‘Trying to pin down jelly’ - exploring intuitive processes in quality assessment for meta-ethnography

Background: Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. However, there is still no agreement as to whether, or how we should appraise studies for inclusion. We aimed to explore the intuitive processes that determined the ‘quality’ of qualitative research for inclusion in qualitative research syntheses. We were particularly interested to explore the way that knowledge was constructed. Methods: We used qualitative methods to explore the process of quality appraisal within a team of seven qualitative researchers funded to undertake a meta-ethnography of chronic non-malignant musculoskeletal pain. Team discussions took place monthly between October 2010 and June 2012 and were recorded and transcribed. Data was coded and organised using constant comparative method. The development of our conceptual analysis was both iterative and collaborative. The strength of this team approach to quality came from open and honest discussion, where team members felt free to agree, disagree, or change their position within the safety of the group. Results: We suggest two core facets of quality for inclusion in meta-ethnography - (1) Conceptual clarity; how clearly has the author articulated a concept that facilitates theoretical insight. (2) Interpretive rigour; fundamentally, can the interpretation ‘be trusted?’ Our findings showed that three important categories help the reader to judge interpretive rigour: (ii) What is the context of the interpretation? (ii) How inductive is the interpretation? (iii) Has the researcher challenged their interpretation? Conclusions: We highlight that methods alone do not determine the quality of research for inclusion into a meta-ethnography. The strength of a concept and its capacity to facilitate theoretical insight is integral to meta-ethnography, and arguably to the quality of research. However, we suggest that to be judged ‘good enough’ there also needs to be some assurance that qualitative findings are more than simply anecdotal. Although our conceptual model was developed specifically for meta-ethnography, it may be transferable to other research methodologies

Patient and Public Involvement (PPI) in evidence synthesis:how the PatMed study approached embedding audience responses into the expression of a meta-ethnography

Background: Patient and public involvement (PPI) has become enshrined as an important pillar of health services empirical research, including PPI roles during stages of research development and analysis and co-design approaches. Whilst user participation has been central to qualitative evidence synthesis (QES) for decades, as seen in the Cochrane consumer network and guidelines, meta-ethnography has been slow to incorporate user participation and published examples of this occurring within meta-ethnography are sparse. In this paper, drawing upon our own experience of conducting a meta-ethnography, we focus on what it means in practice to ‘express a synthesis’ (stage 7). We suggest the methodological importance of ‘expression’ in Noblit and Hare’s seven stage process (Noblit, GW and Hare, RD. Meta-ethnography: synthesizing qualitative studies, 1988) has been overlooked, and in particular, opportunities for PPI user participation within it. / Methods: Meta-ethnography comprises a seven-stage process of evidence synthesis. Noblit and Hare describe the final 7th stage of the meta-ethnography process as ‘expression of synthesis’, emphasizing co-construction of findings with the audience. In a previous study we conducted a meta-ethnography exploring patient and student experience of medical education within primary care contexts. We subsequently presented and discussed initial meta-ethnography findings with PPI (students and patients) in focus groups and interviews. We transcribed patient and student PPI interpretations of synthesis findings. As a research team, we then translated these into our existing meta-ethnography findings. / Results: We describe, with examples, the process of involving PPI in stage 7 of meta-ethnography and discuss three methodological implications of incorporating PPI within an interpretative approach to QES: (1) we reflect on the construct hierarchy of user participants’ interpretations and consider whether incorporating these additional 1st order, 2nd level constructs implies an additional logic of 3rd order 2nd level constructs of the QES team; (2) we discuss the link between PPI user participation and what Noblit and Hare may have meant by ideas of ‘expression’ and ‘audience’ as integral to stage 7; and (3) we link PPI user participation to Noblit and Hare’s underlying theory of social explanation, i.e. how expression of the synthesis is underpinned by ideas of translation and that the synthesis must be ‘translated in the audience’s (user participants) particular language’. / Conclusions: The paper aims to complement recent attempts in the literature to refine and improve guidance on conducting a meta-ethnography, highlighting opportunities for PPI user participation in the processes of interpretation, translation and expression. We discuss the implications of user participation in meta-ethnography on ideas of ‘generalisability’

Employment and breast cancer: A meta-ethnography

This article is available open access through the publisher’s website at the link below. Copyright @ 2011 Blackwell Publishing Ltd.The purpose of this synthesis is to examine the qualitative evidence on the lived experience of breast cancer survivors in relation to return to work. An in-depth search of the literature was undertaken from 1999 until July 2010. Ten relevant papers emerged that reflected the aims of the synthesis. A meta-ethnographic approach was used to synthesise papers. Four concepts emerged that reflected the return to work, these included influencing factors, sickness absence, work ability and work-related problems and experiences of return to work. Further synthesis of concepts led to the development of four final interpretations. These included breast cancer and employment, treatment-induced physical impairment, employer comprehension of breast cancer and fear of work-related failure. These interpretations indicate that employers need to be educated on the work capabilities of cancer survivors post treatment. Improved support facilities are needed for cancer survivors which are supported by European employment legislation and guidance offered by company occupational health departments. Moreover, health care professionals could become more involved in the education of breast cancer patients with regard to the timing of returning to work

Steady and delayed: explaining the different development of meta-ethnography in health care and education

Since its inception in the 1980s, the meta-ethnography approach for synthesising qualitative study accounts has been used extensively in health and social care research and to a lesser extent in educational research. The aim of this article is to reflect on the evolution of the method in both fields. It starts by describing the meta-ethnography approach, charts the rise of evidence-based research in health-related research, and explores the growth in the rate of published health-related meta-ethnographies. It proceeds by offering some explanation for the slower growth in the use of meta-ethnography in educational research. It explains this using the history of the early developments of qualitative approaches in Education and their underpinning paradigms. It then discusses key meta-ethnographies conducted in education, comparing those to more recent ones, in terms of methodological development. The article concludes by drawing lessons about how the conduct of meta-ethnography may be improved in any discipline

Using meta-ethnography to understand the emotional impact of caring for people with increasing cognitive impairment.

The definitive version is available at www.blackwell-synergy.comThe majority of people with degenerative neurological conditions are cared for within their own families. Cognitive impairment can be a significant and increasing symptom of these conditions. In this article we report how a team of experienced researchers carried out a meta-ethnography of qualitative research articles focusing on the impact of caring for a loved one with cognitive impairment. We followed the seven-step process outlined by Noblit and Hare. Synthesized findings from 31 papers suggest emotional impact is complex and uncertain and varies from day to day. The benefit of using meta-ethnography is that the results represent a larger sample size and a reinterpretation of multiple studies can hold greater application for practice. The results of this study offer an opportunity for nurses to be aware of both the positive and negative sides of caring and being cared for. This knowledge can be used to discuss with patients and carers how best to prepare for decreasing cognition and still maintain a worthwhile quality of life

Mission drift in qualitative research, or moving toward a systematic review of qualitative studies, moving back to a more systematic narrative review

The paper argues that the systematic review of qualitative research is best served by reliance upon qualitative methods themselves. A case is made for strengthening the narrative literature review and using narrative itself as a method of review. A technique is proposed that builds upon recent developments in qualitative systematic review by the use of a narrative inductive method of analysis. The essence of qualitative work is described. The natural ability for issues of ethnicity and diversity to be investigated through a qualitative approach is elaborated. Recent developments in systematic review are delineated, including the Delphi and Signal and Noise techniques, inclusion of grey literature, scoping studies and meta-ethnography. A narrative inductive interpretive method to review qualitative research is proposed, using reflective teams to analyse documents. Narrative is suggested as a knowledge-generating method and its underlying hermeneutic approach is defended as providing validity and theoretical structure. Finally, qualities that distinguish qualitative research from more quantitative investigations are delineated. Starting points for reflecting on qualitative studies and their usefulness are listed. Key words: Qualitative Systematic Review, Evidence-Based Policy, Grey Literature, Scoping Studies, Delphi, ‘Signal and Noise’, Meta-ethnography, Narrative Review, Narrative Method, and Reflective Teams

Using Meta-Ethnography to Synthesize Research: A Worked Example of the Relations between Personality on Software Team Processes

Context: The increase in the number of qualitative and mixed-methods research published in software engineering has created an opportunity for further knowledge generation through the synthesis of studies with similar aims. This is particularly true in the research on human aspects because the phenomena of interest are often better understood using qualitative research. However, the use of qualitative synthesis methods is not widespread and worked examples of their consistent application in software engineering are needed. Objective: To explore the use of meta-ethnography in the synthesis of empirical studies in software engineering through an example using studies about the relations between personality and software team processes. Methods: We applied the seven phases of meta-ethnography on a set of articles selected from a previously developed systematic review, to assess the appropriateness of meta-ethnography in this domain with respect to ease of use, and usefulness and reliability of results. Results: Common concepts were identified through reading and interpreting the studies. Then, second order translations were built and used to synthesize a model of the relationships between personality and software team processes. Conclusions: Meta-ethnography is adequate in the synthesis of empirical studies even in the context of mixed-methods studies. However, we believe that the method should not be used to synthesize studies that are too disparate to avoid the development of gross generalizations, which tend to be fruitless and are contrary to the central tenets of interpretive research

Using Meta-Ethnography to Synthesize Relevant Studies: Capturing the Bigger Picture in Dementia with Challenging Behavior within Families

In understanding the range and depth of people’s experiences, it is important to include the wide range of approaches which capture the richness within a given knowledge base. However, systematic reviews using quantitative data alone risk missing findings that can contribute to a better understanding of a research question. In response, meta-ethnography has emerged as a potentially useful method to synthesize and integrate both qualitative and quantitative data from different perspectives using qualitative methodology. In this case study, we describe how we have used meta-ethnography to better understand how families experience dementia. We address a particular issue of selecting the highest quality evidence across a range of epistemologies