Searching For Qualitative Evidence Helen Buckley Woods Learning Outcomes • Describe the particular challenges inherent in identifying qualitative research • Apply appropriate tools to focus a qualitative question • Identify key terms to assist retrieval of qualitative research • Demonstrate an awareness of search filters for qualitative research Today’s Session • A game of two halves: – Constructing a search strategy and sources of evidence – Filters and other techniques Part One: Search strategies and sources • What’s different about searching for Qualitative Research? • Tools for focussing your question • Sources of Qualitative Research • Case study: worked search example • Practical: Sifting Abstracts Exercise Qualitative Research • Qualitative research seeks to understand and interpret personal experiences, behaviours, interactions, and social contexts to explain the phenomena of interest, such as the attitudes, beliefs, and perspectives of patients and clinicians; the interpersonal nature of caregiver and patient relationships; the illness experience; or the impact of human suffering. (Wong et al, 2004) Qualitative Research • “Research that derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants (From Holloway and Wheeler, "Ethical issues in qualitative nursing research," Nursing Ethics, 1995 Sep; 2(3): 223-232). Year introduced: 2003” [MeSH] What do I need to consider? • Qualitative research is small part of the research literature • The indexing in databases is inconsistent and variable • Qualitative studies sometimes have creative titles or inadequate abstracts • Medline might not be your preferred resource. • If searching in limited databases try MEDLINE and CINAHL Focussing Qualitative Questions Applying question tools to your search formulation Health services research uses PATIENT-INTERVENTION-COMPARISON-OUTCOME (PICO) structure Within social sciences research SPICE may be more appropriate: SETTING PERSPECTIVE INTERVENTION / EXPOSURE / INTEREST COMPARISON EVALUATION An example of SPICE [Actual Example] • SETTING – Awaiting Surgery • PERSPECTIVE – Patients • INTERVENTION - Coronary Artery Bypass Graft Surgery • COMPARISON – None • EVALUATION – Uncertainty and Anxiety Another example of SPICE • SETTING – Primary Care • PERSPECTIVE – Patients with Diabetes • INTERVENTION – Good Blood Pressure Control • COMPARISON – None • EVALUATION – Attitudes Try and put this question into the SPICE Framework • What is the impact of childhood cancer on their parents in terms of their quality of life in the home? • Setting • Perspective • Intervention/Exposure • Comparison • Evaluation An alternative - ProPheT! • Problem – First time mothers • Phenomenon of Interest – Attitudes to Breastfeeding • Time – Within first six months of birth Exercise: Use the SPICE or ProPheT framework to formulate your own research question Feedback from Exercise One Sources of Qualitative Research Citation indexes Registers General e.g. ASSIA Subject specific e.g. MEDLINE Evidencebased Research Councils Research Reference lists Databases Contact with researchers/ practitioners SOURCES Handsearching Grey literature Conference proceedings Published copies Indexes Pharmaceutical industry OPACs Databases Direct contact Internet Sources of Qualitative Research - 1 Journal Articles • ASSIA • British Nursing Index • CINAHL • ERIC • MEDLINE • Social Science Citation Index • Sociological Abstracts Sources of Qualitative Research - 2 Dissertations • Dissertation Abstracts • Index to Theses • CINAHL Books and Book Chapters • British Library OPAC • COPAC • Specialist Library Collections Case Study • You are working on an ESRC funded project looking at the benefits of a doula (a woman experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during and just after childbirth) for low-income mothers. Our example of SPICE • SETTING – the Developed World (with comparable health systems to the UK) • PERSPECTIVE – Low-income mothers • INTERVENTION – Doula (Lay support) • COMPARISON – Professional support [or No Support] • EVALUATION – Perceived levels of social support, birth outcomes, levels of breastfeeding etc. Example of Search Strategy in Cinahl Example of Search Strategy in Cinahl Subject headings Identifying Qualitative Research - Terminology • Generic terms: e.g. “qualitative” plus • Exploratory Methods: Focus group, Grounded theory, Action Research, Content analysis, Thematic analysis • Software: Nudist or NVivo • Citations: Glaser & Strauss • Application: Ethnology, Psychology • Phenomenon: Perceptions, Attitudes, User Views, Standpoint, Viewpoint • Approaches: Ethnographic • Data: Stories, Narratives, Descriptions, Themes, Findings • Experiences: Encounters, Experiences Exercise Identifying Qualitative Research from Abstracts • Using the handout provided consider the six references taken from Cinahl or Medline. • For each references mark all the words or phrases that identify the item as qualitative research. Feedback from Exercise Two Recap on the session so far • Challenges in searching for qualitative research • Sources • Tools to help with your question • Case Study • Keywords and subject headings to consider Part Two: Search Filters and other search techniques • Methodological filters • Using a key citation to identify research • Using the web to find research What is a methodological filter? • “A hedge or filter is a standardised search strategy that is designed to be used in conjunction with a subject search to retrieve valid studies from the (primary) medical literature”. • Filters work in one of two ways: – by identifying particular publication types or study designs most likely to answer a question – by isolating subject or free-text terms most likely to be associated with high-quality studies How do they work? • Filters come from 3 different sources:– Subject heading – Keyword – Publication type How do I use a methodological filter? Step One: Carry out a subject search as usual using subject headings and/or free text Step Two: Apply methodological filter appropriate to question you are asking • One-line filter • Maximum sensitivity filter • Maximum specificity filter • Mid-range filter For today, some one-liners ... • MeSH Heading – e.g. Qualitative Research [Medline 2003-] • Keyword – “Findings” • Publication Type – Research [CINAHL only] Methodological filters 1 MEDLINE 1. 2. 3. 4. 5. Nursing-Methodology-Research.DE. qualitative ADJ research grounded ADJ theory ethnograph$ 1 or 2 or 3 or 4 Marks S. “Qualitative Studies”. In McKibbon A, editor. PDQ EvidenceBased Principles and Practice. 1st ed. Hamilton: B.C. Decker, Inc.; 1999. pp 187-204 Methodological filters 2 1. 2. 3. 4. 5. qualitative$ findings interview$ interviews.DE. 1 OR 2 OR 3 OR 4 Grant MJ. “How does your searching grow? A survey of search preferences and the use of optimal search strategies in the identification of qualitative research.” Health Info Libr J. 2004 Mar; 21(1):21-32. Methodological filters 3 Sensitivity-maximising filter interview$ or px.fs. or health-services-administration.DE. Specificity-maximising filter qualitative or themes Optimised filter interview$.TI. or interview$.AB. or interview$.DE. or experience$.TI. or experience$.AB. or experience$.DE. or qualitative Adapted from Wong SS, Wilczynski NL, Haynes RB. “Developing Optimal Search Strategies for Detecting Clinically Relevant Qualitative Studies in MEDLINE”. Medinfo. 2004; 2004:311-6. Definitions • Sensitivity: the ability of a search strategy to identify relevant records • Specificity: the ability of a search strategy to exclude irrelevant records Spring M. (2008). Applying the principles of EBM to public health – searching for public health evidence – the experience at the National Institute for Health and Clinical Excellence (NICE). Eahil conference, Held on 23-28 June, Helsinki, Finland. Methodological filters 4 – Ovid MEDLINE Best Sensitivity • interview:.tw. OR px.fs. OR exp health services administration Best Sensitivity – Small decrease in Sensitivity with large increase in Specificity • interview:.mp. OR px.fs. OR qualitative.tw. Best Specificity • qualitative.tw. OR themes.tw. Best Specificity – Small decrease in Specificity with large increase pin Sensitivity • interviews.mp, t. OR qualitative.mp. OR experiences.tw. Best Optimization of Sensitivity and Specificity • interview:.mp. OR experience:.mp. OR qualitative.tw. Methodological filters - 5 • Don’t forget MeSH heading Qualitative Research – Introduced in 2003, so coverage is limited – But you can combine it with one of the previous filters by using the “OR” operator Methodological filters - 5 • Best sensitivity: exp interviews • Best specificity: audiorecording.sh. • Best optimization of sensitivity and specificity: exp study design • Wilczynski NL, Marks S, Haynes RB. Search strategies for identifying qualitative studies in CINAHL. Qual Health Res. 2007 May;17(5):705-10. Methodological Filters – 6 EMBASE Best Sensitivity (Single term) • interview:.mp. Best Sensitivity (Combination) • interview:.mp. OR qualitative.tw. OR exp health care organization Best Specificity (Single term) • qualitative.tw. Best Specificity (Combination) • qualitative.tw. Or qualitative study.tw. Best Optimization of Sensitivity and Specificity (Single) • exp health care facilities and services Best Optimization of Sensitivity and Specificity (Combination) • interview.tw. OR exp health care organization OR experiences.tw. So how does this work in practice? You are conducting a systematic review to examine the lack of support available for the husbands of women who have been diagnosed with breast cancer. The review commissioners want to answer “what counselling and support services should be offered in response to the husbands’ needs?” You start by searching Medline for published accounts of the husbands’ attitudes to their wives’ disease. Example 1 SPICE breakdown • You break search down into following components: Setting: Perspective: Intervention/ Exposure: Comparison: Evaluation: Primary and Community Care Husbands Wife with breast cancer [Perhaps] the needs of the wives themselves Attitudes Example 1 continued Mapping to Subject Headings • Match SPICE components to relevant MeSH or other headings (if any): Setting: Perspective: Exposure: Comparison: Evaluation: [Primary-Health-Care] Spouses Breast-Neoplasms ??? Attitude-To-Health Example 1 continued Search strategy 1. husband$ OR Spouses.W..DE. 2. 1 AND Breast-Neoplasms#.DE. 3. 2 AND (qualitative OR interview$ OR findings OR Interviews.W..DE. OR Attitude-To-Health#.DE.) Note that in line 3 we have used Grant’s filter Example 1 continued Citation Searching We identify a key methodological or subject text Using the Web to Identify Qualitative Research Google Scholar (scholar.google.com) Scirus http://www.scirus.com/ Scirus Research from Flemming & Briggs (2007) • Findings showed that a simple search strategy (broad-based terms - 3 search terms) was as effective as a complex one (free text - 48 search terms) in locating qualitative research on patients’ experiences of living with a leg ulcer. • It may be feasible to restrict searches with a clear nursing focus to the CINAHL bibliographic database. • Replication of findings with other nursing topics is required. Learning Outcomes • Describe the particular challenges inherent in identifying qualitative research • Apply appropriate tools to focus a qualitative question • Identify key terms to assist retrieval of qualitative research • Demonstrate an awareness of search filters for qualitative research References - 1 • Flemming K, Briggs M. Electronic searching to locate qualitative research: evaluation of three strategies. J Adv Nurs. 2007 Jan;57(1):95-100. • Grant MJ. How does your searching grow? A survey of search preferences and the use of optimal search strategies in the identification of qualitative research. Health Info Libr J. 2004 Mar; 21(1):21-32 • Marks S. Qualitative studies. In: McKibbon A, Eady A and Marks S. PDQ evidence-based principles and practice . Hamilton, Canada: BC Decker Inc., 1999. References - 2 • Spring M. (2008). Applying the principles of EBM to public health – searching for public health evidence – the experience at the National Institute for Health and Clinical Excellence (NICE). Eahil conference, Held on 23-28 June, Helsinki, Finland • Wilczynski NL, Marks S, Haynes RB. Search strategies for identifying qualitative studies in CINAHL. Qual Health Res. 2007 May;17(5):705-10. • Wong SSL, Wilczynski NL, Haynes RB. Developing optimal search strategies for detecting clinically relevant qualitative studies in Medline. Medinfo 2004;311-314.