Meta-ethnography 25 years on: challenges and insights for synthesising a large number of qualitative studies

Abstract

Studies that systematically search for and synthesise qualitative research are becoming more evident in health care, and they can make an important contribution to patient care. Our team was funded to complete a meta-ethnography of patients' experience of chronic musculoskeletal pain. It has been 25 years since Noblit and Hare published their core text on meta-ethnography, and the current health research environment brings additional challenges to researchers aiming to synthesise qualitative research. Noblit and Hare propose seven stages of meta-ethnography which take the researcher from formulating a research idea to expressing the findings. These stages are not discrete but form part of an iterative research process. We aimed to build on the methods of Noblit and Hare and explore the challenges of including a large number of qualitative studies into a qualitative systematic review. These challenges hinge upon epistemological and practical issues to be considered alongside expectations about what determines high quality research. This paper describes our method and explores these challenges. Central to our method was the process of collaborative interpretation of concepts and the decision to exclude original material where we could not decipher a concept. We use excerpts from our research team's reflexive statements to illustrate the development of our methods.

Figure 1

Stages of Meta-ethnography, challenges and factors influencing decision-making. Figure  1 illustrates the stages of Meta-ethnography, challenges and factors influencing decision-making. 1. Getting started; 2. Deciding what is relevant; 3. Reading the studies; 4. Determining how the studies are related; 5. Translating studies into each other; 6. Synthesising translations; 7. Expressing the synthesis.

Figure 2

Analysis. Figure  2 illustrates the process of analysis from [1] 77 original studies, [2] team members’ interpretation of the concepts from the original studies, [3] developing collaborative interpretations of 450 concepts (the raw data), [4] developing conceptual categories through constant comparison and [5] developing a line of argument to explain the conceptual categories.

Figure 3

Using Nvivo to organise analysis. Figure  3 illustrates the nodes and sub-nodes used on NVivo 9 to organise the data extraction and analysis. It illustrates the process of creating collaborative translations from three interpretations in an attached NVivo 9 memo. The concept ‘Ambivalence about diagnosis’ is used as an example to show how a collaborative interpretation becomes part of the conceptual raw data for the meta-ethnography. The process of using NVivo 9 is described further in Additional file 2.