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Report mixed studies reviews

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Saved by Quan Nha HONG
on June 7, 2014 at 3:06:28 pm
 

This page presents a proposal for a template to report mixed studies reviews (adapted from the PRISMA statement).

With regard to meta-narrative and realist syntheses, researchers can use the RAMESES templates (Wong et al., 2013a; Wong et al., 2013b).

 

TITLE 

 

Propose a short take-home title. The title should include “mixed studies review” or “systematic mixed studies review” when applicable.

 

INTRODUCTION AND OBJECTIVES

 

  • Describe the rationale for the review (e.g., a health problem) in the context of what is already known (e.g., an existing literature review paper or a reference book chapter).
  • Formulate questions and/or objectives (qualitative (QUAL) or quantitative (QUAN) or both) being addressed by your review (see 'formulate a review question' for more details)

 

For example, you can include the key elements below (when applicable):

  • Context: Setting, population or participants
  • Process: Program, intervention, exposure 
  • Outcomes: Process-related outcomes, final outcomes
  • Comparison [when enough studies]
  • Process duration or length of follow-up
  • Other elements when needed, e.g., supporting a qualitative question

 

METHODS

 

Justify the use of a MSR

 

Describe your design

 

Eligibility criteria

  • Specify inclusion and exclusion criteria and the rationale for supporting these criteria when needed 

 

Information sources 

  • Specify the specific information sources used in the search (see 'apply an extensive search strategy', section 2.4, for more details) and date last searched
  • Specify the rationale for using all the types of sources 

 

Identification process (including the search strategy in bibliographic databases)

  • Describe (steps and key elements of) the process for identifying potentially relevant records or studies (e.g., guided by a specialized librarian, two independent reviewers, software)
  • Present full electronic search for at least one database (e.g., in an appendix), including any limits used, such that it could be repeated
  • State the process for removing duplicates when needed (e.g., concomitant search in multiple databases using OVID and a keyword search and/or removal of duplicates using a reference management software)

 

Study selection process 

  • Describe (steps and key elements of) the process for selecting relevant studies (e.g., two independent reviewers and software used), specifically:
    • For screening the records (title, authors, source, abstract) based on eligibility criteria (apply general inclusion-exclusion criteria with high sensitivity when needed)
    • For retrieving full-text articles corresponding to retained records 
    • For selecting full-text articles based on eligibility criteria (apply specific inclusion-exclusion criteria with high specificity when needed)

 

Critical appraisal 

  • When applicable, describe (steps and key elements of) the process for appraising included studies (e.g., two independent reviewers), and specifically for assessing the methodological quality of included qualitative, quantitative, and mixed methods studies (see 'appraise the quality of studies'). 
  • Specify how results of this appraisal are used in data collection and data analysis (synthesis)
    • Include all studies with description of their methodological quality
    • Contrast synthesis of ‘lower quality’ studies vs. ‘higher quality’ studies using sensitivity analysis 

 

Synthesis design

  • In one declarative sentence, describe the synthesis design (key elements or phases of the process for synthesizing included studies)
  • State your design in line with the main mixed methods research designs (e.g., cite Creswell & Plano Clark’s (2010) book or Pluye and Hong (2014) paper): convergence qualitative synthesis (QUAL), or convergence quantitative synthesis (QUAN), or sequential exploratory synthesis (QUAL then QUAN), or sequential explanatory synthesis (QUAN then QUAL), or multiphase design

 

 NOTE: The next sections must be organized in accordance with your design
  • Convergence: Complete the four next sections once (QUAL synthesis or QUAN synthesis)
  • Sequential exploratory: Complete the four next sections for QUAL synthesis, then for QUAN synthesis
  • Sequential explanatory: Complete the four next sections for QUAN synthesis, then for QUAL synthesis

 

Data collection process 

  • Describe the process of data extraction from included studies (e.g., two independent reviewers)
  • State any processes for obtaining and confirming data from investigators of included studies (e.g., initial email to the first author and reminder email)

 

Data items 

  • Study characteristics: List all general rubrics for which information were sought to describe included studies. For example: 
    • country based of first authors’ affiliation, journal, publication year, funding sources, ethical approval, settings
    • participants (types and number - sample size)
    • details on intervention or program under review (and on comparative intervention or program when applicable)
    • study approach and design
    • data collection technique and details on measurement (including reliability and validity) or qualitative documentation (including rigor and trustworthiness) of processes and outcomes
    • follow-up period
    • any assumptions and simplifications made
  • QUAL synthesis: List and define all specific themes or categories for which data were sought to address the research/review question/objective, the origin and development of the themes or categories (e.g., inductive from the data, or deductive from existing framework or theory, or both inductive-deductive), and any assumptions and simplifications made.
  • QUAN synthesis: List and define all specific variables for which quantitative data were sought to address the research/review question/objective, specify common variables across studies for which data were found, and any assumptions and simplifications made.

 

Summary measures 

  • QUAN synthesis: State the principal summary measures when applicable (e.g., risk ratio, difference in means)

 

Synthesis

  • State once where and how the integration of qualitative findings and quantitative results of included studies occurs
  • Describe (key elements or steps of) the process of handling data, and combining qualitative findings and quantitative results of included studies 
    • QUAL synthesis, e.g.,  qualitative data thematic analysis process (leading to themes or categories)
    • QUAN synthesis, e.g., quantitative content analysis process (leading to variables and values). State the principal summary measure when applicable (e.g., risk ratio, difference in means) 

 

Additional analyses

  • Describe additional analyses when applicable
    • QUAL synthesis: E.g., subgroup analyses or additional interpretive process for building relationships between themes toward a (new or revised) conceptual framework or theoretical model
    • QUAN synthesis: E.g., sensitivity or subgroup analyses, meta-regression or any linear model (indicating which were pre-specified)

 

RESULTS or PRELIMINARY RESULTS (e.g. preliminary results based on the synthesis of a small sample of included studies)

 

Study selection 

  • Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage
  • Summarize this in a flow diagram (see Illustration below)
  • Give numbers of quantitative, qualitative and mixed methods studies included 

 

Methodological quality of included studies

  • Summarize results of the critical appraisal when applicable
  • Refer in the text to the appraisal of all studies presented in an appendix (table or matrix)
  • Regarding quantitative studies: Present data on risk of bias of each study and, if available, any outcome-level assessment

 

Study characteristics 

  • Specify common rubrics across all studies for which information was found 
  • Summarize the description of studies including their heterogeneity (variability associated with differences between studies)
  • Provide the citations (linking the text with the list of references)
  • Refer in the text to textual descriptions of all included studies presented in an appendix (table or matrix - see description and template at the bottom of this page) 

 

 NOTE: The next sections must be organized in accordance with your design
  • Convergence: Complete the three next sections once (QUAL results or QUAN results)
  • Sequential exploratory: Complete the three next sections for QUAL results, then for QUAN results
  • Sequential explanatory: Complete the three next sections for QUAN results, then for QUAL results

 

Results of individual studies 

  • QUAL synthesis
    • In the text, briefly summarize and refer to the following appendix 
    • Appendix (table or matrix): For all main themes or categories and each study, present a summary of results for each intervention or study group with key illustrations when needed (put quote)
  • QUAN synthesis
    • In the text, briefly summarize and refer to the following appendix 
    • Appendix (table or matrix): For all key process-related variables and outcome variables considered (e.g., positive and negative outcomes), present, for each study: (a) simple summary data for each intervention group and (b) effect estimates and confidence intervals, ideally with a forest plot.

 

Synthesis of results 

  • QUAL synthesis: Present results related to main themes or categories
  • QUAN synthesis: Present results related to key variables (e.g., mean, max, min and standard deviation), and any simple meta-analysis done including confidence intervals and measures of consistency when applicable
  • Additional analysis 
    • Present results considering the methodological quality across studies when applicable (e.g., lower vs. higher quality studies)
    • Give results of additional analyses when applicable
      • QUAL synthesis: E.g., results of subgroup analyses or new/revised conceptual framework or theoretical model
      • QUAN synthesis: E.g., results of subgroup analyses, meta-regression or any linear model

 

DISCUSSION

 

  • Overall summary of results (take-home messages) from the qualitative and/or quantitative synthesis
  • State the main results for each main theme or category, and/or key process/outcome variable
    • Consider their relevance and importance for knowledge users (e.g., health care providers, managers, and decision/policy makers)
    • Take into account the methodological quality across studies (when applicable)
  • Limitations: Specify any element that may affect the cumulative evidence
    • Discuss limitations at the study and process/outcome levels, e.g., lack of rich data for QUAL synthesis, and risk of bias for QUAN synthesis, and their potential consequences on the results
    • Discuss limitations at the review level, e.g., incomplete retrieval of relevant studies (selective publication of reports regarding studies with positive results), and limited reporting (selective reporting of information about included studies), and their potential consequences on the results
  • Describe the contribution of the present review (compared to what is already known as stated in the introduction, see ‘context’) with respect to:
    • Review methods
    • Scientific knowledge
    • Practice, program planning and evaluation, policy making, or else.

 

CONCLUSION

 

  • Provide a general interpretation of the results in the context of other evidence, including implications for knowledge users, e.g., a major recommendation
  • State implications for future research

 

ACKNOWLEDGEMENTS

 

  • Describe sources of funding and other support, e.g., supply of data
  • Describe the role of funders in the review (methods and/or interpretation of results) when applicable
  • Any information about potential conflict of interest must be acknowledged 

 

ILLUSTRATIONS (tables, matrices, figures, boxes) 

 

In addition to tables presenting synthesis results and other relevant information, two illustrations are required: a flow diagram, and a 'Characteristics of the included studies' table.

 

FLOW DIAGRAM

 

Suggested flow diagram for mixed studies reviews. The proposed diagram below was adapted for mixed studies reviews from Moher et al. (2009). 

 

 

 

DESCRIPTION OF INCLUDED STUDIES

 

Summarize key characteristics of the included studies in a table, called ‘Characteristics of included studies’ table. For each study, this may be developed using a descriptive paragraph. While the table must be attached to any publication, the textual description may be provided as an appendix (online supplementary document). ‘Characteristics of included studies’ tables and descriptive paragraphs must contain information on all characteristics for all included studies.

 

As a minimum, include the following characteristics.

·         First author, Year, and ID number of the study, e.g., from the reference manager software.

·         Methodology and methods:

-         Study design or approach (use a typology such as the Mixed Methods Appraisal Tool)

-         Participants (age, sex, other);

-         Setting (e.g., types and number of organizations);

-         Data collection and data analysis.

·         Intervention/exposure (if applicable), or relevant considerations for non-intervention studies.

·         Outcomes (if applicable), or relevant considerations for non-intervention studies (study results should be presented in a separate table if space allows).

·         Critical appraisal and source of funding.

·         Further comments on key characteristics of the study (according to the review question).

 

Five tables may be needed: Three tables for quantitative studies, one for qualitative studies, and one for mixed methods studies. The three tables for quantitative studies are as follows. One for randomized controlled trials, one for non-randomized studies, and one for descriptive studies (see the Mixed Methods Appraisal Tool for definitions and examples).

 

Templates for a ‘Characteristics of included studies’ table 

First author

Journal

Year

ID #

Study design

Setting
Participants

Data collection

Data analysis

Intervention or Program

Comparison intervention

(if applicable)

Or relevant information

(e.g., exposure, condition)

Outcomes

(if applicable)

 Or relevant information

Critical appraisal

Source of funding

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REFERENCES

  • Creswell J, Plano Clark V (2010). Designing and conducting mixed methods research. Thousand Oaks, CA: Sage Publications.
  • Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews andMeta-Analyses: The PRISMA StatementPLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097
  • Pope C, Mays N, Popay J (2007). Synthesizing qualitative and quantitative health evidence. Adelaide: Ramsay Books.
  • Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. 2013. RAMESES publication standards: meta-narrative reviews. BMC Medicine. 11:20
  • Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R. 2013. RAMESES publication standards: realist syntheses. BMC Medicine. 11:21 

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