Acknowledging a Dual Heritage for Qualitative Evidence Synthesis: Harnessing the Qualitative Research and Systematic Review Research Traditions

Qualitative evidence synthesis, an umbrella term that includes all forms of secondary qualitative synthesis and analysis including qualitative systematic review, has emerged from the confluence of conventional systematic review methods with methods for primary qualitative research. With such a mixed heritage, and the juxtaposition of quite different epistemological positions, it is inevitable that the resultant tensions have generated considerable creative energy and significant methodological frictions. These tensions have created an environment within which I have sought to make a contribution. Working with colleagues within the School of Health and Related Research (ScHARR), University of Sheffield, and collaborators at other institutions, including fellow co-convenors of the Cochrane Collaboration Qualitative Methods Group, I have examined the state of qualitative synthesis methods (Paper M1). I have traced and examined the respective contributions of the two components of the mixed heritage through five methodological papers that examine the stages of the systematic review process; searching (Paper M2), quality assessment (Paper M3), framework and thematic synthesis (Paper M4) and exploring heterogeneity (Paper M5) through to consideration of reporting standards (Papers M1-M3). This Thesis explores these issues through five case studies (Case Studies 1-5) to which I have contributed as lead methodologist. While, initially at least, the legacy of conventional systematic review methods could be seen to enjoy dominance, an emerging imperative to review systematically different types of evidence to explore different review questions, coupled with reduced time and resource envelopes within which to address time-critical questions from policy and practice, has opened up a more versatile and pragmatic toolkit. The Thesis concludes by identifying key methodological issues that require further investigation. I contend that many outstanding methodological challenges may derive their most productive insights from a more detailed consideration of corresponding solutions from primary qualitative research. The five papers in this body of work, therefore, make an original contribution to knowledge by establishing and demonstrating methodological principles by which flexible and context sensitive application of the versatile systematic review model can be used to meet the pragmatic demands of health services research and technology assessment.