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Understanding Meta-Ethnography in Health Professions Education Research
... systematic review meta-analysis Luong et al., 2023 後設民族誌整合之派典及理論 interpretivism Luong et al., 2023;Noblit & Hare, 1988 concept metaphor France, Cunningham et al., 2019;Noblit & Hare, 1988 Geertz 1973 thick description Turner 1980translation Geertz 2012Turner Turner, 1980 same-practices hypothesis Turner, 1980Turn-er, 1980 breakdown Turner, 1980 Agar 1986 breakdown resolution coherence Agar, 1986 後設民族誌整合之介紹 meta-ethnography Fetterman, 2020;Noblit & Hare, 1988 meta-analysis Noblit & Hare, 1988Agar, 1986Noblit & Hare, 1988Noblit & Hare, 1988Turner, 1980metaphor Noblit Hare 1988Noblit & Hare, 1988Noblit & Hare, 1988Geertz 1973Nygård 2024 reciprocal translation refutational translation Noblit & Hare, 1988France, Cunningham, et al., 2019Noblit & Hare, 1988 lines-of-argument synthesis; Noblit & Hare, 1988 後設民族誌整合之步驟 1988Noblit Hare 1988 (2) (3) (4) (5) (6) ...
... systematic review meta-analysis Luong et al., 2023 後設民族誌整合之派典及理論 interpretivism Luong et al., 2023;Noblit & Hare, 1988 concept metaphor France, Cunningham et al., 2019;Noblit & Hare, 1988 Geertz 1973 thick description Turner 1980translation Geertz 2012Turner Turner, 1980 same-practices hypothesis Turner, 1980Turn-er, 1980 breakdown Turner, 1980 Agar 1986 breakdown resolution coherence Agar, 1986 後設民族誌整合之介紹 meta-ethnography Fetterman, 2020;Noblit & Hare, 1988 meta-analysis Noblit & Hare, 1988Agar, 1986Noblit & Hare, 1988Noblit & Hare, 1988Turner, 1980metaphor Noblit Hare 1988Noblit & Hare, 1988Noblit & Hare, 1988Geertz 1973Nygård 2024 reciprocal translation refutational translation Noblit & Hare, 1988France, Cunningham, et al., 2019Noblit & Hare, 1988 lines-of-argument synthesis; Noblit & Hare, 1988 後設民族誌整合之步驟 1988Noblit Hare 1988 (2) (3) (4) (5) (6) ...
In this paper, meta-ethnographic synthesis is introduced as a qualitative systematic review method to provide researchers with a comprehensive theoretical foundation of this method and an understanding of its analytical steps. Grounded in interpretivism, this method incorporates Geertz's concept of "thick description" and Turner's concept of "translation" and emphasizes the exploration of meaning within cultural contexts. By continuously comparing and synthesizing similar and divergent concepts and metaphors across multiple qualitative studies, this approach highlights the cultural context and interpretive significance of integrated phenomena, thereby constructing higher-order interpretive frameworks. Moreover, comprehensive explanations are given of the seven phases proposed by Noblit and Hare (1988), i.e., getting started, determining relevant content for the initial inquiry, reading the studies, establishing how the studies are related, translating the studies into each other, synthesizing the translations, and presenting the final synthesis. Furthermore, potential applications of meta-ethnographic synthesis in the field of healthcare are described, including synthesizing multicultural caregiving experiences to elucidate the lived worlds of patients and caregivers. Meta-ethnographic synthesis not only fosters deeper cultural insights but also provides concrete qualitative evidence to inform policy-making and facilitates the translation and exchange of knowledge between academia and clinical practice. The insights provided in this paper highlight that meta-ethnographic synthesis, through its comparison and interpretation, offers unique insights into human experience and cultural diversity, enriching qualitative research with new perspectives and theoretical contributions.
... The meta-ethnographic approach was first proposed by Noblit and Hare [21] and provides a platform for analysing studies and translating key concepts. The opportunity to increase understanding, refine medical education research and practice has led to the growing use of qualitative studies within medical education research [22]. This metaethnography adhered to eMERGe guidance, which aims to increase transparency and rigour in reporting [23]. ...
Purpose: Rapid changes to learning technologies, accelerated by the COVID-19 pandemic, have led to the widespread adoption of virtual education. Pathology is an important medical science that is central to many curricula in health professions education (HPE). It has been impacted by the broader transition to virtual education. This systematic review and meta-ethnography evaluated the experiences of virtual pathology education within HPE. Methods: MEDLINE and EMBASE were systematically searched for peer-reviewed qualitative journal articles describing the experiences of virtual pathology in HPE. Of 1119 articles identified, 17 were synthesised using a meta-ethnographic approach. Results: The final synthesis represented a total of 2126 participants, including 1256 undergraduate medical students, 297 resident doctors, 473 senior clinicians, and 100 teaching faculty. We identified the following third-order constructs: 'Adaptability to learner's needs', 'negative human conse-quences', and 'uncertainty about trajectory'. Conclusion: This review highlights both positive and negative impacts of transitioning pathology education to virtual delivery. The need to enhance current educational practice according to these findings is particularly pressing since the shift to virtual education in pathology looks set to accelerate in years to come. ARTICLE HISTORY
Breastfeeding is the most cost-effective intervention for reducing infant morbidity and mortality, offering benefits for infants and mothers. Despite extensive promotion, global adherence remains below 50 %, resulting in significant clinical, economic, and environmental impacts. Thus, this overview of reviews aims to synthesize barriers and facilitators of breastfeeding, analyze research trends, and identify gaps to guide future research. A comprehensive literature search was conducted, including systematic reviews that examine these factors. The search covered seven electronic data repositories. The methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Bibliometric analysis focused on identifying top journals, authors, and countries, assessing their impact, and exploring trends over time. Findings were classified and analyzed thematically through line-by-line coding, theme description, and analytical formulation. A total of 123 reviews were included, mostly of high quality and published in top journals. Key trends comprised a growing focus on psychosocial and cultural factors, increased representation from low- and middle-income countries, and improved methodological rigor. However, geographical representation remains biased towards high-income countries, and some breastfeeding outcomes need further exploration. Thematic analysis revealed four categories: Therapeutic and care interventions; Support networks and education; Maternal-infant health issues; and Societal and environmental context. In conclusion, this overview of reviews identifies barriers and facilitators of breastfeeding and emphasizes the need for more inclusive research and tailored support. Addressing gaps in evidence for enhancing healthcare systems and policies can improve breastfeeding practices and outcomes worldwide.
BACKGROUND
The ubiquitous use of social media places adolescents at high risk for cyberincivility (disrespectful, insensitive, or disruptive online behaviors). Adolescents who experience cyberincivility can have mental health issues including depression and suicidal ideation. However, no reviews synthesized findings from qualitative studies on cyberincivility among adolescents, which was the aim of this review.
METHODS
Eleven articles were extracted from MEDLINE, Embase, PsycINFO, ERIC, and Education Full Text. Study qualities were assessed using the JBI Critical Appraisal Checklist. A meta‐ethnographic framework guided the thematic analysis.
RESULTS
Five themes were identified: forms of cyberincivility, platforms used for cyberincivility, perceptions and understanding of cyberincivility, adverse impact on health, and perceptions of seeking support. Social media was often used for cyberincivility, and common forms of cyberincivility included impersonation, aggressive verbal behaviors, and social exclusion. Adolescents perceived cyberincivility as persistent and relentless, with severe health impacts including depression, but they hesitate to seek support.
CONCLUSIONS
Considering the negative impact of cyberincivility on adolescents' physical and mental well‐being, it is important to develop anti‐cyberincivility programs in schools. Schools have opportunities to efficiently reach both perpetrators and victims of cyberincivility with anti‐cyberincivility programs rooted in trust building and engagement from family, community, and peers.
Purpose:
Foundation years or internships are an important period for junior doctors to apply their knowledge and gain clinical competency. Experiences gained during the foundation years or internships are likely to inform newly qualified doctors' opinions about how they want to continue their career. We aimed to understand how medical doctors' internship experiences influence their career intention/decision.
Methods:
We conducted qualitative evidence synthesis using meta-ethnography. We searched six electronic bibliographic databases for papers published between 2000-2020 and included papers exploring how foundation years or internship experiences shape doctors' career intention/decisions, including in relation to migration, public/private/dual practice preference, rural/urban preference, and specialty choice. We used the GRADE-CERQual framework to rate confidence in review findings.
Results:
We examined 23 papers out of 6085 citations screened. We abstracted three high-level inter-related themes across 14 conceptual categories: (1) Deciding the personal best fit both clinically and in general (which option is 'more me'?) through hands-on and real-life experiences (2) Exploring, experiencing and witnessing workplace norms; and (3) Worrying about the future in terms of job market policies, future training and professional development opportunities. Confidence in findings varied but was rated high in 8 conceptual categories.
Conclusions:
Our meta-ethnographic review revealed a range of ways in which internship experience shapes medical doctors' career intentions/decisions allowing us to produce a broad conceptual model of this phenomenon. The results highlight the importance of ensuring sufficient, positive and inspiring clinical exposure, improving workplace environment, relationship and culture, refraining from undermining specific specialities and communicating contractual and job market policies early on to young doctors, in order to attract doctors to less popular specialties or work locations where they are most needed. We propose our conceptual model should be further tested in new research across a range of contexts.
Background
Qualitative synthesis approaches are increasingly used in healthcare research. One of the most commonly utilised approaches is meta-ethnography. This is a systematic approach which synthesises data from multiple studies to enable new insights into patients’ and healthcare professionals’ experiences and perspectives. Meta-ethnographies can provide important theoretical and conceptual contributions and generate evidence for healthcare practice and policy. However, there is currently a lack of clarity and guidance surrounding the data synthesis stages and process.
Method
This paper aimed to outline a step-by-step method for conducting a meta-ethnography with illustrative examples.
Results
A practical step-by-step guide for conducting meta-ethnography based on the original seven steps as developed by Noblit & Hare (Meta-ethnography: Synthesizing qualitative studies.,1998) is presented. The stages include getting started, deciding what is relevant to the initial interest, reading the studies, determining how the studies are related, translating the studies into one another, synthesising the translations and expressing the synthesis.
We have incorporated adaptations and developments from recent publications. Annotations based on a previous meta-ethnography are provided. These are particularly detailed for stages 4–6, as these are often described as being the most challenging to conduct, but with the most limited amount of guidance available.
Conclusion
Meta-ethnographic synthesis is an important and increasingly used tool in healthcare research, which can be used to inform policy and practice. The guide presented clarifies how the stages and processes involved in conducting a meta-synthesis can be operationalised.
Cancer is not just one disease, but a large group of almost 100 diseases. Its two main characteristics are uncontrolled growth of the cells in the human body and the ability of these cells to migrate from the original site and spread to distant sites. If the dispersion is not controlled, cancer can outcome in death. One out of every four deaths in the United States (US) is from cancer. It is second only to heart disease as a cause of death in the US. About 1.2 million Americans are diagnosed with cancer per annum; apart from 500,000 die of cancer every year.Palliative care is a well-established approach to maintaining quality of life in end-stage cancer patients. Palliative care nurses have to complete basic diploma/degree/post-graduation in nursing with special training/experience in palliative care. Palliative care nurses often work in collaboration with doctors, allied health professionals, social workers, physiotherapists, and other multidisciplinary clinical care. There is a unique body of knowledge with direct application to the practice of palliative care nursing. This includes pain and symptom management, end-stage disease processes, spiritual and culturally sensitive care of patients and their families, interdisciplinary collaborative practice, loss and grief issues, patient education and advocacy, ethical and legal considerations, and communication skills, etc. The Need for the Palliative Care Nurse is a model that is persistent with basic nursing values, which combines caring for patients and their families behindhand of their culture, age, socioeconomic status, or diagnoses, and engaging in caring relationships that transcend time, circumstances, and location.
Aims
The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting.
Background
Evidence-based policy and practice require robust evidence syntheses which can further understanding of people’s experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality.
Design
The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes.
Methods
The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes.
Findings
Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance.
Conclusion
The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology.
Electronic supplementary material
The online version of this article (10.1186/s12874-018-0600-0) contains supplementary material, which is available to authorized users.
The aim of this study was to provide guidance to improve the completeness and clarity of meta‐ethnography reporting. Evidence‐based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta‐ethnography is a rigorous seven‐phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta‐ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta‐ethnography reporting guidance is needed to improve reporting quality. The eMERGe study used a rigorous mixed‐methods design and evidence‐based methods to develop the novel reporting guidance and explanatory notes. The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta‐ethnography conduct and reporting; (2) a review and audit of published meta‐ethnographies to identify good practice principles; (3) international, multidisciplinary consensus‐building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes. Recommendations and good practice for all seven phases of meta‐ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance.The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta‐ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta‐ethnography outputs to improve practice, policyand service user outcomes in health and other fields. This is the first tailored reporting guideline for meta‐ethnography.
This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho‐oncology, Review of Education, PLoS One and BMC Medical Research Methodology.
Aims
The aim of this study was to provide guidance to improve the completeness and clarity of meta‐ethnography reporting.
Background
Evidence‐based policy and practice require robust evidence syntheses which can further understanding of people's experiences and associated social processes. Meta‐ethnography is a rigorous seven‐phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta‐ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta‐ethnography reporting guidance is needed to improve reporting quality.
Design
The eMERGe study used a rigorous mixed‐methods design and evidence‐based methods to develop the novel reporting guidance and explanatory notes.
Methods
The study, conducted from 2015 ‐ 2017, comprised of: (1) a methodological systematic review of guidance for meta‐ethnography conduct and reporting; (2) a review and audit of published meta‐ethnographies to identify good practice principles; (3) international, multidisciplinary consensus‐building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes.
Findings
Recommendations and good practice for all seven phases of meta‐ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance.
Conclusion
The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta‐ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta‐ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta‐ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho‐oncology, Review of Education, and BMC Medical Research Methodology.
Touch mediates health professionals’ interactions with patients. Different professionals have reported their practices but what is currently lacking is a well-theorized, interprofessional synthesis. We systematically searched eight databases, identified 41 studies in seven professions—nursing (27), medicine (4), physiotherapy (5), osteopathy (1), counseling (2), psychotherapy (1), dentistry (1)—and completed a meta-ethnographic line-of-argument synthesis. This found that touch is caring, exercises power, and demands safe space. Different professions express care through the medium of touch in different ways. They all, however, expect to initiate touch rather than for patients to do so. Various practices negotiate boundaries that define safe spaces between health care professions and patients. A metaphor—the waltz—integrates the practice of touch. Health care professionals connect physically with patients in ways that form strong relationships between them while “dance steps” help manage the risk that is inherent in such an intimate form of connection.
Since its inception in the 1980s, the meta-ethnography approach for synthesising qualitative study accounts has been used extensively in health and social care research and to a lesser extent in educational research. The aim of this article is to reflect on the evolution of the method in both fields. It starts by describing the meta-ethnography approach, charts the rise of evidence-based research in health-related research, and explores the growth in the rate of published health-related meta-ethnographies. It proceeds by offering some explanation for the slower growth in the use of meta-ethnography in educational research. It explains this using the history of the early developments of qualitative approaches in Education and their underpinning paradigms. It then discusses key meta-ethnographies conducted in education, comparing those to more recent ones, in terms of methodological development. The article concludes by drawing lessons about how the conduct of meta-ethnography may be improved in any discipline.
Background: Interprofessional facilitators and teachers are regarded as central to the effective delivery of interprofessional education (IPE). As the IPE literature continues to expand, most studies have focused on reporting learner outcomes, with little attention paid to IPE facilitation. However, a number of studies have recently emerged reporting on this phenomenon.
Aim: To present a synthesis of qualitative evidence on the facilitation of IPE, using a meta-ethnographic approach.
Methods: Electronic databases and journals were searched for the past 10 years. Of the 2164 abstracts initially found, 94 full papers were reviewed and subsequently 12 papers were included. Teams of two reviewers independently completed each step in the review process. The quality of these papers was assessed using a modified critical appraisal checklist.
Results: Seven key concepts embedded in the included studies were synthesized into three main factors which provided an insight into the nature of IPE facilitation. Specifically, the synthesis found that IPE facilitation is influenced by ?contextual characteristics?; ?facilitator experiences?; and the ?use of different facilitation strategies?.
Conclusions: IPE facilitation is a complex activity affected by contextual, experiential and pedagogical factors. Further research is needed to explore the effects of these factors on the delivery of IPE.
Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. Our team was funded to complete a meta-ethnography of patients' experience of chronic musculoskeletal pain. It has been 25 years since Noblit and Hare published their core text on meta-ethnography, and the current health research environment brings additional challenges to researchers aiming to synthesise qualitative research. Noblit and Hare propose seven stages of meta-ethnography which take the researcher from formulating a research idea to expressing the findings. These stages are not discrete but form part of an iterative research process. We aimed to build on the methods of Noblit and Hare and explore the challenges of including a large number of qualitative studies into a qualitative systematic review. These challenges hinge upon epistemological and practical issues to be considered alongside expectations about what determines high quality research. This paper describes our method and explores these challenges. Central to our method was the process of collaborative interpretation of concepts and the decision to exclude original material where we could not decipher a concept. We use excerpts from our research team's reflexive statements to illustrate the development of our methods.
In 2007, the journal Qualitative Research published a review on qualitative evidence syntheses conducted between 1988 and 2004. It reported on the lack of explicit detail regarding methods for searching, appraisal and synthesis, and a lack of emerging consensus on these issues. We present an update of this review for the period 2005–8. Not only has the amount of published qualitative evidence syntheses doubled, but authors have also become more transparent about their searching and critical appraisal procedures. Nevertheless, for the synthesis component of the qualitative reviews, a black box remains between what people claim to use as a synthesis approach and what is actually done in practice. A detailed evaluation of how well authors master their chosen approach could provide important information for developers of particular methods, who seem to succeed in playing the game according to the rules. Clear methodological instructions need to be developed to assist others in applying these synthesis methods.
Background:
Meta-narrative review is one of an emerging menu of new approaches to qualitative and mixed-method systematic review. A meta-narrative review seeks to illuminate a heterogeneous topic area by highlighting the contrasting and complementary ways researchers have studied the same or a similar topic. No previous publication standards exist for the reporting of meta-narrative reviews. This publication standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. The project's aim is to produce preliminary publication standards for meta-narrative reviews.
Design:
A mixed method study synthesising data between 2011 to 2012 from a literature review, online Delphi panel and feedback from training, workshops and email list.
Methods:
We: (a) collated and summarized existing literature on the principles of good practice in meta-narrative reviews; (b) considered the extent to which these principles had been followed by published reviews, thereby identifying how rigor may be lost and how existing methods could be improved; (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, meta-narrative reviews, policy, and/or publishing to produce and iteratively refine a draft set of methodological steps, and publication standards; (d) provided real-time support to ongoing meta-narrative reviews and the open-access RAMESES online discussion list so as to capture problems and questions as they arose; and (e) synthesized expert input, evidence review, and real-time problem analysis into a definitive set of standards.
Results:
We identified nine published meta-narrative reviews, provided real-time support to four ongoing reviews, and captured questions raised in the RAMESES discussion list. Through analysis and discussion within the project team, we summarized the published literature, and common questions and challenges into briefing materials for the Delphi panel, comprising 33 members. Within three rounds this panel had reached consensus on 20 key publication standards, with an overall response rate of 90%.
Conclusions:
This project used multiple sources to draw together evidence and expertise in meta-narrative reviews. For each item we have included an explanation for why it is important and guidance on how it might be reported. Meta-narrative review is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further theoretical and methodological developments. We hope that these standards will act as a resource that will contribute to improving the reporting of meta-narrative reviews.
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.
To evaluate meta-ethnography as a method for synthesising qualitative research studies in health and health care.
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.
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.
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.
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.
Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.
Education is a complex intervention which produces different outcomes in different circumstances. Education researchers have long recognised the need to supplement experimental studies of efficacy with a broader range of study designs that will help to unpack the 'how' and 'why' questions and illuminate the many, varied and interdependent mechanisms by which interventions may work (or fail to work) in different contexts.
One promising approach is realist evaluation, which seeks to establish what works, for whom, in what circumstances, in what respects, to what extent, and why. This paper introduces the realist approach and explains why it is particularly suited to education research. It gives a brief introduction to the philosophical assumptions underlying realist methods and outlines key principles of realist evaluation (designed for empirical studies) and realist review (the application of realist methods to secondary research).
The paper warns that realist approaches are not a panacea and lists the circumstances in which they are likely to be particularly useful.
Concurrent with the recent enthusiasm for qualitative research in the health fields, an energetic call for methods by which to synthesize the knowledge has been generated on various substantive topics. Although there is an emerging literature on meta-analysis and meta-synthesis, many authors overestimate the simplicity of such approaches and erroneously assume that useful knowledge can be synthesized from limited collections of study reports without a thorough analysis of their theoretical, methodological, and contextual foundations and features. In this article, the authors report some of the insights obtained from an extensive and exhaustive metastudy of qualitative studies of chronic illness experience. Their findings reveal the complexities inherent not only in any phenomenon of interest to health researchers but also in the study of how we have come to know what we think we know about it.
To demonstrate the benefits of applying meta ethnography to the synthesis of qualitative research, by means of a worked example.
Four papers about lay meanings of medicines were arbitrarily chosen. Noblit and Hare's seven-step process for conducting a meta ethnography was employed: getting started; deciding what is relevant to the initial interest; reading the studies; determining how the studies are related; translating the studies into one another; synthesising translations; and expressing the synthesis.
Six key concepts were identified: adherence/compliance; self-regulation; aversion; alternative coping strategies; sanctions; and selective disclosure. Four second-order interpretations (derived from the chosen papers) were identified, on the basis of which four third-order interpretations (based on the key concepts and second-order interpretations) were constructed. These were all linked together in a line of argument that accounts for patients' medicine-taking behaviour and communication with health professionals in different settings. Third-order interpretations were developed which were not only consistent with the original results but also extended beyond them.
It is possible to use meta ethnography to synthesise the results of qualitative research. The worked example has produced middle-range theories in the form of hypotheses that could be tested by other researchers.
Producing literature reviews of complex evidence for policymaking questions is a challenging methodological area. There are several established and emerging approaches to such reviews, but unanswered questions remain, especially around how to begin to make sense of large data sets drawn from heterogeneous sources. Drawing on Kuhn's notion of scientific paradigms, we developed a new method-meta-narrative review-for sorting and interpreting the 1024 sources identified in our exploratory searches. We took as our initial unit of analysis the unfolding 'storyline' of a research tradition over time. We mapped these storylines by using both electronic and manual tracking to trace the influence of seminal theoretical and empirical work on subsequent research within a tradition. We then drew variously on the different storylines to build up a rich picture of our field of study. We identified 13 key meta-narratives from literatures as disparate as rural sociology, clinical epidemiology, marketing and organisational studies. Researchers in different traditions had conceptualised, explained and investigated diffusion of innovations differently and had used different criteria for judging the quality of empirical work. Moreover, they told very different over-arching stories of the progress of their research. Within each tradition, accounts of research depicted human characters emplotted in a story of (in the early stages) pioneering endeavour and (later) systematic puzzle-solving, variously embellished with scientific dramas, surprises and 'twists in the plot'. By first separating out, and then drawing together, these different meta-narratives, we produced a synthesis that embraced the many complexities and ambiguities of 'diffusion of innovations' in an organisational setting. We were able to make sense of seemingly contradictory data by systematically exposing and exploring tensions between research paradigms as set out in their over-arching storylines. In some traditions, scientific revolutions were identifiable in which breakaway researchers had abandoned the prevailing paradigm and introduced a new set of concepts, theories and empirical methods. We concluded that meta-narrative review adds value to the synthesis of heterogeneous bodies of literature, in which different groups of scientists have conceptualised and investigated the 'same' problem in different ways and produced seemingly contradictory findings. Its contribution to the mixed economy of methods for the systematic review of complex evidence should be explored further.
Qualitative synthesis has become more commonplace in recent years. Meta-ethnography is one of several methods for synthesising qualitative research and is being used increasingly within health care research. However, many aspects of the steps in the process remain ill-defined.
We utilized the seven stages of the synthesis process to synthesise qualitative research on adherence to tuberculosis treatment. In this paper we discuss the methodological and practical challenges faced; of particular note are the methods used in our synthesis, the additional steps that we found useful in clarifying the process, and the key methodological challenges encountered in implementing the meta-ethnographic approach. The challenges included shaping an appropriate question for the synthesis; identifying relevant studies; assessing the quality of the studies; and synthesising findings across a very large number of primary studies from different contexts and research traditions. We offer suggestions that may assist in undertaking meta-ethnographies in the future.
Meta-ethnography is a useful method for synthesising qualitative research and for developing models that interpret findings across multiple studies. Despite its growing use in health research, further research is needed to address the wide range of methodological and epistemological questions raised by the approach.
Introduction
International Medical Graduates (IMGs) represent a large portion of practicing doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK’s General Medical Council (GMC) recently set targets to ‘eliminate disproportionate complaints’ and ‘eradicate disadvantage and discrimination in medical education’. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs, to identify factors affecting IMGs’ professional practice (either directly or indirectly).
Methods
In September 2019 we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors’ themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts.
Results
Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practicing in all 6 continents in a range of settings, including primary and secondary care. We developed 5 key concepts: Migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the 4 main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented.
Conclusions
This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.
Purpose
Accreditation is widely used by medical schools around the word to evaluate their curricula and educational processes, although its impacts on those involved in the ‘frontline’ of medical education receive little attention. This study systematically identified and synthesised qualitative studies that have explored medical teachers’ and students’ experiences of accreditation.
Methods
Four databases (Pubmed, EMBASE, ERIC, and PsychINFO) were searched for relevant published articles. Synthesis was performed using meta-ethnography.
Results
Eighteen articles were included in the final synthesis with 1017 individual participants from 10 countries. Findings were categorised into four domains, including navigating power differentials, evaluating credibility, influencing medical programmes, and culture and behaviour. The synthesis demonstrates divergent views on the value of accreditation in medical schools from students and staff including both positive and negative impacts on medical education programmes and stakeholders.
Conclusions
Although accreditation is perceived to have many benefits, it also has a number of unintended consequences, including on staff morale, student-teacher relationships, and teacher workloads. Medical teachers also have a number of concerns about the credibility of accreditation standards, assessors, and processes. Regulators and policymakers should consider the views of teachers and students as they seek to improve current accreditation practices.
Background: Empathy and compassion are important in healthcare delivery, and are necessary qualities in medical students.
Aims: To explore medical students', patients' and educators' perceptions of what affects empathy and the expression of compassion; and to address gaps in knowledge, attitudes and skills on how education affects empathy and the expression of compassion in medical students.
Methods: The seven steps by Noblit and Hare were used for this meta-ethnography. Databases were searched for studies in English, published from 2007 to 2017 with outcomes of empathy and compassion. Key themes and concepts were identified, and accounts from the studies were used to build interpretations.
Findings: Thirty-three qualitative studies were included and four main themes were derived: seeing the patient as a person; appreciating the elements of empathy and compassion; navigating in the training environment; and being guided by ideals. Interactions between the patient, the medical student and training environment which affect the development of empathy and compassion are illustrated in a conceptual model.
Conclusions: This meta-ethnography extends our understanding of how medical education affects the expression of empathy and compassion in medical students. The results provide important considerations for medical educators and faculty developers in further developing and improving medical curricula.
Background:
Quantitative research suggests that medical students' empathy declines during their training. This meta-ethnography asks: What new understanding may be gained by a synthesis of interview-based qualitative research on medical students' views and experiences of empathy? How can such a synthesis be undertaken?
Methodology:
A meta-ethnography synthesizes individual qualitative studies to generate knowledge increasing understanding and informing debate. A literature search yielded eight qualitative studies which met the inclusion criteria. These were analyzed from a phenomenological and interpretative perspective.
Results:
The meta-ethnography revealed a conceptual confusion around empathy and a tension in medical education between distancing and connecting with patients. Barriers to empathy included a lack of patient contact and a strong emphasis on the biomedical over the psycho-social aspects of the curriculum. A number of influences discussed in the paper lead students to adopt less overt ways of showing their empathy.
Conclusion:
These insights deepen our understanding of the apparent decline in empathy in medical students. The lessons from these studies suggest that future curriculum development should include earlier patient contact, more emphasis on psycho-social aspects of care and address the barriers to empathy to ensure that tomorrow's doctors are empathetic as well as competent.
Recurrence is a difficult stage in the cancer journey as it brings to the fore the life-threatening nature of the illness. This meta-ethnography examines and synthesises the findings of qualitative research regarding patients' experience of cancer recurrence.
A systematic search of the qualitative studies published between January 1994 to April 2014 was undertaken. Seventeen relevant papers were identified, and a meta-ethnography was conducted.
Six third-order concepts were developed to capture patients' experiences: experiencing emotional turmoil following diagnosis, which described the emotional impact of diagnosis and the influence of previous experiences on how the news were received; experiencing otherness, encompassing changed relationships; seeking support in the health care system, describing the extent of information needs and the importance of the relationship with health care professionals; adjusting to a new prognosis and uncertain future, highlighting the changes associated with uncertainty; finding strategies to deal with recurrence, describing ways of maintaining emotional well-being and regaining a sense of control over cancer; and facing mortality, describing the difficulties in facing death-related concerns and associated consequences.
This meta-ethnography clarifies the fundamental aspects of patients' experience of recurrence. It suggests that health care professionals can promote a positive experience of care and help lessen the psychosocial impact of recurrence by providing information in an approachable way and being sensitive to their changing needs. It also points to the importance of supporting patients in adopting strategies to regain a sense of control and to address their potential mortality and its impact on loved ones. Copyright © 2015 John Wiley & Sons, Ltd.
Copyright © 2015 John Wiley & Sons, Ltd.
In a famous chapter of his Principles of Psychology William James analyzes our sense of reality.¹ Reality, so he states, means simply relation to our emotional and active life. The origin of all reality is subjective, whatever excites and stimulates our interest is real. To call a thing real means that this thing stands in a certain relation to ourselves. “The word ‘real’ is, in short, a fringe.” ² Our primitive impulse is to affirm immediately the reality of all that is conceived, as long as it remains uncontradicted. But there are several, probably an infinite number of various orders of realities, each with its own special and separate style of existence. James calls them “sub-universes” and mentions as examples the world of sense or physical things (as the paramount reality), the world of science, the world of ideal relations, the world of “idols of the tribe”, the various supernatural worlds of mythology and religion, the various worlds of individual opinion, the worlds of sheer madness and vagary.³ The popular mind conceives of all these sub-worlds more or less disconnectedly, and when dealing with one of them forgets for the time being its relations to the rest. But every object we think of is at last referred to one of these sub worlds.“
Faculty experiences of innovative approaches to learning and the changes to their knowledge emerging from such experiences
constitute an important area of inquiry that has to date largely been ignored or has been approached with research methods
ill-suited to examining such experiences. This paper adopts interpretative meta-ethnography as its research framework to investigate
the changes to faculty knowledge that occur when they adopt problem-based learning (PBL). The paper presents themes that emerged
through the analysis and argues for future inquiry.
The study aimed to synthesise qualitative studies of lay experiences of medicine taking. Most studies focused on the experience of those not taking their medicine as prescribed, with few considering those who reject their medicines or accept them uncritically. Most were concerned with medicines for chronic illnesses. The synthesis revealed widespread caution about taking medicines and highlighted the lay practice of testing medicines, mainly for adverse effects. Some concerns about medicines cannot be resolved by lay evaluation, however, including worries about dependence, tolerance and addiction, the potential harm from taking medicines on a long-term basis and the possibility of medicines masking other symptoms. Additionally, in some cases medicines had a significant impact on identity, presenting problems of disclosure and stigma. People were found to accept their medicines either passively or actively, or to reject them. Some were coerced into taking medicines. Active accepters might modify their regimens by taking medicines symptomatically or strategically, or by adjusting doses to minimise unwanted consequences, or to make the regimen more acceptable. Many modifications appeared to reflect a desire to minimise the intake of medicines and this was echoed in some peoples' use of non-pharmacological treatments to either supplant or supplement their medicines. Few discussed regimen changes with their doctors. We conclude that the main reason why people do not take their medicines as prescribed is not because of failings in patients, doctors or systems, but because of concerns about the medicines themselves. On the whole, the findings point to considerable reluctance to take medicine and a preference to take as little as possible. We argue that peoples' resistance to medicine taking needs to be recognised and that the focus should be on developing ways of making medicines safe, as well as identifying and evaluating the treatments that people often choose in preference to medicines.
A move to more systematic and transparent approaches in qualitative evidence synthesis
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Understanding impacts of accreditation on medical teachers and students: a systematic review and meta-ethnography
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Choa G, Arfeen Z, Chan SCC, Rashid MA.
Understanding impacts of accreditation on medical
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Types of syntheses and their criteria
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Strike K, Posner G. Types of syntheses and their criteria.
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