title: Why, when and how to update a meta-ethnography qualitative synthesis.
abstract: BACKGROUND
  Meta-ethnography is a unique, systematic, qualitative synthesis approach widely used to provide robust evidence on patient and clinician beliefs and experiences and understandings of complex social phenomena. It can make important theoretical and conceptual contributions to health care policy and practice.
  
  
  RESULTS
  Since beliefs, experiences, health care contexts and social phenomena change over time, the continued relevance of the findings from meta-ethnographies cannot be assumed. However, there is little guidance on whether, when and how meta-ethnographies should be updated; Cochrane guidance on updating reviews of intervention effectiveness is unlikely to be fully appropriate. This is the first in-depth discussion on updating a meta-ethnography; it explores why, when and how to update a meta-ethnography. Three main methods of updating the analysis and synthesis are examined. Advantages and disadvantages of each method are outlined, relating to the context, purpose, process and output of the update and the nature of the new data available. Recommendations are made for the appropriate use of each method, and a worked example of updating a meta-ethnography is provided.
  
  
  CONCLUSIONS
  This article makes a unique contribution to this evolving area of meta-ethnography methodology.
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Stirling, FK9 4NF, UK. emma.france@stir.ac.uk.
authors.forename: Emma F
authors.initials: EF
authors.lastname: France
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Stirling, FK9 4NF, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: Wells
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Stirling, FK9 4NF, UK.
authors.forename: Heidi
authors.initials: H
authors.lastname: Lang
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Stirling, FK9 4NF, UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
mesh_terms: D000884:Anthropology, Cultural / Q000379:methods*; D006801:Humans; D036301:Qualitative Research; D012196:Review Literature as Topic
keywords: Cancer; Meta-ethnography; Meta-synthesis; Qualitative analysis; Qualitative reviews; Systematic reviews