Qualitative meta‐synthesis
2022; Wiley; Volume: 32; Issue: 1 Linguagem: Inglês
10.1111/nae2.12036
ISSN1750-4910
Autores Tópico(s)Nursing Diagnosis and Documentation
ResumoNurse Author & EditorVolume 32, Issue 1 p. 15-18 OPINIONFree Access Qualitative meta-synthesis Sally Thorne, Corresponding Author Sally Thorne sally.thorne@ubc.ca orcid.org/0000-0002-1156-9425 Correspondence Sally Thorne, Email: sally.thorne@nursing.ubc.caSearch for more papers by this author Sally Thorne, Corresponding Author Sally Thorne sally.thorne@ubc.ca orcid.org/0000-0002-1156-9425 Correspondence Sally Thorne, Email: sally.thorne@nursing.ubc.caSearch for more papers by this author First published: 05 March 2022 https://doi.org/10.1111/nae2.12036AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat INTRODUCTION The question of what do to with a body of qualitative study reports on a particular topic has attracted many nurses to the promise of qualitative meta-synthesis. Conceptualizing it as potentially analogous to quantitative meta-analysis, they feel the allure of generating conclusive evidence that includes the kinds of subject and experiential phenomena explicitly written out of both population-based reports and clinical qualitative measurement studies. However, given the complexity and diversity of qualitative inquiries in our discipline and beyond, the problem of qualitative synthesis is a decidedly different challenge from that of meta-analysis, in which comparable studies of equivalent quality can be aggregated to generated more significant and therefore potentially more conclusive truths. Margarete Sandelowski, a wise and prolific early qualitative nursing meta-synthesist, captured the dilemma quite perfectly by posing the question "How do you sum up a poem?" (p. 366).1 PURPOSE AND BACKGROUND Many of the approaches we now think of collectively as qualitative meta-synthesis originated in the social sciences in an attempt to move the field of qualitatively derived understandings from "little islands of knowledge" (p. 181)2 toward grand sociological theories. Among the first to adapt the idea to the intellectual projects of the applied disciplines were educators Noblit and Hare,3 whose meta-ethnography created a means by which to illuminate evolving interpretations within a field and to cross-interrogate each from the perspective of all others. As nursing and other health researchers began to take up the challenge in the 1990s, they were inspired by the rapidly increasing enthusiasm for quantitative meta-analysis, which was being promoted as among the most significant methodological advancements of the century, expanding the power and precision of research to answer an increasing range of questions for which conventional methodologies had proven inadequate.4 In this evolving context, a range of new meta-synthesis options were introduced into the health research methodology literature, each with its own particular slant and interpretation, and each attracting its own adherents and detractors (see Table 1). Their shared aspiration was to create a methodological vehicle in the form of a prescribed sequence of analytic and synthetic maneuvers applied to an extant body of published qualitative work through which scholars could arrive at overarching or synoptic claims about phenomena of concern to their applied health fields.5 TABLE 1. Some of the early approaches to qualitative meta-synthesis in the applied health fields Year Authors Qualitative meta-synthesis approach 1988 Noblit and Hare3 Meta-ethnography 1994 Estabrooks, Field and Morse6 Qualitative data aggregation 1977 Schreiber, Crooks and Stern7 Qualitative meta-analysis 1998 Popay, Rogers and Williams8 Qualitative systematic review 2001 Kearney9 Grounded formal theory 2001 Paterson, Thorne, Canam, and Jillings10 Meta-study 2003 Sandelowski and Barosso11 Meta-summary 2004 Greenhalgh12 Meta-narrative The primary aim of this short paper is to guide readers through what has become an expanding array of methodological options within the overall rubric of qualitative meta-synthesis. However, given the inflated expectations that have arisen from the conflation between meta-synthesis and its quantitative cousin meta-analysis, a secondary aim is to temper enthusiasm with a realistic sensibility around what it is that qualitative meta-synthesis can and cannot contribute to nursing's evolving knowledge base. It is essential that prospective researchers approach meta-synthesis well informed about the kinds of questions they can appropriately ask of it as well as the nature of the bodies of qualitatively derived material about which they might ask those questions. Further, for work within this genre to have ongoing scholarly integrity, it is of vital importance that there be a coherent alignment between the processes of meta-synthesis and the kinds of conclusions one can logically draw from it. CONDUCTING A QUALITATIVE META-SYNTHESIS The defining characteristic of any systematic review is the use of predetermined and structured protocols to search, screen, appraise, select and summarize study findings in order to answer a narrowly focused research question.13, 14 This involves identifying all possibly relevant published studies, and then applying clearly justified exclusion criteria so as to delimit the subset to be included in the final analysis and synthesis (for detailed methodological guidance, I recommend Malterud15 or Sandelowski and Barroso4). Often hundreds or even thousands of possible study reports are reduced to a tiny fraction of the whole, typically characterized by their similarity. On the basis of that exclusion exercise, claims are made that can have the appearance of representing an entire body of research, even though they capture only those which have held common characteristics as determined by the tight web of the design.16 In the quantitative world, if we are seeking confirmation of the efficacy of a particular intervention for example, this rigidity and emphasis on objectivity and exclusion makes excellent sense. In the world of qualitative meta-synthesis, where we are so often dealing with subjectivities and human experiences, it can play havoc with the logical flow of argument with respect to what exists and what we can make of it. And despite our best efforts to be procedurally objective, Sandelowski reminds us that all reviews are ultimately a form of "disciplined subjectivity," inherently partial, situated, and reflective of a particular moment in time.17 Among the various methodological approaches to qualitive meta-synthesis, we see a significant tension between authors who see the method as inherently critical, reflective, and integrative, and those who see it as primarily aggregative. As a critically interpretive approach, meta-synthesis allows the scholar to unpack and peer into the impact of methodological choices, theoretical positionings, study contexts, and data sets to cross-interrogate the intricate details that explain the perspectives various scholars have drawn from their inquiries, allowing for increasingly comprehensive understandings of phenomena across time and space. This involves truly digging deep into what the individual primary researchers were doing and thinking, and coming to an appreciation for how and why the findings of each study were presented in the manner that they were in the published reports. Within this style of meta-synthesis, even the most straightforward steps in the process (such as locating the findings within a written report, let alone classifying interpreting and integrating them) become much more complicated (and interesting) than one might initially have anticipated.4 Understandably, an approach of this nature requires a depth and range of formal and disciplinary cultural knowledge, including the nuances of language signifiers across study methodologies and academic communities, to be able to interpret the procedural and intellectual ingredients that have shaped each published study report.18, 19 Because of this, in the early days of qualitative meta-synthesis, it was assumed that this method was best managed by interdisciplinary teams of experienced scholars. CONSIDERATIONS Over time, however, the allure of being able to work with qualitative material in a systematic manner while bypassing the exhaustive and time-consuming process of generating an original qualitative dataset has placed qualitative meta-synthesis in the hands of a range of scholars, including those who are less prepared for the intensity of that critically reflective kind of work. Over the past 2 decades, there has been an explosion of published reports claiming a meta-synthesis methodological orientation, a significant proportion of them demonstrating a much different look and feel from the in-depth kinds of projects envisioned by the likes of Noblit and Hare.20 Many of these newer meta-synthesis reports follow the tightly focused and rigidly structured formats of the Cochrane Collaboration for evidence-based practice, or by JBI (formerly known as the Joanna Briggs Institute), a network of partners who collaborate to develop best practice guides for systematic reviews and to train systematic reviewers.21 This kind of product tends to be decidedly aggregative rather than interpretive,22, 23 or as Bergdahl recently characterized it, "turning rich descriptions into thin reductions" (p. 1).24 Based on an assumption that screening out weaker studies allows one to draw better conclusions – an idea that makes complete sense in the world of meta-analysis – many of the aggregative variety of meta-synthesis reports rely on quality appraisal "checklists" that reflect a rather narrow view of what qualitative inquiry is or ought to be. In this context, rather arbitrary decisions as to the supposed features of "good" studies are used to justify narrowing the field to sets of similar studies, as if that represents the entirety of legitimate knowledge guiding a field. However, in a discipline such as nursing, in which recognition of multiple knowledge sources is an accepted means by which to enhance and deepen our interpretation of the phenomena of concern to practice, screening out atypical sources seems far less reasonable than does examining them with a critically reflective lens to explore and extract any potential value. These methodological tensions in the field challenge us to reflect on what the point of qualitative meta-synthesis ought to be within our discipline and, depending on where you land in relation to that question, how it should be conducted. Within the evidence-based practice approach, methodological rules tend to become the primary quality indicator. However, because these products are characterized as a form of systematic review, that nomenclature conveys a sense that they represent a privileged (more certain, more accurate) contribution to knowledge than they may justifiably deserve.25 At their worst, they expropriate qualitatively derived insights from the original scholars whose hard-earned inquiries have grounded them, transforming them into a convenient summary format that may be more likely than the primary studies to attract citations. At best, they add little to the available knowledge beyond what a mediocre scholar could glean on the basis of an afternoon's reading in the library.18, 20 At the opposite end of the spectrum are those scholars who argue for qualitative meta-synthesis as an interpretive, inductive, and critically reflective kind of knowledge product. As Malterud puts it, "qualitative meta-synthesis is supposed to have an interpretive ambition beyond re-narration" (n.p.)15 Proponents of this approach tend to be far less concerned about pre-determined rule-following, including fetishizing quality claims with respect to the integrity of the studies that have produced the original reports. Rather, they will be much more attentive to the presence of an auditable line of reasoning that leads readers to the interpretive conclusions they make on the basis of their cross-comparative inquiry process.17, 18 For a qualitative meta-synthesis to go beyond cataloguing what is already known and into the territory of original scholarly thought, it requires a research question that is thoughtful and well informed. It is not the entrée into the literature as much as an insightfully determined preliminary angle of analysis with sufficient flexibility to allow you to approach most of the potentially relevant research that is available.15 From there, it requires an ongoing set of finely-tuned contextual inclusion and exclusion decisions, tracking not only the logic but also the implications of each on the final result. The more you immerse yourself in critical reflection of the body of qualitative literature in your field, the more fully you come to appreciate the marvelous complexity and "permeable boundaries" of issues, such as whether your phenomenon of interest will have evolved over time, co-existed with other phenomena in different contexts, or been spoken about using different languages and conceptualizations within different disciplines and scholarly communities.26 The paradox of qualitative meta-synthesis is that, although it might be reduced to a technical "data management" exercise in the hands of those who are sufficiently naïve or disinterested to overlook the complexity of health and human phenomena, its power as a methodology only becomes apparent when used by those with the capacity to handle the messiness of these concerns so that they can bring the original thought leaders together into an imaginary creative dialogue capable of capturing multiple ways of understanding across time, context and positionality. Done well, what it makes possible is wisdom, not factual knowledge. CONCLUSION Qualitative meta-synthesis as it is currently being popularized runs the risk of being reduced to a technical exercise with little relevance to meaningful knowledge-building and, of even more concern, the probability of significantly misrepresenting the potential value of an extant body of qualitatively-derived health and illness understanding. Instead of relying upon procedural guidelines developed within the evidence-based movement to strip context and variation from our extant qualitative research, the more critically reflective approaches to qualitative bodies of literature hold tremendous potential for helping us understand what we think we know, and the basis upon which we think we know it. Nursing has long been attracted to qualitative inquiry approaches because they allow us to enter the complexities, subjectivities, and social/political contexts of human health experience. As we take up these systematic approaches to investigating these bodies of qualitative material, I hope we can make it a disciplinary priority to ensure that our methods do justice to the integrity of what has created these marvelous original contributions to our literature, so that the measure of a good meta-synthesis lies squarely in the extent to which it can advance our collective thinking. Biography Sally Thorne, RN, PhD, FAAN, FCAHS, FCAN, is Professor at the School of Nursing, University of British Columbia in Vancouver, Canada, where she also serves as Associate Dean for the Faculty of Applied Science. She is Editor-in-Chief of the journal Nursing Inquiry, and a member of the Authors-in-Residence for Nurse Author & Editor. REFERENCES 1 Sandelowski M, Docherty S, Emden C. Qualitative metasynthesis: issues and techniques. Res Nurs Health. 1997; 20(4): 365- 371. https://doi.org/10.1002/(sici)1098-240x(199708)20:4 3.0.co;2-e Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 2 Glaser BG, Strauss AL. Status Passage. Aldine; 1971. Google Scholar 3 Noblit G, Hare R. Meta-Ethnography: Synthesizing Qualitative Studies. Sage; 1988. CrossrefGoogle Scholar 4 Sandelowski M, Barroso J. Handbook for Synthesizing Qualitative Research. Springer; 2007. Google Scholar 5 Finfgeld DL. Metasynthesis: the state of the art--so far. Qual Health Res. 2003; 13(7): 893- 904. https://doi.org/10.1177/1049732303253462 CrossrefPubMedWeb of Science®Google Scholar 6 Estabrooks CA, Field PA, Morse JM. Aggregating qualitative findings: an approach to theory development. Qual Health Res. 1994; 4(4): 503- 511. https://doi.org/10.1177/104973239400400410 CrossrefGoogle Scholar 7 Schreiber R, Crooks D, Stern PN. Qualitative meta-analysis. In: JM Morse, ed. Completing a Qualitative Project: Details and Dialogue. Sage; 1997: 311- 326. Web of Science®Google Scholar 8 Popay J, Rogers A, Williams G. Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res. 1998; 8(3): 341- 351. https://doi.org/10.1177/104973239800800305 CrossrefCASPubMedWeb of Science®Google Scholar 9 Kearney MH. New directions in grounded formal theory. In: S Schreiber, PN Stern, eds. Using Grounded Theory in Nursing. Springer; 2001: 227- 246. Google Scholar 10 Paterson BL, Thorne S, Canam C, Jillings C. Meta-study of Qualitative Health Research. Sage; 2001. CrossrefGoogle Scholar 11 Sandelowski M, Barroso J. Creating metasummaries of qualitative findings. Nurs Res. 2003; 52(4): 226- 233. https://doi.org/10.1097/00006199-200307000-00004 CrossrefPubMedWeb of Science®Google Scholar 12 Greenhalgh T. Meta-narrative mapping: a new approach to the systematic review of complex evidence. In: B Hurwitz, Greenhalgh, V Skultans, eds. Narrative Research in Health and Illness. Blackwell; 2004: 349- 381. Wiley Online LibraryGoogle Scholar 13 Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Vol. 4. John Wiley & Sons; 2011. Google Scholar 14 Morton S, Berg A, Levit L, Eden J. Finding What Works in Health Care: Standards for Systematic Reviews. National Academies Press; 2019. Google Scholar 15 Malterud K. Qualitative Metasynthesis: A Research Method for Medicine and Health Sciences. Routledge; 2019. CrossrefGoogle Scholar 16 Greenhalgh T, Thorne S, Malterud K. Time to challenge the spurious hierarchy of systematic over narrative reviews? Eur J Clin Invest. 2018; 48(6):e12931. https://doi.org/10.1111/eci.12931 Wiley Online LibraryPubMedWeb of Science®Google Scholar 17 Sandelowski M. Reading, writing and systematic review. J Adv Nurs. 2008; 64(1): 104- 110. https://doi.org/10.1111/j.1365-2648.2008.04813.x Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 18 Thorne S. On the evolving world of what constitutes qualitative synthesis. Qual Health Res. 2019; 29(1): 3- 6. https://doi.org/10.1177/1049732318813903 CrossrefPubMedWeb of Science®Google Scholar 19 Thorne S, Jensen L, Kearney MH, Noblit G, Sandelowski M. Qualitative metasynthesis: reflections on methodological orientation and ideological agenda. Qual Health Res. 2004; 14(10): 1342- 1365. https://doi.org/10.1177/1049732304269888 CrossrefPubMedWeb of Science®Google Scholar 20 Thorne S. Metasynthetic madness: what kind of monster have we created? Qual Health Res. 2017; 27(1): 3- 12. https://doi.org/10.1177/1049732316679370 CrossrefPubMedWeb of Science®Google Scholar 21 Lockwood C, Porrit K, Munn Z, et al. Chapter 2: systematic reviews of qualitative evidence. In: E Aromataris, Z Munn, eds. JBI Manual for Evidence Synthesis. JBI; 2020. https://doi.org/10.46658/JBIMES-20-03. Available from: https://synthesismanual.jbi.global CrossrefGoogle Scholar 22 Greenhalgh T. Outside the box: why are Cochrane reviews so boring? Br J Gen Pract. 2012; 62(600): 371. https://doi.org/10.3399/bjgp12X652418 CrossrefPubMedWeb of Science®Google Scholar 23 Ioannidis JP. The mass production of redundant, misleading, and conflicted systematic reviews and meta-analyses. Milbank Q. 2016; 94(3): 485- 514. https://doi.org/10.1111/1468-0009.12210 Wiley Online LibraryPubMedWeb of Science®Google Scholar 24 Bergdahl E. Is meta-synthesis turning rich descriptions into thin reductions? A criticism of meta-aggregation as a form of qualitative synthesis. Nurs Inq. 2019; 26(1):e12273. https://doi.org/10.1111/nin.12273 Wiley Online LibraryPubMedWeb of Science®Google Scholar 25 Alper BS, Haynes RB. EBHC pyramid 5.0 for accessing preappraised evidence and guidance. Evid Based Med. 2016; 21(4): 123- 125. https://doi.org/10.1136/ebmed-2016-110447 CrossrefPubMedGoogle Scholar 26 Sandelowski M. Metasynthesis of qualitative research. In: H Cooper, PM Camic, DL Long, AT Panter, D Rindskopf, KJ Sher, eds. APA Hand Res Methods Psychol, Vol. 2. American Psychological Association; 2012: 19- 36. CrossrefGoogle Scholar Volume32, Issue1March 2022Pages 15-18 This article also appears in:STATE OF REVIEWS ReferencesRelatedInformation
Referência(s)