Table 1 The seven phases of Noblit and Hare’s meta-ethnography approach

Phase 1: Getting started

‘Identifying an intellectual interest that qualitative research might inform’ ([15], p.26). The focus of the synthesis may be revised through reading interpretive qualitative studies.

Phase 2: Deciding what is relevant to the initial interest

Study selection should be ‘driven by some substantive interest derived from comparison of any given set of studies’ ([15], p.28). Searches for studies need not be exhaustive: ‘unless there is a substantive reason for an exhaustive search, generalizing from all studies of a particular setting yields trite conclusions’ ([15], p.28).

Phase 3: Reading the studies

The repeated reading of studies and noting of metaphors with close attention to details in the studies and what they tell you about your area of interest ([15], p.28).

Phase 4: Determining how the studies are related

Noblit and Hare recommended that reviewers create ‘a list of key metaphors, phrases, ideas and/or concepts (and their relations) used in each account, and [to] juxtapose them’ ([15], p.28) in order to make an initial assumption about how the studies relate to one another. This informs the type of synthesis that will be carried out – a reciprocal or refutational translation or line of argument synthesis.

Phase 5: Translating the studies into one another

The metaphors and/or concepts in each account and their interactions are compared or ‘translated’ within and across accounts while retaining the structure of relationships between central metaphors/concepts within accounts. The translations taken together are ‘one level of meta-ethnographic synthesis’ ([15], p.28). These are systematic comparisons and reciprocal translation is key to a meta-ethnography.

Phase 6: Synthesising translations

If there are many translations from phase 5 these can be compared with one another to see if there are common types of translations or if some translations or concepts can encompass those from other studies. ‘In these cases, a second level of synthesis is possible, analyzing types of competing interpretations and translating them into each other’ ([15], p.28) to reach new interpretations/conceptual understandings.

Phase 7: Expressing the synthesis

Tailoring the communication of the synthesis to the intended audience’s culture and language so that it is intelligible and meaningful to them - ‘the written synthesis is only one possible form’ ([15], p.29).