Background: The amount of data extracted from primary studies during a complex systematic review can create challenges for synthesis, interpretation, and subsequent knowledge exchange. ‘Black box’ reviews that minimise data do not cope easily with, nor address adequately, heterogeneous interventions and populations. Systematic reviews increasingly employ framework synthesis to address these issues. However, some differences exist in how methods, outputs and underlying ways of knowing are described. It is thus timely to examine the evolving use of framework synthesis in systematic reviewing.
Objectives: This systematic review aimed to address the following research questions: How do methods of framework synthesis compare across reviews? Where is framework synthesis located within a range of research synthesis methods (e.g. meta-ethnography, meta-analysis)? What problems are addressed specifically by framework synthesis?
Methods: Reference searches were undertaken via ASSIA, PsycInfo, PubMed, and Web of Science, key contacts and reference lists. Included reports described and/or reflected on the use of framework synthesis in systematic reviews. Data addressing the research questions were extracted. Report characteristics were compared and contrasted using thematic analysis.
Results: We included 15 out of 144 citations located. Seven reports reflected on the applied use of framework synthesis; four described specific details to apply the method; and four placed it within a range of other synthesis methods. The methods of theory selection and development varied, and a deductive but iterative approach was used most often across studies. In terms of epistemological position, most reports placed the method between critical and scientific realism.
Conclusions: Use of an a priori framework, iterative coding and thematic development indicate that framework synthesis is deductive; but its practical use in engaging stakeholders places the method between critical and scientific realism. Methods of selecting the a priori framework and use as a stakeholder engagement decision tool are developing; these could fill gaps not yet addressed by other methods.