School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Vom Christian Hospital, Jos South, Nigeria.
J Adv Nurs. 2019 Dec;75(12):3812-3822. doi: 10.1111/jan.14186. Epub 2019 Sep 16.
To examine the strengths and weaknesses of multi-context (international) qualitative evidence syntheses in comparison with single-context (typically single-country) reviews. We compare a multi-country synthesis with single-context syntheses on facility-based delivery in Nigeria and Kenya.
Discussion paper.
Qualitative evidence increasingly contributes to decision-making. International organizations commission multi-context reviews of qualitative evidence to gain a comprehensive picture of similarities and differences across comparable (e.g., low- and middle-income) countries. Such syntheses privilege breadth over contextual detail, risking inappropriate interpretation and application of review findings. Decision-makers value single-context syntheses that account for the contexts of their populations and health services. We explore how findings from multi- and single-context syntheses contribute against a conceptual framework (adequacy, coherence, methodological limitations and relevance) that underpins the GRADE Confidence in Evidence of Reviews of Qualitative Evidence approach.
Included studies and findings from a multi-context qualitative evidence synthesis (2001-2013) and two single-context syntheses (Nigeria, 2006-2017; and Kenya, 2002-2016; subsequently updated and revised).
Single-context reviews contribute cultural, ethnic and religious nuances and specific health system factors (e.g., use of a voucher system). Multi-context reviews contribute to universal health concerns and to generic health system concerns (e.g., access and availability).
Nurse decision-makers require relevant, timely and context-sensitive evidence to inform clinical and managerial decision-making. This discussion paper informs future commissioning and use of multi- and single-context qualitative evidence syntheses.
Multi- and single-context syntheses fulfil complementary functions. Single-context syntheses add nuances not identifiable in the remit and timescales of a multi-context review. Impact This study offers a unique comparison between multi-context and single country (Nigeria and Kenya) qualitative syntheses exploring facility-based birth. Clear strengths and weaknesses were identified to inform commissioning and application of future syntheses. Characteristics can inform the commissioning of single- and multi-context nursing-oriented reviews across the world.
与单语境（通常是单一国家）综述相比，检查多语境（国际）定性证据综合的优势和劣势。我们将在尼日利亚和肯尼亚的基于设施的分娩方面，将多国综合与单语境综合进行比较。
讨论文件。
定性证据越来越有助于决策。国际组织委托进行多语境定性证据综述，以全面了解可比（例如，低收入和中等收入）国家之间的相似之处和差异。这种综合方法注重广度而不是背景细节，有可能导致对综述结果的不当解释和应用。决策者重视考虑到其人群和卫生服务背景的单语境综合。我们探讨了多语境和单语境综合的发现如何根据支持 GRADE 证据质量评价方法的概念框架（充分性、一致性、方法学限制和相关性）做出贡献。
包括一项多语境定性证据综合研究（2001-2013 年）以及两项单语境综合研究（尼日利亚，2006-2017 年；肯尼亚，2002-2016 年；随后进行了更新和修订）的研究和发现。
单语境综述提供了文化、民族和宗教方面的细微差别以及具体的卫生系统因素（例如，使用代金券制度）。多语境综述则有助于解决普遍的卫生问题和通用的卫生系统问题（例如，获取和可用性）。
护士决策者需要相关、及时和敏感的背景证据，以便为临床和管理决策提供信息。本讨论文件为未来委托和使用多语境和单语境定性证据综合提供了信息。
多语境和单语境综述具有互补功能。单语境综述补充了多语境综述的范围和时间框架内无法识别的细微差别。
本研究对基于设施的分娩的多语境和单一国家（尼日利亚和肯尼亚）定性综合进行了独特的比较。明确了优势和劣势，以指导未来综合的委托和应用。这些特征可以为全球范围内的护理导向的单语境和多语境综述的委托提供信息。
