Utilisation of theoretical models and frameworks in the process of evidence synthesis.

BACKGROUND: A systematic review is a comprehensive enquiry or study of secondary data sources. There is a research question, an a priori articulation of methods and a set of procedures to focus the investigation. Despite these rigorous structures to guide the review, synthesising evidence is a challenging, resource intense and time consuming process. Large volumes of information complicate not only the search functions, but also the conceptualisation of the evidence needed to create the concise and integrated results. Use of a theoretical model or framework could serve as an essential element in effectively focusing the review and designing the methods to respond to the knowledge question.

OBJECTIVE: This scoping review sought to confirm the value of models or frameworks used by authors working within traditional methodologies for evidence synthesis.

INCLUSION CRITERIA: Types of participants The focus of this review was on the context of health care.Types of intervention(s)/phenomena of interest All studies that discussed models or frameworks used specifically to address the process of synthesis were included.Types of studies Discussion, scholarship or methodology papers and reviews were included.Types of outcome All theoretical models or frameworks were described, with specific attention to the purpose of the framework for each study, and the contribution of the framework to the process of synthesis.

SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilised. The databases for published material included CINAHL; Medline; EMBASE; PsycINFO; AMED; Cochrane; Biomed Central; Scirus; and Mednar. Databases for unpublished material included Dissertation Abstracts; Sociological Abstracts; Conference proceedings.

METHODOLOGICAL QUALITY: The review was a focused scoping review to locate and describe the contribution of theoretical models or frameworks to the process of synthesis. The methodological quality of the discussion papers was therefore not assessed.

DATA COLLECTION: Data was extracted from the discussion papers using an adaptation of the standardised data extraction tool from the Joanna Briggs Institute Data Extraction for Narrative, Expert opinion & text (JBI-NOTARI).

DATA SYNTHESIS: Results were discussed in narrative form. The use of frameworks in each step of the synthesis process was discussed.

RESULTS: Eight studies (nine papers) formed the final set included in this review. The studies targeted the following issues: Child protection; end-of-life care; predictors of adolescent sexual behaviour and intention; primary care career choice; prognosis of acute whiplash; reluctance to care; use of Information Technology; young child's post-divorce adjustment. Frameworks were used in four of the seven steps of synthesis, and integration of the data indicated that the use of frameworks in the process of evidence synthesis was valuable and had many advantages.

CONCLUSION: This review illustrates that the addition of structure and guidance provided by a framework can serve to benefit the process of integration. Studies in this review indicated that the use of frameworks helped to inform the association between variables, guide the search strategy, structure and clarify the outcomes, identify knowledge gaps and indicate areas for future research. Used in this manner, frameworks could provide a valuable foundation for the process of synthesis.

IMPLICATIONS FOR PRACTICE: Evidence from systematic reviews informs practice. The incorporation of a theoretical model or framework helps to guide the process of synthesis and clarify the outcomes. This added transparency will facilitate the assimilation of the evidence by the target audience.

IMPLICATIONS FOR RESEARCH: Systematic reviews are the highest level of evidence available at this time. The use of theoretical models or frameworks in the review process strengthens the rigor and transparency of the integrative method. Further research into the contribution of theoretical models or conceptual frameworks to the process of synthesis may be valuable.