Noyes Jane, Popay Jennie
Cochrane Qualitative Research Methods Group University of Wales, Bangor, UK.
J Adv Nurs. 2007 Feb;57(3):227-43. doi: 10.1111/j.1365-2648.2006.04092.x.
This paper reports the findings from a qualitative meta-synthesis concerning people with, or at risk of, tuberculosis, service providers and policymakers and their experiences and perceptions of tuberculosis and treatment.
Directly observed therapy is part of a package of interventions to improve tuberculosis treatment and adherence. A Cochrane systematic review of trials showed an absence of evidence for or against directly observed therapy compared with people treating themselves.
Qualitative systematic review methods were used to search, screen, appraise and extract data thematic analysis was used to synthesize data from 1990 to 2002, and an update of literature to December 2005. Two questions were addressed: 'What does qualitative research tell us about the facilitators and barriers to accessing and complying with tuberculosis treatment?' and 'What does qualitative research tell us about the diverse results and effect sizes of the randomized controlled trials included in the Cochrane review?' Findings help explain the diverse trial results in a Cochrane systematic review of directly observed therapy and tuberculosis and consider implications for research, policy and practice.
Five themes emerged from the 1990 to 2002 synthesis: socio-economic circumstances, material resources and individual agency; explanatory models and knowledge systems in relation to tuberculosis and its treatment; the experience of stigma and public discourses around tuberculosis; sanctions, incentives and support, and the social organization and social relationships of care. Two additional themes emerged from the 2005 update.
The qualitative meta-synthesis improved the relevance and scope of the Cochrane review of trials. The findings make a major contribution to the development of theory concerning global WHO-branded disease control and the practicality of local delivery to people.
本文报告了一项关于结核病患者、结核病高危人群、服务提供者和政策制定者以及他们对结核病和治疗的经历与看法的定性元分析结果。
直接观察治疗是改善结核病治疗和依从性的一系列干预措施的一部分。Cochrane系统评价的试验表明，与患者自行治疗相比，没有证据支持或反对直接观察治疗。
采用定性系统评价方法进行检索、筛选、评估和提取数据，运用主题分析法对1990年至2002年的数据进行综合，并更新到2005年12月的文献。研究了两个问题：“定性研究告诉我们关于获得和遵守结核病治疗的促进因素和障碍有哪些？”以及“定性研究告诉我们关于Cochrane综述中纳入的随机对照试验的不同结果和效应大小有哪些？”研究结果有助于解释Cochrane系统评价中关于直接观察治疗和结核病的不同试验结果，并考虑对研究、政策和实践的影响。
1990年至2002年的综合分析得出了五个主题：社会经济状况、物质资源和个人能动性；与结核病及其治疗相关的解释模型和知识体系；耻辱感的经历以及围绕结核病的公众话语；制裁、激励和支持，以及护理的社会组织和社会关系。2005年更新又得出了两个主题。
定性元分析提高了Cochrane试验综述的相关性和范围。研究结果对全球世界卫生组织品牌疾病控制理论的发展以及向人们提供地方服务的实用性做出了重大贡献。
