Katy Sutcliffe

Integrating qualitative research with trials in systematic reviews

An example review from public health shows how integration is possible and some potential benefits The value of including data from different types of studies in systematic reviews of health interventions is increasingly recognised. A recent editorial accepted that qualitative research should be included in systematic reviews, but pointed to a “daunting array of theoretical and practical problems.”1 This article presents an approach to combining qualitative and quantitative research in a systematic review. We describe how we used this approach in a systematic review of interventions to promote healthy eating among children, full details of which are available.2 The review question was: “What is known about the barriers to, and facilitators of, healthy eating among children aged 4-10 years?” The specific focus of the review was fruit and vegetable intake. We searched for two types of research: controlled trials (randomised or non-randomised) that examined interventions to promote healthy eating and studies that examined childrens perspectives and understandings (views studies), often by using qualitative research methods—for example, in-depth interviews and focus groups. ![][1] But will she eat her greens? Credit: PAUL DARRAH/REX We used conventional systematic review methods: sensitive searching, systematic screening, and independent quality assessment. These methods found 33 trials and eight qualitative studies that met our prespecified inclusion criteria. We assessed studies for quality and reliability according to standards for their specific study types; they were then synthesised individually by using methods appropriate to the study. We conducted a meta-analysis with the data extracted from trials, used qualitative methods to synthesise the textual data extracted from the qualitative studies, and then integrated the findings from the qualitative synthesis with those from the meta-analysis. This gave us one review with three syntheses (fig 1). Fig 1 Stages of the review We maintained the key principles of avoiding bias and maximising … [1]: /embed/graphic-1.gif

Enhancing the usability of systematic reviews by improving the consideration and description of interventions

The importance of adequate intervention descriptions in minimising research waste and improving research usability and reproducibility has gained attention in the past few years. Nearly all focus to date has been on intervention reporting in randomised trials. Yet clinicians are encouraged to use systematic reviews, whenever available, rather than single trials to inform their practice. This article explores the problem and implications of incomplete intervention details during the planning, conduct, and reporting of systematic reviews and makes recommendations for review authors, peer reviewers, and journal editors

Mediating policy-relevant evidence at speed: are systematic reviews of systematic reviews a useful approach?

When swift, accurate appraisal of evidence is required to inform policy concerning broad research questions, and budgetary constraints limit the employment of large research teams, researchers face a significant challenge which is sometimes met by reviewing existing systematic reviews. In this paper we highlight the challenges inherent in the reviews of reviews (RoR) method in order to advance understanding of this important tool for policy makers. Drawing on our experiences, we present, where possible, potential solutions to these challenges to demonstrate that RoRs, despite their limitations, can be useful for mediating policy-relevant evidence at speed.

Gaps in the evidence on improving social care outcomes: findings from a meta-review of systematic reviews

Abstract Adult social care continues to be a central policy concern in the UK. The Adult Social Care Outcomes Framework (ASCOF) is a range of measures nationally available to drive forward improvement on outcomes and quality in local councils. While there is an emphasis on improving transparency, quality and outcomes, drawing on research evidence to achieve these aims is often difficult because the evidence is not easily identifiable, is disparate or of variable quality. We conducted a meta‐review to analyse and summarise systematic review‐level evidence on the impact of interventions on the four outcomes set out in the ASCOF: quality of life, delaying and reducing the need for services, satisfaction with services and safeguarding of vulnerable adults. This paper focuses on the availability of review‐level evidence and the presence of significant gaps in this evidence base. A range of health and social care databases were searched, including MEDLINE, ASSIA and The Cochrane Library in January and February 2012. All systematic reviews evaluating the efficacy of social care interventions for improving ASCOF outcomes for older people, people with long‐term conditions, mental health problems or physical and/or learning disabilities were eligible. Two reviewers independently screened systematic reviews for quality and relevance and extracted data; 43 systematic reviews were included, the majority of which examined the impact of interventions on quality of life (n = 34) and delaying and reducing the need for support (n = 25). Limited systematic review‐level evidence was found regarding satisfaction with services and safeguarding. There were also significant gaps in relation to key social care interventions and population groups. Research priorities include addressing these gaps and the collation of data on interventions, outcomes and populations more closely related to social care. Overall, a more relevant, comprehensive and robust evidence base is required to support improvement of outcomes for recipients of adult social care.

Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis

This is a protocol for a Cochrane Review (Qualitative). The objectives are as follows: The aim of this qualitative evidence synthesis is to explore the perceptions and experiences of potential and actual participants and trial recruiters to improve understanding of how interventions, strategies and processes of recruitment to RCTs potentially work for specific groups across different settings and contexts. The specific objectives of this review are: to describe recruiters’ perceptions and experiences of recruiting participants to RCTs; to describe potential and actual participants’ perceptions and experiences of recruitment to RCTs; to describe why potential participants accept or decline participation in RCTs; to explore the barriers and facilitators to participation in RCTs; to explore how perceptions and experiences of trial recruitment interventions, strategies and processes influence the decision-making of potential and actual participants; to explore to what extent the barriers and facilitators identified are addressed by interventions and strategies designed to improve recruitment evaluated in a previously published Cochrane review (Treweek 2010).

Seasonal influenza vaccination of healthcare workers: systematic review of qualitative evidence

BackgroundMost countries recommend that healthcare workers (HCWs) are vaccinated seasonally against influenza in order to protect themselves and patients. However, in many cases coverage remains low. A range of strategies have been implemented to increase uptake. Qualitative evidence can help in understanding the context of interventions, including why interventions may fail to achieve the desired effect. This study aimed to synthesise evidence on HCWs’ perceptions and experiences of vaccination for seasonal influenza.MethodsSystematic review of qualitative evidence. We searched MEDLINE, EMBASE and CINAHL and included English-language studies which reported substantive qualitative data on the vaccination of HCWs for seasonal influenza. Findings were synthesised thematically.ResultsTwenty-five studies were included in the review. HCWs may be motivated to accept vaccination to protect themselves and their patients against infection. However, a range of beliefs may act as barriers to vaccine uptake, including concerns about side-effects, scepticism about vaccine effectiveness, and the belief that influenza is not a serious illness. HCWs value their autonomy and professional responsibility in making decisions about vaccination. The implementation of interventions to promote vaccination uptake may face barriers both from HCWs’ personal beliefs and from the relationships between management and employees within the targeted organisations.ConclusionsHCWs’ vaccination behaviour needs to be understood in the context of HCWs’ relationships with each other, with management and with patients. Interventions to promote vaccination should take into account both the individual beliefs of targeted HCWs and the organisational context within which they are implemented.

Weight management programmes: Re-analysis of a systematic review to identify pathways to effectiveness.

Previous systematic reviews of weight management programmes (WMPs) have not been able to account for heterogeneity of effectiveness within programmes using top‐down behavioural change taxonomies. This could be due to overlapping causal pathways to effectiveness (or lack of effectiveness) in these complex interventions. Qualitative comparative analysis (QCA) can help identify these overlapping pathways.

The importance of service-users’ perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes

Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear.