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Still too little qualitative research to shed light on results from reviews of effectiveness trials: a case study of a Cochrane review on the use of lay health workers.

Glenton C, Lewin S, Scheel IB - Implement Sci (2011)

Bottom Line: A common theme was participants' appreciation of the lay health workers' shared circumstances, for instance with regard to social background or experience of the health condition.In six studies, researchers explored the experiences of the lay health workers themselves.Issues included the importance of regular supervision and health professionals' support or lack of support.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Welfare, SINTEF Society and Technology, Oslo, Norway. claire.glenton@nokc.no

ABSTRACT

Background: Qualitative research is used increasingly alongside trials of complex interventions to explore processes, contextual factors, or intervention characteristics that may have influenced trial outcomes. Qualitative research conducted alongside trials can also be used to shed light on the results of systematic reviews of effectiveness by looking for factors that can help explain heterogeneous results across trials. In a Cochrane review on the effects of using lay health workers on maternal and child health and infectious disease control, we identified 82 trials. These trials showed promising benefits but results were heterogeneous.

Objective: To use qualitative studies conducted alongside these trials to explore factors and processes that might have influenced intervention outcomes.

Methods: We attempted to identify qualitative research carried out alongside the trials by contacting trial authors, checking papers for references to qualitative research, searching Pubmed for related studies, and carrying out citation searches. For those qualitative studies that we included, we extracted information regarding study objective, data collection and analysis methods, and key themes and categories.

Results: For 52 (63%) of the trials, we found no qualitative research that had been conducted alongside the trials. For 16 (20%) trials, some form of qualitative data collection had been done but was unavailable or had been done before the trial. For 14 (17%) trials, qualitative research had been done during or shortly after the trial, although descriptions of qualitative methods and results were often sparse. Most of these 14 studies aimed to elicit trial participants' perspectives and experiences of the intervention. A common theme was participants' appreciation of the lay health workers' shared circumstances, for instance with regard to social background or experience of the health condition. In six studies, researchers explored the experiences of the lay health workers themselves. Issues included the importance of regular supervision and health professionals' support or lack of support.

Conclusions: Qualitative studies carried out alongside trials of complex interventions could offer opportunities to authors of systematic reviews of effectiveness wishing to understand the heterogeneity of trial results. For interventions of lay health worker programmes at least, too few such studies exist at present for these opportunities to be realised.

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Mentions: Fifty-two (63%) of the 82 trials had no qualitative research linked to them. For ten (12%) of the trials, some form of qualitative data collection was referred to briefly in the paper or in emails from authors, but was unavailable. At least half of this research appeared to have been done before the trial in order to develop the intervention. For a further six (7%) of the trials, qualitative research had been carried out before the trial and was available as either published or unpublished reports. The aim of these studies was to help develop the intervention by exploring the study population's health knowledge and behaviour, factors that influenced this behaviour, experiences of illness and healthcare, or healthcare needs. While these studies may have been important to the development of the trialed intervention, they did not allow us to explore directly the processes or other factors that may have influenced the outcomes of the trials and were therefore not explored further (See also Figure 1).


Still too little qualitative research to shed light on results from reviews of effectiveness trials: a case study of a Cochrane review on the use of lay health workers.

Glenton C, Lewin S, Scheel IB - Implement Sci (2011)

Flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117743&req=5

Figure 1: Flow chart.
Mentions: Fifty-two (63%) of the 82 trials had no qualitative research linked to them. For ten (12%) of the trials, some form of qualitative data collection was referred to briefly in the paper or in emails from authors, but was unavailable. At least half of this research appeared to have been done before the trial in order to develop the intervention. For a further six (7%) of the trials, qualitative research had been carried out before the trial and was available as either published or unpublished reports. The aim of these studies was to help develop the intervention by exploring the study population's health knowledge and behaviour, factors that influenced this behaviour, experiences of illness and healthcare, or healthcare needs. While these studies may have been important to the development of the trialed intervention, they did not allow us to explore directly the processes or other factors that may have influenced the outcomes of the trials and were therefore not explored further (See also Figure 1).

Bottom Line: A common theme was participants' appreciation of the lay health workers' shared circumstances, for instance with regard to social background or experience of the health condition.In six studies, researchers explored the experiences of the lay health workers themselves.Issues included the importance of regular supervision and health professionals' support or lack of support.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Global Health and Welfare, SINTEF Society and Technology, Oslo, Norway. claire.glenton@nokc.no

ABSTRACT

Background: Qualitative research is used increasingly alongside trials of complex interventions to explore processes, contextual factors, or intervention characteristics that may have influenced trial outcomes. Qualitative research conducted alongside trials can also be used to shed light on the results of systematic reviews of effectiveness by looking for factors that can help explain heterogeneous results across trials. In a Cochrane review on the effects of using lay health workers on maternal and child health and infectious disease control, we identified 82 trials. These trials showed promising benefits but results were heterogeneous.

Objective: To use qualitative studies conducted alongside these trials to explore factors and processes that might have influenced intervention outcomes.

Methods: We attempted to identify qualitative research carried out alongside the trials by contacting trial authors, checking papers for references to qualitative research, searching Pubmed for related studies, and carrying out citation searches. For those qualitative studies that we included, we extracted information regarding study objective, data collection and analysis methods, and key themes and categories.

Results: For 52 (63%) of the trials, we found no qualitative research that had been conducted alongside the trials. For 16 (20%) trials, some form of qualitative data collection had been done but was unavailable or had been done before the trial. For 14 (17%) trials, qualitative research had been done during or shortly after the trial, although descriptions of qualitative methods and results were often sparse. Most of these 14 studies aimed to elicit trial participants' perspectives and experiences of the intervention. A common theme was participants' appreciation of the lay health workers' shared circumstances, for instance with regard to social background or experience of the health condition. In six studies, researchers explored the experiences of the lay health workers themselves. Issues included the importance of regular supervision and health professionals' support or lack of support.

Conclusions: Qualitative studies carried out alongside trials of complex interventions could offer opportunities to authors of systematic reviews of effectiveness wishing to understand the heterogeneity of trial results. For interventions of lay health worker programmes at least, too few such studies exist at present for these opportunities to be realised.

Show MeSH
Related in: MedlinePlus