3.3.1 Theoretical underpinning

As a methodology, meta-aggregation is grounded in pragmatism and transcendental (descriptive) phenomenology (Hannes & Lockwood 2011b). It is focused on describing the experience of the phenomenon of interest to gain an in-depth understanding of its meanings that may lead to actionable insights.

Pragmatism is a philosophical and epistemological approach that emphasises the practical consequences of ideas and beliefs and the importance of using research findings to guide practical actions (Kaushik & Walsh 2019). It values experience and action, viewing knowledge as something individuals gain through practical engagement with the world and influenced by our social experiences (Kaushik & Walsh 2019). Pragmatism encourages using this knowledge to solve real-world problems and improve outcomes (Kelly & Cordeiro 2020).

Pragmatic inquiry in research is guided by three key principles (Kelly & Cordeiro 2020). First, it emphasises the production of actionable knowledge, ensuring that the information generated is practical and can be applied to solve real-world problems. Second, it recognises the interconnectedness between experience, knowing and acting. This highlights that our experiences shape our knowledge and inform our actions. Third, it regards inquiry as an experiential process, treating research as an ongoing learning process that relies on practical investigation and adaptation to new insights (Kelly & Cordeiro 2020).

In the context of meta-aggregation, a pragmatic philosophical underpinning focuses on eliciting the practical implications and usefulness of the research findings. This approach is particularly relevant when the goal of the research is to gain actionable insights that can be used to develop recommendations for practice and policy. This involves taking a collaborative approach to research and, where possible, engaging stakeholders in a rigorous research process. Such an approach ensures that the findings are relevant, practical and applicable to the needs of the stakeholders. In this way, the research is designed to produce insights that are actionable and can be implemented in real-world contexts. In other words, a pragmatic approach underpinning meta-aggregation emphasises the use research findings to inform and guide practical action.

Transcendental phenomenology can be traced back to the work of Edmund Husserl, who developed the method of phenomenology as a means of exploring the structures of human consciousness and experience (Moran 2011). Transcendental phenomenology focuses on describing lived experiences directly, uncovering the underlying structures and meanings of phenomena (Croslley 2001; Moran 2011). Unlike hermeneutic perspectives, which involve theoretical interpretation from the text, transcendental phenomenology seeks to understand the essence of experiences rather than theoretical interpretations. This involves analysing and interpreting the experiences of participants to identify and describe the underlying structures that give rise to those experiences (Moran 2011). These structures can then be synthesised to identify common themes or patterns that emerge across multiple participant groups or studies.

As an example, imagine a patient experiencing chronic pain. A transcendental phenomenological perspective in this context would involve exploring not just the physical sensations of pain, but also the deeper structures of the patient’s experience through their own words or other forms of expression. This might include investigating how the pain affects their daily life, their emotional responses to it, their beliefs about the pain and its causes and how it affects their relationships with others and sense of self. By drawing upon a transcendental phenomenological methodological approach, a researcher or clinician could delve into the underlying structures of the patient’s experience of pain, aiming to understand its meaning and significance beyond its physical manifestation. This deeper understanding could inform more holistic approaches to pain management that address not only the physical symptoms but also the psychological, social and existential aspects of the patient’s experience.

In the context of meta-aggregation, transcendental phenomenology informs and guides the approach by emphasising key concepts, such as the ‘essence of experience’ and the process of ‘bracketing’. Transcendental phenomenology aims to gain a deeper understanding of the essence of the experiences being studied and, where possible, to identify the universal features that characterise those experiences. It also seeks to identify and explain significant differences. The use of transcendental phenomenology relies on an explicit reflexive process that includes the importance of ‘bracketing’. This involves becoming aware of and setting aside any preconceptions or assumptions to gain a more objective perspective on the data (Kegley 2022). The reflexive process consists of recognising and acknowledging the biases and beliefs within the review team and being open to new insights that emerge from the data (Kegley 2022).

Informed by both pragmatism and transcendental phenomenology, meta-aggregation of qualitative evidence offers a robust framework for synthesising qualitative data that is both rigorous and highly relevant for informing healthcare practice and policy. These approaches move beyond merely cataloguing original author findings. By valuing the nuanced exploration of lived experiences, meta-aggregation facilitates a richer understanding of intricate healthcare issues.

As a philosophical framework, pragmatism and transcendental phenomenology orientate meta-aggregation towards a deeper understanding of the essence of experiences (through detailed description), while also ensuring that the research findings are relevant and applicable in real-world contexts. This involves transparent, rigorous qualitative methods within a synthesis framework to generate evidence, analyse and interpret the data to identify underlying structures and use the resultant insights to inform practical action and decision-making.

Application in qualitative evidence synthesis

When combined within the framework of meta-aggregation, transcendental phenomenology and pragmatism provide a robust methodology for synthesising qualitative research findings into actionable statements. Transcendental phenomenology guides the description and analysis of experiences, focusing on deeper meanings and structures. A pragmatic approach orientates the approach towards the generation of synthesised knowledge that has practical implications, enabling it to be applied in real-world settings.

Ultimately, the integration of transcendental phenomenology and pragmatism within meta-aggregation enables researchers to generate insights that aim to be (i) actionable in relation to the phenomena of interest, and (ii) that can inform decision-making, policy development and practice across different fields.

This integrated approach to qualitative evidence synthesis influences the:

• Design stage: The principle of actionable knowledge anchors research in the experiences of participants. At the design stage, the principles guide the reviewer to break down the problem and identify elements of the problem that are the most relevant.

• Research process: The principle of actionable knowledge drives decision-making at each stage of the research process, from question development to methods to analysis.

• Research outcome: The approach influences the expression of the research outcome and its applicability, relevance and transferability.

Strengths and limitations

Strengths of this approach include:

• Bringing together transcendental phenomenology, pragmatism and meta-aggregation provides a comprehensive synthesis approach to understanding human experiences, values and preferences. This approach allows for a detailed analysis of experiences while ensuring practical relevance and applicability.

• The integration of pragmatism ensures that the synthesised knowledge has practical implications, enabling it to be applied in real-world settings. This leads to the generation of actionable insights that can inform decision-making, policy development and practice across different fields.

• Meta-aggregation involves systematically gathering and analysing qualitative data from multiple studies, ensuring a rigorous approach to synthesising research findings.

• ·Meta-aggregation is inclusive, as data from all qualitative approaches can be included, allowing for the synthesis of diverse research findings. This ensures that a wide range of perspectives is considered in the synthesis process.

Limitations of this approach include:

• Meta-aggregation does not lend itself to generating new theoretical frameworks or concepts. Instead, it can be used to synthesise existing qualitative evidence to provide comprehensive and detailed descriptive interpretations of a phenomenon to create actionable knowledge for healthcare.

• Dealing with diverse studies that have different methodologies, theoretical frameworks and contexts can be challenging. These differences can sometimes make it difficult to synthesise findings coherently.

• Meta-aggregation is primarily suited to questions of a practical or applied nature, which may limit its utility in addressing more theoretical or abstract research questions.

In summary, pragmatism and transcendental phenomenology, as the theoretical foundations of meta-aggregation, lead to a comprehensive and nuanced description of the phenomenon being studied while also ensuring that the research findings are useful and practical.