Synthesising qualitative findingsAn interpretive perspective
Janet Harris K U Leuven QES Workshop 4 – 6 June 2012
Acknowledgements
These power points build on the materials presented by Angela Harden in the systematic review workshop at K U Leuven, 6th to 8th May 2011
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)
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)
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 beliefs
Scientific realism: it is possible for knowledge to approximate closely an external reality
Spencer et al, 2003
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 realism
Critical realism
Critical realism
Scientific 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 power
Type of question Extent of iteration
Quality assessment Going beyond primary studies Problematizing the literature
The synthetic product
Idealist Realist
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)
Approaches to qualitative evidence synthesis
Noyes & Lewin, 2010 http://cqrmg.cochrane.org/supplemental-handbook-guidance
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 realism
Critical realism
Critical realism
Scientific realism
Iteration throughout
Iteration at searching
Iteration at synthesis
Iteration at synthesis
Iteration at synthesis
Iteration not mentioned
Iteration at searching
Iteration not mentioned
Idealist Realist
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 realism
Critical realism
Critical realism
Scientific 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 assessment
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 realism
Critical realism
Critical realism
Scientific 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 literature
Synthesis typologies
Integrative and interpretive
(e.g. Dixon-Woods et al. 2004; Noblit and Hare, 1988)
Aggregation and configuration
(e.g. Sandelowski, forthcoming)
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 findingConcentration of findings in any one
studyThe frequency with which each of the 93
abstracted findings occurred*Sandelowski M, Barroso J (2003) Creating metasummaries of
qualitative findings Nursing Research 52: 226-233
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: 226-233
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):209-215
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.
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 1st and 2nd order concepts.
Translating studies into one another
Meta-ethnographic synthesisAdapted from Britten et al., 2002
CONCEPTS described in primary studies
Second order interpretations
Third order interpretations
Adherence/compliance:correct and routine medicine takingSelf regulation: problematic adherence; leaving off drugsAversion: eg dislike of taking drugs; harmful side effectsAlternative coping strategies:eg Traditional remedies, self-help
a)Patients conduct cost-benefit analyses: weigh up risks vs benefitsb) Medicine taking influenced by cultural meanings and resources
c)Self regulation includes the use of alternative coping strategies
Sanctions: Drs talk severely about need to take tablets regularly; coercion from significant others, fear of coercion
d) Self regulation is… inhibited by… the threat of social and professional sanctions
e) Self regulation flourishes if sanctions are not severe
Selective disclosure: patients don’t tell Dr of altered doses; manage info to psychiatrists
f) Patients may not articulate views which they do not perceive as medically legitimated
g) Alternative coping strategies are not seen by patients as medically legitimateh) Fear of sanctions and guilt produce selective disclosure
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-building
Grounded theory synthesis steps
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.
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?