A comparison of methods for the systematic review of qualitative research: two examples using meta-ethnography and meta-study

Systematic reviews and meta-analyses have been a central pillar of evidence-basedpractice and policy-making in healthcare over recent years. Traditionally, this hasfocused on effectiveness evidence from trials.. There is increasing understanding,however, that other study designs also provide essential information and this has led tointerest in developing ways to review and synthesis such evidence. Qualitativeresearch has unique potential to illuminate the patient experience.This research has three aims:1) To review and compare the proposed methods of systematic review andsynthesis of qualitative research.2) To develop and assess two methods of systematic review and synthesis ofqualitative research.3) To compare these two methods and suggest how they might be used in apolicy-making context.In addressing these aims, this thesis substantially contributes to debates about thepurpose and practice of systematic review and synthesis of qualitative research,particularly in the context of health technology assessment and related pOlicy-making.I undertake a unique critical comparison of the methods suggested for reviewing andsynthesising qualitative research, based on their approach to key stages of systematicreview. This is used to produce a comprehensive framework for good practice~ I usethe framework in two systematic reviews, one about heavy menstrual bleeding usingmeta-ethnography, and one about hysterectomy using meta-study.These two reviews allow a comparison of the two methods, and in particular explorethe impact of expanding the meta-ethnography approach through meta-study, whichadds explicit steps to assess the impact of study methodology and theory on findings.The ability of meta-study to unpack the procedures and theories that produce particularfindings is key and illuminates the importance of theory in systematic reviews ofqualitative research.Through the two systematic reviews, my thesis also contributes to understanding ofthese reproductive health topic areas through the creation of new insights andconcepts from the synthesis. The synthesis of heavy menstrual bleeding studiesproduced a detailed patient illness model based on women's experiences. In addition,it allowed an understanding of elements that contribute to women's certainty or uncertainty about whether or not their periods could be seen as problematic andrequiring medical help. This helps to establish the limitations of the medical model fordoctors, as well as women who suffer from heavy menstrual bleeding.The synthesis of hysterectomy studies produced a detailed description of the journeythat women make to, and through, hysterectomy, based on their experiences. I alsocreated a theoretical framework, which shows that hysterectomy needs to beunderstood in the context of personal, physical experiences, together with socioculturalforces that affect the way in which hysterectomy is experienced, and that theinteraction of these micro- and macro-concerns mediate through, and affect,relationships with key other people. Methodology affected the research questionsposed and the conclusions of research.Comparing the two methods of review and synthesis showed the importance of takingaccount of the methods and theories that produce research findings. However thisadditional detail may be at the expense of certainty and requires additional resources.