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Table 1 Key processes and characteristics of a critical interpretive synthesis

From: Developing a framework to inform scale-up success for population health interventions: a critical interpretive synthesis of the literature

Key Process or Characteristic

Description

Purpose

To conduct a critical analysis and generate new insights of a topic by examining a broad base of relevant literature.

Process

CIS rejects the “staged” approach to the literature review process and instead supports an iterative, interactive, and recursive approach which recognizes the need for flexibility and reflexivity. Searching, sampling, critiquing, reflecting, and analysis may occur in tandem and/or iteratively. Due to the interpretive process, it is acknowledged that some aspects may not be auditable or reproducible. A precise protocol for CIS is not offered due to the acknowledgement of the “authorial voice”.

Synthesis question

This approach is ideal for synthesis topics that may not be precisely bounded or clearly defined; as the synthesis progresses a more precise definition may develop. Similarly, the review question may evolve and become refined as the synthesis progresses.

Search strategy

Various literature sources may be utilized, including literature databases (peer-reviewed, grey), reference citation, snowballing/review of bibliography, hand searching, expert consultation, and author contacts. Beginning with a broad strategy, the strategy may evolve organically.

Sampling

Eligible studies may include empirical/theoretical literature, editorials, commentaries, and reviews. Inclusion criteria can be flexible and to some extent emergent. The purpose of sampling is to be extensive, but not comprehensive, therefore study selection may include purposive and theoretical sampling. Ongoing selection of potentially relevant literature is informed by reflection and emerging concepts. The intent is to sample literature that will maximize contributions towards conceptual and theoretical development.

Critical appraisal

Depending on the purpose of the review, methodological quality assessment is optional. If the review includes various types of data it may not be feasible to assess methodological rigour consistently as there is no single tool that may be used across all types of studies. CIS suggests greater emphasis should be placed on critiquing throughout the CIS approach rather than just critical appraisal during the sampling phase.

Data extraction

Use of a formal/standard data extraction form is optional.

Coding

Codes for the data are derived from the literature (i.e., inductive).

Analysis

Data analysis includes components of critique, reflection, interpretation, development of new concepts, and integration. Synthesis goes beyond summarization and includes the critical examination, interpretation, and generation of new insights.

Results

CIS leads to the generation of a synthesizing argument (e.g., theory, framework), a critically informed analysis that provides new insights by identifying relationships within and/or between existing constructs in the literature and ‘synthetic constructs’ (new constructs generated through synthesis). The synthesizing argument is grounded in the literature and formed by the process of integrating evidence from across the studies.

  1. Note: Adapted from Dixon-Woods et al. (2006) & Entwistle et al. (2011)