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Greenhalgh T. Cultural Contexts of Health: The Use of Narrative Research in the Health Sector [Internet]. Copenhagen: WHO Regional Office for Europe; 2016. (Health Evidence Network Synthesis Report, No. 49.)

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Cultural Contexts of Health: The Use of Narrative Research in the Health Sector [Internet].

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ANNEX 2. HERMENEUTIC REVIEW

Hermeneutic review was developed in the field of information systems (which, like health care, has witnessed a huge expansion in research publications in recent years and struggles in particular with reviews of ill-defined, interdisciplinary and applied topic areas) (1). It is based on hermeneutic philosophy – a theory of interpretation that deals with the questions and meanings of texts. The goal of hermeneutic review is to achieve a better understanding of a field. While perfect understanding will never be achieved, understanding will progressively improve with close intellectual engagement with key texts. The method developed separately from, but has a closely intellectual affinity with, the technique of critical interpretive synthesis used in systematic reviews of health services research (2).

Heremeneutic review is an interpretive, not a technical, process. It is summarized by Boell and Cecez-Kecmanovic (1) and illustrated schematically in Fig. 1.

Fig. 1.. Hermeneutic review (adapted with permission from Boell and Cecez-Kecmanovic (1)).

Fig. 1.

Hermeneutic review (adapted with permission from Boell and Cecez-Kecmanovic (1)).

Research typically starts with a puzzle or a problem found in research or professional literature, through education, media, or experience in practice. A researcher then begins her/his exploration by first seeking more general introductory texts and review papers which are especially valuable. She/he reads, makes sense of and interprets these texts and finds out further relevant texts in order to identify and understand major ideas, findings, concepts and theories and establish connections among them. During this process the development of understanding progresses gradually while the researcher engages with and makes her/his own way through the literature. Initial ideas and preunderstandings are questioned, refined and extended in the light of what is being learned.

As Fig. 1 shows, the review process consisted of two interlinked hermeneutic cycles: accessing and interpreting the literature and developing the argument. Drawing on insights from the philosopher Ludwig Wittgenstein, the approach distinguishes between puzzles or problems that require information and those that require clarification and insight (1). Searching seeks to identify new information about a problem and more relevant sources of information. As authors interpret and collate these sources, they create an ever-larger set of publications, which is initially overwhelming, foreign and confusing. The more literature they accumulate, the more pressing it becomes to interpret, clarify and understand the ideas they contain (1). This feeds into the lower cycle in Fig. 1.

While hermeneutic review is iterative and places high value on reflection and interpretation (processes which, because they go on inside the researcher's head, are not easy to monitor or standardize), it is not unsystematic. On the contrary, the search phase required a highly systematic process of refining search terms, pursuing references of references and tracking citations forward (citation pearl growth in Fig. 2), managing search data and reference lists, and documenting progress.

Fig. 2. More detailed illustration of the search phase in hermeneutic review (adapted with permission from Boell and Cecez-Kecmanovic (1)).

Fig. 2

More detailed illustration of the search phase in hermeneutic review (adapted with permission from Boell and Cecez-Kecmanovic (1)).

References

1.
Boell SK, Cecez-Kecmanovic D. A hermeneutic approach for conducting literature reviews and literature searches. Commun Assoc Inform Syst. 2014;34(1):257–86.
2.
Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, et al. Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Meth. 2006;6(1):35. [PMC free article: PMC1559637] [PubMed: 16872487]
© World Health Organization 2016.
Bookshelf ID: NBK391063

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