Meta-ethnography
Dr Kate Flemming
Department of Health Sciences
University of York, UK
kate.flemming@york.ac.uk
This is where it all began…..
George Noblit
R Dwight Hare
So what’s it about?
• ‘The meaning of meta-ethnography for us is as a
form of synthesis for ethnographic or other
interpretive studies’ p14
• We use this term [meta-ethnography], in part,
because of the analogy to meta-analysis. We share
the goal of those proposing meta-analytic and
integrative research reviews of “putting together” all
the research available to us. p 25
(Noblit & Hare 1988)
This is about interpretive synthesis
The original text does not deal with other parts
of the systematic reviewing process such as:
• Search strategies
• Inclusion and exclusion criteria
• Quality appraisal
Meta-ethnography

Most widely used method of qualitative synthesis
reported (Hannes & Macaitis 2012)

Enables a systematic and detailed understanding of
how studies are related, through the comparison of
findings within and across studies. These are coded
and condensed into themes which ultimately provide
an interpretation of the whole body of
research(Noblit and Hare 1988)
• However from the interpretive perspective how this
is done depends on the substance of the individual
studies and how they relate to each other
The principle method of synthesis
• Is around the notion of ‘Translation’
• Noblit & Hare describe this as
‘one case is like another except that…’ (p38)
This is not dissimilar to constant comparison
techniques
Family carers’ perceptions
of their educational needs
when providing end-of-life
care
Smoking in pregnancy:
findings from a systematic
review of qualitative
studies of women who
commence pregnancy as
smokers
The Seven Steps of Meta-ethnography
1. Getting started
Noblit and Hare say this is ‘finding something that is
worthy of a synthesis effort’ p26
Need to consider....
• Is qualitative synthesis appropriate for the question
you are asking?
• Is a synthesis on this topic needed?
• What experience does the team need?
2. Deciding what is relevant
Scope of searching:
Does it need to be exhaustive?
• It depends on the purpose of the synthesis
• There is a tendency to undertake exhaustive
searching.
• However searching can be pre-planned to be
comprehensive or iterative ie ‘seek all available
concepts until saturation is achieved’ (Tong et al
2012)
• Various qualitative filters can be used
‘qualitative’, ‘interviews’ & ‘findings’
2. Deciding what is relevant
Other top tips:
• Clear inclusion and exclusion criteria can be helpful
• Use an information scientist if you can
• Track your key papers
Carers review: what we found
• 5507 papers found & 5440 were excluded
• After further sifting 67 papers were suitable for
inclusion
• This was too many!
• We re-read the papers and included those that
reported key concepts highly relevant to the study
aims
• This left us with 35 papers reporting on 34 studies
• At the end of the synthesis process we re-read the
papers not included and included any ‘absent
concepts’
3. Reading the studies
‘Repeated re-reading of the accounts’ p28
During this stage you can also incorporate
• Quality appraisal
• Data extraction – possibly a two stage process
4. Determining how the studies are related
• Refers to how do you start to put the studies
together
• ‘We think it makes sense to create a list of the key
metaphors, phrases, ideas, and/or concepts in each
account’ p28
• ‘When we talk about the key metaphors of a study,
we are referring to what others may call the themes,
perspectives, organizers, and/or concepts revealed by
qualitative studies’ p14
• Then look at the relationship between them
5. Translating the studies into one another
Studies may be related to
each other in one of four
ways:
1. They can be about
different things
2. They can be about
roughly similar things
3. They can be studies that
refute each other
4. They can be studies that
progressively build a line
of argument
Meta-ethnographic
technique:
No point in synthesising!
Reciprocal translation
Refutational synthesis
Lines of argument synthesis
5. Translating the studies into one another
• Reciprocal translation analysis– in an iterative
fashion one study is translated into another
• Refutational synthesis – studies amenable to general
meta-ethnographic approach, but refutations are
examined more closely
• Lines of argument synthesis – more about
interpretation ‘what can we say about the whole
based on the selective studies of the parts?’
5. Translating the studies into one another
• ‘Translations need to protect the particular, respect
holism & enable comparison’ p28
‘I found that I was judged as a disgusting, uneducated, gutter
rat. I found this by the way people would look, question my
motives, make comments on my parental ability etc.’
(Wiggington & Lee 2012, p9)
How does this look in practice?
Flemming et al 2013
How does this look in practice?
Flemming et al 2013
6. Synthesising translations
• Synthesis refers to making a whole into something
more than the parts alone imply
• Translations as a set are one level of metaethnographic synthesis
• The translations can be compared with one another
to determine of there are some that can encompass
others
• This presents the second level of synthesis and is
often presented as a line of argument
How this looks in practice
Flemming et al 2013
7. Expressing the synthesis
• How do you go about telling people what you’ve
done?
• Generally written for academic audiences
• Does this limit how you write up a metaethnography?
• I would argue yes – mainly from the problem of
restrictions of word length in journals
• Suggested that play, art and music could all be
relevant expressions!
Findings represented as diagrams
The findings of the synthesis demonstrate how contexts
constrain positive behaviour change:
• Before
pregnancy
• Through
pregnancy
Being a
smoker
Being a
pregnant smoker
Quitting and
trying to quit
• Point of
delivery
Smoking status
Continuing to
smoke
Questions?
Useful resources
Karin Hannes and Craig
Lockwood (eds) (2012)
Synthesizing Qualitative
Research: Choosing the Right
Approach J Wiley – Blackwell
Michael Saini & Aron Shlonsky
(2012)
Systematic Synthesis of
Qualitative Research (Pocket
Guides to Social Work Research
Methods) OUP USA
References and Further Reading
Britten N, Campbell R, Pope C. et al Using meta-ethnography to synthesise qualitative research: a worked example. J of Health Serv Res Policy 2002;7(4):209-21
Campbell R et al Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Science and Medicine
2003;56: 671-684
Cook A, Smith D, Booth A. Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qualitative Health Research 2012 22, DOI: 10.1177/1049732312452938
Dixon-Woods M, Agarwal S, Jones D, et al. Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Serv Res Policy 2005;10(1):45-53
Flemming K. The use of morphine to treat cancer-related pain: A synthesis of quantitative and qualitative research. Journal of Pain and Symptom Management 2010;
39(1): 139-154
Flemming K & Briggs M. Electronic searching to locate qualitative research: evaluation of three strategies. J Adv Nurs 2007;57(1):95-100
Flemming K. The synthesis of qualitative research and evidence-based nursing. Evidence Based Nursing. 2007;10(3):68-71
Munro S.A. et al Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLOS Medicine 2007;4(7): 1230-1244
Noblit GW & Hare RD. Meta-ethnography: synthesizing qualitative studies. California. Sage Publications, 1988
Noyes J & Lewin S (2010) Supplemental Guidance on Selecting a Method of Qualitative Evidence Synthesis, and Integrating Qualitative Evidence with Cochrane
Intervention Reviews. http://cqrmg.cochrane.org/supplemental-handbook-guidance
Noyes J, Popay J. Directly observed therapy and tuberculosis: how can a systematic review of qualitative research contribute to improving services? A qualitative metasynthesis. Journal of Advanced Nursing 2007; 57: 227-243.
Pearson A Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews. JBI Reports 2004;2(2):45-64
Pope C & Mays N. Synthesising qualitative research. In Pope C & Mays N. (eds) Qualitative Research in Health Care (3rd edition). Oxford. Blackwell Publishing. 2006
Pope C, Mays N, & Popay J. Synthesizing Qualitative and Quantitative Health Evidence: A guide to methods. Maidenhead. Open University Press. 2007
Pound P. et al Resisting medicines: a synthesis of qualitative studies of medicine taking Social Science & Medicine 61 (2005) 133–155
Thomas J, Harden A, Oakley A. et al Integrating qualitative research with trials in systematic reviews. BMJ 2004;328:1010-2
Tong A, Sainsbury P, Craig JC. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist
for interviews and focus groups. Int J Qual Health. 2007;19(6):349-357.
Tong A, Flemming K, McInnes E et al Enhancing transparency in reporting the synthesis of qualitative research:ENTREQ. BMC Medical Research Methodology 2012;
12:181 http://www.biomedcentral.com/1471-2288/12/181