MATRICS: A Method for Aggregating The Reporting of Interventions in Complex Studies

There are few rigorous methods for combining qualitative and quantitative findings from studies with complex interventions using multiple research methods and giving appropriate weight to each without introducing bias to the overall conclusions.We developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) for the ENIGMA study (Evaluating Innovations in Gastroenterology by the NHS Modernisation Agency) – a multi-centre, mixed-methods study to evaluate the impact of the Modernising Endoscopy Services programme [1], funded by the UK National Institute for Health Research (NIHR SDO ref 08/1304/46)

Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS): successful development and testing

Objectives: To develop a tool for the accurate reporting and aggregation of findings from each of the multiple methods used in a complex evaluation in an unbiased way. Study Design and Setting: We developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) within a gastroenterology study [Evaluating New Innovations in (the delivery and organisation of) Gastrointestinal (GI) endoscopy services by the NHS Modernisation Agency (ENIGMA)]. We subsequently tested it on a different gastroenterology trial [Multi-Institutional Nurse Endoscopy Trial (MINuET)]. We created three layers to define the effects, methods, and findings from ENIGMA. We assigned numbers to each effect in layer 1 and letters to each method in layer 2. We used an alphanumeric code based on layers 1 and 2 to every finding in layer 3 to link the aims, methods, and findings. We illustrated analogous findings by assigning more than one alphanumeric code to a finding. We also showed that more than one effect or method could report the same finding. We presented contradictory findings by listing them in adjacent rows of the MATRICS. Results: MATRICS was useful for the effective synthesis and presentation of findings of the multiple methods from ENIGMA. We subsequently successfully tested it by applying it to the MINuET trial. Conclusion: MATRICS is effective for synthesizing the findings of complex, multiple-method studies.6 page(s

Challenges to UK community pharmacy: a bio-photographic study of workspace in relation to professional pharmacy practice

This paper presents a novel, qualitative, bio-photographic study with intertextual analysis highlighting the relationship between community pharmacy workspace and practice. Sixteen pharmacists working across pharmacy types such as independent shops, large and small pharmacy chains and multiple pharmacies such as those in supermarkets participated in data capture and feedback consultation. Findings disclosed workspaces unfit for purpose and a workforce ill at ease with their new professional identity, involving increasingly complex tasks in health provision and retail. There was conflict between delegating to others and taking personal responsibility, and there were pressures from a demanding public within the context of a target-driven, litigious society. The study highlights that innovative, mixed methods in this context reveal nuanced, rich data

New initiatives in the delivery and organisation of gastrointestinal endoscopy services – focus groups in England and Wales

Background – This poster presents a qualitative study that formed part of a mixedmethod evaluation of modernising gastrointestinal endoscopy services in England catalysed by the NHS Modernisation Agency (NHSMA). The complete evaluation of 20 English gastroenterology units, covered quantitative data collection on innovations in units, activity, patient outcomes, health economics, and qualitative data collection on professionals’ and patients’ views and experiences. This evaluation was analysed using an innovative approach (MATRICS) to fully integrate findings from the different arms of the study. Method – As part of the qualitative data capture element of the mixed method study, professionals’ views and experiences were examined through four focus groups with senior health professionals working in endoscopy units that had no support from the NHSMA to examine views independent of their programme. Participants represented 10 different Trusts across England and Wales. Focus groups were facilitated, taperecorded and transcribed. Transcripts were analysed adapting van Manen’s ‘sententious’ or ‘wholistic’ approach to thematic analysis. Seven analysts worked individually and as a group to distil lengthy transcripts into summative paragraphs to capture the essentiality of text. The methodological framework offered a comprehensive approach to data and enabled the group to arrive at a consensus of opinion. Findings - Findings were refined to five major themes: lack of senior management understanding and appropriate management systems in place to support positive change, inadequate resources to engender long-term change, loss of personal autonomy and erosion of professionalism, barriers and facilitators to change that affect meaningful change and, differences between English and Welsh units regarding speed of change and support for change – the Welsh perspective. Conclusions – It is apparent that achieving long-lasting, positive effects of modernisation within complex systems such as gastroenterology services, demands senior management to actively support innovations, consider staff morale and provide appropriate levels of funding. However, although professional morale was low, and participants were frustrated by the perceived lack of management systems that adequately supported their needs, ambition to improve services was strong. The methodological framework for clarifying findings through assessment of the qualitative data offered a comprehensive and applicable approach to data analysis and adapting van Manen’s groupwork approach was inclusive and collaborative, enabling researchers with both quantitative and qualitative expertise to work closely together. This approach offers far-reaching possibilities for experimental studies and large-scale, mixed method studies of the future, including trials

Method for aggregating the reporting of interventions in complex studies (MATRICS)

Background: The synthesis of findings from mixed methods studies can be difficult and complex, with many articles tending to report their results in parallel with little or no integration. Conclusions may be based on findings that disproportionally represent one aspect of the mixed methods design rather than using the findings of all the methods used in a balanced and robust manner (O’Cathain 2008). We have developed a Method for Aggregating The Reporting of Interventions in Complex Studies (MATRICS) in the context of a complex, multi-centre, mixed methods study to evaluate the modernisation of endoscopy services. Method: We listed the effects sought by the study (the aims and objectives), split according to effects on patients, on the NHS and on the rest of society and gave each a unique number. We then listed the methods used to explore those effects and gave each a unique letter. An alphanumeric code was devised to identify and link each effect with a method and vice versa. This code was applied to a comprehensive list of tabulated study findings so that each finding was linked with an effect and a method. All analogous findings were merged and the alphanumeric codes linked with those findings were listed alongside to illustrate that more than one aspect of the study reported that finding. All contradictory findings and their alphanumeric codes were listed separately but in adjacent rows in the table to indicate that different components of the study were not complementary in their findings. Discussion: The MATRICS allowed us to better synthesise and present a large number of findings, to illustrate all complementary findings across multiple research methods and to highlight where findings from different components of the study were contradictory. The MATRICS can be applied to other research on complex interventions using mixed methods with great effect

Group motivational interviewing in schools: Development of a health promotion intervention

Objective: In the light of the shortcomings of curriculum-based health promotion in secondary schools, group motivational interviewing provides a potential alternative approach. This two-phase study set out to establish the key components, feasibility and acceptability of a group motivational interviewing intervention, focused on alcohol consumption. Methods:In phase one, focus groups with 12 students and 8 teachers explored issues with existing health education. Phase two involved the development of a one-hour group motivational interviewing session to address the issues raised. The session was delivered to two classes of students aged 13-15 years, facilitated by two motivational interviewing practitioners. Sessions were observed and audio-recorded and coded by two researchers using the Assessment of Motivational Interviewing Groups Observer Scale (AMIGOS). Student acceptability of the session was captured using a satisfaction questionnaire. Results: Sessions were consistent with motivational interviewing principles, providing empathic and focused discussion while maximising participants’ autonomy and strengths. The majority of students felt listened to during the session, considered it was helpful and felt that they could learn more from this kind of experience. Conclusion: A group motivational interviewing session, developed based on key components identified during focus groups, was shown to be acceptable to students and feasible to deliver in secondary schools. The approach requires further research to establish sustainable delivery mechanisms

Narrating uncertainties about treatment of mental health conditions

Background: Integration of patient views in mental health service planning is in its infancy despite service provision being clearly dominated by narratives from professional consultations and medical records. We wished to clarify perceptions of uncertainty about mental health conditions from a range of provider and user perspectives (patients, carers, parents, mental health service providers) and understand the role of narratives in mental health research. Aims: (1) To explore the utility of qualitative research methods, particularly narrative content analysis in mental health research, and (2) identify aspects of uncertainty in mental health service users and providers. Material: Four hundred and six free text responses were considered as one element of an existing questionnaire about uncertainties about mental health treatments, collected from mental healthcare users and providers through charities, the Mental Health Research Network in Wales, health professionals and websites. Free text responses were analysed using narrative content analysis, an elaborate and rigorous research technique that involves groups of analysts working independently and together over extended group sessions. Findings: Three main themes emerged across respondent groups: "medication and treatment options", "objectification and marginalisation of patient" and "integrity of service delivery". Within these, patients embraced the opportunity to write about their illness at length, whilst carers' and parents' main concerns were about how patients were dealing with their illnesses, the services they were getting and the side effects of treatments. Carers and patients' parents perceived themselves to be the 'go-between', carrying messages between patients and professionals, in order to enable services to function. Mental health service providers and professionals considered uncertainties surrounding medication and treatment from an 'evidence-base' perspective, concentrating on medication choices and the adoption of new approaches to care rather than patient need and expectation. Patients wanted to know what alternatives were available to the drug regimes they were on and felt their opinions were rarely listened to. As a consequence patients felt marginalised by the health systems there to support them and by society as a whole. Conclusions: Narrative content analysis can help distil large amounts of free text data and enable their successful interpretation. Listening to patients' voices should become an integral part of routine service evaluation and may help bring patient expectation more in line with service organisation and delivery towards an optimal delivery of care.9 page(s