Country-specific qualitative synthesis: harvesting pearls or grit?

Session: 

Oral session: Qualitative evidence synthesis methodology

Date: 

Sunday 16 September 2018 - 14:30 to 14:40

Location: 

Carrick 2

All authors in correct order:

Booth A1, Mshelia S2, Analo C2, Nyakango SB3
1 School of Health and Related Research (ScHARR), United Kingdom
2 formerly School of Health and Related Research (ScHARR), UK, Nigeria
3 formerly School of Health and Related Research (ScHARR), UK, Kenya
Presenting author and contact person

Presenting author:

Andrew Booth

Contact person:

Andrew Booth
Abstract text
Background: International qualitative evidence syntheses, as commissioned by the World Health Organization (WHO) and other agencies, offer valuable cross-country perspectives on issues such as facility-based delivery and respectful maternity care. Necessarily, multi-context syntheses seek to offer breadth of coverage (across regions, countries, and settings) within an efficient time- and resource-envelope. Such syntheses have two limitations:
1) they may omit eligible studies that offer important country-specific insights; and
2) they may capture the phenomenon of interest incompletely, resulting, potentially, in immature conceptual frameworks.

Objectives: To compare the coverage, quality and contribution of country-specific and multi-context syntheses of facility-based delivery to inform strategic commissioning of qualitative syntheses.

Methods: We conducted two country-specific qualitative syntheses of attitudes of pregnant women to facility-based delivery, for Nigeria and Kenya, to augment and enhance a pre-existing international WHO synthesis through exhaustive retrieval and inclusion of country-specific findings. We conducted searches across local and regional sources - including university repositories - to augment standard bibliographic databases. We used framework synthesis to facilitate comparison between countries and with the international synthesis. We compared yields of included studies quantitatively (numbers of: studies, open access sources, journals with impact factors) and qualitatively (unique identification of or reinforcement of themes).

Results: Yield of studies for both country-specific syntheses was approximately seven times higher than the number of eligible studies for that country in the multi-context synthesis. On closer examination, however, we found that a large proportion of studies post-dated the multi-context search, were from non-impact factor or predatory journals, or were from non-open access sources. Qualitatively, the additional sources added country-specific nuances.

Conclusions: Inclusion of country-specific syntheses enhances the context-sensitivity of findings but at the potential expense of review quality.

Patient/healthcare consumer involvement: Country-specific syntheses extend consumer perspectives beyond multi-context syntheses and may resonate more clearly with local experience.

Relevance to patients and consumers: 

Evidence from qualitative research studies can potentially add much needed patient or healthcare consumer perspectives, particularly in those low- and middle-income countries where consumer participation and engagement remains in its developmental stages. Country-specific syntheses offer the possibility to augment and enhance international qualitative evidence syntheses, as produced by organisations such as the WHO, offering important social and cultural nuances that might otherwise be overlooked..