Article type
Year
Abstract
Background:
Framework synthesis is increasingly used in systematic reviews of health care practice and policy. However, it appears to be used in different ways.
Objectives:
We demonstrate how framework synthesis methods have been utilised and their contribution to research synthesis methods.
Methods:
We conducted a systematic review and search update of reports which applied, illustrated or discussed framework synthesis. Using framework synthesis methods, findings were incorporated into a previously developed and evolving conceptual framework. Higher order themes were derived using constant comparative analysis.
Results:
Searches identified 61 publications which included 37 applied reviews and 24 illustrative or situated reports. These described varied contexts, concepts, challenges and processes of framework synthesis. Framework synthesis is a realist method that utilises a spectrum of approaches, the choice of which depends on the extent of existing developed theory.
Four approaches emerged. Where theory was underdeveloped, early sense-making either: (1) constructed multidimensional frameworks with stakeholders’ expert knowledge to fractionate or disaggregate the data into meaningful subsets; or (2) utilised widely recognised concepts to frame/provide a shell and then qualitatively identify sub-themes. In other cases, (3) well-established theory closely matching the topic was translated into a framework to test the fit between study data, framework and theory. Where the topic lacked an exact theoretical fit, (4) acceptable a priori theories were identified, potentially refined and adopted (‘best fit’).
While not currently consistently utilized, stakeholder engagement was widely advocated. Where stakeholders were engaged in knowledge production, findings suggested that stakeholders helped to make sense of complex issues underpinning a health condition by addressing challenges to understanding stakeholder priorities, constraints, or to sense-check theory as it developed.
Conclusions:
Our review establishes a spectrum of framework synthesis applications that invoke a framework as: an established theory to test; an analogous theory to be refined; a theoretical shell to hold emergent themes; or a multidimensional framework to fractionate then integrate heterogenous data. The choice of approach depends on the fit between data and existing theory or the scale and heterogeneity of the literature. Exploration of these uses of framework synthesis beyond health are recommended.
Patient or healthcare consumer involvement:
Framework synthesis, when used in conjunction with stakeholder involvement, can help to develop and explore theory that underpins health issues and interventions that inform policy.
Framework synthesis is increasingly used in systematic reviews of health care practice and policy. However, it appears to be used in different ways.
Objectives:
We demonstrate how framework synthesis methods have been utilised and their contribution to research synthesis methods.
Methods:
We conducted a systematic review and search update of reports which applied, illustrated or discussed framework synthesis. Using framework synthesis methods, findings were incorporated into a previously developed and evolving conceptual framework. Higher order themes were derived using constant comparative analysis.
Results:
Searches identified 61 publications which included 37 applied reviews and 24 illustrative or situated reports. These described varied contexts, concepts, challenges and processes of framework synthesis. Framework synthesis is a realist method that utilises a spectrum of approaches, the choice of which depends on the extent of existing developed theory.
Four approaches emerged. Where theory was underdeveloped, early sense-making either: (1) constructed multidimensional frameworks with stakeholders’ expert knowledge to fractionate or disaggregate the data into meaningful subsets; or (2) utilised widely recognised concepts to frame/provide a shell and then qualitatively identify sub-themes. In other cases, (3) well-established theory closely matching the topic was translated into a framework to test the fit between study data, framework and theory. Where the topic lacked an exact theoretical fit, (4) acceptable a priori theories were identified, potentially refined and adopted (‘best fit’).
While not currently consistently utilized, stakeholder engagement was widely advocated. Where stakeholders were engaged in knowledge production, findings suggested that stakeholders helped to make sense of complex issues underpinning a health condition by addressing challenges to understanding stakeholder priorities, constraints, or to sense-check theory as it developed.
Conclusions:
Our review establishes a spectrum of framework synthesis applications that invoke a framework as: an established theory to test; an analogous theory to be refined; a theoretical shell to hold emergent themes; or a multidimensional framework to fractionate then integrate heterogenous data. The choice of approach depends on the fit between data and existing theory or the scale and heterogeneity of the literature. Exploration of these uses of framework synthesis beyond health are recommended.
Patient or healthcare consumer involvement:
Framework synthesis, when used in conjunction with stakeholder involvement, can help to develop and explore theory that underpins health issues and interventions that inform policy.