1. Writing Up and Dissemination

2. Framework for systematic reviews of qualitative research (Garside, 2010) StageTypical activities Developing research questionAssemble team; Consult; Agree approach Scoping exerciseIdentify relevant research; Refine methods Identifying relevant literatureDevelop Inclusion/Exclusion criteria; Focused searches; Citation searches Initial assessment of study reportsPreliminary reading; Identify theories; Assess utility/relevance Analysis and synthesisReading & rereading study reports; Constant comparison; Assess validity Preliminary synthesisCategorising; tabulating; mindmaps; Explore relationships Full synthesisThematic analysis; translation of findings; Theory development; rival explanations DisseminationTarget audiences; Limitations of review ThroughoutMultiple viewpoints; Reflexivity; Audit trail; Ongoing consultation; revisit review purpose

3. What are we trying to achieve? Explicit description of Review Methods Transparent presentation of Data Trustworthiness of Authors’ Analysis and Conclusions Starting Point for Reader’s Own Observations

4. What is required? Conformity to Published Reporting Standards (e.g. PRISMA, [formerly QUOROM] and ENTREQ) Use of Good Practice in Presentation (e.g. STARLITE for literature searches) Imaginative and Thought-Provoking Data Display

5. The Dual Heritage Systematic Review Publishing Guidelines (e.g. PRISMA – formerly QUOROM) Primary Qualitative Research Reporting Traditions Qualitative Research Systematic Reviews QES

6. The Dual Heritage

7. Requirements for a Published QES Systematic Review requires: – Explicit methods – Transparency – Audit Trail Review Question Search strategies & sources Quality Assessment Method of Synthesis Strategies to reduce bias Primary Qualitative Research requires: “Believability” Findings Grounded in the Data Themes/Constructs Selective Findings Reflexivity

8. PRISMA Preferred Reporting Items for Systematic Reviews and Meta- Analyses. Minimum set of items for reporting systematic reviews and meta-analyses. Aim of PRISMA Statement: to help authors improve reporting of systematic reviews and meta-analyses. Focus on randomized trials, but PRISMA also basis for reporting systematic reviews of other types of research, particularly evaluations of interventions. May be useful for critical appraisal of published systematic reviews (not quality assessment instrument to gauge quality of a systematic review).

9. PRISMA Statement 27-item checklist and four-phase flow diagram. Evolving subject to periodic change as new evidence emerges. Update and expansion of now-out dated QUOROM Statement. Website (http://www.prisma-statement.org/) contains current definitive version of PRISMA Statement.http://www.prisma-statement.org/

12. ENTREQ Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) Provisional set of 21 items grouped into five main domains: introduction, methods and methodology, literature search and selection, appraisal, and synthesis of findings. Requires feedback from stakeholders for continued development and extension. Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012 Nov 27;12:181. doi: 10.1186/1471-2288-12-181.

14. COREQ, PRISMA etcetera

15. PRISMA – Explanation & Elaboration PRISMA Explanation and Elaboration document (http://www.plosmedicine.org/article/info:doi/10.13 71/journal.pmed.1000100 ) explains and illustrates principles underlying PRISMA Statement.http://www.plosmedicine.org/article/info:doi/10.13 71/journal.pmed.1000100 Used in conjunction with PRISMA Statement. Part of broader effort, to improve reporting of different types of health research, and in turn to improve quality of research used in healthcare decision-making – EQUATOR Network

16. Equator Network (http://www.equator- network.org/)http://www.equator- network.org/

18. What is STARLITE? STARLITE - proposal for a framework for reporting the literature searching in systematic reviews and health technology assessments An acronym – STAndards for Reporting LITErature searches But also a mnemonic…….

19. STARLITE S - Sampling Strategy T - Type of Studies A - Approaches R - Range of Years (Start Date-End Date) L - Limits I - Inclusion and Exclusions T - Terms Used E - Electronic Sources

20. Edwards A, Pang N, Shiu V, Chan C. The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliat Med. 2010 Dec;24(8):753-70.

21. Good Practice?

22. Four purposes for data presentation Formative – to aid conduct of review and insights from findings Summative – as an output from the review process Integrative – bringing together quantitative and qualitative elements (Covered in Previous Session) Audit – to increase confidence in robustness

26. Deriving descriptive themes

27. 1) Children don’t see it as their role to be interested in health. 2) Children do not see future health consequences as personally relevant or credible. 3) Fruit, vegetables and confectionary have very different meanings for children. 4) Children actively seek ways to exercise their own choices with regard to foods. 5) Children value eating as a social occasion. 6) Children recognise contradiction between what is promoted and what is provided. Children consider taste, not health, to be a key influence on their food choice Food labelled as healthy may lead children to reject them (‘I don’t like it so it must be healthy’) Buying healthy foods not seen as a legitimate use of their pocket money Thematic analysis

29. Kane et al 2007

30. Kylma 2005

31. Audit - Transparency ‘Given the involvement of the researcher in the research process, the question is not whether the data are biased, but to what extent has the researcher rendered transparent the processes by which data have been collected, analysed and presented’ (Popay et al, 1998, p. 348).

32. Overall Process

33. Copyright ©2004 BMJ Publishing Group Ltd. Thomas, J. et al. BMJ 2004;328:1010-1012 Fig 1 Stages of the review

35. Search Process

38. Inclusion and Exclusion

39. Synthesis

43. 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’.

44. 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

46. RAMESES Gough, D. (2013). Meta-narrative and realist reviews: guidance, rules, publication standards and quality appraisal. BMC medicine, 11(1), 22. Greenhalgh, T., Wong, G., Westhorp, G., & Pawson, R. (2011). Protocol-realist and meta-narrative evidence synthesis: evolving standards (RAMESES). BMC Medical Research Methodology, 11(1), 115. Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: realist syntheses. BMC medicine, 11(1), 21. Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013). RAMESES publication standards: meta- narrative reviews. BMC medicine,11(1), 20.

47. Watch This Space! France, E. F., Ring, N., Thomas, R., Noyes, J., Maxwell, M., & Jepson, R. (2014). A methodological systematic review of what's wrong with meta-ethnography reporting. BMC medical research methodology, 14(1), 119. NIHR HS&DR Project: 13/114/60 - Project title: Developing meta-ethnography reporting guidelines and standards for research (eMERGE). Chief investigator: Dr Emma France, University of Stirling [Research in progress] Discussion Ongoing about Standards for Reporting Qualitative Evidence Syntheses