Abstract
Meta-synthesis or qualitative evidence synthesis (QES) is the counterpart of the meta-analysis, wherein the studies addressing qualitative research questions are systematically reviewed and synthesised. QES has a wide range of applications, particularly in fields where understanding complex human experiences, behaviours, and contexts are essential. QES facilitates in deciding the scope of outcomes relevant for the healthcare guidelines, assists the guideline development group in framing the recommendations, and guides the implementation of the interventions. The methodology of meta-synthesis and meta-analysis are similar till the stage of identification of the eligible studies, following all major steps of systematic reviews. This overview discusses the steps involved in undertaking the QES such as team formation, identification of research question, database search, screening of studies, data extraction, risk of bias assessment, commonly used synthesis methods, certainty assessment and the reporting guidelines. Tools and software used, challenges that are commonly encountered and the opportunities in the domain of QES are also explored in the review.
Keywords:
Qualitative evidence synthesis, meta-synthesis, systematic review, evidence-based medicine, thematic synthesis, meta-ethnographyReferences
. Gandhi AP, Shamim MA, Padhi BK. Steps in undertaking meta-analysis and addressing heterogeneity in meta-analysis. Evid. 2023;1:44–59.
. Ratnani I, Fatima S, Abid MM, Surani Z, Surani S. Evidence-Based Medicine: History, Review, Criticisms, and Pitfalls. Cureus. 2023;15:e35266.
. Sackett DL. Evidence-based medicine. Semin Perinatol. 1997;21:3–5.
. Carvalho G. Introduction of the Evidence synthesis: article type. Proceedings Biol Sci. 2018;285.
. Sharp MK, Tyner B, Awang Baki DAB, Farrell C, Devane D, Mahtani KR, et al. Evidence synthesis summary formats for clinical guideline development group members: a mixed-methods systematic review protocol. HRB Open Res. 2021;4:76.
. Cooper N, Germeni E, Freeman SC, Jaiswal N, Nevill CR, Sutton AJ, et al. New horizons in evidence synthesis for older adults. Age Ageing. 2023;52.
. Walsh D, Downe S. Meta-synthesis method for qualitative research: a literature review. J Adv Nurs. 2005;50:204–11.
. Chapter 21:. Qualitative evidence. Cochrane Training. [accessed December 20, 2024].https://training.cochrane.org/handbook/current/chapter-21#section-21-9
. Downe S, Finlayson KW, Lawrie TA, Lewin SA, Glenton C, Rosenbaum S, et al. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 1 – Using qualitative evidence synthesis to inform guideline scope and develop qualitative findings statements. Heal Res Policy Syst. 2019;17:76.
. Carroll C. Qualitative evidence synthesis to improve implementation of clinical guidelines. BMJ. 2017;356:j80.
. Flemming K, Booth A, Garside R, Tunçalp Ö, Noyes J. Qualitative evidence synthesis for complex interventions and guideline development: clarification of the purpose, designs and relevant methods. BMJ Glob Heal. 2019;4:e000882. https://doi.org/10.1136/bmjgh-2018-000882.
. Moberg J, Oxman AD, Rosenbaum S, Schünemann HJ, Guyatt G, Flottorp S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Heal Res Policy Syst. 2018;16:45. https://doi.org/10.1186/s12961-018-0320-2.
. Noyes J, Booth A, Moore G, Flemming K, Tunçalp Ö, Shakibazadeh E. Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: clarifying the purposes, designs and outlining some methods. BMJ Glob Heal. 2019;4:e000893. https://doi.org/10.1136/bmjgh-2018-000893.
. Rehfuess EA, Stratil JM, Scheel IB, Portela A, Norris SL, Baltussen R. The WHO-INTEGRATE evidence to decision framework version 1: integrating WHO norms and values and a complexity perspective. BMJ Glob Heal. 2019;4:e000844. https://doi.org/10.1136/bmjgh-2018-000844.
. Booth A, Moore G, Flemming K, Garside R, Rollins N, Tunçalp Ö, et al. Taking account of context in systematic reviews and guidelines considering a complexity perspective. BMJ Glob Heal. 2019;4:e000840. https://doi.org/10.1136/bmjgh-2018-000840.
. World Health Organization. Guide to qualitative evidence synthesis. Copenhagen:. 2021.
. Lewin S, Glenton C, Lawrie TA, Downe S, Finlayson KW, Rosenbaum S, et al. Qualitative Evidence Synthesis (QES) for Guidelines: Paper 2 – Using qualitative evidence synthesis findings to inform evidence-to-decision frameworks and recommendations. Heal Res Policy Syst. 2019;17:75. https://doi.org/10.1186/s12961-019-0468-4.
. Thomson G, Feeley C, Moran VH, Downe S, Oladapo OT. Women’s experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review. Reprod Health. 2019;16:71. https://doi.org/10.1186/s12978-019-0735-4.
. WHO. Recommendations on antenatal care for a positive pregnancy experience [Internet]. [accessed January 15, 2025]. https://www.who.int/publications/i/item/9789241549912
. Ames HMR, Glenton C, Lewin S. Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev. 2017;2(2):CD011787.
. Downe S, Finlayson K, Tunçalp Ӧ, Metin Gülmezoglu A. What matters to women: a systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women. BJOG. 2016;123:529–39.
. Downe S, Finlayson K, Oladapo OT, Bonet M, Gülmezoglu AM. What matters to women during childbirth: A systematic qualitative review. PLoS One. 2018;13:e0194906.
. WHO. Recommendations on digital interventions for health system strengthening n d. [Internet]. [accessed January 15, 2025]. https://www.who.int/publications/i/item/9789241550505
. World Health Organization. WHO recommendations Intrapartum care for a positive childbirth experience 2018. [Internet]. [accessed January 15, 2025].
. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.
. Noblit GW, Hare RD. Meta-ethnography: Synthesizing qualitative studies. SAGE Publications;. 1988.
. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82:581–629.
. Gough D, Oliver S, Thomas J. An introduction to systematic reviews. SAGE Publications;. 2017.
. Hannes K. Synthesizing Qualitative Research: Choosing the Right Approach. 2012.
. Pearson A, White H, Bath-Hextall F, Salmond S, Apostolo J, Kirkpatrick P. A mixed-methods approach to systematic reviews. Int J Evid Based Healthc. 2015;13:121–31.
. Hosseini M-S, Jahanshahlou F, Akbarzadeh MA, Zarei M, Vaez-Gharamaleki Y. Formulating research questions for evidence-based studies. J Med Surgery, Public Heal. 2024;2:100046.
. Pieper D, Rombey T. Where to prospectively register a systematic review. Syst Rev. 2022;11:8.
. Systematic Review Protocols and Protocol Registries. NIH Library [Internet]. [accessed June 16, 2023]. https://www.nihlibrary.nih.gov/services/systematic-review-service/systematic-review-protocols-and-protocol-registries
. York University. PROSPERO. [Internet]. [accessed January 6, 2023]. https://www.crd.york.ac.uk/prospero/
. Booth A, Stewart L. Trusting researchers to use open trial registers such as PROSPERO responsibly. BMJ. 2013;347:f5870.
. Welcome. Embase [Internet]. [accessed January 18, 2023]. https://www.embase.com/landing?status=yellow
. ProQuest. Better research, better learning, better insights [Internet]. [accessed January 18, 2023]. https://www.proquest.com/
. EBSCOhost Research Platform. EBSCO [Internet]. [accessed January 18, 2023].https://www.ebsco.com/products/ebscohost-research-platform
. CINAHL Complete. EBSCO [Internet]. [accessed January 18, 2023]. https://www.ebsco.com/products/research-databases/cinahl-complete
. Scopus preview. Scopus - Welcome to Scopus n d.[Internet]. [accessed January 18, 2023]. https://www.scopus.com/
. Ovid. Welcome to Ovid Internet]. [accessed January 18, 2023]. https://ovidsp.ovid.com/
. Clarivate. [Internet]. [accessed January 18, 2023]. https://access.clarivate.com/login?app=wos&alternative=true&shibShireURL=https:%2F%2Fwww.webofknowledge.com%2F%3Fauth%3DShibboleth&shibReturnURL=https:%2F%2Fwww.webofknowledge.com%2F&roaming=true
. APA. PsycInfo [Internet]. [accessed January 18, 2023]. https://www.apa.org/pubs/databases/psycinfo
. Booth A, Sutton A, Papaioannou D. Systematic approaches to a successful literature review. 2nd ed. Lodon: SAGE Publications Ltd;. 2016.
. Wilczynski NL, Marks S, Haynes RB. Search strategies for identifying qualitative studies in CINAHL. Qual Health Res 2007;.17:705–10.
. Walters LA, Wilczynski NL, Haynes RB. Developing optimal search strategies for retrieving clinically relevant qualitative studies in EMBASE. Qual Health Res. 2006;16:162–8.
. Wong SS-L, Wilczynski NL, Haynes RB. Developing optimal search strategies for detecting clinically relevant qualitative studies in MEDLINE. Stud Health Technol Inform. 2004;107:311–6.
. McKibbon KA, Wilczynski NL, Haynes RB. Developing optimal search strategies for retrieving qualitative studies in PsycINFO. Eval Health Prof. 2006;29:440–54.
. Booth A. Question formulation and Searching for qualitative evidence n.d.
. Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, et al. PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Syst Rev. 2021;10:39.
. Frandsen TF, Gildberg FA, Tingleff EB. Searching for qualitative health research required several databases and alternative search strategies: a study of coverage in bibliographic databases. J Clin Epidemiol. 2019;114:118–24.
. arXiv.org e-Print archive [Internet]. [accessed January 18, 2023]. https://arxiv.org/
. Homepage ChemRxiv. Cambridge Open Engage [Internet]. [accessed January 18, 2023]. https://chemrxiv.org/engage/chemrxiv/public-dashboard
. Home. SSRN [Internet]. [accessed January 18, 2023]. https://www.ssrn.com/index.cfm/en/
. medRxiv-org. the preprint server for Health Sciences [Internet]. [accessed January 18, 2023]. https://www.medrxiv.org/
. bioRxiv-org. the preprint server for Biology [Internet]. [accessed January 18, 2023]. https://www.biorxiv.org/
. Handsearching. Systematic Reviews in the Health Sciences - Research Guides at Rutgers University [Internet]. [accessed January 18, 2023]. https://libguides.rutgers.edu/c.php?g=337288&p=2269575
. Vassar M, Atakpo P, Kash MJ. Manual search approaches used by systematic reviewers in dermatology. J Med Libr Assoc. 2016;104:302–304–302–304.
. Flemming K, Noyes J. Qualitative evidence synthesis: where are we at?. Int J Qual Methods. 2021;20:1609406921993276.
. Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol .2012;12:181.
. ATLAS ti. The #1 Software for Qualitative Data Analysis - ATLAS-ti n d. [internet]. [accessed December 25, 2024]. https://atlasti.com/
. NVivo. Leading Qualitative Data Analysis Software (QDAS) by Lumivero n d. [internet]. [accessed December 25, 2024]. https://lumivero.com/products/nvivo/
. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.
. Lewin S, Hendry M, Chandler J, Oxman AD, Michie S, Shepperd S, et al. Assessing the complexity of interventions within systematic reviews: development, content and use of a new tool (iCAT_SR). BMC Med Res Methodol .2017;17:76.
. Carroll C, Booth A, Cooper K. A worked example of “best fit” framework synthesis: a systematic review of views concerning the taking of some potential chemopreventive agents. BMC Med Res Methodol. 2011;11:29.
. Carroll C, Booth A, Leaviss J, Rick J. “Best fit” framework synthesis: refining the method. BMC Med Res Methodol. 2013;13:37.
. CASP Checklist:. CASP Qualitative Studies Checklist [internet]. [accessed December 25, 2024]. https://casp-uk.net/casp-tools-checklists/qualitative-studies-checklist/
. COREQ. (COnsolidated criteria for REporting Qualitative research) Checklist n d.[internet]. [cited 2024 Dec 22]. https://onlinelibrary.wiley.com/pb-assets/assets/17416612/COREQ_Checklist-1556513515737.pdf
. JBI. Critical Appraisal Checklist for Qualitative Research [internet]. [cited 2024 Dec 22]. https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Qualitative_Research2017_0.pdf.
. Mays N, Pope C. Qualitative research in health care Assessing quality in qualitative research. BMJ .2000;320:50–2.
. Nested Knowledge. Transforming the systematic review and meta-analysis paradigm from static out-of-date PDFs to dynamic living, interactive web-based visuals n d. [internet]. [accessed December 25, 2024]. https://about.nested-knowledge.com/
. EasySLR. Fly Through Reviews EasySLR [internet]. [cited 2024 Dec 25]. https://www.easyslr.com/
. Oliver SR, Rees RW, Clarke-Jones L, Milne R, Oakley AR, Gabbay J, et al. A multidimensional conceptual framework for analysing public involvement in health services research. Heal Expect an Int J Public Particip Heal Care Heal Policy. 2008;11:72–84.
. Booth A, Noyes J, Flemming K, Gerhardus A, Wahlster P, van der Wilt GJ, et al. Structured methodology review identified seven (RETREAT) criteria for selecting qualitative evidence synthesis approaches. J Clin Epidemiol .2018;99:41–52.
. Lewin S, Booth A, Glenton C, Munthe-Kaas H, Rashidian A, Wainwright M, et al. Applying GRADE-CERQual to qualitative evidence synthesis findings: introduction to the series. Implement Sci. 2018;13:2.
. Isoq. Interactive Summary of Qualitative Findings [internet]. [cited 2025 Jan 28]. https://isoq.epistemonikos.org/
. Wager E, Wiffen PJ. Ethical issues in preparing and publishing systematic reviews. J Evid Based Med. 2011;4:130–4.
. Indian Council of Medical Research (ICMR). Ethical Requirements for Systematic Review & Meta-analysis Proposals. An Addendum to ICMR National Ethical Guidelines for Biomedical and Health Research Involving Human Participants 2017. 2024.
. Duden GS. Challenges to qualitative evidence synthesis – Aiming for diversity and abstracting without losing meaning. Methods Psychol 2021;5:100070. https://doi.org/https://doi.org/10.1016/j.metip.2021.100070.
. Muller AE, Berg RC, Meneses-Echavez JF, Ames HMR, Borge TC, Jardim PSJ, et al. The effect of machine learning tools for evidence synthesis on resource use and time-to-completion: protocol for a retrospective pilot study. Syst Rev .2023;12:7.
. Akl EA, Meerpohl JJ, Elliott J, Kahale LA, Schünemann HJ. Living systematic reviews: 4. Living guideline recommendations. J Clin Epidemiol 2017;91:47–53. https://doi.org/10.1016/j.jclinepi.2017.08.009.
. Carmona C, Carroll C, Baxter S. The move towards living systematic reviews and living guidelines in healthcare: consideration of the possibilities and challenges for living qualitative evidence syntheses. Syst Rev. 2023;12:47.
. World Health Organization. Living guidance for clinical management of COVID-19: living guidance, 23 November 2021. World Health Organization. 2021.
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