Reflexivity in pharmacy practice qualitative research: systematic review of twelve peer-reviewed journals
Authors: Tomlinson J , Medlinskiene K 
Published: April 2024

Abstract

Introduction
Reflexivity is named as an important component for establishing trustworthiness and authenticity within qualitative research. Depending on the philosophical stance of the researcher, subjectivity is often intertwined with qualitative research, thus engagement in reflexivity accounts for how this subjectivity shapes the study and aids to increase its rigor. Walsh’s typology[1] proposed personal, interpersonal, methodological, and contextual dimensions of reflexivity, which are overlapping and interacting, and was endorsed by the International Association for Medical Education (AMEE).[2] As pharmacy professionals conducting research, we bring many aspects (personal and professional experiences, beliefs, values) that can help us develop deeper and richer insights into our work; if not considered through reflexivity, this may have unrealised impacts which can bring the findings under scrutiny.

Aim
This systematic review aimed to explore reflexivity reporting, type, and strategies in qualitative studies published in peer-reviewed pharmacy journals.

Methods
Two reviewers screened twelve pharmacy related peer-reviewed journals from inception to 1st August 2023 for qualitative studies; these were identified as the ‘top’ pharmacy practice journals in JANE (Journal/Author Name Estimator). Then, studies were independently reviewed against inclusion criteria. Any disagreements were discussed to reach a consensus. Qualitative studies discussing reflexivity, having dedicated reflexivity sections in the manuscript, or providing quality checklists with reflexivity were included. Quantitative, mixed methods, and educational research studies were excluded. Two reviewers completed data extraction: reflexivity methods, where discussed in the paper and to what extent, and type of reflexivity as per Walsh’s typology to determine the dimension of reflexivity.[1] Data were synthesised narratively. Quality appraisal of study conduct was not completed and all eligible papers were included.

Results
452 qualitative studies were reviewed and 102 were included from seven journals. Thirty-four studies provided quality checklists and 18 had personal (n=10), interpersonal (n=2), methodological (n=1), or multi-type (n=5) reflexivity. In the remaining 68 articles, reflexivity was personal (n=20), interpersonal (n=3), methodological (n=16), multi-type (n=28), or unclear (n=1). Where reflexivity was presented, it was mostly reported in the manuscript’s methods section or within limitations sections of discussions; some had reflexivity named sections. However, reviewed studies lacked true reflexive comments, and often descriptions of research team backgrounds were provided without consideration of the impact on the study, or the focus was on minimising study bias. Twelve studies alluded to the use of reflexive diaries, journals, or note sheets but lacked detail in how they were implemented.

Conclusion
This is the first systematic review, to our best knowledge, focused on reflexivity reporting in pharmacy practice qualitative studies. It highlighted that reflexivity reporting was poor, often misunderstood, and use of the quality checklist did not increase appropriate reporting. Reflexivity was often described as something researchers ‘did’ to minimise bias, rather than something to embrace and explore as part of qualitative research process. We posit that this could be due to a lack of understanding of what true reflexivity is, unclear quality checklist instructions and limited potential to include it meaningfully in the final manuscript. The review was limited to twelve pharmacy practice journals and articles published in English.

References
1. Walsh R. The methods of reflexivity. Humanist Psychol. 2003; 31(4): 51–66.
2. Olmos-Vega FM, Stalmeijer RE, Varpio L et al. A practical guide to reflexivity in qualitative research: AMEE Guide No. 149. Medical Teacher 2023; 45(3): 241-251.