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Meta-ethnographyDr Kate Flemming
Department of Health SciencesUniversity of York, UK
This is where it all began…..
R Dwight HareGeorge Noblit
So what’s it about?
• ‘The meaning of meta-ethnography for us is as a form of synthesis for ethnographic or other interpretive studies’ p14
• We use this term [meta-ethnography], in part, because of the analogy to meta-analysis. We share the goal of those proposing meta-analytic and integrative research reviews of “putting together” all the research available to us. p 25
(Noblit & Hare 1988)
This is about interpretive synthesis
The original text does not deal with other parts of the systematic reviewing process such as:
• Search strategies• Inclusion and exclusion criteria• Quality appraisal
Meta-ethnography
Most widely used method of qualitative synthesis reported (Hannes & Macaitis 2012)
Enables a systematic and detailed understanding of how studies are related, through the comparison of findings within and across studies. These are coded and condensed into themes which ultimately provide an interpretation of the whole body of research(Noblit and Hare 1988)
• However from the interpretive perspective how this is done depends on the substance of the individual studies and how they relate to each other
The principle method of synthesis
• Is around the notion of ‘Translation’• Noblit & Hare describe this as
‘one case is like another except that…’ (p38)
This is not dissimilar to constant comparison techniques
Family carers’ perceptions of their educational needs when providing end-of-life care
Smoking in pregnancy: findings from a systematic review of qualitative studies of women who commence pregnancy as smokers
The Seven Steps of Meta-ethnography
1. Getting startedNoblit and Hare say this is ‘finding something that is
worthy of a synthesis effort’ p26
Need to consider....• Is qualitative synthesis appropriate for the question
you are asking?• Is a synthesis on this topic needed? • What experience does the team need?
2. Deciding what is relevant
Scope of searching:Does it need to be exhaustive?• It depends on the purpose of the synthesis• There is a tendency to undertake exhaustive searching.• However searching can be pre-planned to be
comprehensive or iterative ie ‘seek all available concepts until saturation is achieved’ (Tong et al 2012)
• Various qualitative filters can be used‘qualitative’, ‘interviews’ & ‘findings’
2. Deciding what is relevant
Other top tips:
• Clear inclusion and exclusion criteria can be helpful• Use an information scientist if you can• Track your key papers
Carers review: what we found
• 5507 papers found & 5440 were excluded• After further sifting 67 papers were suitable for
inclusion• This was too many!• We re-read the papers and included those that
reported key concepts highly relevant to the study aims
• This left us with 35 papers reporting on 34 studies• At the end of the synthesis process we re-read the
papers not included and included any ‘absent concepts’
3. Reading the studies
‘Repeated re-reading of the accounts’ p28
During this stage you can also incorporate• Quality appraisal• Data extraction – possibly a two stage process
4. Determining how the studies are related
• Refers to how do you start to put the studies together
• ‘We think it makes sense to create a list of the key metaphors, phrases, ideas, and/or concepts in each account’ p28
• ‘When we talk about the key metaphors of a study, we are referring to what others may call the themes, perspectives, organizers, and/or concepts revealed by qualitative studies’ p14
• Then look at the relationship between them
Studies may be related to each other in one of four ways:
1. They can be about different things
2. They can be about roughly similar things
3. They can be studies that refute each other
4. They can be studies that progressively build a line of argument
Meta-ethnographic technique:
No point in synthesising!
Reciprocal translation
Refutational synthesis
Lines of argument synthesis
5. Translating the studies into one another
5. Translating the studies into one another
• Reciprocal translation analysis– in an iterative fashion one study is translated into another
• Refutational synthesis – studies amenable to general meta-ethnographic approach, but refutations are examined more closely
• Lines of argument synthesis – more about interpretation ‘what can we say about the whole based on the selective studies of the parts?’
5. Translating the studies into one another
• ‘Translations need to protect the particular, respect holism & enable comparison’ p28
‘I found that I was judged as a disgusting, uneducated, gutter rat. I found this by the way people would look, question my motives, make comments on my parental ability etc.’
(Wiggington & Lee 2012, p9)
How does this look in practice?
Flemming et al 2013
How does this look in practice?
Flemming et al 2013
6. Synthesising translations
• Synthesis refers to making a whole into something more than the parts alone imply
• Translations as a set are one level of meta-ethnographic synthesis
• The translations can be compared with one another to determine of there are some that can encompass others
• This presents the second level of synthesis and is often presented as a line of argument
How this looks in practice
Flemming et al 2013
7. Expressing the synthesis
• How do you go about telling people what you’ve done?
• Generally written for academic audiences• Does this limit how you write up a meta-
ethnography?• I would argue yes – mainly from the problem of
restrictions of word length in journals
• Suggested that play, art and music could all be relevant expressions!
• Before pregnancy
Being a smoker
• Through pregnancy
Quitting and trying to quit
• Point of delivery
Being a pregnant smoker
Continuing to smoke
The findings of the synthesis demonstrate how contexts constrain positive behaviour change:
Smoking status
Findings represented as diagrams
Questions?
Useful resources
Karin Hannes and Craig Lockwood (eds) (2012)Synthesizing Qualitative Research: Choosing the Right Approach J Wiley – Blackwell
Michael Saini & Aron Shlonsky (2012)Systematic Synthesis of Qualitative Research (Pocket Guides to Social Work Research Methods) OUP USA
References and Further Reading
Britten N, Campbell R, Pope C. et al Using meta-ethnography to synthesise qualitative research: a worked example. J of Health Serv Res Policy 2002;7(4):209-21
Campbell R et al Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Science and Medicine 2003;56: 671-
684
Cook A, Smith D, Booth A. Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research 2012 22, DOI: 10.1177/1049732312452938
Dixon-Woods M, Agarwal S, Jones D, et al. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 2005;10(1):45-53
Flemming K. The use of morphine to treat cancer-related pain: A synthesis of quantitative and qualitative research. Journal of Pain and Symptom Management 2010; 39(1):
139-154
Flemming K & Briggs M. Electronic searching to locate qualitative research: evaluation of three strategies. J Adv Nurs 2007;57(1):95-100
Flemming K. The synthesis of qualitative research and evidence-based nursing. Evidence Based Nursing. 2007;10(3):68-71
Munro S.A. et al Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLOS Medicine 2007;4(7): 1230-1244
Noblit GW & Hare RD. Meta-ethnography: synthesizing qualitative studies. California. Sage Publications, 1988
Noyes J & Lewin S (2010) Supplemental Guidance on Selecting a Method of Qualitative Evidence Synthesis, and Integrating Qualitative Evidence with Cochrane Intervention
Reviews. http://cqrmg.cochrane.org/supplemental-handbook-guidance
Noyes J, Popay J. Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative meta-
synthesis. Journal of Advanced Nursing 2007; 57: 227-243.
Pearson A Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews. JBI Reports 2004;2(2):45-64
Pope C & Mays N. Synthesising qualitative research. In Pope C & Mays N. (eds) Qualitative Research in Health Care (3rd edition). Oxford. Blackwell Publishing. 2006
Pope C, Mays N, & Popay J. Synthesizing Qualitative and Quantitative Health Evidence: A guide to methods. Maidenhead. Open University Press. 2007
Pound P. et al Resisting medicines: a synthesis of qualitative studies of medicine taking Social Science & Medicine 61 (2005) 133–155
Thomas J, Harden A, Oakley A. et al Integrating qualitative research with trials in systematic reviews. BMJ 2004;328:1010-2
Tong A, Sainsbury P, Craig JC. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist
for interviews and focus groups. Int J Qual Health. 2007;19(6):349-357.
Tong A, Flemming K, McInnes E et al Enhancing transparency in reporting the synthesis of qualitative research:ENTREQ. BMC Medical Research Methodology 2012; 12:181
http://www.biomedcentral.com/1471-2288/12/181
