A challenging mixed literature review experience

Article type
Pluye P, Grad R, Dunikowski L, Stephenson R
Background: Mixed methods are increasingly used in health research, and methods to integrate quantitative and qualitative data have been described[1,2]. However few publications examine the challenges of the mixed literature review. The Cochrane systematic literature review and the meta-study of qualitative health research constitute well-defined methods to respectively review the literature regarding quantitative and qualitative research[3,4]. To our knowledge, no method exists to concurrently synthesize quantitative results and qualitative findings[5].

Objective: Our presentation aims to illustrate a tentative method to synthesize statistics-based, narrative-based and mixed-methods empirical studies. Our experience combined a mixed-methods quality appraisal with content and lexical analysis.

Methods: We examined the impact of information retrieval technology in medicine. The identification and selection of studies was based on Cochrane methods. The methodological quality of 45 empirical studies was critically appraised by type of data. Methods sections of statistics-based articles were appraised according to the scale proposed by Mitchell and Sullivan (relevant for experimental designs -10 criteria- and observational designs -6 items-)[6] Methods sections of narrative-based articles were appraised using an ad hoc tool (20 items). The absence of consensus regarding the appraisal of qualitative research in medicine led us to build and use a tool based on meta-study of qualitative health research and a guideline for reviewers of medical publications[4,7]. From 24 articles (3 experimental, 4 laboratory-like and 17 observational studies), quantitative results and / or qualitative findings were retained for further analysis when the method satisfied more than 50% of relevant criteria. In four mixed-methods publications, results were retained while findings were not. Subsequently, statistics-based or narrative-based extracts were compared using content analysis and descriptive lexical analysis[8,9]. The review process and analyses were computer-assisted and are therefore auditable.

Results: Promises and shortcomings of this challenging literature review experience are illustrated in terms of combining and integrating quantitative results and qualitative findings "which is a centerpiece of mixed methods designs" (p. 12).1

References: 1. Creswell JW, Fetters MD & Ivankova NV. Designing a mixed methods study in primary care. Ann Fam Med. 2004;2(1):7-12. 2. Scholz RW & Tietje O. Embedded case study methods: Integrating quantitative and qualitative knowledge. London: Sage; 2002. 3. Clarke M, Oxman AD, editors. Cochrane Reviewers Handbook 4.1.6. In: The Cochrane Library, Issue 1, 2003. Oxford: Update Spftware. Updated quarterly. 4. Paterson BL, Thorne SE, Canam C & Jillings C. Meta-study of qualitative health research: A practical guide to meta-analysis and meta-synthesis. London: Sage; 2003. 5. Sandelowski M. Tables or tableaux? The challenges of writing and reading mixed methods studies. In: Tashakkori A, Teddue C, editors. Handbook of mixed methods. London: Sage; 2003. p.321-350. 6. Mitchell E, Sullivan F. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-1997. BMJ. 2001;322:279-82. 7. Malterud K. Qualitative research: Standards, challenges, and guidelines. Lancet. 2001;358(9280):483-488. 8. Lecuyer R. Lanalyse de contenu: notion et etapes. In: Deslauriers JP, editor. Les methodes de la recherche qualitative. Montreal; Presses universitaires du Quebec. 1987. p.49-65. 9. Daoust F. SATO-Presentation. Retrieved March 22, 2004 from http://nouvelle.ato.uqam.ca/forum/satoman