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      “Best fit” framework synthesis: refining the method

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          Abstract

          Background

          Following publication of the first worked example of the “best fit” method of evidence synthesis for the systematic review of qualitative evidence in this journal, the originators of the method identified a need to specify more fully some aspects of this particular derivative of framework synthesis.

          Methods and Results

          We therefore present a second such worked example in which all techniques are defined and explained, and their appropriateness is assessed. Specified features of the method include the development of new techniques to identify theories in a systematic manner; the creation of an a priori framework for the synthesis; and the “testing” of the synthesis. An innovative combination of existing methods of quality assessment, analysis and synthesis is used to complete the process. This second worked example was a qualitative evidence synthesis of employees’ views of workplace smoking cessation interventions, in which the “best fit” method was found to be practical and fit for purpose.

          Conclusions

          The method is suited to producing context-specific conceptual models for describing or explaining the decision-making and health behaviours of patients and other groups. It offers a pragmatic means of conducting rapid qualitative evidence synthesis and generating programme theories relating to intervention effectiveness, which might be of relevance both to researchers and policy-makers.

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          Most cited references35

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          Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews

          Background The inclusion of qualitative studies in systematic reviews poses methodological challenges. This paper presents worked examples of two methods of data synthesis (textual narrative and thematic), used in relation to one review, with the aim of enabling researchers to consider the strength of different approaches. Methods A systematic review of lay perspectives of infant size and growth was conducted, locating 19 studies (including both qualitative and quantitative). The data extracted from these were synthesised using both a textual narrative and a thematic synthesis. Results The processes of both methods are presented, showing a stepwise progression to the final synthesis. Both methods led us to similar conclusions about lay views toward infant size and growth. Differences between methods lie in the way they dealt with study quality and heterogeneity. Conclusion On the basis of the work reported here, we consider textual narrative and thematic synthesis have strengths and weaknesses in relation to different research questions. Thematic synthesis holds most potential for hypothesis generation, but may obscure heterogeneity and quality appraisal. Textual narrative synthesis is better able to describe the scope of existing research and account for the strength of evidence, but is less good at identifying commonality.
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            Rationale and standards for the systematic review of qualitative literature in health services research.

            Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowledges the desirability of a plurality of standards. However, it is argued that three interrelated criteria can be identified as the foundation of good qualitative health research: interpretation of subjective meaning, description of social context, and attention to lay knowledge. These criteria can be examined in relation to different dimensions of any research report, including theoretical basis, sampling strategy, scope of data collection, description of data collected, and concern with generalizability or typicality. But if the concern is with the appropriateness of care and with understanding the factors that shape lay and clinical behavior, then these criteria must form the basis of a hierarchy of qualitative research evidence.
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              A move to more systematic and transparent approaches in qualitative evidence synthesis: update on a review of published papers

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                Author and article information

                Journal
                BMC Med Res Methodol
                BMC Med Res Methodol
                BMC Medical Research Methodology
                BioMed Central
                1471-2288
                2013
                13 March 2013
                : 13
                : 37
                Affiliations
                [1 ]Health Economics and Decision Science (HEDS), School of Health and Related Research (ScHARR), Regent Court, Regent Street, Sheffield, S1 4DA, UK
                [2 ]Health Sciences Research Group - Primary Care, School of Community Based Medicine, University of Manchester, Williamson Building, Manchester, M13 9PL, UK
                Article
                1471-2288-13-37
                10.1186/1471-2288-13-37
                3618126
                23497061
                d2c42249-e866-436c-9433-02c5f14c2024
                Copyright ©2013 Carroll et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 September 2012
                : 4 March 2013
                Categories
                Correspondence

                Medicine
                systematic review,qualitative research,methods,framework synthesis,thematic analysis,sensitivity analysis,smoking cessation,critical appraisal,theory

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