title: Protocol--realist and meta-narrative evidence synthesis: evolving standards (RAMESES).
abstract: BACKGROUND
  There is growing interest in theory-driven, qualitative and mixed-method approaches to systematic review as an alternative to (or to extend and supplement) conventional Cochrane-style reviews. These approaches offer the potential to expand the knowledge base in policy-relevant areas - for example by explaining the success, failure or mixed fortunes of complex interventions. However, the quality of such reviews can be difficult to assess. This study aims to produce methodological guidance, publication standards and training resources for those seeking to use the realist and/or meta-narrative approach to systematic review.
  
  
  METHODS
  We will: [a] collate and summarise existing literature on the principles of good practice in realist and meta-narrative systematic review; [b] consider the extent to which these principles have been followed by published and in-progress reviews, thereby identifying how rigour may be lost and how existing methods could be improved; [c] using an online Delphi method with an interdisciplinary panel of experts from academia and policy, produce a draft set of methodological steps and publication standards; [d] produce training materials with learning outcomes linked to these steps; [e] pilot these standards and training materials prospectively on real reviews-in-progress, capturing methodological and other challenges as they arise; [f] synthesise expert input, evidence review and real-time problem analysis into more definitive guidance and standards; [g] disseminate outputs to audiences in academia and policy. The outputs of the study will be threefold:1. Quality standards and methodological guidance for realist and meta-narrative reviews for use by researchers, research sponsors, students and supervisors2. A 'RAMESES' (Realist and Meta-review Evidence Synthesis: Evolving Standards) statement (comparable to CONSORT or PRISMA) of publication standards for such reviews, published in an open-access academic journal.3. A training module for researchers, including learning outcomes, outline course materials and assessment criteria.
  
  
  CONCLUSIONS
  Realist and meta-narrative review are relatively new approaches to systematic review whose overall place in the secondary research toolkit is not yet fully established. As with all secondary research methods, guidance on quality assurance and uniform reporting is an important step towards improving quality and consistency of studies.
authors.affiliation: Healthcare Innovation and Policy Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, London E1 2AB, UK. p.greenhalgh@qmul.ac.uk
authors.forename: Trisha
authors.initials: T
authors.lastname: Greenhalgh
authors.forename: Geoff
authors.initials: G
authors.lastname: Wong
authors.forename: Gill
authors.initials: G
authors.lastname: Westhorp
authors.forename: Ray
authors.initials: R
authors.lastname: Pawson
mesh_terms: D003697:Delphi Technique; D005069:Evaluation Studies as Topic; D006801:Humans; D010506:Periodicals as Topic / Q000592:standards*; D012108:Research Personnel / Q000193:education; D058028:Research Report / Q000592:standards*; D000078202:Systematic Reviews as Topic