Abstract
BackgroundQualitative synthesis has become more commonplace in recent years. Meta-ethnography is one of several methods for synthesising qualitative research and is being used increasingly within health care research. However, many aspects of the steps in the process remain ill-defined.DiscussionWe utilized the seven stages of the synthesis process to synthesise qualitative research on adherence to tuberculosis treatment. In this paper we discuss the methodological and practical challenges faced; of particular note are the methods used in our synthesis, the additional steps that we found useful in clarifying the process, and the key methodological challenges encountered in implementing the meta-ethnographic approach.The challenges included shaping an appropriate question for the synthesis; identifying relevant studies; assessing the quality of the studies; and synthesising findings across a very large number of primary studies from different contexts and research traditions. We offer suggestions that may assist in undertaking meta-ethnographies in the future.SummaryMeta-ethnography is a useful method for synthesising qualitative research and for developing models that interpret findings across multiple studies. Despite its growing use in health research, further research is needed to address the wide range of methodological and epistemological questions raised by the approach.
Highlights
Qualitative synthesis has become more commonplace in recent years
We found the process of extracting themes complicated; the focus of studies varied from a patient's general experience of TB as an illness to their experience of adherence to a regimen of directly observed therapy
We considered a chronological comparison more appropriate in this case because our included studies ranged over 20 years during which significant shifts in the management of the disease occurred, including the global implementation of the DOTS strategy with its directly observed therapy component
Summary
Step 1: Getting started According to the original method [12], 'getting started' involves determining a research question that could be informed by qualitative research. The equivocal evidence from the original systematic review of strategies to improve adherence to TB treatment [16] provided the rationale for approaching the issue of adherence from the perspective of patients and other stakeholders. A further motivation for synthesizing the body of qualitative evidence was to inform the development of patient-oriented interventions to improve adherence rates to TB treatment in South Africa. We felt that the opinions, attitudes and knowledge of patients regarding treatment, and a theoretical model of adherence behaviour could shape. Experiences of tuberculosis treatment: A meta-ethnographic analysis of facilitators and barriers to inform the development of an adherence-promoting intervention
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