Synthesising quantitative and qualitative research in evidence-based patient information.
BACKGROUND
Systematic reviews have, in the past, focused on quantitative studies and clinical effectiveness, while excluding qualitative evidence. Qualitative research can inform evidence-based practice independently of other research methodologies but methods for the synthesis of such data are currently evolving. Synthesising quantitative and qualitative research in a single review is an important methodological challenge.


OBJECTIVE
This paper describes the review methods developed and the difficulties encountered during the process of updating a systematic review of evidence to inform guidelines for the content of patient information related to cervical screening.


METHODS
Systematic searches of 12 electronic databases (January 1996 to July 2004) were conducted. Studies that evaluated the content of information provided to women about cervical screening or that addressed women's information needs were assessed for inclusion. A data extraction form and quality assessment criteria were developed from published resources. A non-quantitative synthesis was conducted and a tabular evidence profile for each important outcome (eg "explain what the test involves") was prepared. The overall quality of evidence for each outcome was then assessed using an approach published by the GRADE working group, which was adapted to suit the review questions and modified to include qualitative research evidence. Quantitative and qualitative studies were considered separately for every outcome.


RESULTS
32 papers were included in the systematic review following data extraction and assessment of methodological quality. The review questions were best answered by evidence from a range of data sources. The inclusion of qualitative research, which was often highly relevant and specific to many components of the screening information materials, enabled the production of a set of recommendations that will directly affect policy within the NHS Cervical Screening Programme.


CONCLUSIONS
A practical example is provided of how quantitative and qualitative data sources might successfully be brought together and considered in one review.
Goldsmith
Megan R
MR
Cancer Research UK Primary Care Education Research Group, Department of Primary Health Care, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK. megan.goldsmith@dphpc.ox.ac.uk
Bankhead
Clare R
CR
Austoker
Joan
J
D000328:Adult; D003127:Colposcopy; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D006801:Humans; D008403:Mass Screening; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic / Q000379:methods*; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D012107:Research Design; D012196:Review Literature as Topic; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis