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

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 organisations 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 as well as 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 within the remit and timescales of a multi‐context review.