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A hierarchy of evidence for assessing qualitative health research


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Willis, KF 2007 , 'A hierarchy of evidence for assessing qualitative health research' , Journal of Clinical Epidemiology, vol. 60, no. 1 , pp. 43-49 , doi: 10.1016/j.jclinepi.2006.03.014.

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Objective: The objective of this study is to outline explicit criteria for assessing the contribution of qualitative empirical studies in
health and medicine, leading to a hierarchy of evidence specific to qualitative methods.
Study Design and Setting: This paper arose from a series of critical appraisal exercises based on recent qualitative research studies in
the health literature. We focused on the central methodological procedures of qualitative method (defining a research framework, sampling
and data collection, data analysis, and drawing research conclusions) to devise a hierarchy of qualitative research designs, reflecting the
reliability of study conclusions for decisions made in health practice and policy.
Results: We describe four levels of a qualitative hierarchy of evidence-for-practice. The least likely studies to produce good evidencefor-
practice are single case studies, followed by descriptive studies that may provide helpful lists of quotations but do not offer detailed
analysis. More weight is given to conceptual studies that analyze all data according to conceptual themes but may be limited by a lack
of diversity in the sample. Generalizable studies using conceptual frameworks to derive an appropriately diversified sample with analysis
accounting for all data are considered to provide the best evidence-for-practice. Explicit criteria and illustrative examples are described for
each level.
Conclusion: A hierarchy of evidence-for-practice specific to qualitative methods provides a useful guide for the critical appraisal of
papers using these methods and for defining the strength of evidence as a basis for decision making and policy generation. .

Item Type: Article
Authors/Creators:Willis, KF
Keywords: Qualitative research; Hierarchy of evidence; Quality indicators; Empirical studies; Qualitative evidence for clinical practice; Evidence-based medicine 1. Introduction
Journal or Publication Title: Journal of Clinical Epidemiology
ISSN: 0895-4356
DOI / ID Number: 10.1016/j.jclinepi.2006.03.014
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