Methods for the thematic synthesis of qualitative research in systematic reviews

Article

Thomas, James and Harden, A. 2008. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology. 8 (45), pp. 1471-2288.
AuthorsThomas, James and Harden, A.
Abstract

Background
There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies.
Methods
We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved.
Results
We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses.
Conclusion
We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

Keywordssystematic reviews; research methods; qualitative research; thematic synthesis
JournalBMC Medical Research Methodology
Journal citation8 (45), pp. 1471-2288
Year2008
Publisher's version
License
CC BY-ND
Web address (URL)http://dx.doi.org/doi:10.1186/1471-2288-8-45
http://hdl.handle.net/10552/1635
Publication dates
Print10 Jul 2008
Publication process dates
Deposited04 Jul 2012
Additional information

Citation:
Thomas, J. and Harden, A. (2008), 'Methods for the thematic synthesis of qualitative research in systematic reviews', BMC Medical Research Methodology, 8:45, doi:10.1186/1471-2288-8-45.

Permalink -

https://repository.uel.ac.uk/item/864zz

Log in to edit

  • 39
    total views
  • 62
    total downloads
  • 2
    views this month
  • 4
    downloads this month

Related outputs

Qualitative evidence
Noyes, J., Booth, A., Cargo, M., Flemming, K., Harden, A., Harris, J., Garside, R., Hannes, K., Pantoja, T. and Thomas, J. 2019. Qualitative evidence. in: Higgins, J., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. and Welch, V. (ed.) Cochrane Handbook for Systematic Reviews of Interventions The Cochrane Collaboration.
The long-term health and wellbeing impacts of Healthy New Towns: a six-month feasibility study of Healthy New Town demonstrator sites in England
Harden, A., Rance, S., Watts, P., McGowan, V., Findlay, G., Bambra, C. and Brown, H. 2019. The long-term health and wellbeing impacts of Healthy New Towns: a six-month feasibility study of Healthy New Town demonstrator sites in England. National Institute for Health Research.
How do women with social risk factors experience United Kingdom maternity care? A realist synthesis
Rayment-Jones, H., Sandall, J., Harris, J., Harden, A. and Khan, Z. 2019. How do women with social risk factors experience United Kingdom maternity care? A realist synthesis. Birth. 46 (3), pp. 461-474.
Testing the effectiveness of REACH Pregnancy Circles group antenatal care: protocol for a randomised controlled pilot trial
Wiggins, Meg, Sawtell, Mary, Wiseman, Octavia, McCourt, Christine, Greenberg, Lauren, Hunter, Rachael, Eldridge, Sandra, Haora, P., Kaur, Inderjeet and Harden, A. 2018. Testing the effectiveness of REACH Pregnancy Circles group antenatal care: protocol for a randomised controlled pilot trial. Pilot and Feasibility Studies. 4 (1), p. Art. 169.
Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes (EMmY): a protocol for a randomised, placebo-controlled, double-blind pilot trial
Amaefule, Chiamaka Esther, Drymoussi, Zoe, Dodds, Julie, Sweeney, L., Pizzo, Elena, Daru, Jahnavi, Robson, John, Poston, Lucilla, Khalil, Asma, Myers, Jenny, Harden, A., Hitman, Graham A, Khan, Khalid, Zamora, Javier, Huda, Mohammed S B and Thangaratinam, Shakila 2018. Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes (EMmY): a protocol for a randomised, placebo-controlled, double-blind pilot trial. BMJ Open. 8 (9), p. e022831.
'It makes sense and it works': maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles)
Hunter, Louise, Da Motta, Giordana, McCourt, Christine, Wiseman, Octavia, Rayment, Juliet, Haora, P., Wiggins, Meg and Harden, A. 2018. 'It makes sense and it works': maternity care providers' perspectives on the feasibility of a group antenatal care model (Pregnancy Circles). Midwifery. 66, pp. 56-63.
Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations
Sawtell, Mary, Sweeney, L., Wiggins, Meg, Salisbury, C., Eldridge, Sandra, Greenberg, Lauren, Hunter, Rachael, Kaur, Inderjeet, McCourt, Christine, Hatherall, B., Findlay, G., Morris, Joanne, Reading, Sandra, Renton, A., Adekoya, Ruth, Green, Belinda, Harvey, Belinda, Latham, Sarah, Patel, Kanta, VanLessen, Logan and Harden, A. 2018. Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations. Trials. 19 (163).
Cochrane Qualitative and Implementation Methods Group Guidance paper 2: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings
Noyes, Jane, Booth, Andrew, Flemming, Kate, Garside, Ruth, Harden, A., Lewin, Simon, Pantoja, Tomas, Hannes, Karin, Cargo, Margaret and Thomas, James 2018. Cochrane Qualitative and Implementation Methods Group Guidance paper 2: Methods for assessing methodological limitations, data extraction and synthesis, and confidence in synthesized qualitative findings. Journal of Clinical Epidemiology. 97, pp. 49-58.
Cochrane Qualitative and Implementation Methods Group Guidance Series - paper 1: Introduction
Noyes, Jane, Booth, Andrew, Cargo, Margaret, Flemming, Kate, Garside, Ruth, Hannes, Karin, Harden, A., Harris, Janet, Lewin, Simon, Pantoja, Tomas and Thomas, James 2018. Cochrane Qualitative and Implementation Methods Group Guidance Series - paper 1: Introduction. Journal of Clinical Epidemiology. 97, pp. 35-38.
Cochrane Qualitative and Implementation Methods Group Guidance series - paper 6: Methods for question formulation, searching and protocol development for qualitative evidence synthesis
Harris, Janet L., Booth, Andrew, Cargo, Margaret, Hannes, Karin, Harden, A., Flemming, Kate, Garside, Ruth, Pantoja, Tomas, Thomas, James and Noyes, Jane 2018. Cochrane Qualitative and Implementation Methods Group Guidance series - paper 6: Methods for question formulation, searching and protocol development for qualitative evidence synthesis. Journal of Clinical Epidemiology. 97, pp. 39-48.
Cochrane Qualitative and Implementation Methods Group Guidance Paper 4: Methods for integrating qualitative and implementation evidence within intervention effectiveness reviews
Harden, A., Thomas, James, Cargo, Margaret, Harris, Janet, Pantoja, Tomas, Flemming, Kate, Booth, Andrew, Garside, Ruth, Hannes, Karin and Noyes, Jane 2018. Cochrane Qualitative and Implementation Methods Group Guidance Paper 4: Methods for integrating qualitative and implementation evidence within intervention effectiveness reviews. Journal of Clinical Epidemiology. 97, pp. 70-78.
Better together: A qualitative exploration of women’s perceptions and experiences of group antenatal care
Hunter, L. J., Da Motta, G., McCourt, C., Wiseman, O., Rayment, J. L., Haora, P., Wiggins, M. and Harden, A. 2018. Better together: A qualitative exploration of women’s perceptions and experiences of group antenatal care. Women and Birth. 32 (4), pp. 336-345.
Cochrane Qualitative and Implementation Methods Group guidance series—paper 3: methods for assessing evidence on intervention implementation
Cargo, M., Harris, J., Pantoja, T., Booth, A., Harden, A., Hannes, K., Thomas, J., Flemming, K., Garside, R. and Noyes, J. 2018. Cochrane Qualitative and Implementation Methods Group guidance series—paper 3: methods for assessing evidence on intervention implementation. Journal of Clinical Epidemiology. 97, pp. 59-69.
Conduct and reporting of acceptability, attitudes, beliefs and experiences of pregnant women in randomised trials on diet and lifestyle interventions: A systematic review
Hamilton, E. Adela A., Nowell, Ann K., Harden, A. and Thangaratinam, Shakila 2018. Conduct and reporting of acceptability, attitudes, beliefs and experiences of pregnant women in randomised trials on diet and lifestyle interventions: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology. 225, pp. 243-254.
“It’s my diabetes”: Co-production in practice with young people in delivering a ‘perfect' care pathway for diabetes
Sharpe, D., Green, Emma, Harden, A., Freer, Rachelle, Moodambail, Abdul and Towndrow, Steven 2018. “It’s my diabetes”: Co-production in practice with young people in delivering a ‘perfect' care pathway for diabetes. Research for All. 2 (2), pp. 289-303.
Review 5: Evidence review of barriers to, and facilitators of, community engagement approaches and practices in the UK
Harden, A., Sheridan, K., McKeown, Alex, Dan-Ogosi, I. and Bagnall, Anne-Marie 2016. Review 5: Evidence review of barriers to, and facilitators of, community engagement approaches and practices in the UK. Institute for Health and Human Development, University of East London.
National Institute for Health and Care Excellence Review 4: Community engagement – approaches to improve health: map of the literature on current and emerging community engagement policy and practice in the UK
Bagnall, Anne-Marie, South, Jane, Trigwell, Joanne, Kinsella, Karina, White, Judy and Harden, A. 2016. National Institute for Health and Care Excellence Review 4: Community engagement – approaches to improve health: map of the literature on current and emerging community engagement policy and practice in the UK. Leeds Centre for Health Promotion Research, Leeds Beckett University / Institute for Health and Human Development, University of East London.
In memoriam: the contributions to public health research of Farah Jamal, BA, MSc, PhD
Bonell, Chris, Harden, A., Fletcher, Adam and Viner, Russell 2016. In memoriam: the contributions to public health research of Farah Jamal, BA, MSc, PhD. Journal of Epidemiology and Community Health. 70 (4), pp. 329-330.
Timing of the initiation of antenatal care: An exploratory qualitative study of women and service providers in East London
Hatherall, B., Morris, Joanne, Jamal, Farah, Sweeney, Lorna, Wiggins, Meg, Kaur, Inderjeet, Renton, Adrian and Harden, A. 2016. Timing of the initiation of antenatal care: An exploratory qualitative study of women and service providers in East London. Midwifery. 36, pp. 1-7.
Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis
O'Mara-Eves, A, Brunton, Ginny, McDaid, G, Oliver, Sandy, Kavanagh, Josephine, Jamal, F., Matosevic, T, Harden, A. and Thomas, James 2013. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Public Health Research. 1 (4).
An economic model of school-based behavioral interventions to prevent sexually transmitted infections
Cooper, Keith, Shepherd, Jonathan, Picot, Jo, Jones, Jeremy, Kavanagh, Josephine, Harden, A., Barnett-Page, Elaine, Clegg, Andrew, Hartwell, Debbie, Frampton, Geoff and Price, Alison 2012. An economic model of school-based behavioral interventions to prevent sexually transmitted infections. International Journal of Technology Assessment in Health Care. 28 (04), pp. 407-414.
The school environment and student health: a systematic review and meta-ethnography of qualitative research
Jamal, F., Fletcher, Adam, Harden, A., Wells, Helene, Thomas, James and Bonell, Chris 2013. The school environment and student health: a systematic review and meta-ethnography of qualitative research. BMC Public Health. 13 (1), p. 798.
Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK
Cresswell, Jenny A, Yu, Ge, Hatherall, B., Morris, Joanne, Jamal, Farah, Harden, A. and Renton, A. 2013. Predictors of the timing of initiation of antenatal care in an ethnically diverse urban cohort in the UK. BMC Pregnancy and Childbirth. 13 (1), p. 103.
Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis
Bonell, C., Farah, Jamal, Harden, A., Wells, H., Parry, W., Fletcher, A., Petticrew, M., Thomas, J., Whitehead, M., Campbell, R., Murphy, S. and Moore, L. 2013. Systematic review of the effects of schools and school environment interventions on health: evidence mapping and synthesis. Public Health Research. 1 (1).
Consulting with young people to inform systematic reviews: an example from a review on the effects of schools on health
Jamal, F. and Harden, A. 2013. Consulting with young people to inform systematic reviews: an example from a review on the effects of schools on health. UEL Research and Knowledge Exchange Conference 2013. University of East London, London 26 Jun 2013 London University of East London.
Getting older and living longer with HIV: Findings from a pilot study conducted in Newham
Foster, Nena, Freeman, Emily, Harden, A., Tobi, Patrick and Fakoya, Ade 2012. Getting older and living longer with HIV: Findings from a pilot study conducted in Newham. UEL Research and Knowledge Exchange Conference 2012. University of East London, London 03 May 2012 London University of East London.
The school environment and student health: a systematic review and meta-ethnography of qualitative research
Jamal, Farah, Fletcher, Adam, Harden, A., Wells, Helene, Thomas, James and Bonell, Chris 2013. The school environment and student health: a systematic review and meta-ethnography of qualitative research. BMC Public Health. 13 (1), p. 798.
The contribution of a social enterprise to the building of social capital in a disadvantaged urban area of London
Bertotti, M., Harden, A., Renton, A. and Sheridan, K. 2012. The contribution of a social enterprise to the building of social capital in a disadvantaged urban area of London. Community Development Journal. 47 (2), pp. 168-183.
A scoping review of the evidence relevant to life checks for young people aged 9 to 14 years
Harden, A. 2007. A scoping review of the evidence relevant to life checks for young people aged 9 to 14 years. London EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
Thematic synthesis
Harden, A. and Thomas, James 2008. Thematic synthesis. ESRC Research Methods Festival. St Catherine’s College, Oxford 30 Jun - 03 Jul 2008 Southampton ESRC National Centre for Research Methods.
Testing and building theories: mixed methods synthesis
Harden, A. 2008. Testing and building theories: mixed methods synthesis. ESRC Research Methods Festival. St Catherine’s College, Oxford 30 Jun - 03 Jul 2008 Southampton ESRC National Centre for Research Methods.
Critical appraisal and qualitative research: exploring sensitivity analysis
Harden, A. 2008. Critical appraisal and qualitative research: exploring sensitivity analysis. ESRC Research Methods Festival. St Catherine’s College, Oxford 30 Jun - 03 Jul 2008
Social and environmental interventions to reduce childhood obesity: a systematic map of reviews
Harden, A. 2008. Social and environmental interventions to reduce childhood obesity: a systematic map of reviews. London EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
Including diverse groups of children and young people in health promotion and public health research: a review of methodology and practice
Harden, A. 2008. Including diverse groups of children and young people in health promotion and public health research: a review of methodology and practice. London EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
Health promotion, inequalities and young people’s health: a systematic review of research
Harden, A. 2008. Health promotion, inequalities and young people’s health: a systematic review of research. London EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
A review of effectiveness, including cost effectiveness wherever possible, of commissioned healthy weight-related projects in City and Hackney: final report
Harden, A., Estacio, Emee Vida, Tobi, Patrick, Adams-Eaton, Faye, Bertotti, Marcello and Lais, Shahana 2009. A review of effectiveness, including cost effectiveness wherever possible, of commissioned healthy weight-related projects in City and Hackney: final report. London Institute of Health and Human Development, University of East London.
A project to assist Family Actions's Building Bridges practitioners with the use of the Index of Family Relations as an outcome measurement: final report
Harden, A., Lloyd-Reichling, E., Mcdermott, M., Potter, Sylvia and Sayeed, Zahirun 2009. A project to assist Family Actions's Building Bridges practitioners with the use of the Index of Family Relations as an outcome measurement: final report. London University of East London.
The influence of environmental factors on the generalisability of public health research evidence: physical activity as a worked example
Watts, P., Phillips, Gemma, Harden, A. and Renton, A. 2011. The influence of environmental factors on the generalisability of public health research evidence: physical activity as a worked example. International Journal of Behavioural Nutrition and Physical Activity. 8 (1), pp. 1479-5868.
Creating and Maintaining a Healthy Stratford City: Principles and Practices for Success
Sampson, Alice, Harden, A., Brimicombe, A., Bertotti, Marcello, Lais, Shahana, Barrow-Guevera, Gail, Boniwell, Ilona, Joseph, Hipolina, Sheridan, Kevin, Adams-Eaton, Faye, Tobi, Patrick and Li, Yang 2010. Creating and Maintaining a Healthy Stratford City: Principles and Practices for Success. University of East London, Centre for Institutional Studies.
Protocol for a systematic review of the effects of schools and school-environment interventions on health: evidence mapping and syntheses
Harden, A. and Jamal, Farah 2011. Protocol for a systematic review of the effects of schools and school-environment interventions on health: evidence mapping and syntheses. BMC Public Health. 11 (453).
Integrating qualitative research with trials in systematic reviews
Thomas, James, Harden, A., Oakley, Ann, Oliver, Sandy, Sutcliffe, Katy, Rees, Rebecca, Brunton, Ginny and Kavanagh, Josephine 2004. Integrating qualitative research with trials in systematic reviews. British Medical Journal. 328 (7446), pp. 1010-1012.
Applying systematic review methods to studies of people’s views: an example from public health research
Harden, A., Garcia, Jo, Oliver, Sandy, Rees, Rebecca, Shepherd, Jonathan, Brunton, Ginny and Oakley, Ann 2004. Applying systematic review methods to studies of people’s views: an example from public health research. Journal of Epidemiology and Community Health. 58 (9), pp. 794-800.
A project to assist Family Action’s Building Bridges practitioners with the use of the Index of Family Relations as an outcome measurement (Final Report).
Harden, A., Lloyd-Reichling, E., Mcdermott, M., Potter, Sylvia and Sayeed, Zahirun 2009. A project to assist Family Action’s Building Bridges practitioners with the use of the Index of Family Relations as an outcome measurement (Final Report). Family Action, Institute of Health and Human Development and CASS School of Education, University of East London.
Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies
Harden, A., Brunton, Ginny, Fletcher, Adam and Oakley, Ann 2009. Teenage pregnancy and social disadvantage: systematic review integrating controlled trials and qualitative studies. British Medical Journal. 339 (121).
Methods for the thematic synthesis of qualitative research in systematic reviews
Thomas, James and Harden, A. 2008. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology. 8 (45).