Qualitative research synthesis for health policy analysis: what does it entail and what does it offer?

This set of articles has its roots in the 2008 special edition of Health Policy and Planning, titled ‘Future directions for health policy analysis: a tribute to the work of Professor Gill Walt’, which among other things called for ‘better use of the existing but often descriptive body of policy analysis through synthesis of existing case study material’ (Gilson et al. 2008, p. 292). Picking up that challenge, this edition presents a set of five articles that, through synthesis of available research, seek to consolidate and develop the body of health policy analysis (HPA) work in lowand middle-income countries (LMICs). This work is currently fragmented across geographic settings and policy issues, is more descriptive than analytic and is weakly theorized (Gilson and Raphaely 2008; Walt et al. 2008). Policy analysis starts from the ‘understanding that policy making is a process of continuing interaction among institutions (the structure and rules which shape how decisions are made), interests (groups and individuals who stand to gain or lose from change) and ideas (including arguments and evidence) (John 1998)’ (Gilson et al. 2008, p. 291). Such analysis is a legitimate area of academic inquiry and has practical importance for health system development. Qualitative synthesis, meanwhile, can be defined as ‘as any methodology whereby study findings are systematically interpreted through a series of expert judgements to represent the meaning of the collected work. In a qualitative synthesis, the findings of qualitative studies—and sometimes mixed-methods and quantitative research—are pooled. Judgement-based qualitative methodologies are used to draw conclusions regarding the collective meanings of this pool of research’ (Bearman and Dawson 2013, p. 253). Although gaining attention in health research, qualitative synthesis remains a new area of work. Set against the traditions of systematic review, the interpretive judgements involved raise concerns about bias, and there are also questions about whether it is appropriate to draw any form of generalization from qualitative data generated in specific places and times (Wallace et al. 2006; Thomas and Harden 2008). Starting broadly from what Barnett-Page and Thomas (2009) identify as an objective idealist or critical realist epistemological position, we were, nonetheless, emboldened to explore the application of qualitative synthesis to HPA research. These articles are broadly based on the understandings that: