Tema 1: “Introducción a las Comunicaciones Móviles”

Meta-analysis (quantitative) and meta-ethnography (qualitative) are similar in that they both bring together findings from primary research. However, there are also fundamental differences between the two. A meta-analysis is concerned with

aggregating data from randomised control trials to obtain sufficient statistical power in order to detect a cause and effect relationship between a specific intervention and outcome (Egger et al., 1997), which can provide evidence of the effectiveness of the intervention (France et al., 2014). The purpose of a meta-ethnography is, firstly, to identify the concepts within studies, secondly, to compare them with concepts in other studies, and finally, to translate these other studies into each other as a means of developing new conceptual categories. The concept of second-order constructs is used to distinguish the main ‘raw data’ of meta-ethnography, i.e. the clearly

articulated interpretations of researchers regarding their own studies (Britten et al.,2002). This data (second-order constructs) is then further abstracted and

interpreted to develop new conceptual categories (third-order constructs). Once the second-order constructs are identified, the next stage in meta-ethnography is to explore how the second-order constructs are related to each other. The process of constant comparison enables us to see similarities and differences between second- order constructs, and to organise them into new conceptual categories with shared meanings. These new conceptual categories are then described by illustrations and quotations of the second-order constructs. A meta-ethnography helps re-interpret meaning across many relevant qualitative studies and develop new meanings

whereas thematic analysis generates themes from within the original qualitative data (France et al., 2014).

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A meta-ethnography is most suitable for synthesising a limited number of

conceptually rich studies, while the synthesis of a large number of studies may be more suited to a thematic synthesis (Campbell et al., 2011). Furthermore, while many of the approaches to qualitative synthesis report the aggregated themes / concepts that were identified in the primary studies, a meta-ethnography aims to create new interpretations of these original themes. Finally, a meta-ethnography uses a systematic approach which is designed to “preserve the context and meaning of the primary studies” (France et al., 2014).

Recent publications have provided a clear description of the process of each of the stages involved (France 2014) from the original process described by Noblit and Hare (1988). Table 5 provides an outline of the various stages involved in carrying out a meta-ethnography.

Table 5 - Stages involved in Conducting a Meta-Ethnography

Phase Noblit and Hare’s description

1: Getting started

‘Identifying an intellectual interest that qualitative research might inform.’ The focus of the synthesis may be revised

through reading interpretive qualitative studies.

2: Deciding what is relevant to the initial interest

Study selection should be ‘driven by some substantive interest derived from comparison of any given set of studies.’ Searches

for studies need not be exhaustive: ‘unless there is a

substantive reason for an exhaustive search, generalizing from all studies of a particular setting yields trite conclusions.’

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Phase Noblit and Hare’s description

3: Reading the studies

The repeated reading of studies and noting of metaphors with close attention to details in the studies and what they tell you about your area of interest.

4: Determining how the studies are related

Noblit and Hare recommended that reviewers create ‘a list of key metaphors, phrases, ideas and / or concepts (and their relations) used in each account, and [to] juxtapose them’ in

order to make an initial assumption about how the studies relate to one another. This informs the type of synthesis that will be carried out – a reciprocal or refutational translation or line of argument synthesis.

5: Translating the studies into one another

The metaphors and / or concepts in each account and their interactions are compared or ‘translated’ within and across accounts while retaining the structure of relationships between central metaphors / concepts within accounts. The translations taken together are ‘one level of meta-ethnographic synthesis. These are systematic comparisons and reciprocal translation is key to a meta-ethnography.

6: Synthesising translations

If there are many translations from phase 5, these can be compared with one another to see if there are common types of translations or if some translations or concepts can

encompass those from other studies. ‘In these cases, a second level of synthesis is possible, analysing types of competing

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Phase Noblit and Hare’s description

interpretations and translating them into each other’ to reach

new interpretations / conceptual understandings.

7: Expressing the synthesis

Tailoring the communication of the synthesis to the intended audience’s culture and language so that it is intelligible and meaningful to them - ‘the written synthesis is only one possible form.’

Table taken from France et al., (2014), original quotes in italics (Noblit and Hare 1988).

3.1.3.

Aims

The aim of this review is to explore the experiences of participants and peer- supporters in order to identify provider and user perceptions about what makes TBPS an effective intervention. This will be achieved by synthesising qualitative research using a meta-ethnographic approach by using the phases illustrated in Table 5.

3.1.4.

Objectives

The objectives of this review are to:

• Review qualitative studies that explore the experiences of providing and / or receiving telephone-based peer-support

• List the key themes and concepts identified by the authors in the original studies included in this review (first-order constructs)

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• Bring together the themes that are common across all the included studies as second-order constructs

• Use lines of argument to illustrate how each second-order construct was abstracted and interpreted to develop new conceptual categories (third-order constructs)

• Identify, from synthesised data, participants and peer-supporters’

perspectives about the benefits and / or challenges in relation to TBPS, with an aim to identify the characteristics that make such interventions effective.

3.2.

Methods

A search strategy was developed from other reviews of qualitative studies (Britten et al., 2002, Britten et al., 2011, Campbell et al., 2004, Kane et al., 2007), which is described below.

3.2.1.

Databases Searched

Databases searched for this review included MEDLINE, CINHAL, EMBASE, WEB OF SCIENCE, SCIENCE DIRECT, ISI and PSYCINFO.

3.2.2.

Search Terms

The search included combinations of the following terms: peer-support, telephone, adults, experiences, perceptions, qualitative interviews, discourse, narrative, and research, to ensure that all potential studies relating to a TBPS intervention were considered.

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3.2.3.

Inclusion Criteria

The meta-ethnography included studies that had evaluated participants and peer- supporter perspectives about telephone-based peer-support, where qualitative data had been collected via focus groups or individual interviews. The included studies were required to have employed qualitative data collection techniques that generated themes with regard to their experiences of receiving and / or providing the intervention. The search was limited to papers published since 2000, due to the extensive advances in technology.

3.2.4.

Exclusion Criteria

Research conducted prior to 2000 was excluded due to the extensive advances in technology and mobile phone applications in the recent decade. Studies were also excluded if the participants were children, the intervention was not telephone-based (internet-based or group-based) or was not delivered by a peer (nurse led), the effect of telephone support could not be extracted, or the study did not employ qualitative methods of data collection.

3.2.5.

Data Abstraction

The researcher independently analysed the included studies. There was no particular order in which the studies were read, due to their homogeneity.

All of the included studies met the inclusion criteria for the review. The authors of the included studies had clearly identified key themes that were relevant to the ‘experiences or perceptions of receiving and / or delivering telephone-based peer- support.’ The themes and the original quotations supporting them were read and examined. Key themes identified by the original authors that were relevant to the aim

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of the meta-ethnography were listed (known as first-order constructs) (See Table Five - Phase 3).

3.2.5.1. Translating the studies into one another

Following this process, a table was created using flip chart paper to group together similar themes to create second-order constructs that were common across all the included studies. For example, reciprocal support, mutual sharing, and positive reinforcement were grouped together under the second-order construct of ‘mutual support.’ The labels for these second-order constructs were a close paraphrase depicting the original author's own words with little re-interpretation. An original quotation of each second-order construct was listed alongside each second-order construct, again preserving the original terminology and context used in the original papers.

Following this, the second-order constructs were explored to see how they related to each other in order to identify whether “a reciprocal rather than a refutation

translation synthesis was required” (See Table Five - Phase 4 / 5). There was a

general consensus across the included studies, and none of the papers contradicted the findings from the other studies. This process of constantly comparing the second- order constructs enabled similarities and differences to be identified and facilitated the development of new conceptual categories (known as the third-order

constructs).

A line of argument approach ‘‘recognises that often people study different aspects of phenomena and that it might be possible to offer a fuller account of phenomena by arranging the studies’ metaphors in some order that allows us to construct an argument about what the set of ethnographies say’’ (Thorne et al., 2004). In this

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study, a ‘line of argument’ was used to illustrate how the each second-order

construct contributed to the generation of new interpretations of the data, providing new conceptual categories (third-order constructs) (See Table Five - Phase 6 and 7) (Noblit and Hare, 1988).