Mixed studies review (MSR): An introduction P ROF . DR . A NN V AN H - - PDF document

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6-7-2016 Mixed studies review (MSR): An introduction P ROF . DR . A NN V AN H ECKE EANS Summer School 2017 Halle, Germany MEDICAL RESEARCH COUNCIL FRAMEWORK 2 1 6-7-2016 What do you think of results of systematic reviews? 3 "mixed

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  • PROF. DR. ANN VAN HECKE

Mixed studies review (MSR): An introduction

EANS Summer School 2017 Halle, Germany

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MEDICAL RESEARCH COUNCIL FRAMEWORK

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What do you think of results of systematic reviews?

  • "mixed studies review“ [Title/Abstract] OR "realist review“

[Title/abstract] OR "mixed research synthesis“ [Title/abstract] OR "mixed methods review“ [Title/abstract] OR "mixed methods synthesis“ [Title/abstract] n = 168

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10 20 30 40 50 60 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Number of publications

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MIXED STUDIES REVIEW

Take 5 minutes to discuss in your group

  • What do you think a Mixed studies review is?

Be prepared to answer the questions and argue in the larger group

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MIXED STUDIES REVIEW: WHAT?

  • Meta-Needs assessment (Gaber, 2000)
  • Mixed methods review or synthesis (Harden and Thomas 2005)
  • Realist review (Pawson et al. 2005)
  • Mixed research synthesis (Sandelowski, 2006)
  • Mixed approaches to evidence synthesis (Pope et al. 2007)
  • Mixed studies review (Pluye et al. 2009)
  • Mixed methods systematic review (Harden 2010)
  • Systematic mixed studies review (Polit & Beck 2012)

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MIXED STUDIES REVIEW: WHAT?

“A form of literature review in which a reviewer or reviewer team concomitantly reviews qualitative and quantitative studies, and / or mixed methods studies, for the broad purpose of breadth and depth

  • f understanding and corroboration of knowledge based on all types
  • f empirical research, and synthesizes qualitative findings and

quantitative results of primary studies.” (Pluye et al. 2009)

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MIXED STUDIES REVIEW: WHY?

  • “What works under which circumstances” – More complete

understanding of a problem

  • To provide illustrations of context for effect measures,

expecially in case of heterogeneity in effect reviews

  • “Rarely do decision makers have just one question to

answer, they are more likely to have a series of questions” (Harden 2009)

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MIXED STUDIES REVIEW: WHY?

  • Likely to generate more meaningful and useful findings for

patients, policy makers and healthcare professionals of the usefulness of the intervention Mixed studie reviews…

  • “broaden the conceptualisation of evidence, are more

methodologically inclusive and produce syntheses of evidence that will be accessible to and usable by a wider range of consumers” (Sandelowski et al. 2012)

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MIXED STUDIES REVIEW: WHEN?

  • One particular synthesis approach, by itself, is inadequate to

develop a complete understanding

  • Qualitative insights can help to explain or elaborate on

quantitative findings

  • Quantitative review evidence can further generalize, test or

confim qualitative findings (Hannes 2015)

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MIXED STUDIES REVIEW: WHEN?

  • Should pose a question that requires the inclusion of two or

more syntheses that are grounded in different approaches The questions may focus on:

  • The effect of an intervention
  • The cost benefits of the intervention
  • The experiences of people with this intervention

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MIXED STUDIES REVIEW: HOW?

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MIXED STUDIES REVIEW

Take 5 minutes to discuss in your group

  • How would you perform a mixed methods review?

Be prepared to answer the questions and argue in the larger group

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MIXED STUDIES REVIEW

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MIXED STUDIES REVIEW: TYPOLOGY

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  • Realist Synthesis (Pawson 2002)

= a theory-driven approach

= “what works for whom in what circumstances”

  • Frameworks posited by Sandelowski et al. 2006)
  • Segregated methodologies
  • Integrated methodologies
  • Contingent methodologies
  • Framework posited by Johanna Briggs Institute 2014

Example: Greenhalgh et al. (2007). Realist review to understand the efficacy of school feeding programmes. BMJ, 335, 858-861.

MIXED STUDIES REVIEW: TYPOLOGY

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Segregated type of MSR

  • Two separate syntheses of research addressing (sometimes

different but) connecting questions are integrated by a mixed method synthesis

  • Confirmation / refutation or complementary
  • Especially useful in integrating information about both

effectiveness and context in programmatic intervention research

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MIXED STUDIES REVIEW: TYPOLOGY

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Segregated type

MIXED STUDIES REVIEW: TYPOLOGY

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Segregated type of MSR: example described in Harden 2010 Central questions:

  • What is known about the barriers to and facilitators of healthy

eating among children?

  • Do interventions promote healthy eating among children?
  • What are children’s own perspectives on health eating?
  • What are the implications for intervention development?
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MIXED STUDIES REVIEW: TYPOLOGY

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Segregated type of MSR: an example

Statistical meta-analysis / forest plot: Large variation in study findings: Why? Thematic analysis: e.g. Children consider taste, not health, to be a key influence on their food choice Recommendations for interventions that reflected children’s views

MIXED STUDIES REVIEW: TYPOLOGY

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Integrative type of MSR

  • Studies viewed as answering the same research questions are

grouped by findings and not by design (method)

  • Appropriate when textual + numerical findings are perceived as

able to confirm or refute each other

  • Analysis include transformation / configuration of data to create

quantitative and qualitative data that are similar enough to be combined in a single synthesis

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MIXED STUDIES REVIEW: TYPOLOGY

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Integrative type of MSR

  • Analysis include transformation / configuration of data to create

quantitative and qualitative data that are similar enough to be combined in a single synthesis: Quantitative data converted to themes Qualitative data converted to numerical format

Example of integrative type of MSR: Voils et al. (2009). A Bayesian method for the synthesis of evidence from qualitative and quantitative reports: the example of antiretroviral medication adherence. J Health Serv Res Policy. 14(4):226-33.

MIXED STUDIES REVIEW: TYPOLOGY

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Integrated type

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MIXED STUDIES REVIEW: TYPOLOGY

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Contingent type of MSR

  • A coordinated and sequential series of synthesis, can be

integrated and/or segregated in nature

  • i.e. findings from one synthesis to address the research question

is used to address a second question – which may lead to another synthesis addressing a different research question

MIXED STUDIES REVIEW: TYPOLOGY

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Contingent type

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MIXED STUDIES REVIEW: TYPOLOGY

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  • Realist Synthesis (Pawson 2002)

= a theory-driven approach

= “what works for whom in what circumstances”

  • Frameworks posited by Sandelowski et al. 2006)
  • Segregated methodologies
  • Integrated methodologies
  • Contingent methodologies
  • Framework posited by Johanna Briggs Institute 2014

MIXED STUDIES REVIEW: TYPOLOGY

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JBI type

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MIXED STUDIES REVIEW

Take 5 minutes – discuss in your group

  • What are the (methodological) challenges when performing a

mixed methods review? Be prepared to answer the questions and argue in the larger group

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MIXED STUDIES REVIEW: QUALITY?

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Garbage in, garbage out!

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MIXED STUDIES REVIEW: QUALITY?

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What is the minimum set of criteria for appraising the methodological quality of the qualitative, quantitative and mixed methods studies in a mixed studies review? Tool example: Mixed Method Appraisal Tool (Pace et al. 2012)

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STRENGHT AND CHALLENGES

  • Words, pictures, narrative add meaning to numbers
  • Numbers add precision to words, pictures and narratives
  • Can provide stronger evidence for conclusion
  • Can increase insights and understanding
  • Reporting how the expertise of reviewers matched the

reviewed studies, while quality appraisal depends on revierwer expertise

  • Need for mixed competences in research approach in the

research team

  • Comprehensive MSR require resources
  • Infancy – confusion ahead

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FURTHER READINGS MIXED STUDIES REVIEW

  • Hannes (2015). Building a case for mixed-methods review. In. Complex interventions in
  • health. An overview of research methods. Eds. Richards and Hallberg. Routledge

London.

  • Harden et al. (2005). Methodological issues in combining diverse study types in

systematic reviews. Int. J. Social Research Methodology, 8, 257-271.

  • Johanna Briggs Institute Reviewers’ Manual 2014 edition. Australia.
  • Pace et al. (2012). Testing the reliability and efficiency of the pilot Mixed methods

appraisal tool (MMAT) for systematic mixed studies review. IJNS, 49, 47-53.

  • Pluye et al. (2009). A scoring system for appraising mixed methods research, and

concomitantly appraising qualitative, quantitative and mixed methods primary studies in Mixed studies review. IJNS, 46, 529-546.

  • Sandelowski et al. (2006). Defining and designing Mixed research synthesis studies. Res

Sch, 13, 29.

  • Sandelowski et al. (2013). Tekst-in-context: a method for extracting findings in mixed-

methods mixed research synthesis studies. JAN, 69, 1428-1437.

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