Systema(skeoversiktermedkvalita(vevidens

RigmorCBergKursH14.-18.november2016

Forsknings-spørsmålogstudiedesign

Forskningsspørsmål Kunnskap Foretrukket studiedesign

Hvor mange har et problem? (eks mangel på arbeid)

Forekomst Tverrsnittstudier

Hvorfor får noen dette problemet og ikke andre?

Årsak Kohortstudier Kasus-kontrollstudie

Hvordan kan vi avgjøre om noen har dette problemet?

Diagnostikk Tverrsnittstudier (med en referansestandard)

Hva kan vi gjøre for å forebygge eller behandle dette problemet?

Effekt av tiltak Randomiserte kontrollerte studier (evt kontrollerte før-etter-studier)

Hvordan går det med den som har problemet?

Forløp Kohortstudier

Hvordan oppleves det? Hva er det som gjør at det virker?

Holdninger, erfaringer (mekanismer)

Kvalitative metoder

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Research question Qualitative research studies

Cross- sectional studies

Case control studies

Cohort studies Non-

experimental evaluations

Quasi-experi-mental evaluation

RCTs Systematic reviews

Effectiveness: Does this work? Good Good Very good Excellent Feasibility (process): How does it work? Very good Good Good Excellent Salience: Does it matter? Very good Very good Excellent Safety: Will it do more harm than good? Good Good Good Good Good Very good Excellent Acceptability: Will people use the service? Very good Good Good Good Excellent Cost-effectiveness: Is it worth buying this service? Very good Excellent Appropriateness: Is this the right service for these people? Very good Very good Very good

Satisfaction: Are users, providers, others satisfied with the service?

Very good Very good Good Good Good

Legend: Excellent – Very good - Good = extent of contribution which that particular study design is likely to make in answering that particular question. Adapted from Grey (1997) and Petticrew & Roberts (2006).

Table: Appropriateness of different study designs for answering different types of research questions

Kvalita(v&Kvan(ta(v

•  Induk&v•  Todiscoverandgeneratehypotheses•  Complete,detailed,in-depth,rich

descrip(ons•  Languageoftherespondent[words]•  Objec(ve:understandingoflived

experiences

•  Design:cyclical,itera(ve•  Methods:interview,observa(on,focus

group,shadowing,mee(ng,etc•  Process:unstructured,open•  Analysis:languagefocused

•  Deduk&v•  Toverifyandtesthypotheses•  Classifyfeatures,count,andconstruct

morecomplexsta(s(calmodelstoexplainwhatisoccurring[numbers]

•  Objec(ve:comparinggroups,assessingrela(onshipbetween/amongvariables

•  Design:stepwiseapproach•  Methods:survey,bodyfatmeasurement,

caloricintakeassessment•  Process:pre-structured,closed•  Analysis:numericalsta(s(calapproaches

NaturalismePosi(visme

Formerforkvalita(vedata

Terminologi•  Synthesisofqualita(veevidence•  Qualita(veevidencesynthesis•  Qualita(vemeta-summary•  Qualita(veresearchsynthesis•  Metaethnography•  Metasynthesis

Hvaerenoversiktmedkvalita(vforskning?

•  «Anoverviewofprimaryqualita&vestudieswhichcontainsanexplicitstatementofobjec(ves,materials,andmethodsandhasbeenconductedaccordingtoexplicitandreproduciblemethodology»

•  «Aninterpreta(onofqualita(vefindings(reviewfindings)thatarethemselvesinterpre(vesynthesesofdata(studyfindings)includingphenomenologies,ethnographies,groundedtheories,andotherintegratedandcoherentdescrip(onsorexplana(onsofphenomena,events,orcasesthatarethehallmarksofqualita(veresearch»(Sandelowski&Barroso,2007,p.151)

Lidhistorie

•  1985:udrykket«qualita(vemetasynthesis»foråbeskrivesynteseavkvalita(vestudier(Stern&Harris)

•  1988:«metaethnography»(Noblit&Hare)•  1994:førstekvalita(vesyntesen

–  Asynthesisofqualita0veresearchonwellness-illness.k=112(Jensen&Allen)•  2005-2008doblingavkval-SR•  Idag:>200kval-SRsihelse+mangeinnenandrefelt(f.eks.utdanning)

•  November2013:1stkval-SRpublisertiCochraneLibrary(Glentonetal.,2013)

•  2006:Handbookforsynthesizingqualita(veresearch(Sandelowski&Barroso,2006)

•  2011:Synthesizingqualita(veresearch(Hannes&Lockwood,2011)

•  2012:Systema(csynthesisofqualita(veresearch(Saini&Shlonsky,2012)

•  2012:Anintroduc(ontoqualita(veresearchsynthesis:Managingtheinforma(onexplosioninsocialscienceresearch(Major&Savin-Baden,2012)

Hvaernyden?

•  utensammens(lling,risikererågåglippavnymginformasjonellerforvrengekunnskapsgrunnlaget(Dixon-Woodsetal.,2007)

–  Campbelletal.(2003):of7qualstudiesonpa(ents’experiencesofdiabetes,notonereferredtoanother!

•  girgrundigereogmerpresistsvarpåspørsmålom”hvordan”og”hvorfor”ennenkeltstudieràstørreutsagnskrar(Estabrooksetal.,1994;Hammersley,1997;Sandelowskietal.,1997)

•  genereremeromfadendeoggeneraliserendeteoriàresultatermerrelevantforgruppersomhelsepoli(kere,klinikere,forskere(Finfgeld,2003;Dixon-Woodsetal.,2013)

•  girgrundiginnsiktomforholdsombegrenserevt.lederinnføringenavet(ltak(Hardenetal.,2004)

•  girinnsiktihvordanmankanoppnåendring

•  kanbidra(lmuligeforklaringernåreffektstudiervisersprikenderesultater(Thorne,2000)

•  girstørrebreddeiperspek(verogdybdeiresultater(lSReromeffektvedfokuspåopplevelserogholdningerblantdemsom(ltaketvarredetmot,ogdermedhvilke(ltaksomvilværeakseptableogpotensielteffek(ve(Ringetal.,2011;Thomasetal.,2004;Walshe&Downe,2005)

•  Girinformasjonomdesignavnye(ltakellerbidrar(låforklareeffektaveksisterende(ltak

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§  Eksempel:CochraneoversiktfantatDOTs(TB)ikkevarmereffek(vennselv-monitorering.Enkval-SRavdekkethvilkeaspektvedDOTssomvarproblema(skeforpasientene

Eksempler•  Metasynthesisofqualita(veresearchonlivingwithHIVinfec(on(Barroso&Powell-Cope,2000)•  Barriersandfacilitatorstotheimplementa(onoflayhealthworkerprogrammestoimproveaccess

tomaternalandchildhealth:qualita(veevidencesynthesis(Glentonetal.,2013)•  Efficacyandexperiencesoftelephonecounsellingforinformalcarersofpeoplewithdemen(a(Lins

etal.,2011)

•  Reasonsforphysicallyrestrainingpa(entsandresidents:asystema(creviewandcontentanalysis(Evans&Fitzgerald,2002)

•  Understandingyoungpeople’sexperiencesofchronicillness:asystema(creview(Venningetal.,2008)

•  Livingwithearlystagedemen(a:areviewofqualita(vestudies(Steemanetal.,2006)

•  Pa(ents’help-seekingexperiencesanddelayincancerpresenta(on:aqualita(vesynthesis(Smith,Pope&Botha,2005)

•  Evalua(ngmeta-ethnography:asynthesisofqualita(veresearchonlayexperiencesofdiabetesanddiabetescare(Campbelletal.,2003)

LikheterogulikhetermellomSRmedeffektstudierogSRmedkvalita(ve

studier

•  EFFEKTSTUDIER:•  Mål:aggregereellersummere

data,f.eksomeffektav(ltak•  Konsepterogbegrepererklart

definertepåforhånd

§  KVALITATIVE STUDIER: §  Mål: aggregere og utvikle

konsept, forklarende rammerverk eller nye teorier

§  Involverer induksjon og fortolkning

§  Konsepter oppstår gjennom syntetiseringsprosessen

Sources: Noblit and Hare 1988; Dixon-Woods et al. 2005

§  Spørsmål og metoder er spesifisert a priori §  Systematisk tilnærming for å identifisere studier, trekke ut data og

syntetisere data

Systematisk kunnskapsoversikt

Ny analyse av resultater fra flere studier

All relevante primærstudier

Resultater som kan sammenlignes

Fremgangsmåte

Sammeprinsippenegjelder(somforoppsummeringavspørsmålomeffekt).Mennårvioppsummererkvalita(vedata,finsdetandre/flereu{ordringer

1)Bestemmefokus

•  Spesifiserspørsmålet•  Spørsmåletetstyrendekompasshellerennetrigidanker?

2)Søkeederlideratur

•  SøkederkvalstudiervanskeligereennforeffektL– MEDLINEMeSHterm’qualita(veevidence’i2003,CINAHL’qualita(vestudies’i1988

– Finsingendatabaseforkval(foreffektf.eksCENTRAL)

•  Men:SøkefilterforkvalforMEDLINE,CINAHL,PsycINFO,EMBASEJ

Study

3)Velgelideratur

•  Velgallestudienesommøterinklusjonskriteriene

Inklusjons-ogeksklusjonskriterier

4)Vurderemetodiskkvalitet•  Velgsjekkliste,f.eksCASP

•  >100sjekklister(lgjengelig•  1sjekklisteforalleinkludertekvalstudier?•  Ekskluderebasertpåmetodiskkvalitet?

–  Ekskluderestudiermedlav(ere)metodiskkvalitet–  Benydestudiermedlav(ere)metodiskkvalitetmindreenndemedhøy(ere)metodiskkvalitet

–  Ikkebenydeelementersomviikkestolerpå•  Eksklusjonavstudiermedlav(ere)metodiskkvalitetàøkteinternvaliditet,tokmindre(d(Carrolletal.,2011;Harden2007)

CASP–10spørsmål(låevalueremetodiskkvalitetpåkvalita(vforskning

1.  Wasthereaclearstatementoftheaimsoftheresearch?2.  Isaqualita(vemethodologyappropriate?

3.  Wastheresearchdesignappropriatetoaddresstheaimsoftheresearch?4.  Wastherecruitmentstrategyappropriatetotheaimsoftheresearch?5.  Wasthedatacollectedinawaythataddressedtheresearchissue?6.  Hastherela(onshipbetweenresearcherandpar(cipantsbeenadequatelyconsidered?7.  Haveethicalissuesbeentakenintoconsidera(on?8.  Wasthedataanalysissufficientlyrigorous?9.  Isthereaclearstatementoffindings?10.  Howvaluableistheresearch?

desember13,2016

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Screeningques(ons

5)Syntese/Sammens(llefunn

•  Utviklingavmetoderforåsammens(llefunnfrakvalita(vestudierpågår

•  Mesthyppigbruktemetodene:– Metaetnografi–  Tema(sk

–  Cri(calinterpre(vesynthesis–  Narra(vesynthesis–  Contentanalysis

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Skalaavevidenssynteser

Aggregativ Fortolkende

Metaanalysis Bayesian meta-analyse

Metodeeksempler:

Metaethnography

Combining, amalgamating, pooling, and summarising

(quant) data; produce theories

of causality; may include claims

of generalisability

Qualitative evidence is integrated with quantitative evidence

Induction and interpretation of (qual) data, development of

concepts, development of and

specification of theories that

integrate those concepts

Metaetnography

•  7-trinnsprosess:– gemngstarted– decidingwhatisrelevanttotheini(alinterest–  readingthestudies– determininghowthestudiesarerelated–  transla(ngthestudiesintooneanother– synthesisingtransla(ons– expressingthesynthesis

Tema(skanalyse•  Tarforsegspørsmålombehov,hensiktsmessighet,akseptogopplevelser

(om(ltak)•  Fordel:innsiktervervetfrasyntesenavkvalita(vestudiermuliggjør

u{orskningavsta(s(skheterogenitet•  Eksempel:Canceranddisabilitybenefits:asynthesisofqualita(vefindingson

adviceandsupport(Wilson&Amir,2008)

•  Hvordaniden(fisere‘themes’:–  Iden(fisergjentakendeogfremhevedetema/funnistudiene(f.eksudryktmedulikeord,menmeningener(lnærmetlik)

–  Seddissesammenilogiskekategorier/grupper–gidissenavn–  Forklarhvadebetyr

Superduperenkelillustrasjon

engstelig

redd

salt

anspent

bekymringsfull

forpint

foruroliget

fryktsom

livredd

nervøs

oppfarende

skjelven

pepper

paprika

båt

rosmarinoregano

kardemomme

chilli

basilikum

motorsykkel

bekymret

bil

truse

engsteligredd

salt

anspent

bekymringsfull

forpint

foruroliget

fryktsom

livredd

nervøs

oppfarende

skjelven

pepperpaprika

båt

rosmarin oregano

kardemomme

chilli

basilikum

motorsykkel

bekymret

bil

truse

KRYDDER FØLELSERSOMUTTRYKKERUTRYGGHET FREMKOMSTMIDDEL

???

Eksempel•  Whatarethefactorsthatpromoteandhinderthe

con(nua(onofFGM/C?•  AliteraturesearchwasperformeduptoMarch2011in13interna(onaldatabases:

AfricanIndexMedicus,AnthropologyPlus,Bri(shNursingIndexandArchive,TheCochraneLibrary,EMBASE,EPOC,MEDLINE,PILOTS,POPLINE,PsycINFO,SocialServicesAbstracts,SociologicalAbstracts,andWHOLIS.Itwassupplementedwithsearchesofthedatabasesofsixinterna(onalorganiza(onsthatareengagedinprojectsregardingFGM/C,thereferencelistsofrelevantreviewsandincludedstudies,andcommunica(onwithexpertsinvolvedinFGM/C-relatedwork.

•  Studydesignseligibleforinclusionwere…qualita(vestudies...Thepopula(onconsideredinscopewasmembersofcommuni(esprac(cingFGM/CresidinginaWesterncountry,definedasacountrywithacultureofEuropeanorigin(Hun(ngton,1996).Theoutcomeofinterestwastheprac(ceofFGM/C;specifically,thestudieshadtodescribepar(cipants’perspec(vesandunderstandingsofthefactorsperpetua(ngorhinderingthecon(nua(onofFGM/C.Allpublica(onyearsandlanguageswereacceptableandwhenconsideredlikelytomeettheinclusioncriteria,studiesweretranslatedtoEnglish.Unpublishedreportsandbriefandpreliminaryreportswereconsideredforinclusiononthesamebasisaspublishedar(cles.

•  Toassessthequalityofincludedstudies,theCri(calAppraisalSkillsProgramme(CASP)appraisaltoolforqualita(veresearch

•  Theanalysisofqualita(veevidencewasthema(c;thatis,thereviewersiden(fiedprominentorrecurringthemesintheliteratureandsummarizedthefindingsofthedifferentstudiesunderthema(cheadings

Eksempel

Theanalysisofqualita(veevidencewasthema(c;thatis,thereviewersiden(fiedprominentorrecurringthemesintheliteratureandsummarizedthefindingsofthedifferentstudiesunderthema(cheadings(Dixon-Woods,Agarwal,Jones,Young,&Sudon,2005).Theyorganizedandassigneddescrip(vecodestotherawdatafromeachstudy(Level1findings).Next,findingsweregroupedintothema(ccategories,basedoncommonalityofmeaningaswellasfrequencyandstrengthofpar(cipants’cogni(onsaboutFGM/C,therebydevelopingbroaderconceptsthatcapturedsimilarthemesfromdifferentpapers(Level2findings).Giventhatthequan(ta(veevidenceservedastheanaly(cpointofdeparture,thereviewersworkedbyusingbothaprioricodesdevelopedfromtheincludedquan(ta(vestudiestoseekoutevidencefromthequalita(vefindings,aswellasallowingthemestoemergefromthequalita(vedata.Inthelastqualita(veanalysisstep,categorieswerecombinedtocreatesynthesizedthemes(Level3findings).Thisinvolvedreflec(ngonthethema(ccategoriesasawholeandlookingforsimilari(esanddifferencesamongthecategories.Theanalyseswerefirstconductedindividually,andthenthereviewers,throughdiscussionandreflec(on,agreedonasetofcategoriesandanaly(cthemes.Atradi(onintransi(on:Factorsperpetua(ngandhinderingthecon(nuanceofFemaleGenitalMu(la(on/Cumng(FGM/C)summarizedinasystema(creview(Berg&Denison,2013)

Resultateneoppsummertienkonseptuellmodell

Source: Lewin et al. 2011