1. Can Qualitative Metasynthesis Make a Contribution to Evidence-Based Practice?: Issues and Challenges in an Era of Research Integration  
Panel Presentation for:
“Advances in Qualitative Methods”   AcademyHealth
Seattle June 26/2006
Sally Thorne, RN, PhD
University of British Columbia

2. Why Qualitative Metasynthesis?
Proliferation of qualitative research in the health sciences and practice disciplines
New turn to evidence-based practice and systematic reviews of research
Inadequate methodologies for conducting systematic reviews of qualitative research
Under-utilization of qualitative findings in health service/policy

3. Transforming Findings into Evidence?

4. General Definition
An interpretive integration of qualitative findings (i.e.., phenomenologies, ethnographies, grounded theories, and other integrated and coherent descriptions or explanations of phenomena, events, or cases) that are themselves interpretive syntheses of data.
Accommodates all findings, crafting them into a novel interpretation using an inclusive logic.

5. Terminological Context
Social Sciences
Meta-Ethnography (Noblit & Hare, 1988)
Meta-Theorizing (Ritzer, 1991)
Metatheory, Metamethod, Meta-data-analysis (Zhao, 1996)
Health Sciences
Aggregating Qualitative Findings (Estabrooks, Field & Morse (1994)
Qualitative Meta-Analysis (Schreiber, Crooks & Stern (1997)
Meta-Study (Paterson, Thorne, Canam & Jillings, 2001)
Qualitative Metasummary (Sandelowski & Barroso, 2003)

6. What Metasynthesis is Not
Conventional narrative reviews of qualitative or quantitative research
Quantitative meta-analyses of qualitative research
Secondary analyses & pooled case comparisons of qualitative data
Critical integrative literature review

7. Inherent Complexity of the Challenge
Multiple methods
Multiple disciplines
Multiple epistemologies

8. Challenges Across Metasynthesis Approaches
Finding reports of qualitative studies
Appraising qualitative research reports
Finding the findings in research reports
Integrating findings

9. Finding the findings Defining findings Locating them
Classifying findings
Extracting them

10. Working across typologies of findings
Not
research
Not qualitative
Exploratory
Descriptive
Explanatory
Qualitative Research
Farthest
from data
Closest
to data
Borderline studies
No finding
Topical survey
Thematic survey
Conceptual/
thematic
description
Interpretive
explanation
Working across typologies of findings
From: Sandelowski & Barroso (2003

11. Integrating qualitative findings
Preserving the case imperatives of qualitative research
Preventing paralytic immersion in data
Accounting for varying sample sizes
Differentiating idiographic & nomothetic generalization

12. Methodological Variations: Possible approaches to qualitative metasynthesis
Qualitative meta-study
Qualitative research integration

13. Meta-Study “remapping the cognitive status”
of a changing field of study by considering its theoretical, methodological, and epistemological bases within a historical and sociocultural context. (Zhao, 1991, p. 381)

14. Components of Meta-study
Meta-Data-Analysis: “analysis of analyses” or an analysis of the data analyses available in reports about primary qualitative research studies
Meta-Method: study of the rigor, epistemological soundness, and fruitfulness of the research methods used in the research studies
Meta-Theory: uncovering underlying structures of extant theory as the theoretical framework and/or emergent theory that is grounded in the research findings

15. Meta-Study Products
Historical critical analysis of a field, including diversities, patterns and methodological imperfections
Complexity of the final synthesis

16. Qualitative Research Integration
Empirical studies directed toward the combination of research findings in reports of qualitative studies.
Aimed at systematically & judiciously appraising reports of completed qualitative studies in a target research domain
Creating conclusions about knowledge (however provisional and fallible) in a specified field

17. Metasummary – a quantitatively oriented aggregation of qualitative findings that are topical or thematic summaries or surveys. versus Qualitative Metasynthesis - Interpretive syntheses of data in primary qualitative studies

18. Research integration vs. meta-study
Focus
Study findings
Study studies
Primary data
Findings
Various elements of of reports
Orientation to data
Empirical; findings are indices of target events
Discursive; reports are socio-historical constructions
Method examples
Qual metasummary
Qual metasynthesis
Meta-theory, -method
Citation analysis
Discourse analysis
Product examples
Evidence synthesis
Research hypotheses
Critique
Intellectual history

19. Critical Caveats in Qualitative MetaSynthesis
Or…the importance of humility in making claims
Experience thrice-removed
The problem of representation
Discursive readings as correctives to empirical claims

20. Critical Caveats continued
Choices & judgments
Methodological groundings
Homogenizing variation
Reproducing bias
Objectifying meaning

21. Health service/policy research implications: CDM Example
Assumptions underlying acute/compliance model
Role of insider experience research in reshaping analysis
Single disease vs broad based CD analysis
Patterns & themes across disease experience contexts

22. Moving Forward?
Finding appropriate balance between descriptive and normative empirical knowledge forms (including social construction).
Creating language within the qualitative health research community to account for “probable truths” and pragmatic generalizations

23. Slowing momentum toward meta-synthesis until we have a strong foundation of theoretically sound approaches
Strengthening quality criteria for qualitative health research, larger (more population based) studies
Nurturing a culture of complexity, not simplicity, in the presentation of qualitative findings

24. For Further Reference:
Paterson, B., Thorne, S.. Canam, C. & Jillings, C. (2001). Meta-study of Qualitative Research: A Practical Guide to Meta-analysis and Meta-Synthesis. Thousand Oaks, CA: Sage Publications.
Thorne, S., Jensen, L, Kearney, M.H., Noblit, G., & Sandelowski, M. (2004) Reflections on the methodological and ideological agenda in qualitative meta-synthesis. Qualitative Health Research, 14,