TABLE 16

Consensus ratings of the final round (round 3) from both meta-ethnography expert and key stakeholder expert groups

ItemGroupFinal round consensusa
Meta-ethnography expert groupKey stakeholder expert group
Number of important/very important responses%Number of important/very important responses%
Include the term ‘meta-ethnography’ in the title, abstract and/or keywordsAbstract38/399720/2195
While acknowledging publication requirements and house style, the abstract should ideally contain brief details of the study’s background; aim and research question or objectives; search strategy; methods of selection, appraisal, analysis and synthesis of primary study accountsAbstract38/399722/2396
While acknowledging publication requirements and house style, the abstract should ideally contain: main findings including a description of the model, conceptual framework, theory and the number of studies synthesisedAbstract39/3910023/23100
While acknowledging publication requirements and house style, the abstract should ideally differentiate between reported findings of the primary studies and of the synthesisAbstract25/396418/2378
While acknowledging publication requirements and house style, the abstract should ideally contain implications for policy, practice and/or theoryAbstract33/398521/2295
State the research or knowledge gap to be filled by the synthesisIntroduction39/3910023/23100
Describe the availability of qualitative data that potentially could be synthesised (e.g. from an exploratory scoping of literature, if done)Introduction29/397421/2295
Explicitly state review aim(s) compatible with the intention to produce a new theory, new conceptual framework, configuration (interpretation) of data or new model and give details of any refinements to the initial aim(s)Introduction37/399723/23100
Explicitly state review question(s) (or objectives) and give details of any changes or refinements to the initial question(s)/objectivesIntroduction36/399223/23100
State the context of the synthesis (e.g. any funding sources for the synthesis; time scales for the synthesis conduct; political, cultural, social, policy or other relevant contexts). Refer to existing frameworks for guidance on how to specify the review contextIntroduction22/395623/23100
State why meta-ethnography was considered the most appropriate qualitative synthesis approach and whether or not use of other approaches was consideredMethod31/397923/23100
Approach to searching. Indicate whether or not the search(es) was (were) pre-planned (comprehensive search strategies to seek all available studies) or iterative (to seek all available concepts until theoretical saturation is achieved)Method39/3910023/23100
State the rationale for the literature search strategy (e.g. how this was informed by purpose of the synthesis). Refer to existing frameworks for guidance on how to determine if the context in primary study accounts is sufficiently relevant to the context specified in the review questionMethod35/399022/22100
Searching processes. While considering specific requirements of the journal or other publication outlet, state and provide a rationale for how the literature searching was done. Provide details on all the sources accessed for information in the review (e.g. use of any electronic databases, grey literature databases, relevant organisational websites, experts, information specialists, generic web searches, hand searching, reference lists). Where searching in electronic databases has taken place, the details should include, for example, name of database, search terms, dates of coverage and date last searched. Provide the rationale for selection of the data sourcesMethod39/3910023/23100
If iterative or expansive searches were used, provide a rationale for deciding when to stop searchingMethod39/3910023/23100
Rationale for years covered by data searchesMethod37/399522/2396
Study screening methods. Describe the process of study screening (e.g. by title, abstract and full-text review, number of reviewers who screened studies)Method38/399722/22100
Study selection. Specify the inclusion/exclusion criteria (e.g. in terms of population, language, year limits, type of publication, study type, methodology, epistemology, country, setting, type of qualitative data, methods, conceptual richness of data, etc.). Refer to existing frameworks for guidance on how to determine if the context in primary study accounts is sufficiently relevant to the context specified in the review questionMethod38/399723/23100
State if and how quality appraisal of primary study accounts was conducted and give a rationale for this decisionMethod38/399723/23100
State whether papers were read in full or in part and specify the reading process or strategy usedMethod37/399522/2396
Data extraction methods and process. Indicate which sections of the primary study accounts were extracted and analysed (e.g. if used data from anywhere in the publication or just findings and discussion sections, etc.)Method35/389223/23100
Data extraction methods and process. State how the extracted data from the primary studies were recorded (e.g. how was a computer software program or other method used). If publication requirements prevent full reporting, state where readers can access these data in full (e.g. a project website, online files)Method38/399721/2295
Data extraction methods and process. State in which order primary study accounts had data extracted from them (e.g. chronological or starting with an ‘index’ paper, and rationale for that order)Method30/397714/2167
Contributions of reviewers. Identify who was involved in literature searching and screening, reading of studies, data extraction, translation and synthesis. State whether or not processes were conducted independently by reviewers and whether or not data were checked for accuracy (e.g. for screening/data extraction). (Depending on publication requirements, this information could be provided in the ‘Methods’ or the ‘Author contributions’ section)Method35/389222/2396
Reviewers should state what they understand by the synthesis terminology they have used (whichever terms are used) (e.g. metaphor, concept, theme, first-, second- and third-order constructs, LOA synthesis, refutational translation, reciprocal translation)Method38/399721/2295
Determining how studies are related. State which aspect(s) of the studies was (were) compared in order to determine how they are related (e.g. the theoretical approach and/or concepts/metaphors, aims, focus, contexts, overarching explanations for the phenomenon). State how the studies were compared (i.e. the methods and process of comparison). State how studies relate to each other (e.g. reciprocally, refutationally, and/or are about different aspects of the topic)Method39/3910022/22100
Translation and synthesis processes. Clearly differentiate between the different levels of interpretation in the translation and synthesis process by: listing the data from primary studies to be synthesised (concepts, themes, metaphors, second-order constructs, explanations); stating the translated and synthesised concepts developed by reviewers (this could be in a table, grid and/or narrative format); showing the inter-relationships between the data from primary studies and the reviewers’ concepts (e.g. in grids, tables, visual diagrams). Depending on publication requirements, this information could be provided across the methods and findings sections and elsewhere (e.g. project website, online files)Method39/3910020/20100
Translation and synthesis processes. Report steps taken to preserve the context and meaning of the relationships between concepts within and across studies. Refer to existing frameworks for guidance on how to determine the context of primary study accountsMethod38/399722/22100
Translation and synthesis processes. State the order in which studies were translated/synthesised (e.g. chronologically from the earliest or most recent) and the rationale for thisMethod28/397211/2152
Translation and synthesis processes. State whether the translation conducted was reciprocal or refutational, or both (depending on how reviewers have conceptualised reciprocal and refutational translation). State if refutational synthesis was not conducted and say why notMethod34/398717/1894
Translation and synthesis processes. Translation methods used (for reciprocal and/or refutational translation) to translate meaning from one study into another are specific and clearly stated (e.g. give one or more examples of how this was done)Method38/399722/22100
Translation and synthesis processes. State whether or not and how the contexts of the primary study accounts were considered throughout the analysis and synthesis process. Refer to existing frameworks for guidance on how to determine the context of primary study accountsMethod32/398222/22100
Translation and synthesis processes (synthesising translations). State the methods used to develop overarching concepts (‘synthesised translations’)Method39/3910022/22100
Translation and synthesis processes. State if a LOA synthesis was conducted and if not, say why notMethod33/398521/21100
Translation and synthesis processes. State explicitly how the LOA synthesis was conductedMethod37/399520/20100
If a single reviewer conducted the synthesis, give details of how potential alternative interpretations or explanations were considered in the translation and synthesis processesMethod38/399723/23100
Clearly describe and give a rationale for any adaptations or modifications to Noblit and Hare’s25 approachMethod32/398220/20100
Translation and synthesis processes (synthesising translations). Describe the new theory, conceptual framework, model, configuration or interpretation of data developed from the synthesis. If development of a new theory, conceptual framework or model was not possible, state why notMethod38/399723/23100
Provide details on the number of primary study accounts assessed for eligibility and included in the review with reasons for exclusion at each stage as well as an indication of their source of origin (for example, from searching databases, reference lists and so on). You may consider using the example templates (which are likely to need modification to suit the data) that are provided. If publication requirements prevent full reporting, state where readers can access these data in full (e.g. a project website, online files)Findings37/389722/2396
State how many and which studies were synthesisedFindings39/3910023/23100
Study characteristics. Present the characteristics of the included studies (e.g. year of publication, country, population, number of participants, data collection, methodology, analysis, research questions, setting, study funder, participant characteristics relevant to the aim such as, but not limited to, gender, age, socioeconomic status). If publication requirements prevent full reporting, state where readers can access these data in full (e.g. a project website, online files)Findings37/399523/23100
Study characteristics. Describe the context of included studies (depending on which contexts are relevant to the aim). Refer to existing frameworks for guidance on how to specify the context of primary study accountsFindings38/399722/22100
Study selection results. Identify the number of studies screened and provide reasons for study exclusion (e.g. for comprehensive searching provide numbers of studies screened and reasons for exclusion indicated in a figure/flow chart; for iterative searching describe reasons for study exclusion and inclusion based on modifications to the research question and/or contribution to theory development)Findings37/399522/22100
Translation and synthesis processes (synthesising translations). State the interpretive findings of the translation, the synthesis of translations, the LOA synthesis, and any new model, conceptual framework or theory developed in a narrative, grid, table and/or visually (e.g. as an illustration, diagram or film)Findings39/3910020/20100
When quotations are used, state where they originate from (e.g. primary study participants, primary study authors, reviewer’s own field notes)Findings38/399723/23100
Summarise the main interpretive findings of the translation and synthesis, taking into account the synthesis objective(s), review question(s), focus and intended audience(s)Discussion38/3810022/2396
State the qualitative research expertise of reviewers. (Depending on publication requirements, this information could be provided in a different section, e.g. the ‘Author contributions’ section)Discussion20/395115/2365
State reviewer(s)’ background(s) or perspectives that may have influenced the interpretive process such as, but not limited to, epistemological position(s), professional position(s) held, academic discipline, organisation(s) or professional bodies represented. [Depending on publication requirements, this information could be provided in a different section (e.g. the ‘Author contributions’ section)]Discussion33/398521/2391
Discuss the strengths and limitations of the synthesis and its findings. These should include (but need not be restricted to) (a) consideration of all the processes in conduct of the synthesis and (b) comment on the characteristics and content of the primary studies supporting the synthesis findings and how these may have affected the synthesis findingsDiscussion39/3910023/23100
Identify any areas where further research is neededDiscussion38/399723/23100
Where applicable, compare and contrast the synthesis findings (concept, model, theory) with the existing literature (e.g. other syntheses on the same topic)Discussion38/399723/23100
State the implications of the synthesis findings for policy, practice and/or theoryDiscussion37/399523/23100
Provide details of funding source (if any) for the synthesis, the role played by the funder (if any) and any conflicts of interests of the reviewersDiscussion37/399523/23100
Introduction: rationale for the synthesisHeadings36/399222/22100
Introduction: objectives, focus and context of the synthesisHeadings38/399722/22100
Methods: rationale for using meta-ethnographyHeadings35/399022/22100
Methods: searching processes and rationale for theseHeadings38/399722/22100
Methods: selection and appraisal of primary study accountsHeadings37/399522/22100

Methods: reading of primary study accounts and data extraction

Methods: analysis and synthesis processes: determining how studies are related; translating studies; synthesising translations; LOA synthesis; model, conceptual framework or theory generation

Headings37/399522/22100
Findings: primary study flow diagramHeadings38/399721/21100
Findings: primary study characteristicsHeadings35/399020/2195
Findings: main findingsHeadings38/399722/22100
Discussion: summary of findingsHeadings38/399722/22100
Discussion: reflexivityHeadings35/399022/22100
Discussion: strengths, limitations and future research directionsHeadings38/399720/20100
Discussion: comparison with existing literatureHeadings37/399522/22100
Discussion: conclusion, recommendations and implications for policy and practiceHeadings38/399722/22100
Discussion: funding and conflicts of interestHeadings33/388622/22100
a

The levels of consensus were calculated on the number of actual responses to each item. Participants had the opportunity to indicate that they had no expertise on specific items.

From: Appendix 8, Consensus ratings from the final round (round 3) of the eDelphi studies

Cover of Developing a reporting guideline to improve meta-ethnography in health research: the eMERGe mixed-methods study
Developing a reporting guideline to improve meta-ethnography in health research: the eMERGe mixed-methods study.
Health Services and Delivery Research, No. 7.4.
Cunningham M, France EF, Ring N, et al.
Southampton (UK): NIHR Journals Library; 2019 Feb.
Copyright © Queen’s Printer and Controller of HMSO 2019. This work was produced by Cunningham et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

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