Framework Synthesis, Meta-Ethnography and Realist

9.45 am Introducing Three QES
Methods – Framework Synthesis,
Meta-Ethnography and Realist
Drs Andrew Booth and Chris Carroll
Framework for systematic reviews of qualitative research (Garside,
Typical activities
Developing research question
Assemble team; Consult; Agree approach
Scoping exercise
Identify relevant research; Refine methods
Identifying relevant literature
Develop Inclusion/Exclusion criteria; Focused searches;
Citation searches
Initial assessment of study reports
Preliminary reading; Identify theories; Assess
Analysis and synthesis
Reading & rereading study reports; Constant
comparison; Assess validity
Preliminary synthesis Categorising; tabulating; mindmaps; Explore
Full synthesis Thematic analysis; translation of findings; Theory
development; rival explanations
Target audiences; Limitations of review
Multiple viewpoints; Reflexivity; Audit trail; Ongoing
consultation; revisit review purpose
Three QES Methods……..
Best Fit Framework Synthesis
A Framework
How do you create a framework?
 Develop own framework or themes or concepts
for coding
 Oliver S et al: A multidimensional conceptual framework for analysing
public involvement in health services research. Health Expectations 2008,
 Brunton G, Oliver S, Oliver K, Lorenc T. A Synthesis of Research Addressing
Children’s, Young People’s and Parents’ Views of Walking and Cycling for
Transport London. London, EPPI-Centre, Social Science Research Unit,
Institute of Education, University of London; 2006.
 Identify or create a thematic framework or
conceptual model
 Carroll C, Booth A, Cooper K. A worked example of “best-fit” framework
synthesis: A systematic review of views concerning the taking of potential
chemopreventive agents, BMC Medical Research Methodology 2011; 11:
An existing conceptual framework
Conrad K, et al (1996). The worksite environment as a cue to smoking reduction. Research
in Nursing & Health, 19 21-31.
A Framework
Thematic synthesis
Framework synthesis
• Why look at meta-ethnography?
– Most common and longest established QES method
– Hannes K, Macaitis K. A move to more systematic and transparent
approaches in qualitative evidence synthesis: update on a review of
published papers, Qualitative Research, 2012; 12: 402-442.
• What do we mean by meta-ethnography?
• How do you complete the stages of metaethnography?
“... involves taking relevant empirical studies to be synthesised,
reading them repeatedly and noting down key concepts
(interpretive metaphors). These key concepts are the raw data
for the synthesis. Noblit and Hare suggested that the process
by which a synthesis is achieved is one of translation. This
entails examining the key concepts in relation to others in the
original study and across studies ... The purpose of the
translation is to try to derive concepts that can encompass
more than one of the studies being synthesised. The
synthesised concepts may not have been explicitly identified
in any of the original empirical studies”
Campbell R et al. Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research,
HTA 2011; 15: 43
Noblit GW, Hare RD. Meta-Ethnography: Synthesising Qualitative Studies. Newbury Park (CA): Sage
Publications, 1988
Conducting a meta-ethnography (Atkins et
al 2008)
Step 1: Getting started
Step 2: Deciding what is relevant to the initial interest
Step 3: Reading the studies
Step 4: Determining how studies are related
Step 5: Translating studies into one another
Step 6: Synthesising translations
Step 7: Expressing the synthesis
Meta-ethnography: 7 phases
Phase 1: Getting started
Phase 2: Describing what is relevant to initial interest
Phase 3: Reading the studies – repeated reading and
noting of concepts or metaphors
Phase 4: Determining how studies are related – task of
creating a list of key metaphors, phrases, ideas or
concepts (and their relations) used in each account,
and juxtaposing them. Leads to initial assumptions
about relations between studies, e.g. Are they related?
Are they answering the same question, considering the
same problem, from the same perspective?
Meta-ethnography: 7 phases
Phase 5: Translating the studies into one another – the
metaphors and/or concepts in each account and their
interactions are compared with the metaphors and/or
concepts and their interactions in other accounts. First
level of meta-ethnographic synthesis.
Phase 6: Synthesizing translations – unique
metaphors/concepts or one able to encompass those
of other accounts, which are able to produce a new
interpretation/conceptual development.
Phase 7: Expressing the synthesis – communication of
findings that takes account of the intended audience’s
own culture and its concepts and language.
Realist Synthesis
In a nutshell, realist synthesis…
• Configures beginning theory to explain “what
works for whom in what circumstances and in
what respects” (Pawson, 2006, p.74)
• Configures Contexts, Mechanisms and
Outcomes (CMO configurations)
• E.g. Hospital league tables cp. School league
tables, Surgeon performance tables
CMO Configurations
Example CMO Configurations
Example CMO Configurations
e.g. Different
effect sizes
change on
e.g. Explanations for
employee motivation
“We had low morale
Realist synthesis can
• Discover weak links in an “implementation
chain” (critical success factors)
• Adjudicate between rival theories
• Identify contextual factors leading to
improved or impaired effectiveness
• Compare anticipated performance with actual
Steps in a realist synthesis – Iterative!
Identify review questions
Search for primary studies
Extract data &
appraise evidence
Synthesise findings
Sounds easy doesn’t it?
Now select you preferred workshop
choices (1st and 2nd)
A.Best Fit Framework Synthesis
B. Meta-Ethnography
C. Realist Synthesis
And to Coffee Break……..

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