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Systematic Reviews of Qualitative Literature. Catherine Francis-Baldesari UK Cochrane Centre Oxford. Objectives. Discuss the purpose and characteristics of meta-synthesis. Become familiar with the concepts and general processes to conduct a meta-synthesis. What Meta-Synthesis is Not.

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systematic reviews of qualitative literature

Systematic Reviewsof Qualitative Literature

Catherine Francis-Baldesari

UK Cochrane Centre


  • Discuss the purpose and characteristics of meta-synthesis.
  • Become familiar with the concepts and general processes to conduct a meta-synthesis.

UK Cochrane Centre

what meta synthesis is not
What Meta-Synthesis is Not
  • Not a systematic literature review.
  • Not a collation or codifying of studies.
  • Not an aggregation or summing of outcomes.
  • Not a concept analysis.

Finfgeld, D.L. (2003). Metasynthesis: The state of the art- so far. Qualitative Health Research, 13 (7), 893-904

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  • Meta-analysis– aggregating data to reach statistical power for detection of cause and effect between treatment and outcomes.
  • Meta-synthesis – integrating data to reach a new theoretical or conceptual level of understanding and development.

Thorne, S., Jensen, L., Kearney, M.H., Noblit, G., Sandelowski, M. (2004). Qualitative metasynthesis:

Reflections on methodological orientation and ideological agenda. Qualitative Health Research, 14 (10), 1342-1365.


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concept of integration
Concept of Integration
  • More than the sum of parts.
  • Inferences derived from findings as a whole.
  • New higher-order interpretations created.

Thorne, S., Jensen, L., Kearney, N.H., Noblit, G., Sandelowski, M. (2004). Qualitative metasynthesis: Reflections on methodological orientation and ideological agenda. Qualitative Health Research, 14 (10), 1342-1365.

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achieving integration
Achieving Integration

Comprehensive consideration of data

  • Inclusion vs. exclusion
  • Commonalities and differences
  • Sensitivity to patterns
  • Intuitive and logical
  • Theoretical reconstruction of concepts

Silverman, D. (2001). Interpreting Qualitative Data: Methods for Analysing Talk, Text and Interaction (2nd ed.). Thousand Oaks, CA: Sage Publications, Inc.

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characteristics of process
Characteristics of Process
  • Inductive and interpretive in design.
  • Deconstruction and examination of findings from a sample of studies.

Mays, N., Pope, C., Popay, J. (2005). Details of approaches to synthesis: A methodological appendix to the paper. Systematically reviewing qualitative and quantitative evidence to inform management and policy making in the health field. projects/pdf/msynth_appendix_e.pdf- 115.5KB

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Translation of studies into one another.
  • Transformation of parts into whole.
  • Development of theory to explain the range of findings encountered.

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how do we evaluate outputs of qualitative research
How Do We Evaluate Outputs of Qualitative Research?

Conceptual themes


Defensible in design

Rigorous in conduct

Credible in claim

Spencer, L., Ritchie, J., Lewis, J., Dillon, L. (2003). Quality in Qualitative Evaluation: A framework for assessing research evidence. Government Chief Social Researcher’s Office, Cabinet Office, United Kingdom.

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In advancing wider knowledge or understanding about policy, practice, theory or a particular substantive field.

Defensible in design…

By providing a research strategy that can address the evaluative questions posed.

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Rigorous in conduct…

Through the systematic and transparent collection, analysis and interpretation of qualitative data.

Credible in claim…

Through offering well-founded and plausible arguments about the significance of the evidence generated.

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evaluating qualitative studies






Internal validity



External validity

Evaluating Qualitative Studies

Malterud, K. 2001. Qualitative research: standards, challenges, and guidelines. The Lancet, 358, 483-488.

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theory and philosophy
Theory and Philosophy

"Application of nursing theory in practice depends on nurses having knowledge of the theoretical works as well as an understanding of how philosophies, models, and theories can relate to each other.“

Van Sell, S.L. & Kalofissudis, I.A. (2002). The Evolving Essence of the Science of Nursing: Complexity Integration Nursing Theory. E-Book retrieved on January 16, 2006 from

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philosophical framework
Philosophical Framework
  • Determines how reality is explained, the source of knowledge, and the perspective taken in research and practice.

Monti, E. J. & Tingen, M.S. (1999). Multiple Paradigms of Nursing Science [Nursing Theory for the 21st Century]. Advances in Nursing Science,21(4), 64-80.

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theoretical framework
Theoretical Framework
  • Influences how research questions are generated, studies are conducted, data are analysed, findings are understood, and results are used.

Alderson, P. (1998). Theories in health care and research: The importance of theories in health care.

BMJ, 317; 1007-1010.

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conceptual framework
Conceptual Framework
  • Brings theory into practice by organizing themes to form models, and operationalizing findings of synthesis.
  • Enables experience, reflection and wisdom as praxis, allowing practice to drive theory.

Warelow, P.J. (1997). A nursing journey through discursive practice. Journal of Advanced Nursing, 26, 1020-1027.

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person centred practice with older people
Person-Centred Practice with Older People
  • Hermeneutic philosophy guided development of theoretical and conceptual framework.
  • Theoretical frameworkofauthentic consciousness.

McCormack, B. (2003). Conceptual framework for person-centred practice with older people. International Journal of Nursing Practice, 9(3); 202-209.

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Conceptual framework of person-centrednessaddressed patient's and nurse's values within the context of a care environment.
  • Integrationof conversation analysis and reflective conversation for data collection and analysis.
  • Findings suggest nurses need to perceive the patient as an individual and articulate the mutual understanding and expectations in the relationship.

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why do meta synthesis
Why Do Meta-Synthesis?

Theory building

Theory explication

Theoretical development

Schreiber, R., Crooks, D.,&Stern, P. N. (1997). Qualitative meta-analysis. In J. M. Morse (Ed.), Completing a qualitative project (pp 311-326). Thousand Oaks, CA: Sage.

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quantitative viewpoint
Quantitative Viewpoint
  • Determine best practices.
  • Maximize outcomes with minimal expenditures.

Achieve best outcomes in the shortest amount of time at the lowest cost possible.

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concept of compliance newton 2004
Concept of Compliance:Newton (2004)

“At risk populations [for low rates of breastfeeding] include poorly educated, poverty-stricken, young African-American women. Unfortunately, the understanding of why these populations are noncompliant is rudimentary.”

Newton, E.R. (2004). The Epidemiology of Breastfeeding. Clinical Obstetrics & Gynecology,47(3):613-23.

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qualitative viewpoint
Qualitative Viewpoint
  • Strengthen the role of qualitative studies in health sciences research.
  • Improve applicability of qualitative research findings in clinical practice.
  • Build on a qualitative body of knowledge to inform theory, practice, research, and policy.

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concept of self regulation conrad 1985
Concept of Self-Regulation Conrad (1985)
  • Re-frames the medically defined problem of noncompliance.
  • Allows the modification of medication practice for asserting some clinical control over epilepsy.

Barbour, R.S. (2000). The role of qualitative research in broadening the `evidence base' for clinical practice. Journal of Evaluation in Clinical Practice, 6 (2), 155±163.

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Theoretically generalizable understanding of apparently illogical behaviour in a wide range of clinical and non-clinical contexts.
  • Childhood immunizations, observance of safer sex, and daily management of asthma and diabetes.

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steps in meta synthesis
Steps in Meta-Synthesis

1. Getting started. Identification of intellectual interest that qualitative research might inform.

2. Deciding what is relevant to initial interests and inclusion criteria for studies.

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3. Reading the studies. Not a one-time event. As the synthesis develops, studies are read and reread to check relevant metaphors and interpretations.

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4. Determining how the studies are related. Lists of key metaphors, phrases, ideas, or concepts and their relationships from each study and juxtaposed with those of other studies.

This phase is complete when an initial assumption about the relationship between studies can be made.

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5. Translation. Treating accounts in studies as analogies.

Translation maintains central metaphors and concepts in each study related to other metaphors or concepts in the same study.

Compares them to relevant metaphors and concepts from other studies in the form of analogy.

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6. Synthesizing translations.

Translations compared to determine if some metaphors and concepts encompass those from other studies.

If so, another level of synthesis is possible: analyzing competing interpretations and translating them into each other.

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7. Expressing the synthesis.

Meta ethnography must be translated into the language of intended audiences.

Clarity and transparency.

Concise and straightforward.

Noblit, G.W. & Hare, R.D. (1988). Meta-Ethnography: Synthesizing Qualitative Studies. Newbury Park, CA: Sage Publications, Inc.

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  • Extraction of findings from all studies in review.
  • Generation of comprehensive inventory of findings across studies.
  • Findings reduced to parsimonious list.
  • Frequency effect sizes calculated.

Sandelowski, M. & Barroso, J. (2003). Creating Metasummaries of Qualitative Findings. Nursing Research, 52(4), 226-233.

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  • Content analysis from meta findings used to identify patterns and themes common across studies.
  • Constant comparison analysis clarifies distinct, shared meanings.
  • Empirical results become foundation for metasynthesis.

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meta ethnography
  • Critical thinking and conceptual analysis occur simultaneously with insight, creativity and intuition.
  • Analogies and metaphors formed during interpretation become new knowledge and understanding.
  • Dynamic and “real time” self-awareness of the synthesis process is essential.

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types of meta ethnography
Types of Meta-Ethnography



Line of argument

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  • Translations directly comparable.
  • Iterative process – studies translated into each other.
  • Metaphors, themes, concepts, and organizers translated across studies.

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  • Interpretation designed to argue against another interpretation.
  • Explanation not of findings but significance of findings.
  • Exhibits beliefs and ways of arguing.
  • Promotes individual reflexivity.
  • Enriches critical discourse.

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line of argument
Line of Argument
  • Concerned with clinical inference and grounded theorizing.
  • Construction of an interpretation.
  • Involves two steps –
    • translation of studies into one another
    • development of grounded theory, putting similarities and differences between studies into an interpretive order

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  • Meta-synthesis is needed to build on the qualitative body of literature in healthcare.
  • Different philosophical and theoretical approaches result in different designs, analysis, and results.
  • Diversity in approaches to meta-synthesis is important for enlarging discourse.

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Generalization of theory across clinical situations and relationships is critical.
  • Bringing theory to practice, and practice to theory is possible.
  • Nursing is uniquely situated to pursue this methodological paradigm.

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UK Cochrane Centre