Beyond the numbers: Qualitative synthesis and its contribution to knowledge on COVID-19

During the pandemic, we have become accustomed to statistical data dominating public discourse as we learn about rates of transmission and efforts to protect against the virus through vaccination. We have also heard stories about the impact COVID-19 has had on the lives of individuals, including those working in health and social care.

Understanding how the pandemic has affected frontline staff is important in identifying a) how to support them going forwards, and b) lessons for management of potential future outbreaks. This is where a qualitative synthesis can prove informative; this type of review (which may take a range of forms – from meta-aggregation to meta-ethnography) can help us to understand issues such as health behaviours, experiences of illness or providing treatment, acceptability of an intervention, barriers and facilitators to the implementation of a new service.

Qualitative syntheses have been conducted about the pandemic, including a review by Joo and Liu, that explored nurses’ experiences of caring for patients with COVID-19. These authors used thematic synthesis to bring together findings from existing qualitative studies to produce recommendations for future practice.

The review was based on nine qualitative papers that met a pre-specified inclusion criteria, most of which had been conducted in China. These papers were located through searching on five electronic databases. The authors used the CASP checklist for qualitative research for critical appraisal purposes. Five relatively descriptive themes were presented in the review’s findings:

• Limited information – what was available was not always clear or verified, making it hard to know what to believe;  
• Unpredictable tasks and changing practices – having to adapt with little time for orientation to or education in new practices;
• Insufficient support – organisations experiencing shortages of personal protective equipment and lacking space to care for patients with COVID-19;
• Concerns about family – worries about transmitting the virus to loved ones;
• Emotional and psychological stress – powerlessness and isolation contributing to low mood and anxiety, with nurses becoming fearful of entering their workplace.

The importance of qualitative syntheses as a form of evidence has been highlighted by the development of various guidelines on their execution, including direction by Cochrane. These types of reviews are not to be undertaken lightly; an understanding of the particular qualitative synthesis approach used and why is important for producing transparent and credible findings. To support this, a new module has been created on this topic. It will introduce students to underlying principles of and processes associated with synthesising qualitative research. It will prompt them to reflect on which synthesis approach to use, and address issues of quality and rigour. We will take a critical approach to papers like the one produced by Joo and Liu, considering things like – why and how critical appraisal was undertaken and used in a review,  and how to develop higher level concepts to create a more configurative end product that offers a new understanding rather than simply describing findings from individual papers. The course will run in summer 2022 and will be led by Stephanie Tierney (stephanie.tierney@phc.ox.ac.uk).