Background: Qualitative synthesis informs important aspects of evidence-based healthcare, particularly within the practical decision-making contexts that health professionals work in. Of the qualitative methodologies available for synthesis, meta-aggregation is perhaps the most transparently aligned with accepted conventions for the conduct of high-quality systematic reviews.

Objectives: To investigate the development of meta-aggregation as a systematic review methodology and update this methodology.

Methods: A methodological group consisting of experienced qualitative researchers and systematic reviewers was formed to review this methodology. Over a period of two years, the core tenets of this approach and theoretical underpinnings were evaluated.

Results: Meta-aggregation was found to be philosophically grounded in pragmatism and transcendental phenomenology. The essential characteristics of a meta-aggregative review are that the reviewer avoids re-interpretation of included studies, but instead accurately and reliably presents the findings of the included studies as intended by the original authors. This presentations reports on the updated methodology and methods of meta-aggregation within the structure of an a priori protocol and standardized frameworks for reporting of results by over-viewing the essential components of a systematic review report.

Conclusions: Meta-aggregation provides a robust and pragmatic methodology to synthesise qualitative research. This methodology has now been used in dozens of reviews with over 4000 people having been trained in this approach.