Andrew,
There is not really a huge amount about such complex reviews in health
care although here is an increasing discussion. Essentially I think that
there are a number of guiding principles. One overiding one is to be sure
to desrcibe the field - what has been done - and not just what has been
subjected to systematic evaluation.
Three suggestions / examples:
Tricia Greenhalghs account of using messy evidence in a complex area:
Greenhalgh T., Toon P., Russell J., Wong G., Plumb L. & Macfarlane F.
(2003): Transferability of principles of evidence based medicine to
improve educational quality: systematic review and case study of an online
course in primary health care. BMJ 326, 142-145.
And a report of a 'complex' review of ours, which used a variety of data
sources + a paper discussing broader principles:
Forbes A., While A., Ullman R., Lewis S., Mathes L. & Griffiths P. (2002)
A multi method review to identify components of practice which may promote
continuity in the transition from child to adult care for young people
with chronic illness or disability. National Co-ordinating Centre for NHS
Service Delivery and Organisation Research, London.
(http://www.sdo.lshtm.ac.uk/continuityofcare.htm)
Forbes A. & Griffiths P. (2002): Methodological strategies for the
identification and synthesis of 'evidence' to support decision-making in
relation to complex healthcare systems and practices. Nursing Inquiry 9,
141-155.
I'd also suggest chasing up Ray Pawson's attempts to extend the 'realisitc
evaluation' paradigm onto sytematic reviews (there's a paper out there
somewhare but I don't have the reference to hand readily.
Hope this helps
Peter Griffiths
King's College London
|