Background: A variety of different approaches to the synthesis of qualitative data are advocated in the literature, but none is recognised as the preferred method.

Objectives: To describe the application of a pragmatic 'best fit’ framework synthesis approach to qualitative evidence synthesis.

Methods: An evaluation of a novel version of framework synthesis as an approach to qualitative systematic review. The case study was a systematic review exploring adults' views about taking various potential agents for the primary prevention of colorectal cancer. An existing model was identified from the literature that conceptualised attitudes of adult women to the taking of several of these agents. The model identified did not entirely match the topic under study, but was a 'best-fit’ and provided a relevant pre-existing framework and themes against which to map and code data.

Results and Discussion: Twenty papers from North America, Australia, the UK and Europe met the criteria for inclusion. Fourteen themes were identified a priori from the previously identified model, which were then used to code the extracted data. The production of clear definitions for these themes reduced the scope for subjectivity of interpretation and thus enabled rapid and consistent coding of the studies' data by more than one reviewer. The final synthesis also required some secondary thematic analysis to develop themes for data not covered by the a priori framework. The result was a more sophisticated model with additional themes.

Conclusion: This novel and pragmatic 'best fit’ approach to framework synthesis was found to be fit for purpose. It offered a means to reinforce, critique, and develop an existing published model, conceived for a different but relevant population, and produced a relatively consistent or reliable process when compared to more interpretative forms of synthesis. Future research should seek to test further this approach to qualitative data synthesis.