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Background Qualitative synthesis approaches are increasingly used in healthcare research. One of the most commonly utilised approaches is meta-ethnography. This is a systematic approach which synthesises data from multiple studies to enable new insights into patients’ and healthcare professionals’ experiences and perspectives. Meta-ethnographies can provide important theoretical and conceptual contributions and generate evidence for healthcare practice and policy. However, there is currently a lack of clarity and guidance surrounding the data synthesis stages and process. Method This paper aimed to outline a step-by-step method for conducting a meta-ethnography with illustrative examples. Results A practical step-by-step guide for conducting meta-ethnography based on the original seven steps as developed by Noblit & Hare (Meta-ethnography: Synthesizing qualitative studies.,1998) is presented. The stages include getting started, deciding what is relevant to the initial interest, reading the studies, determining how the studies are related, translating the studies into one another, synthesising the translations and expressing the synthesis. We have incorporated adaptations and developments from recent publications. Annotations based on a previous meta-ethnography are provided. These are particularly detailed for stages 4–6, as these are often described as being the most challenging to conduct, but with the most limited amount of guidance available. Conclusion Meta-ethnographic synthesis is an important and increasingly used tool in healthcare research, which can be used to inform policy and practice. The guide presented clarifies how the stages and processes involved in conducting a meta-synthesis can be operationalised.

Aims The aim of this study was to provide guidance to improve the completeness and clarity of meta-ethnography reporting. Background Evidence-based policy and practice require robust evidence syntheses which can further understanding of people’s experiences and associated social processes. Meta-ethnography is a rigorous seven-phase qualitative evidence synthesis methodology, developed by Noblit and Hare. Meta-ethnography is used widely in health research, but reporting is often poor quality and this discourages trust in and use of its findings. Meta-ethnography reporting guidance is needed to improve reporting quality. Design The eMERGe study used a rigorous mixed-methods design and evidence-based methods to develop the novel reporting guidance and explanatory notes. Methods The study, conducted from 2015 to 2017, comprised of: (1) a methodological systematic review of guidance for meta-ethnography conduct and reporting; (2) a review and audit of published meta-ethnographies to identify good practice principles; (3) international, multidisciplinary consensus-building processes to agree guidance content; (4) innovative development of the guidance and explanatory notes. Findings Recommendations and good practice for all seven phases of meta-ethnography conduct and reporting were newly identified leading to 19 reporting criteria and accompanying detailed guidance. Conclusion The bespoke eMERGe Reporting Guidance, which incorporates new methodological developments and advances the methodology, can help researchers to report the important aspects of meta-ethnography. Use of the guidance should raise reporting quality. Better reporting could make assessments of confidence in the findings more robust and increase use of meta-ethnography outputs to improve practice, policy, and service user outcomes in health and other fields. This is the first tailored reporting guideline for meta-ethnography. This article is being simultaneously published in the following journals: Journal of Advanced Nursing, Psycho-oncology, Review of Education, and BMC Medical Research Methodology.

Laura-Jane McCarthy,1 Aoife O’Mahony,1 Aisling A Jennings,2 Sheena McHugh1 1Health Implementation Research Hub, School of Public Health, University College Cork, Cork, Ireland; 2Department of General Practice, School of Medicine, University College Cork, Cork, IrelandCorrespondence: Laura-Jane McCarthy, Health Implementation Research Hub, School of Public Health, University College Cork, Western Gateway Building, Western Road, Cork, T12 XF62, Ireland, Email laura-janemccarthy@ucc.ieBackground: Perimenopause precedes menopause and can cause a wide range of symptoms for women. General Practitioners (GPs) are often the first point of contact for symptom management. Shifting societal attitudes to perimenopause have prompted more women to seek care within general practice, yet many report suboptimal support. Despite the increasing body of research on menopause care, the experiences of perimenopause consultations in general practice have yet to be conceptually synthesised. This qualitative evidence synthesis, therefore, aimed to explore the experiences and perceptions of women and General Practitioners regarding perimenopause consultations in general practice.Methods: We followed the methods of meta-ethnography as developed by Noblit and Hare and our reporting follows the eMERGE reporting guidance. Seven databases were systematically searched to identify studies detailing the experiences of women and GPs during perimenopause consultations. To evaluate confidence in the review findings, we employed the GRADE-CERQual approach.Results: Ten studies were included in the synthesis. Navigating uncharted waters was established as an overarching metaphor in a line of argument encompassing four main themes: (1) Adrift in the sea of perimenopause uncertainty, (2) Taking the helm: women’s advocacy, agency, and negotiated power in perimenopause care, (3) Gendered dynamics: women’s experiences and GP perspectives, (4) Navigating structural obstacles and fragmented care. Findings illustrate how pervasive both uncertainty and the ways in which power is negotiated within clinical encounters shape the quality, depth, and direction of perimenopause consultations. Findings highlight how imbalances in perceptions of knowledge and authority shape perimenopause consultations.Conclusion: This qualitative evidence synthesis highlights the tensions and challenges encountered by women and GPs as they navigate the uncertainties inherent in perimenopause care. The results underscore the importance of sensitive and empathetic communication, where normalisation is delivered with compassion, and uncertainty is acknowledged and conveyed transparently. Openly recognising these uncertainties helps manage expectations.Keywords: perimenopause, general practice, qualitative evidence synthesis, meta-ethnography

Introduction Post‐burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in‐depth understanding of living with post‐burn scars. Design A systematic review and meta‐ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re‐interpreted to formulate themes which formed the basis of undertaking a narrative synthesis. Results Twenty‐five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self‐immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self. Conclusion Living with scars is a challenging process which is more difficult for persons whose injuries are due to self‐immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes. Clinical relevance Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self‐immolation should be considered for early psychosocial support.

Background Communication between patients and staff is a crucial component of safe and effective healthcare. As people age, they have more consultations and these become more complex. As such, older people may be more likely to experience gaps and breakdowns in communication. Objective To develop a better understanding of older people's communication in interactions with primary care staff and the barriers to and enablers of this. Search Strategy Four databases were searched. Search terms covered the sample (older people), domain (verbal communication in healthcare interactions), context (primary care) and research type (qualitative research). Data Extraction and Synthesis A meta‐ethnographic approach was followed by one researcher, with input from the wider team. Twelve studies were included. Details of the designs, participants, methods and results were extracted. Data were synthesised through reciprocal translation, and a line of argument was developed. Main Results Barriers to communication were found in relation to raising and addressing concerns. Barriers arose from patient perceptions of their role, the nature of their relationship with staff, patient and staff perceptions of responsibility and reluctance to broach a topic, individual factors such as memory, how staff respond when concerns are raised and the degree of patient involvement in consultations. Potential enablers of communication were preparation and support from family or peers. Conclusions Synthesising the existing qualitative literature on older people's communication in healthcare interactions enabled the identification of barriers and enablers that can be used to inform the development of an intervention to improve communication with primary care staff. Patient or Public Contribution By identifying healthcare communication as the most important topic for the patient safety of older people with multiple long‐term conditions in primary care and setting the scope of the review, patients and the public were involved in the design of the study. Four public contributors (older people with multiple long‐term conditions and carers of older people with multiple long‐term conditions) attended regular meetings, provided their reflections on the study findings and supported the interpretation of the data.

Background Decision making in health and social care requires robust syntheses of both quantitative and qualitative evidence. Meta-ethnography is a seven-phase methodology for synthesising qualitative studies. Developed in 1988 by sociologists in education Noblit and Hare, meta-ethnography has evolved since its inception; it is now widely used in healthcare research and is gaining popularity in education research. The aim of this article is to provide up-to-date, in-depth guidance on conducting the complex analytic synthesis phases 4 to 6 of meta-ethnography through analysis of the latest methodological evidence. Methods We report findings from a methodological systematic review conducted from 2015 to 2016. Fourteen databases and five other online resources were searched. Expansive searches were also conducted resulting in inclusion of 57 publications on meta-ethnography conduct and reporting from a range of academic disciplines published from 1988 to 2016. Results Current guidance on applying meta-ethnography originates from a small group of researchers using the methodology in a health context. We identified that researchers have operationalised the analysis and synthesis methods of meta-ethnography – determining how studies are related (phase 4), translating studies into one another (phase 5), synthesising translations (phase 6) and line of argument synthesis - to suit their own syntheses resulting in variation in methods and their application. Empirical research is required to compare the impact of different methods of translation and synthesis. Some methods are potentially better at preserving links with the context and meaning of primary studies, a key principle of meta-ethnography. A meta-ethnography can and should include reciprocal and refutational translation and line of argument synthesis, rather than only one of these, to maximise the impact of its outputs. Conclusion The current work is the first to articulate and differentiate the methodological variations and their application for different purposes and represents a significant advance in the understanding of the methodological application of meta-ethnography.

Samar Alotaibi,1,2 Sharron Hinchliff,1 Parveen Ali1,3 1School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Sheffield, UK; 2Maternal and Child Health Nursing Department, College of Nursing, Shaqra University, Al Dawadmi, Saudi Arabia; 3Doncaster and Bassetlaw Teaching Hospitals, Doncaster, UKCorrespondence: Samar Alotaibi, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, 358-362 Mushroom Lane, Sheffield, Sheffield, S10 2TS, UK, Tel +447312147673, Email smsalotaibi1@sheffield.ac.ukAbstract: Women’s intimate and sexual experiences during midlife are shaped by complex biopsychosocial factors, warranting focused attention in research and clinical practice. A hormonal shift in the menopause transition period may cause symptoms such as vaginal dryness, thinned mucosa, and painful intercourse. Other symptoms include decreased libido, and difficulty achieving orgasm during sexual activity. With more women reaching midlife, there is more need to understand how physiology and psychology impact their intimate relationships and overall health. The purpose of this review was to explore published qualitative studies on women’s sexual experiences including function, satisfaction, and challenges during midlife and the menopause continuum. A meta-ethnographic approach was conducted to synthesize all relevant qualitative studies. We searched on the Web of Science, Scopus, and CINAHL for studies published between 2010 and September 2024. Of 1,361 studies identified, 53 studies encompassing diverse cultural contexts met the inclusion criteria and were synthesized. Three main themes were identified: physical symptoms and cultural influences on sexuality during menopause and midlife; emotional, psychological, and relational responses to sexual and bodily changes, including shifts in self-perception, body image, emotional well-being, and relationship dynamics; and adapting to sexual changes during the midlife and menopause transition. The review highlights that biological changes alone are insufficient to fully understand midlife and menopausal women’s sexual experiences, emphasizing the need for a biopsychosocial approach to provide holistic care. Greater attention should be given to midlife women’s sexual health and well-being by raising awareness and encouraging open discussions about menopause and sexual changes. Healthcare professionals play a critical role in recognizing the psychological impacts of these changes and facilitating conversations to help women feel comfortable discussing sensitive topics. The review highlights the need for future research to explore women’s experiences of menopause and sexual health and well-being across diverse cultural contexts, with particular attention to non-Western countries where such perspectives remain underrepresented.Keywords: menopause, midlife, sexuality, intimacy, meta-ethnography, qualitative synthesis

Introduction Despite increased awareness of the detrimental relationship between homelessness and health, people experiencing homelessness remain an underserved population in health and social care research. Due to barriers affecting the accessibility of medicine and healthcare services, as well as reported competing priorities such as food and shelter, evidence has demonstrated that people experiencing homelessness are less likely to undergo routine examinations, receive diagnoses and adhere to prescribed medical treatments. To enhance service design and access for those experiencing homelessness, it is critical to better recognise, understand and address the barriers these individuals face. This meta‐ethnography aims to identify barriers, enablers and interventions to begin addressing this inequality gap. Methods A systematic literature search was undertaken in October and re‐ran in December 2023 across four databases: MEDLINE, Embase, CINAHL and Scopus. Qualitative studies were included if they addressed barriers, enablers and interventions aimed at tackling medicines and health service inequalities among populations experiencing homelessness. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist. Data were synthesised using a meta‐ethnographic approach, as outlined by Noblit and Hare. The review was registered on PROSPERO (CRD42024511502) and performed according to PRISMA guidelines. Results This meta‐ethnographic systematic review synthesised data from eight studies across multiple countries. Three overarching third‐order constructs (termed ‘themes’) were developed through reciprocal translation and centred around: recognising and acknowledging the discrimination, stigma and barriers experienced when using current services; exploring safe and practical use of medicines and the promotion of general health education and appreciating strategies to tackle inequalities, namely community outreach programmes designed for homeless communities. Conclusion This work highlighted the barriers, enablers and interventions that sought to address the inequalities affecting people experiencing homelessness in accessing medication and healthcare services. Future research should utilise lived‐experience narratives and co‐design to further explore ways to tackle wider healthcare accessibility inequalities for this minoritised population. Trial Registration Not applicable, as this is a systematic review. Patient or Public Contribution Public contributors (minority research champions and one public health research champion, H.K.G. and T.G.) informed and shaped this project during study design and conceptualisation. They helped to ensure that the study was conducted, and the findings were reported with sensitivity.

To systematically identify, define, and classify emerging knowledge synthesis methods through a scoping review. MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Methodology Register, the Cochrane Database of Systematic Reviews, Social Sciences Abstracts, Library and Information Science Abstracts, Philosopher's Index, and Education Resources Information Center were searched to identify articles reporting emerging knowledge synthesis methods across the disciplines of health, education, sociology, and philosophy. Two reviewers independently selected studies and abstracted data for each article. In total, 409 articles reporting on 25 knowledge synthesis methods were included after screening of 17,962 titles and abstracts and 1,010 potentially relevant full-text articles. Most of the included articles were an application of the method (83.9%); only 3.7% were seminal articles that fully described the method (i.e., operationalized the steps). Most of the included articles were published after 2005. The methods were most commonly used across the fields of nursing, health care science and services, and health policy. We found a lack of guidance on how to select a knowledge synthesis method. We propose convening an international group of leaders in the knowledge synthesis field to help clarify emerging approaches to knowledge synthesis.

Background The use of visual methods in qualitative evidence synthesis (QES) adds a valuable dimension to the synthesis process by enhancing understanding and knowledge generation. Visual methods are currently underused and underreported in QES. Methods This is the first study to describe accessible visual methods that support various stages of QES and to show the application of visual methods to a Cochrane QES of 43 studies using meta‐ethnography and systematic review methods. This study also addresses the involvement of stakeholders including the public, practical considerations of equity, diversity, inclusion, and reflexivity in the selection and application of visual methods. Results In a novel approach, the review authors utilized a combination of remote and in‐person visual methods to initiate and develop their synthesis, involving stakeholders throughout the process. The review authors used methods including paper labels, cartoons, infographics, virtual whiteboards, and diagrams. The rigorous use of visual methods in the QES facilitated data visualization, remote analysis meetings, interpretation of extensive data, and meaningful patient and public involvement. Conclusion QES authors are encouraged to consider the use of visual methods, particularly when involving the public in the synthesis process. When selecting visual methods, authors should consider how they align with the study's objectives, suit the stage of synthesis, might enhance analysis, their available resources, and the team's technical skills. Plain Language Summary Using visual methods in qualitative evidence synthesis (QES) enhances transparency in the process, helping to understand and create new knowledge. This paper gives an overview of accessible visual methods used at different stages of a QES, with examples from a Cochrane QES that used meta‐ethnography. The importance of including stakeholders, and considering equity, diversity, inclusion, and reflexivity when choosing and using these methods are also outlined. A worked example of a QES using meta‐ethnography shows how visual methods can support synthesis. The authors used a mix of remote and in‐person visual methods to start and develop their synthesis, involving stakeholders throughout. These methods included paper labels, cartoons, infographics, virtual whiteboards, and diagrams. Visual methods helped with data visualization, remote group meetings for analysis, understanding large amounts of data, and meaningful involvement of patients and the public. QES authors are encouraged to use available visual methods, especially when involving the public in the synthesis process.