Appraisal, Extraction and Pooling of Qualitative Data and Text

1. Appraisal, Extraction and Pooling of Qualitative Data and Text - Evidence from qualitative studies, narrative and text. (JBI/CSRTP/2012/0003)

2. Introduction • Recap of Introductory module • Developing a question (PICo) • Inclusion Criteria • Search Strategy • Selecting Studies for Retrieval • This module considers how to appraise, extract and synthesize evidence from qualitative studies and text.

3. Program Overview

4. Program Overview

5. Session 1: Introduction to Qualitative Evidence Synthesis

6. Qualitative Research is… • “…a situated activity that locates the observer in the world. It considers a set of interpretive, material practices that make the world visible…[it] involves an interpretive, naturalistic approach to the world. This means qualitative researchers study things in their natural settings, attempting to make sense of, or to interpret, phenomena in terms of the meanings people bring to them”(Denzin & Lincoln, 2000)

7. Qualitative research and health care • Health care is a people centered process concerned with health and healing • Health care derives much of it’s knowledge from a range of biomedical sciences • However this does not supply all the knowledge that is necessary to provide holistic care for the patients and clients • Qualitative researchers use humanistic frameworks to examine ordinary activities of everyday life

8. Qualitative Research Findings as Evidence for Practice • Qualitative evidence is of increasing importance in health services policy, planning and delivery. • It can play a significant role in: • understanding how individuals / communities perceive health, manage their own health and make decisions related to health service usage; • increasing our understandings of the culture of communities and of health units; • Informing planners and providers; • evaluating components and activities of health services that cannot be measured in quantitative outcomes.

9. Application of Qualitative Research to Practice • As with quantitative research, results from a single study only should not be used to guide practice • The findings of qualitative research should be synthesized in order to develop recommendations for practice

10. Research Paradigms Serve as a model/world view or philosophy that structures knowledge and understanding Define what is to be observed and scrutinised Prioritise questions Inform the interpretation of results

11. Dominant Paradigm 1: Positivist/Empirical-Analytical • Assumptions • There is an external, real world of objects apart from people, which is comprehensible to us • Researchers can compare their claims against this objective reality • Seeks to predict and control

12. Dominant Paradigm 2: Interpretive • Assumptions • Reality as we know it is constructed/produced inter-subjectively (between people). • Meaning and understanding are developed socially and experientially. • Researchers’ values are inherent in research. • Findings of knowledge claims are created • All interpretations are located in a particular context, setting and moment. • Seeks to understand

13. Dominant Paradigm 3: Critical • Assumptions • Examines issues of power and envisions new opportunities • Main task social critique, whereby the restrictive and alienating conditions of the status quo are brought to light • Common assumptions with Interpretivism; however, moves past describing meaning to emancipation and change. • Seeks to critique and emancipate

14. Qualitative Methodologies

15. Phenomenology • Assumes that people come to know a phenomena through their experience of it • Focuses on INDIVIDUAL meaning • Emphasizes a focus on people's subjective experiences and interpretations of the world. • Understand how the world appears to others.

16. Ethnography • Study of Culture/specific cultural group. • What is the way of life of this group of people? • Everyday life is worth of study. • Focuses on SOCIAL meaning. • Researcher immerses self in cultural group. • Field Work - primarily participant observation and interview data • Focuses on the context of communities • Used increasingly in healthcare to explore the relationship between health and culture.

17. Grounded theory • Develop theory grounded in real world; • Searches and generates theoretical explanations from observations of the world (induction); • The constant collection and iterative analysis of data to enable theory to emerge; and • Data are not constrained by predetermined theoretical framework, but define boundaries of inquiry.

18. Basis in critical social science; Researchers interact with the participants to achieve change; Often community-based; used with implementation studies in healthcare; and Treats the individual as an autonomous being, capable of exercising agency Action Research

19. Discourse analysis Discourse – to talk, converse; hold forth in speech or writing on a subject; Discourse as patterns of ways of representing phenomena in language; Application of critical thought to social situations and the unveiling of (hidden) politics within socially dominant or marginalised discourses.

20. Qualitative data analysis Is based on principles of thematic analysis for most methodologies A process of identifying and presenting meaning in the form of themes, metaphors or concepts; there is wide variability in the terms used and how they are defined; Not suited to all methodologies (i.e. discourse analysis)

21. Qualitative data analysis Three strategies: Data analysis as a separate step following data collection Data analysis occurs simultaneously with data collection Data collection and analysis are ‘staged’

22. Congruity between Paradigm, Methodology and Methods

25. Group Work 1 • In pairs, work through the Group Work 1 task in the Workbook. • Reporting back

26. Session 2: The Systematic Review of Qualitative Evidence Trends and Debates within the International Literature

27. Meta-synthesis: approaches

30. Meta-synthesis: worked examples Meta aggregation Meta ethnography

31. Meta aggregation A structured and process driven approach to systematic review drawing on the classical understandings and methods associated with systematic review of quantitative literature as practiced by the Cochrane Collaboration

32. Meta aggregation Based on an a-priori protocol Established, answerable question Explicit criteria for inclusion Documented review methods for searching, appraisal, extraction and synthesis of data

33. Meta aggregation Explicitly aligned with: Philosophy of pragmatism Delivers readily useable findings Informs decision making at the clinical or policy level Transcendental phenomenology Looks for common or “universal” essences of meaning Attempts to “bracket” pre-understandings of the reviewer

34. Transcendental Phenomenology • Based on the philosophic traditions of Husserlian phenomenology: • the intuitive examination of essences that have immediate validity; • Seeks to avoid undue influence of the reviewer on the text; • Seeks to generate practice level theory that has explanatory power for policy or practice • Seeks to preserve the intended meaning of text

35. The needs and experiences of people with a diagnosis of skin cancer: a systematic review Janet Barker, Arun Kumar, Wendy Stanton and Fiona Bath-Hextall, JBI Library of Systematic Reviews, 2011; 9(4):104-121

36. Inclusion Criteria • Participants • Adults with a diagnosis of skin cancer. • Phenomena of Interest • The needs and experiences of people with skin cancer. • Context • Hospital or community-located dwellers. • Types of studies • All qualitative studies that described or analyzed the needs and experiences with people who had been diagnosed with skin cancer.

37. Methods Each paper was assessed independently by two reviewers for methodological quality. The internal validity (quality) of research papers was assessed using JBI-QARI. There were no disagreements between the two reviewers and therefore a third reviewer was not required.

38. Results

39. Results ( cont/…) A total of 12 findings were extracted from the 2 included qualitative papers These findings were aggregated into 4 categories on the basis of similarity of meaning. The categories were synthesized to generate 2 synthesized findings.

40. Results/cont.. • The 2 studies used a qualitative approach but neither specified a particular methodological approach. • Both studies were conducted in the United Kingdom (UK), using semi structured interviews.

42. Recommendations arising • There is a real need to increase knowledge of skin cancer so that people do not delay in seeking medical help as early diagnosis can dramatically improve both prognosis and the patient experience since early lesions are treated more simply compared with larger or neglected lesions. • Health professionals caring for these patients need to understand the psychosocial concerns of this patient group in order to design services appropriately and to provide patients with the support they need and information that they can easily understand.

43. Meta-Ethnography Explicitly aligned with philosophy of interpretivism Searches for new meaning Focuses on multiple realities

44. Hermeneutic Interpretivism Is the basis for meta-ethnography Interpretation of text for its inner meaning Focuses on the reviewers interpretive skills Seeks to re-interpret the published literature Seeks to generate new, mid level theoretical explanations Seeks engagement between reviewer and text

45. Meta ethnography From within the social sciences to develop theories from existing ethnographic data, Iterative development of emic interpretations, Incorporates 7 phases, these can be aligned to the systematic review process, but there is no requirement to do so.

46. Meta ethnography Identify the research interest Decide which studies to include Read the studies Determine how the studies are related Translate the studies in to each other Synthesize the translations Express the synthesis

47. Meta ethnography: 3 stages of synthesis First order interpretations Themes, metaphors or concepts identified Second order interpretations The researchers interpretation of how the identified concepts relate to each other Third order interpretations Seeks to encompass themes within each other

48. Interpretation Second Order Interpretation: Reciprocal Like interpretations are brought together “this one is like that one..” Refutational Competing discourses; must also have a relationship that can be explored Third Order Interpretation: Line of argument Asks what do the parts infer about the whole

49. Patient adherence to Tuberculosis treatment Salla A. Munro, Simon A. Lewin, Helen J. Smith, Mark E. Engel1, Atle Fretheim, Jimmy Volmink. ‘Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research’. PLoS Medicine July 2007.

50. Inclusion criteria Patients, carers or health professionals delivering DOTs Perceptions of adherence was the phenomena of interest Context was patients undergoing DOTs therapy for TB Qualitative studies on the perception of adherence