'Qualitative' research, systematic reviews, and evidence-informed policy and practice

This thesis makes a distinctive contribution to debates about how to include and quality assess `qualitative' research in systematic reviews. It analyses sets of quality criteria, assesses the impact of study quality on findings and compares `quantitative' and `qualitative' perspectives on quality. The research consists of a review of the literature and three new methodological studies. The first study surveyed and evaluated quality assessment tools, the second analysed the development of a new tool, and the third examined the relationship between the quality of `qualitative' research and the findings of systematic reviews.\ud A large number of different quality criteria have been proposed for `qualitative' research but assessment tools represent 'good practice' guides rather than aids to distinguish between `good' and `bad' studies. Continuous funding, a policy-focussed context, and a multi-disciplinary team which viewed research questions as drivers for quality assessment were important factors for developing a unique tool which did help to distinguish between studies. There was no straightforward relationship between study quality and the findings of reviews. However, excluding lower quality studies had little impact on review findings. Studies which made the biggest contribution to reviews were those with appropriate methods for the review question and findings displaying conceptual depth. In contrast to procedures for `quantitative' research, engaging with study findings as well as study methods is important for assessing fully the quality of `qualitative' research.\ud This thesis generates important empirical evidence for debates about how to assess the quality of `qualitative' research. It shows how standard quality assessment protocols need to be altered better to fit `qualitative' research, reveals how study quality can impact on review findings and demonstrates some problems with the terms `qualitative' and `quantitative'. Future debate in this area should focus on how to identify reliable answers to questions about intervention process, context and need. \u

Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies

Objectives To determine the impact on teenage pregnancy of interventions that address the social disadvantage associated with early parenthood and to assess the appropriateness of such interventions for young people in the United Kingdom

The influence of environmental factors on the generalisability of public health research evidence: physical activity as a worked example

BACKGROUND: It is rare that decisions about investing in public health interventions in a city, town or other location can be informed by research generated in that specific place. It is therefore necessary to base decisions on evidence generated elsewhere and to make inferences about the extent to which this evidence is generalisable to the place of interest. In this paper we discuss the issues involved in making such inferences, using physical activity as an example. We discuss the ways in which elements of the structural, physical, social and/or cultural environment (environmental factors [EFs]) can shape physical activity (PA) and also how EFs may influence the effectiveness of interventions that aim to promote PA. We then highlight the ways in which EFs may impact on the generalisability of different types of evidence. DISCUSSION: We present a framework for thinking about the influence of EFs when assessing the generalisability of evidence from the location in which the evidence was generated (place A) to the location to which the evidence is to be applied (place B). The framework relates to similarities and differences between place A and place B with respect to: a) the distributions of EFs; b) the causal pathways through which EFs or interventions are thought to exert their effect on PA and c) the ways in which EFs interact with each other. We suggest, using examples, how this scheme can be used by public health professionals who are designing, executing, reporting and synthesising research on PA; or designing/implementing interventions. SUMMARY: Our analysis and scheme, although developed for physical activity, may potentially be adapted and applied to other evidence and interventions which are likely to be sensitive to influence by elements of the structural, physical, social and/or cultural environment such as the epidemiology of obesity and healthy weight promotion