By Lisa Arai
Senior Research Associate
Centre for Academic Primary Care
Anybody who has worked on a systematic review will know you spend a lot of time thinking about the type of research papers to include in your review and those you will exclude. Tightly defined inclusion criteria, as well as critical appraisal, an explicit synthesis stage and measures to reduce reviewer bias (such as inter-rater checks), are what distinguish systematic from traditional reviews (a point usefully made by Mark Petticrew more than a decade ago, when he sought – among other things – to debunk the notion that systematic reviews are simply larger versions of traditional reviews).
Over many years teaching research methods, I’ve noticed students often regard this early stage of the review process as troublesome. It’s often approached with an uncertainty that, if not properly resolved, can render the review unwieldy. Or its significance might be underestimated; viewed solely as the means to generate search terms and keep the review within strict parameters.
Yet deciding on inclusion criteria is much more than a methodological issue. Questions about what research to include often involves engaging with bigger, long-standing and often contentious debates associated with the review topic.
This is something we’re grappling with in the VOICES project, a systematic review of the qualitative literature on children’s experiences of domestic violence and abuse (DVA). Until relatively recently, there was little qualitative research on children’s experience of DVA and, given ethical and practical problems with collecting data from children (well summarised recently by Norwegian researchers, Cater and Overlien), it was often mothers who provided accounts of children’s experiences, not children themselves.
In a project on the child’s voice, should we only include studies where children themselves are the research participants? What about research where adults relate their own childhood experiences of DVA? These can be powerful testimonies which, when viewed through an adult lens, can galvanise those affected to social action (as in the case of Sir Patrick Stewart – yes, he of Star Trek: The Next Generation fame – patron of Refuge, the women and children’s DVA charity, who has written a moving account of growing up with an abusive father). And what of third party accounts of family experiences of DVA, such as those related by friends and neighbours? These offer valuable insights about the impact of DVA on children but, with this body of research, there is even greater distance from the voice of the child.
These issues are at the heart of the work of sociologists of childhood, especially that of influential theorists such as Allison James and Alan Prout who published seminal research in the late 20th century on the social construction of childhood and the importance of the child’s voice. From this perspective, the child’s voice on DVA offers an opportunity to explore children as: ‘…active constructors of their own social worlds’. Child’s voice-focused research often highlights the ways in which children are not passive bystanders, or ‘victims’, of DVA, but can demonstrate agency and resilience. Though this may not always be evident to observers. As the authors of UNARS, a large, multi-country study of children’s experience of DVA observe: ‘Children’s ways of coping were not always obvious, and may seem, to a clinically trained gaze, to be problematic, even dysfunctional’.
This statement has resonance for VOICES, where we will explore the implications of our findings for primary care health professionals, most of whom have little training on DVA (though initiatives like RESPONDS, an educational programme to increase professionals’ knowledge of child safeguarding in the context of DVA, are a welcome development). There is a continuing need to engage with children about DVA, and child-focused approaches are likely to be the most fruitful in terms of understanding the impact of DVA on their lives. As the UNARS researchers say, it is important to ‘…. recognise children’s capacity for meaning-making in adverse situations and agency in relation to them…’ so that children who have experienced DVA can be supported appropriately and effectively.
So, in considering what to include or exclude from a review, it’s important not to see this foundational stage as an obstacle to negotiate before the proper work of the review can commence. Depending on the review focus, this stage can take you into the heart of complex and sometimes thorny debates and issues.
Our task now, as researchers on VOICES, is to make sense of accounts of children’s experiences of DVA, to continue to engage with debates about how we do this and, in recognising the unique place of the child’s voice on DVA, deciding if we should prioritise that voice above others’.