Meta-study as Diagnostic

What is it about?

Having previously conducted qualitative syntheses of the diabetes literature, we wanted to explore the changes which have recently been presented in the qualitative diabetes literature (in terms of theoretical approaches, methodological practices, substantive knowledge). The aim of this research was to explore the feasibility of synthesising existing qualitative syntheses of patient perspectives of diabetes using meta-study methodology. We conducted a systematic review of qualitative literature, published between 2000 and 2013, and six papers were identified as qualitative syntheses. Meta-study methodology was employed to compare the theoretical, methodological, analytic and synthetic processes across the six studies, exploring the potential for an overarching synthesis. We identified that while research questions have increasingly concentrated on specific aspects of diabetes, the focus on systematic review processes has overshadowed qualitative theory and methods. This can inhibit the production of compelling results with meaningful clinical applications. While we were unable to produce a synthesis of syntheses, we recommend that researchers who conduct qualitative syntheses pay equal attention to qualitative traditions (particularly those which include patients) and systematic review processes, in order to produce research products that are both credible and applicable.

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Why is it important?

Theoretically, we have identified how the earlier interest in ethnography has been subsumed by a form of qualitative systematic review that can be more aggregative than interpretive. Methodologically, we have detailed the loss of analytical rigour, with the foregrounding of replicable search strategies replacing the analytical practices of qualitative synthesis. Substantively, we have found a shift from an interest in patient experience to (the rhetoric of) self-management. In sum, we were unable to identify a cumulative body of knowledge that contributes to our understanding of the lived experience of diabetes, and were thus unable to produce a synthesis of syntheses. We can only truly identify what patient experiences of diabetes care might be (in policy directives and supportive clinical practices), when we have patients with experience of diabetes fully involved in identifying the ontology (constitution of knowledge), archaeology (policies and practices) and architecture (institutional structures) of how we got where we are now. We can only achieve this with patients active and meaningful participation in research.

Perspectives