Systematic Reviews
of
Qualitative Literature
Catherine Francis-Baldesari
UK Cochrane Centre
Oxford
Objectives
Discuss the purpose and characteristics of
meta-synthesis.
Become familiar with the concepts and
general processes to conduct a metasynthesis.
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What Meta-Synthesis is Not
Not a systematic literature review.
Not a collation or codifying of studies.
Not an aggregation or summing of outcomes.
Not a concept analysis.
Finfgeld, D.L. (2003). Metasynthesis: The state of the art- so far. Qualitative Health Research, 13
(7), 893-904
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Purpose
Meta-analysis – aggregating data to reach
statistical power for detection of cause and effect
between treatment and outcomes.
Meta-synthesis – integrating data to reach a
new theoretical or conceptual level of
understanding and development.
Thorne, S., Jensen, L., Kearney, M.H., Noblit, G., Sandelowski, M. (2004). Qualitative metasynthesis:
Reflections on methodological orientation and ideological agenda. Qualitative Health Research,
14 (10), 1342-1365.
,
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Concept of Integration
More than the sum of parts.
Inferences derived from findings as a
whole.
New higher-order interpretations
created.
Thorne, S., Jensen, L., Kearney, N.H., Noblit, G., Sandelowski, M. (2004). Qualitative metasynthesis:
Reflections on methodological orientation and ideological agenda. Qualitative Health Research, 14
(10), 1342-1365.
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Achieving Integration
Comprehensive consideration of data



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Inclusion vs. exclusion
Commonalities and differences
Sensitivity to patterns
Intuitive and logical
Theoretical reconstruction of concepts
Silverman, D. (2001). Interpreting Qualitative Data: Methods for Analysing Talk, Text and
Interaction (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.
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Characteristics of Process
Inductive and interpretive in design.
Deconstruction and examination of findings
from a sample of studies.
Mays, N., Pope, C., Popay, J. (2005). Details of approaches to synthesis: A methodological appendix to the
paper. Systematically reviewing qualitative and quantitative evidence to inform management and policy
making in the health field. http://www.chsrf.ca/funding_opportunities/commissioned_research/
projects/pdf/msynth_appendix_e.pdf - 115.5KB
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Translation of studies into one another.
Transformation of parts into whole.
Development of theory to explain the
range of findings encountered.
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How Do We Evaluate Outputs of
Qualitative Research?
Conceptual themes
Contributory
Defensible in design
Rigorous in conduct
Credible in claim
Spencer, L., Ritchie, J., Lewis, J., Dillon, L. (2003). Quality in Qualitative Evaluation: A framework
for assessing research evidence. Government Chief Social Researcher’s Office, Cabinet
Office, United Kingdom.
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Contributory…
In advancing wider
knowledge or
understanding about
policy, practice,
theory or a particular
substantive field.
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Defensible in design…
By providing a
research strategy that
can address the
evaluative questions
posed.
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Credible in claim…
Through offering wellfounded and plausible
arguments about the
Rigorous in conduct… significance of the
evidence generated.
Through the systematic
and transparent
collection, analysis and
interpretation of
qualitative data.
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Evaluating Qualitative Studies
Qualitative
Quantitative
Credibility
Confirmability
Transferability
Dependability
Internal validity
Objectivity
Generalisability
External validity
Malterud, K. 2001. Qualitative research: standards, challenges, and guidelines. The Lancet, 358, 483-488.
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Theory and Philosophy
"Application of nursing theory in practice
depends on nurses having knowledge of
the theoretical works as well as an
understanding of how philosophies,
models, and theories can relate to each
other.“
Van Sell, S.L. & Kalofissudis, I.A. (2002). The Evolving Essence of the Science of Nursing: Complexity
Integration Nursing Theory. E-Book retrieved on January 16, 2006 from
http://www.nursing.gr/Complexitytheory.pdf
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Philosophical Framework
Determines how reality is explained, the
source of knowledge, and the perspective
taken in research and practice.
Monti, E. J. & Tingen, M.S. (1999). Multiple Paradigms of Nursing Science [Nursing Theory for the 21st
Century]. Advances in Nursing Science, 21(4), 64-80.
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Theoretical Framework
Influences how research questions are
generated, studies are conducted, data
are analysed, findings are understood, and
results are used.
Alderson, P. (1998). Theories in health care and research: The importance of theories in health care.
BMJ, 317; 1007-1010.
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Conceptual Framework
Brings theory into practice by organizing
themes to form models, and operationalizing
findings of synthesis.
Enables experience, reflection and wisdom
as praxis, allowing practice to drive theory.
Warelow, P.J. (1997). A nursing journey through discursive practice. Journal of Advanced Nursing, 26,
1020-1027.
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Person-Centred Practice
with Older People
Hermeneutic philosophy guided
development of theoretical and
conceptual framework.
Theoretical framework of authentic
consciousness.
McCormack, B. (2003). Conceptual framework for person-centred practice with older people.
International Journal of Nursing Practice, 9(3); 202-209.
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Conceptual framework of person-centredness
addressed patient's and nurse's values within the
context of a care environment.
Integration of conversation analysis and reflective
conversation for data collection and analysis.
Findings suggest nurses need to perceive the
patient as an individual and articulate the mutual
understanding and expectations in the
relationship.
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Why Do Meta-Synthesis?
Theory building
Theory explication
Theoretical development
Schreiber, R., Crooks, D.,&Stern, P. N. (1997). Qualitative meta-analysis. In J. M. Morse (Ed.),
Completing a qualitative project (pp 311-326). Thousand Oaks, CA: Sage.
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Quantitative Viewpoint
Determine best practices.
Maximize outcomes with minimal
expenditures.
Achieve best outcomes in the
shortest amount of time at the
lowest cost possible.
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Concept of Compliance:
Newton (2004)
“At risk populations [for low rates of
breastfeeding] include poorly educated,
poverty-stricken, young African-American
women. Unfortunately, the understanding of
why these populations are noncompliant is
rudimentary.”
Newton, E.R. (2004). The Epidemiology of Breastfeeding. Clinical Obstetrics & Gynecology, 47(3):613-23.
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Qualitative Viewpoint
Strengthen the role of qualitative studies
in health sciences research.
Improve applicability of qualitative
research findings in clinical practice.
Build on a qualitative body of knowledge
to inform theory, practice, research, and
policy.
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Concept of Self-Regulation
Conrad (1985)
Re-frames the medically defined problem
of noncompliance.
Allows the modification of medication
practice for asserting some clinical control
over epilepsy.
Barbour, R.S. (2000). The role of qualitative research in broadening the `evidence base' for
clinical practice. Journal of Evaluation in Clinical Practice, 6 (2), 155±163.
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Theoretically generalizable understanding
of apparently illogical behaviour in a wide
range of clinical and non-clinical contexts.
Childhood immunizations, observance of
safer sex, and daily management of
asthma and diabetes.
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Steps in Meta-Synthesis
1. Getting started. Identification of
intellectual interest that qualitative
research might inform.
2. Deciding what is relevant to initial
interests and inclusion criteria for studies.
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3. Reading the studies. Not a one-time
event. As the synthesis develops, studies
are read and reread to check relevant
metaphors and interpretations.
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4. Determining how the studies are related.
Lists of key metaphors, phrases, ideas, or
concepts and their relationships from each
study and juxtaposed with those of other
studies.
This phase is complete when an initial
assumption about the relationship
between studies can be made.
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5. Translation. Treating accounts in studies
as analogies.
Translation maintains central metaphors
and concepts in each study related to
other metaphors or concepts in the same
study.
Compares them to relevant metaphors
and concepts from other studies in the
form of analogy.
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6. Synthesizing translations.
Translations compared to determine if
some metaphors and concepts
encompass those from other studies.
If so, another level of synthesis is possible:
analyzing competing interpretations and
translating them into each other.
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7. Expressing the synthesis.
Meta ethnography must be translated into
the language of intended audiences.
Clarity and transparency.
Concise and straightforward.
Noblit, G.W. & Hare, R.D. (1988). Meta-Ethnography: Synthesizing Qualitative
Studies. Newbury Park, CA: Sage Publications, Inc.
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Metasummary
Extraction of findings from all studies in
review.
Generation of comprehensive inventory of
findings across studies.
Findings reduced to parsimonious list.
Frequency effect sizes calculated.
Sandelowski, M. & Barroso, J. (2003). Creating Metasummaries of Qualitative Findings. Nursing
Research, 52(4), 226-233.
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Analysis
Content analysis from meta findings used
to identify patterns and themes common
across studies.
Constant comparison analysis clarifies
distinct, shared meanings.
Empirical results become foundation for
metasynthesis.
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Meta-Ethnography
Critical thinking and conceptual analysis
occur simultaneously with insight,
creativity and intuition.
Analogies and metaphors formed during
interpretation become new knowledge and
understanding.
Dynamic and “real time” self-awareness of
the synthesis process is essential.
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Types of Meta-Ethnography
Reciprocal
Refutational
Line of argument
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Reciprocal
Translations directly comparable.
Iterative process – studies translated into
each other.
Metaphors, themes, concepts, and
organizers translated across studies.
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Refutational
Interpretation designed to argue against
another interpretation.
Explanation not of findings but significance
of findings.
Exhibits beliefs and ways of arguing.
Promotes individual reflexivity.
Enriches critical discourse.
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Line of Argument
Concerned with clinical inference and
grounded theorizing.
Construction of an interpretation.
Involves two steps –
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
translation of studies into one another
development of grounded theory, putting
similarities and differences between studies
into an interpretive order
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Summary
Meta-synthesis is needed to build on the
qualitative body of literature in healthcare.
Different philosophical and theoretical
approaches result in different designs,
analysis, and results.
Diversity in approaches to meta-synthesis
is important for enlarging discourse.
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Generalization of theory across clinical
situations and relationships is critical.
Bringing theory to practice, and practice to
theory is possible.
Nursing is uniquely situated to pursue this
methodological paradigm.
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Questions?
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