Assembling the findings of multiple primary qualitative studies using a systematic process may have a number of additional benefits: they may help generate more comprehensive and generalisable theory; they may add greater breadth and depth to existing systematic reviews of effectiveness by focusing on the views of those towards whom the interventions are directed; or they may provide insights into the reasons why interventions succeed or fail . In doing so, reviews of qualitative studies may usefully inform the implementation of interventions and programmes.
Although combining the findings of studies using qualitative approaches appears to be a worthwhile exercise, the nature of qualitative research raises challenges for its evaluation and synthesis . Key issues include the differing philosophical assumptions underpinning studies within the interpretivist paradigm, such as those drawing on phenomenological or ethnographic approaches, and whether or how to synthesize the findings of such studies. Concerns have also been expressed regarding the loss of explanatory context when the findings of multiple studies are combined, particularly given the importance of context in the analysis and interpretation of qualitative data. Whether and how to critically appraise qualitative studies included in a synthesis is also problematic. Some authors suggest that this imposes a positivist approach to ‘quality’ on studies conducted within a very different tradition .
A number of approaches to the synthesis of qualitative data have been proposed. Some are based on analysis methods used in primary research and most represent either an integrative or interpretive approach to synthesis [5,7]. Meta-ethnography is an interpretive approach originally developed by Noblit and Hare for combining the findings of ethnographic research conducted in the field of education . This synthesis method has the potential to provide a higher level of analysis, generate new research questions and reduce duplication of research. The approach has been used for research syntheses in health care, particularly for questions relevant to patient experiences of illness and care, such as lay experiences of chronic illness, of which there are now a number of published examples [4,13,14]. Some authors suggest that the strength of this approach lies in its attempt to preserve the interpretive properties of primary data , but there are several methodological questions surrounding its use for combining primary research, particularly research from different theoretical perspectives.
Conducting a meta-ethnography of qualitative literature: Lessons learnt