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Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and...

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Can Qualitative Can Qualitative Metasynthesis Make a Metasynthesis Make a Contribution to Evidence- Contribution to Evidence- Based Practice?: Based Practice?: Issues and Challenges in an Era Issues and Challenges in an Era of Research Integration of Research Integration Sally Thorne, RN, PhD University of British Columbia Panel Presentation for: Panel Presentation for: Advances in Qualitative Advances in Qualitative Methods” Methods” AcademyHealth AcademyHealth Seattle Seattle June 26/2006 June 26/2006
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Page 1: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Can Qualitative Metasynthesis Can Qualitative Metasynthesis Make a Contribution to Evidence-Make a Contribution to Evidence-Based Practice?:Based Practice?:

Issues and Challenges in an Era of Issues and Challenges in an Era of Research IntegrationResearch Integration

  

Sally Thorne, RN, PhD

University of British Columbia

Panel Presentation for: Panel Presentation for:

““Advances in Qualitative Methods”  Advances in Qualitative Methods”   AcademyHealthAcademyHealth

Seattle Seattle June 26/2006June 26/2006

Page 2: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Why Qualitative Metasynthesis?

Proliferation of qualitative research in the health sciences and practice disciplines

New turn to evidence-based practice and systematic reviews of research

Inadequate methodologies for conducting systematic reviews of qualitative research

Under-utilization of qualitative findings in health service/policy

Page 3: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Transforming Findings into Evidence?

Page 4: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

General Definition

An interpretive integration of qualitative findings (i.e.., phenomenologies, ethnographies, grounded theories, and other integrated and coherent descriptions or explanations of phenomena,

events, or cases) that are themselves interpretive syntheses of data.

Accommodates all findings, crafting them into a novel interpretation using an inclusive logic.

Page 5: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Terminological Context

Social Sciences Meta-Ethnography (Noblit & Hare, 1988)

Meta-Theorizing (Ritzer, 1991)

Metatheory, Metamethod, Meta-data-analysis (Zhao, 1996)

Health Sciences Aggregating Qualitative Findings (Estabrooks, Field & Morse (1994) Qualitative Meta-Analysis (Schreiber, Crooks & Stern (1997) Meta-Study (Paterson, Thorne, Canam & Jillings, 2001) Qualitative Metasummary (Sandelowski & Barroso, 2003)

Page 6: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

What Metasynthesis is Not

Conventional narrative reviews of qualitative or quantitative research

Quantitative meta-analyses of qualitative research Secondary analyses & pooled case comparisons

of qualitative data Critical integrative literature review

Page 7: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Inherent Complexity of the Challenge

Multiple methods

Multiple disciplines

Multiple epistemologies

Page 8: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Challenges Across Metasynthesis Approaches

Finding reports of qualitative studies

Appraising qualitative research reports

Finding the findings in research reports

Integrating findings

Page 9: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Finding the findings

Defining findingsfindings Locating them Classifying findings Extracting them

Page 10: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

NotNotresearchresearch

Not qualitativeNot qualitativeresearchresearch

ExploratoryExploratory DescriptiveDescriptive ExplanatoryExplanatory

Qualitative ResearchQualitative Research

Farthestfrom data

ClosestClosestto datato data

Borderline studiesBorderline studies

No No findingfinding

Topical Topical surveysurvey

Thematic Thematic surveysurvey

Conceptual/ Conceptual/ thematicthematic

descriptiondescriptionInterpretiveInterpretiveexplanationexplanation

Working across typologies of findings

From: Sandelowski & Barroso (2003

Page 11: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Integrating qualitative findings

Preserving the case imperatives of qualitative research

Preventing paralytic immersion in data Accounting for varying sample sizes Differentiating idiographic & nomothetic

generalization

Page 12: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Methodological Variations:Possible approaches to qualitative metasynthesis

Qualitative meta-study

Qualitative research

integration

Page 13: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Meta-Study

of a changing field of study by considering its theoretical, methodological, and epistemological bases within a historical and sociocultural context. (Zhao, 1991, p. 381)

 

“remapping the cognitive status”

Page 14: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Components of Meta-study

Meta-Data-AnalysisMeta-Data-Analysis: “analysis of analyses” or an analysis of the data analyses available in reports about primary qualitative research studies

 Meta-MethodMeta-Method: study of the rigor, epistemological

soundness, and fruitfulness of the research methods used in the research studies

 Meta-TheoryMeta-Theory: uncovering underlying structures of extant

theory as the theoretical framework and/or emergent theory that is grounded in the research findings

Page 15: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Meta-Study Products

Historical critical analysis of a field, including diversities, patterns and methodological imperfections

Complexity of the final synthesis

Page 16: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Qualitative Research Integration

Empirical studies directed toward the combination of research findings in reports of qualitative studies.

Aimed at systematically & judiciously appraising reports of completed qualitative studies in a target research domain

Creating conclusions about knowledge (however provisional and fallible) in a specified field

Page 17: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Metasummary – a quantitatively oriented aggregation of qualitative findings that are topical or thematic summaries or surveys.

versus

Qualitative Metasynthesis - Interpretive syntheses of data in primary qualitative studies

Page 18: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Research integration vs. meta-study

Research Integration

Meta-study

Focus Study findings Study studies

Primary data Findings Various elements of of reports

Orientation to data Empirical; findings are indices of target events

Discursive; reports are socio-historical constructions

Method examples Qual metasummaryQual metasynthesis

Meta-theory, -methodCitation analysisDiscourse analysis

Product examples Evidence synthesisResearch hypotheses

CritiqueIntellectual history

Page 19: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Critical Caveats in Qualitative MetaSynthesis

Or…the importance of humility in making claims

1. Experience thrice-removed

2. The problem of representation

3. Discursive readings as

correctives to empirical claims

Page 20: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

4. Choices & judgments

5. Methodological groundings

6. Homogenizing variation

7. Reproducing bias

8. Objectifying meaning

Critical Caveats continued

Page 21: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Health service/policy research implications: CDM Example Assumptions underlying

acute/compliance model Role of insider experience

research in reshaping analysis

Single disease vs broad based CD analysis

Patterns & themes across disease experience contexts

Page 22: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Moving Forward? Finding appropriate balance

between descriptive and normative empirical knowledge forms (including social construction).

Creating language within the qualitative health research community to account for “probable truths” and pragmatic generalizations

Page 23: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

Slowing momentum toward meta-synthesis until we have a strong foundation of theoretically sound approaches

Strengthening quality criteria for qualitative health research, larger (more population based) studies

Nurturing a culture of complexity, not simplicity, in the presentation of qualitative findings

Page 24: Can Qualitative Metasynthesis Make a Contribution to Evidence- Based Practice?: Issues and Challenges in an Era of Research Integration Can Qualitative.

For Further Reference:

Paterson, B., Thorne, S.. Canam, C. & Jillings, C. (2001). Meta-study of Qualitative Research: A Practical Guide to Meta-analysis and Meta-Synthesis. Thousand Oaks, CA: Sage Publications.

Thorne, S., Jensen, L, Kearney, M.H., Noblit, G., & Sandelowski, M. (2004) Reflections on the methodological and ideological agenda in qualitative meta-synthesis. Qualitative Health Research, 14, 1342-1365.


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