The ConQual Approach

The ConQual approach, also called “summary of findings” is a systematic method to consider what increases or decreases confidence in the results of the qualitative studies (43). This depends on the type of the research, the dependability of the study, and the credibility of findings. The analysis of these criteria results in a ConQual score (high, moderate, low, and very low). The analysis starts off by pre-ranking the papers from (1) high, (2) moderate, or (3) low to (4) very low. In this pre-ranking, qualitative studies are considered high, and text and opinion papers are ranked low (32). From this starting point, each paper is then graded for dependability and next for credibility. Depending on the specific criteria for both dependability and credibility, the initial ranking either stays the same or moves down to one or more levels.

Dependability is measured by asking questions regarding the appropriateness of the conduct of the research. Questions two, three, four, six, and seven of the abovementioned JBI Critical Appraisal Checklist are asked (see Table 1). If four to five “yes” responses are given, the initial ranking of the paper remains the same. Two to three “yes” responses lead to moving down one level in the ranking. Zero to one “yes” responses lead to moving down two levels in the ranking. Credibility is measured by cross-checking how many findings of which level of credibility (unsupported, credible, and unequivocal) were included in the categories associated with the synthesized finding. If a synthesized finding consists of only unequivocal findings, the ranking (yielded in the dependability analysis) remains unchanged. However, if a synthesized finding consists of a mix of unequivocal and credible findings, only credible, or a mix of credible and not supported findings or, last, of only not supported findings, the ranking (yielded in the dependability analysis) is downgraded accordingly (−1, −2, −3, and −4).

All included studies were of qualitative design and, therefore, received an initial ranking of “high.” For all three synthesized findings, the majority of the included studies received two to three “yes” responses on the ConQual identified criteria for dependability; therefore, the ranking moved down to one and yielding a “moderate” level of confidence. Credibility levels of the second and third synthesized findings were downgraded one level due to a mix of unequivocal and credible ratings, and the first synthesized finding remained unchanged due to only unequivocal ratings. The so-called summary of findings can be seen in Table 3.

ConQual summary of findings.