Using a combined realist and socio-ecological approach to integrating quantitative and qualitative systematic review evidence in a health teachnology assessment setting
Authors: Robertson, C., van Teijlingen, E. et al.
Conference: Cochrane 21st Colloquium
Dates: 19 September-23 October 2013
Background: Systematic reviews of the effectiveness of interventions can be complemented by including qualitative evidence. While the Cochrane handbook offers guidance, many methods for synthesising and integrating qualitative evidence exist and integrated reviews remain rare. Objectives: To describe the process used for conducting an integrated systematic review of evidence-based management strategies for treating obesity in men. Methods: Quantitative and qualitative researchers met weekly, with regular feedback from a UK service user group, to identify and link data. We used quantitative pooling where possible and narrative synthesis of the clinical, process and cost effectiveness data. Deductive and inductive approaches guided qualitative data analysis, with coding of data in a thematic index according to a priori or emergent themes. We compared and contrasted qualitative and quantitative findings both within and between studies, and within epistemological disciplines. Results: We included 31 randomised controlled trials, 16 non-randomised studies and five economic evaluation studies in our quantitative reviews. We included 22 qualitative studies linked to interventions. Few included quantitative studies reported qualitative data or were linked to qualitative publications, even where it was clear qualitative work had been conducted. We developed an emergent logic model (see figure 1) for conducting the integrated synthesis. We identified key social determinants for obesity along with important motivators, barriers and facilitators for engagement with obesity interventions. Conclusions: Integrated reviews offer invaluable contextual socio-economic and cultural information for those designing public health interventions. Including qualitative evidence in our review provided valuable insights for identifying factors associated with the effectiveness of obesity interventions. Conducting an integrated review proved time consuming and the extent of our integration was limited due to paucity of linked quantitative and qualitative evidence. Clearer guidance for conducting integrated reviews according to different research questions could be useful.
Preferred by: Edwin van Teijlingen