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Table 4 Summary of the phases of meta-ethnography conduct and updating

From: Why, when and how to update a meta-ethnography qualitative synthesis

Noblit and Hare’s [3] 7 phases How we conducted each phase in our original HNC meta-ethnography How we conducted each phase in our updated HNC meta-ethnography
1. “Getting started” (the topic focus). To examine patients’ experiences of HNC to provide a context for future research. To examine patients’ experiences of HNC to provide a context for future research.
2. Deciding what is relevant to the initial interest. Exhaustive systematic search strategy; inclusion of qualitative studies of the experience of HNC up to September 2007. Included 15 articles. Replicated earlier search strategy and inclusion criteria from September 2007 to September 2011. Identified a further 14 relevant articles.
3. Reading the studies. We identified, recorded and described on index cards all the primary study authors’ concepts and main conclusions in the 15 articles. We identified, recorded and described on index cards the primary study authors’ concepts and main conclusions in the 14 articles.
4. Determining how studies are related. We directly compared the primary study authors’ concepts and found them to be reciprocal (about roughly similar things). We juxtaposed the primary study authors’ concepts from each new article with our 11 translated concepts from phase 5 of the original to compare meanings. Most concepts from the new articles were reciprocal, but some were contradictory.
5. Translating the studies into one another. We systematically compared the meanings of all the primary study authors’ concepts across the articles and grouped the concepts according to shared meaning through reciprocal translation to produce 11 translated concepts. We continued the original translation process by systematically comparing the meanings of the primary study authors’ concepts from each new article with our 11 translated concepts from the original. Most concepts confirmed or enhanced the original translated concepts. We developed 9 additional translated concepts. We re-examined the articles in the original meta-ethnography to check if they did in fact support the new issues and concepts.
6. Synthesising translations. We compared and contrasted our 11 translated concepts and found that some could encompass or were similar to others resulting in a final six synthesised concepts (“synthesised translations”): uncertainty and waiting, disruption to daily life, the diminished self, making sense of the experience, sharing the burden, and finding a path. We juxtaposed the 11 original and 9 new translated concepts with our six synthesised concepts from phase 6 of the original meta-ethnography to systematically compare meanings. We refined our synthesised concepts to reflect the new and contradictory concepts.
7. Expressing the synthesis. In written form in an unpublished doctoral thesis. In written and diagrammatic form in a published journal article.