ESRC Methods Festival 2008 Session 55 : Interpretive Synthesis Meta Ethnography Catherine Pope 3 July 2008

2 Meta-ethnography : synthesizing qualitative studies George W. Noblit & R Dwight Hare Qualitative Research Methods Series Sage, 1988

3 Definition of synthesis Activity or 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 characterization of the parts as a means of creating the whole Strike & Posner (1983) in Noblit & Hare (1988)

4 Features of meta ethnography Comparative and systematic synthesis of published research Interpretive rather than aggregative Translation of qualitative studies into one another

5 Synthesis: how studies are related Directly comparable as ‘reciprocal’ translations Studies taken together represent a ‘line of argument’ (rarely) in opposition to each other as ‘refutational’

6 7 Stages in meta ethnography Getting started : formulating the research ‘interest’ Deciding what is relevant (mapping, searching, selection) Repeated reading of studies Decide how studies are related Translation (analogous to constant comparison) Synthesizing the translations (second order construct) Expression (writing/presentation)

7 Exercise: identifying concepts Syndicate reading (10 min) You have 1 of 2 papers - read the findings/discussion NOT the whole paper. Identify the key concepts (10 min) Working with your group, fill in the grid supplied. You may identify –first order concepts (every day understandings /respondents’ terms used in the paper) –second order concepts (authors’ labels for themes/ concepts authors’ develop in the paper) Feedback (10 min)

8 Reciprocal translation Similar to constant comparison look for overlap are some concepts better than others in terms of scope and use. sometimes we learn more from this process of translation than from the concepts alone. Aim for third order concepts/ theory/ our interpretation Chart/draw ‘mindmap’ of connections between concepts

9 Evaluating meta ethnography Rona Campbell 1, Nicky Britten 2, Pandora Pound 1, Myfanwy Morgan 4, Roisin Pill 5, Catherine Pope 3, Lucy Yardley 6, Gavin Daker-White 1, Jenny Donovan 1 1 Department of Social Medicine, University of Bristol, 2 Peninsula Medical School, Universities of Exeter, and Plymouth 3 School of Nursing and Midwifery, University of Southampton, 4 Department of Public Health Sciences, King ’ s College, London 5 Department of General Practice, University of Wales College of Medicine, Cardiff. 6 Department of Psychology, University of Southampton Funded by MRC HSRC & NHS HTA

10 Medicines synthesis Papers whose primary focus is patients’ views of medicines prescribed and taken for the treatment of a long or short term condition (excluding medicines only taken for preventive purposes)

11 10 years: inclusive Electronic searches: 21 studies Medline, Embase, Cinahl, Web of Science, PsychInfo, Zetoc Handsearches: 21 studies Checking with team members, going through journals, checking references, library searches, reference manager, concordance website Total: 42 studies

12 Number of studies by condition

13 Translating studies into each other Britten 1996 ‘Unorthodox accounts’: People giving these accounts more likely to be critical of medication, described it as unnatural and damaging, be critical of doctors and generally active rather than passive Lumme-Sandt et al 2000 ‘Self-help repertoire’: People offering this type of account preferred natural remedies, had strong negative views about medication and did not obey doctors ‘Moral repertoire’: These people stressed they only took a little medication, used it responsibly and moderately, when explaining why they needed medication gave reasons beyond their control

14 Example of synthesising translations across illness groups ‘Rejecters/sceptics’ Dowell & Hudson (general medication) Reject medication due to their values, bypassing testing process. ‘Unorthodox Accounts’ Britten (general medication) ‘Self-help repertoire’ Lumme- Sandt et al (general medication) ‘Purposeful non-adherence’ Johnson et al (hypertension) A conscious decision not to take drugs, possibly following testing ‘Active users’ Dowell & Hudson (general medication) Conscious decision to modify regimen, following testing and deliberation ‘Justifiers and Excusers’ (Siegel et al (HIV) Excuses offered by those who ‘admit behaviour wrong but deny responsibility’. Justifications offered by those who ‘take responsibility for behaviour yet deny it has negative consequences’.

15 Model of medicine taking Passive accepters – accept medicine without question Active accepters – accept medicine after evaluating it Take medicines and follow prescription Medicine prescribed Worries and concerns about medicine Some concerns can be dealt with through process of evaluation Take medicines but not as prescribed Active modifiers – modify regimen after evaluating it Rejecters – reject regimen completely Some concerns cannot be resolved through evaluation and may affect medicine taking Issues to do with identity may affect medicine taking These groups show resistance

16 Reconceptualising findings Resistance The strategies people adopted to manage their medicine taking indicate varying degrees of resistance to the prescriptions they were given. The literature on “non compliance” only exists because people have resisted taking medicines despite sustained advice.