There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

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Methods for the thematic synthesis of qualitative research in systematic reviews

Such diverse thinkers as Lao-Tze, Confucius, and U.S. Defense Secretary Donald Rumsfeld have all pointed out that we need to be able to tell the difference between real and assumed knowledge. The systematic review is a scientific tool that can help with this difficult task. It can help, for example, with appraising, summarising, and communicating the results and implications of otherwise unmanageable quantities of data. This is important because quite often there are so many studies, and their results are often so conflicting, that no policymaker or practitioner could possibly carry out this task themselves.Systematic review methods have been widely used in health care, and are becoming increasingly common in the social sciences (fostered, for example, by the work of the Campbell Collaboration). 

This book outlines the rationale and methods of systematic reviews, giving worked examples from social science and other fields. It requires no previous knowledge, but takes the reader through the process stage by stage. It draws on examples from such diverse fields as psychology, criminology, education, transport, social welfare, public health, and housing and urban policy, among others.The book includes detailed sections on assessing the quality of both quantitative, and qualitative research; searching for evidence in the social sciences;meta-analytic and other methods of evidence synthesis; publication bias; heterogeneity; and approaches to dissemination.

Systematic Reviews in the Social Sciences: A Practical Guide

Titles & abstract s Titles & abstracts Include N=54 Include N=121 Include N=89 Exclude N = 0 Exclude N = 1,024 Exclude N = 21

Guidance on the conduct of narrative synthesis in systematic Reviews. A Product from the ESRC Methods Programme. Version 1

Conventional systematic review techniques have limitations when the aim of a review is to construct a critical analysis of a complex body of literature This article offers a reflexive account of an attempt to conduct an interpretive review of the literature on access to healthcare by vulnerable groups in the UK This project involved the development and use of the method of Critical Interpretive Synthesis (CIS) This approach is sensitised to the processes of conventional systematic review methodology and draws on recent advances in methods for interpretive synthesis Many analyses of equity of access have rested on measures of utilisation of health services, but these are problematic both methodologically and conceptually A more useful means of understanding access is offered by the synthetic construct of candidacy Candidacy describes how people's eligibility for healthcare is determined between themselves and health services It is a continually negotiated property of individuals, subject to multiple influences arising both from people and their social contexts and from macro-level influences on allocation of resources and configuration of services Health services are continually constituting and seeking to define the appropriate objects of medical attention and intervention, while at the same time people are engaged in constituting and defining what they understand to be the appropriate objects of medical attention and intervention Access represents a dynamic interplay between these simultaneous, iterative and mutually reinforcing processes By attending to how vulnerabilities arise in relation to candidacy, the phenomenon of access can be better understood, and more appropriate recommendations made for policy, practice and future research By innovating with existing methods for interpretive synthesis, it was possible to produce not only new methods for conducting what we have termed critical interpretive synthesis, but also a new theoretical conceptualisation of access to healthcare This theoretical account of access is distinct from models already extant in the literature, and is the result of combining diverse constructs and evidence into a coherent whole Both the method and the model should be evaluated in other contexts

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Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

Guidance on the conduct of narrative synthesis in sytematic reviews

A systematic review was conducted to examine the barriers to, and facilitators of, healthy eating among young people (11-16 years). The review focused on the wider determinants of health, examining community- and society-level interventions. Seven outcome evaluations and eight studies of young people's views were included. The effectiveness of the interventions was mixed, with improvements in knowledge and increases in healthy eating but differences according to gender. Barriers to healthy eating included poor school meal provision and ease of access to, relative cheapness of and personal taste preferences for fast food. Facilitators included support from family, wider availability of healthy foods, desire to look after one's appearance and will-power. Friends and teachers were generally not a common source of information. Some of the barriers and facilitators identified by young people had been addressed by soundly evaluated effective interventions, but significant gaps were identified where no evaluated interventions appear to have been published (e.g. better labelling of food products), or where there were no methodologically sound evaluations. Rigorous evaluation is required particularly to assess the effectiveness of increasing the availability of affordable healthy food in the public and private spaces occupied by young people.

Young people and healthy eating: a systematic review of research on barriers and facilitators

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Young people and physical activity: a systematic review of research on barriers and facilitators

Barriers to, and facilitators of, the health of young people: a systematic review of evidence on young people's views and on interventions in mental health, physical activity and healthy eating. Vol. 1, Overview. Vol. 2, Complete report

Finding a haystack among the needles: making health promotion and public health reviews in the Cochrane Database of Systematic Reviews available to policy makers

Jonathan Shepherd

Papers

Young people and healthy eating: a systematic review of research on barriers and facilitators

Young people and physical activity: a systematic review of research on barriers and facilitators

Barriers to, and facilitators of, the health of young people: a systematic review of evidence on young people's views and on interventions in mental health, physical activity and healthy eating. Vol. 1, Overview. Vol. 2, Complete report

Finding a haystack among the needles: making health promotion and public health reviews in the Cochrane Database of Systematic Reviews available to policy makers