What is it like as a young woman facing a health worker who tells you that you are infected with HIV and need to take drugs for the rest of your life? What do patients believe is happening when health workers come to their house and demand a specimen of sputum? Qualitative research helps with these questions, and systematic reviews delineate common threads across these studies. This raises the question: when do we have enough qualitative research on a topic?
Qualitative research studies provide important signals to help identify healthcare needs and shape services to make them work best for people, yet the emerging science of evidence synthesis of these studies is helping identify the common threads.
What isn’t clear to researchers, and those commissioning research studies, is whether qualitative research should be updated and that’s exactly what a team, including LSTM’s Professor Paul Garner, Director of the READ-It consortium, set out to achieve. Led by Dr Anke Rohwer from Stellenbosch University, the team updated a qualitative synthesis on studies around taking antiretroviral treatments in Africa: did adding further studies change the findings since the first review conducted five years ago?
The original review included 62 papers with rich findings, sampled from 261 eligible papers. This update identified additional 301 eligible papers published during the last three years, of which 82 had rich findings and were included. Dr Rohwer and her colleagues analysed these new studies carefully, to see whether each confirmed the previous review results, added to it, provided deeper understanding, or simply refuted it.
Themes of stories shared by study participants included poverty, social identity, social isolation, misinformation, authoritarian health systems, poor clinic systems, daily medication, social support; and the concept of a tipping point, critical to adherence, which is when patients make a decision between sticking with treatment or stopping treatment. The new studies mostly confirmed the previous findings; they added details to some themes that deepen understanding of the relationship between external and internal factors influencing adherence.
However, despite careful evaluation of the new literature, the team found no new themes, and found no studies that refuted the previous theory published in 2019. This surprised the authors, as they anticipated that the changes in time, with society, with policy, in public opinion, or other external factors might change the previous findings.
This findings suggest that at least here where much research has been done, qualitative research thematic data saturation can occur. Professor Garner, senior author on the paper, explained: “This is important for these reviews: authors should be much more considered in planning updates, focusing effort where understanding is less well developed rather than just repeating a synthesis. Even more important are the implications for new primary research. Funders and researchers should ensure high-quality evidence synthesis of qualitative research has been conducted before new studies are carried out to avoid wasting resources on unnecessary studies. Synthesis can highlight where saturation has been achieved and new studies could constitute research waste.”
Rohwer AC, Hendricks L, Oliver S, Garner P. Testing for saturation in qualitative evidence syntheses: an update of HIV adherence in Africa (2021) PLOS One DOI: https://doi.org/10.1371/journal.pone.0258352
This publication is associated with the Research, Evidence and Development Initiative (READ-It). READ-It (project number 300342-104) is funded by UK aid from the UK government; however, the views expressed do not necessarily reflect the UK government’s official policies.