Cited by 2,289Meta-analysis and systematic reviewsPublic Health and Social InequalitiesQualitative Research Methods and Applications

The DOI matches its Crossref record; 67 of the 68 references it cites were found in a registry or an index; 20 of the 71 sources its claims cite were checked for support.

Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

Open access

Abstract

BACKGROUND: Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK METHODS: This project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis. RESULTS: Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people's eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research. DISCUSSION: By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This paper describes the development of Critical Interpretive Synthesis (CIS), an interpretive review method for complex, diverse literatures, illustrated through a synthesis of access to healthcare by vulnerable groups in the UK. Its central substantive output is a synthesising argument in which access is understood through the synthetic construct of candidacy, jointly negotiated between people and health services.

Key findings

  • The illustrative CIS of access to healthcare by socio-economically disadvantaged people included 119 papers and generated a critique of utilisation as a measure of equity of access, arguing that utilisation studies rest on questionable normative assumptions and difficult-to-measure “need.”
  • The core synthetic construct is “candidacy”: eligibility for medical attention and intervention is jointly negotiated between individuals and health services, is dynamic and contingent, and is shaped by identification, navigation, permeability of services, appearances, adjudications, offers, resistance, and operating conditions.
  • Access is recast as a dynamic interplay between health services defining appropriate objects of medical attention and people constituting what they understand to be appropriate objects of medical attention.
  • Searching generated over 100,000 records at one stage; the sampling frame totalled approximately 1,200 records, and approximately 20 papers were excluded as “fatally flawed.”

Methods

  • Design: a reflexive account and development of CIS, sensitised to conventional systematic review methodology but drawing on interpretive synthesis, meta-ethnography, and grounded theory; question formulation, searching, sampling, critique, and analysis were iterative rather than staged.
  • Data/sample: literature on access to NHS healthcare in the UK by potentially vulnerable groups defined by funders as children, older people, members of minority ethnicities, men/women, and socio-economically disadvantaged people; the illustrative synthesis reported here focused on socio-economically disadvantaged people and included 119 papers.
  • Analysis: qualitative-style analysis using QSR N5, constant comparison, purposive then theoretical sampling, and generation of a synthesising argument and synthetic constructs; formal quality appraisal was limited, with only papers deemed fatally flawed excluded.

Limitations

  • Stated by the authors: they make no claim to reproducibility; a different team using the same papers might produce a different theoretical model; later sampling was highly intuitive and guided by emerging theory; only a fraction of all relevant papers was analysed; search transparency, comprehensiveness, and reproducibility are difficult to demonstrate; formal data extraction’s value requires further evaluation; and both the method and model should be evaluated in other contexts.
  • Stated by the authors: the evidence that socially disadvantaged people’s candidacy is judged less eligible for some interventions is “not particularly strong.”
  • Evident from the text: the illustrative synthesis is UK-focused and centres on socio-economically disadvantaged people, although the authors suggest candidacy is transferable; the approach produces one privileged, authorial reading rather than a reproducible product.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-2288-6-35

Cites

67 of 67 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

69 Own interpretation · 42 No basis given · 21 No full text of the sources · 7 Not checked yet · 6 Partly supported · 5 Own result · 2 Supported · 2 Supported so far · 1 Mixed support · 1 Not supported · 1 Own method · accuracy not yet measured

Verify all 8 references — free account

Show all 46 claims

  • It may state two separate claims as one. 51
  • Probably not a substantial claim. 92
111 of 111
  • The paper relies on this without support.

    The literature on access to healthcare is large, diverse, and complex.

    “Like many areas of healthcare practice and policy, the literature on access to healthcare is large, diverse, and complex.”
  • The paper relies on this without support.

    The groups defined by the funders (children, older people, members of minority ethnicities, men/women, and socio-economically disadvantaged people) are potentially vulnerable groups for access to NHS healthcare.

    “These groups had been defined at the outset by the funders of the project (the UK Department of Health Service Delivery and Organisation R&D Programme) as children, older people, members of minority ethnicities, men/women, and socio-economically disadvantaged people.”
  • The paper relies on this without support.

    The literature on access to healthcare by vulnerable groups is large, amorphous and complex.

    “where there is a large, amorphous and complex body of literature”
  • The paper relies on this without support.

    Access to healthcare by vulnerable groups is a challenging area for interpretive review.

    “particularly in challenging areas such as access to healthcare”
4 of 4

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

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Citations

Cites

Show all 68 references

Research works printed but not linked: 7

  1. NHS Centre for Reviews and Dissemination: Undertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. 2001, York: NHS CRD
  2. Booth A: Cochrane or cock-eyed? How shoul we conduct systematic reviews of qualitative research?. Proceedings of the Qualitative Evidence-based Practice Conference, Taking a Critical Stance. 2001, Coventry University, May 14 2001
  3. Schutz A: Collected Papers. 1962, The Hague: Martinus Nijhoff, 1:
  4. Sutton M, Gravelle H, Leyland A, Morris S, Muirhead M, Noble M, Parkin D, Windmeijer F: Small area study of supply and demand determinants of healthcare resource use and estimation of relative needs for primary care trusts in England. English Department of Health/Advisory Committee on Resource Allocation. 2002
  5. Cornwell J: Hard Earned Lives. 1984, London: Tavistock
  6. Anderson E, Petersen S, Wailoo M: Health concerns and needs of traveller families. Health Visitor. 1997, 70: 148-150.
  7. House of Commons Health Committee: Inequalities in access to maternity services. Eighth report of session 2002–2003. 2003, London: Stationery Office

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Metadata

Authors
Dixon-Woods, M., Cavers, D., Agarwal, S., Annandale, E., Arthur, A., Harvey, J., Hsu, R., Katbamna, S., Olsen, R., Smith, L., Riley, R., & Sutton, A. J.
Affiliations
  • Western General Hospital (GB)
  • University of Leicester (GB)
  • University of Nottingham (GB)
  • Loughborough University (GB)
Venue
BMC Medical Research Methodology
Published
2006-07-26
Volume
6
Issue
1
Pages
35-35
ISSN
1471-2288 (ISSN-L)
OpenAlex
W2135504732
Cited by
2,289
References
68
Citations by year
2026: 297 · 2025: 187 · 2024: 204 · 2023: 167 · 2022: 172 · 2021: 173 · 2020: 184 · 2019: 135 · 2018: 150 · 2017: 113 · 2016: 97 · 2015: 81 · 2014: 81 · 2013: 68 · 2012: 55
FWCI
11.86
Type
journal article
Language
en
Open access
Locations
  • BMC Medical Research Methodology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Leicester Research Archive (University of Leicester) (submittedVersion)
  • Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Social Sciences › Health › Public Health and Social Inequalities
  • Social Sciences › Education › Qualitative Research Methods and Applications
Keywords
health care access, vulnerable populations, critical interpretive synthesis, candidacy, equitable access, health care utilization, interpretive synthesis, health disparities
MeSH terms
United Kingdom, Health Services Accessibility, Health Services Research, Humans, Patient Acceptance of Health Care, Research Design, Sampling Studies, Socioeconomic Factors, State Medicine, Meta-Analysis as Topic, Vulnerable Populations, Resource Allocation

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