Health Development Agency Integrative approaches to qualitative and quantitative evidence

The Health Development Agency (www.hda.nhs.uk) is the national authority and information resource on what works to improve people's health and reduce health inequalities in England. It gathers evidence and produces advice for policy makers, professionals and practitioners, working alongside them to get evidence into practice. iii Contents Foreword iv Summary 1 What is the role of qualitative approaches in traditional trials and experimental studies? 2 Background 2 Multi-method research 2 Qualitative research in trials 3 Why synthesise evidence from quantitative and qualitative studies? 4 At what point in the development of a field of knowledge is it appropriate to pull qualitative and quantitative learning together? 6 Generating hypotheses and questions 6 Informing the selection of outcomes for review 6 Extending or guiding sampling 6 Providing explanations and informing conclusions 6 What constitutes good evidence from qualitative studies? 7 Are there hierarchies of evidence within the different types of qualitative investigation? 10 How may the findings of qualitative and quantitative research be synthesised? 11 Advice from the NHS Centre for Reviews and Dissemination 11 The interpretive/integrative distinction 11 Narrative summary 12 Thematic analysis 15 Grounded theory 15 Meta-ethnography 17 Estabrooks, Field and Morse's aggregation of findings approach 19 Qualitative meta-analysis 19 Qualitative meta-synthesis 19 Meta-study 21 Miles and Huberman's cross-case data analysis techniques 22 Content analysis 23 Case survey 24 Qualitative comparative analysis 24 Bayesian meta-analysis 25 Meta-needs assessment 27 Discussion 28 Quantitising and qualitising 28 Issues in qualitative synthesis 28 Conclusions 31 References 32 Quant-and-qual.indd 3/26/2004, 10:10 AM 3 iv In 2000 the Health Development Agency (HDA) was established to, among other things, build the evidence base in public health, with particular reference to reducing inequalities in health (Department of Health, 2001). Since then the HDA has been engaged in a programme of developing methodologies and protocols to do precisely that (Swann et al., 2002). There are two important ideas behind the HDA's remit, political and scientific. The political imperative is a clear commitment to tackling the long-term problem at the heart of public health – that, as the health of the population as a whole continues to improve, at the same time the gradient in inequalities in health across the population, from the most to the least advantaged becomes worse (Acheson, 1998) There is, in other words, a long-standing problem of inequalities in health. The scientific principle is that the best available evidence should be used in order to …