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To describe a sequential mixed methods review method that prioritized synthesized qualitative evidence from primary studies to explain the complexities of older persons with multiple chronic conditions’ unplanned readmission experiences.
Background
Segregated mixed methods review studies frequently prioritize quantitative evidence synthesis to examine the effectiveness of interventions; utilizing qualitative evidence to explain quantitative data. There is a lack of guidance about how to prioritize qualitative evidence.
Results
Five procedural steps were developed to prioritize qualitative evidence synthesis. In Step 1, research questions were developed. In Step 2, databases were searched, studies were mapped to their method (qualitative or quantitative) and appraised. In Step 3, meta-synthesis and applied thematic analysis were used to synthesize extracted qualitative evidence about the psychosocial processes and factors that influenced unplanned readmission. In Step 4, quantitative evidence was synthesized using vote counting to determine the factors influencing unplanned readmission. In Step 5, a matrix was used to compare, determine the agreement between the qualitative and quantitative evidence, juxtapose findings, and uphold validity. Factors were mapped to the model of psychosocial processes and analytic themes.
Conclusion
Prioritizing qualitative evidence synthesis in a mixed methods review study prioritizes participants’ experiences, perspectives, and voices to understand complex clinical problems from participants who experienced the event. Synthesizing and integrating evidence facilitates the construction of holistic new understandings about phenomenon and expands mixed methods systematic review methods.
Implications
Prioritizing patients’ perspectives is useful for developing new client-centered interventions, establishing best practices for future reviews, generating theories, and expanding research methods.
The book adopts a two-pronged empirical strategy to test the theory. First, a deep dive into a country’s political institutions is required, to ascertain whether electoral districts meeting the conditions for group-based clientelism exist. Second, after these electoral districts have been identified, the researcher must gather data on voting behavior, resource allocations, and other confounding variables at the level of the administrative entity within (tournament-possible) electoral districts and devise stringent empirical tests capable of pitting the theory’s expectations against those of rival theories. This chapter implements the first prong of this empirical strategy, using information about Japan. It presents a detailed overview of how electoral district boundaries are drawn, how votes are counted, what the relevant lower-tier entities are (in Japan’s case, they are municipalities) and how these entities are funded. It explains that Japanese municipalities depend for large shares of their revenue on national treasury disbursements (NTD), which are allocated by bureaucrats but vulnerable to influence by politicians. It classifies the universe of electoral districts that have been used in Japan’s Lower House elections, 1980–2014, as tournament-possible (or not), and it presents evidence that election outcomes are qualitatively different across both sets of districts, in the direction expected by the theory.
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