This analysis provides a comprehensive review of studies on ME/CFS that, broadly defined, utilize qualitative methods. Qualitative methods aim to identify interrelated themes across cases and analyze the themes through a scientific process that is both creative and multilayered [12
]. This review includes studies of different populations of interest including physicians or other health care professionals, experiences of people with ME/CFS, a comparison of people with ME/CFS versus other chronic conditions such as FM or cancer-related fatigue, and family system responses.
Most studies used a grounded theory approach to the analysis of data. Grounded theory as a methodological framework is rooted in phenomenology and the goal is to identify central, context-dependent psychological and structural processes [14
]. The grounded theory and constant comparison analysis process, as outlined by Glaser and Strauss, involves reading all interviews, identifying and categorizing themes, re-reading and revising, making comparisons, reviewing the codes, and reflecting. provides a complete overview of every article used in this analysis. The table includes the specific make-up of the population studied, the case definition used, the methods the researchers used for inclusion and classification of participants, the methodological strategies, and tools used in the analysis.
Overview of Qualitative ME/CFS Literature
Article selection was initiated by searching for peer-reviewed qualitative studies on ME/CFS up until May 2010 within the following major scientific databases: ProQuest, PubMed, PsycInfo, Web of Science, and Google Scholar. We searched topic and subject headings with the following keywords: qualitative, ethnography, narrative, grounded theory, chronic fatigue syndrome, Myalgic Encephalomyelitis, Myalgic Encephalopathy, ME/CFS, CFS, ME, post-viral fatigue syndrome, chronic mononucleosis, and chronic fatigue immune dysfunction syndrome. The search produced over 1,000 articles and 325 articles were originally screened for this review. Of those 325 articles, two were articles retrieved via personal communication with an author. Seventy-five (75) articles were assessed from this pool. Studies were assessed by identifying salient methodological aims, sampling and design, analytic strategy, theoretical grounding, and a clear discussion of research implications. Forty (40) articles were further excluded from this sample. Studies that were not methodologically rigorous or did not include this level of detail were excluded from the synthesis. As well, studies that did not primarily examine ME/CFS were excluded. The final synthesis included 34 empirical qualitative studies and one previous meta-analysis. See for the number of studies included and excluded throughout the identification, screening, and eligibility processes using the PRISMA standards [16
Identification and Selection of Qualitative Studies on ME/CFS
The analysis phase began with reading each of the articles. The researchers then proceeded to analyze each of the articles based on three substantive areas. First, the authors identified major theoretical differences among the articles. Major theoretical differences might include the focus and scope of the study, composition of the population of interest in the study, or the theory of thought about the illness to which the researcher subscribed. Second, major themes and findings of each study were identified. Third, implications and recommendations for future research were identified. The authors then synthesized the theoretical differences, major findings, and recommendations. This analysis is organized in and further explained in the results section.
Content Analysis of Major Themes from Qualitative ME/CFS Studies