Background: Framework synthesis (FS) is a method for synthesis of qualitative research in systematic reviews (SRs), which is being increasingly utilised to synthesise data from diverse sources to explore complex healthcare issues. While published guidance on conducting mixed-methods SRs and qualitative FS is available, there is little consensus on conducting mixed-methods FS.
Objectives: To conduct a targeted literature review (TLR) to evaluate the current use and methodology of FS in mixed-methods literature reviews.
Methods: This TLR was conducted according to a prespecified protocol. In February 2023, we searched MEDLINE, Embase and Cochrane Database of Systematic Reviews (via Ovid) for mixed-methods reviews using FS. Records were reviewed by a single individual at the title/abstract and full-text review stages. Information was extracted on rationale for FS use, framework development, extraction, synthesis and integration of quantitative and qualitative data, quality assessment (QA), outputs and reported limitations of FS.
Results: We initially identified 240 unique records, of which 123 were excluded at title/abstract review and 68 excluded at full-text review, leaving 49 peer-reviewed publications for analysis. All but four reviews were SRs, with two rapid reviews, one scoping review and one SR of SRs. Primary quantitative, qualitative or mixed-methods studies were eligible for inclusion; secondary research or opinion were included in less than 25% of reviews. Two reviews only extracted author summary or interpretation of quantitative findings. The level of detail on how FS was conducted varied, with some detailing the process step by step and others only citing the method. Very few described how quantitative and qualitative data were integrated. Where reported, methods included convergent synthesis, whereby quantitative data are transformed into qualitative statements through narrative interpretation (“qualitising”), and the Pillar Integration Process, whereby data are listed by type and then matched to corresponding qualitative or quantitative data before further synthesis. Most reviews used QA tools designed to appraise multiple study designs; however, some did not perform formal QA owing to heterogeneity. Few reviews cited qualitative reporting guidelines.
Conclusions: The volume of mixed-methods literature reviews using FS being published is increasing. With limited consensus on best practice, further guidance and improved transparency in reporting is required.