The Cochrane Collaboration Colloquium: Incorporating qualitative information in systematic reviews
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This document discusses the role that qualitative research could play in Cochrane reviews. It provides examples of how qualitative research has contributed to understanding factors like patient behavior, barriers to treatment, and medicine taking strategies. Integrating qualitative research into Cochrane reviews faces some methodological challenges, as the review process differs from established quantitative practices. Organizational challenges also require discussion around guidance, inclusion of qualitative research in reports, and support for mixed method reviewers.
The Cochrane Collaboration Colloquium: Incorporating qualitative information in systematic reviews
- 1. What is qualitative research? What role could it have in Cochrane? What challenges arise for CC if qualitative research is taken seriously? Questions for debate and discussion not answers!
- 2. It isn’t… A way of measuring quality of life A methods tool-kit Always small scale Anything that includes the consumers’ voice The easy option for the non-numerate!
- 3. It is a method of scientific enquiry that.. Illuminates why people act in the way they do and how action is shaped by social contexts Dependent on conceptual not numerical analysis Generalisable on basis of theory not statistical probability
- 4. What role can qualitative research have in the collaboration? Improving effectiveness reviews Extending beyond questions of effectiveness:
- 5. Improving Effectiveness Reviews E.G. Helping to identify meaningful outcomes Physiotherapy interventions to improve continence Dignity v quality of life
- 6. Extending Cochrane reviews: Questions that QR might address: Are interventions aimed at the ‘right’ problem? How can evaluated interventions be improved? How are effective interventions implemented in ‘real life’ Two examples
- 7. The case of Directly Observed Therapy (DOTS) for the treatment of Tuberculosis DOTS: WHO branded package of interventions including observing people take medication Cochrane Review : reported absence of evidence for or against DOTS compared with people treating themselves Volmick & Garner, 1997/02/06 CE003343 Systematic review of qualitative research on factors shaping people’s help seeking behaviour Noyes & Popay, Journal of Advanced Nursing forthcoming
- 8. What does the Qualitative Research systematic review contribute? Questions appropriateness of interventions that assume Barriers to cure are cultural Patients are irresponsible Highlights other barriers: material e.g. poverty Stigma Social relationships of care Reveals resourcefulness of people despite the barriers Aids interpretation of results of trials in Cochrane review Suggests ways of improving interventions: e.g. more support less inspection
- 9. The case of medicine taking Many Cochrane reviews focus on effectiveness of medicines improving compliance Qualitative research review on medicine taking & compliance Pound P et al. Social Science & Medicine 2005;61:133-155
- 10. Rethinking non-compliance: Four types of medicine taking strategies two involving active resistance : passive accepters; active accepters, active modifiers rejecters. So what? Do study results reflect the impact of these strategies through randomisation? Can systematic reviews take account of this behavioural diversity? What are the implications for implementation of ‘effective’ medicines? Is the effectiveness of medicines best maximised by: Promoting compliance with ‘recommended’ regimes Working with patients to support active acceptance and modification
- 11. Including qualitative research in Cochrane reviews: methodological challenges Need to focus on the right challenges: the bridge in the distance not the edges of the sign Systematic reviews of qualitative research can be: Systematic Transparent And involve ‘consumers’ But other aspects of qualitative research review process different to established practice in Cochrane
- 12. How the practice of effectiveness reviews and qualitative research review differ Protocol: an enabling framework not a straight jacket Review question(s ): may be revised as review proceeds Review process: iterative not linear and/or staged Searching: not always comprehensive, may involve sampling Inclusion: on basis of methodological quality contentious. Reproducibility : not inevitable Qualitative research expertise : essential
- 13. Including qualitative research in Cochrane reviews: Organisational Challenges: Need discussion about: Approach to & content of guidance How product of QR reviews are included in review reports and the CC library How reviewers are supported When two ‘rivers’ meet There will be some turbulence but Change & adaptation can create a new and more substantial river