Qualitative Metasynthesis
A Research Method for Medicine and Health Sciences

Qualitative Metasynthesis presents a research method developed for upcycling and synthesis of qualitative primary studies, aimed at researchers within medicine and health sciences.

This book demonstrates how and why qualitative metasynthesis can be a method for reuse and expansion of medical knowledge. It presents the principles of metasynthesis as a qualitative research method, so that the reader can assess whether this is a research strategy that fits the aim of their study. The author offers practical advice for conducting research using this methodology. The presentation is illustrated by a study carried out by the author and collaborators, reflecting on real-life challenges and solutions as an example of meta-ethnography, one of the most frequently used strategies for qualitative metasynthesis. The author also looks at systematic reviews, a methodology developed within in the tradition of evidence-based medicine, discussing strengths, weaknesses and pitfalls of this methodology. Rooted in the interpretative paradigm, qualitative metasynthesis challenges several of the principles from the evidence-based medicine tradition, offering reflections on challenges when epistemologically very different methodologies intersect.

This book should be considered essential reading for anyone carrying out qualitative research within the fields of medicine, health and social care.

1. Utilization and upcycling of existing research

knowledge

We do not have to start from scratch

Qualitative studies – an open mind, but no blank slates

Research waste or exploiting knowledge capital? Recycling, upcycling and sustainable

management of knowledge resources What will this book offer you?

The role of the nursing home doctor in end-of-life care – a concrete example

From chaos and individual research reports to systematic reviews

Comprehensive and critical reading of

the research literature The information deluge Broad mapping

Systematic reviews – a specific kind of research literature summary

Evidence from research results Multipurpose knowledge capital Evidence-based medicine

Different research questions require

different evidence from relevant methodologies

From summary and renarration to interpretation and synthesis Descriptive, interpretative or both? Meta-analysis

Qualitative metasynthesis

Which kinds of research questions can

be studied with qualitative metasynthesis?

2. Project planning and literature management

Careful preparations are profitable investments Summing up research – a stepwise process

A research question that is both flexible

and determined Choosing a strategy

The protocol 24

Registration of the project

Literature search

Overview and steady course

Search strategy

Search terms in logical combinations Search sources and databases

Grey literature

Language

Before you set off seriously

Screening and selection of potentially relevant primary studies Reference management

Systematic screening and rough classification Reading candidate articles in depth

with quality assessment Supplementary search

What characterizes your sample?

Flowsheet for search and selection Hallmarks of the primary studies Identification of results from the

primary studies

Organizing the material from data extraction

3. Analysis and synthesis

Interpretation of the results from the primary studies

Synthesis is more than summary and renarration

Levels of interpretation – concepts of first, second and third orders

Different strategies for metasynthesis

Meta-ethnography

Background

Metaphors and translations

Analytical perspectives

Strategy for analysis – seven steps The matrix as a tool for analysis

A specific example of analysis and synthesis Contemporary meta-ethnography

Other methods for qualitative metasynthesis Critical interpretive synthesis

Thematic synthesis

Realist synthesis

Reporting your study – writing the article

Elements in the article

Method, material and analysis Synthesis and results

Transparency in reporting qualitative metasyntheses

4. Theoretical and methodological challenges

Qualitative methods encounter evidence-based medicine

Scientific paradigms

Common features, differences and opposites

Social anthropology and metasynthesis

A complete and independent literature review?

Situated knowledges

Cherry picking

Finding the needle in the haystack Independent appraisals or bias?

Which evidence is the best evidence?

The evidence hierarchy

A universal gold standard?

Grading of evidence

New pyramids

Diversity or standardization of knowledge

Merging apples and oranges – the synthesis of heterogeneous data

Sustainable evidence

Three steps forward and two steps back

Grading of qualitative metasynthesis

Mixed methods and qualitative metasynthesis

Qualitative and quantitative methods in the same study

Multi-methodological exploration of complex research questions

Qualitative metasynthesis with mixed methods Synthesis of qualitative primary studies

with different designs

5. Final comments

Ethics and privacy protection Regulations and approvals

Distance as a challenge

Contributing something new

What do you need to conduct a qualitative metasynthesis?

Competence and experience

Relevant primary studies with useful presentations of results

Resources and personal traits

Set off!

You are not alone

Newer and more exciting Wheat or chaff?

Sustainable competence – new

opportunities for collaboration

References

Index

Kirsti Malterud, MD PhD, was a general practitioner for 35 years, combined with academic work as a researcher at Uni Research/NORCE Research Centre and a Professor of General Practice at the University of Bergen, Norway. Her list of research publications is extensive, with empirical studies about vulnerable groups of patients as well as methodological contributions on qualitative research methods.