1056 — Use of Ecomaps in Qualitative Research -- An Integrative Review

Lead/Presenter: Veena Manja, 
All Authors: Manja V (VA WNY HCS, Buffalo, NY; McMaster University, Hamilton, Ontario, Canada) MacMillan HL (McMaster University, Hamilton, Ontario, Canada) Nrusimha A (Stanford University, Stanford, CA) VanBorek N (McMaster University, Hamilton, Ontario, Canada) Schwartz L (McMaster University, Hamilton, Ontario, Canada) Jack SM (McMaster University, Hamilton, Ontario, Canada)

Objectives:
Qualitative research plays a central role in exploring individuals' experiences and perceptions of health, wellness, illness and health care services and is being used in the VA. Visual tools are increasingly being used as data elicitation tools. An ecomap applies ecosystems theory to human relationships, provides an illustration of strength and quality of relationships and flow of energy and resources. This study is an integrative review of the use of ecomaps in qualitative research.

Methods:
A literature search of studies using ecomaps was conducted from inception to July 2016 using the keywords 'ecomap*', 'ecomapping' and 'graphic elicitation' in Medline, Embase, PsycINFO, SSRN, Scopus and CINAHL. Citations were screened in duplicate and selected full text publications were reviewed in duplicate. Data were extracted by one reviewer and a random sample reviewed in duplicate. A method of constant comparison involving identification of patterns, themes, or relationships in the data was used to convert extracted data into systematic categories to provide a comprehensive portrayal of use of ecomaps in qualitative research.

Results:
227 unique citations were screened, of which 47 publications were included in the final review. Several benefits of using ecomaps were identified, including identifying and acknowledging the nature of relationships between individuals, teams, and organizations; facilitating change; tracking change over time; improving rapport and engagement with patients; and improving clinician understanding of the importance of social contexts. From a methodologic perspective, the ecomap facilitates ongoing iterative question posing and is a source of data triangulation, increasing credibility of qualitative findings. Ecomaps were also used for primary and secondary analysis. Several modifications of the ecomap were identified to accommodate changing needs of patient and researchers.

Implications:
In qualitative studies, use of ecomaps has several benefits including improving patient engagement, understanding the nature of relationships between individuals, teams and organizations and to increase study rigor. Their use should be considered in research for data elicitation, analysis and interpretation

Impacts:
The essential role of qualitative research is increasingly being recognized; use of ecomaps enhances qualitative studies. Ecomaps can be used to triangulate findings and reach a more comprehensive understanding of the phenomenon under study.