Metasynthesis : a guide to knitting smoke

Since the seminal production of Noblit and Hares’ book Meta-ethnography published in 1988, the quest for an optimal route to synthesising qualitative evidence has gained momentum. Theoretical arguments in this area range diametrically from the impossibility of progressing knowledge based on qualitative evidence in the absence of such synthesis, to the impossibility of synthesising knowledge that is particular, context-specific, and dependent on the primary investigator as research instrument. Even if the need for such synthesis is accepted, there is debate at every stage of the process, from the acceptable range of inclusion of studies for reviews to the place of formal search strategies, inclusion criteria, quality assessment, and the optimum method of synthesis. This paper explores all of these dimensions and dilemmas, with reference to the theoretical and methodological literature in this area. It also discusses solutions that have been employed by the author and her colleagues in undertaking a series of metasynthesis-based reviews in the area of maternity care.