Using a combined realist and socio-ecological approach to integrating quantitative and qualitative systematic review evidence in a health technology assessment setting

Tags: Poster
Robertson C1, Archibald D1, Avenell A1, Douglas F2, Hoddinott P3, van Teijlingen E4, Boyers D5, Stewart F1, Boachie C1, Fioratou E6, ROMEO Project Group AT7
1Health Services Research Unit, University of Aberdeen, UK, 2Rowett Institute of Nutrition and Health, University of Aberdeen, UK, 3Health Services Research Unit, University of Aberdeen, UK and School of Nursing, Midwifery and Health, University of Stirling, UK, 4Centre for Midwifery, Maternal & Perinatal Health, Bournemouth University, UK, 5Health Services Research Unit, University of Aberdeen, UK and Health Economics Research Unit, University of Aberdeen, UK, 6Health Services Research Unit, University of Aberdeen, UK and Multidisciplinary Assessment of Technology Centre for Healthcare, University of Nottingham, UK, 7Men’s Health Forum, UK

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 Fig. 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.