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

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 findings Locating them Classifying findings Extracting them

Working across typologies of findings Not research Not qualitative Exploratory Descriptive Explanatory Qualitative Research Farthest from data Closest to data Borderline studies No finding Topical survey Thematic survey Conceptual/ thematic description Interpretive explanation 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 “remapping the cognitive status” of a changing field of study by considering its theoretical, methodological, and epistemological bases within a historical and sociocultural context. (Zhao, 1991, p. 381)  

Components of Meta-study Meta-Data-Analysis: “analysis of analyses” or an analysis of the data analyses available in reports about primary qualitative research studies   Meta-Method: study of the rigor, epistemological soundness, and fruitfulness of the research methods used in the research studies Meta-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 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 metasummary Qual metasynthesis Meta-theory, -method Citation analysis Discourse analysis Product examples Evidence synthesis Research hypotheses Critique Intellectual history

Critical Caveats in Qualitative MetaSynthesis Or…the importance of humility in making claims Experience thrice-removed The problem of representation Discursive readings as correctives to empirical claims

Critical Caveats continued Choices & judgments Methodological groundings Homogenizing variation Reproducing bias Objectifying meaning

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.