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Abstract
Systematic reviews of the literature on healthcare or workplace interventions rarely include data from qualitative studies, because these do not meet the standard quantitative criteria of evidence. In this paper, we argue that the routine exclusion of qualitative research from systematic reviews eliminates a source of rich understanding of the phenomena under study, which could guide both the development and implementation of programs. Using a recent example of a systematic review of workplace-based return-to-work (RTW) intervention practices, which included both quantitative and qualitative components, we describe elements of the qualitative search, analysis and findings, and discuss the benefits of this approach.
At the outset of our review, we found that well-done qualitative studies in an applied field like the one being reviewed are rare. The authors of these studies often appeared to lack training in qualitative methodology and expertise in the analysis and interpretation of the data that they were collecting. Consequently, we found mostly descriptive studies, and rarely those with any explanatory capacity. Nonetheless, these studies were included in the review when they were credible and shed light on return-to-work dynamics and implementation. While our judgements about study quality were guided by a quality assessment framework which has been developed by the National Centre for Social Research in the UK, we found that we drew heavily on our experience and training as qualitative researchers.
We found that, while the quantitative side of this review might identify effective workplace-based 'interventions' for successful return-to-work, the qualitative component informed the implementation of any interventions, and also identified social dynamics that impact on the formation and execution of possible interventions. While qualitative evidence is not amenable to quantitative, numerical summary, findings from the twelve qualitative studies included in the review were amenable to meta-ethnographic analysis, and new findings did arise from these overlapping and collated information.
The strengths of these qualitative studies are not necessarily in identifying what ought to be done in workplaces ("best practices") but in highlighting the reality of local dynamics and interaction and in drawing attention to contextual and process factors--practical issues that are well-equipped to guide implementation. For instance, we learned not only that supervisors can play a key role in return-to-work, but that the quality and type of their interaction with injured workers can either doom or enhance the success of a return-to-work intervention.
We found that this systematic review of qualitative literature provided valuable information about the development and implementation of return-to-work programs. These qualitative studies are well-equipped to at least describe, if not explain, social phenomenon such as values, social interaction, and organizational dynamics that tend to be non-quantifiable but that bear on health conduct. We believe that systematic reviews of the literature stand to gain a more complete understanding of their issue when they include a qualitative component, and that this inclusion will provide a means of "raising the bar" involved in current systematic reviews of the literature.
At the outset of our review, we found that well-done qualitative studies in an applied field like the one being reviewed are rare. The authors of these studies often appeared to lack training in qualitative methodology and expertise in the analysis and interpretation of the data that they were collecting. Consequently, we found mostly descriptive studies, and rarely those with any explanatory capacity. Nonetheless, these studies were included in the review when they were credible and shed light on return-to-work dynamics and implementation. While our judgements about study quality were guided by a quality assessment framework which has been developed by the National Centre for Social Research in the UK, we found that we drew heavily on our experience and training as qualitative researchers.
We found that, while the quantitative side of this review might identify effective workplace-based 'interventions' for successful return-to-work, the qualitative component informed the implementation of any interventions, and also identified social dynamics that impact on the formation and execution of possible interventions. While qualitative evidence is not amenable to quantitative, numerical summary, findings from the twelve qualitative studies included in the review were amenable to meta-ethnographic analysis, and new findings did arise from these overlapping and collated information.
The strengths of these qualitative studies are not necessarily in identifying what ought to be done in workplaces ("best practices") but in highlighting the reality of local dynamics and interaction and in drawing attention to contextual and process factors--practical issues that are well-equipped to guide implementation. For instance, we learned not only that supervisors can play a key role in return-to-work, but that the quality and type of their interaction with injured workers can either doom or enhance the success of a return-to-work intervention.
We found that this systematic review of qualitative literature provided valuable information about the development and implementation of return-to-work programs. These qualitative studies are well-equipped to at least describe, if not explain, social phenomenon such as values, social interaction, and organizational dynamics that tend to be non-quantifiable but that bear on health conduct. We believe that systematic reviews of the literature stand to gain a more complete understanding of their issue when they include a qualitative component, and that this inclusion will provide a means of "raising the bar" involved in current systematic reviews of the literature.