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Table 2 Key Processes in critical interpretive synthesis

From: Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups

▪ A review question should be formulated at the outset, but should remain open to modification. Precise definitions of many constructs may be deferred until late in the review and may be a product of the review itself. ▪ Searching, sampling, critique and analysis proceed hand in hand, and should be seen as dynamic and mutually informative processes. ▪ Searching initially should use a broadly defined strategy, including purposive selection of material likely or known to be relevant. ▪ The analysis should be aimed towards the development of a synthesising argument: a critically informed integration of evidence from across the studies in the review. The synthesising argument takes the form of a coherent theoretical framework comprising a network of constructs and the relationships between them. The synthesising argument links synthetic constructs (new constructs generated through synthesis) and existing constructs in the literature. ▪ There is a need for constant reflexivity to inform the emerging theoretical notions, as these guide the other processes. ▪ Ongoing selection of potentially relevant literature should informed by the emerging theoretical framework. Literatures not directly or obviously relevant to the question under review may be accessed as part of this process. ▪ CIS encourages an ongoing critical orientation to the material to be included in the review. Some limited formal appraisal of methodological quality of individual papers is likely to be appropriate. Generally the aim will be to maximise relevance and theoretical contribution of the included papers. ▪ Formal data extraction procedures may be helpful, particularly at the outset of the review, but are unlikely to be an essential feature of the approach. ▪ CIS does not offer aim to offer a series of pre-specified procedures for the conduct of review. It explicitly acknowledges the "authorial voice"; that some aspects of its production of the account of the evidence will not be visible or auditable; and that its account may not be strictly reproducible. Its aim is to offer a theoretically sound and useful account that is demonstrably grounded in the evidence. ▪ CIS demands constant reflexivity on the part of authors of reviews. Authors are charged with making conscientious and thorough searches, with making fair and appropriate selections of materials, with seeking disconfirming evidence and other challenges to the emergent theory, and with ensuring that the theory they generate is, while critically informed, plausible given the available evidence.