SCIE Report 9: Using qualitative research in systematic reviews: Older people's views of hospital discharge

Published February 2006

Context

SCIE's role is to create, maintain, disseminate and implement the evidence base for policy and practice in social care. By evidence base, we mean knowledge gathered systematically and rigorously from all available evidence, minimising bias and assembling as complete as possible a picture of the knowledge available. We call this a 'systematic review' and it is one of the key foundations for evidence-based policy and practice.

However, the major international bodies working on systematic reviews in health and social care focus on quantitative studies. But if, for example, we wanted to know not only whether a particular intervention works but also whether the outcome of that intervention is what service users want, then we also have to include different kinds of studies, such as qualitative accounts, and descriptive and observational work. In the systematic review community, these are sometimes referred to as 'studies with diverse designs'.

There is now a stream of work on developing systematic reviews to incorporate additional sources of evidence. But little of this work has been undertaken in social care, and none of the examples cited above directly relates to social services.

SCIE has developed a programme of work to fill this gap, including an overview of methods of synthesising findings from studies with diverse designs

Purpose

This report is designed to provide a working example of 'qualitative synthesis' (a descriptive synthesis from qualitative studies) in the field of social care, specifically older people's views of hospital discharge. It focuses on older people and hospital discharge because of new policy developments and the existence of a high-quality systematic review that was relevant to the topic.

Audience

The report is intended for use by SCIE researchers and is also aimed at all those who conduct research, in particular systematic reviews, in the social care sector.

Messages from the report

You will need to read the full report to see a working example of a qualitative synthesis of older people's views of hospital discharge. However, below are a number of findings from the review team about the effectiveness of qualitative syntheses based on their experience:

• Undertaking a qualitative synthesis is a demanding task, adding complexity at every stage of the systematic review process. There must, therefore, be a strong rationale for making systematic reviews more complicated.
• The first part of the rationale for conducting a qualitative synthesis must be a commitment to asking a wider range of questions than those addressed by systematic reviews that focus solely on controlled studies.
• The power of the qualitative synthesis lies in the way it both enhances the traditional review of controlled studies and provides new ways of understanding the issues and new avenues for investigation.
• The value of the qualitative synthesis depends on the credibility of the analytic methods, particularly in the relationship between the findings and the evidence.
• A qualitative synthesis provides a much firmer basis for conclusions than a traditional literature review because of the systematic selection of studies containing primary evidence.
• Qualitative syntheses offer an essential addition to the creation of the knowledge base for policy and practice, particularly by providing access to information on why interventions work and whether they respond to the concerns of people who use services.
• Qualitative syntheses may also draw attention to new ways of understanding how people behave and what they expect from services.
• Qualitative syntheses should become an integral element in the conduct of systematic reviews to underpin evidence-based policy and practice in social care.

Related links

SCIE's resources on using knowledge in social care