3.3.13.2 Developing synthesised findings
- Carolyn Phillips
Analytics
As meta-aggregation is theoretically underpinned by phenomenology and pragmatism, the synthesised finding is presented as a descriptive statement. A synthesised finding is a detailed, overarching, descriptive statement that represents the meaning of two or more categorised findings. This descriptive statement provides meaningful insights that are actionable in relation to the phenomenon of interest and can inform recommendations for policy and practice.
The process of developing synthesised findings should be clearly articulated, with any deviations from the protocol explicitly explained. Recommendations for developing synthesised findings are presented below.
A synthesised finding should have a clear, recognisable link back to the systematic review question.
·A synthesised finding is written as a statement that can lead to the development of recommendations for practice. However, the synthesised findings themselves are NOT recommendations for practice and should not be worded as such.
A synthesised finding statement captures a detailed understanding, providing insights into the phenomenon of interest.
A synthesised finding represents the meaning of two or more categorised findings.
Each synthesised finding should be accompanied by an explanatory statement. This statement provides detailed information, aligned to the findings, to assist the reader in understanding the whole and inclusive meaning of the synthesised finding.
In developing a synthesised finding, reviewers should be immersed in the data (findings/categories), developing a rich and nuanced understanding of the phenomenon being explored.
A synthesised finding is more than a topic summary or label that simply describes each category. A synthesised finding should be grounded in the data and should make sense of the phenomenon being explored through examination of the interconnections between a group of categories. This synthesised finding presents an insightful, detailed and nuanced understanding of the core meaning of a group of categories.
Interconnections refer to the relationships or connections between different things or entities; they can be physical, social, economic or cultural. Interconnections can be a direct or indirect network of links that connect different elements together. The concept of interconnections highlights the idea that different elements are not isolated from each other but instead, interconnected and interdependent. A synthesised finding brings together the findings and categories, conveying a deeper understanding of these connections and how they relate to each other.
Synthesised findings may be presented in various formats (e.g. in the first person, using multiple voices, no specific voice or ‘if/then statements’) so long as they provide insight into the phenomenon of interest in a way that informs an actionable statement.
Guiding questions for the review team to discuss when moving between findings, categories and synthesised findings:
Are there similarities and/or differences between the findings and categories?
Do they fit into a broader concept?
How are they linked?
Responding to divergent data
Categories that cannot be synthesised within a synthesised finding are referred to as divergent data. Similar to divergent data when developing categories, divergent data when developing synthesised findings may be a result of insufficient extraction and analysis, or they may represent a nuance of experience related to a specific population or context. If divergent categories are identified, the review team should consider the following:
Review the categorisation process and assess whether the divergent data is similar or in contrast to other categories.
Review the process of developing synthesised findings
·Consult an expert qualitative researcher to review the data synthesis process.
Analyse the context in which these divergent categories arise. Consider the features of the population or context (related to the findings included within the category) that may explain the divergent data.
Do not try and ‘force’ a category to ‘fit’ into the analytical scheme.
Carry the single category, into a synthesised finding. This option should be preceded by the above recommendations.
Examples of synthesised findings
The examples below demonstrate the various ways in which a synthesised finding can be presented. All the examples provide insights into the phenomenon of interest and are framed to lead to action.
Example 1
Synthesised finding: What I want from my provider: to be a respectful, empathetic and holistic partner in my care (Norberg et al. 2019).
Explanatory statement: Crucial to continued engagement in care is the relationship between the patient and provider. Patients continue in care, in part, because of a humanistic connection that occurs when there is empathy, true listening, trust, consideration of the whole person and involvement in decision-making.
Example 2
Synthesised finding: Homeless women who access healthcare services at community-based settings feel as if their homelessness qualifies them as second-class citizens, which impedes future access (Allen & Vottero 2020).
Explanatory statement: The interpersonal relationship between provider and patient is a vital component of the overall experience of homeless women when accessing healthcare. Whether it is from the system itself or providers within the system, lacking the empathy and general respect that each woman deserves results in avoidance of future healthcare access.
Example 3
Synthesised finding: One-stop care that is de-stigmatising and welcoming to diverse cultures keeps clients in care (Norberg et al. 2019).
Explanatory statement: One-stop services that assist people with multiple medical care needs and ‘wraparound’ services are more likely to keep patients engaged from testing through viral load suppression. Accessibility of all services is likely to minimise the stigma associated with specialty HIV care. Clinic operations that minimise wait times, provide flexible and accessible appointments, ensure continuity in providers and facilitate handoffs to other professional or community services prevent dropping out of care. Easy access to linkage to insurance, drug assistance programs and ‘wraparound’ services play a vital role.
Example 4
Synthesised finding: If strategies are in place to assist overseas nurses to establish informal networks of friends and professional colleagues, the transition to effective practitioner will be enhanced (Konno 2006).
Explanatory statement: Overseas nurses who feel lonely, isolated or as ‘outsiders’ experience difficulty in settling in to nursing in Australia.