1. Planning Your Review

2. Process of Qualitative Evidence Synthesis (Major & Savin-Baden 2010) Identify Studies related to research question ↓ Collate Qualitative Studies across chosen topic ↓ Examine theories and methods used in each study in-depth ↓ Compare and Analyse findings for Each Study ↓ Synthesise findings for each study ↓ Undertake interpretation of findings across studies ↓ Present interpretive narrative about synthesis of findings ↓ Provide series of recommendations

3. Stages of a Qualitative Evidence Synthesis? Formulating the review question Conducting a systematic literature search Screening and selecting appropriate research articles Analyzing and synthesizing qualitative findings Maintaining quality control Presenting findings (Sandelowski & Barroso, 2007)

4. Garside, 2010, PhD Thesis

5. Eight Key Questions 1.THE QUESTION: Starting Point or Early Outcome of Review? 2.THE QUESTION: Comprehensive Searching versus Sampling 3.THE DATA: Participants’ Comments and/or Authors’ Interpretations 4.THE DATA: Qualitative Data Versus Qualitative Research 5.STUDY QUALITY: Rich and Thick? 6.STUDY QUALITY: Appraisal for Exclusion or Moderation 7.ROLE OF THEORY: Theory Secure or Evolving 8.ROLE OF THEORY: Theory Generating/Theory Validating/Other

6. THE QUESTION

7. Is Your Question…… Fixed? – Pre-defined as a PICO (Population- Intervention-Comparison- Outcome) or SPICE (Setting-Perspective- Interest, Phenomenon of – Comparison- Evaluation) – Question is an “Anchor” (e.g. attached to an Effectiveness review) Negotiable? – To be explored as part of initial review process – Becomes clearer as you examine data (cp. Grounded theory approaches) – Question is a “Compass” NB. Even answering a fixed PICO question for HTAs may require exploration of phenomenon of untreated/pretreated condition (Lorenc et al, 2012)

8. Will You Describe or Interpret? All Reviews figure on continuum between Description and Interpretation Description – What does the data say? – factual reporting of “epidemiology” of studies, themes etc… Reader does work of interpretation Interpretation – What does the data mean? – “diagnosis” – subjective interpretation of “signs and symptoms” from data and themes etc… Reviewer does work of interpretation – may be contested

10. THE DATA/STUDY QUALITY

11. A Caution! “it was found to be necessary…to include evidence not relating directly to interventions. In this respect, these reviews appear to be generally representative of the field of public health, where relatively little substantive qualitative evidence on specific interventions is available…..this is probably the case in many areas of social and health research. If so, limiting inclusion to qualitative studies of interventions alone will not be a practicable course of action, due to the lack of data (cf. Garside et al., 2009a)” (Lorenc et al, 2012).

12. Data/Study Quality How Rich (“Thick”) is Your Data? – Qualitative data from “thin” studies (or textual responses to surveys) will not sustain interpretive approaches – Rich/“Thick” reports will sustain interpretive approaches – may allow selective sampling/ theoretical saturation How Will You Use Quality Assessment? – To Exclude Studies? (May be a luxury you cannot afford) – To Moderate Study Findings? (Will you examine which findings are supported by which quality studies? – Qualitative Sensitivity Analysis)

13. ROLE OF THEORY

14. Will You Generate, Explore, Test Theory (Gough et al, 2012)? Generate – may require “suspension of disbelief” – quality assessment/value judgement may come later (cp. Brainstorming)- Explore – looking for patterns Test – quality assessment differentiates well- supported and unsupported data NB. We (Carroll & Booth) are currently conducting empirical work on systematic identification of Theories Pragmatic outputs e.g. HTAs or Clinical Guidelines may not require theory Other outputs may have theory generation as a major objective

15. What Are Your Choices? Dixon Woods et al, 2004 Booth et al 2011 Hannes & Lockwood, 2011 Ring et al, 2011 Gough et al, 2012 Pope et al, 2007

16. Toolbox Texts Popay J, Roberts H, Sowden A et al. (2006) Guidance on the Conduct of Narrative Synthesis in Systematic Reviews: a Product from the ESRC Methods Programme. Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009 Aug 11;9:59. http://www.biomedcentral.com/1471-2288/9/59 http://www.biomedcentral.com/1471-2288/9/59 Barnett-Page, E and Thomas, J (2009) Methods for the synthesis of qualitative research: a critical review. NCRM Working Paper. NCRM. (Unpublished) http://eprints.ncrm.ac.uk/690/1/0109%2520Qualitative%2520synthesis%2520 methods%2520paper%2520NCRM.pdf http://eprints.ncrm.ac.uk/690/1/0109%2520Qualitative%2520synthesis%2520 methods%2520paper%2520NCRM.pdf Dixon-Woods M, Agarwal S, Young B et al (2006). Integrative approaches to qualitative and quantitative evidence. Health Development Agency http://www.nice.org.uk/niceMedia/pdf/Integrative_approaches_evidence.pdf http://www.nice.org.uk/niceMedia/pdf/Integrative_approaches_evidence.pdf Pope C, Mays N & Popay J. Synthesizing Qualitative and Quantitative Health Evidence: A Guide to Methods. ISBN: ISBN: 033521956X Open University Press. Thomas J, Harden A (2008) Methods for the thematic synthesis of qualitative research in systematic reviews BMC Medical Research Methodology 8:45http://www.biomedcentral.com/1471-2288/8/45http://www.biomedcentral.com/1471-2288/8/45

17. Decisions? Decisions! Hannes, K., & Lockwood, C. (2011). Synthesizing qualitative research: choosing the right approach. BMJ Books.

18. Non-Epistemological/Non- Methododological Considerations Available Expertise – In Reviewing and In Qualitative Research Available Time Relationship with Quantitative Syntheses – Pre-existing Review – Sequentially – In Parallel – [Iteratively] – [Combined Methods versus Separate Methods] To include: Any Qualitative Research? OR Specific methods? OR only well-described methods and thick detail of findings?

19. What does the Field look like? Some Tools – PubMed Health Services Research Special Queries http://www.nlm.nih.gov/nichsr/hedges/search.html – PubMed Reminer – http://bioinfo.amc.uva.nl/human- genetics/pubreminer/ http://bioinfo.amc.uva.nl/human- genetics/pubreminer/

26. Similar Reviews? http://www.mendeley.com/groups/518691/cochrane- qes-register/ http://www.mendeley.com/groups/518691/cochrane- qes-register/

27. Some Practicalities Use of/Selection of Methodological Filters Key studies for Citation Searching Examples of Data Extraction Forms Selection of Critical Appraisal Checklist Innovative Ways of Presentation

28. Conclusions Question may involve experience of Condition as well as Intervention studies Scoping is Time Well-Spent Searching will be more challenging Sifting will be more time-consuming Allow extra time for Interpretation (Synthesis is not an End but a Means!)

29. References - 1 Barnett-Page E, Thomas J. Methods for the synthesis of qualitative research: a critical review. BMC Med Res Methodol. 2009 Aug 11;9:59. Booth, A, Papaioannou, D and Sutton, A J (2011). Systematic Approaches to a Successful Literature Review. SAGE publications Candy B, King M, Jones L, Oliver S. Using qualitative synthesis to explore heterogeneity of complex interventions. BMC Med Res Methodol. 2011 Aug 26;11:124. Dixon-Woods M, Agarwal S, Young B, Jones D, Sutton A. (2004) Integrative approaches to qualitative and quantitative evidence. London: Health Development Agency Gough, D, Oliver, S, Thomas J (2012) An Introduction to Systematic Reviews. London: Sage Publications. Lorenc, T., Pearson, M., Jamal, F., Cooper, C. and Garside, R. (2012), The role of systematic reviews of qualitative evidence in evaluating interventions: a case study. Res. Synth. Method, 3: 1–10.

30. References - 2 Popay J, Roberts H, Sowden A, Pettticrew M, Arai L, Rodgers M, Britten N: Guidance on the conduct of narrative synthesis in systematic reviews. http://www.lancs.ac.uk/fass/proj ects/nssr/2007. http://www.lancs.ac.uk/fass/proj ects/nssr/2007 Pope C, Mays N, Popay J: Synthesizing Qualitative and Quantitative Health Evidence: a Guide to Methods. Maidenhead: Open University Press; 2007. Ring N., Ritchie K, Mandava L, Jepson R. (2011) A guide to synthesising qualitative research for researchers undertaking health technology assessment and systematic reviews. NHS Quality Improvement Scotland and University of Stirling, Edinburgh. Snilstveit, B., Oliver, S., & Vojtkova, M. (2012). Narrative approaches to systematic review and synthesis of evidence for international development policy and practice. Journal of development effectiveness, 4(3), 409- 429. Thomas J, Harden A (2009) Methods for the thematic synthesis of qualitative research in systematic reviews, BMC Medical Research Methodology 8:45