LAUSR

AIMS To examine the strengths and weaknesses of multi-context (international) qualitative evidence syntheses in comparison with single-context (typically single-country) reviews. We compare a multi-country synthesis with single-context syntheses on facility-based delivery in Nigeria and Kenya. DESIGN Discussion Paper. BACKGROUND Qualitative evidence increasingly contributes to decision-making. International organisations commission multi-context reviews of qualitative evidence to gain a comprehensive picture of similarities and differences across comparable (e.g. low- and middle-income) countries. Such syntheses privilege breadth over contextual detail, risking inappropriate interpretation and application of review findings. Decision-makers value single-context syntheses that account for the contexts of their populations and health services. We explore how findings from multi- and single-context syntheses contribute against a conceptual framework (adequacy, coherence, methodological limitations and relevance) that underpins the GRADE Confidence in Evidence of Reviews of Qualitative Evidence approach. DATA SOURCES Included studies and findings from a multi-context qualitative evidence synthesis (2001-2013) and two single-context syntheses (Nigeria, 2006-2017; and Kenya, 2002-2016; subsequently, updated and revised). FINDINGS Single-context reviews contribute cultural, ethnic and religious nuances as well as specific health system factors (e.g. use of a voucher system). Multi-context reviews contribute to universal health concerns and to generic health system concerns (e.g. access and availability). IMPLICATIONS FOR NURSING Nurse decision-makers require relevant, timely and context-sensitive evidence to inform clinical and managerial decision-making. This discussion paper informs future commissioning and use of multi- and single-context qualitative evidence syntheses. CONCLUSION Multi- and single-context syntheses fulfil complementary functions. Single-context syntheses add nuances not identifiable within the remit and timescales of a multi-context review. This article is protected by copyright. All rights reserved.