3.4 The JBI Approach to qualitative synthesis

JBI uses a meta-aggregative approach to the synthesis of qualitative evidence. Meta aggregation is sensitive to the nature and traditions of qualitative research while being predicated on the process of systematic review (Pearson 2004). The meta-aggregative approach is sensitive to the practicality and usability of the primary author’s findings and does not seek to re-interpret those findings as some other methods of qualitative synthesis do. A strong feature of the meta-aggregative approach is that it seeks to enable generalizable statements in the form of recommendations to guide practitioners and policy makers (Hannes and Lockwood 2011). In this regard, meta aggregation contrasts with meta-ethnography or the critical interpretive approach to qualitative evidence synthesis, which have a focus on re-interpretation and theory generation rather than aggregation.

JBI recognizes the usefulness of alternate interpretive approaches such as meta-ethnography, as well as narrative synthesis and thematic synthesis. By way of illustration:

• the usefulness of meta- ethnography lies in its ability to generate theoretical understandings that may or may not be suitable for testing empirically,

• narrative synthesis of text is useful in drawing together different types of research evidence (e.g. qualitative, quantitative, economic), and

• thematic synthesis is of use in drawing conclusions based on common elements across otherwise heterogeneous studies.

JBI considers, however, that these approaches do not seek to provide guidance for action and aim only to ‘anticipate’ what might be involved in analogous situations and to understand how things connect and interact. Meta-aggregation is the preferred JBI approach for developing recommendations for action. The JBI SUMARI software is designed to facilitate meta-aggregation, however it can also be used successfully in meta-ethnography and other interpretive processes as a data management tool.

The core assumptions detailed in subsequent sections of this Chapter include:

• The requirement for an a priori protocol that describes all steps in the review, decisions on how they will be undertaken and appends all templates that will be used during the review;

• Comprehensive and exhaustive searching, independent critical appraisal and standardised data extraction;

• Synthesis of findings that authentically represents the aggregation of data from primary studies;

• Presentation of a meta-aggregative schematic that represents the findings and their aggregation in to categories, and the aggregation of categories in to synthesized findings; and

• The development of recommendations for policy or practice with assigned grades of recommendation.