Meta-ethnography offers a rigorous method for synthesizing multiple qualitative studies to advance understanding of a topic. Developed by Noblit and Hare in the field of education,1 meta-ethnography is well established in applied health research.2-5 The goal is to synthesize existing qualitative research to arrive at new insights, interpreting beyond the findings that are currently reported. A meta-ethnographic review is a qualitative interpretation of qualitative interpretations, and researchers must be prepared to embrace the complexity that comes with this approach.
In this article, we provide a synopsis of how to read a meta-ethnographic review as well as how to get started if interested in conducting a meta-ethnographic review. We briefly explain the 7 steps of meta-ethnography and follow this with an overview of 3 critical approaches to synthesizing the data (ie, to interpret the interpretations). The Box lists several resources readers may find useful when designing a meta-ethnographic study.
▪ Campbell R, Pound P, Morgan M, et al. Evaluating meta-ethnography: systematic analysis and synthesis of qualitative research. Health Technol Assess. 2011;15(43):1-164. doi:10.3310/hta15430
▪ Noblit GW, Hare RD. Meta-Ethnography: Synthesizing Qualitative Studies. Sage Publications; 1988.
▪ France EF, Cunningham M, Ring N, et al. Improving reporting of meta-ethnography: the eMERGe reporting guidance. BMC Med Res Methodol. 2019;19(1):25. doi:10.1186/s12874-018-0600-0
▪ Toye F, Seers K, Allcock N, Briggs M, Carr E, Barker K. Meta-ethnography 25 years on: challenges and insights for synthesising a large number of qualitative studies. BMC Med Res Methodol. 2014;14:80. doi:10.1186/1471-2288-14-80
The 7 Steps of Meta-Ethnography
While each meta-ethnographic study is unique, the approach can be broken down into 7 distinct, but overlapping, steps or phases.1
1. Getting Started
A review typically begins with the identification of an issue needing further investigation or clarification. Often, an issue well-suited for meta-ethnographic work is one that has been rigorously investigated and well-described but continues to lack clarity or consensus. A team of researchers with relevant and varied expertise in the area of interest should be established.
2. Deciding What Is Relevant
This step is critically important, if somewhat self-evident. Identifying a clear focus will support the review in moving forward effectively. This phase also involves selection of studies to be included in the review, based on criteria negotiated by the research team.
3. Reading the Studies
The researchers will carefully read each of the selected studies with a focus on identifying notable concepts. This phase shares a similar approach as open coding in qualitative data analysis, by denoting ideas that may be further categorized and elucidated through the review.
4. Determining How the Studies Are Related
While phase 3 serves as a type of coding, phase 4 mirrors the act of grouping codes into themes. This broader categorization of themes is done iteratively, and multiple team members can contribute. Various methods to organize data can be used (eg, diagrams or qualitative data analysis software) to purposefully bring together concepts and see how they relate to, or contest, each other.
5. Translating the Studies Into One Another
Translation involves exploring the analogies, metaphors, themes, and concepts that can help make sense of the relationships between studies. It is during this phase that the researchers work differently (ie, using reciprocal translation, refutational synthesis, or lines-of-argument synthesis), depending on how the studies relate to each other, as discussed in the next section.
6. Synthesizing Translations
During this phase, the researchers work with identified concepts from the reviewed studies to arrive at new interpretations. It involves searching for overarching explanations and identifying gaps, overlaps, and silences.
7. Expressing the Synthesis
Finally, the meta-ethnographic insights should be reported in a manner that advances understanding on a particular topic. The eMERGe Reporting Guidelines provide useful guidance.4
Key Approaches to Translation and Synthesis
In steps 4 through 6, the researchers grapple with how to conduct the translation and synthesis activities. Noblit and Hare identified 4 ways that qualitative studies can relate to each other.1 If the studies are about different phenomena altogether, then there is no use synthesizing them and meta-ethnography is not the right approach. However, if the studies are addressing the same general phenomenon, then meta-ethnography is a good choice. The studies may be related in 3 different ways. They may say similar things, say contradictory things, or say different things requiring additional sensemaking. These lead to the following types of syntheses:
1. Reciprocal Translation
This approach applies when concepts in one study can incorporate those of another because they are very similar in meaning. Reciprocal translation focuses on finding the analogies and explanations that best represent the whole.
2. Refutational Synthesis
This approach applies when the concepts in different studies––or the studies themselves––contradict or refute one another. In these types of syntheses, the refutations themselves become units of analysis.
3. Lines-of-Argument Synthesis
This approach applies when the qualitative studies under review identify different aspects of the topic that can be drawn together in a new interpretation. In other words, the synthesis leads to a new storyline emerging. While it is not necessary to identify and adhere to one approach, these synthesis methods serve as useful analytical tools for meta-ethnographic interpretation.
Careful consideration of the key concepts and assumptions that underpin meta-ethnography synthesis work, as well as the steps involved in the process, are essential to readers' confidence in the quality of the review as well as for those contemplating performing a meta-ethnographic review. Meta-ethnography, by synthesizing qualitative evidence in a way that extends beyond the meaning of the original studies it interprets, has significant potential to expand understanding in the field of health professions education.