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Narrative Synthesis in Systematic Reviews

Narrative Synthesis in Systematic Reviews

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Narrative Synthesis in Systematic Reviews

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  1. Narrative Synthesis in Systematic Reviews An ESRC Research Methods Programme project Mark Rodgers Lisa Arai, Nicky Britten, Mark Petticrew, Jennie Popay, Helen Roberts, Amanda Sowden

  2. Structure of the Presentation • What is “narrative synthesis”? • Where does narrative synthesis (NS) fit in a systematic review? • Why do we need guidance? • Developing a framework for NS • Building on the framework

  3. What Is a “Narrative Synthesis”? • NS are findings summarised and explained in words • As used here, NS refers to the approach adopted to bringing together the findings from studies included in a systematic review • No clear definition of NS • “Not a meta-analysis” • Can be alternative or complementary to MA

  4. Where does it fit? ‘Typical’ systematic review process: • Define review question • Literature search • Study selection • Data extraction • Study appraisal • Synthesis • Conclusions/recommendations

  5. Why Do We Need Guidance? • NS lacks transparency • NS lacks reproducibility • Variations in practice • No coherent guidance currently exists

  6. Developing guidance for NS • Difficult (impossible?) to produce prescriptive guidance on the conduct of NS • Most appropriate approach depends on context • A NS “toolkit” may be better than traditional “guidance” • Requires a structure

  7. A framework for NS • An descriptive framework of the NS process: • Developing a theory • Developing a preliminary synthesis • Exploring relationships in the data • Assessing the robustness of the synthesis

  8. Developing a theory • “Theory of change” linking resources, activities, intermediate outcomes and ultimate goals • How the intervention works, why and for whom • Has implications for review question and inclusion criteria as well as interpretation • Consider early in the review process • Can be presented in narrative and/or diagrammatic form

  9. Developing a preliminary synthesis • Initial description of the results of included studies • Organise results to describe patterns, e.g. in: • size/direction of effects • factors/processes impacting on implementation • quality • Product of this process is preliminary and should be interrogated further

  10. Exploring relationships in the data • Explore relationships: • Between study characteristics and their findings • Between the findings of different studies • Explore influence of heterogeneity: • Variations in outcomes, methods, populations, interventions, settings etc • Theory may help develop plausible explanations for observed differences • Investigation of context partly dependent upon reporting of included studies

  11. Assessing the robustness of the synthesis • Robustness of NS depends on two related elements: • Methodological quality of included studies • ‘Trustworthiness’ of the synthesis product • Availability of key information in primary studies • Overall assessment of the strength of evidence available to support conclusions

  12. Building on the framework (1) • Populated framework with range of “tools and techniques” (e.g. tabulation, idea webbing/conceptual mapping, transforming and translating data) • Allow reviewer to select tools/techniques most appropriate to the data being synthesised • Not necessarily linear or sequential process – reviewers will move iteratively between elements

  13. Building on the framework (2) • Conducted two ‘test’ NS of domestic smoke alarm promotion interventions: one effects, one implementation • Qualified success - the approach can be further developed and refined • Would benefit from application to a wider range of syntheses • http://www.lancs.ac.uk/fass/projects/nssr/