Can Qualitative Metasynthesis Make a Contribution to Evidence-Based Practice?: Issues and Challenges in an Era of Resear

1. 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

2. 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

3. Transforming Findings into Evidence?

4. 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.

5. 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)

6. 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

7. Inherent Complexity of the Challenge • Multiple methods • Multiple disciplines • Multiple epistemologies

8. Challenges Across Metasynthesis Approaches • Finding reports of qualitative studies • Appraising qualitative research reports • Finding the findings in research reports • Integrating findings

9. Finding the findings • Defining findings • Locating them • Classifying findings • Extracting them

10. Working across typologies of findings Closest to data Farthest from data Conceptual/ thematic description Thematic survey No finding Interpretive explanation Topical survey Exploratory Descriptive Explanatory Not research Not qualitative research Qualitative Research Borderline studies From: Sandelowski & Barroso (2003

11. Integrating qualitative findings • Preserving the case imperatives of qualitative research • Preventing paralytic immersion in data • Accounting for varying sample sizes • Differentiating idiographic & nomothetic generalization

12. Methodological Variations:Possible approaches to qualitative metasynthesis • Qualitative meta-study • Qualitative research integration

13. 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)

14. 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

15. Meta-Study Products • Historical critical analysis of a field, including diversities, patterns and methodological imperfections • Complexity of the final synthesis

16. 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

17. 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

18. Research integration vs. meta-study

19. 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

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

21. 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

22. 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

23. 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

24. 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.