Introduction

The introduction describes the background focus of the problem or issue analysed, a description of the contexts and determinants of the problem and a clear statement of the importance, timeliness and policy relevance of the issue to the target audience.

Methodology

The method section should leave a transparent trail for others to replicate the search and to alert readers to any potential bias connected to the inclusion/exclusion of information. As was the case for the review protocol, it is essential to describe which databases, websites and other sources were searched, and what key terms were used (4–9). Often the methodology is expanded in an annex.

The ENTREQ statement (enhancing transparency in reporting the synthesis of qualitative research) (10) might be useful, particularly in reporting explicitly the methods of a qualitative synthesis. It consists of 21 items grouped into five main domains, which can help the authors to report the stages most commonly associated with the synthesis of qualitative health research: searching and selecting qualitative research, quality appraisal and methods for synthesizing qualitative findings.

The methods should include sources of information used; search strategy and databases searched; inclusion/exclusion criteria and data extraction; type of review applied; and a statement of the source of any grading scale applied to the evidence.

Results

Findings should be presented as precisely as possible so that decision-makers have access to key evidence to build upon. Discussing interpretation of results in terms of “certainty” helps policy-makers to understand what is known and what is not known about the subject, while avoiding statistical jargon where possible.

There are many guidelines available for reporting the synthesis process and findings that have increased the standardization of reporting study results and helped to ensure that crucial information is available for translating evidence into practice and policy. Examples include CONSORT (consolidated standards of reporting trials (11)), STROBE (strengthening the reporting of observational studies in epidemiology (12)), TREND (transparent reporting of evaluations with nonrandomized designs (13)), COREQ (consolidated criteria for reporting qualitative research (14)) and CERQual (15). Keeping in mind that these technical guidelines are focused on producing syntheses for policy-making, it is important that the findings and policy options are linked.

Given the nontechnical background of most policy-makers, authors are recommended to state clearly that the lack of available evidence does not mean that there is no effect of such a programme or intervention, merely that the effect is not known. This precautionary principle should be mentioned in the reports.

Discussion

The discussion section includes the strengths and limitations of the review and additional considerations to operationalize proposed policy options in national/regional/local contexts. As relevant, it is important to recognize possible opinions and debate around the issue, including:

• cost and cost–effectiveness;
• potential social, legal and ethical implications;
• current debate in the field (e.g. media);
• ongoing projects (e.g. evaluation or action) of particular importance in the field and protocols of ongoing or planned projects; and
• other aspects important for the issue/topic of concern.

In addition, the discussion should reflect on the publication and language bias. Unfunded and small sample studies are less likely to be published in the format of peer-reviewed articles (contributing to publication bias). It is well known that papers reporting positive results have a higher chance of publication than those that find an intervention ineffective (16,17). The findings of unpublished studies may be more controversial than those that were published and, consequently, bias the synthesis. The bias also includes the tendency for authors to submit, and editors to accept for publication, research that is consistent with previously published findings (16).

Conclusions

The conclusions is the section where the reader finds the synthesis question and detailed (much more than in the Summary) policy options (section 2.7) proposed by the findings. This section is often read together with the summary before the reader proceeds to the main report.

References

The list of referenced sources is a key element of a synthesis report as it allows the reader to judge the basis on which the arguments are built and it provides a guide to the currently available sources on the topic in question, which can then be used further.

Annexes

Although the synthesis is a short and targeted document, authors sometimes decide that their argument needs further support and so include one or more annexes (e.g. the details of the methodology).