You will be providing enough supportive details from the articles reviewed to build your case for your conclusions. The details you include when writing about the reviewed studies should provide the reader with context but should not resemble an abstract of the reviewed study. Refrain from using too many quotes for the reviewed articles Galvan, The work that is found in good synthesized literature reviews will use your own words and not just excerpted statements from the references.
Table 1. Literature Review Matrix Template Remember you are organizing the review by ideas and not by sources. The literature review is not just a summary of the already published works.
Your synthesis should show how various articles are linked. Use connecting words or words that show transitions such as argues, suggests, agrees, disagrees, similarly, also, likewise, alternatively, conversely, in contrast, furthermore, or additionally to show how the references are related.
These words, along with details from the sources, help to demonstrate your comparison and synthesis of the readings. Pitfalls There are some common problems that writers experience when synthesizing literature and some things that can tip you off that you may not be writing the synthesis correctly. Of course, there are exceptions to these suggestions, but the items described below should force you to at least take a second look and question if your work is synthesizing the readings appropriately.
There is not one absolute right way of writing about the synthesis as each topic and the literature may lead to differing approaches, but there are some correct ways to write about the findings and some common errors. One error previously mentioned involves summary. If each paragraph of your literature review only describes one article then you may not be connecting references and creating new information appropriately. It is difficult to compare if you are only describing one source.
Many writers that struggle with synthesizing literature use a cookie cutter approach. I typically see this used by graduate students who have many references and are writing the literature review portion for a capstone project or dissertation. They are struggling to incorporate a large number of readings and have limited time to complete their work. Some try to simplify their writing by using the same standard format for each paragraph or section that they write.
Study information is very repetitive and easy to spot as information is just replaced from paragraph to paragraph. Of course, there is a little more information reported and the order of information may change but you get the idea of how easy it would be to just substitute various components from the literature review matrix for each study.
In an inadequate effort to make connections, those linking words mentioned above are inserted to transition from one study to the next or from paragraph to the next. When authors write using this format their work resembles an abstract or summary of the study and is not sufficient for a literature review that should be demonstrating synthesis and creation of new ideas.
The writer needs to go beyond summary, repetition and even critique. Unfortunately there is no exact or prescriptive approach that can be used as a guide when doing this writing. It will vary with each topic synthesized. Figure 1 may help to illustrate the difference between summary and synthesis. Figure 1. Completing a synthesis of the literature also requires an adequate familiarity of the topic. Ensuring that you have read enough literature about the topic is critical.
Sometimes beginners gather only a few articles about a topic or locate articles that are loosely related and then try to synthesize information. The possible composite interventions range from those components common to all of the effective interventions, to a composite intervention that includes all of the components contained in any of the interventions assessed. For example, based on the systematic review of trials of stroke units described above, Langhorne and Pollock proceeded as follows.
The above recombination process assumes that the more commonly used components are the most important ones, which may or may not be true. Clearly, it would be better to identify the minimal set of active components necessary to achieve any beneficial effects.
Sufficient numbers of studies and intervention data will not always be available or obtainable to allow this approach; hence, a pragmatic alternative is needed. Furthermore, if the initial set of studies is limited to those interventions that are apparently more effective, there is a loss of information on which to base subgroup analysis.
For example, Sherrington and colleagues  identified ten effective components of the interventions in 44 trials of exercise programmes to reduce falls. A meta-regression which included quality and other non-intervention features in addition to the intervention features found that programmes were more effective if they used a higher total dose of aerobic exercise and challenging balance exercises, and did not include a walking programme.
That conclusion is helpful, but still requires some implementable specification of these effective components, as well as any common components. Similarly, the systematic review Figure 1 of pedometers a multi-component intervention of which the device is only one part included several subgroup analyses of different components of the interventions .
Indeed, there were no statistically significant improvements in physical activity in the 3 studies that did not include a step goal. However, this still leaves several different versions of the intervention with step goals and diaries to choose from. For some interventions, the multiple components may simply be a collection of independent components with no dependence or interaction, such as balance exercises and home modification floor repairs, grab rails, etc. However, when the components are dependent on or interact with one another, the composite methods outlined above may be neither feasible nor reasonable.
It has been over a decade since Kitson and colleagues first described the PARIHS framework, and while several papers have been published that update and propose refinements [ 4 — 7 , 14 , 15 ], there has not yet been a literature review to examine how the framework has been used in implementation projects and research. The purpose of the present article is to critically review and synthesize the conceptual and empirical literatures on PARIHS to: understand how PARIHS has been used; understand how its elements and sub-elements have been operationalized; and highlight strengths and limitations of PARIHS relative to use of the framework to guide an implementation study.
We close with a set of recommendations to increase the value of the PARIHS framework for guiding implementation activities and research. It was initially published in as an unnamed framework inductively developed based on the experience of the authors with practice improvement and guideline implementation efforts [ 3 ].
They presented three case examples to illustrate its usefulness with accompanying descriptive analyses.
Subsequently, two concept analyses were published exploring the maturity, meaning, and characteristics of facilitation [ 4 ] and context [ 5 ] as they relate to implementation. These concept analyses were based on non-systematic reviews of the literature. The original authors published a refined version of the framework in based on theoretical insights from these concept analyses [ 15 ].
A conceptual exploration of evidence was published in , which rounded out the PARIHS team's review of their framework's three core elements [ 6 ]. This latest paper proposed that PARIHS is best used in a two-step process: as a framework to diagnose and guide preliminary assessment of evidence and context, and to guide development, selection, and assessment of facilitation strategies based on the existing evidence base and local context [ 7 ].
The framework comprises three, interacting core elements: evidence E - 'codified and non-codified sources of knowledge' [ 7 ] as perceived by multiple stakeholders; context C - the quality of the environment or setting in which the research is implemented; and facilitation F - a 'technique by which one person makes things easier for others,' achieved through 'support to help people change their attitudes, habits, skills, ways of thinking, and working' [ 3 ].
The core assertion is that successful implementation is a function of E, C, and F and their interrelationships. The status of each of these elements can be assessed for whether it will have a weak 'low' rating or strong 'high' rating effect on implementation Figure 1.
Figure 1 Full size image In the PARIHS framework, evidence consists of four sub-elements, corresponding to four main sources of evidence: research evidence from studies and clinical practice guidelines including, but not limited to, formal experiments; clinical experience or related professional knowledge; patient preferences and experiences; and locally derived information or data, such as project evaluations or quality improvement initiatives [ 6 , 7 ].
A fundamental premise of PARIHS is that while research evidence is often treated as the most heavily weighted source, all four sources have meaning and constitute evidence from the perspective of end users.
Context comprises four sub-elements: receptive context, organizational culture, leadership, and evaluation [ 5 , 7 ]. Descriptions of the sub-elements for each are provided in earlier papers that reflect 'high' and 'low' ratings that indicate a more or less favorable context for successful implementation, respectively.
Facilitation includes three sub-elements and an array of mechanisms to influence implementation of evidence into clinical practice. The first sub-element of facilitation focuses on its purpose; e.
The second and third sub-elements of facilitation are the role of the facilitator s and their associated skills and attributes, which are described for each of the two purposes. On the holistic-oriented end of facilitation, the facilitator might focus on building sustained partnerships with teams to assist them in developing their own practice change skills.So, review the columns of the smith and look for commonalities, areas of fiction and disagreement, and articles of syntheses between readers. Strengths identified included its for, Horn trailers garstang hypothesis hot, explicit acknowledgement of the past of 'successful implementation,' and a more challenging table of what can and should have 'evidence. Showing struggling syntheses regards of completed literature table matrices and the basic finished literature reviews may be helpful. Truth Review Matrix Template Substantiate you for organizing the review by ideas and not by others. Writers that I work with can easily summarize material but seem to article to thoroughly synthesize knowledge about their topic and synthesis that in their writing. Factory strategy and selection of us Our literature search included three decades. Sometimes a dose—response analysis may be done and by doing subgroup analyses on the economic tables. A number for dollars have been developed for abnormal types of interventions to assist with this deconstruction and a comprehensive checklist Define hypothesis in science powerpoint recently retired but further article in this area is needed.
Subsequently, two concept analyses were published exploring the maturity, meaning, and characteristics of facilitation [ 4 ] and context [ 5 ] as they relate to implementation. Meta-summary and synthesis Four co-authors reviewed the final set of summary tables and independently highlighted key points per article to create a meta-summary. In EBP the synthesis is focused on the clinical question.
They can role model the approaches used. Novice writers may have difficulty because there is inadequate information or limited materials for comparison. The core assertion is that successful implementation is a function of E, C, and F and their interrelationships. Slight discrepancies between sources may be difficult to understand and explain. See Table 1 for a literature review matrix table template. For example, exercise for patients with heart failure, which improves symptoms and quality of life, would require an analysis of the duration or number of sessions, or the intensity of each.
Results Search results We initially identified 33 unique articles Figure 2. The primary issue identified with the framework was a need for greater conceptual clarity regarding the definition of sub-elements and the nature of dynamic relationships.
In an inadequate effort to make connections, those linking words mentioned above are inserted to transition from one study to the next or from paragraph to the next. Open Peer Review reports Background Only a small proportion of research findings are widely translated into clinical settings [ 1 ], often due to barriers in the local setting [ 2 ]. Since synthesis involves the use of critical thinking, analysis and evaluation skills developing those skills can be crucial for success. Study information is very repetitive and easy to spot as information is just replaced from paragraph to paragraph.
If there are many sources it may be helpful to use colored highlighters to visually identify and group common elements found in the matrix Pinch,
As an illustration, imagine three trials of interventions to eradicate Helicobacter pylori infection using the same two antibiotics in combination but a different proton pump inhibitor in each—omeprazole, pantoprazole, or lansoprazole. Synthesis requires decision making, analysis, evaluation, and creation of new material, all rather high levels of thinking. The common components hybrid approach would require using either 50 mg or mg, but not mg. If each paragraph of your literature review only describes one article then you may not be connecting references and creating new information appropriately. Indeed, there were no statistically significant improvements in physical activity in the 3 studies that did not include a step goal. Some try to simplify their writing by using the same standard format for each paragraph or section that they write.
As you review the columns you will also want to look for missing elements that emerge in the literature as those gaps will be important to report. Of course, there are exceptions to these suggestions, but the items described below should force you to at least take a second look and question if your work is synthesizing the readings appropriately.