Country-specific qualitative synthesis: harvesting pearls or grit?

Tags: Oral
Booth A1, Mshelia S2, Analo C2, Nyakango SB2
1School of Health and Related Research (ScHARR), 2formerly School of Health and Related Research (ScHARR), UK

Background: International qualitative evidence syntheses, as commissioned by the World Health Organization (WHO) and other agencies, offer valuable cross-country perspectives on issues such as facility-based delivery and respectful maternity care. Necessarily, multi-context syntheses seek to offer breadth of coverage (across regions, countries, and settings) within an efficient time- and resource-envelope. Such syntheses have two limitations:

1) they may omit eligible studies that offer important country-specific insights; and

2) they may capture the phenomenon of interest incompletely, resulting, potentially, in immature conceptual frameworks.

Objectives: To compare the coverage, quality and contribution of country-specific and multi-context syntheses of facility-based delivery to inform strategic commissioning of qualitative syntheses.

Methods: We conducted two country-specific qualitative syntheses of attitudes of pregnant women to facility-based delivery, for Nigeria and Kenya, to augment and enhance a pre-existing international WHO synthesis through exhaustive retrieval and inclusion of country-specific findings. We conducted searches across local and regional sources - including university repositories - to augment standard bibliographic databases. We used framework synthesis to facilitate comparison between countries and with the international synthesis. We compared yields of included studies quantitatively (numbers of: studies, open access sources, journals with impact factors) and qualitatively (unique identification of or reinforcement of themes).

Results: Yield of studies for both country-specific syntheses was approximately seven times higher than the number of eligible studies for that country in the multi-context synthesis. On closer examination, however, we found that a large proportion of studies post-dated the multi-context search, were from non-impact factor or predatory journals, or were from non-open access sources. Qualitatively, the additional sources added country-specific nuances.

Conclusions: Inclusion of country-specific syntheses enhances the context-sensitivity of findings but at the potential expense of review quality.

Patient/healthcare consumer involvement: Country-specific syntheses extend consumer perspectives beyond multi-context syntheses and may resonate more clearly with local experience.