BackgroundConventional 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 UKMethodsThis 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.ResultsMany 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.DiscussionBy 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.

Use of serial qualitative interviews to understand patients' evolving experiences and needs | The BMJ http://www.bmj.com/content/339/bmj.b3702.full.print 1/8This site uses cookies. More info Close By continuing to browse the site you are agreeing to our use of cookies. Interviewing patients over the course of their illness can give a much better picture of their experience than single interviews, but the approach is rarely used. Scott Murray and colleagues explain how to get the most from itLongitudinal qualitative research offers considerable advantages over the more typical single "snapshot" techniques in understanding patients' changing experience of illness. Serial qualitative interviews are a convenient and efficient approach to developing an ongoing relationship between the participant and researcher, thereby facilitating discussion of sensitive and personal issues while also allowing exploration of changing needs and experiences.Serial interview studies are widely used by social science researchers in anthropology, criminology, education, psychology, and social policy.1 2 3 4 5 6 However, they remain underused in medicine.7 Using our experience with the technique, we suggest when researchers might wish to use serial interviews and discuss the methods, the data generated, and how to avoid potential pitfalls. When to use serial interviewsSerial interviews are suitable for research that aims to explore evolving and complex processes or when time is needed to develop a relationship between researcher and participants. We have used the approach to study the changing experiences and needs of people with lung and brain cancers, heart failure, severe chronic obstructive pulmonary disease, and spiritual distress, and access to care for south Asian patients at end of life (table⇓).8 9 10 11Others have shown the value of this approach in, for example, understanding childhood asthma, exploring stigma related to HIV infection, reconstruction of self identity after diagnosis of chronic fatigue syndrome, complex clinician-1

Use of multiperspective qualitative interviews to understand patients' and carers' beliefs, experiences, and needs | The BMJ http://www.bmj.com/content/339/bmj.b4122.full.print 1/7This site uses cookies. More info Close By continuing to browse the site you are agreeing to our use of cookies.

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