Cited by 389Meta-analysis and systematic reviewsHealth Policy Implementation ScienceClinical practice guidelines implementation

Qualitative evidence synthesis for complex interventions and guideline development: clarification of the purpose, designs and relevant methods

Open access
Flemming, Kate, Booth, Andrew, Garside, Ruth, Tunçalp, Özge, Noyes, Jane·2019·BMJ Global Health

Abstract

This paper is one of a series exploring the implications of complexity for systematic reviews and guideline development, commissioned by the WHO. The paper specifically explores the role of qualitative evidence synthesis. Qualitative evidence synthesis is the broad term for the group of methods used to undertake systematic reviews of qualitative research evidence. As an approach, qualitative evidence synthesis is increasingly recognised as having a key role to play in addressing questions relating to intervention or system complexity, and guideline development processes. This is due to the unique role qualitative research can play in establishing the relative importance of outcomes, the acceptability, fidelity and reach of interventions, their feasibility in different settings and potential consequences on equity across populations. This paper outlines the purpose of qualitative evidence synthesis, provides detail of how qualitative evidence syntheses can help establish understanding and explanation of the complexity that can occur in relation to both interventions and systems, and how qualitative evidence syntheses can contribute to evidence to decision frameworks. It provides guidance for the choice of qualitative evidence synthesis methods in the context of guideline development for complex interventions, giving 'real life' examples of where this has occurred. Information to support decision-making around choice qualitative evidence synthesis methods in the context of guideline development is provided. Approaches for reporting qualitative evidence syntheses are discussed alongside mechanisms for assessing confidence in the findings of a review.

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Crossref · 10.1136/bmjgh-2018-000882

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  • Inductive thematic analysis is the most appropriate method for synthesizing a mixed research design.

    “Inductive thematic analysis was considered the most appropriate method for synthesizing a mixed research design (Flemming et al., 2019).”

    From Outcome domains and assessment measures in school-based youth mentoring programs: a systematic review (2026) · cites this paper as Flemming et al., 2019

    The QES methods section describes thematic synthesis as one option and says method choice depends on the review question and context. The thematic synthesis subsection says it may work well for questions about sociocultural acceptability, but does not recommend inductive thematic analysis as the most appropriate method for a mixed research design. Pages are not specified in our copy. (LLM, conf=0.84)

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  1. [35]World Health Organization (WHO). WHO recommendations: optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting. 2012 http://apps.who.int/iris/bitstream/10665/77764/1/9789241504843_eng.pdf. 23844452
  2. [40]WHO. WHO recommendations on antenatal care for a positive pregnancy experience. 2016 http://apps.who.int/iris/bitstream/10665/250796/1/9789241549912-eng.pdf (accessed 23 Oct 17). 28079998
  3. [42]WHO. WHO recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy. 2013 http://apps.who.int/iris/bitstream/10665/94555/1/9789241506076_eng.pdf?ua=1. 24649520

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Authors
Flemming, K., Booth, A., Garside, R., Tunçalp, Ö., & Noyes, J.
Affiliations
  • University of York (GB)
  • University of Sheffield (GB)
  • University of Exeter (GB)
  • World Health Organization (CH)
  • Bangor University (GB)
Corresponding author
Flemming, Kate
Venue
BMJ Global Health
Publisher
BMJ
Published
2019-01
Volume
4
Issue
Suppl 1
Pages
e000882
ISSN
2059-7908 (ISSN-L)
OpenAlex
W2912370207
Cited by
389
References
48
Citations by year
2026: 31 · 2025: 51 · 2024: 66 · 2023: 51 · 2022: 79 · 2021: 40 · 2020: 49 · 2019: 21 · 2017: 1
Type
conference abstract
Language
en
Open access
Licence
cc-by-nc
Locations
  • BMJ Global Health (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Open Research Exeter (University of Exeter) (submittedVersion, cc-by)
Funders
  • United States Agency for International Development
  • Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
qualitative evidence synthesis, complex interventions, clinical guideline development, intervention complexity, system complexity, evidence-to-decision framework, equity

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