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Quality Appraisal for Reliability Studies (QAREL and Quality Assessment of Studiess of Diagnostic Accuracy (QUADAS-2) scores were completed to assess article quality.
Figure 1 summarises our conceptual approach to quality appraisal for meta-ethnography.
Carroll and colleagues used sensitivity analysis to show the possible benefits of quality appraisal for qualitative research synthesis [ 9].
We therefore need to consider the relative contribution of methodological and conceptual quality to the process of quality appraisal for qualitative synthesis, and beyond.
For example, Carroll and colleagues used sensitivity analysis to show the possible benefits of quality appraisal for qualitative research synthesis [ 27].
Twenty-five publications were excluded after full text analysis and eight publications were excluded after the quality appraisal for reasons shown in Figure 1.
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We relied mostly on systematic reviews (including one Cochrane review) for the quality appraisal of individual studies for Questions B and E [ 7, 25], but these described the risk of biases and not the other GRADE criteria for assigning grades of evidence [ 11].
There is also recent guidance on how to select a particular qualitative synthesis approach to suit a research aim [ 23, 24] and on the quality appraisal of studies for inclusion in a meta-ethnography [ 7, 42].
Some recent guidance has also been developed on if and how to conduct quality appraisal of studies for inclusion in a meta-ethnography [ 21] and on how to select a qualitative synthesis approach to suit a research aim [ 22– 22].
The need for quality appraisal of included studies in systematic review has been recognised for many years however, how deficiencies in study quality should be addressed in meta-analysis is not as clear [ 17, 18].
The methodological quality of included articles was independently assessed by 2 reviewers (TM and FB), using different tools for the 2 types of studies: the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool for diagnostic accuracy articles [ 17] and the Quality Appraisal of Reliability Studies QARELL) checklist for diagnostic reliability articles [ 18].
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Justyna Jupowicz-Kozak
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