Aims: To examine the strengths and weaknesses of multi-context (international) qualitative evidence syntheses in comparison with single-context (typically single-country) reviews. We compare a multi-country synthesis with single-context syntheses on facility-based delivery in Nigeria and Kenya.
Design: Discussion paper.
Background: Qualitative evidence increasingly contributes to decision-making. International organizations commission multi-context reviews of qualitative evidence to gain a comprehensive picture of similarities and differences across comparable (e.g., low- and middle-income) countries. Such syntheses privilege breadth over contextual detail, risking inappropriate interpretation and application of review findings. Decision-makers value single-context syntheses that account for the contexts of their populations and health services. We explore how findings from multi- and single-context syntheses contribute against a conceptual framework (adequacy, coherence, methodological limitations and relevance) that underpins the GRADE Confidence in Evidence of Reviews of Qualitative Evidence approach.
Data sources: Included studies and findings from a multi-context qualitative evidence synthesis (2001-2013) and two single-context syntheses (Nigeria, 2006-2017; and Kenya, 2002-2016; subsequently updated and revised).
Findings: Single-context reviews contribute cultural, ethnic and religious nuances and specific health system factors (e.g., use of a voucher system). Multi-context reviews contribute to universal health concerns and to generic health system concerns (e.g., access and availability).
Implications for nursing: Nurse decision-makers require relevant, timely and context-sensitive evidence to inform clinical and managerial decision-making. This discussion paper informs future commissioning and use of multi- and single-context qualitative evidence syntheses.
Conclusion: Multi- and single-context syntheses fulfil complementary functions. Single-context syntheses add nuances not identifiable in the remit and timescales of a multi-context review. Impact This study offers a unique comparison between multi-context and single country (Nigeria and Kenya) qualitative syntheses exploring facility-based birth. Clear strengths and weaknesses were identified to inform commissioning and application of future syntheses. Characteristics can inform the commissioning of single- and multi-context nursing-oriented reviews across the world.
目的: 研究多语境(国际)定性证据合成法的优势和劣势,并将其与单语境(通常为单一国家)审查进行比较。我们比较了尼日利亚和肯尼亚基于设施交付的多国合成法与单语境合成法。 设计: 讨论稿。 背景: 定性证据越来越有助于决策。国际组织委员会对定性证据进行多语境审查,以全面了解可比较(如低收入和中等收入)国家之间的异同。这种合成法特权范围超出具体的语境内容,有解释不当和应用审查结果的风险。决策者重视考虑其人口和卫生服务语境的单语境合成法。我们探究了多频单语境合成法的审查结果如何促进概念框架(充分性、一致性、方法论局限性和相关性)的形成,因为该框架支持定性证据审查证据中的等级置信度。 资料来源: 包括多语境定性证据合成法(2001-2013年)和两个单语境合成法(尼日利亚,2006-2017年;肯尼亚,2002-2016年;随后更新并修订)的研究及其结果。 发现: 单语境审查有助于查明文化、种族和宗教的细微差别以及特定的卫生系统因素(例如,凭单制度的使用)。多语境审查有助于查明常见健康问题和一般健康系统问题(如可及性和可用性)。 护理启示: 护理决策者需要相关、及时和与上下文相关的证据来告知临床和管理决策。这篇讨论稿为将来多语境和单语境定性证据合成法的调试和使用提供了参考。 结论: 多语境和单语境合成法实现互补功能。单语境合成法增加了在多语境审查范围和时标内无法识别的细微差别。 影响: 本研究用一种独特的方式比较多语境与单一国家(尼日利亚和肯尼亚)探索基于设施分娩的定性合成法。 明确了优势和劣势,为将来合成法的调试和应用提供参考。 这种独特性可以为全国各地进行单一和多语境护理审查的调试提供参考。.
Keywords: facility-based delivery; midwives; nursing research; qualitative evidence synthesIs; research findings; systematic reviews.
© 2019 John Wiley & Sons Ltd.