literature on research synthesis methods is dominated by publications premised on positivist assumptions. The rhetoric of systematic reviews, best-evidence synthesis and What Works Clearinghouse privileges syntheses with positivist orientations. Contesting the hegemony of positivist research syntheses, this paper makes a case for research syntheses that are informed by diverse epistemological orientations. It illuminates how research syntheses with distinct epistemological orientations can serve complementary, equally worthwhile, purposes.

User experience and care integration in transitional care for older people from hospital to home: a meta-synthesis

This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence.