Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups.
Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups.
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DOI：
10.1186/1471-2288-6-35
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发表时间：
2006-07-26
影响因子：
4
通讯作者：
Sutton, Alex J
中科院分区：
文献类型：
--
作者：
Dixon-Woods, Mary;Cavers, Debbie;Sutton, Alex J
背景：当综述的目的是对复杂的文献进行批判性分析时，传统的系统综述技术存在局限性。本文提供了对英国弱势群体获得医疗保健的文献进行解释性审查的尝试的反思性描述。 方法：该项目涉及批判性解释综合（CIS）方法的开发和使用。这种方法对传统系统审查方法的过程很敏感，并借鉴了解释性综合方法的最新进展。结果：许多对获取公平性的分析都依赖于卫生服务利用的衡量标准，但这些在方法论和概念上都存在问题。候选资格的综合结构提供了一种更有用的理解获取机会的方法。候选资格描述了人们如何在自己和医疗服务机构之间确定医疗保健的资格。它是个人不断协商的财产，受到人们及其社会背景以及资源分配和服务配置的宏观影响的多重影响。卫生服务不断地构建和寻求定义适当的医疗关注和干预对象，同时人们也参与构建和定义他们所理解的适当的医疗关注和干预对象。访问代表了这些同时、迭代和相辅相成的过程之间的动态相互作用。通过关注与候选资格相关的脆弱性如何出现，可以更好地理解获取现象，并为政策、实践和未来研究提出更合适的建议。讨论：通过对现有解释综合方法进行创新，不仅可以产生用于进行我们所谓的批判性解释综合的新方法，还可以产生获得医疗保健的新理论概念。这种对获取的理论解释与文献中已有的模型不同，是将不同的结构和证据组合成一个连贯整体的结果。该方法和模型都应该在其他环境中进行评估。
BACKGROUND: Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK METHODS: This project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis.RESULTS: Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research.DISCUSSION: By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.