ESRC Methods Festival 2008 Session 55 : Interpretive Synthesis

Meta Ethnography

Catherine Pope 3 July 2008

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Meta-ethnography : synthesizing qualitative studies

George W. Noblit & R Dwight Hare

Qualitative Research Methods Series

Sage, 1988

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Definition of synthesisActivity or the product of activity where some set of parts is combined or integrated into a whole…

(Synthesis) involves some degree of conceptual innovation, or employment of concepts not found in the characterization of the parts as a means of creating the whole

Strike & Posner (1983) in Noblit & Hare (1988)

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Features of meta ethnography

• Comparative and systematic synthesis of published research

• Interpretive rather than aggregative

• Translation of qualitative studies into one another

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Synthesis: how studies are related

• Directly comparable as ‘reciprocal’ translations

• Studies taken together represent a ‘line of argument’

• (rarely) in opposition to each other as ‘refutational’

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7 Stages in meta ethnography • Getting started : formulating the research ‘interest’

• Deciding what is relevant (mapping, searching, selection)

• Repeated reading of studies

• Decide how studies are related

• Translation (analogous to constant comparison)

• Synthesizing the translations (second order construct)

• Expression (writing/presentation)

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Exercise: identifying concepts • Syndicate reading (10 min)• You have 1 of 2 papers - read the findings/discussion NOT the

whole paper.

• Identify the key concepts (10 min) • Working with your group, fill in the grid supplied. You may

identify – first order concepts (every day understandings

/respondents’ terms used in the paper)– second order concepts (authors’ labels for themes/

concepts authors’ develop in the paper)• Feedback (10 min)

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Reciprocal translation• Similar to constant comparison

• look for overlap

• are some concepts better than others in terms of scope and use.

• sometimes we learn more from this process of translation than from the concepts alone.

• Aim for third order concepts/ theory/ our interpretation

• Chart/draw ‘mindmap’ of connections between concepts

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Evaluating meta ethnography

Rona Campbell1, Nicky Britten2, Pandora Pound1, Myfanwy Morgan4,

Roisin Pill5, Catherine Pope3, Lucy Yardley6, Gavin Daker-White1, Jenny Donovan1

1Department of Social Medicine, University of Bristol, 2Peninsula Medical School, Universities of Exeter, and Plymouth 3School of Nursing and Midwifery, University of Southampton, 4Department of Public Health Sciences, King’s College, London 5Department of General Practice, University of Wales College of Medicine, Cardiff. 6

Department of Psychology, University of Southampton

Funded by MRC HSRC & NHS HTA

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Medicines synthesisPapers whose primary focus is patients’ views of medicines prescribed and taken for the treatment of a long or short term condition (excluding medicines only taken for preventive purposes)

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10 years: 1992-2001 inclusive• Electronic searches: 21 studies

Medline, Embase, Cinahl, Web of Science, PsychInfo, Zetoc

• Handsearches: 21 studies

Checking with team members, going through journals, checking references, library searches, reference manager, concordance website

• Total: 42 studies

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Number of studies by condition

0

2

4

6

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10

12

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Translating studies into each otherBritten 1996

• ‘Unorthodox accounts’: People giving these accounts more likely to be critical of medication, described it as unnatural and damaging, be critical of doctors and generally active rather than passive

Lumme-Sandt et al 2000

• ‘Self-help repertoire’: People offering this type of account preferred natural remedies, had strong negative views about medication and did not obey doctors

• ‘Moral repertoire’: These people stressed they only took a little medication, used it responsibly and moderately, when explaining why they needed medication gave reasons beyond their control

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Example of synthesising translations across illness groups

‘Rejecters/sceptics’ Dowell & Hudson (general medication)

Reject medication due to their values, bypassing testing process.

‘Unorthodox Accounts’ Britten (general medication)

‘Self-help repertoire’ Lumme-Sandt et al (general medication)

‘Purposeful non-adherence’ Johnson et al (hypertension)

A conscious decision not to take drugs, possibly following testing

‘Active users’ Dowell & Hudson (general medication)

Conscious decision to modify regimen, following testing and deliberation

‘Justifiers and Excusers’ (Siegel et al (HIV)

Excuses offered by those who ‘admit behaviour wrong but deny responsibility’. Justifications offered by those who ‘take responsibility for behaviour yet deny it has negative consequences’.

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Model of medicine taking

Passive accepters – accept medicine without questionActive

accepters – accept medicine after evaluating it

Take medicines and follow prescription

Medicine prescribed

Worries and concerns about medicine

Some concerns can be dealt with through process of evaluation

Take medicines but not as prescribed

Active modifiers – modify regimen after evaluating it

Rejecters – reject regimen completely

Some concerns cannot be resolved through evaluation and may affect medicine taking

Issues to do with identity may affect medicine taking

These groups show resistance

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Reconceptualising findingsResistance

• The strategies people adopted to manage their medicine taking indicate varying degrees of resistance to the prescriptions they were given.

• The literature on “non compliance” only exists because people have resisted taking medicines despite sustained advice.