In addition, researchers have been interested in defining and categorizing different types of synthesis designs (see Table 1). Also, new synthesis methods have been developed to integrate qualitative and quantitative evidence such as critical interpretive synthesis, meta-narrative synthesis, and realist synthesis. For example, several critical appraisal tools for assessing the quality of quantitative and qualitative studies have been developed. The past decade has been rich with methodological advancements of reviews of qualitative and quantitative evidence. They can be used to provide (a) a deeper understanding of quantitative evidence, (b) a statistical generalization of findings from qualitative evidence, or (c) a corroboration of knowledge obtained from quantitative and qualitative evidence. These reviews can yield a rich and highly practical understanding of complex interventions and programs. This new type of review has been labelled with various terms such as integrative review, mixed methods review, mixed methods research synthesis, mixed research synthesis, and mixed studies review. In recent years, there has been a growing interest in synthesizing evidence derived from studies of different designs. Indeed, the analysis of qualitative evidence can complement those of quantitative studies by providing better understanding of the impact of contextual factors, helping to focus on outcomes that are important for patients, families, caregivers, and the population and exploring the diversity of effects across studies. Also, while reviews focusing on RCTs can help to answer the question, “What works for whom?,” other important questions remain unanswered such as “Why does it work?,” “How does it work?,” or “What works for whom in what context?.” Such questions can be addressed by reviewing qualitative evidence. For example, in several fields such as public health, RCTs are not always appropriate nor sufficient to address complex and multifaceted problems. However, a focus on quantitative evidence is insufficient in areas where research is not dominated by RCTs. Traditionally, systematic reviews have given preference to quantitative evidence (mainly from randomized controlled trials (RCTs) and to clinical effectiveness questions). Systematic reviews have been used by policy-makers, researchers, and health service providers to inform decision-making. Also, recommendations are made to improve the conducting and reporting of this type of review. The findings provide guidance on how to combine qualitative and quantitative evidence. Performing systematic reviews of qualitative and quantitative evidence is challenging because of the multiple synthesis options. Within the convergent synthesis design, three subtypes were found: (a) data-based convergent synthesis design, where qualitative and quantitative evidence is analyzed together using the same synthesis method, (b) results-based convergent synthesis design, where qualitative and quantitative evidence is analyzed separately using different synthesis methods and results of both syntheses are integrated during a final synthesis, and (c) parallel-results convergent synthesis design consisting of independent syntheses of qualitative and quantitative evidence and an interpretation of the results in the discussion. Two main types of synthesis designs were identified: convergent and sequential synthesis designs. The analysis of this literature highlighted a lack of transparency in reporting how evidence was synthesized and a lack of consistency in the terminology used. ResultsĪ total of 459 reviews were included. The included reviews were analyzed according to three concepts of synthesis processes: (a) synthesis methods, (b) sequence of data synthesis, and (c) integration of data and synthesis results. Reviews were included if they were systematic reviews combining qualitative and quantitative evidence. Six databases were searched from inception to December 2014. MethodsĪ review of systematic reviews combining qualitative and quantitative evidence was performed. The aim of this review of reviews was to identify and develop a typology of synthesis designs and methods that have been used and to propose strategies for synthesizing qualitative and quantitative evidence. Although several typologies of synthesis designs have been developed, none have been tested on a large sample of reviews. This type of review is increasingly popular, has been used to provide a landscape of existing knowledge, and addresses the types of questions not usually covered in reviews relying solely on either quantitative or qualitative evidence. Systematic reviews of qualitative and quantitative evidence can provide a rich understanding of complex phenomena.
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