Nuances in following a qualitative evidence synthesis protocol: refining eligibility criteria and focus during the screening of the updated search

ID: 

337

Session: 

Poster session 3

Date: 

Tuesday 18 September 2018 - 12:30 to 14:00

All authors in correct order:

Odendaal W1, Jocelyn Anstey Watkins JA2, Leon N3, Goudge J4, Griffiths F5, Tomlinson M6, Daniels K7
1 Health Systems Research Unit, South African Medical Research Council, Department of Psychiatry, Stellenbosch University, South Africa
2 Division of Health Sciences, Warwick Medical School, University of Warwick, UK
3 Health Systems Research Unit, South African Medical Research Council, School of Public Health, Brown University, Providence, Rhode Island, South Africa
4 Centre for Health Policy, School of Public Health, University of the Witwatersrand, South Africa
5 Division of Health Sciences, Warwick Medical School, University of Warwick, Centre for Health Policy, School of Public Health, University of the Witwatersrand, UK
6 Department of Psychology, University of Stellenbosch, South Africa
7 Health Systems Research Unit, South African Medical Research Council, Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, South Africa
Presenting author and contact person

Presenting author:

Willem Odendaal

Contact person:

Willem Odendaal
Abstract text
Background:
A protocol serves as road map for the conduct of a review and the rigour with which it is applied determines the quality of the review. However, there are often components in a protocol that are not detailed, which allow a degree of discretion to the review authors in how they are executed. Qualitative evidence syntheses using GRADE-CERQual may be even more open to such discretions, given that the methodology is less well established than for effectiveness reviews. It may also be more true for contemporary and emerging topics such as mobile health (mHealth).

Objectives:
To describe the process of 1) refining the eligibility criteria during screening, and 2) deciding on a more focused screening of the updated search records, for a GRADE-CERQual qualitative evidence synthesis review.

Methods and results:
The review is about health workers' perceptions and experiences of using mHealth technologies.

Refining the eligibility criteria: Despite a detailed and comprehensive definition of mHealth, there were many instances during the screening where the co-screeners disagreed on whether the technology used was mHealth. All the team members 'voted' on unresolved cases with the reason for their decision. This was recorded and resulted in a refined criteria document that was used to resolve future disagreements.

More focused screening: A second search was mandated given the time lapse from the first search. From the 23 included studies from the first search, 38 findings were drafted. For screening of the records from the second search, the review team drafted a list of topics that were not represented or were under-represented in the findings, for example high-income settings. They also identified findings graded as low confidence findings because of inadequate reporting in the literature, and screened with the purpose of looking for studies that added evidence to these findings. The eligibility document and focused screening of the second search contributed towards a more nuanced implementation of the review protocol.

Conclusions:
Protocol components may often not be detailed and comprehensive enough to account for unexpected issues arising during the review. Transparent and appropriate measures to deal with these instances may enhance the methodological rigour and quality of the review.

Patient or healthcare consumer involvement:
Not applicable.

Relevance to patients and consumers: 

mHealth has become a standard feature of delivering primary healthcare (PHC) services, particularly in remote and poorly resourced settings. This presentation reflects on the methodology of a qualitative evidence synthesis on health workers’ perceptions of using mHealth to deliver PHC services. Its findings will feed into WHO guidelines for the use of digital technologies, including mHealth. As such, this presentation will inform what is presented to WHO, and may ultimately impact how PHC is delivered using mHealth.