Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research
Top Cited Papers
- 1 December 2011
- journal article
- research article
- Published by National Institute for Health and Care Research in Health Technology Assessment
- Vol. 15 (43), III-+
- https://doi.org/10.3310/hta15430
Abstract
Background: Methods for reviewing and synthesising findings from quantitative research studies in health care are well established. Although there is recognition of the need for qualitative research to be brought into the evidence base, there is no consensus about how this should be done and the methods for synthesising qualitative research are at a relatively early stage of development. Objective: To evaluate meta-ethnography as a method for synthesising qualitative research studies in health and health care. Methods: Two full syntheses of qualitative research studies were conducted between April 2002 and September 2004 using meta-ethnography: (1) studies of medicine-taking and (2) studies exploring patients' experiences of living with rheumatoid arthritis. Potentially relevant studies identified in multiple literature searches conducted in July and August 2002 (electronically and by hand) were appraised using a modified version of the Critical Appraisal Skills Programme questions for understanding qualitative research. Candidate papers were excluded on grounds of lack of relevance to the aims of the synthesis or because the work failed to employ qualitative methods of data collection and analysis. Results: Thirty-eight studies were entered into the medicine-taking synthesis, one of which did not contribute to the final synthesis. The synthesis revealed a general caution about taking medicine, and that the practice of lay testing of medicines was widespread. People were found to take their medicine passively or actively or to reject it outright. Some, in particular clinical areas, were coerced into taking it. Those who actively accepted their medicine often modified the regimen prescribed by a doctor, without the doctor's knowledge. The synthesis concluded that people often do not take their medicines as prescribed because of concern about the medicines themselves. 'Resistance' emerged from the synthesis as a concept that best encapsulated the lay response to prescribed medicines. It was suggested that a policy focus should be on the problems associated with the medicines themselves and on evaluating the effectiveness of alternative treatments that some people use in preference to prescribed medicines. The synthesis of studies of lay experiences of living with rheumatoid arthritis began with 29 papers. Four could not be synthesised, leaving 25 papers (describing 22 studies) contributing to the final synthesis. Most of the papers were concerned with the everyday experience of living with rheumatoid arthritis. This synthesis did not produce significant new insights, probably because the early papers in the area were substantial and theoretically rich, and later papers were mostly confirmatory. In both topic areas, only a minority of the studies included in the syntheses were found to have referenced each other, suggesting that unnecessary replication had occurred. Limitations: We only evaluated meta-ethnography as a method for synthesising qualitative research, but there are other methods being employed. Further research is required to investigate how different methods of qualitative synthesis influence the outcome of the synthesis. Conclusions: Meta-ethnography is an effective method for synthesising qualitative research. The process of reciprocally translating the findings from each individual study into those from all the other studies in the synthesis, if applied rigorously, ensures that qualitative data can be combined. Following this essential process, the synthesis can then be expressed as a 'line of argument' that can be presented as text and in summary tables and diagrams or models. Meta-ethnography can produce significant new insights, but not all meta-ethnographic syntheses do so. Instead, some will identify fields in which saturation has been reached and in which no theoretical development has taken place for some time. Both outcomes are helpful in either moving research forward or avoiding wasted resources. Meta-ethnography is a highly interpretative method requiring considerable immersion in the individual studies to achieve a synthesis. It places substantial demands upon the synthesiser and requires a high degree of qualitative research skill. Meta-ethnography has great potential as a method of synthesis in qualitative health technology assessment but it is still evolving and cannot, at present, be regarded as a standardised approach capable of application in a routinised way.Keywords
Funding Information
- Health Technology Assessment Programme (06/90/12)
This publication has 21 references indexed in Scilit:
- Meta‐synthesis of presence in nursingJournal of Advanced Nursing, 2006
- The Travesty of Choosing After Positive Prenatal DiagnosisJournal of Obstetric, Gynecologic & Neonatal Nursing, 2005
- Documentation of Individualized Patient Care: a qualitative metasynthesisNursing Ethics, 2005
- Becoming an Involved Father of an InfantJournal of Obstetric, Gynecologic & Neonatal Nursing, 2005
- Lay Understanding of Familial Risk of Common Chronic Diseases: A Systematic Review and Synthesis of Qualitative ResearchAnnals of Family Medicine, 2004
- Nonvocal Ventilated Patients Perceptions of Being UnderstoodWestern Journal of Nursing Research, 2004
- Metasynthesis: The State of the Art—So FarQualitative Health Research, 2003
- Modern biomedical research: an internally self-consistent universe with little contact with medical reality?Nature Reviews Drug Discovery, 2003
- Pumping iron: compliance with chelation therapy among young people who have thalassaemia majorSociology of Health & Illness, 2000
- Symptom Interpretation and Medication Adherence among Late Middle-age and Older HIV-infected AdultsJournal of Health Psychology, 1999