GUEST EDITORIAL

Top 10 Tips for Undertaking Synthesis

Research
Kathleen Knafl, Robin Whittemore

Correspondence to: Kathleen Knafl Keywords: synthesis; literature review; writing for publication
E-mail: kknafl@email.unc.edu Research in Nursing & Health, 2017, 40, 189–193
Accepted 24 January 2017
Kathleen Knafl
DOI: 10.1002/nur.21790
Frances Hill Fox Distinguished Professor
Published online 7 March 2017 in Wiley Online Library (wileyonlinelibrary.com).
School of Nursing
University of North Carolina at Chapel Hill
408 Carrington Hall,
Chapel Hill, NC 27599

Robin Whittemore
Professor,
School of Nursing
Yale University
Orange, CT

Knowledge in the form of best research evidence is a key com-
ponent of evidence-based practice (Sackett, Rosenberg, Gray,
Haynes, & Richardson, 1996). However, the voluminous, often
unwieldy, body of research in many areas of nursing practice
makes it difficult to draw conclusions about what is known. Simi-
lar studies may yield conflicting results, and researchers often
study similar topics using different theoretical orientations and
methods. With over 26 million publications listed in the PubMed
database, millions with links to full-text content, and over 13,000
journals in the Web of Science database (including over 100
nursing journals), the volume of information, even in a focused
area of inquiry, can be overwhelming.
Over 30 years ago, in his bestselling book Megatrends,
Naisbett (1982) famously stated, “We are drowning in informa-
tion, but starved for knowledge” (p.17). His observation cap-
tures what many of us experience when faced with trying to
make sense of a particular body of literature. The dramatic
growth of research makes the need for synthesis more press-
ing than ever. For both clinicians committed to evidence-
based practice and researchers wanting to build on and
extend the current body of knowledge, synthesizing research
provides a powerful tool for determining what we know. Yet,
synthesizing the research can be a challenging undertaking.
Recognizing the importance of synthesis, research-
ers have directed increased attention to developing and
refining synthesis methods. As a result, multiple options
are available for anyone proposing to undertake a synthe-
sis project. Kearney (2016) addressed the importance of
novice review authors being exposed to literature reviews
that “serve as examples to support well-substantiated,
nuanced claims about the state of the science” (p. 6), and
in Table 1 we provide citations for strong examples of dif-
ferent types of reviews. Despite the many excellent resour-
ces available to support synthesis research, undertaking a
research synthesis can be daunting. The increasing sophis-
tication of methods and guidelines has contributed to the
scope and quality of the work being done but at the same
time poses new challenges.
While there are numerous synthesis methods, the
steps of the process are similar. In this guest editorial, we
draw on our experiences conducting synthesis research
and differentiating the various synthesis approaches to
offer our top 10 tips for undertaking a synthesis study. In
Table 2 we provide further elaboration on the tips by identi-
fying some key questions that need to be addressed during
the review process.
Tip #1. Seize the Moment
Conducting top-quality research synthesis is clearly
important for evidence-based practice and to guide

C 2017 Wiley Periodicals, Inc.
190 RESEARCH IN NURSING & HEALTH
Table 1. Synthesis Methods and Defining Characteristics
Synthesis method Defining characteristics
Systematic review Research synthesis of studies with homogenous
quantitative designs, sample,
intervention, and outcome
Meta-analysis A type of systematic review that combines
evidence using statistical methods
Integrative review Synthesis of research or literature with
heterogeneous designs. Can include
theoretical articles.
Scoping review Broad review of literature to map key concepts,
types of evidence, and gaps in research in a
defined area
Qualitative synthesis Research synthesis of studies with qualitative
designs
Mixed studies review Research synthesis of studies with both
quantitative and qualitative designs
RE-AIM review Review of the reach, efficacy, adoption,
implementation, and maintenance of an
intervention
Umbrella review Review of systematic reviews
future research. The journal Systematic Reviews is
focused entirely on the publication of syntheses and the
development of synthesis methods. All journals, regard-
less of their focus, benefit from publishing review
articles, because they often are cited more frequently
than articles reporting primary research. Review articles
also can increase journal downloads and the impact
factor of a journal. Authors benefit from writing review
articles because published reviews establish the
author's expertise in the field and can further interest in
the importance of the author's field of inquiry. Vicki
Conn, Editor of the Western Journal of Nursing
Research, has written several editorials to encourage
nurses in all stages of their careers to publish review
articles (Conn, 2014a,b,c).
Tip #2. Assemble a Team With the
Requisite Expertise
Synthesis research is time-consuming and complex.
There are numerous design decisions to be made, from
finalizing the question to developing the research synthe-
sis protocol. There are also challenges to implementing
the research synthesis protocol. Therefore, having a qual-
ified team who have diverse areas of expertise will
greatly improve both the review process and the out-
come. Likely members of a research synthesis team
include a content expert, a methods expert with experi-
ence applying the design and analysis methods to be
used, a librarian skilled in data-base searching, and a
data manager.
Research in Nursing & Health
Example
Stall, Nowaczynski, and Sinha (2014). Systematic review of
outcomes of home-based primary care programs for
homebound older adults.
Kalyani et al. (2010). Vitamin D treatment for the prevention of
falls in older adults: A systematic review and meta-analysis.
Gibbons et al. (2014). Liminality as a conceptual frame for
understanding the family caregiving rite of passage: An
integrative review.
Nam et al., (2015). Social networks and future direction for
obesity research: A scoping review.
LeBlanc et al. (2016). Facilitators and barriers to HIV
screening: A qualitative meta-synthesis.
Leeman et al. (2015). Parent-to-child transition in managing
cystic fibrosis: A research synthesis.
Kahwati et al. (2011). RE-AIM evaluation of the Veterans Health
Administration’s MOVE! Weight Management Program.
Chesla (2010). Do family interventions improve health?
Tip #3. Continue to Refine Your Research
Question and Protocol
It takes time to finalize the research synthesis question.
Often a preliminary scoping review is conducted to better
understand the research that has been completed on the
topic of interest and to determine the scope and magnitude
of the body of research (Arksey & O'Malley, 2005; Levac,
Colquhoun, & O’Brien, 2010). How much research has
been published? Are there areas of research with conflict-
ing results? Have research reviews been published on the
topic? How long ago were the research reviews published?
During the phase of refining the synthesis question, it is
important to assess the potential for publication and the
feasibility of the review, and it is equally important to be
willing to redirect based on the existing research that has
been published on the topic. For example, your original
plan to complete a meta-analysis may need to be modified
if a scoping study reveals that most of the research in the
field is qualitative.
Tip #4. Dream Big and Start Small
In her guest editorial “Top 10 Tips for Successful Grants-
manship,” Grey (2000) advised readers to “Dream big, start
small,” reminding us “Rome wasn’t built in a day, and nurs-
ing science will not be built on one project” (p. 91). We
think this is excellent advice for anyone doing synthesis
research. It most likely will be impossible to synthesize an
entire area of inquiry in one study. While it is important to
dream big and have overarching ideas about the potential
 SYNTHESIS RESEARCH/ KNAFL AND WHITTEMORE 191

Table 2. Research Synthesis Process

Steps of the Process Key questions to consider

Determine aim(s) of review Are there prior reviews on which to build?

Define and assemble team
Develop protocol
Conduct literature search
Select studies per protocol
Appraise quality of studies
Extract data from studies
Analyze data and present
results
Interpret results
Write report
How will this review contribute to knowledge development and nursing science?
What areas of expertise are needed to complete the review?
Do I need to involve colleagues from outside my school or university?
What synthesis method will best address the synthesis question?
What procedures will I use to be systematic and rigorous in my review?
How will I make optimal use of library resources in developing the search protocol?
How will I maintain a record of search yields from different data bases?
How will I ensure consistent application of inclusion/exclusion criteria?
How will I categorize and maintain a record of the rationale for excluding studies?
How will I identify and select a quality appraisal system that is appropriate for my synthesis question and
approach?
What checks will I use to ensure the consistent application of the appraisal system and how will I resolve
differences?
What kind of extraction format or template will I use?
How will I ensure the accuracy and completeness of data extracted from each report?
What methods will I use to compare data across studies?
What format will I use for presenting results?
How will I address inconsistent findings and study quality in my interpretation?
How will I situate my results in the larger body of knowledge in the field?
What are appropriate publication outlets?
What tables will I include in my published report?
How will I address limitations and make recommendations for future research and clinical practice?

implications of a research synthesis, all research synthesis
projects need to be feasible.
We often get questions about the sample size for
research synthesis projects. “How many articles are
enough? How many are too many?” We always answer, “It
depends.” We have conducted reviews that were published
with as few as seven articles and as many as 100 articles.
The sample size depends on the research synthesis ques-
tion, the type of data extracted, and how information-dense
the articles included in the review are. For beginners, we
recommend refining your research question to limit the
scope of the project and thus the number of articles to syn-
thesize. All of the approaches included in Table 1 can be
used to conduct either large- or small-scale reviews. A
modest project gives a novice an opportunity to master a
synthesis approach without being overwhelmed by the
data.
Tip #5. Review Your Options and Gather
Your Resources
Once you have finalized the research synthesis question,
the method is determined based on the overarching syn-
thesis goal and the existing evidence. Do you want to
describe results, integrate the results into a thematic
description or conceptual model, identify areas for future
research, or assess the weight of evidence that certain
types of interventions are efficacious or certain relation-
ships are significant? Do you need to have a sample of
articles with very homogenous methods, or with a variety of
methodologies? In their article on methods for knowledge
synthesis, Whittemore, Chao, Jang, Minges, and Park
(2014) included a list of resources for conducting various
types of reviews and emphasized the importance of align-
ing the research question, the available body of literature,
and the proposed synthesis approach.
Tip #6. Engage Your Team in Making
Challenging Decisions
There will be many challenging decisions in the develop-
ment and implementation of the synthesis protocol. For
example, deciding what quality appraisal tool(s) to use can
be especially difficult. There is no gold standard for many
synthesis designs, and there are numerous options. The
National Heart, Lung, and Blood Institute (2014) have
developed quality appraisal tools for quantitative designs,
and a widely used quality appraisal tool for qualitative
designs is the Critical Appraisal Skills Programme (CASP)
checklist (CASP UK, 2013).
Deciding what to do with quality scores is another
important decision. Do you include or exclude reports from
your sample based on quality? Do you consider quality
when interpreting the results, by closely examining the
quality scores of outliers? In screening articles to include in
the review, categories of “yes,” “no,” and “maybe” will
develop. How will you determine which of the “maybe”
articles are included or excluded? Having a plan and a

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192 RESEARCH IN NURSING & HEALTH
strong team is essential for making thoughtful, defensible
decisions.
Tip #7. Get Organized and Stay
Organized
There are many details and decisions in conducting a
research synthesis. It is important to document these and
maintain an audit trail of all decisions and challenges to the
implementation of the protocol. Attention to detail is essen-
tial in documenting your search strategies and yields
(terms, databases, dates, etc.), screening procedures, data
needed to comply with PRISMA guidelines (Moher et al.,
2009), data extraction procedures, quality assessment, and
the process for verifying analyses. It also is essential to
maintain a well-organized database with the results of all of
the data extraction, analysis, and synthesis efforts (Havill
et al., 2014). New software programs (e.g., EndNote, Covi-
dence) continue to be developed to facilitate the manage-
ment of sources and data in conducting systematic
reviews.
Tip #8. Don’t Rush, Be Patient, and
Persevere
Conducting a quality research synthesis takes time,
patience, and perseverance. It is important to carefully con-
sider all of the time-consuming aspects of a research syn-
thesis and to have a sufficient number of qualified team
members, including research assistants, to assure that you
are able to meet project deadlines. You cannot conduct a
quality research synthesis in 2 or 3 months. Each step of
the process is time-consuming, and you should never sacri-
fice quality for the sake of speed. Because synthesis
research is time-consuming, it often is desirable to update
your database search as you near completion of the project
to enhance the currency of the review.
Tip #9. Analyze, Then Synthesize
Analysis is examining each study with the goal to under-
stand specific results that address the research question,
as well as factors within each study that may have contrib-
uted to the results. Further analysis is then conducted to
compare results across studies. In comparing results
across studies, the team should consider: Are the results of
the studies fairly consistent? If not, can studies be grouped
together based on their differences? Do factors such as
setting, sample, measurement, or study quality help explain
inconsistencies?
Although you need to examine and understand the
results of individual studies, avoid simply describing each
study (e.g., “Study 1 reported this . . . Study 2 reported
this”). After analysis, synthesis is needed. Combine the
Research in Nursing & Health
results of the multiple studies into a coherent understand-
ing of the topic that answers the research question. Tables
and figures often are used to highlight the results of the
data synthesis.
Tip #10. Keep Calm, Carry on, and
Remember to Celebrate
The process of conducting a research synthesis can be
tedious and time-consuming. Thus, we encourage our
teams (and ourselves) to keep calm, carry on, and cele-
brate milestones (big and small) along the way. This keeps
us engaged and committed to the project over time. Plus, it
adds some fun to the process.
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Conflict of Interest
The authors declare no conflict of interest.
Research in Nursing & Health
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