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