Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research
Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research
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DOI：
10.3310/hta15430
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发表时间：
2011-12-01
影响因子：
3.6
通讯作者：
Donovan, J.
中科院分区：
文献类型：
--
作者：
Campbell, R.;Pound, P.;Donovan, J.
背景：医疗保健领域定量研究结果的综述和综合方法已经很成熟。尽管人们认识到需要将定性研究纳入证据基础，但对于应该如何做以及定性研究综合方法的发展还处于相对早期阶段，尚未达成共识。
目的：评估元民族志作为一种综合健康和医疗保健领域定性研究的方法。
方法：2002年4月至2004年9月期间，使用元民族志对定性研究进行了两次全面综合：（1）服药研究；（2）探索类风湿性关节炎患者生活体验的研究。2002年7月和8月通过多次文献检索（电子检索和手工检索）确定的潜在相关研究，使用批判性评估技能计划中用于理解定性研究问题的修订版进行评估。候选论文因与综合目的无关或因未采用定性的数据收集和分析方法而被排除。
结果：38项研究纳入服药综合，其中1项未对最终综合有贡献。综合结果显示人们对服药普遍持谨慎态度，自行测试药物的做法很普遍。人们被发现被动服药、主动服药或完全拒绝服药。在某些临床领域，有些人是被迫服药的。那些主动接受药物的人经常在医生不知情的情况下修改医生规定的用药方案。综合结论是，人们经常不按规定服药是因为担心药物本身。“抵抗”作为一个概念从综合中浮现出来，它最能概括非专业人员对处方药的反应。有人建议政策重点应放在与药物本身相关的问题上，以及评估一些人优先使用的替代治疗的有效性。对类风湿性关节炎患者生活体验的研究综合始于29篇论文。4篇无法综合，剩下25篇论文（描述22项研究）对最终综合有贡献。大多数论文关注的是类风湿性关节炎患者的日常生活体验。这次综合没有产生重大的新见解，可能是因为该领域早期的论文内容丰富且理论性强，后期的论文大多是验证性的。在这两个主题领域，综合中只有少数研究相互引用，这表明出现了不必要的重复。
局限性：我们仅评估了元民族志作为一种综合定性研究的方法，但还有其他方法正在被使用。需要进一步研究以调查不同的定性综合方法如何影响综合结果。
结论：元民族志是一种综合定性研究的有效方法。如果严格应用将每项个体研究的结果相互转化为综合中所有其他研究结果的过程，就能确保定性数据可以被整合。遵循这一关键过程，综合结果可以表述为一种“论证思路”，可以以文本形式以及汇总表、图表或模型呈现。元民族志可以产生重大的新见解，但并非所有元民族志综合都能如此。相反，有些综合会确定一些已经达到饱和且一段时间内没有理论发展的领域。这两种结果对于推动研究进展或避免资源浪费都有帮助。元民族志是一种高度解释性的方法，需要深入研究个体研究才能实现综合。它对综合者有很高的要求，需要具备高度的定性研究技能。元民族志作为定性卫生技术评估中的一种综合方法具有很大潜力，但它仍在发展，目前不能被视为一种能够常规应用的标准化方法。
Background: Methods for reviewing and synthesising findings from quantitative research studies in health care are well established. Although there is recognition of the need for qualitative research to be brought into the evidence base, there is no consensus about how this should be done and the methods for synthesising qualitative research are at a relatively early stage of development.Objective: To evaluate meta-ethnography as a method for synthesising qualitative research studies in health and health care.Methods: Two full syntheses of qualitative research studies were conducted between April 2002 and September 2004 using meta-ethnography: (1) studies of medicine-taking and (2) studies exploring patients' experiences of living with rheumatoid arthritis. Potentially relevant studies identified in multiple literature searches conducted in July and August 2002 (electronically and by hand) were appraised using a modified version of the Critical Appraisal Skills Programme questions for understanding qualitative research. Candidate papers were excluded on grounds of lack of relevance to the aims of the synthesis or because the work failed to employ qualitative methods of data collection and analysis.Results: Thirty-eight studies were entered into the medicine-taking synthesis, one of which did not contribute to the final synthesis. The synthesis revealed a general caution about taking medicine, and that the practice of lay testing of medicines was widespread. People were found to take their medicine passively or actively or to reject it outright. Some, in particular clinical areas, were coerced into taking it. Those who actively accepted their medicine often modified the regimen prescribed by a doctor, without the doctor's knowledge. The synthesis concluded that people often do not take their medicines as prescribed because of concern about the medicines themselves. 'Resistance' emerged from the synthesis as a concept that best encapsulated the lay response to prescribed medicines. It was suggested that a policy focus should be on the problems associated with the medicines themselves and on evaluating the effectiveness of alternative treatments that some people use in preference to prescribed medicines. The synthesis of studies of lay experiences of living with rheumatoid arthritis began with 29 papers. Four could not be synthesised, leaving 25 papers (describing 22 studies) contributing to the final synthesis. Most of the papers were concerned with the everyday experience of living with rheumatoid arthritis. This synthesis did not produce significant new insights, probably because the early papers in the area were substantial and theoretically rich, and later papers were mostly confirmatory. In both topic areas, only a minority of the studies included in the syntheses were found to have referenced each other, suggesting that unnecessary replication had occurred.Limitations: We only evaluated meta-ethnography as a method for synthesising qualitative research, but there are other methods being employed. Further research is required to investigate how different methods of qualitative synthesis influence the outcome of the synthesis.Conclusions: Meta-ethnography is an effective method for synthesising qualitative research. The process of reciprocally translating the findings from each individual study into those from all the other studies in the synthesis, if applied rigorously, ensures that qualitative data can be combined. Following this essential process, the synthesis can then be expressed as a 'line of argument' that can be presented as text and in summary tables and diagrams or models. Meta-ethnography can produce significant new insights, but not all meta-ethnographic syntheses do so. Instead, some will identify fields in which saturation has been reached and in which no theoretical development has taken place for some time. Both outcomes are helpful in either moving research forward or avoiding wasted resources. Meta-ethnography is a highly interpretative method requiring considerable immersion in the individual studies to achieve a synthesis. It places substantial demands upon the synthesiser and requires a high degree of qualitative research skill. Meta-ethnography has great potential as a method of synthesis in qualitative health technology assessment but it is still evolving and cannot, at present, be regarded as a standardised approach capable of application in a routinised way.