Can Qualitative Metasynthesis
Make a Contribution to EvidenceBased Practice?:
Issues and Challenges in an Era of
Research Integration
Panel Presentation for:
Sally Thorne, RN, PhD
University of British Columbia
“Advances in Qualitative Methods”
AcademyHealth
Seattle
June 26/2006
Why Qualitative Metasynthesis?

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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,
that are themselves
interpretive syntheses of data.
events, or cases)
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)
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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)
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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

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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
Closest
to data
No
finding
Not
research
Farthest
from data
Topical
survey
Not qualitative
research
Borderline studies
Thematic
survey
Conceptual/
thematic
description
Interpretive
explanation
Exploratory
Descriptive
Explanatory
Qualitative Research
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
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Historical critical analysis of
a field, including diversities,
patterns and
methodological
imperfections
Complexity of the final
synthesis
Qualitative Research Integration

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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 metasummary
Qual metasynthesis
Meta-theory, -method
Citation analysis
Discourse analysis
Product examples
Evidence synthesis
Critique
Research hypotheses Intellectual 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
Critical Caveats continued
4. Choices & judgments
5. Methodological groundings
6. Homogenizing variation
7. Reproducing bias
8. Objectifying meaning
Health service/policy research
implications: CDM Example
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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?
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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
in the
qualitative findings
simplicity,
presentation of
For Further Reference:
Paterson, B., Thorne, S.. Canam, C. & Jillings, C. (2001). Metastudy 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.