OCCUPATIONAL THERAPY AND QUALITATIVE EVIDENCE SYNTHESIS

What is a Qualitative Evidence Synthesis (QES)?

A qualitative evidence synthesis combines and analyses evidence from individual qualitative research studies addressing similar research questions across different contexts.  QES can “generate new theoretical and conceptual models, identify research gaps, and provide evidence for the development, implementation and evaluation of health interventions” (Tong et al., 2012). There are two broad approaches to QES, meta-synthesis and meta-aggregation, reflecting different purposes and different philosophical stances about knowledge generation.  Meta-synthesis, originating in the 1980s, uses “methods consistent with interpretive science and qualitative research” (Gewurtz et al., 2008, p. 302). An aim of meta-syntheses is to gain new insights to contribute to model and theory development.  Meta-aggregation is an emerging approach in which qualitative findings are categorised and summarised rather than transformed (Peoples et al., 2011).  Meta-aggregation is consistent with the Cochrane Collaboration’s process of systematic reviews which aims that evidence generated through qualitative research can be systematically reviewed alongside quantitative data (Bennett et al., 2013).

What search terms can be used to find QES, in addition to meta-synthesis and meta-aggregation?

Occupational therapists have used the following terms: systematic thematic synthesis, systematic review of qualitative research, meta summary, metasynthesis, meta-ethnography, and aggregated analysis.  Other terms include meta-study, critical interpretative synthesis, and narrative synthesis.

What can qualitative research inform us about? What do QES tell us that may differ from individual studies?

Qualitative research can provide us with in-depth and nuanced evidence about client perspectives and experiences (e.g., occupational engagement following stroke).   While QES are not meant to replace individual studies, they systematically integrate qualitative evidence from multiple studies to tell us more about a topic at a more abstract level than single studies alone. QES can increase confidence in the transferability of findings to a client group by identifying meaningful experiences common to a larger number of participants from a wider range of contexts.

How are QES done?

QES are typically undertaken by a team of 2-4 researchers who define a research topic and undertake a systematic review of the qualitative literature in relevant databases such as CINAHL, PsycINFO, EMBASE, and AMED.  Occupational therapists have used a number of approaches including meta-ethnography (Noblit & Hare, 1988), systematic thematic synthesis (Thomas & Harden, 2007), and aggregated analysis (Sandelowski, et al. 1997; Estabrooks et al. 1994).

Are there any guides or checklist for appraising the quality of a QES?

Occupational therapists have used quality checklists, composite checklists or quality criteria to determine whether to include publications in a QES. Critical appraisal checklist includes those of UK National Centre for Social Research (Spencer et al., 2003) and Critical Appraisal Skills Programme (CASP (2006). Enhancing transparency in reporting the synthesis of qualitative research or “ENTREQ”  is a checklist for reviewing the transparency of reporting in a QES (Tong et al., 2012).

How can I use their findings in my practice?

QES can help to find answers to clinical practice questions about the effectiveness of interventions, why they are effective and for whom (Noyes et al., 2008). QES can increase the comprehensiveness of evidence gathered from clients and key stakeholders. For example, in occupational therapy QES studies, the sample size in some studies can be up to 400 with the majority having over 200 participants.  A further advantage of QES is the larger span of years than is possible in many individual studies and the range of contexts and countries from which they are drawn.

References

Bennett, S., O’Connor, D., Hannes, K., & Doyle, S. (2013). Appraising and understanding systematic reviews of quantitative and qualitative evidence. In T. Hoffmann, S. Bennett, & C. Del Mar (Eds.), Evidence-based practice across the health professions (2nd ed.) (pp. 283-312). Sydney: Churchill Livingstone.

Critical Appraisal Skills Programme (CASP). (2006). Critical Skills Appraisal Programme (CASP): Qualitative research. Public Health Resource Unit.  Retrieved from: http://www.casp-uk.net/index.aspx?o=1150

Estabrooks, C.  A., Field, P.  A., & Morse, J. M. (1994). Aggregating qualitative findings: An approach to theory development. Qualitative Health Research, 4, 503–511.

Gewurtz, R., Stergiou-Kita, M., Shaw, L., Kirsh, B., & Rappolt, S. (2008). Qualitative meta-synthesis: Reflections on the utility and challenges in occupational therapy. Canadian Journal of Occupational Therapy, 75(5) 301-308.

Noblit, G. W. & Hare, R. D. (1988). Meta-ethnography: Synthesising qualitative studies. Qualitative research methods: Volume 11. Newbury Park, CA: Sage.

Noyes, J., Popay, J., Pearson, A., Hannes, K., & Booth, A. (2008). Qualitative research and Cochrane reviews. In J. P. T. Higgins & S. Green (Eds.). Cochrane handbook for systematic reviews of interventions (pp. 571- 591). [Cochrane Book Series]. The Cochrane Collaboration.

Peoples, H., Satink, T., & Steultjens, E. (2011). Stroke survivors’ experiences of rehabilitation: A systematic review of qualitative studies. Scandinavian Journal of Occupational Therapy, 18, 163–171.

Rice, P. L., & Ezzy, D. (1999). Qualitative research methods: A health focus. Melbourne, Australia: Oxford University Press.

Sandelowski, M., Docherty, S., & Emden, C. (1997). Qualitative metasynthesis: Issues and techniques. Research in Nursing and Health, 20, 365–371.