ARM@DA’s Realist Review Literature Search

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Hello, I’m Mark Clowes and I’m the information specialist on the ARM@DA Project team. So what is an information specialist and why does this research project need one? As our previous blog explained, the ARM@DA realist review involves consulting recent research and stakeholders to explore the use of remote/digital maternity care. My job focusses on the first part…

Anyone can find information online using Google; however if this is the only way you search, it’s easy to miss something. So a project like ARM@DA calls on a librarian or information specialist like me to be sure they don’t miss something important. We try to search in a “systematic” way so that those who fund, use and benefit from the research can be confident that the team has found everything that matters. Most research is reported in journal articles – essentially magazines aimed at research and professional audiences – but relevant knowledge is also found on websites; reports from organisations; conference papers; or academic dissertations.

When I start a project such as ARM@DA I follow a few stages:

Conceptualising the question: breaking the topic down into building blocks such as Who? Does What? and What Else Could Be Done? With What Result? In our case, our population (pregnant women) is the Who? and the intervention of interest (digital/remote care) is the What?

Identifying search terms: We can’t count on previous researchers using exactly the same terms as us; a service for pregnant women might mention specific parts of the maternity journey (e.g. antenatal or postnatal) or different clinical specialties (e.g. midwifery; obstetrics). Do authors mention “remote care” or have they used technical words (telecare/telemedicine/online consultation) or the names of apps (Skype or Zoom)? We also rely on our project advisors and stakeholders to tell us about specialist clinical software we may have otherwise missed.

Choosing sources: Where do I look? I use a mixture of search engines like Google Scholar and free specialist databases such as PubMed or The Cochrane Library as well as subscription resources such as CINAHL or EMBASE. Some of these sources add extra descriptive information making it easier to “map” our search words to relevant journal articles.

At this point in a project I am ready to execute the search”.

Even though I have been doing this a long time I rarely get a new search “right first time” and often have to “fine tune” my first attempt. I need to balance the risk of missing something relevant against drowning the team in thousands of
irrelevant results! For ARM@DA my searches found about 90% of our included papers. For the rest we relied on suggestions from experts, checking reference lists of useful papers and similar “safety net” techniques. Again it’s worth remembering that lots of clinical expertise and good practice doesn’t even get into print – yet another reason why we need women, the public and clinical staff to suggest what we have missed!

ARM@DA, as a “realist review”, differs from other types of review. We search in two phases; first to look for suggestions (“programme theories”) from healthcare workers, women and others to explain why remote care may or may not be a good way of delivering care. Then we look again at the literature to see whether any research backs up (or offers alternative views on) what they have suggested. As the information specialist I aim to identify studies that are rich in detail; highly relevant to the UK, and rigorous (high quality research). The ARM@DA research team then sorts through what I have found to make sure our project covers all the various systems in use. They also want to reflect the fact that pregnant women are not a single group but vary in terms of ethnicity, culture, age and social
background, but not all groups are equally visible in published research.

Reviews are a team effort and my search is only the first stage; but this systematic approach should provide a strong foundation for the rest of the project. My last take before passing on the baton to the reviewers is to keep records of how I have searched so that you, as a future reader of/listener to our research can be sure that we have made strenuous attempts to identify the best available evidence and that our review will help pregnant women to identity the best care for their situation.