Storylines of research in diffusion of innovation: a meta-narrative approach to systematic review

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Abstract

Producing literature reviews of complex evidence for policymaking questions is a challenging methodological area. There are several established and emerging approaches to such reviews, but unanswered questions remain, especially around how to begin to make sense of large data sets drawn from heterogeneous sources.

Drawing on Kuhn's notion of scientific paradigms, we developed a new method—meta-narrative review—for sorting and interpreting the 1024 sources identified in our exploratory searches. We took as our initial unit of analysis the unfolding ‘storyline’ of a research tradition over time. We mapped these storylines by using both electronic and manual tracking to trace the influence of seminal theoretical and empirical work on subsequent research within a tradition. We then drew variously on the different storylines to build up a rich picture of our field of study. We identified 13 key meta-narratives from literatures as disparate as rural sociology, clinical epidemiology, marketing and organisational studies. Researchers in different traditions had conceptualised, explained and investigated diffusion of innovations differently and had used different criteria for judging the quality of empirical work. Moreover, they told very different over-arching stories of the progress of their research. Within each tradition, accounts of research depicted human characters emplotted in a story of (in the early stages) pioneering endeavour and (later) systematic puzzle-solving, variously embellished with scientific dramas, surprises and ‘twists in the plot’. By first separating out, and then drawing together, these different meta-narratives, we produced a synthesis that embraced the many complexities and ambiguities of ‘diffusion of innovations’ in an organisational setting. We were able to make sense of seemingly contradictory data by systematically exposing and exploring tensions between research paradigms as set out in their over-arching storylines. In some traditions, scientific revolutions were identifiable in which breakaway researchers had abandoned the prevailing paradigm and introduced a new set of concepts, theories and empirical methods. We concluded that meta-narrative review adds value to the synthesis of heterogeneous bodies of literature, in which different groups of scientists have conceptualised and investigated the ‘same’ problem in different ways and produced seemingly contradictory findings. Its contribution to the mixed economy of methods for the systematic review of complex evidence should be explored further.

Introduction

A systematic review is a literature review undertaken according to an explicit, rigorous and transparent method. Systematic reviews of complex evidence are particularly challenging methodologically. They typically demand repeated iterations of the research question, cover large bodies of evidence, include many different research designs and require the judicious combination of qualitative and quantitative data (Dixon–Woods, Agarwal, Young, Jones, & Sutton, 2004; Mays, Roberts, & Popay, 2001; Thomas et al., 2004). Furthermore, systematic reviews commissioned by policymakers embody a tension between academic values (such as focus, rigour, accuracy and comprehensiveness) and service values (such as timescale, fitness for purpose, value for money and credibility with decision-makers).

In 2002, the UK Department of Health funded a systematic review on ‘Diffusion, spread and sustainability of innovations in health service delivery and organisation’, with a view to informing the modernisation agenda for UK health services (Department of Health, 2001). We used this work as an opportunity to develop the methodological base for the synthesis of evidence across multiple disciplinary fields. The main findings about diffusion of innovations are reported elsewhere (Greenhalgh et al., 2004), and the full report is available as a book (Greenhalgh et al., 2005); this paper discusses methodological issues.

Section snippets

The methodological challenges

Like many reviewers of complex bodies of evidence, we found it hard to get started. There were several reasons for this. First, although our final report includes detailed definitions of key terms such as ‘innovation’, ‘spread’, ‘sustainability’, and ‘organisation’, we were initially working with much fuzzier and contested definitions, which made it impossible to set clear inclusion criteria for primary studies. Second, we did not know where to look for the good research studies on the

Meta-narrative review: developing the idea

We drew on a theoretical approach developed by Kuhn (1962) in The Structure of Scientific Revolutions. He introduced the notion of ‘normal science’—that most science, most of the time, is conducted according to a set of rules and standards which are considered self-evident by those working in a particular field, but which are not universally accepted. Any group of researchers views the world through a particular ‘lens’ or paradigm that has four dimensions: conceptual (what are considered the

Meta-narrative review: applying the method

The phases of meta-narrative review are shown in Box 1. We have presented them as separate and sequential, but in reality each phase overlapped with, and fed into, the next.

Some examples of meta-narratives on the spread of innovations

The 13 meta-narratives that contributed to the final report are summarised in Table 1 and described in detail in our full report (Greenhalgh et al., 2005).

We describe below three examples of very different meta-narratives of diffusion of innovations. For each tradition we have (a) identified the landmark empirical study or studies that formed a model for further work within that tradition, (b) outlined the dimensions of the paradigm (conceptual, theoretical, methodological, instrumental) and

Discussion

In the early stages of this work, peer reviewers were concerned that our part-completed review did not make sense. The reviewers who read our final report made various criticisms of the detail of our work, but all were agreed on one conclusion: it illuminated and clarified a previously confusing literature. Our hypothesis—an important one for the synthesis of complex evidence—is that we made the crucial leap towards sensemaking when we made the decision to systematically produce ‘storied’

Conclusion

We are still developing and refining the technique of meta-narrative review and placing it appropriately alongside other approaches to the synthesis of complex evidence. We provisionally conclude that in situations where the scope of a project is broad and the literature diverse, where different groups of scientists have asked different questions and used different research designs to address a common problem, where different groups of practitioners and policymakers have drawn on the research

Acknowledgements

This research was funded by a grant from the UK Department of Health. We thank Brian Balmer, Jerome Bruner, Jeanette Buckingham, Hasok Chang, Lewis Elton, Gene Feder, Brian Hurwitz, Vieda Skultans, Allen Young and two anonymous referees for helpful feedback on earlier drafts of this paper. Anna Donald and Francis Maietta contributed to early fieldwork for the review. We also thank the numerous peer reviewers who provided an insightful critique of our part-completed work and thus pushed us

Reference (58)

  • D. Davis et al.

    Impact of formal continuing medical educationdo conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?

    Journal of American Medical Association

    (1999)
  • S. Dawson

    Never mind solutionswhat are the issues? Lessons of industrial technology transfer for quality in health care

    Quality in Health Care

    (1995)
  • M. Denzin et al.

    Handbook of qualitative research

    (1994)
  • Department of Health. (2001). The NHS plan. London: NHS...
  • M. Dixon-Woods et al.

    Integrative approaches to qualitative and quantitative evidence

    (2004)
  • D. Evans et al.

    Reasons for physically restraining patients and residentsa systematic review and content analysis

    International Journal of Nursing Studies

    (2002)
  • E. Ferlie et al.

    Evidence-based medicine and organisational changean overview of some recent qualitative research

  • Freemantle, N., Harvey, E.L., Wolf, F., Grimshaw, J.M., Grilli, R., Bero, L.A., (2003). Printed educational materials,...
  • S. Fuller

    Thomas Kuhna philosophical history for our times

    (2000)
  • D.A. Garvin

    Building a learning organization

    Harvard Business Review

    (1993)
  • A. Granados et al.

    EUR-ASSESS project subgroup report on dissemination and Impact

    International Journal of Technology Assessment in Health Care

    (1997)
  • L.W. Green et al.

    Dissemination and utilization of health promotion and disease prevention knowledgetheory, research and experience

    Canadian Journal of Public Health

    (1996)
  • T. Greenhalgh et al.

    Diffusion of innovations in health service organisationsa systematic literature review

    (2005)
  • T. Greenhalgh et al.

    Diffusion of innovations in service organisations: Systematic literature review and recommendations for future research

    Millbank Quarterly

    (2004)
  • Grilli, R., Freemantle, N., Minozzi, S., Domenighetti, G., Finer, D., (2000). Mass media interventions, effects on...
  • J.M. Grimshaw et al.

    Effectiveness and efficiency of guideline dissemination and implementation strategies

    Health Technology Assessment Report

    (2004)
  • R. Grol

    Improving the quality of medical care. Building bridges among professional pride, payer profit, and patient satisfaction

    Journal of American Medical Association

    (2001)
  • A. Haines et al.

    Implementing findings of research

    British Medical Journal

    (1994)
  • M.T. Hansen et al.

    What's your strategy for managing knowledge?

    Harvard Business Review

    (1999)
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