Considering axiological integrity: a methodological analysis of qualitative evidence syntheses, and its implications for health professions education

Addressing equity, diversity, and inclusion in JBI qualitative systematic reviews: a methodological scoping review

OBJECTIVE

The objective of this methodological scoping review was to investigate ways in which qualitative review teams are addressing equity, diversity, and inclusion (EDI) in the process of conducting and reporting qualitative systematic reviews that use JBI guidelines.

INTRODUCTION

To promote health equity, there is a need for evidence synthesis processes and practices to develop approaches that incorporate EDI. Some guidance is available to guide equity-focused review methods and reporting, but this is primarily oriented to quantitative systematic reviews. There is currently limited knowledge about how review teams are addressing EDI within qualitative evidence syntheses.

INCLUSION CRITERIA

This review included English-language qualitative systematic reviews, published in 2022, that used all the steps outlined in JBI guidance for qualitative reviews.

METHODS

A 1-year sample of published reviews was identified from a search undertaken on March 17, 2023, of 2 health care databases: MEDLINE (Ovid) and CINAHL (EBSCOhost). Data extraction followed a framework approach, using an adapted preexisting equity template. This included attention to i) the reporting of a range of characteristics associated with EDI, ii) search approaches, and iii) analytical approaches (including reflexivity, intersectionality, and knowledge user engagement). Data were analyzed using descriptive statistics and narrative summary.

RESULTS

Forty-three reviews met the inclusion criteria. The majority of reviews (n=30) framed their questions and aims in a generic/universal (rather than EDI-focused) way. Six reviews justified their population focus in terms of an EDI-related issue. Only one review included a knowledge user. The sociodemographic and other key characteristics of the samples in underpinning studies were poorly reported, making it hard to discern EDI-related issues or to undertake EDI-related analyses. Thirteen of the reviews included non-English-language evidence sources, and 31 reviews included gray literature sources. Ten reviews demonstrated an element of intersectional or otherwise critical approaches within their analyses of categories and synthesized findings (whereby issues of power and/or representation were explicitly considered). Only 8 reviews included discussions of review team composition and reflexivity within the review process.

CONCLUSIONS

This EDI-focused methodological enquiry has highlighted some limitations within current qualitative evidence synthesis practice. Without closer attention to EDI, there is a danger that systematic reviews may simply serve to amplify, rather than illuminate, existing gaps, silences, and inequitable knowledge claims based on dominant representations. This review sets out a range of suggestions to help qualitative evidence synthesis teams to more systematically embed EDI within their methods and practices.

REVIEW REGISTRATION

Open Science Framework https://osf.io/wy5kv/.

Conducting research by mixed methods: an autoethnography account of a PhD research in facilities management from a developing country

Purpose

Despite the increasing discourse on mixed methods (MM) in academic literature, less attention has been focused on its methodological development in the built environment in developing countries. This paper aims to examine the basis and challenges of the application of MM for health-care facilities management (FM) research in Ghana.

Design/methodology/approach

This paper adopts autoethnography as its research method, coupled with a scholarly review of methodological literature to position a technical view on the application of mixed methods for health-care FM research in a developing country.

Findings

This paper contributes and lends support to the methodological strength of MM as epistemologically coherent and useful for understanding the intricacies of health-care FM. This paper advances the proposition that the nascent stage of FM development in Ghana, paucity of literature, epistemological and axiological considerations underscore the choice of a sequential MM. The attitude of research participants, ethical challenges and time-lapse for data analysis were observed as practical challenges.

Research limitations/implications

Discussion of data integration is excluded.

Practical implications

This paper provides a nuanced understanding of the concept of MM in health-care FM and set forth practical recommendations worthy to enhance the application of MM research.

Originality/value

This paper is among the few focusing on methodological discussion of health-care FM. This paper proposes a framework to guide researchers in the application of mixed methods.

The Implicit Association Test in health professions education: A meta-narrative review

INTRODUCTION

Implicit bias is a growing area of interest among educators. Educational strategies used to elicit awareness of implicit biases commonly include the Implicit Association Test (IAT). Although the topic of implicit bias is gaining increased attention, emerging critique of the IAT suggests the need to subject its use to greater theoretical and empirical scrutiny.

METHODS

The authors employed a meta-narrative synthesis to review existing research on the use of the IAT in health professions education. Four databases were searched using key terms yielding 1151 titles. After title, abstract and full-text screening, 38 articles were chosen for inclusion. Coding and analysis of articles sought a meaningful synthesis of educational approaches relating to the IAT, and the assumptions and theoretical positions that informed these approaches.

RESULTS

Distinct, yet complementary, meta-narratives were found in the literature. The dominant perspective utilizes the IAT as a metric of implicit bias to evaluate the success of an educational activity. A contrasting narrative describes the IAT as a tool to promote awareness while triggering discussion and reflection.

DISCUSSION

Whether used as a tool to measure bias, raise awareness or trigger reflection, the use of the IAT provokes tension between distinct meta-narratives, posing a challenge to educators. Curriculum designers should consider the premise behind the IAT before using it, and be prepared to address potential reactions from learners such as defensiveness or criticism. Overall, findings suggest that educational approaches regarding implicit bias require critical reflexivity regarding assumptions, values and theoretical positioning related to the IAT.