<ul><li>What is qualitative research?  </li></ul><ul><li>What role could it have in Cochrane? </li></ul><ul><li>What chall...
It isn’t… <ul><li>A way of measuring quality of life  </li></ul><ul><li>A methods tool-kit  </li></ul><ul><li>Always small...
It is a method of scientific enquiry that.. <ul><li>Illuminates why people act in the way they do and how action is shaped...
What role can qualitative research have in the collaboration?  <ul><li>Improving  effectiveness reviews </li></ul><ul><li>...
Improving  Effectiveness Reviews  <ul><li>E.G.  Helping to identify meaningful  outcomes  </li></ul><ul><li>  Physiotherap...
Extending  Cochrane reviews:   <ul><ul><li>Questions that QR might address:  </li></ul></ul><ul><ul><li>Are interventions ...
The case of Directly Observed Therapy (DOTS) for the treatment of Tuberculosis <ul><li>DOTS:  WHO branded package of inter...
What does the Qualitative Research systematic review contribute?   <ul><li>Questions appropriateness of  interventions tha...
The case of medicine taking   <ul><li>Many Cochrane reviews focus  on  </li></ul><ul><ul><li>effectiveness of medicines  <...
Rethinking non-compliance:  <ul><li>Four types of medicine taking strategies two involving  active resistance :  </li></ul...
Including qualitative research in  Cochrane reviews: methodological challenges  <ul><li>Need to focus on the right challen...
How the practice of effectiveness reviews and qualitative research review differ <ul><li>Protocol:  an enabling framework ...
Including qualitative research in  Cochrane reviews: Organisational  Challenges:     <ul><li>Need discussion about:  </li>...
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The Cochrane Collaboration Colloquium: Incorporating qualitative information in systematic reviews

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Jennie Popay speaking at the XIV Cochrane Colloquium in Dublin, Ireland

Published in: Health & Medicine, Technology
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  • The Cochrane Collaboration Colloquium: Incorporating qualitative information in systematic reviews

    1. 1. <ul><li>What is qualitative research? </li></ul><ul><li>What role could it have in Cochrane? </li></ul><ul><li>What challenges arise for CC if qualitative research is taken seriously? </li></ul><ul><li>Questions for debate and discussion not answers! </li></ul>
    2. 2. It isn’t… <ul><li>A way of measuring quality of life </li></ul><ul><li>A methods tool-kit </li></ul><ul><li>Always small scale </li></ul><ul><li>Anything that includes the consumers’ voice </li></ul><ul><li>The easy option for the non-numerate! </li></ul>
    3. 3. It is a method of scientific enquiry that.. <ul><li>Illuminates why people act in the way they do and how action is shaped by social contexts </li></ul><ul><li>Dependent on conceptual not numerical analysis </li></ul><ul><li>Generalisable on basis of theory not statistical probability </li></ul>
    4. 4. What role can qualitative research have in the collaboration? <ul><li>Improving effectiveness reviews </li></ul><ul><li>Extending beyond questions of effectiveness: </li></ul>
    5. 5. Improving Effectiveness Reviews <ul><li>E.G. Helping to identify meaningful outcomes </li></ul><ul><li> Physiotherapy interventions to improve continence </li></ul><ul><ul><ul><ul><ul><li>Dignity v quality of life </li></ul></ul></ul></ul></ul>
    6. 6. Extending Cochrane reviews: <ul><ul><li>Questions that QR might address: </li></ul></ul><ul><ul><li>Are interventions aimed at the ‘right’ problem? </li></ul></ul><ul><ul><li>How can evaluated interventions be improved? </li></ul></ul><ul><ul><li>How are effective interventions implemented in ‘real life’ </li></ul></ul><ul><ul><li>Two examples </li></ul></ul>
    7. 7. The case of Directly Observed Therapy (DOTS) for the treatment of Tuberculosis <ul><li>DOTS: WHO branded package of interventions including observing people take medication </li></ul><ul><li>Cochrane Review : reported absence of evidence for or against DOTS compared with people treating themselves </li></ul><ul><li>Volmick & Garner, 1997/02/06 CE003343 </li></ul><ul><li>Systematic review of qualitative research on factors shaping people’s help seeking behaviour </li></ul><ul><li>Noyes & Popay, Journal of Advanced Nursing forthcoming </li></ul>
    8. 8. What does the Qualitative Research systematic review contribute? <ul><li>Questions appropriateness of interventions that assume </li></ul><ul><ul><li>Barriers to cure are cultural </li></ul></ul><ul><ul><li>Patients are irresponsible </li></ul></ul><ul><li>Highlights other barriers: </li></ul><ul><ul><li>material e.g. poverty </li></ul></ul><ul><ul><li>Stigma </li></ul></ul><ul><ul><li>Social relationships of care </li></ul></ul><ul><li>Reveals resourcefulness of people despite the barriers </li></ul><ul><li>Aids interpretation of results of trials in Cochrane review </li></ul><ul><li>Suggests ways of improving interventions: e.g. more support less inspection </li></ul>
    9. 9. The case of medicine taking <ul><li>Many Cochrane reviews focus on </li></ul><ul><ul><li>effectiveness of medicines </li></ul></ul><ul><ul><li>improving compliance </li></ul></ul><ul><li>Qualitative research review on medicine taking & compliance </li></ul><ul><li>Pound P et al. Social Science & Medicine 2005;61:133-155 </li></ul>
    10. 10. Rethinking non-compliance: <ul><li>Four types of medicine taking strategies two involving active resistance : </li></ul><ul><ul><li>passive accepters; </li></ul></ul><ul><ul><li>active accepters, </li></ul></ul><ul><ul><li>active modifiers </li></ul></ul><ul><ul><li>rejecters. </li></ul></ul><ul><li>So what? </li></ul><ul><ul><li>Do study results reflect the impact of these strategies through randomisation? </li></ul></ul><ul><ul><li>Can systematic reviews take account of this behavioural diversity? </li></ul></ul><ul><ul><li>What are the implications for implementation of ‘effective’ medicines? </li></ul></ul><ul><li>Is the effectiveness of medicines best maximised by: </li></ul><ul><ul><li>Promoting compliance with ‘recommended’ regimes </li></ul></ul><ul><ul><li>Working with patients to support active acceptance and modification </li></ul></ul>
    11. 11. Including qualitative research in Cochrane reviews: methodological challenges <ul><li>Need to focus on the right challenges: the bridge in the distance not the edges of the sign </li></ul><ul><li>Systematic reviews of qualitative research can be: </li></ul><ul><ul><li>Systematic </li></ul></ul><ul><ul><li>Transparent </li></ul></ul><ul><ul><li>And involve ‘consumers’ </li></ul></ul><ul><li>But other aspects of qualitative research review process different to established practice in Cochrane </li></ul>
    12. 12. How the practice of effectiveness reviews and qualitative research review differ <ul><li>Protocol: an enabling framework not a straight jacket </li></ul><ul><li>Review question(s ): may be revised as review proceeds </li></ul><ul><li>Review process: iterative not linear and/or staged </li></ul><ul><li>Searching: not always comprehensive, may involve sampling </li></ul><ul><li>Inclusion: on basis of methodological quality contentious. </li></ul><ul><li>Reproducibility : not inevitable </li></ul><ul><li>Qualitative research expertise : essential </li></ul>
    13. 13. Including qualitative research in Cochrane reviews: Organisational Challenges: <ul><li>Need discussion about: </li></ul><ul><ul><li>Approach to & content of guidance </li></ul></ul><ul><ul><li>How product of QR reviews are included in review reports and the CC library </li></ul></ul><ul><ul><li>How reviewers are supported </li></ul></ul><ul><li>When two ‘rivers’ meet </li></ul><ul><ul><li>There will be some turbulence </li></ul></ul><ul><ul><li>but </li></ul></ul><ul><ul><li>Change & adaptation can create a new and more substantial river </li></ul></ul>

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