Synthesizing Qualitative Research E-Book

Karin Hannes

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Organic Synthesis: State of the Art
• Sprache: Englisch

Seitenzahl: 321

Veröffentlichungsjahr: 2011

Beschreibung

A considerable number of journal publications using a range of qualitative synthesis approaches has been published. Mary Dixon-Woods and colleagues (Mary Dixon-Woods, Booth, & Sutton, 2007) identified 42 qualitative evidence synthesis papers published in health care literature between 1990 and 2004. An ongoing update by Hannes and Macaitis (2010)identified around 100 additional qualitative or mixed methods syntheses. Yet these generally lack a clear, detailed description of what was done and why (Greenhalgh et al, 2007; McInnes & Wimpenny, 2008). Choices are most commonly influenced by what others have successfully used in the past or by a particular school of thought (Atkins et al, 2008; Britten et al, 2002). This is a substantive limitation.

This book brings balance to the options available to researchers, including approaches that have not had a substantial uptake among researchers. It provides arguments for when and why researchers or other parties of interest should opt for a certain approach to synthesis, which challenges they might face in adopting it and what the potential strengths and weaknesses are compared with other approaches.

This book acts as a resource for readers who would otherwise have to piece together the methodology from a range of journal articles. In addition, it should stimulate further development and documentation of synthesis methodology in a field that is characterized by diversity.

Leseprobe

Contents

Cover

Title Page

Copyright

Dedication

List of contributors

Preface

Acknowledgements

Chapter 1: “It looks great but how do I know if it fits?”: an introduction to meta-synthesis research

Introduction

The Uses of Qualitative Evidence Synthesis

The Origins of Qualitative Evidence Synthesis

Historical Overview

An Overview of Qualitative Synthesis Methods

Making Sense of the Myriad of Qualitative Evidence Synthesis Methods

About This Book

Conclusions

References

Chapter 2: Obstacles to the implementation of evidence-based practice in Belgium: a worked example of meta-aggregation

Introduction

A Worked Example

The Process of Meta-Aggregation

Discussion

References

Chapter 3: Medicine taking for asthma: a worked example of meta-ethnography

Introduction

The Method

A Worked Example Taken from the Medicine-Taking Synthesis (Pound et al. 2005)

Conclusions

Acknowledgements

References

Chapter 4: The use of morphine to treat cancer related pain: a worked example of critical interpretive synthesis

Introduction

Mixed Methods Research

Critical Interpretive Synthesis

A Worked Example of Critical Interpretive Synthesis

Conclusion

References

Chapter 5: The Internet in medical education: a worked example of a realist review

Introduction

Internet-Based Medical Education: A Realist Review of What Works, for Whom, and in What Circumstances

The Realist Review Process

Chapter Summary

References

Chapter 6: Mixed methods synthesis: a worked example

Introduction

Steps in A Mixed Methods Approach

A Worked Example

Strengths and Challenges of the Approach

Conclusion

References

Chapter 7: Bayesian approaches to the synthesis of qualitative and quantitative research findings

Introduction

An Overview of the Bayesian Framework

The Quantitizing approach

The Qualitizing Approach

The Qualitative-As-Prior Approach

Discussion of the Three Approaches

References

Chapter 8: Conclusion

Introduction

Beset by Questions and Alternatives

Continuing Controversies?

Concluding Remarks

References

Index

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Library of Congress Cataloging-in-Publication Data

Synthesizing qualitative research : choosing the right approach / edited by Karin Hannes, Craig Lockwood.

p.; cm.

Includes bibliographical references and index.

ISBN 978-0-470-65638-9 (pbk.)

1. Qualitative research. 2. Medicine–Research–Methodology. 3. Biology–Research–Methodology.

I. Hannes, Karin. II. Lockwood, Craig, 1971-

[DNLM: 1. Qualitative Research. 2. Biomedical Research–methods. 3. Meta-Analysis as Topic. W 20.5]

R853.Q34S96 2011

610.72′1–dc23

2011022676

This book is published in the following electronic formats: ePDF 9781119959816; Wiley Online Library 9781119959847;

ePub 9781119959823

This book is dedicated to the future of synthesis science; a disparate field with rich potential for further methodological development. We trust that this book makes both a useful, practical contribution to what is known here and now and enables the next generation of students, academics, theorists, and researchers to draw upon some of today's best synthesis scientists for tomorrow's methodology.

List of contributors

Nicky Britten, PhD Professor of Applied Health Care Research Peninsula Medical School University of Exeter Exeter, Devon, UK

Fiona Campbell Research Associate School of Health and Related Research University of Sheffield Sheffield, UK

Jamie L. Crandell, PhD Research Assistant Professor University of North Carolina at Chapel Hill, NC USA

Kate Flemming, PhD RN Research Fellow Department of Health Sciences The University of York York, UK

Karin Hannes, PhD Doctor-Assistant Centre for Methodology of Educational Research Faculty of Psychology and Education, K.U. Leuven Belgium

Centre for Evidence-Based Medicine Belgian Branch of the Cochrane Collaboration Belgium

Angela Harden, PhD Professor of Community and Family Health Institute for Health and Human Development School of Health and Biosciences University of East London London, UK

Josephine Kavanagh, BA, MA Research Officer EPPI-Centre Social Science Research Unit Institute of Education University of London London, UK

Nathan Manning, PhD Systematic Reviewer Kleijnen Systematic Reviews and Adjunct Research Fellow The Joanna Briggs Institute The University of Adelaide Australia

Elizabeth McInnes, PhD Deputy Director Nursing Research Institute – Australian Catholic University and St Vincents and Mater Health Sydney National Centre for Clinical Outcomes Research (NaCCOR) St Vincent's Hospital Darlinghurst, NSW Australia

Barbara L. Paterson, PhD RN Professor & Dean Thompson Rivers University School of Nursing Kamloops BC Canada

Alan Pearson, AM Executive Director The Joanna Briggs Institute Faculty of Health Sciences The University of Adelaide Australia

Catherine Pope, PhD Professor of Medical Sociology University of Southampton Southampton, UK

Margarete Sandelowski, PhD RN Cary C. Boshamer Distinguished Professor University of North Carolina at Chapel Hill Chapel Hill, NC USA

James Thomas, PhD Reader in Social Policy EPPI-Centre Social Science Research Unit Institute of Education University of London London, UK

Corrine I. Voils, PhD Associate Professor of Medicine Durham Veterans Affairs Medical Center and Duke University Medical Center Durham, NC USA

Geoff Wong, MD(Res) Senior Lecturer in Primary Health Care and GP Principal Healthcare Innovation and Policy Unit Centre for Health Sciences Blizard Institute Barts and The London School of Medicine and Dentistry London, UK

Preface

The growth in qualitative evidence synthesis methods, and the increasing number of reviews that are published using these methods, is a clear indicator that what was once a field for the “interested few” is becoming mainstream practice. There are now large numbers of published qualitative synthesis papers, as well as a growing body of academic and theoretical work to further inform the conduct of qualitative reviews, and to further stimulate methodological development. It is within the last few years that the majority of methodological development has occurred, and within this timeframe, good theorists have enhanced and refined their methods, as is evident in the quality of published qualitative synthesis reports seen in mainstream journals to date. The majority of methodological guidance though is buried in websites or published in specialized journals. The few books available tend to have a limited focus on a particular methodology, or are theoretical rather than practical. Methodology papers in journals serve to flag issues or ideas, but limitations prevent the level of depth and explanation possible in a book. The word limit of journal articles prevents many authors from comprehensively describing their full methods, and providing appropriate illustration or exemplars is also problematic in most journals.

Writing about synthesis methods included the process of choosing between different approaches, selecting what would be appropriate for this particular book and what would be put into the drawer until a new opportunity for writing arose. Although first intended as a compendium of all qualitative evidence synthesis methods, we decided to focus this book on six commonly used methodologies for qualitative evidence synthesis. We opted to portray those synthesis approaches that have particularly been developed by and for researchers involved in systematically reviewing literature. Our choice has been influenced by previously published overviews of approaches from colleague methodologists, personal knowledge, and connections and the conversations that occur in our respective fields internationally. We have focused on methods that have been developed with the aim of synthesizing primary studies, providing the reader with a detailed stepwise description on how to move from original research texts to a review of qualitative literature. We believe that these approaches will generate interest from the international community of researchers, practitioners and policymakers currently involved in qualitative evidence synthesis.

The book is meant to be a guide to reviewers and users from any discipline, although most of the worked examples are situated in the field of healthcare. It is not a penultimate book of methods for qualitative synthesis, neither will everyone agree with our particular selection and how we have categorized them. Approaches that have been used in practice but are not covered in our book include narrative summary, thematic analysis, grounded theory, meta-study, cross-case techniques, content analysis, case survey, and qualitative comparative analysis methods. Some of these methods have drawn upon the principles of basic research designs. These adapted versions of basic research methods for the purpose of synthesis are promising, but currently lack the transparency important to a community of researchers involved in systematic reviewing. They offer little guidance on particular aspects such as search strategies, critical appraisal, and sampling of primary studies, neither do they discuss why these should or should not be done. Furthermore, they lack clarity of the particular features of the synthesis approach as compared to other synthesis methods and have not yet formally been subject to an evaluation of their appropriateness in the context of systematically reviewing literature.

The methods included here are some of the better developed and used approaches available at this point in time; yet no single text has brought them together before, nor provided the diverse and high quality example syntheses that the authors, and in some chapters, originators of the methodology have conducted. Some of the synthesis methods presented are meant to build theory and deepen understanding, while others have been created to develop lines of action for policy and practice or to provide the current state of the art on a particular topic. We feel it is most important that those engaging in a qualitative or mixed method evidence synthesis have a clear understanding of what particular approaches intend to do and which method best fits a researcher's goal and epistemological position.

Most researchers publishing qualitative or mixed-method syntheses do not successfully answer the question of why, among other approaches, they have opted for a particular method. Generally authors state that their choice was influenced by what fits their particular school of thought or by what others have successfully used in the past. The latter is particularly the case for meta-ethnography, currently a very commonly used approach and one of the few that has published methodological guidance. This is a substantive limitation though which offers future reviewers limited opportunities to critique or gain insights from such decision-making processes. This book not only offers to guide readers and potential users in how to apply a particular approach, it also guides general readers through the considerations as to why they should opt to choose a certain approach for their research project. Through the presentation of worked examples of different approaches, it brings more balance and a more insightful perspective to the options available to researchers. The book does not simply resort to technical reporting of method, but rather focuses on illustrating the challenges users of an approach are likely to come across. These challenges are often hidden or only partly addressed in published articles, where the main interest is to present the content of the work rather than the methodology.

In summary, we believe this book provides a detailed and integrated resource for readers who would otherwise have to piece together methodology from a disparate range of journal articles and other resources. We do not see this book as an end point, since much remains to be learned and written within the field of qualitative and mixed-method synthesis. Instead, we hope to stimulate further pragmatic, intellectual, and methodological curiosity in the richly rewarding field of qualitative evidence synthesis.

Karin Hannes Craig Lockwood

Acknowledgements

We would not do justice to the hard work of the contributing authors on each of their worked examples, if we were not to put them first on our list of people to acknowledge. For some of them the production of their chapters coincided with serious life events, including very positive experiences but also more challenging issues, on a personal or a professional level. Therefore, a special thank you for the commitment and dedication that finally led us to the publication of this book is appropriate. We sincerely thank all academics that have assisted us in completing the initial peer review of the included chapters; Wim Van den Noortgate, Patrick Onghena and Mieke Heyvaert from the Centre for Methodology of Educational Research at K.U. Leuven, and Nathan Manning, former employee of the Joanna Briggs Institute. We also thank the staff members from both our hosting institutes for enthusiastically following up on the progress of the book. In addition, conversations and debates on approaches to qualitative evidence synthesis with methodological experts worldwide and colleague researchers from other research institutes have inspired us to embark on this particular journey, not least the Cochrane Qualitative Research Methods Group, whose convenors have been a wonderful forum for discussion and truly enriched our understanding of evidence synthesis.

We are most grateful for permission given to reproduce extracts from the following:

Figure 2.1 Reproduced with permission from the Joanna Briggs Institute, Reviewers' Manual, 2008.

Figures 2.3 to 2.6 Reproduced from Hannes K, Goedhuys J & Aertgeerts B. Obstacles to implementing Evidence-Based Practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines. Acta Clinica Belgica (in press), with permission from Acta Clinica Belgica.

Figures 3.1 and 3.2 Reproduced from Pound et al. Resisting Medicines: a synthesis of qualitative studies of medicine taking. Social Science & Medicine 2005; 61(1): 133–155, 2005, with permission from Elsevier.

Figure 4.1 and Tables 4.2, 4.4 and 4.5 Reproduced from Flemming K. ‘Synthesis of quantitative and qualitative research: an example using Critical Interpretive Synthesis’, Journal of Advanced Nursing 2010; 66(1):201–217, 2010, with permission from John Wiley & Sons Ltd.

Table 4.3 Reproduced from Flemming K. ‘Synthesis of quantitative and qualitative research: an example using Critical Interpretive Synthesis’, Journal of Advanced Nursing 2010; 66(1):201–217, 2010, (using data from Hawker et al 2002), with permission from John Wiley & Sons Ltd.

Figure 6.1 Reproduced from Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, Oakley A, Applying systematic review methods to studies of people’s views: an example from public health, Journal of Epidemiology and Community Health58: 794–800, 2004, with permission from BMJ Publishing Group Ltd.

Figure 6.2 Reproduced from Campbell F, Johnson M, Messina J, et al. Behavioural interventions for weight management in pregnancy: A systematic review of quantitative and qualitative data. BMC Public Health 2011, 11:491 doi:10.1186/1471–2458–11–491

Table 7.1 and Figure 7.1 Adapted from Voils et al. 2009 with permission from the Royal Society of Medicine Press, London.

Chapter 1

“It Looks Great But How Do I Know If It Fits?”: An Introduction to Meta-Synthesis Research

Barbara L. Paterson, RN PhD

Thompson Rivers University, School of Nursing, Kamloops BC, Canada

In the past decade, there has been a proliferation of methods to synthesize qualitative research studies. Although several qualitative evidence synthesis methods share common epistemological tenets, developers of these methods rarely make clear how their particular method differs from and is unique to other synthesis records. The following chapter is intended both as an introduction to the book and as a way of making sense of the multiple epistemological, theoretical, and methodological interpretations of qualitative evidence synthesis that are apparent in the synthesis methods that exist today. The chapter provides a general overview of the history and current state-of-the-art of qualitative evidence synthesis. It also includes a general overview of qualitative evidence synthesis methods and a framework to assist researchers in the selection of a synthesis method.

Introduction

Qualitative evidence synthesis, the focus of this book, is defined as the study of qualitative studies (Patterson et al. 2001). It is the synthesis or amalgamation of individual qualitative research reports (commonly called “primary research reports”) that relate to a specific topic or focus in order to arrive at new or enhanced understanding about the phenomenon under study. It entails an interpretive process by which “the constituent study texts can be treated as the multivocal interpretation of a phenomenon, just as the voices of different participants might be in a single qualitative study” (Zimmer 2006). In the 1990s there existed few definitive guidelines about how qualitative evidence synthesis could be enacted. Now, a decade later, almost every journal in the health and social sciences contains articles about the need for qualitative synthesis to provide evidence to support clinical practice and to identify directions for future research.

There has been a proliferation of ideas about how to conduct qualitative synthesis, each set of authors offering different insights about how this could be best achieved, and most suggesting that their method is the most credible. However, there exists much confusion about how the various synthesis methods compare to each other and the factors that researchers should consider to determine which method best suits their needs, purposes, and ideological stance. This chapter is intended both as an introduction to the book and as a way of making sense of the multiple qualitative evidence synthesis methods that exist. The chapter consists of a brief overview of the uses and evolution of qualitative evidence synthesis methods, including how the various synthesis methods compare to one another. Following this synopsis, I will detail the factors that researchers should consider when selecting particular qualitative evidence synthesis methods. In conclusion, I will provide an overview of the contributions of the book to the field of qualitative evidence synthesis.

The Uses of Qualitative Evidence Synthesis

The appeal of qualitative evidence synthesis lies mainly in its ability to effect outcomes that are not feasible or possible in a single qualitative study. By providing a broad overview of a body of qualitative research, syntheses can reveal more powerful explanations that are available in a single study, leading to greater generalizability of the research findings and often to increased levels of abstraction (Sherwood 1999). A synthesis of multiple qualitative studies can also refute or revise the current understanding of a particular phenomenon. For example, a synthesis of qualitative research about the experience of living with a chronic illness (Paterson 2001) resulted in a model of chronic illness that challenged the current notions about the trajectory of chronic illness as linear with one ideal end-point. In addition, qualitative evidence synthesis can assist researches to: explore differences and similarities across settings, sample populations, and researchers' disciplinary, methodological and/or theoretical perspectives (NHS CRD 2001); generate operational models, theories, or hypotheses that can be tested in later research (Thorne & Paterson 1998); identify gaps and areas of ambiguity in the body of research, thereby revealing directions for future research (NHS CRD 2001); provide a historical overview of the development of concepts or theories over time (Paterson et al. 2001); complement the findings or the interpretation of quantitative systematic reviews (Tranfield 2006); and inform the development of questionnaires or surveys by identifying the significant attributes of a phenomenon (Tranfield 2006).

The Origins of Qualitative Evidence Synthesis

There is some debate as to where the idea of qualitative synthesis first originated. Walsh and Downe (2005) indicate that Stern and Harris were the first to refer to the need for qualitative evidence synthesis, while Paterson and colleagues (2001) acknowledge the work of Statham, Mauksch, and Miller as pioneering this concept. It is generally agreed, however, that the need for a comparative analysis of the findings of qualitative research was stimulated by the explosion of single qualitative research studies in the 1980s and 1990s.

As early as 1997, Sandelowski, Docerty, and Emden (1997) cautioned qualitative researchers that they were in danger of “eternally reinventing the wheel” unless they found some way of identifying and categorizing the relationships between findings of various qualitative studies. At the same time there was growing recognition of the need to use empirical evidence to inform policy and practice (Garrett & Thomas 2004). Researchers began to entertain the notion that qualitative research could be synthesized to contribute evidence to the field. In the quantitative research realm, the method of meta-analysis1 (Glass et al. 1981) gave rise to an increasing appreciation for the synthesis of research, particularly as published meta-analyses were shown to contribute many benefits, such as the assessment of empirical evidence and generating theory (Russell 2005). However, until recently, the world of systematic reviews has been dominated by syntheses of quantitative research using the techniques of meta-analysis. This in part reflects the reputation of qualitative research as less credible and rigoros than quantitative research (Pearson 2004). It also mirrors the competing and often conflicting understandings of what qualitative evidence synthesis is and how to enact it.

Historical Overview

There have been four distinct phases in the evolution of qualitative synthesis. In the first phase in the late 1980s to the 2000s, two educational researchers, Noblit and Hare (1998), delineated the steps of qualitative evidence synthesis in their book about “meta-ethnography.” These authors referred to meta-ethnography as involving the comparison, analysis, interpretation, and translation of the findings of individual qualitative studies. Although the method has undergone some recent adaptations, it continues to be one of the most popular synthesis methods.

The second phase in the development of qualitative evidence synthesis methods was the introduction of meta-study (2001) in the early 2000s. Meta-study is in keeping with the interpretive paradigm (2001); consequently, this method emphasizes qualitative evidence synthesis as an interpretive process. The developers of this method argue that because qualitative research focuses on meaning in context, a synthesis of qualitative research studies must capture how the sociocultural and historical context of the primary research, as well as the research method and theoretical frames of such research, influenced what questions the qualitative researchers asked, their research design, and their interpretation of the data (2001).

The third phase of the evolution of qualitative evidence synthesis in the years following the publication of the text on meta-study is characterized by the inclusion of qualitative research in systematic reviews. The Cochrane Collaboration, which had previously relied exclusively on the results of quantitative studies, developed a Qualitative Methods Group to develop and disseminate methods for incorporating qualitative evidence in systematic reviews (Booth 2001). Developers of qualitative synthesis methods that purport to conduct a systematic review commonly typify the Cochrane Collaboration in their understanding of such a review as both systematic and rigoros. They emphasize that if the findings of qualitative syntheses are to be seen as credible and trustworthy, qualitative research syntheses must include a critical and transparent appraisal of the research (Pearson 2004). Such researchers have developed critical appraisal tools and computer data analysis software (e.g., Qualitative Assessment and Review Instrument) for such purposes (McInnes & Wimpenny 2008).

The fourth phase in the history of qualitative evidence synthesis has occurred simultaneously with the third phase. Synthesis methods introduced in this phase focus on integrating qualitative and quantitative research in the following ways: (1) using quantitative meta-analysis and statistical techniques to quantify the impact, quality, and/or relevance of the findings of primary research studies; (2) using qualitative interpretive methods to identify prevalent themes in the quantitative and qualitative research within a body of research; and (3) combining the results of an aggregation of the findings of quantitative research with that of qualitative research and then using quantitative and/or qualitative strategies to synthesize or determine the weight of the evidence of this aggregated data. An example of a combined qualitative–quantitative synthesis is the work of Thomas and colleagues (Thomas et al. 2003) in identifying interventions that promote children's intake of fruits and vegetables. The researchers conducted a meta-analysis of quantitative studies and a thematic analysis of qualitative research. Then they developed a matrix to show how effective interventions were connected to children's views about those interventions.

Several researchers (e.g., Sandelowski, Thorne, Noblit) who initially pioneered synthesis methods have evolved in their understanding of how to conduct qualitative evidence synthesis, in part because of the increasing sophistication of understanding in the field of evidence synthesis and in part in response to what funders and other stakeholders now demand in terms of credible evidence. Sandelowski, for example, initially questioned the merit of obscuring the richness of qualitative findings by synthesizing them (Sandelowski et al. 1997) but recently, following her experience in synthesizing several hundred qualitative studies about women with HIV/AIDS, she has espoused the quantitative aggregative techniques of meta-summary in part as a means of addressing the critiques of qualitative synthesis as lacking standards of rigor and needing to account for issues of credibility and validity in qualitative syntheses (Gough & Elbourne 2002).

An Overview of Qualitative Synthesis Methods

In 2003, Finfgeld (2003) identified five various qualitative evidence synthesis methods. Since then, at least a dozen more have been developed. Despite their epistemological, methodological, and terminological differences, qualitative evidence synthesis methods share the common attributes of (1) involving a team of researchers (i.e., it is rare to encounter qualitative research syntheses that involve a lone researcher), (2) investigating a number of primary research reports, and (3) organizing the synthesis according to a concept, theory, and/or research objective (Yager 2006).

Most synthesis methods can be categorized according to where they fit in relation to specific attributes (Figure 1.1). Three of these attributes (aggregative/interpretive, epistemology, and degree of iteration) occur on a continuum; that is, synthesis methods can be categorized according to where they fit in a range between two poles. A defining attribute is whether the method is mainly interpretive or mainly aggregative.

Figure 1.1 Attributes of qualitative evidence synthesis methods.

Qualitative evidence synthesis methods include elements of both aggregation and interpretation, but one of these is more prominent than the other in each method. Mainly aggregative synthesis methods entail listing the findings of various primary research studies and then further combining them into themes or similar descriptors to produce a general description of the phenomenon under study; they treat the findings as if they are isolated from the contexts in which they occurred. Mainly interpretive synthesis methods, on the other hand, extend the aggregation of findings to produce a new abstract model or theory of the phenomenon under study that considers the context under which the research was conducted, the data interpreted, and the research report written (Gough & Elbourne 2002). Examples of mainly aggregative methods are the systematic review method used by the Joanna Briggs Institute, meta-summary, thematic analysis, content analysis, case survey, qualitative comparative analysis, and Bayesian meta-analysis (McInnes & Wimpenny 2008). Examples of mainly interpretive methods are meta-study, narrative synthesis, narrative summary, formal grounded theory, and meta-ethnography (McInness & Wimpenny 2008).

Another attribute of synthesis methods is the epistemological position. The range of epistemological stances in qualitative evidence synthesis methods extends from idealism, wherein the researcher assumes that all knowledge is constructed, to realism in which researchers assume that they see the world as it is (Spencer et al. 2003). The developers of narrative synthesis (Popay et al. 2007), critical interpretive synthesis (CIS) (Dixon-Woods et al. 2006a a), and meta-study (Paterson et al. 2001) indicate that the methods represent a ‘subjective idealist’ method. However, other methods (e.g., ecological triangulation, framework synthesis, thematic synthesis) hold to a more realist stance that highlights the possibility for research to adequately represent an external reality.

Another defining attribute of qualitative evidence synthesis methods is the degree of iteration. Some methods, such as meta-study, formal grounded theory, or thematic analysis, are iterative and circular in their processes. Researchers using these methods often revise their initial decisions and processes as they progress in the synthesis and encounter new data or reflect on the primary research. Other methods, such as framework synthesis or thematic synthesis, provide a highly structured approach to selecting, organizing, and tabulating the primary research data. Qualitative evidence synthesis methods also vary as to their intended outcomes. For example, developers of thematic synthesis (Thomas et al. 2003; Harden et al. 2004; Thomas et al. 2007) view the intended product of such a synthesis as informing practice or policy. Kearney (2001), on the other hand, indicates that the outcome of formal grounded theory is a middle-range theory that can be tested in future research.

The defining attributes of a particular synthesis method are often interconnected and influence one another. For example, methods that have a realist epistemological stance tend not to alter their research question or their review process during the synthesis and the primary research literature is not problematized (Yager 2006).

Making Sense of the Myriad of Qualitative Evidence Synthesis Methods

Despite the advances in qualitative evidence synthesis, there continues to be considerable debate within the field that centers around the various philosophical and methodological underpinnings of the synthesis methods and the terminology that is used. Researchers who promote a particular qualitative evidence synthesis method often admit to making adaptations to existing synthesis methods but rarely do they explicate why they made them.

It is common to see that researchers have amalgamated synthesis methods, even if the methods differ considerably in their epistemological and methodological underpinnings, without stating why they chose to do this. For example, Bélanger and Rodríguez (2008) state in their synthesis of qualitative research on multidisciplinary primary care teams that, “Our work has been largely inspired by the Sandelowski and Barroso” (2007) method (p. 588) but in fact, cite Paterson and colleagues' (2001) guidelines for how to analyze data using the procedures of meta-ethnography. Thorpe and colleagues (2009) indicate that their qualitative evidence synthesis drew on the methods described by Zimmer (2006), although Zimmer discussed more than one synthesis method and these had different epistemological foundations. In the past decade, there have been several efforts to address the limitations and ambiguities of the previous qualitative evidence synthesis methods.

Books have been written proposing specific synthesis methods and providing procedural steps and guidelines on how to implement those methods. Each of these texts has highlighted the complexity of qualitative evidence synthesis; they have called for qualitative researchers to continue to explore and share their insights about qualitative evidence synthesis. None, however, provide much guidance about how to determine which of the existing synthesis methods the best fit is for their purposes. I do not wish to imply that making such a decision is an easy one. Different synthesis teams make such a decision based on their unique notions of which considerations or criteria are the priority. There is also considerable overlap and ambiguity in the descriptions of many qualitative evidence synthesis methods. It may not always be clear, for example, how to determine what the anticipated outcomes of the synthesis will be. Despite these caveats, I offer the following as possible considerations when selecting the qualitative evidence synthesis method you use.

The Nature of the Research

Will the synthesis method result in the expected and desired outcomes?

Is the method congruent with the goals of the synthesis project?

The nature of the research includes consideration of whether the qualitative evidence synthesis method will result in the expected and desired outcomes; that is, whether the method fits the goals of the synthesis project. The outputs of synthesis methods that have a more idealist and constructivist orientation, such as meta-narrative and CIS, are generally complex and conceptual. They offer useful insights to policymakers and practitioners but require further interpretation before they can be applied to practice or policy development (Yager 2006). In contrast, realist methods, such as thematic synthesis, tend to produce outcomes that are more concrete and definitive; for example, a list of key dimensions of the phenomenon under study.

If the anticipated outcome is the development of a theory, you may consider a qualitative evidence synthesis method that promises to generate theory, such as formal grounded theory or meta-study. However, if your intention is to produce findings that will have immediate utility to informing directions for policy, you should select a method that is intended for such a purpose, such as thematic synthesis. An additional consideration is the type and quality of the primary research that is available. At times, the available primary research may be too few or too many, too homogenous or too heterogeneous, to enact the procedures of a particular synthesis method in the way the developers prescribe. For example, Wilson and Amir (2008) rejected meta-ethnography as a synthesis method when they discovered that the six primary research reports they had located were so different that they could not effectively enact the third phase of meta-ethnography, the translation of studies into one another. Although they briefly contemplated conducting the third phase within a subset of the studies, they concluded that they had too few studies to do that.

Nature of the Research Team

Is there the necessary mix of disciplinary, methodological, and other perspectives among the research team to enact this method?

Is the expertise needed for this method (e.g., statistical analysis, theoretical expertise) available?

In selecting a qualitative evidence synthesis method, researchers should ask themselves what the research team requires in terms of skills, knowledge, perspectives, and experiences to carry out a particular method and whether they have these. Some synthesis methods require a research team that is diverse in terms of their expertise and experience. The developers of meta-study (Paterson et al. 2001) indicate that this complex synthesis method requires researchers who offer different disciplinary and methodological expertise to examine a body of qualitative research. However, recently Paterson (2009) revised this measure of diversity to include variations in both academic and clinical experience. Other synthesis methods, such as that promoted by the Joanna Briggs Institute, can be carried out by two researchers who do not necessarily have content expertise in the field of study (McInnes & Wimpenny 2008). Still other synthesis methods, such as those that use quantitative strategies, for example Bayesian meta-analysis, require specific expertise, such as statistical analysis and quantitative research techniques.

Nature of the Researcher

How tolerant is the researcher to the amount of structure and ambiguity that is inherent in the method?

Is his/her epistemological stance congruent with that of the synthesis method?

Researchers vary in their personal preferences regarding research methods. Some synthesis methods may appeal to some researchers but not others. Some synthesis methods are ambiguous in how they are enacted and the procedural steps are not clearly defined. This can be extremely frustrating for a novice synthesist or someone who prefers a structured method (Wilson & Amir 2008). However, McInnes and Wimpenny (2008) caution that even seemingly structured methods require some level of interpretation at the synthesis stage and this interpretation defies fixed rules. The epistemological stance of the researcher must also be considered in the selection of a qualitative research method. Researchers should select a synthesis method that best fits their view of research epistemology. Researchers whose epistemological stance supports the use of formal appraisal criteria or checklists to determine if a primary research report has sufficient quality to be included, will appreciate synthesis methods such as meta-narrative and thematic synthesis because they provide criteria on which to base exclusion and inclusion decisions. However, they are likely to be frustrated with methods that are more inclusive of primary research regardless of quality, such as meta-study and meta-ethnography (Finlayson & Dixon 2008).

Resource Requirements

How much personnel, time and effort are required for this method?

Is there adequate funding to support expenses incurred in implementing this method?

Does the primary research support the method?

Qualitative evidence synthesis methods differ significantly in their resource requirements, and consequently, in their requirements for funding. The methodological complexity of a particular method should be considered in the selection decision because it will determine what resources are needed to undertake and complete a qualitative evidence synthesis. In addition, researchers proposing to conduct a qualitative evidence synthesis should also consider the number of researchers who are to be involved in the synthesis project. Synthesis methods vary in whether they can be accomplished by one or two researchers or whether they require a team of experts. Some qualitative evidence synthesis methods, such as meta-study, require considerable personnel, time, and effort; others, such as meta-ethnography, can be accomplished with a few people over a few months. If regular research team meetings and the provision for relationship building are critical to a synthesis method, such as in meta-study, researchers should consider if the available funding will cover this. Meetings of the team may entail costs of researchers' travel to attend the meetings if they do not live in the same region as the team leader, or the costs of other meeting venues such as videoconference or web-based conferences (Paterson et al. 2009). Some synthesis methods require funds to support the purchase of qualitative and/or quantitative data analysis software programs and funding for personnel who enter data into these programs. Others have costs related to literature retrieval and file management.

An Example