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  • Critical assessment of methodological limitations of included studies

Critical assessment of methodological limitations of included studies

You will use your assessments during the GRADE CERQual process to help determine the confidence we have in the QES findings.

You will use your assessments during the GRADE CERQual process to help determine the confidence we have in the QES findings.


About this phase

What happens before this step 

Have identified and found all relevant full text articles 

Description 

To critically appraise the methodological limitations of the included studies 

Why is this step important? 

You will use your assessments during the GRADE CERQual process to help determine the confidence we have in the QES findings 

Responsible 

Project leader and at least one other team member 

Tasks 

Two people independently or through discussion assess the methodological limitations of the included studies and then come to an agreement where the assessments differ. 

Tools 

The recommended tool for NIPH is the adapted Critical Appraisal Skills Program (CASP) Checklist (see questions below)(3-5) 

 

Deliverable 

A methodological assessment 

There is no consensus on the necessity, merit or appropriate approach to appraising the quality of qualitative research. Many QES authors feel that quality appraisal can assist readers in evaluating the credibility of conclusions and can allow decision makers to understand the transferability of the findings. There are over 100 recognised appraisal tools (6). The CAMELOT project based at the NIPH is attempting to look into how we can solve this problem and best assess the methodological quality of included primary qualitative studies.  

We believe that it is important to methodologically assess the primary studies included within a QES. However, the results of these assessments are often determined by how well the study is reported. We do not exclude studies based on methodological assessment, but the assessment can influence the confidence we have in the findings they contribute to during the GRADE CERQual assessments.  

The recommended tool at NIPH is the adapted version of the CASP checklist. It uses the following eight questions with possible answer of yes/maybe/no and a comment field to elaborate for each of the questions. 

  1. Are the setting/s and context described adequately? 
  2. Is the sampling strategy described and is this appropriate? 
  3. Is the data collection strategy described and justified? 
  4. Is the data analysis described and is this appropriate? 
  5. Are the claims made/findings supported by sufficient evidence? 
  6. Is there evidence of reflexivity? 
  7. Does the study demonstrate sensitivity to ethical concerns? 
  8. Any other concerns? 

The following assessment options are used to describe the methodological limitations of the included studies: 

  • Minor 
  • Minor to moderate 
  • Moderate 
  • Moderate to severe 
  • Severe 

Relevant resources:  

Selecting studies and assessing methodological limitations  

Noyes J, Booth A, Flemming K, Garside R, Harden A, Lewin S, Pantoja T, Hannes K, Cargo M, Thomas J, Cochrane Qualitative and Implementation Methods Group Guidance Paper 2: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings, Journal of Clinical Epidemiology (2018), doi: 10.1016/j.jclinepi.2017.06.020. 

Munthe-Kaas HM, Glenton C, Lewin S, Noyes J, Booth A. Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: Stage 1 in the development of the CAMELOT tool. BMC Medical Research Methodology (2019) 19:113 

Referanser

  1. Ames HM, Glenton C, Lewin S. Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database of Systematic Reviews. 2017(2).
  2. Ames HM, Glenton C, Lewin S, Tamrat T, Akama E, Leon N. Clients’ perceptions and experiences of targeted digital communication accessible via mobile devices for reproductive, maternal, newborn, child, and adolescent health: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews. 2019(10).
  3. Ames H, Mosdøl A, Blaasvær N, Nøkleby H, Berg R, Langøien L. Communication of children’s weight status: what is effective and what are the children’s and parents’ experiences and preferences? A mixed methods systematic review. BMC public health. 2020;20(1):1-22.
  4. Majid U, Vanstone M. Appraising qualitative research for evidence syntheses: a compendium of quality appraisal tools. Qualitative health research. 2018;28(13):2115-31.