By Katie Gallacher:
The late John Donne famously said “No man is an island”. However can we say the same of our research projects? In relation to quantitative research, we probably can. Systematic review has become the “gold standard” method of research used to inform national policies and guidelines. This is widely accepted as a method of synthesis for quantitative research, but finding an equivalent for qualitative studies has been more controversial. As part of my PhD, I have endeavoured to carry out a systematic review of qualitative studies, fully aware there is still widespread debate about whether this is an appropriate or worthwhile task (and I certainly found it no mean feat!).
Renowned qualitative researchers Glaser and Strauss warned in their early work that the continued failure to link local grounded theories into larger formal theories would relegate the findings of individual studies to “little islands of knowledge” which may never be utilised if kept in separation. So should we start to build bridges between these islands in order to encourage policy makers to use qualitative research in their decision making? Would this help us ‘keep up’ with our quantitative neighbours? Or does the synthesis of qualitative work simply destroy the underlying principles of this type of research? Any thoughts on this by readers would be greatly appreciated!
In a nutshell, quantitative research is generally associated with a realist positivist stance, which assumes that knowledge is objective and true and accessible through what can be observed. This is the customary stance taken by those carrying out a systematic review, the typical purpose of which is to summarise the findings of available studies to estimate the ‘true’ answer to a particular research question. Qualitative work has strong links with interpretivism rather than positivism. This assumes that there are multiple realities, and that knowledge is a socially produced construct, making truly interpretivist approaches deeply cynical of any one coherent theory as a singular explanation of phenomena. As you can imagine, holding this viewpoint makes the synthesis of studies challenging, as if there is no ‘truth’ to be discovered, only a collection of different stories that all have their own truths, then synthesis would be pointless and would destroy the integrity of individual projects. Sandelowski eloquently states “Just as it goes against the nature of poetry to attempt to summarize even one poem about love, so it seems both epistemologically and ethically inappropriate to attempt to summarize findings from one or more qualitative studies about human experiences of health and illness”.
I hold the opinion, similar to others before me, that by synthesising qualitative studies, it is possible to generate more powerful theory, and that by not doing so we risk isolation from policy makers and clinicians. I am an academic GP carrying out a PhD which examines the experiences of those who have had a stroke, and I believe that the synthesis of qualitative research can add to our knowledge of how individuals experience healthcare, and how we can improve their interactions with healthcare providers. I understand that not all patients have the same experience, and that caution should be exerted when making generalisations. But with enough knowledge about the sample being researched, and with enough transparency in reporting by qualitative researchers, I believe that synthesis is possible, and in fact, important. So, I guess my stance is that of a ‘modified’ or ‘critical’ realist, with sensitivity to the heterogeneous nature of the studies involved, and with the appreciation that what I seek to understand is a variety of representations of the reality of living with stroke. Are there any other modified realists out there? Or indeed any realists or interpretivists who would like to challenge my viewpoint?
Even for those who feel that synthesis is possible, the best method remains under debate, with a plethora of choices available. This could be viewed as inspiring or infuriating, either way it is certainly a demonstration of how popular this type of research is becoming. As is the case with all good research, the correct method is no doubt heavily reliant on the individual research question and underlying assumptions. One thing is for certain: the increasing numbers of qualitative studies and their use in informing health policy has undoubtedly led to a demand for the appraisal and synthesis of this type of research, and this has to be a good thing. So let’s continue to build bridges!