Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews

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Abstract
Techniques for the systematic review of evidence of effectiveness are now well established. Health‐care professionals argue, however, for a need to recognise evidence of appropriateness and feasibility and for the development of methodologies to appraise and synthesise the results of qualitative research. This paper describes a participatory project designed to develop systems to systematically review qualitative evidence. The Qualitative Assessment and Review Instrument is described in detail, and a suite of programs designed to conduct comprehensive reviews of evidence for health‐care practice is outlined. As evidence‐based practice increases in sophistication, and its influence in health service delivery expands, the need for broadening the view of what constitutes legitimate evidence is advanced by clinicians and the approach described attempts to achieve a balance in evidence review that recognises the value of quantitative and qualitative evidence.