Conducting a meta-ethnography of qualitative tuberculosis treatment adherence studies: a reflection on the process

Article type
Authors
Lewin S, Munro S, Smith H, Engel M, Fretheim A, Volmink J
Abstract
Background: As is the case for randomized controlled trials, an increasingly large number of qualitative studies are being undertaken to explore different dimensions of health and health care. Synthesising qualitative research findings may facilitate a better understanding of the state of knowledge in a particular field and promote the more effective use of this research evidence. Meta-ethnography is a systematic method for synthesising qualitative research findings, through the mutual translation and transfer of ideas, concepts and metaphors across different studies.

Objectives: To discuss the methodological and practical issues encountered in applying the meta-ethnographic approach to
synthesising qualitative literature on stakeholder experiences of tuberculosis medication adherence.

Methods: The process of meta-ethnography involves, firstly, identifying studies relevant to a particular review question through systematic searching; secondly, the identification of themes in existing studies; and, thirdly, the 'translation' of these themes into one another. We present the issues encountered while conducting a meta-ethnography of stakeholder perceptions of tuberculosis treatment adherence and discuss their implications for meta-syntheses of qualitative studies.

Results: The challenges encountered during the process included, among others, locating relevant qualitative literature from within the very large body of published work on tuberculosis, ascertaining the relevance of these studies, and assessing the quality of qualitative studies. The secondary interpretation of data also presents a unique challenge to a qualitative synthesis, especially the process of understanding and retaining the contextual nature of the original research and developing conceptual frameworks that encompass the findings from a wide range of studies.

Conclusions: Meta-ethnography is a challenging yet promising approach to synthesising qualitative research. How best to utilise this approach, both in 'stand alone' syntheses of qualitative studies and alongside systematic reviews of randomized controlled trials, needs further consideration and research.