meta synthesis literature review example

Meta-synthesis method for qualitative research: a literature review

Affiliation.

• 1 Department of Midwifery, Faculty of Health, University of Central Lancashire, Preston PR1 2HE, UK. [email protected]
• PMID: 15788085
• DOI: 10.1111/j.1365-2648.2005.03380.x

Aim: This paper discusses the purpose and stages of meta-synthesis and the epistemological status of knowledge generated from the technique. Particular attention is paid to exploring the contested areas of the method that remain.

Background: There is a growing interest in meta-synthesis as a technique for generating new insights and understanding from qualitative health care research. An increasing number of meta-synthesis papers are appearing in the nursing and midwifery literature.

Methods: Literature on the technique of meta-synthesis and examples of meta-synthesis papers were searched and reviewed. A meta-synthesis exercise was undertaken, and this informed reflection and critique of the method.

Findings: Meta-synthesis attempts to integrate results from a number of different but inter-related qualitative studies. The technique has an interpretive, rather than aggregating, intent, in contrast to meta-analysis of quantitative studies. Examples from the literature indicate that some aspects of the technique are not yet fully established.

Conclusion: Despite the contingent nature of evidence gleaned from meta-synthesis and current lack of consensus about some of its aspects, meta-synthesis is an important technique for qualitative researchers and can deepen understanding of the contextual dimensions of health care.

Publication types

• Data Interpretation, Statistical
• Meta-Analysis as Topic*
• Nursing Research / methods*
• Qualitative Research*
• Review Literature as Topic

• Research article
• Open access
• Published: 08 January 2021

Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis

• Raabia Sattar   ORCID: orcid.org/0000-0002-1003-9772 1 , 2 ,
• Rebecca Lawton 1 , 2 ,
• Maria Panagioti 3 &
• Judith Johnson 1 , 2  

BMC Health Services Research volume  21 , Article number:  50 ( 2021 ) Cite this article

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Qualitative synthesis approaches are increasingly used in healthcare research. One of the most commonly utilised approaches is meta-ethnography. This is a systematic approach which synthesises data from multiple studies to enable new insights into patients’ and healthcare professionals’ experiences and perspectives. Meta-ethnographies can provide important theoretical and conceptual contributions and generate evidence for healthcare practice and policy. However, there is currently a lack of clarity and guidance surrounding the data synthesis stages and process.

This paper aimed to outline a step-by-step method for conducting a meta-ethnography with illustrative examples.

A practical step-by-step guide for conducting meta-ethnography based on the original seven steps as developed by Noblit & Hare (Meta-ethnography: Synthesizing qualitative studies.,1998) is presented. The stages include getting started, deciding what is relevant to the initial interest, reading the studies, determining how the studies are related, translating the studies into one another, synthesising the translations and expressing the synthesis.

We have incorporated adaptations and developments from recent publications. Annotations based on a previous meta-ethnography are provided. These are particularly detailed for stages 4–6, as these are often described as being the most challenging to conduct, but with the most limited amount of guidance available.

Meta-ethnographic synthesis is an important and increasingly used tool in healthcare research, which can be used to inform policy and practice. The guide presented clarifies how the stages and processes involved in conducting a meta-synthesis can be operationalised.

Peer Review reports

The range of different methods for synthesising qualitative research has grown in recent years [ 1 ]. There are now a number of different qualitative synthesis methods including qualitative meta-synthesis, narrative synthesis, thematic synthesis, interpretative synthesis, grounded theory and meta-ethnography. A qualitative synthesis is defined as ‘any methodology whereby study findings are systematically interpreted through a series of expert judgements to represent the meaning of the collected work’ [ 2 ] .. In a qualitative synthesis the findings of qualitative studies are pooled [ 2 ] . The use of some types of qualitative syntheses allow for the inclusion of mixed-methods and quantitative research studies alongside qualitative studies. A qualitative synthesis approach can be used to examine the available literature, and review and integrate the primary research studies related to a specific question or phenomenon, to reveal deeper insights or explanations that would not be possible from a single study [ 3 ]. The various qualitative synthesis approaches mentioned above differ in their purposes, philosophical traditions and whether they primarily aggregate or re-interpret the study findings [ 4 , 5 ]. Meta-ethnography is an inductive, interpretative approach upon which most interpretative qualitative synthesis methods are based [ 6 ] and is the most commonly utilised qualitative synthesis approach in healthcare research [ 7 ].

Meta-ethnography is particularly suited to developing conceptual models and theories [ 8 ]. This method of qualitative synthesis is often chosen over alternative approaches as it is more suitable for the development of analytical rather than descriptive findings [ 9 ]. A meta-ethnography differs from other qualitative synthesis approaches as the reviewer re-interprets the conceptual data (themes, concepts or metaphors) created by the authors of the primary study whilst taking into account the primary data (participant quotes) using a unique translation synthesis method in order to transcend the findings of individual study accounts and create higher order themes [ 10 , 11 ]. Meta-ethnographic reviews offer greater description of methods and higher order interpretation compared to conventional narrative literature reviews [ 12 ]. In health sciences, meta-ethnographies can be used to generate evidence for healthcare and policy [ 13 ]. A meta-ethnographic synthesis approach is suitable when researchers are interested in conceptual or theoretical understandings of a particular phenomenon. Unlike some qualitative synthesis approaches which allow the inclusion of mixed-methods design studies (such as thematic synthesis and interpretative synthesis), a meta-ethnographic approach enables only the inclusion of qualitative studies. A meta-ethnography can include multiple study designs, whereas other approaches such as grounded theory require only the inclusion of similar study approaches [ 14 ].

Although meta-ethnography is a widely used qualitative literature synthesis method within healthcare research, it is poorly demarcated and there is a lack of clarity surrounding the description of the data analysis process. A number of reviews have used this approach [ 15 , 16 , 17 , 18 , 19 , 20 ] but do not provide a fully rigorous description of the stages involved in the analysis process. Given the value of qualitative meta-synthesis in integrating the findings from multiple studies into a higher conceptual level, it is important to provide detailed guidance on each of the steps involved in conducting a meta-ethnography. This paper aims to fill this gap by outlining a step-by-step method for conducting meta-ethnography. We describe our interpretation of each of the seven steps outlined by Noblit & Hare [ 10 ] who first proposed this approach. We also incorporate adaptations and developments by recent researchers [ 21 ] and provide annotations where applicable to assist in describing the stages involved.

The worked example we are using is a published meta-ethnography (reference and author names omitted for author anonymity during peer review). Where applicable, illustrative examples from this review are provided alongside the each phase to demonstrate the process.

Within a meta-ethnographic synthesis, the process of translation is key and unique. It is defined as ‘comparing the metaphors and concepts in one account with the metaphors and concepts in others’ [ 10 ]. A meta-ethnography should involve a reciprocal and refutational translation, where possible combined with a line of argument synthesis [ 22 , 23 ]. Reciprocal translation occurs when concepts in one study can incorporate those of another [ 22 ], whereas a refutational translation explains and explores differences, exceptions, incongruities and inconsistencies [ 1 , 22 , 24 ]. Reviewers often overlook refutational translation [ 24 , 25 ]; however studies may refute each other [ 26 , 27 ] or concepts within studies may refute one another [ 27 , 28 ]. Therefore it may be possible to conduct both a reciprocal and refutational translation [ 22 ]. A line of argument synthesis is not an alternative to conducting a translation but is viewed as the next stage of analysis [ 23 ]. A line of argument synthesis is the translation of accounts that interpret different aspects of the same phenomenon under study, which results in producing a whole that is greater than the sum of its individual parts [ 10 , 15 ]. Although Noblit & Hare [ 10 ] describe meta-ethnography as a seven step process, it is important to acknowledge that this process is iterative and the phases are not discrete but may overlap and run in parallel [ 10 ]. A meta-ethnography reporting tool, eMERGE has very recently been developed, and provides a framework for reviewers to follow when reporting the important aspects of a meta-ethnography [ 22 ].

In order to identify relevant literature to inform the present guide, we searched for articles which described an evaluation or discussed methodological issues in conducting a meta-ethnography or provided guidance for reporting a meta-ethnography. We then scanned the reference lists of relevant articles to identify further relevant literature. We also drew on the results from two recent systematic reviews [ 23 , 29 ]. As such, while the searches conducted for the present article were not systematic, the guide reflects recent methodological recommendations in the wider methodological literature. All relevant articles were read and recommendations were noted; where any disagreement between authors of papers was apparent, guidance which was based on systematic reviews of the evidence rather than individual reflections was prioritised.

Doing a meta-ethnographic synthesis: a step-by-step guide with illustrated examples

Phase 1: getting started.

The initial stage requires the authors to identify an area of interest [ 10 ]. The reviewers need to consider if a synthesis of the topic is required and whether a qualitative synthesis and the meta-ethnographic approach fits with the research question [ 30 ]. E.g. A meta-ethnographic synthesis approach is suitable when researchers are interested in conceptual or theoretical understandings of a particular phenomenon. It is also important to determine whether there is a large and growing body of qualitative research in this area, and whether synthesizing qualitative findings can contribute valuable knowledge to the existing literature [ 31 ]. As proposed by Campbell and colleagues [ 32 ], we emphasize, that at this stage, it is important to establish a team of researchers who have different approaches, opinions and the key skills to conduct the meta-ethnography, as this will add rigour to the meta-ethnographic review.

We were interested in the disclosure of adverse events within healthcare; specifically in the perceptions and experiences of patients and healthcare professionals relating to these events. We were aware of the large and growing body of qualitative research in this area. Our searches revealed that there was no qualitative synthesis specific to the experiences of adverse event disclosure. We believed that synthesizing the views, attitudes and experiences of both groups (patients and healthcare professionals) would enable us to understand what patients require from the disclosure conversation and what healthcare professionals currently offer. Our motivation for synthesizing the body of qualitative evidence was to inform future disclosure interventions which were acceptable to patients and practical for healthcare professionals to deliver. Synthesizing qualitative findings can make valuable knowledge accessible to healthcare professionals and policy makers [ 31 ].

Phase 2: deciding what is relevant to the initial interest

Once you have chosen your topic of interest, phase 2 involves the following steps: a) defining the focus of the synthesis, b) selecting studies for inclusion in the synthesis and locating relevant studies, c) developing inclusion and exclusion criteria and d) quality assessment of the included studies [ 12 ].

2a. Defining the focus of the synthesis

An important decision involves deciding whether to include all the studies within your chosen area of interest. It is necessary to find a balance between a review which has a broad scope, and a focus which will yield a manageable number of studies. The scope of a meta-ethnography is more restricted compared to other qualitative narrative reviews. This is due to the avoidance of making gross generalisations across disparate fields [ 10 , 26 ]. There is currently no agreement to how many studies should be included in the synthesis. Some researchers argue that synthesizing a large number of studies may interfere with the ability to produce a useful interpretative output and could result in an aggregative synthesis [ 23 ]. Synthesizing too few studies can result in underdeveloped theories/concepts [ 24 , 28 ]. A large number of studies have varied from 40 [ 32 ] to over 100 [ 24 ]. The volume of data, rather than just the number of studies is important and team size and resources will affect the ability to manage this data [ 22 ]. It is recognised that focusing on a particular aspect of your chosen topic interest and excluding certain aspects may result in some papers being overlooked. However it is important to make this choice to ensure that you have manageable number of studies [ 12 ].

Our systematic review question focused on ‘The views and experiences of patients and healthcare professionals on the disclosure of adverse events’. We focused on studies which examined the views and experiences of patients (and/or family members, members of the general public) and healthcare professionals. We found that qualitative research in the area of adverse event disclosure was limited. As this was an under-researched area, we were able to include all the available qualitative studies in this research area (enabling us to include both patients’ and healthcare professionals’ views on adverse event disclosure).

Phase 2b: locating relevant studies

The second important step involves locating potentially relevant qualitative studies by conducting a systematic search of the literature. In order to conduct a systematic search, a well-constructed and comprehensive search strategy needs to be developed. Qualitative searches can yield a large number of search results, which can be daunting and time consuming to screen. One of the ways to make your search strategy more specific is through the use of qualitative search filters. Empirically tested search filters for qualitative studies have been developed [ 33 , 34 , 35 ]. However it is possible that some of the potentially relevant studies may be missed when using such filters. Decisions regarding your search strategy and screening depend on your aims and resources available. We advise the use of a librarian for reaching decisions on the content of searches. Multiple databases are utilised to locate relevant articles and this can be further supplemented by hand searching. This is important as it can locate relevant articles which are not indexed or inaccurately indexed, and minimises the risk of missing relevant studies [ 24 ].

Some argue that a more purposive sampling approach may be more appropriate [ 36 , 37 ], which aims to provide a holistic interpretation of a phenomenon, where the extent of searching is driven by the need to reach theoretical saturation rather than to identify all eligible studies [ 24 , 38 ]. Detailed information on purposive sampling technique is available [ 24 , 28 ]. Also, to avoid the potential problem of having too few descriptively or conceptually-rich studies, knowledge-building and theory-generating systematic reviewers can conduct expansive searches of the literature [ 28 ]. We do not describe here how to conduct a systematic search of the literature, however there are a number of papers which describe this process [ 39 , 40 , 41 ].

We searched five electronic databases, and our search strategy included a combination of the three major concepts (disclosure, safety incident and experience). We also supplemented the database searches by hand searching relevant journals and reference lists. We chose not to apply qualitative filters in order to capture all the possible relevant articles.

Phase 2c: decisions to include studies

A number of factors should be considered when deciding whether to include or exclude studies from the synthesis. An important consideration is the expertise of the review authors and the time available to complete the review [ 36 ]. Reviewers should consider the likelihood of excluding valuable insights on the basis of quality, and the contribution of these studies to the development and interpretation of findings. Would excluding such studies affect the coherence of qualitative synthesized findings? [ 36 ]. Also, an important consideration is the nature of the primary data which is available to synthesise [ 23 ]. Including predominantly thin descriptive data can be problematic as it is difficult to further interpret data which lacks depth [ 23 ]. Conceptually rich data which is explanatory, or rich descriptive data which provides sufficient detail to be further developed is suitable for meta-ethnography. Therefore selecting studies based on this suitability is one of the approaches reviewers should consider. Further discussion on decisions to include studies is available [ 36 ].

Phase 2d: quality appraisal

There is a lack of agreement surrounding the use of quality appraisal for qualitative studies [ 30 ]. Some researchers argue there are difficulties with quality appraisal as some aspects of qualitative research are difficult to appraise and therefore depend on subjective judgement [ 5 ]. Although this debate continues, we argue that at least some quality appraisal of studies needs to be considered to give an indication of the credibility of the included studies. Critically appraising the studies and assigning numerical scores to indicate level of quality is also useful as it can be used as a way to order the studies for analysis. Previous published qualitative reviews have either used the highest scoring paper as the ‘index study’ [ 15 ] or have arranged all the papers in chronological order by date, and used the most recently published paper as the ‘index study’ [ 42 ]. One of the limitations is of assigning numerical scores using CASP and the use the highest scoring as an index study is that it focuses on the methodological rather than conceptual strength. Other reviewers have chosen a ‘conceptually rich’ index account [ 43 , 44 ] however it is unclear how this ‘conceptually rich’ index account should be selected. The different ways of ordering study accounts has yet to be formally empirically compared and there is no guidance for reviewers [ 23 ]. However the order could affect the synthesis output [ 11 , 12 , 24 , 45 ]. There are different perspectives to the use of tools in the quality assessment of qualitative research [ 46 ]. Some recommend the exclusion of studies based on a low-quality assessment and others refute this view and suggest that such tools may not truly assess the meaningfulness and potential impact of qualitative findings [ 47 ]. However, we believe that these checklists can equip novice qualitative researchers with the resources to evaluate qualitative research efficiently.

Two common and widely used quality assessment tools are the Critical Appraisal Skills Programme (CASP) and the Qualitative Assessment and Review Instrument (JBI-QARI). The Critical Appraisal Skills Checklist (CASP) provides detailed instructions and decision rules on how to interpret the criteria [ 48 ]. This checklist contains a number of questions which help the reviewer to assess the rigour, credibility and relevance of each study [ 49 , 50 , 51 , 52 ]. All studies are critically appraised and each study is assigned a numerical score out of ten, where a higher score is correlated to a higher quality [ 15 ]. The two studies ranked with the highest scores are used as index studies, and can be used as the first studies from which concepts are translated into other studies and therefore shaping the analysis [ 12 ]. Similarly, the Qualitative Assessment and Review Instrument (JBI-QARI) is a 10 item checklist which assesses the methodological quality of a study, and determines the extent to which a study has addressed the possibility of bias in its design, conduct and analysis [ 53 ]. Some researchers provide guidelines for determining and excluding studies which have major methodological flaws [ 54 ]. However, it can be argued that excluding studies based on quality criteria may result in the exclusion of insightful studies. GRADE-CERQual is a recently developed approach which provides guidance for assessing how much confidence to place in findings from systematic reviews of qualitative research [ 55 ]. The application of GRADE-CERQual can be helpful for appraising the overall quality of the qualitative synthesis [ 55 ] but a quality appraisal of primary studies is required before applying the CERQual tool.

We used the CASP checklist to assess the quality of included studies. We chose to use the CASP as it propagates a systematic process through which the strengths and weaknesses of a research study can be identified [ 56 ]. The CASP guidelines are easy to follow, especially for novice researchers [ 56 ]. We made a decision in advance not to exclude studies with low quality scores. We believed that although some authors may have failed to describe the methods in sufficient detail for us to determine that quality criteria had been met, lack of reporting did not necessarily mean it was poorly conducted research [ 12 ]. We did however use the quality rating of the studies in our synthesis approach. The study ranked with the highest score was used as the ‘index study’ and was the first study from which concepts were translated into other studies and therefore shaping the analysis [ 12 ].

Phase 3: Reading the studies

It is during this phase where the synthesis process begins. First, this involves repeatedly reading the included studies and familiarising yourself with the key concepts and metaphors. It is important at this stage to become as familiar as possible with the content and detail of the included studies. A concept is defined as ‘having some analytical or conceptual power, unlike more descriptive themes [ 26 ]. It is important to acknowledge that reading the studies is not a discrete phase; reading occurs throughout the synthesis process. The notion of first, second order and third order constructs [ 26 ] are useful in distinguishing the ‘data’ of the meta-ethnography which are defined in Table  1 below.

Once you have read through the chosen studies, the next step involves extracting the ‘raw data’ from the studies for the synthesis. The raw data for a meta-ethnographic synthesis are the first and second order constructs [ 29 , 31 ]. The data needs to be extracted from each of the studies, which can be done by using a standardised data extraction form [ 11 ]. Alternative ways to extract data include creating a list of metaphors and themes [ 32 ] or coding concepts in Nvivo; a software programme for the analysis of qualitative data [ 31 ]. The data should be extracted verbatim, so there is no risk of losing important data [ 12 ] and to preserve the original terminology used by the primary authors. However, some authors of a previous meta-ethnography chose to record summaries of primary author interpretations due to the large number of studies included in their synthesis [ 12 ]. However, one of the drawbacks of recording such summaries is that there is the risk of potentially losing important detail.

It is essential at this stage to extract information on study characteristics for each study, using a separate data extraction form as it provides context for interpretations and explanation of each study [ 57 ]. This includes information on study sample, data collection methods, data analysis methods, study outcomes and study conclusions.

We have provided an example of a data extraction table we used to extract the raw data (Fig.  1 ).

Example of a data extraction table

Phase 4: determining how the studies are related

During this stage, the relationships between the key concepts from the different papers need to be considered. A concept is described as a ‘ meaningful idea that develops by comparing particular instances’ [ 29 , 45 ]. It is also important that concepts explain and do not only describe the data [ 29 , 45 ] as one of the aims of qualitative analysis is to develop concepts which help to understand an experience and not just describe it [ 58 ]. In order to consider the relationship between concepts from the different studies, you are required to look across the studies for common and recurring concepts. This can be done by creating a list of the themes [ 10 ]. These are then juxtaposed against each other to examine the relationships between the key concepts and metaphors these themes reflect and to identify common and recurring concepts. From this list, the themes from the different studies are then clustered into relevant categories, where we grouped common concepts from studies according to the common underlying metaphors, an approach which has previously been used [ 12 , 31 , 59 ]. During this phase it is essential to examine the contextual data about each study. This includes settings, aims and focuses. These newly formed categories are labelled using terminology which encompasses all the relevant concepts they contain. This phase is likely to be iterative, and clusters may be revised through discussions within the review team of how they are related and by making reference to the original text.

Other authors have used diagrams [ 11 , 32 ] or coding using qualitative analysis software [ 31 ]. The use of lists or tables in phase 4 is useful when synthesising a small number of studies, however such an approach would be unwieldy when there are hundreds of concepts, whereas coding in NVivo is efficient [ 23 ]. However, the recording of links between concepts within primary studies may be difficult when using NVivo [ 23 ].

During this phase, for our review we created a list of the themes from each paper (Fig.  2 ) listed under each study name. As we had included both healthcare professional and patient studies, we also labelled whether the study had included patients, healthcare professionals or both groups.

List of key metaphors/concepts from each study

The next step involved reducing the themes from the different studies into relevant categories (Fig.  3 ).

Reducing themes into relevant categories

It is important to note that the category labels you create during this phase are not the higher third order constructs, but are descriptive labels. The third order constructs are developed within the next two phases. However, the data within each category forms the basis of reciprocal translation or refutational synthesis in the next stages. This approach can work well when you have a manageable number of studies, however this can prove to be challenging when you have a larger number of studies. In previous meta-ethnographies where a large number of studies have been included, a thematic analysis of themes was carried out instead [ 12 ].

Phase 5: translating the studies into one another

The original method of meta-ethnography suggests that this phase involves ‘comparing the metaphors and concepts in one account with the metaphors and concepts in others’ [ 10 ]. However, despite a number of meta-ethnographies being conducted, it is unclear how this should be done and how this phase of the analysis should be recorded. To address this lack of clarity, we will now outline below one way in which this can be done. During this phase, each concept from each paper is compared with all the other papers to check for the presence or absence of commonality. Doing this highlights the similarities and differences between the concepts and metaphors and allows the researcher to organise them into further conceptual categories, which results in the development of the higher third order constructs.

This phase is approached by arranging the studies either chronologically [ 32 ] from the highest scoring paper to the lowest scoring paper (where the scores are generated during the quality appraisal process [ 15 ]. Arranging the studies chronologically is advised when you are including a large number of papers over a large time span [ 12 , 29 ]. The order in which studies are compared may influence the synthesis, as earlier papers will have a strong influence on the subsequent development of ideas [ 60 ]. The reviewer first starts by summarising the themes and concepts from paper 1. Summarising involves comparing and contrasting the concepts taking into account study contexts. They then summarise the themes and concepts from paper 2, commenting first on what is similar with paper 1 and then what paper 2 may add to paper 1 or where its findings diverge from paper 1 [ 12 , 29 ]. Next, paper 3 is summarised, considering what is similar to papers 1 and 2, and then noting any areas of divergence and anything that paper 3 adds to the knowledge offered in papers 1 and 2. This process continues until you have synthesised all the papers and produces a synthesis of the primary author interpretations (see Fig.  4 ) which are useful in aiding with the development of the third order constructs in the next stage.

Primary data synthesis of the primary author interpretations

Examining the key concepts within and across the studies is similar to the method of constant comparison [ 29 ]. During this phase, it is important to refer back to the table of study characteristics you recorded earlier, (country, sample, recruitment method, gender, publication date etc.) to use as a context for the comparisons [ 15 ] as well the full papers. This process can also be supported by creating a translations table, as this is a useful way to display this level of synthesis [ 61 ] (see Fig.  5 for an example of a translations table). Maintaining a personal journal during this phase of the analysis can help to ensure that the researcher is aware of their position from a theoretical point of view [ 62 ]. Discussing the key concepts and their meanings with team members can result in collaborative interpretations.

Example of a translations table

We conducted two separate syntheses; one for the views of patients and one for healthcare professionals, and conducted a line of argument synthesis of all the included studies, therefore we found it useful to have two separate translation tables; one for each group. Part of the translation table for healthcare professionals is shown in Fig. 5 (see example of table below).

Phase 6: Synthesising the translations

This phase is described by [ 10 ] as ‘making the whole into something more than the parts alone imply’. However, similar to Phase 5, there has been no clear guidance on how to carry out this phase. During this phase, the studies are now viewed as a ‘whole’ with the aim of developing a framework [ 29 , 31 ]. When writing about how the studies are related, reviewers can present this in a narrative and/or diagrammatic form [ 30 ]. Phase 6 can be broken down into the following two stages; (a) reciprocal and refutational synthesis and (b) line of argument synthesis.

(A) Reciprocal and refutational synthesis

This stage of the synthesis involves deciding whether the studies are sufficiently similar in their focus to allow for a reciprocal translation synthesis. Alternatively, the studies may refute each other in which case a refutational synthesis is conducted. It is possible to conduct both types of synthesis to discuss similar accounts (reciprocal translation synthesis) and also explore any contradictions between the studies (refutational synthesis) [ 23 ]. Generally, reciprocal translation syntheses are conducted more frequently in reviews than refutational syntheses and guidance on how to conduct a refutational synthesis is currently limited [ 23 ]. Below we first discuss how to carry out a reciprocal translation and then describe the way a refutational synthesis can be conducted. Referring to the translations table of data developed in the stages above allows reviewers to establish the relationship between the studies and consider how to approach a reciprocal and refutational synthesis.

Reciprocal translation

It is during this phase where the shared themes across the studies are summarised by juxtaposing the first and second order constructs. This leads to the generation of new concepts which provide a fuller account of the given phenomenon and resolve any contradictions [ 63 ]. These are known as the original third order constructs developed by the review authors and provide a new understanding of the phenomena [ 15 ]. To put briefly, this can be achieved by reading the primary data synthesis (Fig. 4 ) alongside the translations table (Fig. 5 ) and drawing out the main points to form the reciprocal translations and therefore developing the third order constructs. It is important to constantly check the summary and third order constructs you are developing against the translations table to ensure it is consistent with the original data.

Refutational synthesis

There are limited published examples of refutational synthesis [ 25 , 45 ] as reviewers often focus on reciprocal translations [ 25 ]. Also reviewers may conduct a refutational synthesis, but not label it as such [ 23 ]. There are two published examples of refutational synthesis [ 43 , 64 ]. This is not surprising given the lack of guidance available on how to conduct a refutational synthesis. The purpose of a refutational synthesis is to explore and explain the differences, exceptions, incongruities and inconsistencies in concepts across the studies [ 1 , 24 ]. Refutational synthesis focuses on identifying, understanding and reconciling the contradictions, rather than developing concepts around the similarities. Similar to reciprocal translation, reviewers are required to refer back to the primary data synthesis and translations table in order to develop third order constructs. The contradictions between the concepts across the studies may be explained by differences in participants, settings or study design. During this phase, it is helpful to refer back to the study characteristics table as this can help provide context for interpretations and explanations [ 57 ]. It has been suggested that a refutational translation can be approached by placing two refutational concepts at either end of a continuum and proceed by analysing the differences between the concepts [ 22 , 28 ]. In order to express the refutational findings, a narrative can be created so that the findings ‘are placed into context’ [ 28 ].

(B) A lines of argument synthesis

A lines of argument synthesis can then be created from the third order constructs, which involves ‘making a whole into something more than the parts alone imply’ (known as higher order interpretations) [ 10 ]. A lines of argument synthesis means that there is an ‘interpretation of the relationship between the themes, which further emphasises a key concept that may be hidden within individual studies in order to discover the whole from a set of parts’ [ 10 ]. This is classed as a further higher level of interpretative synthesis, and provides scope for developing new insights.

A lines of argument synthesis is achieved by constant comparison of the concepts and developing a ‘grounded theory that puts the similarities and differences between the studies into interpretative order’ [ 10 ]. Practically, reviewers can approach this phase by reading through the reciprocal translations and noting down the similarities and differences between each of the third-order constructs. These notes can then be used to construct interpretations of how each third order construct relates to the others in the analysis. These relationships can then be represented using a diagram to aid understanding. Each of the reviewers can carry out this stage independently, and merge their findings as a team to produce the final line of argument synthesis. Diagrams can be used to develop the line of argument synthesis and it is suggested that discussions between team members are vital to this process [ 29 , 30 ]. A lines of argument synthesis can be a useful way to bring together and explain the perspectives of two or more different groups and interpreting the relationship between the themes. This is particularly relevant for research in healthcare, where often the views of one or more groups are examined on a phenomenon (e.g. patients and healthcare professionals). An example of a line of argument synthesis from the worked example is presented in Fig.  6 .

Example of a line of argument synthesis developed

We conducted separate reciprocal translations for the first- and second-order constructs relating to patients and healthcare professionals, resulting in third order constructs which related to solely either patients or professionals. Therefore, the synthesis process for our review consisted of three steps- (1) reciprocal translations of the patient studies to understand patients’ views and experiences of disclosure, (2) reciprocal translations of the healthcare professional studies to explore healthcare professionals views and experiences on disclosure and (3) a line of argument synthesis which contributed to the identification of both the key elements of an ideal disclosure desired by patients and the facilitators for healthcare professionals which can increase the likelihood of this taking place. We initially considered a refutational translation instead of a line-of-argument synthesis, but it was apparent during the synthesis that the concepts from the patient and healthcare professional studies were not contradictory in nature; rather they described alternate perspectives of the same phenomenon. Therefore we believed a line of argument synthesis was the most appropriate for the aim of our synthesis. During this stage of the analysis, we found it helpful to place all the third order constructs in a table to enable visual comparison (see Table  2 ).

The third order constructs should be theoretically rich. In our synthesis, although we found that the data we were dealing with was descriptive, it was rich descriptive data. This therefore provided us with sufficient detail to further interpret this and develop third order constructs [ 23 ]. The third order constructs we developed reflected the data we were dealing with, but allowed us to produce higher levels of analysis. Reviewers should take caution when dealing descriptive data. They need determine whether it is ‘thin descriptive data’ which could be problematic to further interpret due to lack of depth, or ‘rich descriptive data’ which can provide sufficient detail to be further interpreted [ 23 ].

Phase 7: expressing the synthesis

Reviewers should follow the eMERGE reporting guidance when writing up the synthesis [ 22 ] and the PRISMA guidelines may be used alongside this if systematic searches are conducted as many journals may require a PRISMA diagram [ 65 ]. In addition to these standard reporting methods as described by the eMERGE guidance [ 22 ] the final phase can be broken down into the following three stages; (a) summary of findings, (b) strengths, limitations & reflexivity and (c) recommendations and conclusions (refer to [ 22 ] where this phase is described in further detail).

Meta-ethnography is an evolving approach to synthesising qualitative research and is being increasingly used in healthcare research [ 29 ]. A meta-ethnographic approach offers a greater description of methods and higher-order interpretation (an overarching explanation of a phenomenon that goes beyond what the study parts alone imply), compared to a conventional narrative literature review [ 12 ]. The use of this approach can assist in generating evidence for healthcare staff, researchers and policy-makers. Although this approach is being used by numerous reviewers, transparency on how each of the stages should be conducted is still poor and there is a lack of clarity surrounding the exact stages reviewers utilise to reach their final synthesis [ 23 ]. The ultimate aim of qualitative research synthesis in healthcare is to contribute towards improvements in patient care and experience, as well as improving the processes for healthcare professionals involved [ 39 ]. In order for a meta-ethnography syntheses to be considered to be of high quality and useful, the meta-ethnographic approach needs to be rigorous and consistent. Therefore, a clear understanding of the steps included in a meta-ethnography is vital to produce a synthesis which is rigorous and comprehensive. Poorly reported methods of meta-ethnography can also make it challenging, particularly for early career qualitative researchers to conduct this synthesis. Therefore, we have provided a practical step-by-step guide to assist reviewers with conducting a meta-ethnographic synthesis of qualitative research. High quality qualitative research synthesis should not end with the final write up and further research needs to focus on how the impact of qualitative research can be maximised to improve healthcare.

Like any other method, the meta-ethnographic approach is not without its limitations. Within a meta-ethnography, although reviewers provide a synthesis, this is only one interpretation and as qualitative synthesis is subjective, several alternative interpretations are likely to be possible [ 66 ]. The subjective nature of a meta-ethnography may also affect the representativeness of the synthesis findings. To develop this guide, we searched for articles in a number of ways which is described in detail in the methods section. However, as a systematic literature search was not conducted to identify articles for the development of this guide, there is the potential that this may have resulted in the exclusion of some articles. Whilst we have provided guidance on how to conduct a meta-ethnographic synthesis, it is important to note that this is a flexible guide, which researchers can utilise and adapt the stages, according to their own research questions and the phenomenon under study. Some of the steps and challenges described in this guide hold true for systematic reviews in general. However, this guide aimed to offer practical step-by-step guidance on how to conduct meta-ethnography for even those researchers who may not be experienced in conducting systematic reviews as well as being unfamiliar with a meta-ethnographic approach. This guide was developed to assist with conducting a meta-ethnography within healthcare research. Although this guide would be potentially useful beyond healthcare research, there might be additional challenges and considerations in other research fields which may not be fully captured in this guide.

Conclusions

There was previously a lack of step-by-step guide to meta-ethnography conduct. In this paper, we have filled this gap by providing a practical step-by-step guide for conducting meta-ethnography based on the original seven steps as developed by Noblit & Hare [ 10 ]. We have incorporated adaptations and developments by recent publications and we provide detailed annotations, particularly for stages 4–6 which are often described as being the most challenging to conduct, yet the least amount of guidance is provided for conducting these stages. We have described each stage in relation to one of the previous meta-ethnographies we have conducted to aid understanding, and allows the reader to follow on from one step to the next easily.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

This report is independent research funded by the National Institute for Health Research, Yorkshire and Humber Applied Research Collaborations. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.

This research was funded by NIHR CLAHRC Yorkshire and Humber.

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RS, RL and JJ originated the idea for this guide to conducting a meta-ethnography. RS, RL and JJ conducted the original meta-ethnography from which annotations and examples are based on within this manuscript. All authors contributed to the development of the method, and read and approved the final manuscript. RS drafted the first version of this manuscript. RS, RL, JJ and MP made significant contributions to the ideas developed and presented in this manuscript.

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RS 1 is a PhD student (MSc, BSc Honours) based in the School of Psychology at the University of Leeds and Bradford Institute for Health Research. RL 2 (PhD, BA) is a Professor in Psychology of healthcare, based at the University of Leeds and Bradford Institute for Health Research. MP 3 (PhD, MSc, BSc Honours) is a senior research fellow based at the Centre for Primary Care, Manchester. JJ 4 (PhD, BSc Honours) is a clinical psychologist based at the University of Leeds and Bradford Institute for Health Research.

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Sattar, R., Lawton, R., Panagioti, M. et al. Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis. BMC Health Serv Res 21 , 50 (2021). https://doi.org/10.1186/s12913-020-06049-w

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Meta-syntheses integrate and interpret research results from multiple qualitative primary studies (Erwin et al., 2011; Leary & Walker, 2018; Lockwood et al., 2015; MacEntee, 2019). 

What is a meta-synthesis?

Meta-syntheses  contribute to:

• Bridging of research gaps and practice (Erwin et al., 2011)
• Improved decision making in evidence-based practice (Erwin et al., 2011; Korhonen et al., 2013)
• Representing participants' perspectives, behaviours, emotions, beliefs, and experiences (Korhonen et al., 2013; Lachal et al., 2017; Tong et al., 2012)
• Understanding patient responses to various interventions (Lockwood et al., 2015; MacEntee, 2019)
• Comparison of a variety of healthcare contexts (Lachal et al., 2017; Tong et al., 2012)
• Stronger results because the source of evidence comes from many different scholars and primary studies (Korhonen et al., 2013; Leary & Walker, 2018)
• Generation of new primary research and knowledge (Erwin et al., 2011; Lachal et al., 2017; Leary & Walker, 2018; Tong et al., 2012)

• Meta-synthesis (Temple University Library)
• Origins, methods and advances in qualitative meta-synthesis
• Meta-analysis and meta-synthesis methodologies: Rigorously piecing together research
• Meta-synthesis of qualitative case studies: An approach to theory building
• Meta-synthesis of qualitative research: The challenges and opportunities
• The acceptability of physical activity interventions to older adults: A systematic review and meta-synthesis
• Digitized patient–provider interaction: How does it matter? A qualitative meta-synthesis
• Health practitioners' readiness to address domestic violence and abuse: A qualitative meta-synthesis.
• Meta-ethnography in healthcare research: A guide to using A meta-ethnographic approach for literature synthesis
• Meta‐synthesis on migraine management
• The nurse's role in palliative care: A qualitative meta‐synthesis
• Proposed teacher competencies to support effective nature of science instruction: A meta-synthesis of the literature
• What’s the meaning of the concept of caring? A meta‐synthesis
• Women’s psychological experiences of physiological childbirth: A meta-synthesis

Erwin, E. J., Brotherson, M. J., & Summers, J. A. (2011). Understanding qualitative metasynthesis: Issues and opportunities in early childhood intervention research . Journal of early intervention, 33(3), 186-200. https://doi.org/10.1177/1053815111425493

Korhonen, A., Hakulinen-Viitanen, T., Jylhä, V., & Holopainen, A. (2013). Meta-synthesis and evidence-based health care: A method for systematic review . Scandinavian Journal of Caring Sciences, 27(4), 1027-1034. https://doi.org/10.1111/scs.12003

Lachal, J., Revah-Levy, A., Orri, M., & Moro, M. R. (2017). Metasynthesis: An original method to synthesize qualitative literature in psychiatry . Frontiers in Psychiatry, 8 , Article 269. https://doi.org/10.3389/fpsyt.2017.00269

Leary, H., & Walker, A. (2018). Meta-Analysis and meta-synthesis methodologies: Rigorously piecing together research . TechTrends, 62 (5), 525-534. https://doi.org/10.1007/s11528-018-0312-7

Lockwood, C., Munn, Z., & Porritt, K. (2015). Qualitative research synthesis: methodological guidance for systematic reviewers utilizing meta-aggregation. JBI Evidence Implementation, 13 (3). https://journals.lww.com/ijebh/Fulltext/2015/09000/Qualitative_research_synthesis__methodological.10.aspx

MacEntee, M. I. (2019). A typology of systematic reviews for synthesising evidence on health care. Gerodontology, 36 (4), 303-312. https://doi.org/10.1111/ger.12439

Tong, A., Flemming, K., McInnes, E., Oliver, S., & Craig, J. (2012). Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ . BMC Medical Research Methodology, 12 (1), 181-181. https://doi.org/10.1186/1471-2288-12-181

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• Expert Opinion - Policy Review
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• Systematic Search and Review

" Qualitative meta-synthesis is an intentional and coherent approach to analyzing data across qualitative studies. It is a process that enables researchers to identify a specific research question and then search for, select, appraise, summarize, and combine qualitative evidence to address the research question" (Erwin et al, 2011).

Further Reading/Resources

Erwin, E. J., Brotherson, M. J., & Summers, J. A. (2011). Understanding qualitative metasynthesis: Issues and opportunities in early childhood intervention research. Journal of Early Intervention , 33 (3), 186-200 . Full Text Finlayson, K. W., & Dixon, A. (2008). Qualitative meta-synthesis: a guide for the novice. Nurse researcher , 15 (2). Full Text Finfgeld-Connett, D. (2018). A guide to qualitative meta-synthesis . New York, NY, USA:: Routledge. Catalogue Link  

Douglas, S. N., Jensen, E. J., & West, P. (2022). Barriers and Benefits Experienced by Caregivers Seeking Medical Care for Their Children with Autism Spectrum Disorders: a Qualitative Meta-synthesis. Review Journal of Autism and Developmental Disorders , 1-13. Full Text

References Erwin, E. J., Brotherson, M. J., & Summers, J. A. (2011). Understanding qualitative metasynthesis: Issues and opportunities in early childhood intervention research. Journal of Early Intervention , 33 (3), 186-200 . Full Text

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How to conduct a meta-analysis in eight steps: a practical guide

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1 Introduction

“Scientists have known for centuries that a single study will not resolve a major issue. Indeed, a small sample study will not even resolve a minor issue. Thus, the foundation of science is the cumulation of knowledge from the results of many studies.” (Hunter et al. 1982 , p. 10)

Meta-analysis is a central method for knowledge accumulation in many scientific fields (Aguinis et al. 2011c ; Kepes et al. 2013 ). Similar to a narrative review, it serves as a synopsis of a research question or field. However, going beyond a narrative summary of key findings, a meta-analysis adds value in providing a quantitative assessment of the relationship between two target variables or the effectiveness of an intervention (Gurevitch et al. 2018 ). Also, it can be used to test competing theoretical assumptions against each other or to identify important moderators where the results of different primary studies differ from each other (Aguinis et al. 2011b ; Bergh et al. 2016 ). Rooted in the synthesis of the effectiveness of medical and psychological interventions in the 1970s (Glass 2015 ; Gurevitch et al. 2018 ), meta-analysis is nowadays also an established method in management research and related fields.

The increasing importance of meta-analysis in management research has resulted in the publication of guidelines in recent years that discuss the merits and best practices in various fields, such as general management (Bergh et al. 2016 ; Combs et al. 2019 ; Gonzalez-Mulé and Aguinis 2018 ), international business (Steel et al. 2021 ), economics and finance (Geyer-Klingeberg et al. 2020 ; Havranek et al. 2020 ), marketing (Eisend 2017 ; Grewal et al. 2018 ), and organizational studies (DeSimone et al. 2020 ; Rudolph et al. 2020 ). These articles discuss existing and trending methods and propose solutions for often experienced problems. This editorial briefly summarizes the insights of these papers; provides a workflow of the essential steps in conducting a meta-analysis; suggests state-of-the art methodological procedures; and points to other articles for in-depth investigation. Thus, this article has two goals: (1) based on the findings of previous editorials and methodological articles, it defines methodological recommendations for meta-analyses submitted to Management Review Quarterly (MRQ); and (2) it serves as a practical guide for researchers who have little experience with meta-analysis as a method but plan to conduct one in the future.

2 Eight steps in conducting a meta-analysis

2.1 step 1: defining the research question.

The first step in conducting a meta-analysis, as with any other empirical study, is the definition of the research question. Most importantly, the research question determines the realm of constructs to be considered or the type of interventions whose effects shall be analyzed. When defining the research question, two hurdles might develop. First, when defining an adequate study scope, researchers must consider that the number of publications has grown exponentially in many fields of research in recent decades (Fortunato et al. 2018 ). On the one hand, a larger number of studies increases the potentially relevant literature basis and enables researchers to conduct meta-analyses. Conversely, scanning a large amount of studies that could be potentially relevant for the meta-analysis results in a perhaps unmanageable workload. Thus, Steel et al. ( 2021 ) highlight the importance of balancing manageability and relevance when defining the research question. Second, similar to the number of primary studies also the number of meta-analyses in management research has grown strongly in recent years (Geyer-Klingeberg et al. 2020 ; Rauch 2020 ; Schwab 2015 ). Therefore, it is likely that one or several meta-analyses for many topics of high scholarly interest already exist. However, this should not deter researchers from investigating their research questions. One possibility is to consider moderators or mediators of a relationship that have previously been ignored. For example, a meta-analysis about startup performance could investigate the impact of different ways to measure the performance construct (e.g., growth vs. profitability vs. survival time) or certain characteristics of the founders as moderators. Another possibility is to replicate previous meta-analyses and test whether their findings can be confirmed with an updated sample of primary studies or newly developed methods. Frequent replications and updates of meta-analyses are important contributions to cumulative science and are increasingly called for by the research community (Anderson & Kichkha 2017 ; Steel et al. 2021 ). Consistent with its focus on replication studies (Block and Kuckertz 2018 ), MRQ therefore also invites authors to submit replication meta-analyses.

2.2 Step 2: literature search

2.2.1 search strategies.

Similar to conducting a literature review, the search process of a meta-analysis should be systematic, reproducible, and transparent, resulting in a sample that includes all relevant studies (Fisch and Block 2018 ; Gusenbauer and Haddaway 2020 ). There are several identification strategies for relevant primary studies when compiling meta-analytical datasets (Harari et al. 2020 ). First, previous meta-analyses on the same or a related topic may provide lists of included studies that offer a good starting point to identify and become familiar with the relevant literature. This practice is also applicable to topic-related literature reviews, which often summarize the central findings of the reviewed articles in systematic tables. Both article types likely include the most prominent studies of a research field. The most common and important search strategy, however, is a keyword search in electronic databases (Harari et al. 2020 ). This strategy will probably yield the largest number of relevant studies, particularly so-called ‘grey literature’, which may not be considered by literature reviews. Gusenbauer and Haddaway ( 2020 ) provide a detailed overview of 34 scientific databases, of which 18 are multidisciplinary or have a focus on management sciences, along with their suitability for literature synthesis. To prevent biased results due to the scope or journal coverage of one database, researchers should use at least two different databases (DeSimone et al. 2020 ; Martín-Martín et al. 2021 ; Mongeon & Paul-Hus 2016 ). However, a database search can easily lead to an overload of potentially relevant studies. For example, key term searches in Google Scholar for “entrepreneurial intention” and “firm diversification” resulted in more than 660,000 and 810,000 hits, respectively. Footnote 1 Therefore, a precise research question and precise search terms using Boolean operators are advisable (Gusenbauer and Haddaway 2020 ). Addressing the challenge of identifying relevant articles in the growing number of database publications, (semi)automated approaches using text mining and machine learning (Bosco et al. 2017 ; O’Mara-Eves et al. 2015 ; Ouzzani et al. 2016 ; Thomas et al. 2017 ) can also be promising and time-saving search tools in the future. Also, some electronic databases offer the possibility to track forward citations of influential studies and thereby identify further relevant articles. Finally, collecting unpublished or undetected studies through conferences, personal contact with (leading) scholars, or listservs can be strategies to increase the study sample size (Grewal et al. 2018 ; Harari et al. 2020 ; Pigott and Polanin 2020 ).

2.2.2 Study inclusion criteria and sample composition

Next, researchers must decide which studies to include in the meta-analysis. Some guidelines for literature reviews recommend limiting the sample to studies published in renowned academic journals to ensure the quality of findings (e.g., Kraus et al. 2020 ). For meta-analysis, however, Steel et al. ( 2021 ) advocate for the inclusion of all available studies, including grey literature, to prevent selection biases based on availability, cost, familiarity, and language (Rothstein et al. 2005 ), or the “Matthew effect”, which denotes the phenomenon that highly cited articles are found faster than less cited articles (Merton 1968 ). Harrison et al. ( 2017 ) find that the effects of published studies in management are inflated on average by 30% compared to unpublished studies. This so-called publication bias or “file drawer problem” (Rosenthal 1979 ) results from the preference of academia to publish more statistically significant and less statistically insignificant study results. Owen and Li ( 2020 ) showed that publication bias is particularly severe when variables of interest are used as key variables rather than control variables. To consider the true effect size of a target variable or relationship, the inclusion of all types of research outputs is therefore recommended (Polanin et al. 2016 ). Different test procedures to identify publication bias are discussed subsequently in Step 7.

In addition to the decision of whether to include certain study types (i.e., published vs. unpublished studies), there can be other reasons to exclude studies that are identified in the search process. These reasons can be manifold and are primarily related to the specific research question and methodological peculiarities. For example, studies identified by keyword search might not qualify thematically after all, may use unsuitable variable measurements, or may not report usable effect sizes. Furthermore, there might be multiple studies by the same authors using similar datasets. If they do not differ sufficiently in terms of their sample characteristics or variables used, only one of these studies should be included to prevent bias from duplicates (Wood 2008 ; see this article for a detection heuristic).

In general, the screening process should be conducted stepwise, beginning with a removal of duplicate citations from different databases, followed by abstract screening to exclude clearly unsuitable studies and a final full-text screening of the remaining articles (Pigott and Polanin 2020 ). A graphical tool to systematically document the sample selection process is the PRISMA flow diagram (Moher et al. 2009 ). Page et al. ( 2021 ) recently presented an updated version of the PRISMA statement, including an extended item checklist and flow diagram to report the study process and findings.

2.3 Step 3: choice of the effect size measure

2.3.1 types of effect sizes.

The two most common meta-analytical effect size measures in management studies are (z-transformed) correlation coefficients and standardized mean differences (Aguinis et al. 2011a ; Geyskens et al. 2009 ). However, meta-analyses in management science and related fields may not be limited to those two effect size measures but rather depend on the subfield of investigation (Borenstein 2009 ; Stanley and Doucouliagos 2012 ). In economics and finance, researchers are more interested in the examination of elasticities and marginal effects extracted from regression models than in pure bivariate correlations (Stanley and Doucouliagos 2012 ). Regression coefficients can also be converted to partial correlation coefficients based on their t-statistics to make regression results comparable across studies (Stanley and Doucouliagos 2012 ). Although some meta-analyses in management research have combined bivariate and partial correlations in their study samples, Aloe ( 2015 ) and Combs et al. ( 2019 ) advise researchers not to use this practice. Most importantly, they argue that the effect size strength of partial correlations depends on the other variables included in the regression model and is therefore incomparable to bivariate correlations (Schmidt and Hunter 2015 ), resulting in a possible bias of the meta-analytic results (Roth et al. 2018 ). We endorse this opinion. If at all, we recommend separate analyses for each measure. In addition to these measures, survival rates, risk ratios or odds ratios, which are common measures in medical research (Borenstein 2009 ), can be suitable effect sizes for specific management research questions, such as understanding the determinants of the survival of startup companies. To summarize, the choice of a suitable effect size is often taken away from the researcher because it is typically dependent on the investigated research question as well as the conventions of the specific research field (Cheung and Vijayakumar 2016 ).

2.3.2 Conversion of effect sizes to a common measure

After having defined the primary effect size measure for the meta-analysis, it might become necessary in the later coding process to convert study findings that are reported in effect sizes that are different from the chosen primary effect size. For example, a study might report only descriptive statistics for two study groups but no correlation coefficient, which is used as the primary effect size measure in the meta-analysis. Different effect size measures can be harmonized using conversion formulae, which are provided by standard method books such as Borenstein et al. ( 2009 ) or Lipsey and Wilson ( 2001 ). There also exist online effect size calculators for meta-analysis. Footnote 2

2.4 Step 4: choice of the analytical method used

Choosing which meta-analytical method to use is directly connected to the research question of the meta-analysis. Research questions in meta-analyses can address a relationship between constructs or an effect of an intervention in a general manner, or they can focus on moderating or mediating effects. There are four meta-analytical methods that are primarily used in contemporary management research (Combs et al. 2019 ; Geyer-Klingeberg et al. 2020 ), which allow the investigation of these different types of research questions: traditional univariate meta-analysis, meta-regression, meta-analytic structural equation modeling, and qualitative meta-analysis (Hoon 2013 ). While the first three are quantitative, the latter summarizes qualitative findings. Table 1 summarizes the key characteristics of the three quantitative methods.

2.4.1 Univariate meta-analysis

In its traditional form, a meta-analysis reports a weighted mean effect size for the relationship or intervention of investigation and provides information on the magnitude of variance among primary studies (Aguinis et al. 2011c ; Borenstein et al. 2009 ). Accordingly, it serves as a quantitative synthesis of a research field (Borenstein et al. 2009 ; Geyskens et al. 2009 ). Prominent traditional approaches have been developed, for example, by Hedges and Olkin ( 1985 ) or Hunter and Schmidt ( 1990 , 2004 ). However, going beyond its simple summary function, the traditional approach has limitations in explaining the observed variance among findings (Gonzalez-Mulé and Aguinis 2018 ). To identify moderators (or boundary conditions) of the relationship of interest, meta-analysts can create subgroups and investigate differences between those groups (Borenstein and Higgins 2013 ; Hunter and Schmidt 2004 ). Potential moderators can be study characteristics (e.g., whether a study is published vs. unpublished), sample characteristics (e.g., study country, industry focus, or type of survey/experiment participants), or measurement artifacts (e.g., different types of variable measurements). The univariate approach is thus suitable to identify the overall direction of a relationship and can serve as a good starting point for additional analyses. However, due to its limitations in examining boundary conditions and developing theory, the univariate approach on its own is currently oftentimes viewed as not sufficient (Rauch 2020 ; Shaw and Ertug 2017 ).

2.4.2 Meta-regression analysis

Meta-regression analysis (Hedges and Olkin 1985 ; Lipsey and Wilson 2001 ; Stanley and Jarrell 1989 ) aims to investigate the heterogeneity among observed effect sizes by testing multiple potential moderators simultaneously. In meta-regression, the coded effect size is used as the dependent variable and is regressed on a list of moderator variables. These moderator variables can be categorical variables as described previously in the traditional univariate approach or (semi)continuous variables such as country scores that are merged with the meta-analytical data. Thus, meta-regression analysis overcomes the disadvantages of the traditional approach, which only allows us to investigate moderators singularly using dichotomized subgroups (Combs et al. 2019 ; Gonzalez-Mulé and Aguinis 2018 ). These possibilities allow a more fine-grained analysis of research questions that are related to moderating effects. However, Schmidt ( 2017 ) critically notes that the number of effect sizes in the meta-analytical sample must be sufficiently large to produce reliable results when investigating multiple moderators simultaneously in a meta-regression. For further reading, Tipton et al. ( 2019 ) outline the technical, conceptual, and practical developments of meta-regression over the last decades. Gonzalez-Mulé and Aguinis ( 2018 ) provide an overview of methodological choices and develop evidence-based best practices for future meta-analyses in management using meta-regression.

2.4.3 Meta-analytic structural equation modeling (MASEM)

MASEM is a combination of meta-analysis and structural equation modeling and allows to simultaneously investigate the relationships among several constructs in a path model. Researchers can use MASEM to test several competing theoretical models against each other or to identify mediation mechanisms in a chain of relationships (Bergh et al. 2016 ). This method is typically performed in two steps (Cheung and Chan 2005 ): In Step 1, a pooled correlation matrix is derived, which includes the meta-analytical mean effect sizes for all variable combinations; Step 2 then uses this matrix to fit the path model. While MASEM was based primarily on traditional univariate meta-analysis to derive the pooled correlation matrix in its early years (Viswesvaran and Ones 1995 ), more advanced methods, such as the GLS approach (Becker 1992 , 1995 ) or the TSSEM approach (Cheung and Chan 2005 ), have been subsequently developed. Cheung ( 2015a ) and Jak ( 2015 ) provide an overview of these approaches in their books with exemplary code. For datasets with more complex data structures, Wilson et al. ( 2016 ) also developed a multilevel approach that is related to the TSSEM approach in the second step. Bergh et al. ( 2016 ) discuss nine decision points and develop best practices for MASEM studies.

2.4.4 Qualitative meta-analysis

While the approaches explained above focus on quantitative outcomes of empirical studies, qualitative meta-analysis aims to synthesize qualitative findings from case studies (Hoon 2013 ; Rauch et al. 2014 ). The distinctive feature of qualitative case studies is their potential to provide in-depth information about specific contextual factors or to shed light on reasons for certain phenomena that cannot usually be investigated by quantitative studies (Rauch 2020 ; Rauch et al. 2014 ). In a qualitative meta-analysis, the identified case studies are systematically coded in a meta-synthesis protocol, which is then used to identify influential variables or patterns and to derive a meta-causal network (Hoon 2013 ). Thus, the insights of contextualized and typically nongeneralizable single studies are aggregated to a larger, more generalizable picture (Habersang et al. 2019 ). Although still the exception, this method can thus provide important contributions for academics in terms of theory development (Combs et al., 2019 ; Hoon 2013 ) and for practitioners in terms of evidence-based management or entrepreneurship (Rauch et al. 2014 ). Levitt ( 2018 ) provides a guide and discusses conceptual issues for conducting qualitative meta-analysis in psychology, which is also useful for management researchers.

2.5 Step 5: choice of software

Software solutions to perform meta-analyses range from built-in functions or additional packages of statistical software to software purely focused on meta-analyses and from commercial to open-source solutions. However, in addition to personal preferences, the choice of the most suitable software depends on the complexity of the methods used and the dataset itself (Cheung and Vijayakumar 2016 ). Meta-analysts therefore must carefully check if their preferred software is capable of performing the intended analysis.

Among commercial software providers, Stata (from version 16 on) offers built-in functions to perform various meta-analytical analyses or to produce various plots (Palmer and Sterne 2016 ). For SPSS and SAS, there exist several macros for meta-analyses provided by scholars, such as David B. Wilson or Andy P. Field and Raphael Gillet (Field and Gillett 2010 ). Footnote 3 Footnote 4 For researchers using the open-source software R (R Core Team 2021 ), Polanin et al. ( 2017 ) provide an overview of 63 meta-analysis packages and their functionalities. For new users, they recommend the package metafor (Viechtbauer 2010 ), which includes most necessary functions and for which the author Wolfgang Viechtbauer provides tutorials on his project website. Footnote 5 Footnote 6 In addition to packages and macros for statistical software, templates for Microsoft Excel have also been developed to conduct simple meta-analyses, such as Meta-Essentials by Suurmond et al. ( 2017 ). Footnote 7 Finally, programs purely dedicated to meta-analysis also exist, such as Comprehensive Meta-Analysis (Borenstein et al. 2013 ) or RevMan by The Cochrane Collaboration ( 2020 ).

2.6 Step 6: coding of effect sizes

2.6.1 coding sheet.

The first step in the coding process is the design of the coding sheet. A universal template does not exist because the design of the coding sheet depends on the methods used, the respective software, and the complexity of the research design. For univariate meta-analysis or meta-regression, data are typically coded in wide format. In its simplest form, when investigating a correlational relationship between two variables using the univariate approach, the coding sheet would contain a column for the study name or identifier, the effect size coded from the primary study, and the study sample size. However, such simple relationships are unlikely in management research because the included studies are typically not identical but differ in several respects. With more complex data structures or moderator variables being investigated, additional columns are added to the coding sheet to reflect the data characteristics. These variables can be coded as dummy, factor, or (semi)continuous variables and later used to perform a subgroup analysis or meta regression. For MASEM, the required data input format can deviate depending on the method used (e.g., TSSEM requires a list of correlation matrices as data input). For qualitative meta-analysis, the coding scheme typically summarizes the key qualitative findings and important contextual and conceptual information (see Hoon ( 2013 ) for a coding scheme for qualitative meta-analysis). Figure  1 shows an exemplary coding scheme for a quantitative meta-analysis on the correlational relationship between top-management team diversity and profitability. In addition to effect and sample sizes, information about the study country, firm type, and variable operationalizations are coded. The list could be extended by further study and sample characteristics.

Exemplary coding sheet for a meta-analysis on the relationship (correlation) between top-management team diversity and profitability

2.6.2 Inclusion of moderator or control variables

It is generally important to consider the intended research model and relevant nontarget variables before coding a meta-analytic dataset. For example, study characteristics can be important moderators or function as control variables in a meta-regression model. Similarly, control variables may be relevant in a MASEM approach to reduce confounding bias. Coding additional variables or constructs subsequently can be arduous if the sample of primary studies is large. However, the decision to include respective moderator or control variables, as in any empirical analysis, should always be based on strong (theoretical) rationales about how these variables can impact the investigated effect (Bernerth and Aguinis 2016 ; Bernerth et al. 2018 ; Thompson and Higgins 2002 ). While substantive moderators refer to theoretical constructs that act as buffers or enhancers of a supposed causal process, methodological moderators are features of the respective research designs that denote the methodological context of the observations and are important to control for systematic statistical particularities (Rudolph et al. 2020 ). Havranek et al. ( 2020 ) provide a list of recommended variables to code as potential moderators. While researchers may have clear expectations about the effects for some of these moderators, the concerns for other moderators may be tentative, and moderator analysis may be approached in a rather exploratory fashion. Thus, we argue that researchers should make full use of the meta-analytical design to obtain insights about potential context dependence that a primary study cannot achieve.

2.6.3 Treatment of multiple effect sizes in a study

A long-debated issue in conducting meta-analyses is whether to use only one or all available effect sizes for the same construct within a single primary study. For meta-analyses in management research, this question is fundamental because many empirical studies, particularly those relying on company databases, use multiple variables for the same construct to perform sensitivity analyses, resulting in multiple relevant effect sizes. In this case, researchers can either (randomly) select a single value, calculate a study average, or use the complete set of effect sizes (Bijmolt and Pieters 2001 ; López-López et al. 2018 ). Multiple effect sizes from the same study enrich the meta-analytic dataset and allow us to investigate the heterogeneity of the relationship of interest, such as different variable operationalizations (López-López et al. 2018 ; Moeyaert et al. 2017 ). However, including more than one effect size from the same study violates the independency assumption of observations (Cheung 2019 ; López-López et al. 2018 ), which can lead to biased results and erroneous conclusions (Gooty et al. 2021 ). We follow the recommendation of current best practice guides to take advantage of using all available effect size observations but to carefully consider interdependencies using appropriate methods such as multilevel models, panel regression models, or robust variance estimation (Cheung 2019 ; Geyer-Klingeberg et al. 2020 ; Gooty et al. 2021 ; López-López et al. 2018 ; Moeyaert et al. 2017 ).

2.7 Step 7: analysis

2.7.1 outlier analysis and tests for publication bias.

Before conducting the primary analysis, some preliminary sensitivity analyses might be necessary, which should ensure the robustness of the meta-analytical findings (Rudolph et al. 2020 ). First, influential outlier observations could potentially bias the observed results, particularly if the number of total effect sizes is small. Several statistical methods can be used to identify outliers in meta-analytical datasets (Aguinis et al. 2013 ; Viechtbauer and Cheung 2010 ). However, there is a debate about whether to keep or omit these observations. Anyhow, relevant studies should be closely inspected to infer an explanation about their deviating results. As in any other primary study, outliers can be a valid representation, albeit representing a different population, measure, construct, design or procedure. Thus, inferences about outliers can provide the basis to infer potential moderators (Aguinis et al. 2013 ; Steel et al. 2021 ). On the other hand, outliers can indicate invalid research, for instance, when unrealistically strong correlations are due to construct overlap (i.e., lack of a clear demarcation between independent and dependent variables), invalid measures, or simply typing errors when coding effect sizes. An advisable step is therefore to compare the results both with and without outliers and base the decision on whether to exclude outlier observations with careful consideration (Geyskens et al. 2009 ; Grewal et al. 2018 ; Kepes et al. 2013 ). However, instead of simply focusing on the size of the outlier, its leverage should be considered. Thus, Viechtbauer and Cheung ( 2010 ) propose considering a combination of standardized deviation and a study’s leverage.

Second, as mentioned in the context of a literature search, potential publication bias may be an issue. Publication bias can be examined in multiple ways (Rothstein et al. 2005 ). First, the funnel plot is a simple graphical tool that can provide an overview of the effect size distribution and help to detect publication bias (Stanley and Doucouliagos 2010 ). A funnel plot can also support in identifying potential outliers. As mentioned above, a graphical display of deviation (e.g., studentized residuals) and leverage (Cook’s distance) can help detect the presence of outliers and evaluate their influence (Viechtbauer and Cheung 2010 ). Moreover, several statistical procedures can be used to test for publication bias (Harrison et al. 2017 ; Kepes et al. 2012 ), including subgroup comparisons between published and unpublished studies, Begg and Mazumdar’s ( 1994 ) rank correlation test, cumulative meta-analysis (Borenstein et al. 2009 ), the trim and fill method (Duval and Tweedie 2000a , b ), Egger et al.’s ( 1997 ) regression test, failsafe N (Rosenthal 1979 ), or selection models (Hedges and Vevea 2005 ; Vevea and Woods 2005 ). In examining potential publication bias, Kepes et al. ( 2012 ) and Harrison et al. ( 2017 ) both recommend not relying only on a single test but rather using multiple conceptionally different test procedures (i.e., the so-called “triangulation approach”).

2.7.2 Model choice

After controlling and correcting for the potential presence of impactful outliers or publication bias, the next step in meta-analysis is the primary analysis, where meta-analysts must decide between two different types of models that are based on different assumptions: fixed-effects and random-effects (Borenstein et al. 2010 ). Fixed-effects models assume that all observations share a common mean effect size, which means that differences are only due to sampling error, while random-effects models assume heterogeneity and allow for a variation of the true effect sizes across studies (Borenstein et al. 2010 ; Cheung and Vijayakumar 2016 ; Hunter and Schmidt 2004 ). Both models are explained in detail in standard textbooks (e.g., Borenstein et al. 2009 ; Hunter and Schmidt 2004 ; Lipsey and Wilson 2001 ).

In general, the presence of heterogeneity is likely in management meta-analyses because most studies do not have identical empirical settings, which can yield different effect size strengths or directions for the same investigated phenomenon. For example, the identified studies have been conducted in different countries with different institutional settings, or the type of study participants varies (e.g., students vs. employees, blue-collar vs. white-collar workers, or manufacturing vs. service firms). Thus, the vast majority of meta-analyses in management research and related fields use random-effects models (Aguinis et al. 2011a ). In a meta-regression, the random-effects model turns into a so-called mixed-effects model because moderator variables are added as fixed effects to explain the impact of observed study characteristics on effect size variations (Raudenbush 2009 ).

2.8 Step 8: reporting results

2.8.1 reporting in the article.

The final step in performing a meta-analysis is reporting its results. Most importantly, all steps and methodological decisions should be comprehensible to the reader. DeSimone et al. ( 2020 ) provide an extensive checklist for journal reviewers of meta-analytical studies. This checklist can also be used by authors when performing their analyses and reporting their results to ensure that all important aspects have been addressed. Alternative checklists are provided, for example, by Appelbaum et al. ( 2018 ) or Page et al. ( 2021 ). Similarly, Levitt et al. ( 2018 ) provide a detailed guide for qualitative meta-analysis reporting standards.

For quantitative meta-analyses, tables reporting results should include all important information and test statistics, including mean effect sizes; standard errors and confidence intervals; the number of observations and study samples included; and heterogeneity measures. If the meta-analytic sample is rather small, a forest plot provides a good overview of the different findings and their accuracy. However, this figure will be less feasible for meta-analyses with several hundred effect sizes included. Also, results displayed in the tables and figures must be explained verbally in the results and discussion sections. Most importantly, authors must answer the primary research question, i.e., whether there is a positive, negative, or no relationship between the variables of interest, or whether the examined intervention has a certain effect. These results should be interpreted with regard to their magnitude (or significance), both economically and statistically. However, when discussing meta-analytical results, authors must describe the complexity of the results, including the identified heterogeneity and important moderators, future research directions, and theoretical relevance (DeSimone et al. 2019 ). In particular, the discussion of identified heterogeneity and underlying moderator effects is critical; not including this information can lead to false conclusions among readers, who interpret the reported mean effect size as universal for all included primary studies and ignore the variability of findings when citing the meta-analytic results in their research (Aytug et al. 2012 ; DeSimone et al. 2019 ).

2.8.2 Open-science practices

Another increasingly important topic is the public provision of meta-analytical datasets and statistical codes via open-source repositories. Open-science practices allow for results validation and for the use of coded data in subsequent meta-analyses ( Polanin et al. 2020 ), contributing to the development of cumulative science. Steel et al. ( 2021 ) refer to open science meta-analyses as a step towards “living systematic reviews” (Elliott et al. 2017 ) with continuous updates in real time. MRQ supports this development and encourages authors to make their datasets publicly available. Moreau and Gamble ( 2020 ), for example, provide various templates and video tutorials to conduct open science meta-analyses. There exist several open science repositories, such as the Open Science Foundation (OSF; for a tutorial, see Soderberg 2018 ), to preregister and make documents publicly available. Furthermore, several initiatives in the social sciences have been established to develop dynamic meta-analyses, such as metaBUS (Bosco et al. 2015 , 2017 ), MetaLab (Bergmann et al. 2018 ), or PsychOpen CAMA (Burgard et al. 2021 ).

3 Conclusion

This editorial provides a comprehensive overview of the essential steps in conducting and reporting a meta-analysis with references to more in-depth methodological articles. It also serves as a guide for meta-analyses submitted to MRQ and other management journals. MRQ welcomes all types of meta-analyses from all subfields and disciplines of management research.

Gusenbauer and Haddaway ( 2020 ), however, point out that Google Scholar is not appropriate as a primary search engine due to a lack of reproducibility of search results.

One effect size calculator by David B. Wilson is accessible via: https://www.campbellcollaboration.org/escalc/html/EffectSizeCalculator-Home.php .

The macros of David B. Wilson can be downloaded from: http://mason.gmu.edu/~dwilsonb/ .

The macros of Field and Gillet ( 2010 ) can be downloaded from: https://www.discoveringstatistics.com/repository/fieldgillett/how_to_do_a_meta_analysis.html .

The tutorials can be found via: https://www.metafor-project.org/doku.php .

Metafor does currently not provide functions to conduct MASEM. For MASEM, users can, for instance, use the package metaSEM (Cheung 2015b ).

The workbooks can be downloaded from: https://www.erim.eur.nl/research-support/meta-essentials/ .

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Hansen, C., Steinmetz, H. & Block, J. How to conduct a meta-analysis in eight steps: a practical guide. Manag Rev Q 72 , 1–19 (2022). https://doi.org/10.1007/s11301-021-00247-4

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METHODS article

Metasynthesis: an original method to synthesize qualitative literature in psychiatry.

• 1 AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
• 2 Université Paris Descartes, Sorbonne Paris Cité, Paris, France
• 3 CESP, Faculté de médecine, Université Paris-Sud, Faculté de médecine, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), INSERM, Université Paris-Saclay, Villejuif, France
• 4 Service Universitaire de Psychiatrie de l’Adolescent, Centre Hospitalier Argenteuil, Argenteuil, France
• 5 ECSTRA Team, UMR-1153, INSERM, Paris Diderot University, Sorbonne Paris Cité, Paris, France
• 6 Université Paris-Sud, Paris, France

Background: Metasynthesis—the systematic review and integration of findings from qualitative studies—is an emerging technique in medical research that can use many different methods. Nevertheless, the method must be appropriate to the specific scientific field in which it is used. The objective is to describe the steps of a metasynthesis method adapted from Thematic Synthesis and phenomenology to fit the particularities of psychiatric research.

Method: We detail each step of the method used in a metasynthesis published in 2015 on adolescent and young adults suicidal behaviors. We provide clarifications in several methodological points using the latest literature on metasyntheses. The method is described in six steps: define the research question and the inclusion criteria, select the studies, assess their quality, extract and present the formal data, analyze the data, and express the synthesis.

Conclusion: Metasyntheses offer an appropriate balance between an objective framework, a rigorously scientific approach to data analysis and the necessary contribution of the researcher’s subjectivity in the construction of the final work. They propose a third level of comprehension and interpretation that brings original insights, improve the global understanding in psychiatry, and propose immediate therapeutic implications. They should be included in the psychiatric common research toolkit to become better recognized by clinicians and mental health professionals.

The use of qualitative research is proliferating in medical research ( 1 ). Over the past two decades, numerous studies in the field of psychiatry have used a qualitative protocol ( 2 , 3 ), and it has been recognized as a valuable way to “ obtain knowledge that might not be accessible by other methods and to provide extensive data on how people interpret and act upon their illness symptoms ” ( 4 ). What matters most is the respondent’s perspective and the joint construction by the respondent and the researcher of a context-dependent, multiple, and complex reality ( 5 ). In this respect, the qualitative approach is close to that of the psychiatrist: what is important is what the patient feels and experiences and what emerges during the interaction between the patient and the psychiatrist. Indeed, the subjective coconstruction inherent to most of qualitative methods seems especially close to the psychiatric clinical meeting. Both are useful for building up local theory that helps to increase two important aspects of theory: individually relevant theory for clinical work and field-specific general theory for research ( 6 ). Qualitative research offers a thick description (one that encompass all the complexity of the phenomenon, behavior, or context) of a phenomenon and attempts to document the complexity and multiplicity of its experience ( 6 ). Similarly, in their day-to-day clinical work, psychiatrists attribute great importance to complexity and try to place symptoms within the patient’s history, in all of its intricate context—which again plays a crucial role in therapeutic choices.

Some have expressed concern, however, that because qualitative studies are isolated and rarely used to contribute to practical knowledge, they do not play a significant role in the movement toward evidence-based medicine ( 5 ). To alleviate this concern and enable qualitative work to contribute to this movement, an increasing number of teams have worked to develop and apply synthesis methods to these data. Qualitative syntheses refer to a collection of different methods for systematically reviewing and integrating findings from qualitative studies ( 7 ). The aims of such methods are to capture the increasing volume of qualitative research, to facilitate the transfer of knowledge to improve healthcare, and to bring together a broad range of participants and descriptions ( 8 , 9 ). Qualitative syntheses require not only a systematic approach to collecting, analyzing, and interpreting results across multiple studies, but also to develop overarching interpretation emerging from the joint interpretation of the primary studies included in the synthesis ( 10 , 11 ). Therefore, it involves going beyond the findings of any individual study to make the “whole into something more than the parts alone imply” ( 12 ).

Qualitative syntheses are now recognized as valuable tools for examining participants’ meanings, experiences, and perspectives, both deeply (because of the qualitative approach) and broadly (because of the integration of studies from different healthcare contexts and participants). They have been shown to be particularly useful to identify research gaps, to inform the development of primary studies, and to provide evidence for the development, implementation, and evaluation of health interventions ( 13 ). Because of this growing importance, an important work has been done in the last ten years, in order to ensure the quality of qualitative syntheses, such as: describing the methods to ensure reproducibility, develop tools for assessing the quality of the primary articles, and establish reporting guidelines [see, for example, the ENTREQ statement ( 13 ), the GRADE-Cerqual protocol ( 14 ), and the Cochrane or EVIDENT works ( 15 , 16 )].

However, despite some qualitative syntheses have been successfully conducted in the field of mental health ( 2 , 3 , 17 – 20 ), no study considers the methodological specificities inherent to psychiatric epistemological stance ( 7 ). Filling this gap has been one of the aims of our team since 2011. In this methodological article, we aimed to discuss the challenge of implementing metasynthesis to improve the understanding of youths suicide. In this study, we adapted the Thematic Synthesis developed by Thomas and Harden and incorporate a phenomenological approach in order to deal with new rigor with general as well as psychiatric issues ( 21 ). We will present each step of the method (Figure 1 ) and will propose methodological discussions. The detailed description of the findings can be found elsewhere ( 22 ).

Figure 1 . Distribution in time for articles included in the metasynthesis.

Conducting a Metasynthesis

Before start—constitution of a research group.

The constitution of the research group and the definition of the study method are an important step before engaging in any synthesis work. The researcher must work in collaboration with researchers of diverse backgrounds ( 9 ). A collaborative approach improves quality and rigor and subjects the analytical process to group reflexivity ( 11 ). The research team should include members trained in qualitative synthesis as well as those expert in the topic being studied ( 23 ). As there are many ways to do qualitative syntheses, the research team will have to choose one of them adapted to the research question and to the expertise of the group ( 15 ).

Our team is composed of adolescent and child psychiatrists and psychologists from France and elsewhere (Italy, Chile, and Brazil) and focuses on developing qualitative research ( 24 – 26 ) and metasynthesis in adolescent psychiatry and related fields ( 22 , 27 , 28 ). Our method is adapted from thematic synthesis ( 21 ), which combines and adapts approaches from both metaethnography and grounded theory ( 10 ). Metaethnography, as well as Thematic Synthesis, takes place in six or seven steps from data collection to text coding and finally writing the synthesis. Original authors of metaethnography were trained in grounded theory, a qualitative method developed in the social sciences, laying on conceptual coding combine to construct a new theory. Thematic synthesis allows the researcher to include much more studies in the synthesis and to use tools coming from quantitative reviews, as systematic literature searches. This method perfectly suits to psychiatric research: user-friendliness for both researchers and readers; standardized in its most subjective steps but flexible, to make it adaptable to various patients or situations, such as children, patients with psychological disabilities or psychotic disorders, and to different researchers’ backgrounds (e.g., phenomenology, psychology, or psychoanalysis). We add a phenomenological perspective with a coding close to Smith’s interpretative phenomenological analysis (IPA) ( 29 ). IPA is also a qualitative method of coding a text, laying on phenomenology and hermeneutics. The level of coding is what makes sense to the reader (for example, a letter, a word, a sentence, the absence of a word, or a sentence). Phenomenology allows avoiding never-ending debates about theories of the psyche and focuses on the patient experience which is at the heart of psychiatric care. We understand that published manuscripts provide only thin data sets that are not eligible for a complete phenomenological analysis. Rather we tried to let ourselves guided by the impressions the text generated in us. It was like one article was assimilated as one participant, as it is mainly the voice of the main writer. We applied Smith’s tips on how reading and coding the data.

Define the Research Question and the Selection Criteria

Defining the research question is a crucial substep ( 9 ). This question must be broad enough to be of interest but small enough to be manageable ( 5 , 23 ) and has already been explored by enough studies ( 30 ). Inclusion and exclusion criteria may be fixed on methodological aspects, on participants selected, on thematic focuses or language specificities ( 9 , 31 ).

Youths suicide is a focus that were suitable for qualitative methods. We chose this subject because youth suicide is a major public health issue worldwide as well as a complex disorder that encompasses medical, sociological, anthropological, cultural, psychological, and philosophical issues. It has been widely explored by qualitative research. The lack of effectiveness of current care let us think that new insights could be expected by qualitative exploration. A first selection of articles, as well as an existing literature review on the topic, served to specify some starting information and enable initial decisions, including the definition of the research question, specification of the scope and the inclusion criteria. Then, the questions were constructed through reading and confronting these articles with our first qualitative study in the theme and our clinical knowledge of the theme.

As we wanted to study the therapeutic relationship and barriers to effective care, we decided to include research concerning not only the population being treated (the adolescents and young adults, and their parents), but also the healthcare professionals who care for these patients. A first screening of the literature showed us that optimal scope required a large range of ages, from 15 to 30 years old. The common thread linking all these youths was the importance of their parents in their everyday life. We chose to include only qualitative research, because it remains unclear how to deal with mixed method (combining qualitative and quantitative datasets) ( 23 ). Although databases contain articles in different languages, we chose to include only articles published in English (as most studies are now published in English) and French (as it is our first language) ( 22 , 27 ).

Study Selection

There is a debate on the choice of sampling method, some authors using an exhaustive sampling, some others, an expansive one ( 30 ). We privileged exhaustive systematic searches ( 32 ) since our method allowed large samples and because our target audience was the mental health community, which is accustomed to quantitative systematic reviews ( 9 ). Only journal articles were included, as most scientific data are published in this form ( 33 ). The first selection of articles served to specify the choice of keywords and databases for the electronic search. To ensure both sensitivity and specificity, we decided to use a combined approach of thesaurus terms and free-text terms. This technique maximizes the number of potentially relevant articles retrieved and ensures the highest level of rigor ( 34 ). Keywords were established during research team meetings, and were reported in the article or as supplemental material for more clarity ( 35 ). As each database has its own thesaurus terms, and as keywords encompasses different meanings in each discipline ( 36 ), the keywords were specific for each one.

We used four clusters of keywords: (i) those that concern the topic of interest (such as suicide, obesity, or anorexia nervosa), (ii) those that concern the participants (gender, age, profession, etc.), (iii) those that concern qualitative research (such as qualitative research, interviews, focus groups , or content analysis ), and (iv) those that concern perceptions and understanding, often called “views” ( 33 ) (such as knowledge, perception, self-concept, feeling , or attitude ). The last cluster takes all its importance in the phenomenological perspective of the analysis. An example of the final algorithm used (in the PubMed Web search) is provided in Table 1 .

Table 1 . Algorithm used in the PubMed Web search from Ref. ( 22 ).

Similar work was conducted to select the databases. After consulting reference articles ( 33 , 37 , 38 ), we decided to conduct the search in five electronic databases covering medical, psychological, social, and nursing sciences: MEDLINE, EMBASE, CINAHL, PsycINFO, and Social Science Citation Index (SSCI). Not long ago, CINAHL was the most important database for finding qualitative research, but as qualitative research proliferates in medical research, more and more qualitative articles are referenced in MEDLINE ( 33 ) and EMBASE. PsycINFO was a good database for finding qualitative articles with a psychological approach. We decided to add SSCI to broaden and complexity the outlook with a sociological point of view. We followed recommendations published on MEDLINE ( 39 ), CINAHL ( 40 ), EMBASE ( 41 ), and PsycINFO ( 42 ) for choosing search terms. Finally, we decided not to use the methodological databases’ filters for qualitative research, as these have undergone little replication and validation ( 43 ).

We decided to include articles published only in or after 1990. Two points impelled this decision: first, there was very little qualitative research on suicide before the year 2000 and even less before the 1990s (Figure 2 ). Second, we chose to consider as outdated research findings and results published more than 20 years ago were outdated, given the evolution of medical practices ( 44 ). However, this choice must be adapted to the topic of metasynthesis.

Figure 2 . Flowchart of the metasynthesis steps.

The results of database searches were entered into a bibliographic software program (Zotero©) for automatic removal of duplicates. Then, two authors independently screened all titles and abstracts and selected the studies according to our inclusion criteria (defined earlier). If the abstract was not sufficient, we read the full text. Disagreements were resolved during working group meetings. Full texts of potentially relevant articles were then examined, and a second selection was performed. At this phase, we also checked each article’s reference list looking for new articles we might have overlooked. The final selection represented from 2 to 3% of the total initially obtained. This rate is consistent with the findings of other metasyntheses ( 23 ). For clarity, the selection process was also presented in a flowchart (Figure 3 ). We referred to STARLITE principles to report our literature search ( 45 ) (Table 2 ).

Figure 3 . Flowchart for selecting studies from Ref. ( 22 ).

Table 2 . STARLITE principles applied to the literature search report of Ref. ( 22 ).

Quality Assessment of Included Studies

There is no consensus about whether quality criteria should be applied to qualitative research, or, for those who think they should be, about which criteria to use and how to apply them. Nevertheless a growing number of researchers are choosing to appraise studies for metasyntheses ( 46 ) and some authors state that a good metasynthesis can no longer avoid this methodological step ( 7 ). The reasons and methods for quality assessment fit into three general approaches: assessment of study conduct, appraisal of study reporting, and an implicit judgment of the content and utility of the findings for theory development ( 13 ). There is certainly not one best appraisal tool, but rather a wide choice of good ones ( 8 ).

We chose the Critical Appraisal Skills Program (CASP) ( 47 ), which is the most frequently used instrument ( 46 ), addresses all the principles and assumptions underpinning qualitative research ( 13 ). It is one of the instruments recommended by the Cochrane Collaboration ( 48 ) and has been used in several important thematic analyses of medical topics. As proposed by Boeije et al., we weighted our assessment by applying a three-point scale to each criterion (0 = criterion not met; 1/P = criterion partially met; 2/T = criterion totally met) ( 49 ) (Table 3 ).

Table 3 . Evaluation of the quality of the studies according to the Critical Appraisal Skill Programme (CASP) from Ref. ( 22 ).

We have not excluded any study on quality criteria. We think that the goal of the quality assessment is not to help selecting the more rigorous article. Either, this step is important to improve the overall rigor of the metasynthesis: by easily evaluating the quality of each article, the readers will have the possibility to make their own evaluation of the quality of the results of the metasynthesis ( 9 ). To enhance the rigor of the synthesis, we published the full results of this assessment ( 50 ).

Extracting and Presenting the Formal Data

To understand the context of each study, readers need the formal data about each study: the number and type of participants in each study, its location, and the method of data collection and of analysis. These data must be extracted and presented in a way that enables readers to form their own opinions about the studies included. We presented these data systematically, in a table with the following headings:

– Identification of the study.

– Summary of the study’s aim.

– Country where the study took place.

– Details about the participants: age, gender, type, and number.

– Method of data collection (e.g., semistructured interviews or focus groups).

– Analysis method (grounded theory, phenomenology, thematic, etc.).

Data Analysis

This step is probably the most subjective: its performance is highly influenced by the authors’ backgrounds ( 13 ). There are many ways to analyze, as many as there are authors. All researchers build on their personal knowledge and background for the analysis, sometimes described as bricolage , following Claude Levi-Strauss: “ the bricoleur combines techniques, methods, and materials to work on any number of projects and creations. Whereas a typical construction process might be limited by the history or original use of individual pieces, the bricoleur works outside of such limitations, reorganizing pieces to construct new meaning. In other words, unlike linear, step-by-step processes, the bricoleur steps back and works without exhaustive preliminary specifications ” ( 51 , 52 ). The synthesis will inevitably be only one possible interpretation of the data ( 9 ), as it depends on the authors’ judgment and insights ( 21 ). The qualitative synthesis does not result simply from a coding process, but rather from the researchers’ configuration of segments of coded data “ assembled into a novel whole ” ( 53 ).

In this process, the multidisciplinary team is essential to assess rigor and develop richer and more complex understandings. Triangulation of the analyses is enhanced when researchers with diverse background consider the same data set ( 11 ). “ Collaborative working not only improve quality and rigour, but subjects the analytical process to group reflexivity ” ( 54 ).

The first step of this process involved carefully reading and rereading each study ( 21 ). It is an active reading, with the intention of appraising, familiarizing, identifying, extracting, recording, organizing, comparing, relating, mapping, stimulating and verifying. In other words, it is reading with “ the intention of collating a synthesizable set of accounts ” ( 11 ).

The second step was coding: at least two different researchers coded each part of the data (whole manuscripts), performing a line-by-line coding, close to the phenomenological analysis described by Smith et al. ( 29 ).

In the third step, the codes were grouped and categorized into a hierarchical tree structure. This step is very close to the translation work described by Noblit and Hare ( 12 ). It involves comparing themes across articles to match themes from one article with those from another while ensuring that each key theme captured similar themes from different articles. We obtained a list of descriptive themes very close to the data.

In our example, we highlighted the sentence “You’re going to school, you’re getting an education, but you’re depressed” and coded it depressed . The code is then combined with others in a theme named “The experience of distress.”

Finally, in the last and most subjective step of the analysis, we generated analytical themes, which depended largely on the “judgment and insights of the reviewers” ( 21 ). This step is very similar the development of third-order interpretations—“ the synthesis of both first and second order constructs into a new model or theory about a phenomenon ” ( 23 )—and requires going beyond the content of original studies to achieve a higher level of interpretation and going beyond the descriptive synthesis to propose a more conceptual line-of-argument ( 21 , 23 ). This work has two types of underlying aims. The first type may be theoretical, by enabling a higher level of comprehension of a phenomenon; in medical science, this may be to better describe and understand a pathology. The second type may be to answer clinical questions about pathology and care directly.

In our example, we clearly fulfilled the second aim. The results leaded us to discuss new insights about suicidal youths’ care. The experience of incomprehension shared by all the protagonists of the care interferes with the capacity for empathy of both family members and professionals. We could use the concepts of intersubjectivity to witness the violence driven by the suicidal act.

Writing the Synthesis

Throughout the analysis process, the authors build themes that take place in the story they are telling about the participant’s experience ( 21 ). Then, the expression of the synthesis is our story of the studied phenomenon.

The results of the metasynthesis consist of the themes that we developed in the analysis. They are built by first and second order constructs. We did not define actual third-order themes; rather, third-order constructs helped us to build the synthesis into a story. We organized the themes into superordinate themes, which are interpretations of the themes and can be considered third-order interpretations.

For example, in one of the developed theme called the experience of distress we described that the young people experienced depressive symptoms. The participants described feelings of sadness, sorrow, mental pain, despair, detachment, anger, and irritability . The authors interpreted that as despair . We organized all these closed related feeling into the individual experience of distress . We decide not to speak about depression , first because some healthcare professionals repeated that they may diagnose depression “ but certainly not on a routine basis ” ( 22 ), then because we adopted a phenomenological approach and we felt that distress encompasses a broader and more complex experience.

Metasynthesis results prepare the framework for the discussion, the most interpretative part of the review, where hypothesis and proposals are presented. We offer our understanding of the participants’ experience. Both our presentation and our discourse are influenced by our aim: to answer clinical questions by suggesting specific actions or considerations for care; the discussion and the answers are intended to be useful for the readers of our article, as well as for us ( 23 ).

Our conclusion is that “ the violence of the message of a suicidal act and the fears associated with death lead to incomprehension and interfere with the capacity for empathy of both family members and professionals. The issue in treatment is to be able to witness this violence so that the patient feels understood and heard, and thus to limit recurrences ” ( 22 ). This issue is clear and simple and it leads to an immediate application to clinical practice which is described in the implication for practice chapter.

Finally, we discuss the limitation of the findings. The principal limitations were methodological (with our method, the access to participants’ data is partial), and in the sampling (we didn’t take in consideration the influence of gender on the experience of suicidal behavior). That exercise enhances the credibility of the publication, enabling readers to measure the importance and generalizability of the findings.

The written synthesis has to fulfill the standard for reporting synthesis of qualitative research. We chose to refer to Tong and al. ENTREQ statement ( 13 ) attached to the publication.

Our method is based on Thomas and Harden Thematic Synthesis ( 21 ). After a broad-scale review of literature on the topic of metasynthesis, we have decided to clarify the definition of some aspects of the method and modify or expand others, because we wanted both a medical and a psychological approach. For example, we opted to use a systematic search method and a weighted version of the CASP to assess quality.

Most metasynthesis authors argue that these reviews achieve a third-order level of interpretation, that is, that they are more than the sum of their results. If, as we think, qualitative research can achieve a moderate level of generalization with clinical implications, metasyntheses may transform these findings into more highly abstracted and generalizable theoretical frameworks. We “ push their findings toward the nomothetic end of the idiographic-nomothetic continuum ” ( 44 ). Qualitative specialists certainly do not shy away from stressing the importance of context in their studies, or from arguing that the context of one study may not be applicable to others. It is true that, in a way, metasyntheses decontextualize concepts to attain greater generalizability ( 44 ). But we can relate this act to the response of clinicians reading a qualitative article: they will try to apply the concepts to their own situations ( 21 ). Authors of metasyntheses are proposing their own interpretation of the concept and its generalizability. The scientific value of metasynthesis lies in its role as a summary of several studies and as the interpretation of varying context, as well as in its ability to weight each result and to propose greater generalizability.

Qualitative research is an invaluable method for gaining new insights into mental disorders ( 6 ). Its development in recent years requires that we improve methods for synthesizing their results. We think this way of doing metasynthesis is appropriate to psychiatric research in its intermediate position that stresses both progress in the general comprehension of disorders and direct clinical implications. It offers an appropriate balance between three components: an objective framework, which includes the selection, inclusion, and appraisal of studies; a rigorously scientific approach to data analysis; and the necessary contribution of the researcher’s subjectivity in the construction of the final work. The balance for a qualitative metasynthesis is, we think, very similar to the clinical approach to each patient. It necessitates a robust scientific background, a rigorous step-by-step—symptom by symptom—progression, and finally a part of art that depends on each clinician: the subjective part of therapy.

Finally, we think that metasyntheses enable insights that no other method can provide. Qualitative research sheds new light on scientific questions by emphasizing the participants’ subjective understanding and experience ( 6 ). Metasynthesis proposes a third level of comprehension and interpretation that brings original insights. In our study ( 22 ), we emphasized an original point in the relationship that was no found in any result from each primary study: the difficulty of professionals and parents to understand and cope with suicide as an obstacle to the care of the suicidal adolescent. Therefore, our study’s analysis went deeper and proposed original results.

Author Contributions

Conceived and designed the experiments and final approval: JL, AR-L, MO, and MM. Conducted the literature review: JL and MO. Performed the experiments: JL, MO, and AR-L. Wrote the article: JL (all the article), AR-L (analysis), MO (introduction and analysis), and MM (discussion).

Conflict of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Acknowledgments

We would like to thank Jo Ann Cahn for revising our English.

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Keywords: qualitative research, metasynthesis, metaethnography, qualitative evidence synthesis, psychiatry, suicide

Citation: Lachal J, Revah-Levy A, Orri M and Moro MR (2017) Metasynthesis: An Original Method to Synthesize Qualitative Literature in Psychiatry. Front. Psychiatry 8:269. doi: 10.3389/fpsyt.2017.00269

Received: 05 September 2017; Accepted: 17 November 2017; Published: 01 December 2017

Reviewed by:

Copyright: © 2017 Lachal, Revah-Levy, Orri and Moro. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Jonathan Lachal, jonathan.lachal@gmail.com

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Literature Syntheis 101

How To Synthesise The Existing Research (With Examples)

By: Derek Jansen (MBA) | Expert Reviewer: Eunice Rautenbach (DTech) | August 2023

One of the most common mistakes that students make when writing a literature review is that they err on the side of describing the existing literature rather than providing a critical synthesis of it. In this post, we’ll unpack what exactly synthesis means and show you how to craft a strong literature synthesis using practical examples.

This post is based on our popular online course, Literature Review Bootcamp . In the course, we walk you through the full process of developing a literature review, step by step. If it’s your first time writing a literature review, you definitely want to use this link to get 50% off the course (limited-time offer).

Overview: Literature Synthesis

• What exactly does “synthesis” mean?
• Aspect 1: Agreement
• Aspect 2: Disagreement
• Aspect 3: Key theories
• Aspect 4: Contexts
• Aspect 5: Methodologies
• Bringing it all together

What does “synthesis” actually mean?

As a starting point, let’s quickly define what exactly we mean when we use the term “synthesis” within the context of a literature review.

Simply put, literature synthesis means going beyond just describing what everyone has said and found. Instead, synthesis is about bringing together all the information from various sources to present a cohesive assessment of the current state of knowledge in relation to your study’s research aims and questions .

Put another way, a good synthesis tells the reader exactly where the current research is “at” in terms of the topic you’re interested in – specifically, what’s known , what’s not , and where there’s a need for more research .

So, how do you go about doing this?

Well, there’s no “one right way” when it comes to literature synthesis, but we’ve found that it’s particularly useful to ask yourself five key questions when you’re working on your literature review. Having done so,  you can then address them more articulately within your actual write up. So, let’s take a look at each of these questions.

1. Points Of Agreement

The first question that you need to ask yourself is: “Overall, what things seem to be agreed upon by the vast majority of the literature?”

For example, if your research aim is to identify which factors contribute toward job satisfaction, you’ll need to identify which factors are broadly agreed upon and “settled” within the literature. Naturally, there may at times be some lone contrarian that has a radical viewpoint , but, provided that the vast majority of researchers are in agreement, you can put these random outliers to the side. That is, of course, unless your research aims to explore a contrarian viewpoint and there’s a clear justification for doing so. 

Identifying what’s broadly agreed upon is an essential starting point for synthesising the literature, because you generally don’t want (or need) to reinvent the wheel or run down a road investigating something that is already well established . So, addressing this question first lays a foundation of “settled” knowledge.

Need a helping hand?

2. Points Of Disagreement

Related to the previous point, but on the other end of the spectrum, is the equally important question: “Where do the disagreements lie?” .

In other words, which things are not well agreed upon by current researchers? It’s important to clarify here that by disagreement, we don’t mean that researchers are (necessarily) fighting over it – just that there are relatively mixed findings within the empirical research , with no firm consensus amongst researchers.

This is a really important question to address as these “disagreements” will often set the stage for the research gap(s). In other words, they provide clues regarding potential opportunities for further research, which your study can then (hopefully) contribute toward filling. If you’re not familiar with the concept of a research gap, be sure to check out our explainer video covering exactly that .

3. Key Theories

The next question you need to ask yourself is: “Which key theories seem to be coming up repeatedly?” .

Within most research spaces, you’ll find that you keep running into a handful of key theories that are referred to over and over again. Apart from identifying these theories, you’ll also need to think about how they’re connected to each other. Specifically, you need to ask yourself:

• Are they all covering the same ground or do they have different focal points  or underlying assumptions ?
• Do some of them feed into each other and if so, is there an opportunity to integrate them into a more cohesive theory?
• Do some of them pull in different directions ? If so, why might this be?
• Do all of the theories define the key concepts and variables in the same way, or is there some disconnect? If so, what’s the impact of this ?

Simply put, you’ll need to pay careful attention to the key theories in your research area, as they will need to feature within your theoretical framework , which will form a critical component within your final literature review. This will set the foundation for your entire study, so it’s essential that you be critical in this area of your literature synthesis.

If this sounds a bit fluffy, don’t worry. We deep dive into the theoretical framework (as well as the conceptual framework) and look at practical examples in Literature Review Bootcamp . If you’d like to learn more, take advantage of our limited-time offer to get 60% off the standard price.

4. Contexts

The next question that you need to address in your literature synthesis is an important one, and that is: “Which contexts have (and have not) been covered by the existing research?” .

For example, sticking with our earlier hypothetical topic (factors that impact job satisfaction), you may find that most of the research has focused on white-collar , management-level staff within a primarily Western context, but little has been done on blue-collar workers in an Eastern context. Given the significant socio-cultural differences between these two groups, this is an important observation, as it could present a contextual research gap .

In practical terms, this means that you’ll need to carefully assess the context of each piece of literature that you’re engaging with, especially the empirical research (i.e., studies that have collected and analysed real-world data). Ideally, you should keep notes regarding the context of each study in some sort of catalogue or sheet, so that you can easily make sense of this before you start the writing phase. If you’d like, our free literature catalogue worksheet is a great tool for this task.

5. Methodological Approaches

Last but certainly not least, you need to ask yourself the question: “What types of research methodologies have (and haven’t) been used?”

For example, you might find that most studies have approached the topic using qualitative methods such as interviews and thematic analysis. Alternatively, you might find that most studies have used quantitative methods such as online surveys and statistical analysis.

But why does this matter?

Well, it can run in one of two potential directions . If you find that the vast majority of studies use a specific methodological approach, this could provide you with a firm foundation on which to base your own study’s methodology . In other words, you can use the methodologies of similar studies to inform (and justify) your own study’s research design .

On the other hand, you might argue that the lack of diverse methodological approaches presents a research gap , and therefore your study could contribute toward filling that gap by taking a different approach. For example, taking a qualitative approach to a research area that is typically approached quantitatively. Of course, if you’re going to go against the methodological grain, you’ll need to provide a strong justification for why your proposed approach makes sense. Nevertheless, it is something worth at least considering.

Regardless of which route you opt for, you need to pay careful attention to the methodologies used in the relevant studies and provide at least some discussion about this in your write-up. Again, it’s useful to keep track of this on some sort of spreadsheet or catalogue as you digest each article, so consider grabbing a copy of our free literature catalogue if you don’t have anything in place.

Bringing It All Together

Alright, so we’ve looked at five important questions that you need to ask (and answer) to help you develop a strong synthesis within your literature review.  To recap, these are:

• Which things are broadly agreed upon within the current research?
• Which things are the subject of disagreement (or at least, present mixed findings)?
• Which theories seem to be central to your research topic and how do they relate or compare to each other?
• Which contexts have (and haven’t) been covered?
• Which methodological approaches are most common?

Importantly, you’re not just asking yourself these questions for the sake of asking them – they’re not just a reflection exercise. You need to weave your answers to them into your actual literature review when you write it up. How exactly you do this will vary from project to project depending on the structure you opt for, but you’ll still need to address them within your literature review, whichever route you go.

The best approach is to spend some time actually writing out your answers to these questions, as opposed to just thinking about them in your head. Putting your thoughts onto paper really helps you flesh out your thinking . As you do this, don’t just write down the answers – instead, think about what they mean in terms of the research gap you’ll present , as well as the methodological approach you’ll take . Your literature synthesis needs to lay the groundwork for these two things, so it’s essential that you link all of it together in your mind, and of course, on paper.

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Systematic Reviews & Other Review Types

• What is a Systematic Review?
• What is a Scoping Review?
• What is a literature review?
• What is a Rapid Review?
• What is a Mixed Methods Review?
• What is a Network Meta-Analysis?
• What is an Overview of Reviews?

What is a Meta-Syntheses?

• What is an Integrative Review?
• What is a Diagnostic Test Accuracy Review?
• What is a Living Systematic Review?

A meta-synthesis brings together qualitative data to form a new interpretation of the research field.  It helps to generate new theories or an explanatory theory of why the intervention works or not.  It creates a hypothesis for future testing or comparison with trial outcomes.

Meta-syntheses are best designed t o re-interpret meaning across many qualitative studies.

(S. Atkins et al (2008)

Meta-Syntheses Resources:

• What makes a good systematic review and metaanalysis?
• Protocol-developing meta-ethnography reporting guidelines (eMERGe)
• Conducting a meta-ethnography
• Cochrane Qualitative & Implementation Methods Group
• Emerge Project

How a Meta-Syntheses differs from a Systematic Review

Timeframe:  12 months or less. 

Question: " A clearly formulated question helps to set boundaries for the scope and depth of a meta-ethnography" (Atkins S.)

Sources and searches:  Not as exhaustive as a systematic review, unless the question requires exhaustive searching.  Can search within a particular setting.  Search specifically for qualitative studies if possible (be careful with search filters).  Search may rely more heavily on inclusion and exclusion criteria.

Selection:  Different screening process--includes repeated reading of articles to connect and record concepts or themes. 

Appraisal:  Focus is on the translation of studies and then systematically compared or 'translated' within and across studies while retaining the structure of the relationships between central concepts/themes and includes a 'thematic analysis'.

Synthesis: Qualitative Differs from a Meta-Analysis (Quantitative)   "The goal is  not  aggregative  in the sense of 'adding studies together' as with a meta-analysis.  On the contrary,  it is interpretative in broadening understanding of a particular phenomenon." (Source: Grant et al (2009))

There are 3 types of synthesis that may be used.  A second level of synthesis is possible.

• Reciprocal Translation: Concepts in one study can incorporate those of another.
• Refutational Translation: Concepts in different studies contradict one another.
• Line of Argument Synthesis: Studies identify different aspects of the topic that can be drawn together in a new interpretation.

(France EF, Ring N  et al 1988)

Limitations of a Meta-Syntheses

• Only appropriate for high-quality qualitative studies
• Can only accommodate a limited number of primary studies
• Choice of a meta-ethnography may not be confirmed until pool of evidence known
• Requires significant methodological skill and experience with qualitative methods
• May take time to engage with the evidence and develop theory
• Requires further interpretation by policy makers and practitioners

Source: M. Petticrew et al (2013) and Li T. et al (2001)

Other names for a Meta-Syntheses

Meta-synthesis, Meta-ethnography, Qualitative Evidence Synthesis, Qualitative Meta-Synthesis, Meta narrative review (related)

Temple Attribution

Adapted with permission from Temple University Libraries. https://guides.temple.edu/systematicreviews

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• Med J Islam Repub Iran

A meta-synthesis study of literature review and systematic review published in nurse prescribing

Azar darvishpour.

1. PhD Candidate, Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran & Social Determinants of Health (SDH) Research Center, School of Nursing and Midwifery, Guilan University of Medical Sciences (GUMS), Guilan, Iran. ri.ca.smug@ruophsivrad

Soodabeh Joolaee

2. Associate Professor of Nursing, Center for Nursing Care Research, Department of Nursing Management, Faculty of Nursing and Midwifery, Iran University of Medical Science, Tehran, Iran. moc.oohay@seealooj

Mohammad Ali Cheraghi

3. Associate Professor, Department of critical Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran. moc.oohay@0002ilaihgareh

Background: Prescribing represents a new aspect of practice for nurses. To make qualitative results more accessible to clinicians, researchers, and policy makers, individuals are urged to synthesize findings from related studies. Therefore this study aimed to aggregate and interpret existing literature review and systematic studies to obtain new insights on nurse prescription.

Methods: This was a qualitative meta synthesis study using Walsh and Downe process. In order to obtain data all Digital National Library of Medicine's databases, search engines and several related sites were used. Full texts with "review and nurs* prescri* " words in the title or abstract in English language and published without any time limitation were considered. After eliminating duplicate and irrelevant studies, 11 texts were selected. Data analysis was conducted using qualitative content analysis. Multiple codes were compared based on the differences and similarities and divided to the categories and themes.

Results: The results from the meta synthesis of the 11 studies revealed 8 themes namely: leading countries in prescribing, views, features, infrastructures, benefits, disadvantages, facilitators and barriers of nursing prescription that are discussed in this article. The results led to a schematic model.

Conclusion: Despite the positive view on nurse prescribing, there are still issues such as legal, administrative, weak research and educational deficiencies in academic preparation of nurses that needs more effort in these areas and requires further research.

Introduction

Many countries have introduced non-medical prescription to improve efficiency and access to medication, particularly where access to doctors can be difficult ( 1 ). The number of countries where nurses are legally permitted to prescribe medication has grown considerably over the last two decades ( 2 ). Now in many countries (Australia, USA, UK, Canada, Ireland, etc) specific groups of nurses are allowed to prescribe various drugs ( 3 ).

In fact, in countries with a well-developed education system for nurses, opportunities exist for nurses to obtain advanced practice training and graduate education; in the US, Canada and the United Kingdom. For example, a nurse practitioner typically defined as a registered nurse who is educated to function in an advanced clinical role and prescribing is one aspect of this advanced clinical role ( 4 ).

The benefits of non-medical prescribing have been consistently reported in the literature ( 1 ). Improved speed and convenience of access to medicines have been consistently reported as key benefits of non-medical prescription by patients and health professionals ( 1 ).

According to this, the World Health Organization (WHO) in the fifth meeting of the regional advisory panel in the Eastern Mediterranean nursing convention (Islamabad, Pakistan, 2001) recommended that it required nurses as first-line health care providers to be empowered and prepared to prescribe properly ( 5 ). However, nurses in many countries still do not have the authority to prescribe medication. The introduction of major policy initiatives, such as nurse prescribing, requires high level of discussion and policy development to ensure successful implementation ( 6 ). Accordingly, each country can utilize international experiences to minimize their inevitable losses and damages. It can give new insight regarding the different aspects and necessity of implementation of nurse drug prescribing in leading countries. A significant number of review studies have been conducted related to nurse prescribing ( 2 , 7 - 16 ). Each of these studies has contributed to our understanding of nurse prescribing, but to both advance knowledge and policy making for its implementation, knowledge synthesis across multiple studies is required. To make qualitative results more accessible to clinicians, researchers, and policymakers, individuals are urged to synthesize findings from related studies ( 17 ). Thus the purpose of this study was to aggregate and interpret existing literature review and systematic review studies to obtain new insights on nurse prescribing drugs, and to present a schematic model of nurse prescribing that can be a useful framework for its implementation. According to the purpose of the study, the following questions were considered in literature reviews:

• - What is the overall view on nurse prescribing?
• - What are the positive and negative outcomes of nurse prescribing?
• - What are the barriers and facilitators for its implementation?

Qualitative Meta synthesis method was applied to conduct this study. The purpose of the Meta synthesis is to dig below the surface of what is currently understood regarding a phenomenon, to emerge with the kernel of a new truth, a better kind of understanding of something ( 18 ). Metasynthesis, a systematic synthesis of findings across qualitative studies, seeks to generate new interpretations for which there is a consensus within a particular field of study ( 19 ). A qualitative meta synthesis integrates individual qualitative studies by bringing together and breaking down the findings (themes, metaphors, or categorizations) of individual studies, elucidating the key features, and combining these findings into a transformed whole –a single description of the findings that authentically represents all of the cases ( 20 ).

The meta synthesis process employed in this study followed that done by Walsh and Downe (2005) ( 21 ). Walsh and Downe developed and proposed a seven-step approach for the qualitative meta-synthesis: ( 1 ) framing a meta-synthesis exercise, ( 2 ) locating relevant papers, ( 3 ) deciding what to include, ( 4 ) appraising studies, ( 5 ) comparing and contrasting exercise, ( 6 ) reciprocating translation, and ( 7 ) synthesizing translation ( 21 ).

Search strategy included all of the following databases, search interfaces and journals of INLM (Integrated Digital National Library of Medicine) from August 14, 2012 to December week 4 2012: EBSCO host (CINAHL), EBSCO host (Medline), Ovid SP (MEDLINE(R)), Cochran Library, Scopus, Web of science, Elsevier, Emelard, JAMA Journals, Wiley, Oxford Journals, Springer and Thieme Journals and few related sites (World Health Organization (www.who.int), websites for health professionals ( http://www.nurse-prescriber.co . uk), Google Scholar (scholar.google.com) and http://journals.cambridge.org/action/ search).

The inclusion, exclusion criteria and appropriate data sources were identified. The inclusion criteria included: all studies without time restriction that contain search terms (review and nurs* prescri*) in the title or abstract, with published full text in English. The review studies that had a search strategy were included but review studies of experts' opinion and without a search strategy were excluded from the meta synthesis.

One researcher screened all titles and abstracts and two other researchers during supervising the process of study, screened full texts as relevant to the purpose of study. Quality assessment and data extraction was carried out by three researchers.

The qualities of included papers were appraised using AMSTAR tool (Assessment of Multiple Systematic Reviews consists of 11 items) ( 22 ) and CASP tool (Critical Appraisal Skills Program for Review articles with 10 items) ( 23 ). Studies were awarded a score between 0 and 11 for AMSTAR and 0-10 for CASP tool. Studies rated as low, medium, and high quality.

The electronic search yielded 5829 results in which. 49 were duplicated and 5739 had no relevant to the research objectives and therefore excluded. This reduced the number of texts to 41. The full texts of the remaining 41articles were reviewed and a further 30 put aside and not reviewed (i.e. book review). Finally, 11 studies were selected, reviewed and included in this study ( 2 , 7 - 16 ). Figure 1 shows summary of the selection process for articles used in the study. Table 1 illustrates search strategy of Ovid SP (MEDLINE(R))

The flowchart for the search and selection process

4 of these 11 review articles were considered as systematic review and 7 literature review. Systematic review articles were evaluated by means of AMSTAR in which three were strong (score of 0.8) and one moderate (score of 0.51 to 0.79). Review articles with CASP (Critical Appraisal Skills Program) tool were tested that three were evaluated as "strong" (score more than 0.8) and 4 "moderate" articles (score of 0.51 to 0.79).

All 11 studies that met the inclusion criteria were read line by line several times in order to get the intended message of the content as well as an accurate impression of the context. The results and conclusions of studies were considered as “meaning units” and coded, integrated, synthesized and categorized. Multiple codes based on the differences and similarities compared and divided into category and themes. The results of meta synthesis revealed 8 themes namely: Leading countries in prescribing, Views, Features, Infrastructures, Benefits, Disadvantages, Facilitators and Barriers. Examples illustrating these themes can be found in Tables 1 , ​ ,2 2 and ​ and3. 3 . These themes are described bellow.

Further research is needed to provide a picture for investigated concept. The results were lead to a schematic model ( Fig. 2 ). This model of nurse prescribing can help policymakers to identify areas for attention.

Schematic model of nurse prescribing medicine

Leading countries in prescription drug

The results showed that four studies in this meta synthesis focused on the leading countries in prescription drug ( 2 , 13 - 15 ).

Bhanbhro et al (2011) found that the majority of studies about nurse prescribing were undertaken in the UK with only one from USA, Canada, Botswana and Zimbabwe each ( 15 ). In addition, Kroezen et al (2011) showed that seven Western European and Anglo-Saxon countries (Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA) had implemented nurse prescribing medicines. Netherlands and Spain were in the process of introducing nurse prescribing drug policies ( 2 ).

Views relating to nurse prescribing

Nine studies indicated the views (doctors, nurses, and patients) related to nurse prescriber ( 8 - 16 ). All of these studies have reported positive views on nurse. For example Latter and Courtenay (2004) stated: “The review highlights that nurse prescribing has generally been evaluated positively to date” ( 10 ).

Also Van Ruth et al (2008) mentioned "The effects of nurse prescribing seem positive, although the high risk of bias in the studies means they must be regarded with caution" ( 12 ).

In addition, Bhanbhro et al. (2011) reported that non-medical prescribing was widely accepted and viewed positively by patients and professionals ( 15 ).

Only two studies noted indirectly negative views of physicians on the nurse practitioners prescribing medicine as follows:

"Nurses and pharmacists were positive about supplementary prescribing (SP) but the medical profession were more critical and lacked awareness/ understanding, according to the identified literature" ( 11 ).

Also Creedon, et al (2009) quoted Wilhelmsson and Foldeivi (2003) that the Swedish GPs had lacked knowledge on the training of nurse prescribers, which could account for their negative views on nurse prescribing ( 13 ).

However, these negative views can be a barrier that should be given particular importance to the implementation of nurse prescriber.

Results showed that seven authors came up with the issue of Features of nurse prescribing ( 2 , 7 , 10 , 12 - 14 , 16 ).This issue consists of 4 category (Prescribing patterns, Areas of nurse prescribing, Confidence in prescribing and Quality and safety of practice) that emerged in this study. Table 2 shows summary of emerged cods and categories of this issue.

The findings showed the most important feature of nurse prescribing was long consultation results of Horrocks et al (2002) and Van Ruth et al (2008) studies. These studies noted that longer consultations lead to better quality of care and increase patient satisfaction and improve patient-centered care as the main goal of health care system ( 7 , 12 ).

Eight studies ( 7 - 10 , 12 - 14 , 16 ) investigated benefits of nurse prescribing. These benefits were categorized as: benefits for health system, patients, and nurses. Benefits for health system consists of better care delivery, acquiring patients satisfaction, reduction in number of required personnel, effectiveness and potentially reduction in costs.

There were some benefits for patients including convenience, easier access to drugs and care, receive better care, health promotion, earlier treatment, reduce in waiting time for medication, safety, satisfaction of care, improvement in compliance with medications, prevention of relapses, closeness and proximity of patients to health care providers, make sense of the nurses concerns expressed by patients and reduction in the number of journeys some carers had to make. And benefits for nurses included reduction in workload, time saving, professional autonomy, professional development, satisfaction of role, increasing clinical competence, better use of nurses' skills and experience, recognition abilities, capabilities and expertise of nurses, better accountability, enhance the effective monitoring and reporting of adverse drug reactions, improve communication between the professional health care team. In addition, the evidence showed that nurse prescribing was also useful for physicians and other health care professionals. Jabareen (2008) quoted Crossman (2006) that Nurse prescribing allows GPs to take on more complex cases ( 27 ). Also Bowskill (2009) quoted Jordan, Knight and Pointon (2004) and Jones et al (2007) that nurse prescribing was a useful means for reducing professional distance, enabling nurse prescribers to work more closely with medical colleagues ( 28 ).

Disadvantages

Two studies ( 9 , 16 ) mentioned disadvantages of nurse prescribing. Harris (2004) stated this Disadvantage as follows: "Most of nurses felt that there was additional work associated with record keeping and administration" ( 9 ). Price et al (2012) has quoted the disadvantage as "safety concerns" including: working outside the parameters of Patient Group Directions (PGD), poor record keeping and the development of PGD that failed to comply with legal requirements ( 16 ).

Infrastructures

In total, the meta synthesis showed that three authors investigated the infrastructures of nurse prescribing ( 2 , 10 , 15 ). Most other studies were not relevant to the main study question. This issue covered three categories (legal status, educational and organizational conditions).

Only one study stated the legal restrictions as follows: "All Western-European and Anglo-Saxon countries that have realized or initiated nurse prescribing have imposed legal restrictions on which categories of nurses can prescribe medicines" ( 2 ).

Two studies ( 2 , 15 ) addressed organizational conditions as illustrated in the following comment:

"The gradual growth over time of legislative authority and in the numbers of non-medical prescribers, particularly nurses, in some countries suggests that the acceptability of nonmedical prescribing is based on the perceived value to the health care system as a whole ( 15 ) and "It is nonetheless clear that most countries operate some sort of mandatory registration system in which nurse prescribers have to be registered before they are allowed to prescribe" ( 2 ).

One study ( 2 ) which focused on educational conditions stated: "nurses are required to successfully complete a prescribing course before they are allowed to start prescribing and one of the most important requirements for nurses internationally to enter prescribing programs is sufficient clinical experience" and also: "nurses must have three - five years of clinical experience in their own field of practice, before they are eligible for endorsements as a nurse practitioner and hence for prescribing medicines".

The results indicated barriers to nurse prescribing categories included: legal limitations, executive factors, educational deficiencies, research weaknesses, humanistic factors such as concerns about the adequacy of pharmacologic knowledge and unaware of physicians about nurse prescribing education ( Table 3 ).

Facilitators

The results of the meta synthesis indicated the facilitators of nurse prescribing such as training and educational preparations, managerial factor for support mechanisms and competency assessment, organizational factors to aware physicians and other staff about nurse prescribing. Table 4 shows summary of facilitators in nurse prescribing implementation identified by the meta-synthesis.

As the results show in Schematic model ( Fig. 2 ), barriers and facilitators are directly in contact with infrastructures. In fact, with structural reforming, the barriers will be eliminated and the implementation of the nurse prescribing will be facilitated.

Our analysis showed different aspects of nurse prescribing that can help other countries act on its implementation with greater recognition.

The first theme "the leading countries in prescribing" depicted that the implementation of nurse prescribing in UK was higher than other countries. Nurse drug prescribing in the UK has grown significantly over the last decade and it is well established as a mainstream qualification ( 29 ).

Despite this fact that nurse prescribing has had well growth in European and American countries, but unfortunately, there is no evidence to indicate its implementation in Asian countries. This may be attributed due to diverse policy of health care system, cultural, economical, political and social conditions dominated in these countries that the nurses. Hence, despite the useful information derived from leading countries, the health policy makers should consider their context for nurse prescribing implementation.

This issue can also be looked at the other side that may be nurses are prescribing in these countries now, but it has not been published in online articles. As the Miles et al (2006) mentioned detailed information about the specific nature of nurse prescribing in low-resource settings was generally lacking in the literature ( 30 ).

The theme "Views"(second theme) indicated the views of different stakeholders (doctors, nurses, and patients) on nurse prescribing. Although all reviews studies reported positive views regarding nurse prescribing but negative views of physicians was reported which may be due to lack of knowledge on the training of nurse prescribers. Health professions have often specific knowledge in their field and do not have sufficient awareness about other professions. This may cause resistance to implementation of such activities that have overlap with their areas of functions. However, the health policy makers should pay special attention to this issue in their strategic planning and provide proper context for professional's familiarity with other fields. For instance it is recommended some of nursing courses be taught by physicians. In this way, doctors may become more familiar with the content of nursing courses and also nurses learn better interaction with physicians.

Another theme in our findings was" features of nurse prescribing". One of the features of nurse prescribing noted in studies was longer consultations of nurse prescribers than physicians that can lead patient-centered care as a main goal of health care system. This feature is a unique characteristic of nursing that is affected by holistic perspective toward patient. Based on the Irajpour et al (2012) study, more problems raise when some professionals treat patients as medical cases only worth studying rather than a human who needs health services ( 31 ). Thus nurse prescribing with their holistic view may probably face fewer problems.

"Benefits" and "disadvantages" were the two other themes emerged in our study.

These results showed in contrast to the considerable benefits of nurse prescribing, there are a few disadvantages that can be corrected by managerial planning. Each of identified benefits is enough important to support the development of nurse prescribing in all countries. These benefits are likely to be extended if nurse practitioners are able to prescribe ( 32 ). Here's a point worth mentioning that these reviews despite the many benefits of nurse prescribing have not addressed cost-benefit and cost- effectiveness of nurse prescribing. In other words, there are very few published evaluations about the clinical outcomes and cost effectiveness of nurse prescribing, particularly in direct comparison with doctors, the traditional prescribers of medication ( 30 ).

For example it is mentioned in Venning et al (2000) study that clinical care and health service costs of nurse practitioners and general practitioners were similar. However, they concluded if nurse practitioners were able to maintain the benefits while reducing their return consultation rate or shortening consultation times, they could be more cost effective than general practitioners ( 33 ). Another possible explanation for cost- effectiveness of nurse prescribing may be the view of hospitals in the past which considered nurses as cheap labor and believed they “owned” nurses. Today, many hospitals hold the same view ( 34 ). Thus with a simple count it may be concluded that the nurse prescribing is both cost-benefit and cost-effectiveness. However more information is needed about the cost-benefit and cost-effectiveness of nurse prescribing that point to the need for further research.

Another theme in this meta-synthesis was infrastructures. Although the main issues for implementation of nurse prescribing (legal status, educational and organizational conditions) have been expressed in studies, but there is no available evidence regarding the cultural and political context that strongly affect on the entire topic of nurse prescribing. Importance of this issue is stated in Mills et al study (2oo6) who mentioned some of issues may be somewhat irrelevant when it comes to politically and economically unstable environments ( 30 ).

Thus it seems that one of the priorities of nurse prescribing implementation is providing cultural and political context. However these factors can affect as the barriers in nurse prescribing implementation because they can influence on views of policy makers and managers. Then their views can impact on strategic planning, implementation, and supportive structure or even on interaction of medical team colleagues.

The results identified a broad range of barriers and facilitators (Theme 7 and 8). These factors should be inferred as guides for policymakers to implementation of the nurse prescribing. Also the results revealed there are still issues such as legal, administrative, weak research and educational deficiencies in leading countries which needs for more effort to be made in these areas. Based on this review lack of confidence in applied pharmacology and therapeutics is an issue categorized in human factors as the barrier of nurse drug prescription. Conversely, self-confidence is a facilitator in nurse prescribing. On the other hand, delegating authority and enhancing self-confidence of nurses can help them to apply their knowledge in practice ( 35 ).

Miles et al (2oo6) expressed there are key elements of success in developing mechanisms for nurse prescribing such as strong political, support of nursing and academic programs to educate. ( 30 ). However, one of the problems highlighted with training programs is that many academic nursing education programs are not always feasible, affordable or attainable, particularly in rural areas ( 30 ). Support mechanisms are other important issues that are addressed in this meta synthesis. For providing this the nurse managers can play an important role. This support can undertake any facilitating activity, such as providing facilities, means and equipment, information, education, rewards and even some symbolic behaviors that nurses perceive to be facilitating ( 35 ). Also the support that physicians give in terms of ongoing training and supervision is important key in nurse prescribing ( 36 ).

Considering the findings of this study, it seems that nursing prescribing is positive experience and other countries can introduce its implementation without serious concern. In this metasynthesis, the most important factors identified including providing valuable information for nurse managers and policy makers. However, the results revealed there are still issues such as legal, administrative, weak research and educational deficiencies in leading countries that needs more effort in these areas. Appropriate training and support mechanisms are needed in order to facilitate implementation of nurse prescribing. In spite of the useful information that has been obtained from the study of the leading countries, cultural and social factors of each country are also of great importance. Hence health policy makers should identify barriers and facilitators within their own context and use this information to promote health system.

Ethical Considerations

Although the ethical issues were minimal in this study since no human subjects were involved, the researchers still had an ethical responsibility arising from this study. In order to fulfill this, the researchers considered the ethical responsibility as follows:

• Commitment to respecting moral rights of authors and no forging parts or all of the results (data making‏)
• Intentional manipulation of data or analyzes (falsification), or reporting methods not used by the researchers

Recommendations for future research

There are little evidences reporting the economic and financial outcomes of non-medical prescribing. It is therefore recommended that future studies explore cost-benefit and cost-effectiveness of nurse prescribing.

Considering the importance of the cultural context of health systems in implementation of programs, policymakers must recognize this within their own context. It is suggested that next research should be on understanding of infrastructures and existing context of nurse prescribing in each country.

There is also a need for more theory-based research on nurse prescribing. Future research should address this.

Limitations

Limitations of this synthesis include the exclusion of unpublished and in progress reviews and systematic reviews.

Acknowledgements

This study is part of a PhD thesis financially supported by Tehran University of Medical Sciences (Grant Number: 1929).

Conflict of Interest

No conflict of interest associated with this work.

Cite this article as: Darvishpour A, Joolaee S, Cheraghi M.A. A meta-synthesis study of literature review and systematic review published in nurse prescribing. Med J Islam Repub Iran 2014 (22 July). Vol. 28:77.

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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically evaluate: mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

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A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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Literature Reviews & Evidence Syntheses

• Getting Started

Definitions & Examples of Evidence Syntheses

Literature (narrative) review, systematic review, scoping review, integrative review, meta-analysis, meta-synthesis.

• Literature Reviews
• Systematic Reviews

There are a number of types of evidence syntheses. Below, each of the most common types are defined, and an example from a published paper is included. Note that the example articles are available through Lavery Library subscriptions and may require you to sign into your Fisher account.

• A broad term referring to reviews with a wide scope and non-standardized methodology
• Search strategies, search comprehensiveness, and time range for selected sources will vary and do not follow an established protocol.
• Very common for use in undergraduate and graduate student assignments

Example from published literature

• Intentional integration of diversity ideals in academic libraries: A literature review This link opens in a new window.
• Systematic and transparent method used to collect and categorize existing evidence on a broad question of scientific, policy, or management importance
• Compares, evaluates, and synthesizes evidence to look for an effect of an intervention
• Takes time, in some cases up to a year or more, to complete
• Most commonly referred to as type of evidence synthesis; sometimes confused as a blanket term for other types of reviews
• Stakeholders’ Acceptability of Pharmacist-Led Screening in Community Pharmacies: A Systematic Review This link opens in a new window.
• Looking to identify research gaps and opportunities for evidence synthesis rather than searching for the effect of an intervention
• May critically evaluate evidence, but does not attempt to synthesize the results in the same way as systematic reviews (see reporting/writing guidelines from Environmental Evidence Journal's Systematic Map and Evidence-Based Forestry's Guidance on Systematic Maps )
• Takes time to complete, potentially longer than a systematic review
• To learn more about scoping reviews read Arksey & O'Malley's 2007 paper: Scoping Studies: Towards a methodological framework
• The use of digital stories as a health promotion intervention: a scoping review This link opens in a new window.
• Answers questions about practice by evaluating the quality of each study included in the review and interprets and synthesizes studies into meaningful conclusions
• Differs from a systematic review in that they look "more broadly at a phenomenon of interest . . .and allows for diverse research, which may contain theoretical and methodological literature" (Toronto & Remington, 2020, p. 2)
• Change fatigue in nursing: An integrative review This link opens in a new window.

Toronto, C. E., & Remington, R. (Eds.). (2020). A step-by-step guide to conducting an integrative review . Springer International Publishing AG.

• Studies for a Meta-analysis should be selected using systematic review searching methods
• Statistical technique for combining the findings from quantitative studies
• Results are portrayed with a Forest Plot to show strength and direction of effect
• Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis
• Studies for a Meta-synthesis should be selected using systematic review searching methods
• An approach to analyze data across qualitative studies
• Uses established methodologies to triangulate, code and translate study data. See  Guidance on choosing qualitative evidence synthesis methods for use in health technology assessments of complex interventions p.16 for more information on Qualitative Synthesis Methods
• ‘Into the Wild’: A meta-synthesis of talking therapy in natural outdoor spaces
• << Previous: Getting Started
• Next: Literature Reviews >>
• Last Updated: Jan 31, 2024 9:24 AM
• URL: https://libguides.sjf.edu/literature-reviews

• How it works

Published by Nicolas at January 16th, 2024 , Revised On January 23, 2024

Literature Review Examples – How To Write One?

A literature review is a critical analysis of existing scholarly literature on a particular topic. It is often required as part of academic assignments, such as research papers , theses, and dissertations. However, writing a good literature review can be challenging, especially for first-time students. 

Table of Contents

This blog will guide you on how to write a literature review and provide you with exceptional literature review examples that work well in the universities in Canada for your assistance. Let’s get started.

What Is A Literature Review?

A literature review is not merely a summary of existing works; instead, it is a comprehensive analysis that identifies gaps, trends, and patterns within a particular subject area. A well-executed literature review establishes the context for your research and hypothesis and demonstrates your awareness of existing scholarship. Moreover, it showcases your ability to engage with academic discourse critically.

Purpose Of A Literature Review

The purpose of a literature review is to:

• Demonstrate your knowledge of the existing literature on your topic.
• Identify the key themes, debates, and gaps in the literature.
• Position your own research in the context of the existing literature.
• Show how your research will contribute to the field.

How To Write A Literature Review Example

Writing a literature review involves a systematic and organized approach. Follow the research paper format stated by your organization. Here’s a step-by-step guide to help you write an effective literature review:

Step 1: Define The Scope And Purpose

• Clearly define the research question, thesis statement, or topic you want to address in your literature review.
• Determine the scope of your review by setting boundaries for the time period, geographic location, and specific aspects of the topic you want to cover.
• Identify the purpose of your literature review, such as providing an overview, identifying gaps in existing research, or evaluating the current state of knowledge.

Step 2: Conduct A Comprehensive Literature Search

• Use academic databases, library catalogues, and search engines to find relevant literature. Common databases include PubMed , Google Scholar , and specialized databases related to your field.
• Use a combination of keywords and controlled vocabulary to refine your search.
• Keep track of the sources you find, including bibliographic information, abstracts, and key findings.
• Read professionally written examples of literature review for better understanding.

Step 3: Evaluate And Select Sources

• Critically evaluate the quality and relevance of each source. Consider the credibility of the author, the publication venue, and the methodology used in the studies.
• Organize the selected sources into themes or categories based on commonalities and differences.
• Identify key theories, concepts, or methodologies that are central to your topic.
• For example, in a finance thesis , add sources that are only relevant to the specific topic of finance that you wish to explore. 

Step 4: Synthesize Information

• Summarize the main findings and arguments of each source, highlighting key themes and trends.
• Identify areas of agreement and disagreement among the sources.
• Organize the information in a logical and coherent manner. You can use a chronological, thematic, or methodological approach, depending on the nature of your literature review.

Step 5: Write And Revise

• Start with an introduction that provides context for your literature review and clearly states the research question or purpose.
• Organize the body of your literature review based on the themes or categories you identified during the synthesis.
• Discuss each source in relation to your research question, highlighting key findings and their implications.
• Conclude by summarizing the main contributions of the literature to your research question and identifying any gaps or areas for future research.
• Revise and edit your literature review for clarity, coherence, and conciseness.

APA Literature Review Example

Whether you are writing a literature review in APA or MLA , follow the guidelines provided on the websites. Here is a comprehensive example of a literature review in APA that will provide a better understanding of how to write a literature review. 

Literature Review: The Impact of Social Media on Mental Health in Adolescents

Social media has become an integral part of the lives of adolescents, with platforms such as Facebook, Instagram, Twitter, and Snapchat dominating their online experiences. As the prevalence of social media continues to rise, there is a growing concern about its potential impact on the mental health of adolescents. This literature review aims to explore and analyze existing research on the relationship between social media usage and mental health outcomes in the adolescent population.

Social Media Usage Patterns

Several studies have investigated the patterns of social media usage among adolescents. Smith et al. (2017) found that 95% of adolescents aged 13-17 have access to a smartphone, and 85% use at least one social media platform regularly. Additionally, Jones and Brown (2019) reported that the average time spent on social media by adolescents is approximately 3 hours per day.

Cyberbullying and Mental Health

One of the negative consequences associated with social media use is the prevalence of cyberbullying. Patchin and Hinduja (2018) highlighted that adolescents who experience cyberbullying are more likely to report symptoms of depression and anxiety. This finding is consistent with a longitudinal study by Williams et al. (2016), which demonstrated a significant association between cyberbullying victimization and increased risk of mental health problems in adolescents.

Social Comparison and Body Image

Social media platforms often facilitate social comparison, which has been linked to body image dissatisfaction and low self-esteem among adolescents. Fardouly et al. (2020) conducted a meta-analysis of 15 studies and found a moderate effect size, indicating a strong association between social media use and negative body image. Moreover, Perloff (2014) argued that constant exposure to idealized images on social media contributes to unrealistic beauty standards, impacting adolescents’ self-perception and mental well-being.

Fear of Missing Out (FOMO) and Anxiety

The Fear of Missing Out (FOMO) is a psychological phenomenon associated with anxiety and stress related to the fear of not being included or missing out on experiences others are having. Primack et al. (2017) conducted a cross-sectional analysis and discovered a positive correlation between higher social media use, FOMO, and increased levels of anxiety among adolescents. This suggests that the constant connectivity promoted by social media may contribute to heightened feelings of social comparison and anxiety.

Positive Aspects of Social Media Use

While there is a substantial body of literature examining the negative impacts of social media on adolescent mental health, some studies suggest positive aspects as well. Moreno et al. (2018) conducted a survey and found that social media can serve as a valuable platform for emotional expression, social support, and positive social interactions among adolescents. Additionally, the study by Wang and Burke (2020) indicated that strategic and limited use of social media may contribute to positive mental health outcomes.

The existing literature provides a deep understanding of the complex relationship between social media use and mental health outcomes in adolescents. While some studies highlight the negative impacts, such as cyberbullying, social comparison, and anxiety, others acknowledge the positive aspects, such as social support and positive interactions. Future research should focus on the development of effective interventions and guidelines to promote healthy social media use among adolescents.

Types Of Literature Review

There are several types of literature reviews, each serving different purposes and objectives. Here are some common types:

Narrative Or Traditional Literature Review

• Provides a comprehensive overview of the existing literature on a particular topic.
• Summarizes and synthesizes information from various sources without a specific methodological approach.

Systematic Literature Review

• Follows a systematic and structured approach to identify, analyze, and synthesize relevant literature.
• Involves a clearly defined research question and a detailed search strategy.
• Aims to minimize bias and subjectivity in the selection and analysis of studies.

Systematic Literature Review Example

Conducted in accordance with PRISMA guidelines, this systematic literature review focuses on the efficacy of cognitive-behavioural therapy (CBT) for anxiety disorders in pediatric populations. A comprehensive search across databases identified 25 relevant studies meeting the inclusion criteria. Results indicate consistent positive outcomes in symptom reduction across various anxiety disorders, including generalized anxiety and social anxiety (Jones et al., 2020; Smith & Brown, 2019). However, methodological variations in CBT delivery and outcome measures highlight the need for standardized protocols. This review underscores the robust evidence supporting CBT’s effectiveness in treating pediatric anxiety, while advocating for more uniform research methodologies to enhance comparability and generalizability (Johnson et al., 2018).

Meta-Analysis

• A specialized form of systematic review that involves statistical analysis of quantitative data from multiple studies.
• Combines results from different studies to derive overall conclusions or effect sizes.
• Requires homogeneity in study design and outcome measures for accurate analysis.

Meta-Synthesis

• Meta-synthesis is a qualitative approach that synthesizes findings from multiple qualitative studies.
• Involves the interpretation and integration of themes, concepts, or qualitative data across different studies.

Scoping Review

• A preliminary literature review on a broad topic to identify key concepts, gaps, and research areas.
• Provides an overview without necessarily synthesizing the evidence.

Scoping Literature Review Example 

This scoping review investigates the breadth of literature on the impact of mindfulness interventions on stress reduction. Initial searches in databases such as PubMed and PsycINFO yielded 80 relevant articles. Key themes emerged, including diverse intervention formats (e.g., mindfulness-based stress reduction, mindfulness apps), target populations (e.g., healthcare professionals, students), and outcome measures (e.g., self-reported stress levels, physiological markers). Noteworthy is the limited exploration of long-term effects and variations in intervention delivery. The review provides a foundation for future research directions, emphasizing the need for standardized methodologies and comprehensive assessments to advance our understanding of mindfulness interventions’ effectiveness in stress reduction (Smith et al., 2021; Brown & Jones, 2020).

Critical Review

• Evaluates and critiques the strengths and weaknesses of existing literature.
• Focuses on the methodology, theoretical framework, and overall quality of the studies reviewed.

Integrative Review

• Aims to provide a comprehensive understanding of a topic by integrating findings from different types of studies (quantitative, qualitative, or both).
• May include a range of research designs and methodologies.

Rapid Review

• Conducted within a shorter timeframe, often for decision-making purposes.
• Involves a streamlined review process with limitations in terms of depth and comprehensiveness.

Umbrella Review

• A review of existing systematic reviews and meta-analyses on a specific topic.
• Provides a higher level of evidence synthesis by examining the findings of multiple reviews.

Mixed Methods Review

Incorporates both quantitative and qualitative research studies to gain a comprehensive understanding of a research question.

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Tips For Writing A Good Literature Review

Here are a few additional tips for writing a good literature review in a dissertation or thesis :

Tip 1: Start Early 

Do not wait until the last minute to start writing your literature review. It takes time to do a good job.

Tip 2: Read Widely

Do not just read the most recent articles on your topic. Be sure to read older articles as well.

Tip 3: Take Breaks

Do not try to write your literature review all at once. Take breaks to avoid getting burned out.

Tip 4: Get Feedback

Ask your professor or a classmate to read your literature review and give you feedback.

Common Mistakes To Avoid When Writing A Literature Review

While literature review examples can provide valuable guidance, it is equally important to be aware of common pitfalls that can undermine the effectiveness of your literature review.

• Lack of Focus: A literature review should have a clear focus and not attempt to cover an entire field. Define the boundaries of your review and concentrate on the most relevant and recent literature.
• Overreliance on Secondary Sources: While reviews of existing reviews can be informative, relying solely on secondary sources, such as newspapers , may lead to a lack of depth in your analysis. Strive to include primary research studies to strengthen the credibility of your literature review.
• Failure to Synthesize: Merely summarizing individual studies without synthesizing their findings can result in a disjointed and unconvincing literature review. Connect the dots between different sources to provide a cohesive narrative.
• Ignoring Contradictory Evidence: A robust literature review acknowledges and addresses conflicting findings in the existing literature. Ignoring contradictory evidence can weaken the overall credibility of your review.

Frequently Asked Questions

What is a literature review.

A literature review is a critical analysis of existing research and scholarly works on a specific topic. It involves summarizing, evaluating, and synthesizing relevant literature to identify gaps, patterns, and trends. The review provides a foundation for understanding the current state of knowledge and informs future research directions.

How to write a literature review example?

To write a literature review, define your purpose, conduct a comprehensive search, critically evaluate sources, organize them thematically, and synthesize key findings. Structure your review with an introduction, thematic sections, and a conclusion. Properly cite sources, seek feedback, and revise. Maintain clarity, coherence, and adherence to citation styles throughout.

How to start a literature review example?

Begin your literature review with a concise introduction, providing context for the topic and clearly stating its importance. Define the scope and purpose, indicating the key themes or questions to be addressed. Engage readers by highlighting the relevance and significance of the reviewed literature to the broader research field.

How to write a literature review introduction example?

In this literature review, we explore the evolving landscape of artificial intelligence in healthcare. As advancements accelerate, understanding the implications of patient care and ethical considerations is crucial. This review aims to synthesize existing literature, identifying key trends, challenges, and opportunities in the intersection of artificial intelligence and healthcare delivery.

How to conclude a literature review example?

In conclusion, this literature review reveals the multifaceted nature of social media’s impact on mental health. While negative outcomes are associated with social comparison and excessive use, positive effects include social support. Thorough research is essential, considering individual differences and evolving social media dynamics, for a comprehensive understanding of its influence.

How to critique a literature review example?

This literature review demonstrates a comprehensive analysis of existing research on climate change adaptation strategies. Strengths include a clear organization and synthesis of findings. However, potential limitations include an emphasis on studies from specific regions, possibly affecting the generalizability of the conclusions. Further exploration of diverse geographic contexts could enhance the review’s robustness.

What is a preliminary literature review?

A preliminary literature review is an initial exploration of existing research on a specific topic. It helps researchers identify key concepts, relevant studies, and gaps in the literature before conducting an in-depth review. This phase informs the development of research questions and refines the focus for a more comprehensive literature review.

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