title: A methodological systematic review of what's wrong with meta-ethnography reporting.
abstract: BACKGROUND
  Syntheses of qualitative studies can inform health policy, services and our understanding of patient experience. Meta-ethnography is a systematic seven-phase interpretive qualitative synthesis approach well-suited to producing new theories and conceptual models. However, there are concerns about the quality of meta-ethnography reporting, particularly the analysis and synthesis processes. Our aim was to investigate the application and reporting of methods in recent meta-ethnography journal papers, focusing on the analysis and synthesis process and output.
  
  
  METHODS
  Methodological systematic review of health-related meta-ethnography journal papers published from 2012-2013. We searched six electronic databases, Google Scholar and Zetoc for papers using key terms including 'meta-ethnography.' Two authors independently screened papers by title and abstract with 100% agreement. We identified 32 relevant papers. Three authors independently extracted data and all authors analysed the application and reporting of methods using content analysis.
  
  
  RESULTS
  Meta-ethnography was applied in diverse ways, sometimes inappropriately. In 13% of papers the approach did not suit the research aim. In 66% of papers reviewers did not follow the principles of meta-ethnography. The analytical and synthesis processes were poorly reported overall. In only 31% of papers reviewers clearly described how they analysed conceptual data from primary studies (phase 5, 'translation' of studies) and in only one paper (3%) reviewers explicitly described how they conducted the analytic synthesis process (phase 6). In 38% of papers we could not ascertain if reviewers had achieved any new interpretation of primary studies. In over 30% of papers seminal methodological texts which could have informed methods were not cited.
  
  
  CONCLUSIONS
  We believe this is the first in-depth methodological systematic review of meta-ethnography conduct and reporting. Meta-ethnography is an evolving approach. Current reporting of methods, analysis and synthesis lacks clarity and comprehensiveness. This is a major barrier to use of meta-ethnography findings that could contribute significantly to the evidence base because it makes judging their rigour and credibility difficult. To realise the high potential value of meta-ethnography for enhancing health care and understanding patient experience requires reporting that clearly conveys the methodology, analysis and findings. Tailored meta-ethnography reporting guidelines, developed through expert consensus, could improve reporting.
authors.affiliation: Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling and Glasgow Caledonian University, Unit 13 Scion House, Stirling University Innovation Park, Stirling FK9 4NF, Scotland, UK. emma.france@stir.ac.uk.
authors.forename: Emma F
authors.initials: EF
authors.lastname: France
authors.forename: Nicola
authors.initials: N
authors.lastname: Ring
authors.forename: Rebecca
authors.initials: R
authors.lastname: Thomas
authors.forename: Jane
authors.initials: J
authors.lastname: Noyes
authors.forename: Margaret
authors.initials: M
authors.lastname: Maxwell
authors.forename: Ruth
authors.initials: R
authors.lastname: Jepson
mesh_terms: D000884:Anthropology, Cultural / Q000379:methods*; D003627:Data Interpretation, Statistical; D006801:Humans; D011643:Publishing; D036301:Qualitative Research; D012107:Research Design