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What is Metasynthesis?
Metasynthesis is a type of systematic review which synthesizesqualitative researchfindings from individual studies to generate new interpretations and advance a field of knowledge.
Metasynthesis is considered original research and uses previously published qualitative research reports as its database.
Although considered analogous toquantitative meta-analysis, metasynthesis has developed its own dimensions and directions.
There is, however, lively debate and disagreement regarding the appropriate methods for conducting metasynthesis and the types of conclusions drawn.
Purpose
Metasynthesis interprets, evaluates, and presents the similar and different aspects of the findings of qualitative studies in a particular field.
The outcomes often include theory development, higher-level abstraction, generalizability, and new knowledge development.
When is Metasynthesis Appropriate?
Qualitative metasynthesis is appropriate to answer research questions about human experiences when multiple qualitative studies on the topic are available.
The goal is to use a structured, transparent, and auditable method to advance knowledge in a field of study.
Qualitative metasynthesis is best suited to reinterpret meaning and generate new theories or explanations of interventions based on findings from multiple high-quality qualitative studies.
Conducting Qualitative Metasynthesis Research
Step 1: Formulating a Research Question for Qualitative Metasynthesis
The first step in any research project, including a qualitative metasynthesis, isposing a question. Although this sounds straightforward, it is a critical and nuanced process.
This question should be broad enough to be interesting but focused enough to be manageable.
As the researcher becomes more familiar with the body of literature, they can refine their question to guide them toward meaningful decisions about what to include in the metasynthesis.
Examples
Step 2: Conducting a Systematic Literature Search
The next step is to conduct a systematic search of the qualitative literature using clearly defined search terms and databases.
This may include searching electronic databases, reviewing reference lists of relevant articles, and contacting experts in the field.
It’s important to be transparent about the search strategy and document all decisions for auditability. The goal is to identify all potentially relevant studies for consideration.
BothSTARLITE(Standards for Reporting Literature searches) andPRISMA(Preferred Reporting Items for Systematic reviews and Meta-Analyses) provide appropriate guidance for reporting qualitative literature searches.
Information Sources
To capture as much available data within certain parameters, an inclusivesearch strategyis recommended.
Specify all databases, registers, websites, organisations, reference lists and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted.
Anexhaustive, systematic search strategyis developed with the assistance of an expert librarian.
It is important to note that this may not be an exhaustive list of all potential databases.
Search Strategy
Present the full search strategies for all databases, registers and websites, including any filters and limits used.
When conducting these searches, it is important to combine browsing of texts (publications) with periods of more focused systematic searching. This iterative process allows the search to evolve as the review progresses.
It is important to note that this information may not be entirely comprehensive and up-to-date. You may want to consult other sources for more information and to confirm the accuracy of this information.
Step 3: Screening and Selecting Appropriate Research Articles
Once the literature search is complete, the next step is to screen and select the studies that will be included in the metasynthesis.
This involves carefully reviewing each study to determine its relevance to the research question and its methodological quality.
The goal is to identify studies that are both relevant to the research question and of sufficient quality to contribute to a meaningful synthesis.
Eligibility criteria
Specify the inclusion and exclusion criteria for the review.
Eligibility criteria are a set of predefined characteristics used to determine which studies will be included or excluded from a metasynthesis.
These criteria are based on the research question and the specific goals of the metasynthesis. Clearly defining and specifying the eligibility criteria is essential to ensure that the included studies are relevant, appropriate, and able to contribute to the metasynthesis findings.
For example, researchers might choose to focus on a specific population group, a particular time period, or studies employing specific qualitative research methods.
Selection Process
Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.
The selection process in qualitative metasynthesis involves multiple reviewers to ensure rigor and reliability.
Two reviewers should independently screen titles and abstracts, removing duplicates and irrelevant studies based on predefined inclusion and exclusion criteria.
Step 4: Evaluating the Quality of Studies
Data collection process
Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.
To gather data for the metasynthesis, researchers identify themes and findings already presented in the qualitative research reports included in the review.
Data extraction focuses on information relevant to the research question, such as risk or recovery factors related to a particular phenomenon.
Data is extracted from the findings, discussion, and conclusions of each primary study, including participant quotes and the authors’ interpretations.
It can be useful to focus on the authors’ interpretations of findings rather than individual participant quotes, as the latter lacks the full context of the original data.
Quality Appraisal Tools
Both the CASP and QARI tools provide structured approaches to assessing the quality of qualitative studies, helping researchers to make informed decisions about which studies to include in their metasynthesis.
By using these tools, researchers can ensure that the studies included in their analysis are of high quality and contribute meaningful insights to the overall synthesis.
Researchers use tools like theCritical Appraisal Skills Programme(CASP)to assess the quality of the qualitative studies included in the metasynthesis.
TheCochrane Collaboration,a global independent network of researchers, professionals, and patients, recommends the use of CASP for appraising qualitative studies included in systematic reviews and metasyntheses.
Another quality appraisal tools for meta-synthesis is theQualitative Appraisal and Review Instrument(QARI).
Other quality appaisal tools include:Consolidated Criteria for Reporting Qualitative Research(COREQ), andEvaluation Tool for Qualitative Studies(ETQS).
Step 5: Extract Data, Including as Themes, Concepts, or Quotes
This step is critical, as it lays the foundation for the subsequent analysis and synthesis of the findings.
The focus during data extraction is identifying and documenting key concepts, themes, or interpretations from each study relevant to the metasynthesis research question.
The following strategies can be used for data extraction:
Automation Tools
The extracted data should be organized in a way that facilitates the subsequent analysis and synthesis process, such as using a spreadsheet, qualitative data analysis software, or a structured summary table.
Researchers might record this extracted data using tools like Microsoft Excel spreadsheets. Researchers often use qualitative analysis software like NVivo to organize and code extracted information.
This helps manage the large volume of data from multiple sources.
It is important to strike a balance between capturing the relevant data and maintaining the context and richness of the original studies.
The data extraction process should be iterative, allowing for refinement and modification as the metasynthesis progresses and new insights emerge.
Step 6: Synthesizing Findings
Develop a new interpretation: Synthesize the findings to generate a new understanding or theory that goes beyond the individual studie
The goal of the synthesis step is to produce a meaningful, integrated understanding of the phenomena that goes beyond the sum of its parts.
This involves a thorough analysis of the contextual factors influencing the original studies and carefully considering the relationships between different concepts and themes.
It’s important to note that the synthesis process is iterative and may require multiple rounds of analysis and refinement to arrive at a coherent and well-supported interpretation of the data.
While there’s no standardized protocol, the qualitative synthesis methods often borrow from grounded theory, meta-ethnography, and meta-study:
Meta-ethnography
Meta-ethnographyuses a systematic process of comparing conceptual data from different qualitative studies to uncover overarching concepts, theories, and models that go beyond what each individual study could reveal on its own.
The ultimate aim of meta-ethnography is to createnew interpretationsrather than just summarizing the findings of the collected studies. This sets it apart from other qualitative synthesis methods that may focus on aggregating findings without necessarily seeking to build new understanding.
This process aims to preserve the original context and meaning of each study’s findings while also allowing for comparison and the development of new insights.
Noblit and Hare, who developed meta-ethnography, outlined aseven-stage process.
Grounded Theory
By applyinggrounded theoryto a qualitative metasynthesis, researchers can move beyond a simple aggregation of findings and generate a higher-level understanding of the phenomena being studied.
This approach allows for the development of new theories or the refinement of existing ones based on the collective findings of multiple qualitative studies.
Meta-Study
A meta-study involves the systematic analysis of a collection of related studies, with the aim of identifying common themes, patterns, and conclusions across the included research.
When applied to a metasynthesis, a meta-study can help to further synthesize and integrate the findings that have already been identified through the metasynthesis process.
The researcher moves beyond the individual findings and themes identified in the primary sources and works to integrate and synthesize them into a coherent, higher-level understanding of the phenomena under study.
This process involves examining the relationships, patterns, and connections between the various themes and concepts, and considering how they contribute to a more comprehensive understanding of the research topic.
Step 7: Present Synthesis of Findings Across Studies
When presenting the synthesis of findings across studies, consider the audience and use visuals such as charts, tables, and figures to represent the findings graphically.
Numbers can also be used, but it is important to present rich descriptions of the data, quotations, and the development of the conceptual model or working hypotheses drawn from the integration.
Disseminate the results: Share the metasynthesis findings through publications, presentations, or other means to contribute to the broader understanding of the topic.
Reporting Guidelines
PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is a widely used reporting guideline for systematic reviews and meta-analyses of quantitative studies.
Although primarily intended for quantitative research synthesis, certain aspects of PRISMA, such as guidelines for reporting literature searches and selection strategies, can be applied to qualitative evidence synthesis as well.
However, PRISMA is not designed to address the specific reporting requirements of qualitative synthesis methods like meta-ethnography
eMERGe(enhancing Meta-Ethnography Reporting Guidance) is a reporting guideline specifically designed for meta-ethnography.
This type of qualitative synthesis uses interpretive methods to translate findings from multiple studies into a new, overarching understanding of a phenomenon.
Because of the unique interpretive processes involved, generic guidelines for qualitative synthesis, like ENTREQ, are insufficient for meta-ethnography, as they don’t address the complex analytical synthesis phases.
eMERGe was developed to address this gap and to improve the transparency and completeness of meta-ethnography reporting.
Ensuring Validity and Reliability
Ensuring the validity and reliability of a metasynthesis is crucial for producing high-quality, trustworthy findings that can contribute to the advancement of knowledge in a field.
1. Transparency and Rigor in Reporting
Transparency in reporting is essential for ensuring the validity and reliability of a metasynthesis.
Researchers should provide a clear and detailed description of their methods, including the search strategy, inclusion and exclusion criteria, quality appraisal process, and data analysis techniques.
This transparency allows other researchers to assess the rigor of the metasynthesis and replicate the study if needed.
Researchers should also be transparent about their decision-making processes throughout the synthesis, such as how they resolved disagreements among the research team or how they handled conflicting findings from different studies.
Providing a clear audit trail of the research process enhances the credibility and trustworthiness of the metasynthesis findings.
Strategies for Achieving Transparency and Rigor:
2. Use of Established Methods
Using established, well-recognized methods for conducting a metasynthesis can help ensure its validity and reliability.
These established methods provide a structured framework for conducting the synthesis, including guidelines for formulating the research question, searching and selecting studies, appraising study quality, extracting and analyzing data, and presenting the findings.
By adhering to these established methods, researchers can ensure that their metasynthesis is conducted in a rigorous and standardized manner, enhancing its validity and reliability.
3. Reflexivity of Researchers
Reflexivityis a critical aspect of ensuring the validity and reliability of a metasynthesis. Researchers should be aware of their own background, assumptions, and biases and how these may influence their interpretations and conclusions.
Engaging in reflexivity involves continuously examining one’s own role in the research process, questioning one’s assumptions, and considering alternative explanations for the findings.
Researchers should document their reflexive processes, such as keeping a reflexive journal or engaging inpeer debriefing, to enhance the transparency and trustworthiness of the metasynthesis.
Reflexivity also involves being open to alternative interpretations and seeking out disconfirming evidence that may challenge one’s initial conclusions.
By actively engaging in reflexivity throughout the synthesis process, researchers can minimize the influence of their own biases and ensure that the findings are grounded in the data rather than their preconceptions.
Considerations for Reflexivity:
Reviewers conducting a metasynthesis should explicitly describe the influence of these factors on their conclusions.
For instance, if a large number of studies were synthesized, the reviewers should detail how they preserved conceptual richness and remained grounded in the data, such as translating studies in smaller clusters.
Advanages
Qualitative metasynthesis offers a valuable approach to strengthening and deepening the understanding of a particular field of study, such as early childhood intervention.
This systematic process of analyzing and interpreting data across qualitative studies provides a unique and important contribution to bridging the gap between research and practice1.
Advantages Over Other Research Methods:
Disadvantages
Further Reading
Example Metasynthesis Studies
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
