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Title: Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups
Authors: Dixon-Woods, Mary
Cavers, Debbie
Agarwal, Shona
Annandale, Ellen
Arthur, Antony J.
Harvey, Janet
Hsu, Ronald T.
Katbamna, Savita
Olsen, Richard
Smith, Lucy K.
Riley, Richard D.
Sutton, Alex J.
First Published: 26-Jul-2006
Publisher: Biomed Central
Citation: BMC Medical Research Methodology, 2006, 6 (35)
Abstract: Background: Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature. This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK Methods: This project involved the development and use of the method of Critical Interpretive Synthesis (CIS). This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis. Results: Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually. A more useful means of understanding access is offered by the synthetic construct of candidacy. Candidacy describes how people’s eligibility for healthcare is determined between themselves and health services. It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services. Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention. Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes. By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research. Discussion: By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare. This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole. Both the method and the model should be evaluated in other contexts.
DOI Link: 10.1186/1471-2288-6-35
ISSN: 1471-2288
Type: Article
Rights: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This is the final publisher edited version of the paper published as BMC Medical Research Methodology, 2006, 6 (35). This version was first published at, doi: 10.1186/1471-2288-6-35.
Appears in Collections:Published Articles, Dept. of Health Sciences

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