BMC Medical Research Methodology 2008, 8:45
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guish between 'data-driven' or 'theory-driven' approaches.
Moreover they suggest that, "if thematic analysis is limited to
summarising themes reported in primary studies, it offers little
by way of theoretical structure within which to develop higher
order thematic categories..." [[35], p47]. Part of the prob-
lem, they observe, is that the precise methods of thematic
synthesis are unclear. Our approach contains a clear sepa-
ration between the 'data-driven' descriptive themes and
the 'theory-driven' analytical themes and demonstrates
how the review questions provided a theoretical structure
within which it became possible to develop higher order
thematic categories.
The theme of 'going beyond' the content of the primary
studies was discussed earlier. Citing Strike and Posner
[59], Campbell et al. [[11], p672] also suggest that synthe-
sis "involves some degree of conceptual innovation, or employ-
ment of concepts not found in the characterisation of the parts
and a means of creating the whole". This was certainly true
of the example given in this paper. We used a series of
questions, derived from the main topic of our review, to
focus an examination of our descriptive themes and we do
not find our recommendations for interventions con-
tained in the findings of the primary studies: these were
new propositions generated by the reviewers in the light
of the synthesis. The method also demonstrates that it is
possible to synthesise without conceptual innovation.
The initial synthesis, involving the translation of concepts
between studies, was necessary in order for conceptual
innovation to begin. One could argue that the conceptual
innovation, in this case, was only necessary because the
primary studies did not address our review question
directly. In situations in which the primary studies are
concerned directly with the review question, it may not be
necessary to go beyond the contents of the original studies
in order to produce a satisfactory synthesis (see, for exam-
ple, Marston and King, [60]). Conceptually, our analytical
themes are similar to the ultimate product of meta-ethnog-
raphies: third order interpretations [11], since both are
explicit mechanisms for going beyond the content of the
primary studies and presenting this in a transparent way.
The main difference between them lies in their purposes.
Third order interpretations bring together the implications
of translating studies into one another in their own terms,
whereas analytical themes are the result of interrogating a
descriptive synthesis by placing it within an external theo-
retical framework (our review question and sub-ques-
tions). It may be, therefore, that analytical themes are more
appropriate when a specific review question is being
addressed (as often occurs when informing policy and
practice), and third order interpretations should be used
when a body of literature is being explored in and of itself,
with broader, or emergent, review questions.
This paper is a contribution to the current developmental
work taking place in understanding how best to bring
together the findings of qualitative research to inform pol-
icy and practice. It is by no means the only method on
offer but, by drawing on methods and principles from
qualitative primary research, it benefits from the years of
methodological development that underpins the research
it seeks to synthesise.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
Both authors contributed equally to the paper and read
and approved the final manuscript.
Acknowledgements
The authors would like to thank Elaine Barnett-Page for her assistance in
producing the draft paper, and David Gough, Ann Oakley and Sandy Oliver
for their helpful comments. The review used an example in this paper was
funded by the Department of Health (England). The methodological devel-
opment was supported by Department of Health (England) and the ESRC
through the Methods for Research Synthesis Node of the National Centre
for Research Methods. In addition, Angela Harden held a senior research
fellowship funded by the Department of Health (England) December 2003
- November 2007. The views expressed in this paper are those of the
authors and are not necessarily those of the funding bodies.
References
1. Chalmers I: Trying to do more good than harm in policy and
practice: the role of rigorous, transparent and up-to-date
evaluations. Ann Am Acad Pol Soc Sci 2003, 589:22-40.
2. Oakley A: Social science and evidence-based everything: the
case of education. Educ Rev 2002, 54:277-286.
3. Cooper H, Hedges L: The Handbook of Research Synthesis New York:
Russell Sage Foundation; 1994.
4. EPPI-Centre: EPPI-Centre Methods for Conducting Systematic Reviews
2006 [http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=89]. London: EPPI-
Centre, Social Science Research Unit, Institute of Education, Univer-
sity of London
5. Higgins J, Green S, (Eds): Cochrane Handbook for Systematic Reviews of
Interventions 4.2.6 2006 [http://www.cochrane.org/resources/hand
book/]. Updated September 2006. Accessed 24th January 2007
6. Petticrew M, Roberts H: Systematic Reviews in the Social Sciences: A
practical guide Oxford: Blackwell Publishing; 2006.
7. Chalmers I, Hedges L, Cooper H: A brief history of research syn-
thesis. Eval Health Prof 2002, 25:12-37.
8. Juni P, Altman D, Egger M: Assessing the quality of controlled
clinical trials. BMJ 2001, 323:42-46.
9. Mulrow C: Systematic reviews: rationale for systematic
reviews. BMJ 1994, 309:597-599.
10. White H: Scientific communication and literature retrieval.
In The Handbook of Research Synthesis Edited by: Cooper H, Hedges L.
New York: Russell Sage Foundation; 1994.
11. Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, Donovan
J: Evaluating meta-ethnography: a synthesis of qualitative
research on lay experiences of diabetes and diabetes care.
Soc Sci Med 2003, 56:671-684.
12. Dixon-Woods M, Bonas S, Booth A, Jones DR, Miller T, Sutton AJ,
Shaw RL, Smith JA, Young B: How can systematic reviews incor-
porate qualitative research? A critical perspective. Qual Res
2006, 6:27-44.
13. Sandelowski M, Barroso J: Handbook for Synthesising Qualitative
Research New York: Springer; 2007.
14. Thorne S, Jensen L, Kearney MH, Noblit G, Sandelowski M: Qualita-
tive meta-synthesis: reflections on methodological orienta-
tion and ideological agenda. Qual Health Res 2004, 14:1342-1365.
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