Date of Award
Master of Science (MSc)
Health Research Methodology
Objectives: (i) To determine the types and impact of uncertainty in the decision-making process of policy-makers regarding the implementation of the human papillomavirus (HPV) vaccine. (ii) To determine the relative strengths and limitations of qualitative and quantitative knowledge synthesis methodologies as well as their contributing role to the policy-making regarding the HPV vaccine.
Methods: A systematic review and a meta-ethnography were conducted concurrently. Four different search strategies, of nine different databases, were used to target all potential quantitative and qualitative literature published from 1990 to 2011. Studies were selected after abstract and full-text screening by two reviewers, with disagreements resolved by consensus. English language studies of any study design that addressed the HPV vaccine and policy were eligible for inclusion. Quality appraisal of included studies was undertaken using available criteria and tools according to study design. The criteria sets by Tong and colleagues and CASP were used for the qualitative literature while the economic evaluations were appraised with criteria set by Nujiten and colleagues. Quality of the cross-sectional study was not systematically appraised. Data extraction forms were designed for each study type. The data extracted included: study characteristics, types of uncertainty, number of types within each study, policy decision measured as the authors’ final recommendation, and perceptions of the confidence of these recommendations as rated by the reviewers. Chi-square tests were conducted to determine if presence or absence of uncertainty influenced decisions. Pearsons Correlations were conducted to determine the relationship between the amount of uncertainty and perceived certainty of the decision. The qualitative analysis was conducted using steps outlined by Noblit and Hare to determine how studies were related, to translate studies into one another, and to synthesize translations.
Results: Of the initial pool (n= 865), 21 studies met inclusion criteria and were considered; 17 quantitative and 4 qualititative. (i) The simulation cohorts of the decision analytic models did not vary by study appreciably. Chi square analyses failed to find evidence that policy decisions were influenced by presence or absence of uncertainty. Further, no statistically significant correlation was found between amount of uncertainty and perceived certainty with the funding decision. At least four types of uncertainties were identified in each qualitative study including but not exclusive to cost, public acceptance due to the sexually transmitted nature of HPV, as well as the health care system’s ability to implement and monitor the vaccine. After employing the Noblit and Hare translation process, four broad types were identified: uncertainties around managing different public acceptability viewpoints, the manufacturer’s role and input, the actual vaccine’s characteristics, and the system’s ability to implement a vaccination program. (ii) Specific and measurable outcomes could only be identified a priori for the quantitative studies due to the nature of questions asked. Locating relevant qualitative studies was more complex and time-consuming due to variation in the manner that each study’s defining features and information are catalogued and searched. A lack of reporting in both the qualitative and quantitative studies disabled a thorough assessment of methodological quality. Data extraction only varied in the manner that the data was recorded. The quantitative results consisted of specific types of data (numerical or categorical) while qualitative results were descriptive.Within data analysis, the types of uncertainty were determined through reciprocal translation while the impact of uncertainty was tested using two statistical techniques. These differences highlight the rigidity and flexibility of quantitative and qualitative literature, respectively.
Conclusions: Using both qualitative and quantitative methods enabled a more complete understanding of the role of uncertainty within the decision-making process. Regardless of the methodology used, each type of knowledge synthesis method provided relevant data in regards to the HPV vaccine; simply from different perspectives.
Hafid, Tamana, "Methodological Comparison of Systematic Review and Meta-Ethnography: Uncertainty in the Decision-Making Process of Policy-Makers Specific to the Human Papillomavirus Vaccine" (2012). Open Access Dissertations and Theses. Paper 6770.
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