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Integrating qualitative research with trials in systematic reviews
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Research questionWhat is known about the barriers to, and facilitators of, fruit and vegetable intake among children aged 4-10 years?Synthesis of quantitative and qualitative studies Controlled trials 1. Application of inclusion criteria 2. Quality assessment (n=33) 3. Data extraction 4. Quantitative synthesis (n=21) Qualitative trials 1. Application of inclusion criteria 2. Quality assessment (n=8) 3. Data extraction 4. Quantitative synthesis (n=8) Fig 1 Stages of the review Evidence for Policy
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“In general, the use to date of interpretive approaches to synthesis has been confined to the synthesis of qualitative research only [6-8].”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [8]
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“Methods for including qualitative and quantitative evidence in systematic reviews developed by the EPPI Centre at the Institute of Education, London, have involved refinements and extensions of conventional systematic review methodology [6-8], and have limited their application of interpretive techniques to synthesis of qualitative evidence.”
From Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups (2006) · cites this paper as [8]
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Efficacy and experiences of telephone counselling for informal carers of people with dementia
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“Quality assessment For qualitative research various strategies to protect against bias and enhance the reliability and external validity of findings have been summarised in checklists (Boulton, Fitzpatrick & Swinburn, 1996; Mays & Pope, 1995; Thomas et al., 2004).”
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Older Patients’ Experiences of Heart Failure—An Integrative Literature Review
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Theory-based evaluation and the social impact of the arts
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“…study work that is usually small scale, takes place in very specific contexts, and uses predominantly qualitative methods, an issue that is of wider concern within social research and evidence based policy making (Britten et al., 2002; Spencer, Ritchie, Lewis, & Dillon, 2003; Thomas et al., 2004).”
BackgroundSystematic review and meta‐analysis: prevalence of alcohol use among young people in eastern Africa
Francis, J. M., Grosskurth, H., Changalucha, J., Kapiga, S. H., & Weiss, H. A. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12267 · Cited by 88
“There is currently an emphasis to incorporate both qualitative and quantitative evidence in the systematic reviews (Pearson 2004; Thomas et al. 2004).”
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“Seven sources address conceptualization of synthesizing opportunities (The Joanna Briggs Institute 2014; Thomas et al. 2004; Popay et al. 2006; Jones 2005; Pope et al. 2007; Pawson 2002; Lucas et al. 2007).”
BackgroundSystematic reviews: from ‘bare bones’ reviews to policy relevance
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Quality of life in osteogenesis imperfecta: A mixed‐methods systematic review
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“…reviews have traditionally focused mostly on quantitative research, the inclusion and integration of qualitative research will contribute to the presentation of varied perspectives on QoL [Thomas et al., 2004; Whittemore and Knafl, 2005] and improving best practice for individuals with OI.”
BackgroundRichardson, M. A., Moore, D. A., Gwernan‐Jones, R., Coon, J. T., Ukoumunne, O. C., Rogers, M., Whear, R., Newlove-Delgado, T. V., Logan, S., Morris, C., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19450 · Cited by 112
“Where such overarching reviews exist, they have typically been able to focus on explanations of the effectiveness findings and considered a quantitative and qualitative review focused on the same intervention.(412) In the current overarching synthesis we have drawn together findings from four reviews, with a focus at…”
BackgroundA look back over the past 40 years of female entrepreneurship: mapping knowledge networks
Santos, G. M. C., Marques, C. S., & Ferreira, J. J. (2018) · Scientometrics · doi:10.1007/s11192-018-2705-y · Cited by 89
“Many systematic reviews have been based on an explicitly quantitative meta-analysis of the available data, but a smaller number have used more qualitative analyses (i.e. content analysis) (Thomas et al. 2004).”
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“agreements resolved through discussion or inclusion of a third reviewer until consensus was achieved (JW or ZR) (Thomas et al., 2004).”
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Rai, S. S., Syurina, E. V., Peters, R. M. H., Putri, A. I., & Zweekhorst, M. B. M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17186657 · Cited by 89
“The qualitative data were thematically analyzed and synthesized [49].”
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“Reviewers can synthesize qualitative and quantitative research separately then integrate their findings (21).”
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“Understanding patient experiences and barriers to dental care in this population might also aid the design of a workable intervention that aligns with patients’ values to increase patient acceptability and uptake.(37) The limitations of the current study need to be considered when interpreting the findings.”
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“This way of mixing the data has been used by other researchers to combine two reviews; one on patient perspectives and one on effectiveness [12].”
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“There is precedent for such an approach, and it is now generally accepted that syntheses of qualitative research, like meta-analyses of quantitative studies, can provide new insights and inform clinical and public health practice [27-30] as well as the work of health service managers and policy-makers [2].”
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“Eight components were scored (selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop outs, intervention integrity and analyses) from which an overall quality rating was calculated (strong/moderate/weak) (Thomas 2003; Thomas et al. 2004a).”
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“This study includes data from different types of research studies (quantitative, qualitative and mixed method studies); this is increasingly advocated as it avoids bias and maximises transparency (Polit et al., 2001; Thomas et al., 2004).”
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“In a systematic review of facilitators of and barriers to healthy eating, Thomas et al. (2004 ) developed a matrix of qualitative concepts to which quantitative data were added.”
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“…of SRs of qualitative evidence in evaluating interventions may include explaining heterogeneity in the findings of quantitative evaluation research (Thomas et al., 2004), providing indicative prima facie evidence of the likelihood of intervention effectiveness in areas where quantitative outcome…”
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Health literacy in persons at risk of and patients with coronary heart disease: A systematic review
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“A mixed methods synthesis was undertaken, in line with Thomas et al. (2004) [55] in order to benefit from findings from mixed methods, quantitative and qualitative studies.”
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“Integrating studies with different methodological backgrounds when undertaking systematic literature reviews is problematic and difficult (Thomas et al., 2004; Lucas et al., 2007).”
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The Impact of Robotic-Assisted Surgery on Team Performance: A Systematic Mixed Studies Review
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“Dividing studies into categories based on the number of critical appraisal criteria met is consistent with other studies that have applied sensitivity analysis to qualitative synthesis findings [70, 82, 83].”
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“Combining qualitative and quantitative studies could provide a greater understanding concerning treatment fidelity in behavioural change studies [28,34].”
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“Increasingly, qualitative aspects of STEM research are being integrated into the process (Thomas et al., 2004).”
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“We used this mixed methods approach to strengthen the richness of our findings and enhance data validity (Thomas et al., 2004; Owen et al., 2010; Rowe et al., 2012; Lawrence and Kinn, 2012).”
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Self-citationThe synthesis of qualitative research and evidence-based nursing
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Moving psychiatric deinstitutionalization forward: A scoping review of barriers and facilitators
Montenegro, C., Irarrázaval, M., Moller, J. G., Thomas, F., & Ortiz, J. U. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.18 · Cited by 47
“Secondly, grouping and organizing the codes into an inductively developed set of categories.”
Coaching to develop leadership for healthcare managers: a mixed-method systematic review protocol
Hu, S., Chen, W., Hu, H., Huang, W., Chen, J., & Hu, J. (2022) · Systematic Reviews · doi:10.1186/s13643-022-01946-z · Cited by 43
Aamland, A., Malterud, K., & Werner, E. L. (2012) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813432.2012.704812 · Cited by 43
Cochrane and Campbell Collaborations, and health equity
Tugwell, P., Petticrew, M. P., Robinson, V. A., Kristjansson, E., & Maxwell, L. J. (2006) · The Lancet · doi:10.1016/s0140-6736(06)68490-0 · Cited by 42
A systematic review of lay views about infant size and growth
Lucas, P. J., Arai, L., Baird, J., Kleijnen, J., Law, C., & Roberts, H. M. (2006) · Archives of Disease in Childhood · doi:10.1136/adc.2005.087288 · Cited by 43
Purnomo, J., Coote, K., Mao, L., Fan, L., Gold, J., Ahmad, R., & Zhang, L. (2018) · BMC Infectious Diseases · doi:10.1186/s12879-018-2972-5 · Cited by 40
“Employing qualitative studies in a systematic review will provide a more in-depth perspectives of the target group of an intervention [78], whether such intervention is feasible, meaningful and appropriate to the target group [79].”
BackgroundDo safety briefings improve patient safety in the acute hospital setting? A systematic review
Ryan, S., Ward, M. E., Vaughan, D., Murray, B., Moore, Z. E. H., O’Connor, T., Nugent, L., & Patton, D. (2019) · Journal of Advanced Nursing · doi:10.1111/jan.13984 · Cited by 43
Patient experience of uncertainty in cancer genomics: a systematic review
Bartley, N., Napier, C. E., Best, M. C., & Butow, P. N. (2020) · Genetics in Medicine · doi:10.1038/s41436-020-0829-y · Cited by 42
“Analysis Analysis was conducted using a three-stage synthesis process that combined qualitative and quantitative studies comprehensively and rigorously to answer the review questions.(22) As meta-analysis was not possible due to the heterogeneity of study outcomes, the first analysis focused on identifying and summari…”
MethodBangpan, M., Chiumento, A., Dickson, K., & Felix, L. M. (2017) · doi:10.21201/2017.8937 · Cited by 47
Implementing Juvenile Drug Treatment Courts: A Meta-aggregation of Process Evaluations
Wilson, D. B., Olaghere, A., & Kimbrell, C. S. (2019) · Journal of Research in Crime and Delinquency · doi:10.1177/0022427819826630 · Cited by 41
Balance, Balancing, and Health
Lipworth, W. L., Hooker, C., & Carter, S. M. (2011) · Qualitative Health Research · doi:10.1177/1049732311399781 · Cited by 40
“Syntheses of qualitative research, like meta-analyses of quantitative studies, can inform clinical and public health practice (Atkins et al., 2008; Campbell et al., 2003; Kuper, Reeves, & Levinson, 2008; Thomas et al., 2004).”
MethodGibson, C. E., Goeman, D., & Pond, D. C. (2020) · BMC Family Practice · doi:10.1186/s12875-020-01177-y · Cited by 41
“Page 7/42 In this systematic review a rigorous and transparent method was utilised to organise, describe, explore and interpret the ndings and generate new insights [19, 20].”
MethodMomsen, A. H., Ørtenblad, L., & Maribo, T. (2022) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2021.101529 · Cited by 40
McMahon, T., & Ward, P. (2012) · Systematic Reviews · doi:10.1186/2046-4053-1-56 · Cited by 41
“Methods to integrate intervention studies and the views of immigrants in this review of evidence drew on reviews carried out by the EPPICentre in the UK [75,80-82].”
Wallace, J., Byrne, C., & Clarke, M. J. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005834 · Cited by 41
Evidence‐based practice in psychology: Implications for research and research training
Bauer, R. M. (2007) · Journal of Clinical Psychology · doi:10.1002/jclp.20374 · Cited by 39
“It is important for psychologists to become more familiar with these methods because many systematic reviews in the EBP literature contain the results of qualitative studies (Thomas et al., 2004).”
BackgroundThe manipulation of drugs to obtain the required dose: systematic review
Richey, R. H., Craig, J. V., Shah, U. U., Ford, J. L., Barker, C. E., Peak, M., Nunn, A. J., & Turner, M. A. (2012) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2011.05916.x · Cited by 41
“There are challenges with the synthesis of different types of studies and data in the same review; however, the risk of excluding potentially valuable information where only one type of evidence is used has also been identified (Roberts et al. 2002, Thomas et al. 2004).”
BackgroundSimmons, B. M. (2012) · Smith College Studies in Social Work · doi:10.1080/00377317.2011.638889 · Cited by 38
“There is significant criticism within the social work literature regarding this form of evidence hierarchy within EBP (Gould, 2006, 2010; McNeil, 2006; Raw, 1998; Thomas et al., 2004; Witkin & Harrison, 2001).”
BackgroundMoore, D. A., Richardson, M. A., Gwernan‐Jones, R., Coon, J. T., Stein, K., Rogers, M., Garside, R., Logan, S., & Ford, T. J. (2015) · Journal of Attention Disorders · doi:10.1177/1087054715573994 · Cited by 38
“Where such overarching reviews exist, they have typically been able to focus on explanations for unequivocal findings of effectiveness and considered a single quantitative and qualitative review of the same intervention (Thomas et al., 2004).”
BackgroundMethodMcCashin, D., Coyle, D., & O’Reilly, G. (2019) · Journal of Medical Internet Research · doi:10.2196/13540 · Cited by 38
“There is considerable debate surrounding the quality assessment of qualitative research, and even if this can ever be appropriately appraised [39].”
Variations of mixed methods reviews approaches: A case study
Hong, Q. N., Rees, R. W., Sutcliffe, K., & Thomas, J. (2020) · Research Synthesis Methods · doi:10.1002/jrsm.1437 · Cited by 52
Self-citation
Metadata
- Authors
- Thomas, J., Harden, A., Oakley, A., Oliver, S., Sutcliffe, K., Rees, R., Brunton, G., & Kavanagh, J.
- Affiliations
- University of London (GB)
- Corresponding author
- Thomas, James
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2004-04-22
- Volume
- 328
- Issue
- 7446
- Pages
- 1010-1012
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC404509
- OpenAlex
- W2015804289
- Cited by
- 515
- References
- 13
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 13 · 2023: 20 · 2022: 27 · 2021: 21 · 2020: 26 · 2019: 33 · 2018: 22 · 2017: 12 · 2016: 30 · 2015: 30 · 2014: 29 · 2013: 35 · 2012: 41
- FWCI
- 6.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UEL Research Repository (University of East London) (acceptedVersion)
- UEL Research Repository (University of East London) (submittedVersion, cc-by-nd)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Education › Qualitative Research Methods and Applications
- Keywords
- fruit and vegetable intake, children, barriers and facilitators, dietary behavior, mixed methods synthesis, systematic review methodology
- MeSH terms
- Clinical Trials as Topic, Humans, Quality Assurance, Health Care, Review Literature as Topic, Meta-Analysis as Topic, Biomedical Research
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