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Qualitative interpretive meta-synthesis in social work research: Uncharted territory


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The authors present the field of social work with a methodology specifically aimed at the synthesis of qualitative research informed by existing methods and applications yet tailored to the unique values and goals of the profession of social work. Findings Though qualitative research in social work is commonplace, currently, the field lacks a methodology to synthesize these qualitative studies. A synthesis of qualitative studies results in generation of a more in-depth understanding of the phenomena studied that can be used to develop theory and inform practice and policy. Applications This methodology enables synergistic understanding of phenomena with richness in diversity of settings, participants, and qualitative traditions. This synergistic understanding can be used to develop theory and inform practice and policy.
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Journal of Social Work
2014, Vol. 14(3) 279–294
!The Author(s) 2013
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DOI: 10.1177/1468017313476797
Qualitative interpretive
meta-synthesis in social
work research:
Uncharted territory
Regina TP Aguirre
The University of Texas at Arlington, Arlington, USA
Kristin Whitehill Bolton
The University of Texas at Arlington, Arlington, USA
Summary: The authors present the field of social work with a methodology
specifically aimed at the synthesis of qualitative research informed by existing methods
and applications yet tailored to the unique values and goals of the profession of
social work.
Findings: Though qualitative research in social work is commonplace, currently, the
field lacks a methodology to synthesize these qualitative studies. A synthesis of quali-
tative studies results in generation of a more in-depth understanding of the phenomena
studied that can be used to develop theory and inform practice and policy.
Applications: This methodology enables synergistic understanding of phenomena with
richness in diversity of settings, participants, and qualitative traditions. This synergistic
understanding can be used to develop theory and inform practice and policy.
Social work, meta-analysis, meta-synthesis, qualitative methods, qualitative synthesis,
social work research, systematic review
Since social work’s inception, the profession has sought to enhance human well-
being from a holistic perspective, acknowledging that humans do not live in vac-
uums – humans are constantly acting and reacting within their social, emotional,
Corresponding author:
Regina TP Aguirre, School of Social Work, The University of Texas at Arlington, 211 S. Cooper, Box 19129,
Arlington, TX 76019, USA.
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Appendix D: Recently Published Article
and physical environments (International Federation of Social Workers
[IFSW], 2000). This holistic perspective is prevalent throughout in both social
work practice and social work research. Social work research maintains this atten-
tion to the whole as evidenced by the rise in focus on mixed methods, systematic
reviews, and meta-analyses over the past 30 years (Littell, Corcoran, & Pillai, 2008)
– all of which aim to capture a more holistic view of a phenomenon. Specifically,
mixed methods accomplishes this through combining qualitative and quantitative
methods in primary data collection; systematic reviews ‘‘sum up the best available
research on a specific question’’ (The Campbell Collaboration, n.d.); and meta-
analysis is a ‘‘statistical procedure that integrates the results of several independent
studies considered to be combinable’’ (Egger, Davey, & Phillips, 1997, p. 1533).
Each of these exhibits an effort to bring together multiple sources of evidence,
specific to a particular phenomenon, into a comprehensive whole that offers
insight in terms of social work practice and policy, expanding and deepening the
breadth of evidence-based practice. Mixed methods and systematic reviews
provide a platform for the integration of qualitative and quantitative evidence
on a topic and meta-analysis provides an integration approach for purely
quantitative evidence, but, so far, the discipline of social work has not embraced
a definitive technique or method for cross-study analysis to synthesize qualitative
An extensive review of the qualitative social work literature revealed that social
work lacks a methodology to synthesize qualitative findings; however, Padgett
(2004) notes a considerable amount of qualitative research is conducted in the
field of social work. Our review unveiled four articles synthesizing qualitative
studies among the scholarly social work literature (Forte, 2009; Hodge,
2011; McCalman et al., 2010; Watkins, Walker, & Griffith, 2010), each has used
different approaches to the task (e.g. Finfgeld, 2003; Noblit & Hare, 1988)
borrowed from nursing, a profession aiming to enhance well-being in terms of
health (American Nursing Association, 2004) similar to our goal of enhancing
overall well-being.
Since synthesizing qualitative research allows for knowledge gleaned from indi-
vidual qualitative studies of a particular phenomenon to come together in a
broader, in-depth, and more holistic understanding of that phenomenon, having
a method uniquely designed for the social work profession’s mission is deemed
highly desirable. In this paper, we discuss, in generalities, current approaches to
synthesis and present a model for synthesizing qualitative research tailored to the
field of social work that we have developed and implemented.
How is qualitative research synthesized?
Aggregative versus interpretive
Prior to presenting a social work oriented approach to synthesizing qualitative
research, it is important to have a general
understanding of existing approaches
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heretofore used to synthesize studies. Two overarching approaches depict the
nature of the methodological procedure. Some researchers operate under the
assumption that a qualitative synthesis is an aggregative process while others
view qualitative synthesis as an interpretive process. Aggregative syntheses take
on a quantitative approach (for example determining an effect size through fre-
quency and intensity) (Sandelowski & Barroso, 2003, 2007). On the other hand,
interpretive syntheses focus on theory development (Dixon-Woods et al., 2006) and
concept development, and follow a traditional qualitative methodological founda-
tion that does not exhibit quantitative features. Multiple differences exist between
these two approaches as well as some similarities; however, we have highlighted
differences relevant to our reasoning for selecting our methodological preference.
Since we want to present a method that focuses on uncovering the whole of a given
phenomenon, we believe the interpretive approach is most congruent with our
primary goals of a holistic understanding and theory development. The choices
of our colleagues (Forte, 2009; Hodge, 2011; McCalman et al., 2010; Watkins et al.,
2010) in conducting their syntheses also reflect a preference for the interpretive
Nomenclature: Varied approaches to cross study analysis
To enhance further understanding, one must be capable of differentiating qualita-
tive synthesis from quantitative meta-analysis, systematic review, literature review,
and varying approaches to qualitative synthesis.
Quantitative cross study analysis, systematic review and literature review
The synthesis of quantitative studies is most commonly referred to as meta-
analysis, and as stated before can be defined as a ‘‘statistical procedure that inte-
grates the results of several independent studies considered to be combinable’’
(Egger et al., 1997, p. 1533). According to Rubin and Babbie (2008) a ‘‘meta-
analysis simply involves calculating the mean effect size across previously com-
pleted research studies on a particular topic’’ (p. 550). Furthermore, a meta-ana-
lysis increases the external validity of findings through a larger sample size and
minimizes the sampling error. In turn, increasing the external validity of the
research findings adds to the breadth, rigor, and credibility of the results.
Both systematic reviews and literature reviews consist of a detailed overview of
existing literature. The authors of these reviews summarize findings instead of
synthesizing them.
Qualitative cross study analysis
Although use of qualitative cross study analysis in social work research is in its
infancy, it has become a widely discussed, theorized and applied concept in the field
of nursing. Numerous researchers in nursing have developed methods to conduct
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qualitative synthesis (Estabrooks, Field, & Morse, 1994; Finfgeld-Connett, 2010;
Jensen & Allen, 1996; Sandelowski & Barroso, 2007; Sandelowski, Docherty, &
Emden, 1997) and applied these (Barroso & Powell-Cope, 2000; Beck, 2001, 2002;
Britten et al., 2002; Campbell et al., 2003; Dixon-Woods et al., 2006; Finfgeld,
1999, 2000; Jensen & Allen, 1994; Kearney, 2001; McCormick, Rodney, &
Varcoe, 2003; Nelson, 2002; Paterson, 2001; Paterson, Thorne, & Dewis, 1998;
Sandelowski & Barroso, 2003; Thorne & Paterson, 1998). Each of the methods
and subsequent applications in the nursing field has generated a wealth of
understanding of strengths and limitations of various aspects of qualitative cross
study analysis.
As discussed previously, qualitative cross study analysis or synthesis can be
approached aggregatively or interpretively. A qualitative metasummary is defined
as ‘‘a quantitatively oriented aggregation of qualitative findings that are themselves
topical or thematic summaries or surveys of data’’ (Sandelowski & Barroso, 2007,
p. 151). In essence, a metasummary incorporates quantitative research methods to
express correlations and findings, while a qualitative synthesis lacks any trace of
quantitative research methods, maintaining its inherent qualitative identity.
Sandelowski and Barroso (2007) have also used the term ‘meta-synthesis’ to
describe this method.
There are many interpretive methods
for qualitative synthesis; those that seem
most commonly used include: meta-ethnography, meta-study, grounded formal
theory, and cross-case analysis. In preparation for this paper, we studied these in
depth and reviewed worked examples of each, identifying what we wanted to keep
from each of these approaches and what we wanted to address in our method in
terms of limitations. Before presenting our method, we define these methods briefly
along with noting limitations of each.
Meta-ethnography seeks to explicate relationships between and within individual
studies through metaphors (Noblit & Hare, 1988; worked examples: Barroso &
Powell-Cope, 2000; Beck, 2001, 2002; Jensen & Allen, 1994; Nelson, 2002;
Paterson et al., 1998). However, this methodology does not suggest a sampling
method or strategies regarding appraisal of individual studies. Grounded Formal
Theory is an extension of grounded theory and utilizes the constant comparative
method for data collection, analysis, and theory development (Strauss & Corbin,
1998; worked examples: Finfgeld, 2000; Kearney, 2001). The limitation to this
method lies in the possibility of theoretical saturation being achieved prior to the
inclusion of all of the relevant studies. Furthermore, this methodology does not offer
an explanation on how to address this issue. Cross-case Analysis was suggested by
Miles and Hubberman (1994), and consists of a technique to identify categories
within individual studies, refine, and cross-reference with other studies (worked
example: McNaughton, 2000). Again, similar to grounded formal theory and
meta-ethnography, this method fails to provide guidance related to sampling or
inclusion criteria. Finally, a meta-study is a highly systematic process involving sev-
eral evaluative phases prior to the actual synthesis: meta-theory, meta-method, and
meta-data analysis (worked example: Watkins et al., 2010). These phases are then
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followed by the actual meta-synthesis. Furthermore, this method provides guidance
regarding sampling and appraisal techniques.
Our proposed method: Qualitative interpretive
From our standpoint, in presenting this model, our goal of an interpretive quali-
tative meta-synthesis is not to generate a systematic review, a literature review, or
quantify qualitative data, but to create a synergy of qualitative findings. However,
as in all qualitative research, some aspects of the process will vary as it is emergent
and contextual in nature. Throughout the presentation of the method, we note
these areas for researchers who choose to conduct qualitative interpretive meta-
syntheses. The first step in presenting our model is to define it: considering the three
words in ‘‘interpretive meta-synthesis’’’, ‘‘interpretive’’ meaning that we eschew
aggregating findings quantitatively; ‘‘meta’’ ‘‘denoting a change of position or
condition’’ and ‘‘synthesis’’ being ‘‘the combination of ideas to form a theory or
system’’ (Meta, 2011; Synthesis, 2011). We conceptualize qualitative interpretive
meta-synthesis (QIMS) as a means to synthesize a group of studies on a related
topic into an enhanced understanding of the topic of study wherein the position of
each individual study is changed from an individual pocket of knowledge of a
phenomenon into part of a web of knowledge about the topic where a syn-
ergy among the studies creates a new, deeper and broader understanding. This
can be considered akin to social work’s person-in-environment approach to
practice. Just as each person a social worker interacts with is not a lone island
but rather a part of a system of relationships with other people, organizations,
policies, and environments, so too, each individual qualitative study captures only
a snapshot of the human experience of a phenomenon. Qualitative studies give in-
depth views of a particular phenomenon experienced by a particular group in a
particular situation yet the combination of these studies in QIMS allows us to see
what is the shared human experience of this phenomenon and what aspects may be
The development of QIMS
In developing this method, we have drawn from multiple approaches to qualitative
cross study analysis in an attempt to operationalize a method specific to the field of
social work. As we describe our proposed method for conducting QIMS in social
work, we wish to emphasize that this is not a linear process but rather an iterative
one as illustrated in Figure 1, depicting the method. Since developing the method,
we have implemented it in 22 different cross study analyses across a wide range of
social work topics, using these implementations to refine the steps.
In addition to
describing the proposed methodology, a partial worked example from one of 22
qualitative interpretive meta-syntheses we have conducted (Aguirre & Bolton,
forthcoming) to date will be used to enhance understanding of each step.
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The partial worked example is a QIMS on volunteer motivations in crisis settings
(Aguirre & Bolton, forthcoming).
The steps in QIMS
The first step in beginning a QIMS is to formulate a research question. Once this is
accomplished, a sample is selected, followed by steps in analysis (theme extraction,
theme synthesis, triangulation, etc.), and credibility reporting.
Sampling. Sampling for QIMS is a combination of purposive and theoretical sam-
pling, and is common practice in qualitative research. Purposive sampling is used to
initially select studies followed by theoretical sampling to test, add, and elaborate on
the emerging analysis (Dixon-Woods et al., 2006). Sample selection in a QIMS dif-
fers slightly from traditional sampling techniques used in literature reviews and
systematic reviews. Researchers should cast a broad net including grey literature
(i.e., dissertations or unpublished studies), books, and studies from various discip-
lines. Furthermore, literature searches should be exhaustive in nature to ensure the
inclusion of all relevant studies in the synthesis.
Limiting searches to internet
databases can limit the overall scope of the synthesis and result in omission of per-
tinent data. Throughout the search process, we recommend that researchers develop
a quorum chart to depict the process of data collection, review, elimination, and
inclusion. Quorum charts are commonly found in systematic reviews or meta-
analyses and offer a precise and rigorous outline of the sampling process.
Things to consider: Traditions, context, temporal relevance and fatal flaws. After
exhausting all resources and compiling studies related to the research topic,
Figure 1. Meta-synthesis path to synergistic understanding.
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the next step is to narrow the list of studies which may include consideration of
traditions, context, temporal relevance and fatal flaws. In the existing literature on
qualitative synthesis, there are varying opinions regarding whether or not to
include studies in the sample from varying qualitative traditions. Some researchers
are cautious of synthesizing findings from qualitative studies generated using dif-
ferent qualitative traditions out of concern that there would be a misrepresentation
of the original research (e.g., Jensen & Allen, 1996). We certainly recognize the
among traditions and are aware of the concern of comparing ‘‘apples
to oranges’’ (Padgett, 2008). However, we, along with others (e.g. Finfgeld, 2003),
encourage including studies from various traditions for two major reasons. First,
the wide range of philosophical and methodological traditions researchers employ
(Padgett, 2008), each expose a different aspect of a phenomenon. For example,
ethnographies focus on culture and phenomenologies on the lived experience of a
phenomenon – each provides a portion of a richer picture or understanding of the
phenomena under study. Including studies of various traditions such as phenom-
enology and ethnography in a QIMS further advances social work’s goal in
research to understand a given phenomenon across cultures and situations so as
to develop and improve client-centered policy, theory, advocacy, and services.
To illustrate our second reason, we consider the point at which these various
traditions and philosophies impact a study. These are employed at every stage of
the study to arrive at the essence of the experience under study. However, the
resulting essence is reported in units that are easily compared across these trad-
itions and philosophies. As illustrated later in this paper, data gathered from the
articles for a QIMS are not to be rewritten, reworked, or analyzed. In fact, it is our
goal to maintain the original themes from the articles included in the sample, so as
to decrease the opportunity for researcher bias and increase reliability across find-
ings. We conceptualize this similarly to the argument for including studies in a
meta-analysis that employ various statistical techniques. In a meta-analysis, the
results are compared on the basis of an effect size, a result that each study produces
regardless of whether using analysis of variance, multiple regression, etc. This is
similar to our procedure in the sense that we take the themes demonstrated in the
qualitative studies and synthesize these across the sample selected. We are not by
any means altering the methodological approaches nor the impact these had on the
processes in the original studies; we are simply focused on the end results presented
by the original researchers.
In addition to considering traditions when narrowing the sample, contextual
relevance is of concern as well. Studies related to the research topic may differ
from the context of the research question and should be discarded accordingly.
For example, if conducting a QIMS on motivations to volunteer in crisis situations,
articles on volunteer motivation related to non-crisis situations would need to be
discarded even though these are related to volunteer motivation. During the pro-
cess of discarding studies, it is important that the researcher not eliminate a study
because it is a ‘‘negative case’’ (or disconfirming case). Patton (2002) emphasizes
the importance of the ‘‘negative case’’ because ‘‘our understanding of those
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patterns and trends is increased by considering the instances and cases that do not
fit within the pattern’’ (p. 554). For example, one study may have findings or
conclusions different from all other studies in the sample. This ‘‘negative case’’
needs to be acknowledged and incorporated similarly to the way a ‘‘negative
case’’ would be in a qualitative study. Including and maintaining the integrity of
this ‘‘negative case’’ is imperative to the quality and trustworthiness of the QIMS as
a whole.
Similar to the contextual relevance is the temporal relevance. Determining the
temporal relevance of each study helps maintain the relevance of the synthesis and
increases its transferability (Sandelowski, Barroso, & Voils, 2007). For example, a
qualitative interpretive meta-synthesis on the use of new technologies in counseling
done in the 21st century would not include previous research on use of the tele-
phone in counseling since the telephone is not a ‘‘new’’ technology.
A final aspect to consider in narrowing the sample is ‘‘fatal flaws’’ (Dixon-
Woods et al., 2006) and these should be eliminated from the sample at the research-
er’s discretion. Fatal flaws can include, but are not limited to, researcher bias, lack
of triangulation, or questionable trustworthiness. Furthermore, researchers must
differentiate between fatal flaws and poor data presentation. If the text presenting a
study is sub-par, it may be included because data within the paper could remain a
vital piece to the sample itself. Sub-par studies would include manuscripts that are
poorly organized, difficult to read, or fail to present writing at a scholarly level.
Even if the presentation of a study is sub-par, the content may be rich with data
pertinent to the topic of inquiry. The process of differentiating between fatal flaws
and sub-par text is subjective in nature and elimination is at the discretion of the
researcher conducting the QIMS. The lack of specific criteria for elimination may
be viewed as a limitation but the process of determining whether a study contains a
fatal flaw is commonly done in systematic reviews, literature reviews, and meta-
analyses as well with the individual researchers’’ deciding the criteria.
Theme extraction. Following the selection and identification of the sample, a table
should be created to list and identify characteristics of the participants and studies
including demographics, methods, and major findings (see Table 1 for a partial
example from Aguirre and Bolton (forthcoming). Once this is completed each
study should be read repeatedly while identifying metaphors, concepts, terms,
and phrases (Noblit & Hare, 1988). Terms used by researchers may differ but
common themes may present themselves across studies. The outcome of repeatedly
reading while identifying metaphors, concepts, terms and phrases should generate a
collage of comparable themes resulting in the emergence of a synergistic picture of
the phenomenon. For example, we conducted a QIMS including 5 research reports
focusing on motivations for crisis volunteers. We developed a table comprising the
phrases and components of the process associated with the themes found among
the research studies included in the QIMS (see Table 2 for a partial example from
Aguirre & Bolton [forthcoming]). This table was accompanied by direct quotes
from the research studies divided into categorical subheadings in the findings
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Table 1. Example table of studies included in a QIMS.
Authors Date
Tradition and data
collection method
Ages, race/ethnicity,
gender Education level
Rath 2007 Grounded Theory;
8 22–58, White, female Not specified Rape Crisis
& Fothergill
2009 Did not specify;
Data gathered
through 2 waves
of interviews
34 Not reported; Majority
White, other races/
ethnicities represented:
Native American,
Iranian, Moroccan,
African American,
Korean, and Mexican
American; 17 male, 17
Most have college
& Yanay
2008 Did not specify;
Data gathered
through inter-
views and
20 20–50, not reported,
Varied from High
School to
Masters degrees
Rape Crisis
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section. Once the researcher is satisfied all of the key concepts and themes have
been extracted from the research studies as well as categorized and organized, it is
time to synthesize the results.
Synthesis of themes. The identification of themes in each study is followed by the
actual data synthesis. Once themes are recorded, the studies are translated into one
another. This process of translation must maintain the integrity of each individual
study while allowing for the synthesis of similar themes. Noblit and Hare state:
an adequate translation maintains the central metaphors and/or concept of
each account in their relation to other key metaphors or concepts in that account.
It also compares both the metaphors and concepts and their interactions in one
account with the metaphors or concepts and their interactions in other accounts.
(1988, p. 28)
Jensen and Allen (1996) state that a meta-synthesis ‘‘is credible when it re-pre-
sents such faithful descriptions or interpretations of human experience that the
people having that experience would immediately recognize it from those descrip-
tions or interpretations as their own’’ (p. 556). In other words, failure to maintain
the integrity of the original studies results in decreasing the trustworthiness of the
meta-synthesis. One way to limit the loss of original integrity is to utilize
participant quotes from the original research reports included in the interpretive
For example, in our QIMS on volunteers, we maintained the integrity of each
individual research study yet grouped the themes presented in the individual
research studies into five overarching themes (See Table 3 for a partial example
from Aguirre & Bolton [forthcoming]). We then incorporated quotes from the
Table 2. Example table of theme extraction in a QIMS.
Authors Original Themes
Rath (2008) 1. Motivation to train
2. Complexity of change
3. Changes in personal relationships
4. Personal change
5. Feminism
Steffen & Fothergill (2009) 1. Personal healing
2. Self-concept
Community sentiment and involvement
Yanay & Yanay (2008) 1. Motivation saturation
2. Completion
3. Lack of support
4.Lack of direction
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original text to further develop the relationship between the themes from the ori-
ginal articles and the newly developed overarching themes.
Triangulation: Synergistic understanding or entropy. Familiarity with triangulation
is imperative before engaging in a QIMS.
The purpose of triangulation in QIMS is
similar to that of triangulation in a qualitative study. Triangulation is a method
used to regulate the trustworthiness of qualitative research; specific to QIMS, this is
a means of verifying that translation across studies has provided a synergistic
understanding rather than a disordered and biased misunderstanding – entropy.
There are four types of triangulation: data collection methods, tradition, sources,
and analysts (Patton, 2002). All four types of triangulation can and should be
utilized in a QIMS. Triangulation of data collection methods, tradition, and
sources are inherent in the process with various studies providing diversity in the
three areas. For example, 1) a synthesis may include studies where data collection
methods included interviews, focus groups, and observation; 2) synthesizing across
traditions provides triangulation of traditions; and 3) multiple qualitative studies
bring multiple sources of data (e.g., multiple participants’ perspectives).
Triangulation of analysts is the key in any type of qualitative analysis, with
QIMS being no different. This is especially the case for researchers who include
their own studies to conduct a qualitative synthesis, as they will need an objective
analyst in the triangulation process. This will help prevent the inclusion of infor-
mation from the original data not included in the final report used in the synthesis.
Description of synergistic understanding. The final steps of a QIMS are descrip-
tion of the phenomena and synergistic understanding. Description of the
Table 3. Example table synthesis of themes in a QIMS.
New, overarching theme Extracted, original themes with authors and publication year
Lived experience Personal healing (Steffen & Fothergill, 2009)
Self-concept (Steffen & Fothergill, 2009)
Motivation to train – experience with sexual
violence (Rath, 2008)
Changed personal experiences (Rath, 2008)
Personal change (e.g. self-awareness) (Rath, 2008)
Internal/Personal fulfillment Motivation to train (Rath, 2008)
Desire to volunteer
Career exploration
Major life changes (Rath, 2008)
Changed personal experiences (Rath, 2008)
Motivational saturation (Yanay & Yanay, 2008)
Negative cases Lack of support (Yanay & Yanay, 2008)
Lack of direction (Yanay & Yanay, 2008)
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phenomena is when the researchers begin to develop their written report. In some
cases, the researchers may realize their findings are inadequate and further research
is required in order to strengthen the breadth of the study. This may involve
alteration of the research question to widen the sampling pool through theoretical
sampling or adjusting the parameters of the search terms. Regardless, it is import-
ant for the researcher to complete the process in the same order (see Figure 2) to
maintain the systematic process of the QIMS. This phase is relatively subjective
and may vary from researcher to researcher. The result will be synergistic under-
standing where the researcher is able to generate conclusions, theory, and implica-
tions based on the description generated from the synthesis of the included studies.
All methods of research encompass limitations associated with data collection, data
analysis, and researcher bias – and QIMS is no exception. The main criticism of
qualitative research is the subjectivity of the data analysis and the uncontested ques-
tion of potential researcher bias. All research, both qualitative and quantitative, is
subject to possible researcher bias and the role of the researcher is to be aware and
address limitations in every research initiative and all levels of research inquiry.
Fortunately, qualitative research has established specific procedures for limiting and
minimizing researcher bias, especially through the four levels of triangulation previ-
ously discussed. A primary criticism of qualitative cross study analysis in other fields is
the recommendation we have presented here to synthesize across traditions. As noted
Figure 2. Cycles to synergy: Data extraction for synergistic understanding.
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previously, this allows for the different traditions to shed light on the different aspects
of a synergistic understanding demonstrated in QIMS. Without inclusion of all rele-
vant available studies, regardless of tradition, the understanding would be partial.
Implications for social work
QIMS provides a structured methodology for further, synergistic, understanding of
phenomena with richness in diversity of settings, participants, and qualitative trad-
itions. These synergistic understandings would be grounded in studies generated
across different qualitative traditions yet focusing on clients who share some simi-
larity depending upon the research question. Synthesis of qualitative studies and
the emergence of synergistic understanding increases efficacy in integrating quali-
tative research into evidence-based practice. It is our hope that the social work
community will embrace the technique of QIMS not only to increase the under-
standing of phenomena but to strengthen the perception of qualitative research as a
rigorous component in evidence-based practice.
1. A more detailed description of approaches is not offered here due to space limitations. For
more, please refer to Dixon-Woods, Agarwal, Jones, Young, & Sutton (2005) and Finfgeld
2. For an in-depth discussion of interpretive synthesis, see Jensen and Allen (1996).
3. These 22 meta-syntheses were conducted under the supervision of the first author by
social work doctoral students in classes on qualitative research. These are in various
stages of the publication process with one published and one in press (Aguirre &
Bolton, forthcoming; Smith & Aguirre, 2012).
4. See Barroso et al. (2003) for information regarding retrieval of qualitative studies.
5. Researchers should refrain from looking at original data even if it is available. This
reduces the possibility of researcher bias in the analysis process.
6. A useful resource for quorum charts is Liberati et al. (2009).
7. See Zimmer (2006) for an extensive discussion.
8. This is extensively discussed in Patton (2002).
This research received no specific grant from any funding agency in the public, commercial,
or not-for-profit sectors.
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... Thus, we sought to fill this gap by examining studies focused on the adjustment experiences of ISAs. A qualitative interpretive meta-synthesis is a method used in social work research to synthesize the findings of qualitative studies (Aguirre & Bolton, 2014). We used qualitative interpretive metasynthesis to conduct an exhaustive search of the literature, construct themes, and synthesize themes of qualitative research regarding ISAs and their adjustment experiences. ...
... A review of the literature found the majority of studies that look specifically at the psychosocial adjustment experiences of ISAs are qualitative in nature; thus, we determined a qualitative interpretive meta-synthesis (QIMS) would be an appropriate methodology to use for this study. QIMS synthesizes qualitative research to gain a deeper understanding of the phenomenon (Aguirre & Bolton, 2014). QIMS focuses on creating a synergy of qualitative findings and is interpretive, as opposed to focusing on the aggregate, which is common in systematic reviews and meta-analyses (Aguirre & Bolton, 2014). ...
... QIMS synthesizes qualitative research to gain a deeper understanding of the phenomenon (Aguirre & Bolton, 2014). QIMS focuses on creating a synergy of qualitative findings and is interpretive, as opposed to focusing on the aggregate, which is common in systematic reviews and meta-analyses (Aguirre & Bolton, 2014). Watkins-Kagebein and colleagues (2019) suggest researchers can use QIMS instead of conducting one's own qualitative study, where sample size may be low, to increase sample size by using previous qualitative research on the topic. ...
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International college students face psychosocial adjustment challenges transitioning into college, which may be heightened for international student-athletes (ISAs) who also have to adjust to Division I (DI) athletics. Even so, there are limited articles that synthesize the research on this population. Thus, we sought to fill this gap by examining studies focused on the adjustment experiences of ISAs. A qualitative interpretive meta-synthesis is a method used in social work research to synthesize the findings of qualitative studies (Aguirre & Bolton, 2014). We used qualitative interpretive meta-synthesis to conduct an exhaustive search of the literature, construct themes, and synthesize themes of qualitative research regarding ISAs and their adjustment experiences. We identified 11 articles with three overarching themes: (a) acculturative stress, (b) adjustment to the college experience, and (c) adjustment to athletics in the United States. Findings suggest ISAs experience not only transitional stress related to their identities as a student and as an athlete but also from their acculturation experiences. Thus, we propose ISAs transitioning to college experience a ternary-or three way-role negotiation of student identity, athlete identity, and cultural identity. Social workers employed at Division I institutions and within Division I athletic departments have the opportunity to advocate for the needs of this population.
... However, these studies investigate end-of-life care practitioners' experiences of specific concepts, that is-existential distress, moral distress, capacity to cope with death, and death anxiety. This qualitative interpretive metasynthases (QIMS) (Aguirre & Bolton, 2014) study draws on the narrative research understanding of "experience." Narrative research into experience explores peoples "stories of lived experience" (Riessman, 2008;Tamboukou et al., 2013), rather than people's experiences of specific concepts. ...
... QIMS is a methodology that grounds social work values, concepts, and practice into research (Aguirre & Bolton, 2014). In a QIMS study, original themes from primary qualitative research on a specific topic are synthesized to "create a new, deeper, and broader understanding" (Aguirre & Bolton, 2014, p. 283). ...
... In a QIMS study, original themes from primary qualitative research on a specific topic are synthesized to "create a new, deeper, and broader understanding" (Aguirre & Bolton, 2014, p. 283). A QIMS study is a rigorous and iterative process that involves developing a research question, sampling, extracting themes, synthesizing themes, triangulation, and writing and disseminating findings (Aguirre & Bolton, 2014). The QIMS methodology is well suited to exploring complex topics, such as end-of-life care, by generating synergistic understandings (Aguirre & Bolton, 2014). ...
Social workers are an integral part of end-of-life (EOL) care interdisciplinary services and provide comprehensive psychosocial support to dying people. However, despite the rewards, EOL care social work is wrought with challenges. There is currently limited research into the experience of EOL care social workers. Therefore, this qualitative interpretive meta-synthesis (QIMS) study examines the experience of EOL care social workers as revealed in existing literature. The QIMS methodology was used to synthesize and interpret findings from four original qualitative studies to elicit an in-depth response to the research question: What is the experience of social workers who work in EOL care? Findings The theme “EOL care social work is a privilege and a struggle” emerged, with six associated contributing factors: Privilege—(1) death is sacrosanct, (2) death is an opportunity for growth and healing, and (3) the religious/spiritual element of EOL care. Struggle—(1) ongoing pain and heightened emotions, (2) conflict of values, and (3) contextual challenges. This QIMS study serves as a preliminary phase to a subsequent, larger study. Applications This QIMS study provides a foundation for further narrative research into the experience of EOL care social workers. In addition, findings from this QIMS study highlights areas for further attention to foster the well-being of EOL care social workers. Finally, findings from this QIMS study could augment relevant EOL care content in undergraduate social work education.
... This study was guided by the Population/Problem Interest/ Intervention Context (PICO) framework (Twa, 2016) and the Qualitative Interpretive Meta-Synthesis guidelines (QIMS) (Aguirre & Bolton, 2014). The PICO framework has been widely used in the development of clinical research questions, as it effectively captures key elements that are needed for a focused research question (Icahn School of Medicine Mt. ...
... To mitigate biases, the QIMS guidelines require that each author reveal their backgrounds and qualifications (Aguirre & Bolton, 2014;Patton, 1999). To this end, each of the authors has provided personal and professional information below. ...
... According to Patton (1999) there are four types: the data collections, traditions, sources, and analyst. In this study, triangulation was used to ensure orderliness as well as reduce bias across the studies (Aguirre & Bolton, 2014). Regarding the types, the data collection consisted of searching for data through the university databases. ...
Objectives: Older immigrants totaled 7.3 million in 2018, representing 13.9 percent of the population of seniors in the U.S. While this population is found to contribute significantly to society, along with new opportunities comes circumstantial challenges. Of these, one of the most salient issues for foreign-born older adults is social isolation. Additionally, this population may be at an increased risk for social isolation with poor mental health because migrating to a new country might result in resettlement challenges. Despite these concerns, less is known about the consequences of social isolation among older immigrant adults. Hence, this study seeks to explore consequences of social isolation among older immigrants, as well as interventions to combat isolation. Methods: Guided by the Population Interest Context (PICO) framework and the Qualitative Interpretive Meta-Synthesis (QIMS) guidelines. Results: The final sample of seven full text articles were published between 2011 and 2021, totaling 286 participants with ages ranging from 61 to 93 years old. Findings from the study indicated that older immigrants are at risk of social isolation and loneliness because they have fewer social connections due to leaving behind their familiar social group in the home country, encounter linguistic challenges that negatively contribute to greater social isolation and poor mental health. Despite these difficulties older immigrants reported various social interventions, access to senior centers, community programs and services to be of greater importance in building social networks. Conclusion: Authors discuss opportunities for future research, such as exploring evidence-based studies on interventions for social isolation and loneliness of older immigrant populations.
... Qualitative Interpretive Meta-Synthesis (QIMS) was developed by Aguirre and Bolton (2014) ers, 2020). The detailed outline provided by Aguirre and Bolton (2014) was utilized in this study. ...
... Qualitative Interpretive Meta-Synthesis (QIMS) was developed by Aguirre and Bolton (2014) ers, 2020). The detailed outline provided by Aguirre and Bolton (2014) was utilized in this study. The results of this study are separated into two articles to allow a richer synthesis of the findings. ...
... Demographic information is included in Table 1. In a QIMS, the original themes and subthemes are extracted intact from the articles (see Table 2) in order to maintain the integrity of the original research (Aguirre & Bolton, 2014). Forty-three themes were pulled from the 10 articles. ...
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Qualitative studies have examined runaway youth and their choices to leave home, their involvement living on the streets, and their lived experiences as stigmatized youth. For the present study, a Qualitative Interpretative Meta-Synthesis (QIMS) was conducted to synthesize the data from these various studies. A systematic search located qualitative research that focused on girls who were or had been runaways. They were synthesized in this analysis. The themes of power/control and stigma are analyzed with a Foucaultian lens with an eye toward informing social workers of their roles in the power/control structures that create stigma for runaway youth. Keywords: Runaway, Qualitative Interpretive Meta-Synthesis, Foucault, Power/control, stigma
... Qualitative meta-synthesis is commonly used to explore care experiences in health disciplines (Martín et al., 2016) and has begun to attract interest as a methodology in social work in recent years (Aguirre & Bolton, 2014 as the keywords. In English, we used "China" or "Chinese" + "cancer" or "tumours" or "malignancy" or "neoplasm" (and other MeSH words) + "caregiver" or "informal caregiver" or "family caregiver" (and other related words) + "qualitative" (see Table 1). ...
... In qualitative meta-synthesis, the results of the original studies are treated as secondary data for synthesis (Sliva, 2015). The process of qualitative interpretive meta-synthesis we followed for this article (Aguirre & Bolton, 2014) includes four stages: (1) the data familiarisation stage, which requires two researchers to familiarise themselves with the data through repeatedly reading the results of the original studies in the context of their respective methodological frameworks; ...
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Qualitative meta-synthesis is a coherent approach to answering an overarching re- search question by synthesising past qualitative studies so as to create new mean- ings from their results. We conducted a qualitative meta-synthesis to systematically evaluate and integrate the caregiving experiences of adult children providing care for an elderly parent with cancer. The search was conducted in the databases Web of Science, PubMed, Embase, MEDLINE, Cochrane Library, Grew Literature in the Health Sciences, CNKI, WanFang Data, VIP, SINOMED and China Academic Journals as well as Chinese grey literature databases (China Academic Conference Literature Database/中国学术会议文献数据库, National Science and Technology Library) from inception to June 9, 2021. Thirteen studies were included in the final synthesis. The caregiver experiences they describe are synthesised into three primary themes: care needs, care burden and care gains, with numerous secondary themes. Besides our findings that seem to align with those from studies focused on other cultures, we have highlighted three main discoveries from the synthesis that stand out in the Chinese context: (1) many sub-themes related to specific caregiving skills; (2) a strong ex- pectation for health professionals to improve their communication skills with family caregivers; (3) the negative and positive influences of filial piety in caregiving experi- ences. Our findings can help multidisciplinary healthcare teams in China support adult children as caregivers in their emphasis on improving caregiver education and train- ing, ways of making the most of potential care gains, and ways of easing care burdens.
... Guided by the stress process model, the present study will fill this gap by synthesizing the factors that are related to emotional stress among professionals in dementia care through their own voices, using qualitative interpretive meta-synthesis (QIMS, Aguirre & Bolton, 2013). Aguirre and Bolton's (2014) approach to qualitative interpretive meta-synthesis (QIMS) was adopted in this study. A QIMS is "a means to synthesize a group of studies on a related topic into an enhanced understanding of the topic of study" (Aguirre & Bolton, 2013, p. 5). ...
... Triangulation is an important aspect of QIMS that increases rigor, reduces bias, and improves finding quality (Aguirre & Bolton, 2014;Creswell & Poth, 2018). Following triangulation conventions employed by other QIMS studies, the researchers gathered data from multiple sources (e.g., Tarbet, Moore, & Alanazi, 2021), which increased the number of participants overall as well as the diversity of demographic characteristics, types of professionals represented in the study, and the care settings represented. ...
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Emotional stress is a common problem for many professionals in dementia care. Although a plethora of quantitative studies have examined the factors that affect care professionals’ emotional stress, little qualitative research has provided in-depth understanding of professional stress experiences. To magnify the voices of professionals who share their experiences of stress in caring for older adults with dementia, a qualitative interpretive meta-synthesis of five qualitative studies was conducted. Guided by Pearlin’s stress process model, four themes were identified: (1) emotional attachments to older adults with dementia; (2) difficulties in dementia care; (3) stressful working environment; and (4) conflicts with family members of older adults with dementia. Findings further highlighted that professionals’ genuine concern for the well-being of older adults with dementia reinforced the perception of stressors identified in each of the preceding themes. These results could inform the improvements of emotional support for care professionals in practice and policy arenas.
... This framework focuses on the relation among studies through extracting common themes and translating each study into one another in order to distill overarching themes. In the rst step of the analysis procedure, each of the studies within the ltered list were read scores of times and summary tables were developed displaying information as regards the aim, context, design, research questions, participants, data collection instruments, and ndings (Aguirre, & Bolton, 2014). In the second step, each study's ndings were listed by including authors' ideas, codes, categories, and themes in order to identify how the studies were related. ...
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The first years of teaching are well documented to pose several challenges for novice teachers as their knowledge and skills of pre-service years are tested within real-life classroom settings. Accordingly, the current meta-synthesis paper aims to outline the challenges novice EFL teachers face to draw a general picture of the challenges recorded in the current literature and to establish guidelines for future studies. To this end, qualitative studies investigating novice ELF teachers’ challenges were scanned and filtered according to inclusion and exclusion criteria, revealing a total of 12 studies published in peer-reviewed journals within the last decade (i.e., 2010-2020). Subsequently, the results of the studies at hand were subjected to thematic analysis revealing four overarching themes: 1) Student-related challenges, 2) Lack of professional knowledge and expertise, 3) Workplace-related challenges, and 4) Educational system-related challenges.
Scholars have increased their interest in the body as it relates to social inequality and health. The purpose of this review was to understand social work’s engagement with and adoption of embodiment. The authors identified peer-reviewed articles to answer research questions about the number of publications, journals, countries and topic areas. There were 89 articles published over a 20-year period with the highest number in medical journals and the most prolific region, the United Kingdom. Major topic areas included gender, ageing and disability. The authors discuss findings and silences in the data and offer suggestions for the field going forward.
Despite scholarly debate on the topic of success, how women define career success remains unclear. For many decades, research on the concept of success has largely used quantitative methods to assess the external aspects of success in a male-dominated culture. Using a total of 18 articles from 1999 to 2020, this qualitative meta-synthesis aims to gain detailed insights into women’s definitions of career success and to capture their perspectives on the barriers they face. A systematic search was conducted across four databases: Sociological Abstracts, SocINDEX, SCOPUS, and Google Scholar. This study is novel in that it is the first synthesized research that qualitatively studies the concept of career success. From this review, three distinct themes regarding women’s definition of career success emerged: (1) having support, (2) having accomplishments, and (3) feeling belonging. This article also establishes three themes regarding the obstacles to women’s career path toward success: (1) work–family/work–life imbalance, (2) gender bias/gender discrimination, and (3) the lack of mentors and role models. In contrast to previous research, the findings of this qualitative meta-synthesis indicate that while women define career success individually, they acknowledge that the professional objective aspects of success are important or even central to them in their life. The limitations of the study are noted, and the implications and future research directions are discussed.
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Objectives To support workforce deficits and rising demand for medicines, independent prescribing (IP) by nurses, pharmacists and allied health professionals is a key component of workforce transformation in UK healthcare. This systematic review of qualitative research studies used a thematic synthesis approach to explore stakeholders’ views on IP in primary care and identify barriers and facilitators influencing implementation. Setting UK primary/community care. Participants: Inclusion criteria were UK qualitative studies of any design, published in the English language. Six electronic databases were searched between January 2010 and September 2021, supplemented by reference list searching. Papers were screened, selected and quality-appraised using the Quality Assessment Tool for Studies with Diverse Designs. Study data was extracted to a bespoke table and two reviewers used NVivo software to code study findings. An inductive thematic synthesis was undertaken to identify descriptive themes and interpret these into higher order analytical themes. The Diffusion of Innovations and Consolidated Framework for Implementation Research were guiding theoretical anchors. Primary and secondary outcome measures: N/A. Results Twenty-three articles addressing nurse, pharmacist and physiotherapist IP were included. Synthesis identified barriers and facilitators in four key stages of implementation: 1) “Preparation”, 2) “Training”, 3) “Transition” and 4) “Sustainment”. Enhancement, substitution, and role specific implementation models reflected three main ways that the IP role was used in primary care. Conclusions In order to address global deficits, there is increasing need to optimise use of IP capability. Although the number of independent prescribers continues to grow, numerous barriers to implementation persist. A more coordinated and targeted approach is key to overcoming barriers identified in the four stages of implementation and would help ensure that IP is recognised as an effective approach to help alleviate workforce shortfalls in the UK, and around the world. PROSPERO registration number CRD42019124400.
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Objective: to report the experience of applying the focus group technique for production of data in qualitative research. Method: four group sessions were held from May to June 2015, with the participation of professionals from the public sector of PHC and from specialized service. Results: the way focus group was developed is described in steps: planning, recruitment, ambience, group sessions, and evaluation. Conclusion: we highlight that the focus group, as a technique to produce data in collective space, can contribute not only to the construction of knowledge in Nursing, but also to the research approach with the assistance practice.
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Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site ( should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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Recognizing that spiritual needs often emerge in health care settings, the Joint Commission requires spiritual assessments in numerous organizations frequented by older adults. Given that many gerontological practitioners have received little training in identifying spiritual needs, a qualitative meta-synthesis (N = 9 studies) was conducted to identify and describe older adults’ perceptions of their spiritual needs in health care settings. Five interrelated categories emerged: (a) spiritual practices; (b) relationship with God; (c) hope, meaning, and purpose; (d) interpersonal connection; and (e) professional staff interactions. The implications of the findings are discussed as they inform the spiritual assessment process.
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Meta-ethnography is presented as an innovative method for the systematic review of a set of symbolic interactionist ethnographies of mutual aid group work. Interpretive metaphors and themes from each study are synthesized in relation to the major phases of the planned change process. ‘Transformation through interaction’ is identified as the master integrative theme. Grounded lessons for mainstream group work are also generated. The merits and limitations of meta-ethnography in relation to the project of translation science, the bridging of the social worlds of researcher and practitioner, are also discussed.
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This is an account of a qualitative study designed to elicit and analyse the narratives of women who had trained to be volunteer counsellors at a Rape Crisis centre. Little prior research has focused on the experiences of workers in Rape Crisis centres and this project was designed to explore women's experiences in ways that were meaningful to them. The research methods used were face-to-face, unstructured, in-depth individual interviews and group sessions. Participants in the individual interviews had all undertaken Rape Crisis training within the preceding two years. The group sessions involved all workers who were actively involved with the Rape Crisis centre at the time of the research. Five themes emerged from an inductive analysis of the data: motivation to train, complexity and change, changes in personal relationships, personal change and feminism. Overall the study highlights the complex, transformative processes that volunteer Rape Crisis counsellors may experience. The article concludes by identifying implications for practice that may serve to enhance training for volunteer counsellors in the future.
Background The limitations of traditional forms of systematic review in making optimal use of all forms of evidence are increasingly evident, especially for policy-makers and practitioners. There is an urgent need for robust ways of incorporating qualitative evidence into systematic reviews. Objectives In this paper we provide a brief overview and critique of a selection of strategies for synthesising qualitative and quantitative evidence, ranging from techniques that are largely qualitative and interpretive through to techniques that are largely quantitative and integrative. Results A range of methods is available for synthesising diverse forms of evidence. These include narrative summary, thematic analysis, grounded theory, meta-ethnography, meta-study, realist synthesis, Miles and Huberman's data analysis techniques, content analysis, case survey, qualitative comparative analysis and Bayesian meta-analysis. Methods vary in their strengths and weaknesses, ability to deal with qualitative and quantitative forms of evidence, and type of question for which they are most suitable. Conclusions We identify a number of procedural, conceptual and theoretical issues that need to be addressed in moving forward with this area, and emphasise the need for existing techniques to be evaluated and modified, rather than inventing new approaches.
The primary purpose of this project was to better clarify how individuals overcome drug and alcohol problems without participating in 12 step-type self-help groups or formal treatment. A secondary purpose was to infer implications for clinical practice. These objectives were accomplished by synthesizing qualitative findings related to self-resolution of drug and alcohol problems. Based on this work, self-resolution appears to be a temporal process that is motivated by personal interpretations of life circumstances. The central self-resolution strategy involves investing and reinvesting in self. This process varies in difficulty and is influenced by a number of intrapersonal, interpersonal, and extrapersonal factors. Owing to the nature of the change process, stage-appropriate brief interventions are recommended to help individuals invest and reinvest in themselves.
The authors suggest that findings of independent, similar research articles may be aggregated into a cohesive study. Such a procedure greatly enhances the generalizability of the original studies and produces a relatively solid mid-range theory. In this article, the criteria for selecting studies, possible problems inherent in the aggregation approach, and potential areas for application are discussed.
Health, disease, wellness, and illness have long been concepts central to health care disciplines. To further develop theory regarding the individual's experience of health and disease, a meta-analysis was undertaken of 112 qualitative studies from 1980 to 1991. A synthesis of qualitative research was done to derive substantive interpretations about health, disease, wellness, and illness from grounded theory, phenomenological, and ethnographic perspectives. The texts were compared and analyzed, creating new interpretations through synthesis of reciprocal translations. A dialectic model of wellness-illness was inductively derived. The process, meaning, and context inherent in the experience of health-disease are described as "living-in-the-world" of health-disease. Wellness-illness is depicted as the human experience of actual or perceived function-dysfunction. The theory emerging from this meta-analysis of qualitative research provides a synthesis of the commonalities among individual representations of health and disease.