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DISCUSSION PAPER
Correspondence to K. Hannes:
e-mail: karin.hannes@ped.kuleuven.be
Karin Hannes MSc PhD
Doctor-Assistant
Centre for Methodology of Educational
Research, Catholic University Leuven,
Belgium and,
Belgian Centre for Evidence-Based Medicine,
Belgian Cochrane Branch, Leuven, Belgium
Craig Lockwood RN MnSc
Associate Director Research
and Innovation
Joanna Briggs Institute, University of
Adelaide, South Australia, Australia
H A N N E S K . & L O C K W O O D C . ( 2 0 1 1 ) Pragmatism as the philosophical foundation for the Joanna Briggs meta-aggregative approach to qualitative evidence
synthesis. Journal of Advanced Nursing 67(7), 16321642.
doi: 10.1111/j.1365-2648.2011.05636.x
Abstract
Aim. This paper presents a discussion of the role of the philosophy of pragmatism
in the Joanna Briggs meta-aggregative approach to qualitative evidence synthesis.
Background. An increasing number of qualitative evidence syntheses are being
published in journals, many of them influenced by an interpretive or a critical-realist
perspective. One approach to qualitative evidence synthesis is meta-aggregation.
Originally designed to model the transparency, auditability and reliability of the
established process for effectiveness reviews, meta-aggregation makes a case for the
production of synthesized statements that refer to lines of action informing decision-making at the clinical or policy level.
Data sources. This paper draws from the literature written on the philosophy of
pragmatism (18772008) and from the user guidance on meta-aggregation developed by the Joanna Briggs Institute between 2004 and 2007.
Discussion. Meta-aggregation as a methodology is founded on the principles and
assumptions of the philosophical traditions of pragmatism. Meta-aggregation can
only reach its full potential if the lines of action suggested will somehow be supported by measures of effectiveness, as demonstrated in mixed method research.
Implications for nursing. The lines of action presented as the result of a metaaggregative synthesis are directive in nature and inform healthcare practitioners at
the point of practical decision-making.
Conclusion. The real verification of the lines of action suggested in a metaaggregation consists of the satisfactorily ending consequences, mental or physical,
which the synthesized statements that summarize the basic ideas emerging from the
studies are able to generate in end users.
Keywords: meta-aggregation, meta-synthesis, nursing, philosophy, pragmatism,
qualitative evidence synthesis
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Introduction
Since the early 1990s, debates on what constitutes evidence
have largely been influenced by the positivistic paradigm. The
dominant belief system in the field of health care is led by the
gold standard of the Systematic Review of Randomised
Controlled Trials (RCTs) that guides decision-making processes (Hannes et al. 2005). While clearly crucial in answering questions of effectiveness, these reviews fail to address
all the uncertainties in the complex field of health care
(Flemming 2007a). It is increasingly acknowledged that the
richness of qualitative evidence and process-related information provides credible, complementary material to address
practice and policy-related questions. For such findings to be
considered an in-depth analysis, it has been argued that larger
samples drawn together in a synthesis would be helpful
(Sandelowski et al. 1997).
Since the late 1980s, researchers with a qualitative background have engaged themselves in developing methods to
synthesize findings from qualitative research, providing an
alternate and complementary lens to informing practitioners
and policy makers (Noblit & Hare 1988, Paterson et al. 2001,
Sandelowski & Barroso 2003, Pawson et al. 2004, Pearson
2004, Thomas & Harden 2008). In the last couple of years,
there has been an increase in the number of qualitative
evidence syntheses (QES) published (Dixon-Woods et al.
2007, K. Hannes & K. Macaitis, unpublished data).
Approaches that have been used include amongst others
meta-ethnography, meta-study, thematic synthesis, narrative
synthesis, content analysis, formal grounded theory, crossstudy analysis and meta-aggregation (Finfgeld 2003, DixonWoods et al. 2005, Flemming 2007b). Some of these
approaches have been influenced by an interpretive paradigm,
including, for example, narrative synthesis (Popay et al.
2007), critical interpretive synthesis (Dixon-Woods et al.
2006) and meta-study (Paterson et al. 2001). These
approaches have a particular interest in placing qualitative
insights within a larger discourse and in the development of
conceptual, theoretical frameworks to increase the understanding of how things connect and interact. Other
approaches, such as realist synthesis (Pawson et al. 2004),
have found a theoretical base in critical realism, a paradigm
supporting the acquisition of knowledge about the external
world as it really is, while, recognizing that perception is a
function of, and thus fundamentally marked by, the human
mind (Collier 1994).
The Joanna Briggs meta-aggregative approach to QES was
designed to model the Cochrane Collaborations process of
systematic reviews summarizing results of quantitative studies, whilst being sensitive to the nature of qualitative research
2011 The Authors
Journal of Advanced Nursing 2011 Blackwell Publishing Ltd
Background
Meta-aggregation was developed through a consensus project, initiated by the Joanna Briggs Institute in 2001,
including qualitative researchers from different Australian
universities (Table 1). Drawing on the early work of
Estabrooks et al. (1994) and Sandelowski et al. (1997), this
group considered how a systematic process of extracting and
synthesizing qualitative data can occur to reflect a rigorous
process equivalent to the existing processes applied to the
results of RCTs and other quantitative research. The outcome
of the project was an aggregative approach that emphasized
the complexity of interpretive and critical understandings of
phenomena; recognized the need to ensure that the approach
to synthesis is transparent about the procedure of synthesis;
and ensure that the synthesized statements would be practical
and usable.
A particular feature of the Joanna Briggs meta-aggregative
approach is that it has been designed to move beyond the
University of Adelaide,
Joanna Briggs Institute
University of Newcastle
University of Technology,
Sydney
James Cook University of
Northern Queensland
Curtin University
University of Southern
Queensland
University of Adelaide
Charles Sturt University
La Trobe University
La Trobe University
Joanna Briggs Institute
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Data sources
This paper draws from the literature written on the philosophy of pragmatism between 1877 and 2008 and mainly
focuses on the work of Peirce, James and Dewey. In addition
to the more philosophically oriented books and papers, we
used the guidance on meta-aggregation developed and
produced by the Joanna Briggs Institute between 2004 and
2007 and published papers on a variety of qualitative
evidence synthesis approaches (from 1994 to 2010) as a
basis to discuss the specific features of the meta-aggregative
approach.
Discussion
Methodological characteristics of the Joanna Briggs metaaggregative approach
Although different methods to synthesis have aligned themselves with different epistemological frameworks or paradigms they seem to share some basic characteristics. They
seek to emphasize the complexity of interpretive and critical
understandings of phenomena and require a series of steps,
the first being a conceptualization of the phenomenon under
study based on the personal interest of a researcher, gaps in
current research or a response to priorities set by professional
organizations or policy makers. Most syntheses, if not all,
include a formulation of objectives and inclusion criteria, a
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To aggregate findings of
included studies
To generate new
knowledge/theory, using
processes of interpretation
To deconstruct research
traditions/theoretical
assumptions as a means of
contextualizing findings
Meta-aggregation
Meta-ethnography
Meta-study
Grounded theory
Content analysis
To aggregate findings of
original research papers
Thematic synthesis
Critical interpretive
synthesis
Purpose
Approach
Constant comparative
method
Not specified
Comprehensive, including
grey literature sources
Recommended, although
open to inclusion based
on relevance of particular
studies
Not specified
Use of a framework or
checklist for critical
appraisal
Refutational and/or
reciprocal translation, line
of argument synthesis
Identification of recurrent
themes and development
of a critique (on the included
literature) that informs
sampling, selection and
theory generation
Line-by-line coding,
development of descriptive
and analytical themes
(placed in an external
theoretical framework)
Comprehensive framework;
meta-data-analysis/
meta-method/meta-theory/
meta-synthesis
Coded data categorized
under thematic headings,
counted and tabulated
Opposed, includes all studies
that provide insight into the
phenomena of interest
Quality judged as the extent
to which it informs theory
Not comprehensive,
seeks saturation
theoretical sampling
Identification of potentially
relevant papers to provide
a sampling frame
Usually comprehensive,
although open to the
argument of conceptual
saturation
Synthesized statements
represented as lines of action
informing practice or policy
in the form of a
standardized chart
Higher order interpretation
of study findings
Required, using a
standardized critical
appraisal instrument
Comprehensive, with a
detailed search strategy
required at protocol stage
Summary of findings of
primary studies under
thematic headings
Reconceptualization of
phenomenon based on
critique of epistemological
and normative assumptions
of the literature
Outcome
Method of synthesis
Critical appraisal
Search strategy
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Acknowledgements
This article has been produced as part of a visiting research
fellowship at the Joanna Briggs Institute, Australia. We
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Conflict of interest
No conflict of interest has been declared by the authors.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Author contributions
KH was responsible for the study conception and design,
performed the data collection, performed the data analysis
and was responsible for the drafting of the manuscript. CL
made critical revisions to the paper for important intellectual
content and provided administrative, technical or material
support.
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2011 The Authors
Journal of Advanced Nursing 2011 Blackwell Publishing Ltd
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