Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis

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Abstract

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.

Related collections

Most cited references 69

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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.

David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2009)

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Is Open Access

Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series

Simon Lewin, Andrew Booth, Claire Glenton … (2018)

The GRADE-CERQual (‘Confidence in the Evidence from Reviews of Qualitative research’) approach provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research (or qualitative evidence syntheses). The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. Confidence in the evidence from qualitative evidence syntheses is an assessment of the extent to which a review finding is a reasonable representation of the phenomenon of interest. CERQual provides a systematic and transparent framework for assessing confidence in individual review findings, based on consideration of four components: (1) methodological limitations, (2) coherence, (3) adequacy of data, and (4) relevance. A fifth component, dissemination (or publication) bias, may also be important and is being explored. As with the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach for effectiveness evidence, CERQual suggests summarising evidence in succinct, transparent, and informative Summary of Qualitative Findings tables. These tables are designed to communicate the review findings and the CERQual assessment of confidence in each finding. This article is the first of a seven-part series providing guidance on how to apply the CERQual approach. In this paper, we describe the rationale and conceptual basis for CERQual, the aims of the approach, how the approach was developed, and its main components. We also outline the purpose and structure of this series and discuss the growing role for qualitative evidence in decision-making. Papers 3, 4, 5, 6, and 7 in this series discuss each CERQual component, including the rationale for including the component in the approach, how the component is conceptualised, and how it should be assessed. Paper 2 discusses how to make an overall assessment of confidence in a review finding and how to create a Summary of Qualitative Findings table. The series is intended primarily for those undertaking qualitative evidence syntheses or using their findings in decision-making processes but is also relevant to guideline development agencies, primary qualitative researchers, and implementation scientists and practitioners. Electronic supplementary material The online version of this article (10.1186/s13012-017-0688-3) contains supplementary material, which is available to authorized users.

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Methods for the synthesis of qualitative research: a critical review

Elaine Barnett-Page, James Thomas (2009)

Background In recent years, a growing number of methods for synthesising qualitative research have emerged, particularly in relation to health-related research. There is a need for both researchers and commissioners to be able to distinguish between these methods and to select which method is the most appropriate to their situation. Discussion A number of methodological and conceptual links between these methods were identified and explored, while contrasting epistemological positions explained differences in approaches to issues such as quality assessment and extent of iteration. Methods broadly fall into 'realist' or 'idealist' epistemologies, which partly accounts for these differences. Summary Methods for qualitative synthesis vary across a range of dimensions. Commissioners of qualitative syntheses might wish to consider the kind of product they want and select their method – or type of method – accordingly.

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Author and article information

Contributors

Raabia Sattar:

ORCID: http://orcid.org/0000-0002-1003-9772

ps15rs@leeds.ac.uk

Rebecca Lawton: r.j.lawton@leeds.ac.uk

Maria Panagioti: maria.panagioti@manchester.ac.uk

Judith Johnson: j.johnson@leeds.ac.uk

Journal

Journal ID (nlm-ta): BMC Health Serv Res

Journal ID (iso-abbrev): BMC Health Serv Res

Title: BMC Health Services Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6963

Publication date (Electronic): 8 January 2021

Publication date PMC-release: 8 January 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 50

Affiliations

[1 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, University of Leeds, ; Leeds, LS2 9JT UK

[2 ]GRID grid.418449.4, ISNI 0000 0004 0379 5398, Bradford Institute for Health Research, ; Bradford, BD9 6RJ UK

[3 ]GRID grid.5379.8, ISNI 0000000121662407, National Institute of Health Research for Primary Care Research, Manchester Academic Health Science Centre, , University of Manchester, ; Manchester, M13 9PL UK

Author information

Raabia Sattar http://orcid.org/0000-0002-1003-9772

Article

Publisher ID: 6049

DOI: 10.1186/s12913-020-06049-w

PMC ID: 7796630

PubMed ID: 33419430

SO-VID: 40e78a73-2a98-4c91-99ea-f38b82b4862b

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 10 June 2020

Date accepted : 26 December 2020

Funding

Funded by: NIHR CLAHRC Yorkshire & Humber

Custom metadata

ScienceOpen disciplines: Health & Social care

Keywords: meta-ethnography,research methods,qualitative synthesis,qualitative health research

Data availability: