Qualitative evidence syntheses: Assessing the relative contributions of multi‐context and single‐context reviews

Abstract

Aims To examine the strengths and weaknesses of multi‐context (international) qualitative evidence syntheses in comparison with single‐context (typically single‐country) reviews. We compare a multi‐country synthesis with single‐context syntheses on facility‐based delivery in Nigeria and Kenya. Design Discussion paper. Background Qualitative evidence increasingly contributes to decision‐making. International organizations commission multi‐context reviews of qualitative evidence to gain a comprehensive picture of similarities and differences across comparable (e.g., low‐ and middle‐income) countries. Such syntheses privilege breadth over contextual detail, risking inappropriate interpretation and application of review findings. Decision‐makers value single‐context syntheses that account for the contexts of their populations and health services. We explore how findings from multi‐ and single‐context syntheses contribute against a conceptual framework (adequacy, coherence, methodological limitations and relevance) that underpins the GRADE Confidence in Evidence of Reviews of Qualitative Evidence approach. Data sources Included studies and findings from a multi‐context qualitative evidence synthesis (2001–2013) and two single‐context syntheses (Nigeria, 2006–2017; and Kenya, 2002–2016; subsequently updated and revised). Findings Single‐context reviews contribute cultural, ethnic and religious nuances and specific health system factors (e.g., use of a voucher system). Multi‐context reviews contribute to universal health concerns and to generic health system concerns (e.g., access and availability). Implications for nursing Nurse decision‐makers require relevant, timely and context‐sensitive evidence to inform clinical and managerial decision‐making. This discussion paper informs future commissioning and use of multi‐ and single‐context qualitative evidence syntheses. Conclusion Multi‐ and single‐context syntheses fulfil complementary functions. Single‐context syntheses add nuances not identifiable in the remit and timescales of a multi‐context review. This study offers a unique comparison between multi‐context and single country (Nigeria and Kenya) qualitative syntheses exploring facility‐based birth. Clear strengths and weaknesses were identified to inform commissioning and application of future syntheses. Characteristics can inform the commissioning of single‐ and multi‐context nursing‐oriented reviews across the world.

A systematic review of the impact of ‘missed care’ in primary, community and nursing home settings

“…This review privileges countries of direct applicability to a UK context. The merits of multi‐context and single‐context syntheses have been debated elsewhere (Booth, Mshelia, Analo, & Nyakang'o, 2019). Excluded studies from countries such as Switzerland (Zuniga et al, 2015) and Belgium might have contributed further data.…”

“…This review privileges countries of direct applicability to a UK context. The merits of multi-context and single-context syntheses have been debated elsewhere (Booth, Mshelia, Analo, & Nyakang'o, 2019).…”

Factors influencing the utilisation of facility-based delivery in Nigeria: a qualitative evidence synthesis

“…with included studies from multiple countries). 11 One methodological concern is that multi-context reviews access a fraction of relevant evidence. The multi-context review 4 , a high-quality qualitative synthesis, only identified 2 studies from Nigeria.…”

What are the barriers and facilitators to polio vaccination and eradication programs? A systematic review

“…This review employed the multi-context approach to synthesize data, providing a wide range of evidence that allows cross-setting comparison and applying study findings to broader settings [47,48]. Although such an approach offers transferable patterns of findings at a global level, they may be too general to target important local characteristics or audiences, leading to the study overlooking the relevance of specific contexts and blurring critical differences across different studies [47,48]. It might also appear that the study is ignoring the significance of context in evidence synthesis [48].…”