3.3.3 Reflexivity

Reflexivity is a fundamental concept in qualitative research, including qualitative systematic reviews (Finlay 2002; Lockwood et al. 2023). It refers to the critical self-awareness and self-examination that researchers engage in throughout the research process, particularly regarding their own perspectives, biases, values and preconceptions (Finlay 2002; Lockwood et al. 2023; Rankl, Johnson & Vindrola-Padros 2021).

There are different descriptions of the role of reflexivity in qualitative synthesis methodologies. The terminology and meaning of terms can vary; some authors use ‘reflexivity’, while others prefer ‘reflection’ or even both terms. In general, all these usages link reflexivity with the concepts of validity and credibility.

Sandelowski and Barroso (2002) define reflexivity as a measure of validity in meta-synthesis. It is a technique that should be evident in primary qualitative research, and is specifically intended to ensure that the study is scientifically and/or ethnographically valid or ‘good’.

Guidance published by the Cochrane Effective Practice and Organisation of Care (EPOC) group on developing qualitative evidence synthesis protocols advises teams to consider reflexivity both prospectively (i.e. prior to the review, considering how the team positions and identities may frame the review and key methodological decisions) and retrospectively (i.e. considering how the review process may have, in turn, influenced the review team’s presuppositions and understandings) (Glenton et al. 2022; Kaushik & Walsh 2019). Guidance related to meta-ethnography varies in relation to reflexivity, with a lack of clarity regarding the description of the process or methods (Sattar et al. 2021). However, the recent eMERGE guidance on meta-ethnography reporting (France et al. 2019) includes a comprehensive account of reflexivity that should be undertaken and reported as part of the review process.

It is recommended that all qualitative evidence synthesis using a meta-aggregation approach adopt a reflexive approach and include a critical reflection statement. These reflections should consider the theoretical standpoint, identities of team members and potential power relations within the team (and how these were negotiated). In line with the methodological approach to meta-aggregation, the reflexive process should involve a discussion of ‘bracketing’ (Dörfler & Stierand 2021) and how the research team attempted to make explicit, yet avoid undue influence of their own standpoints on the analytical process. Reviewers should develop their own stance on reflexivity in their review and in its reporting. Typically, reflexivity is woven throughout the research process and may be reported in multiple sections; it may also be presented as a single statement commonly presented in the methods section.  It may be helpful to consider Walsh’s (2003) characterisation of reflexivity, which is considered within four overlapping and interacting dimensions: personal, interpersonal, methodological and contextual.

• Personal reflexivity requires researchers to reflect on and clarify their expectations, assumptions and conscious and unconscious reactions to contexts, participants and findings. Researchers then need to consider how these influence the interpretation and categorisation of synthesised findings. Personal reflexivity ought to occur continuously across the duration of the investigation and should be interwoven into all aspects of the project—from project conception to research outputs.

• Interpersonal reflexivity refers to how the relationships surrounding the research process influence the context, the people involved and the findings. Reflexive research collaboration involves active and ongoing exploration of the interplay between team members’ motivations, expectations and assumptions, while examining how these perspectives and dynamics can be leveraged or managed.

• Methodological reflexivity refers to researchers critically considering the nuances and impacts of their methodological decisions. It often begins with thoughtful consideration of researchers’ paradigmatic orientation. Methodological reflexivity means focusing on the meaning of these decisions and ensuring that they are ethical, rigorous and paradigmatically aligned.

• Contextual reflexivity considers how the research questions and their answers are embedded in and influenced by a social field of assumptions and practices (e.g. health discipline of review team members, reviewers’ particular cultural experiences and beliefs).

Techniques to record reflexivity include regular team discussions, reflexive writing, journaling, memo writing, field notes or audio recordings. Collaborative reflexive strategies can involve team approaches to help uncover unnoticed framings and assumptions (Dörfler & Stierand 2021; Glenton et al. 2022; Rankl et al. 2021). Collaborative research teams may need to establish a shared understanding of reflexivity and to create an environment that feels safe for all members to openly share their experiences and perspectives. This process may require dedicated time and careful facilitation.