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Table 2 CERQual assessments of data adequacy in the context of a review finding—examples [7, 12]

From: Applying GRADE-CERQual to qualitative evidence synthesis findings—paper 5: how to assess adequacy of data

Example 1: minor concerns A qualitative evidence synthesis explored factors affecting the implementation of lay or community health worker programmes for maternal and child health [12]. One of the review findings was relatively complex and explanatory in that it made claims about programme recipients’ attitudes towards the lay health workers and suggested factors that appear to influence these attitudes:  “Programme recipients were generally very positive to lay health workers. Reasons for this included the respect, kindness and concern shown by lay health workers, and their non-dogmatic approach. Recipients also appreciated the similarities they saw between themselves and the lay health workers, either because they came from the same community or because they shared similar social backgrounds.” Twenty-five studies contributed to this finding. Ten of these studies described how recipients were generally positive to the lay health workers, but offered little or superficial information about the factors that appeared to influence these attitudes. However, nine of the studies gave more detailed and specific information about these factors. Based on an overall assessment of the richness of the data and the quantity of the data, we concluded that we had only minor concerns about data adequacy. Example 2: serious concerns Another finding from the same qualitative evidence synthesis made the following claim:  “Recipients who lived near town and therefore had short distances to doctors preferred doctors to lay health workers” This finding was also relatively complex and explanatory as it suggested an association between where people live and their preferences regarding different groups of healthcare workers. However, the data upon which this finding was based offered very little information about this phenomenon, and it was not possible to properly explore or understand why doctors were preferred, and what role the distance to doctors played in people’s preferences. The finding was also only based on two studies. Based on an overall assessment of the richness of the data and the quantity of the data, we concluded that we had serious concerns about data adequacy. Example 3: serious concerns A second qualitative evidence synthesis explored the mistreatment of women during childbirth in health facilities [10]. One of the review findings described a relatively unexplored phenomenon as well as making a claim that was unexpected:  “Studies from Benin and Sierra Leone suggest that either the mother or baby may be detained in the health facility, unable to leave until they pay their hospital bills.” Two studies contributed to this finding and the data that this finding was based on were superficial. While the finding was relatively narrow in scope, the small number of studies was of concern as the finding was unexpected and we were unsure of the extent to which studies undertaken in other settings or groups would have reported similar issues. The lack of rich data was also of concern as we were unable to properly understand this unexplored phenomenon. For instance, it was unclear from the studies whether women and babies were commonly detained, how long women and babies were detained for, and how they experienced this phenomenon. We therefore concluded that we had serious concerns about data adequacy. Example 4: No or very minor concerns A third qualitative evidence synthesis explored parents’ views and experiences of communication about child vaccination [7], and included the following review finding:  “Parents generally found the amount of vaccination information they received to be inadequate.” Seventeen studies contributed to this finding. The data that this finding was based on were often relatively superficial. However, as the finding was a relatively simple, primarily descriptive finding, we concluded that we had no or very minor concerns about data adequacy. Example 5: moderate concerns The same qualitative evidence synthesis [7] included the following finding:  “Parents want vaccination information resources to be available at a wider range of health services and community and online settings, for instance through schools, pharmacies, clinics and libraries.” Only four studies contributed to this finding and both had relatively thin data, which did give us some concern. However, we judged this to be a relatively simple and descriptive finding. We therefore concluded that we had moderate concerns about data adequacy.