The illustrative 'grand round', 'case report' and 'case series' have a long tradition in clinical practice and research. Presenting detailed critiques, typically of one or more patients, aims to provide insights into aspects of the clinical case and, in doing so, illustrate broader lessons that may be learnt. In research, the conceptually-related case study approach can be used, for example, to describe in detail a patient's episode of care, explore professional attitudes to and experiences of a new policy initiative or service development or more generally to 'investigate contemporary phenomena within its real-life context'[1]. Based on our experiences of conducting a range of case studies, we reflect on when to consider using this approach, discuss the key steps involved and illustrate, with examples, some of the practical challenges of attaining an in-depth understanding of a 'case' as an integrated whole. In keeping with previously published work, we acknowledge the importance of theory to underpin the design, selection, conduct and interpretation of case studies[2]. In so doing, we make passing reference to the different epistemological approaches used in case study research by key theoreticians and methodologists in this field of enquiry.
The Framework approach is a practical approach, comprising of five stages (familiarisation; identifying a thematic framework; indexing; charting; mapping and interpretation), to managing and analysing large datasets particularly if time is limited, as was the case in our study of recruitment of South Asians into asthma research (Table 1)[3, 24]. Theoretical frameworks may also play an important role in integrating different sources of data and examining emerging themes. For example, we drew on a socio-technical framework to help explain the connections between different elements - technology; people; and the organisational settings within which they worked - in our study of the introduction of electronic health record systems (Table 3)[5]. Our study of patient safety in undergraduate curricula drew on an evaluation-based approach to design and analysis, which emphasised the importance of the academic, organisational and practice contexts through which students learn (Table 4)[6].
Practical Research Methodology Pdf Download
There are other examples of scoping reviews investigating research methodology, with perhaps the most pertinent examples being two recent scoping reviews of scoping review methods [9, 10]. Both of these scoping reviews investigated how scoping reviews had been reported and conducted, with both advocating for a need for clear guidance to improve standardization of methods [9, 10]. Similarly, a scoping review investigating methodology was conducted by Tricco and colleagues30 on rapid review methods that have been evaluated, compared, used or described in the literature. A variety of rapid review approaches were identified with many instances of poor reporting identified. The authors called for prospective studies to compare results presented by rapid reviews versus systematic reviews.
Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process.
We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research.
Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.
In an effort to provide guidance to authors undertaking scoping studies, Arksey and O'Malley [6] developed a six-stage methodological framework: identifying the research question, searching for relevant studies, selecting studies, charting the data, collating, summarizing, and reporting the results, and consulting with stakeholders to inform or validate study findings (Table 2). While this framework provided an excellent methodological foundation, published scoping studies continue to lack sufficient methodological description or detail about the data analysis process, making it challenging for readers to understand how study findings were determined [1]. Arksey and O'Malley [6] encouraged other authors to refine their framework in order to enhance the methodology.
In this paper, we apply our experiences using the Arksey and O'Malley framework to build on the existing methodological framework. Specifically, we propose recommendations for each stage of the framework, followed by considerations for the advancement, application, and relevance of scoping studies in health research. Continual refinement of the framework stages may provide greater clarity about scoping study methodology, encourage researchers and clinicians to engage in this process, and help to enhance the methodological rigor with which authors undertake and report scoping studies [1].
We each completed a scoping study in separate areas of rehabilitation using the Arksey and O'Malley framework [6]. Goals of these studies included: identifying research priorities within HIV and rehabilitation [7], applying motor learning strategies within pediatric physical and occupational therapy intervention approaches [8], and exploring the use of theory within studies of knowledge translation [9]. The amount of literature reviewed in our studies ranged from 31 (DL) to 146 (KO) publications. Upon discovering that we had similar challenges implementing the scoping study methodology, we decided to use our experiences to further develop the existing framework. We conducted an informal literature search on scoping study methodology. We searched CINAHL, MEDLINE, PubMed, ERIC, PsycInfo, and Web of Science databases using the search terms 'scoping,' 'scoping study,' 'scoping review,' and 'scoping methodology' for papers published in English between January 1990 and May 2010. Reference lists of pertinent papers were also searched. This search yielded seven citations that reflected on scoping study methodology, which were reviewed by one author (DL). After independently considering our own experiences utilizing the Arskey and O'Malley [6] framework, we met on seven occasions to discuss the challenges and develop recommendations for each stage of the methodological framework.
A strength of scoping studies includes the breadth and depth, or comprehensiveness, of evidence covered in a given field [1]. However, practical issues related to time, funding, and access to resources often require researchers to consider the balance between feasibility, breadth, and comprehensiveness. Brien et al.[5] reported that their search strategy yielded a vast amount of literature, making it difficult to determine how in depth to carry out the information synthesis. Although Arksey and O'Malley [6] identify these concerns and provide some suggestions to support these decisions, we also struggled with the trade-off between breadth and comprehensiveness and feasibility in our scoping studies. As such, we recommend that researchers ensure decisions surrounding feasibility do not compromise their ability to answer the research question or achieve the study purpose. Second, we recommend that a scoping study team be assembled whose members provide the methodological and context expertise needed for decisions regarding breadth and comprehensiveness. When limiting scope is unavoidable, researchers should justify their decisions and acknowledge the potential limitations of their study.
Stage five is the most extensive in the scoping process, yet it lacks detail in the Arksey and O'Malley framework. Scoping studies have been criticized for rarely providing methodological detail about how results were achieved [1]. We appreciate the importance of breaking the analysis phase into meaningful and systematic steps so that researchers can provide this undertake scoping studies and report on findings in a rigorous manner. As a result, we recommend three distinct steps in framework stage five to increase the consistency with which researchers undertake and report scoping study methodology: analyzing the data, reporting results, and applying meaning to the results. As described in the existing framework, analysis (otherwise referred to as collating and summarizing) should involve a descriptive numerical summary and a thematic analysis. Arksey and O'Malley [6] describe the need to provide a descriptive numerical summary, stating that researchers should describe the characteristics of included studies, such as the overall number of studies included, types of study design, years of publication, types of interventions, characteristics of the study populations, and countries where studies were conducted. However, the description of thematic analysis requires additional detail to assist authors in understanding and completing this step. In our experience, this analytical stage resembled qualitative data analytical techniques, and researchers may consider using qualitative content analytical techniques [10] and qualitative software to facilitate this process. 2ff7e9595c
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