can qualitative metasynthesis make a contribution to evidence- based practice?: issues and...
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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
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
Transforming Findings into Evidence?
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.
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)
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
Inherent Complexity of the Challenge
Multiple methods
Multiple disciplines
Multiple epistemologies
Challenges Across Metasynthesis Approaches
Finding reports of qualitative studies
Appraising qualitative research reports
Finding the findings in research reports
Integrating findings
Finding the findings
Defining findingsfindings Locating them Classifying findings Extracting them
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
Integrating qualitative findings
Preserving the case imperatives of qualitative research
Preventing paralytic immersion in data Accounting for varying sample sizes Differentiating idiographic & nomothetic
generalization
Methodological Variations:Possible approaches to qualitative metasynthesis
Qualitative meta-study
Qualitative research
integration
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”
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
Meta-Study Products
Historical critical analysis of a field, including diversities, patterns and methodological imperfections
Complexity of the final synthesis
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
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
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
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
4. Choices & judgments
5. Methodological groundings
6. Homogenizing variation
7. Reproducing bias
8. Objectifying meaning
Critical Caveats continued
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
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
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
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.