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Received: 26 September 2016    Revised: 1 October 2018    Accepted: 13 October 2018

DOI: 10.1111/nin.12273

F E AT U R E

Is meta-­synthesis turning rich descriptions into thin reductions?

A criticism of meta-­aggregation as a form of qualitative
synthesis

Elisabeth Bergdahl

The Faculty of Nursing and Health

Sciences, Nord University, Bodø, Norway
Correspondence
Elisabeth Bergdah, The Faculty of Nursing
and Health Sciences, Nord University, Bodø,
Norway.
Emails: elisabeth.bergdahl@nord.no,
bergdahl_elisabeth@hotmail.com
Abstract
Meta-­synthesis of qualitative research can be an important way to consolidate and
grow nursing knowledge and theory. However, from recent readings of such works in
the nursing literature, one can observe that there is increasing use of meta-­synthesis
being used as a way to simply aggregate qualitative research findings in a manner
claimed to be similar to quantitative meta-­research while also remaining compatible
with the qualitative research tradition. The aim of this paper is to discuss whether
this meta-­aggregation form of research has a sound epistemological foundation and
should be considered a viable form of meta-­synthesis. The conclusion drawn is that
meta-­aggregation falls short of being a sound method and is not compatible with the
qualitative research philosophy. It is also concluded that meta-­aggregation should
not be seen as a form of qualitative meta-­synthesis. Meta-­synthesis is best under-
stood as a way to re-­interpret, compare and translate disparate qualitative studies
using different conceptual apparatus into a consolidated knowledge of fundamental
importance to nursing care practitioners. To conclude, aggregating qualitative re-
search tends to turn rich descriptions into thin abstractions that are of little use to
nursing practice knowledge and does not advance nursing science.

KEYWORDS
meta-synthesis, methodology, qualitative methods, systematic reviews and meta-analyses

1 |  I NTRO D U C TI O N
Synthesizing qualitative research through meta-­synthesis can be an
important way to consolidate and grow nursing knowledge and the-
ory. However, on the basis of recent readings of such works in the
nursing literature, there is a need for critically reviewing the increas-
ing use of something calling itself meta-­synthesis that is essentially
a way to ‘aggregate’ qualitative research reports (Britten, Garside,
Pope, Frost, & Cooper, 2017; Thorne, 2015, 2017) in order to pro-
duce ‘evidence’ for practice (Lockwood, Munn, & Porritt, 2015;
Pearson, Robertson-­
Malt, & Rittenmayer, 2011). Some authors
consider meta-aggregation as being different from meta-synthesis.
Meta-­aggregation is said to be closer to quantitative meta-­studies
while still being compatible with the nature of qualitative research
(Lockwood et al., 2015; Pearson et al., 2011).
In this paper, I argue that meta-­aggregation is a different ap-
proach that is in contrast to meta-­synthesis and should not be con-
sidered a form of meta-­synthesis. If that is correct, meta-­aggregation
cannot be justified as a proper scientific practice in terms of being
a form of meta-­synthesis. I will also discuss and challenge the claim
that the aggregative method is compatible with the epistemologi-
cal, philosophical and ethical foundation of the qualitative research
tradition. I will explain how meta-­
aggregation, as described by
Lockwood et al. (2015), Lockwood and Pearson (2013), and Pearson
et al. (2011), repeats the mistakes that led Noblit and Hare (1988) to
develop meta-­ethnography in the first instance.

Nursing Inquiry. 2019;26:e12273. wileyonlinelibrary.com/journal/nin © 2019 John Wiley & Sons Ltd  |  1 of 8
https://doi.org/10.1111/nin.12273
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2 |  BAC KG RO U N D
Meta-­s ynthesis originated as a method to re-­interpret different
qualitative research publications into a coherent whole and poten-
tially produce novel and useful theory (Paterson, Thorne, Canam,
& Jillings, 2001). Meta-­s ynthesis, as described by Paterson et al.
(2001) and Sandelowski and Barroso (2007), was inspired and
adapted from meta-­ethnography. Noblit and Hare (1988) devel-
oped meta-­ethnography after their failed attempt at aggregat-
ing qualitative research. Noblit and Hare conclude: ‘As is now
apparent, research synthesis, especially ethnographic synthesis,
must be more sophisticated than we imagined. By not having an
explicit theory of social explanation to undergird the synthesis,
we inappropriately relied on an aggregate theory’ (1988, p. 24).
Sandelowski and Barroso (2007) and Paterson et al. (2001) can
be said to have adopted meta-­ethnography into meta-­s ynthesis
as used in nursing. Sandelowski and Barroso defined qualitative
meta-­
s ynthesis as: ‘…an interpretive integration of qualitative
findings that are themselves interpretive syntheses of data, in-
cluding the phenomenologies, ethnographies, grounded theories,
and other coherent descriptions or explanations of phenomena,
events, or cases that are the hallmark findings of qualitative re-
search’ (2007, p. 18). Thus, synthesis is usually regarded as the
last phase in a meta-­s tudy where one tries to fill in the blanks and
construct a ‘…new, integrated, and more complete interpretation
of findings that offers greater understanding in depth and breadth
than the findings from individual studies’ (Bondas & Hall, 2007, p.
115).
There has also been some debate about the use of the term me-
ta-synthesis. For example, rather basic literature reviews are some-
times labelled as meta-­synthesis products even though they actually
do not offer a synthesis, which is viewed as a problem (cf. Thorne,
2015).
The tendency to oversimplify meta-­s ynthesis is not new. In
a review of meta-­s ynthesis research, Bondas and Hall (2007) re-
ported some concerns over how meta-­synthesis has been exe-
cuted. Among the most critical problems were a lack of analysis
and theorization, as well as a tendency towards unsupported over-­
theorization, where the results rely more on a theoretical perspec-
tive, brought in by the authors of the synthesis, than the actual
underlying research they were supposed to synthesize. There was
also a tendency to base the conclusion only on what appeared
in the findings section of the original study reports, as well as a
general lack of discussion or explanation as to how the findings
were synthesized. Bondas and Hall argued that: ‘… meta-­s ynthesis
studies run the risk of becoming a superficial trend without en-
gaging in the ontological and epistemological questions; they run
the risk of remaining a secondary round of descriptive studies’ and
concluded that, although meta-­s ynthesis ‘…creates the possibility
of articulating theories that account for contradictions and com-
plexities within the field’, that possibility seldom becomes realized
(2007, p. 111).
Another criticism is that many of the synthesis products that have
been published lack a theoretical perspective and, consequently, the
purpose of performing a meta-­synthesis—knowledge development—
will not have been achieved (cf. Bondas & Hall, 2007). In a review of
studies published as meta-­synthesis, France, Ring, Noyes, Maxwell,
and Jepson (2014) conclude that 38% of the published reviews fail to
create any new interpretation of primary studies. They further report
that 13% of the studies did not have an approach that suits the research
aim. Part of the critique is that not all authors try to achieve a synthesis
in spite calling their attempts meta-­synthesis and citing source litera-
ture on meta-­synthesis and meta-­ethnography (Thorne, 2017).
There has also been criticism of the actual approach implied by
meta-­synthesis; it is seen as a complicated process that lacks pre-
cise steps and therefore is difficult to repeat (Pearson et al., 2011).
Instead, these authors argue for another method of meta-­research,
one strongly inspired by quantitative meta-­research and system-
atic reviews, called meta-­aggregation. Lockwood et al. (2015) and
Lockwood and Pearson (2013) advocate not synthesizing but instead
performing an aggregation of qualitative research in a manner in-
spired by quantitative systematic reviews. These authors like to clas-
sify meta-­aggregation as a kind of meta-­synthesis. Other authors,
such as Thorne (2017), question if the aggregative approaches, as
described by Pearson et al. (2011), Pearson, Wiechula, Court, and
Lockwood (2005), Lockwood and Pearson (2013) and Lockwood
et al. (2015), can be regarded as a form of meta-­synthesis. The ag-
gregative version of meta-­research is said to have been developed
to mimic quantitative research, while being compatible with quali-
tative research tradition (Lockwood et al., 2015). I regard the sim-
plified studies that are labelled as meta-­synthesis as problematic.
However, in this paper, I focus on questioning if meta-­aggregation
has a place as a method in the qualitative research tradition. The
reason for this focus is that over-­simplified meta-­synthesis seems
to stem from a misunderstanding or misuse of meta-­synthesis by in-
experienced researchers, while meta-­aggregation is proposed as an
alternative, different and more systematic approach to qualitative
meta-­research—a framing I find particularly problematic since aggre-
gation seems incompatible with the qualitative tradition.
3 | M E TA-­S Y NTH E S I S A N D M E TA-­
AG G R EG ATI O N : T WO D I FFE R E NT
A PPROAC H E S
The proponents of meta-­
aggregation point out that meta-­
aggregation is different from meta-­
synthesis. Meta-­
aggregation
searches for something called a ‘common meaning’ by ‘engaging
in inductive generalization to develop a knowledge of essences
through the performance of phenomenological reduction’ (Pearson
et al., 2011; Chapter 2, Aggregative review, para 4). Pearson et al.
(2011) also state that meta-­aggregation is an interpretive approach,
while meta-­synthesis is constructivist, which is described as a major
difference. A meta-­aggregation aims to find a common meaning and
BERGDAHL
express that generalization as an ‘indicatory statement’ which can
form recommendations to guide practitioners and policy-­makers
(Lockwood & Pearson, 2013; The Joanna Briggs Institute, 2014).
In contrast, meta-­ethnography avoids reduction and is compara-
tive rather than generalizing (Noblit & Hare, 1988), and while the
result of aggregation is a generalized statement, the result of a
meta-­
synthesis is a theoretical integration of the research find-
ings (Sandelowski & Barroso, 2007). This integration—synthesis—is
a way of creating a whole that is greater than the parts (Noblit &
Hare, 1988), exactly the opposite of reduction and finding a com-
mon meaning. Lockwood et al. (2015) argue along the same lines and
contrast their method with meta-­ethnography and the critical inter-
pretive approach of meta-­synthesis.
Pearson et al. (2011) further argue that the methods used for ag-
gregation and systematic review should ideally limit the researcher’s
creativity to ensure repeatable results. With meta-­synthesis, as with
all proper research, creativity is always required, as well as the abil-
ity to interpret data to observe both similarities and differences and
to create new theoretical representations that make the complexity
of social interaction understandable. As Paterson et al. (2001) state,
… prescriptions for practice, research or theory de-
velopment that are derived from meta-­study research
cannot be regarded as the only possible findings that
could be drawn from the body of available research,
but rather as those findings constructed by a specific
meta-­synthesis at a given point in accordance to their
own interpretative skills.  (p. 7)
In contrast, meta-­aggregation aims to generate evidence for practice
through a process of interpretation that assumes there will be one
common meaning that can be extracted from the included research.
Pearson et al. (2011) see aggregation as an interpretation of
meaning and consider the methods of meta-­synthesis as construc-
tivist rather than interpretive. However, this is a problematic po-
sition for several reasons. First, in some regard, all knowledge is
constructed, a view that virtually all 20th-­century philosophy of sci-
ence agrees on, including postmoderns Feyerabend (2010) and, from
the more analytical side, Quine (1992) and Popper (2002). Another
issue is the interpretation of ‘meaning’; what that actually means is
not clarified (cf. Paley, 2016). Instead, there are some vague refer-
ences to a similarity in meaning to create categories and to an influ-
ence from ‘transcendental phenomenology’ (Lockwood & Pearson,
2013; Lockwood et al., 2015).
4 | W H Y AG G R EG ATI O N C A N N OT WO R K :
FU RTH E R E PI S TE M O LO G I C A L D I S C U S S I O N
Lockwood and Pearson (2013) describe how Noblit and Hare’s meta-­
ethnography got its foundational insights from a failed study regard-
ing desegregation in American schools. According to Noblit and
Hare, the reason for the failure was reliance on aggregation. In spite
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of knowing that Noblit and Hare (1988) clearly describe why and
how aggregation cannot work when trying to integrate qualitative
research, Lockwood and Pearson (2013) do not mention Noblit and
Hare’s lengthy discussion around aggregation, nor that the ‘founda-
tional insight’ was that aggregation cannot work.
The mistake Noblit and Hare present first is the idea of try-
ing to ‘attain “general” conclusions’ (1988, pp. 22–23) or attempt-
ing to generalize. Nevertheless, Lockwood et al. (2015) mean that
the advantage of aggregation is that it enables something they call
‘generalizable statement’, Noblit and Hare also point out that their
attempt at aggregation failed, as it did not enable explanatory syn-
theses. In stark contrast, Munn, Lockwood, and Moola (2015) state
that the very fact that they do not attempt to synthesize or theo-
rize is an advantage with meta-­aggregation. Furthermore, they do
not explain why aggregation, generalization, disregarding synthesis,
de-­contextualizing and searching for the essence of meaning should
be a virtue and not a vice, in spite of Noblit and Hare’s explanation
of why aggregation cannot work. Neither is it explained how these
practices are compatible with and sensitive to qualitative tradition
beyond stating, without explanation, that it is inspired by early 20th-­
century pragmatism and interpretative phenomenology (Lockwood
et al., 2015). However, it is hard to see how any phenomenological
position would be compatible with a non-­constructivist position; as
Crotty puts it: ‘Constructionism and phenomenology are so inter-
twined that one could hardly be phenomenological while espousing
either an objectivist or a subjectivist epistemology’ (1998, p. 18).
When Noblit and Hare described attempts to aggregate rather than
interpret and reconstruct studies in the process of synthesis, they
concluded that the ‘…attempt ended up neither truly ethnographic
nor informative’ (1988, p. 20). They realized that the aggregating ap-
proach they tried to use did not and could not work. In some regard,
anyone suggesting an aggregating approach to qualitative meta-­
research ‘synthesis’ must deal with the problems of aggregation that
Noblit and Hare (1988) describe. In fact, many of the features men-
tioned by advocates of meta-­aggregations are factors that Noblit
and Hare see as mistakes they made, which led them to abandon
attempts to aggregate qualitative research and instead develop
meta-­ethnography.
One example of an aggregative meta-­study is the one by Bath‐
Hextall, Nalubega, and Evans (2017) regarding skin cancer, The
needs and experiences of patients with skin cancer: a qualitative sys-
tematic review with meta-synthesis. The study follows the Joanna
Briggs Institute (JBI) methodology for qualitative systematic review
(Pearson et al., 2011). The authors list 153 unequivocal or credible
findings sorted into 15 categories and aggregated into four ‘syn-
thesized findings’. The findings are ‘the time of diagnosis’, ‘the time
around treatment and immediately afterwards’, ‘the time after treat-
ment and the follow-­up period’ and ‘satisfaction with skin cancer
care and confidence in healthcare providers’. These four generaliza-
tions are, arguably, less informative than the abstracts from the 16
included studies, which is in line with the experiences of Noblit and
Hare regarding aggregation (1988). In other words, it is not an issue
that only concerns reporting the findings. The aggregation approach
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is the problem; to get results that could be regarded as descriptive
and construct thematic statements that can be of use in intervention
and implementation (c.f. Sandelowski & Leeman, 2012), one needs to
present differences between the included studies not only common-
alities. In addition, in contrast to a meta-­synthesis, the result does
not offer a ‘…greater understanding in depth and breadth than the
findings from individual studies’ (Bondas & Hall, 2007, p. 115).
The meta-­aggregation method also seems to pre-­suppose that
all data should fit into a tree-­like structure of similarity in meaning
(Pearson et al., 2011; The Joanna Briggs Institute, 2014). This form
of result is a construction, arguably, more so than in meta-­synthesis.
One needs to force all the interpretation of findings into two levels,
and the findings that do not fit into that framework will be left out.
Most importantly, there is no room for discussing contradictions and
exceptions, nor method and theory. The results run the risk of be-
coming meaningless abstractions that do not say anything profound
about how things work (cf. Bendalossi, 2013).
5 |  G E N E R A LIZ ATI O N A N D FI N D I N G
CO M M O N M E A N I N G , T U R N I N G R I C H
D E S C R I P TI O N I NTO TH I N R E D U C TI O N
Finding a common meaning among several underlying findings and
categories (Pearson et al., 2011; The Joanna Briggs Institute, 2014)
could be likened to generating findings using the highest common
denominator in mathematics: the more cases one adds, the fewer
common factors there are going to be. Thus, very few and common
abstract attributes are left, and any context-­dependent attribute or
property is sorted away. Interpretation towards common meaning
will naturally evolve from specific terms to less specific and more
general, less informative and abstract terms. This stands in contra-
diction to what is understood as good, post-­positivistic, scientific
practice, which sees a more specific theory as more scientific, or
better, than an abstract and non-­specific theory (Feyerabend, 2010;
Popper, 2002; Quine, 1992).
The process of generalization and finding a common meaning
becomes even more problematic, since much qualitative research
already has a categorization in which the findings may have two or
three layers of themes, subthemes, categories, and subcategories
between the findings and the collected data. Adding new layers
of abstraction pulls the aggregated result even further from its in-
tended context and the original data. Searching for a common mean-
ing also seems to run the risk of neglecting, crucial contradictory
findings in specific contexts.
Noblit and Hare (1988) also warn that ignoring meaning in con-
text was a significant reason why aggregation failed, while Pearson
et al. (2011) state that one should focus on cross-­study generaliza-
tion and essence of meaning that is general for all included stud-
ies. Noblit and Hare also explain that it was a significant mistake
to focus on commonalities, while Pearson et al. (2011) state that
meta-­aggregation focuses on common meaning and generalization
to a common meaning. Leading voices in the interpretivist qualitative
research tradition are explicitly against generalization; for example,
Denzin (1983) argues that ‘the interpretivist rejects generalization
as a goal’ (p. 133).
In other words, many of the mistakes and warnings that Noblit
and Hare (1988) describe as the reasons that aggregation will not
and cannot work are brought forward as advantages by the propo-
nents of meta-­aggregation. In that way, the core focus on common
meaning in meta-­aggregation is a serious weakness in the approach
described by Lockwood et al. (2015), Lockwood and Pearson (2013),
Pearson et al. (2011) and in the JBI manual (The Joanna Briggs
Institute (2014). The manual states that a category should arise from
findings that ‘…convey the whole, inclusive meaning of a group of
similar findings’. Nowhere is it explained what is meant by ‘the whole
inclusive meaning’ or indeed what a ‘meaning’ is supposed to be, yet
it is a core property of the method to find common meaning.
Lockwood and Pearson (2013) even see quantitative meta-­
research as positivistic and suggest positivism as an ideal of how
qualitative meta-­research should be done; in so doing they disre-
gard that qualitative science is incompatible with positivism, since
constructivist and interpretive methods reject the notion of an ob-
jective truth that can be found, and verified, by empirical methods
(Crotty, 1998). Lockwood and Pearson (2013) also believe that there
is objective meaning to be discovered but, as Crotty (1998) points
out, most social and qualitative research tends to invoke a construc-
tivist epistemology that rejects the notion that any objective, mind-­
independent meaning exists. In this search for common objective
meaning, critical thinking and hypothetical reasoning are not part of
the meta-­aggregation method, as critical thinking is dependent on
the creation of a hypothesis of interpretation and on comparative
analysis (cf. Föllesdal, 1994). The problem seems to be the same as in
so-­called phenomenological methods aiming to find meaning, where
meaning is not in the data but rather is something the analyst brings
to the data. Paley (2016) puts the issue this way:
Consequently, there cannot be any criteria for dis-
tilling the meaning of a phenomenon from the data,
as if the data already contained it. Meaning only ar-
rives when a theory is applied to the phenomenon
concerned, and an inference is made on that basis.
 (p. 116)
The impossibility of meaning attribution without theory also ex-
plains why Noblit and Hare (1988) aggregation did not work; without
a theoretical starting point and comparing the included studies’ the-
oretical and contextual likeness and differences, a scientific result is
not possible.
6 | TR A N S L ATI N G B E T W E E N CO NTE X T S
O R LO O K I N G FO R S I M I L A R ITI E S
Another example of meta-­aggregation that shows the problem of
search for common meaning is found in a paper by Lamb, Buchanan,
BERGDAHL
Godfrey, Harrison, and Oakley (2008). These authors used meta-­
aggregation to ‘…appraise and synthesize best available evidence
on the psychosocial spiritual experience of elderly individuals re-
covering from stroke’ (p. 432). This particular meta-­aggregation has
been used by Pearson et al. (2011) as an example of the strength
of meta-­aggregation. Lamb et al. present four synthesized findings:
‘Connectedness’, ‘Re-­
constructing life’, ‘Life-­
altering event’ and
‘Sudden unexpended event’. One could say that this aggregation
moves knowledge backward, from specific and actionable knowl-
edge to broad generalization. The included studies are often spe-
cific, trying to understand aspects of the phenomena and if and how
those phenomena are different in particular settings or for a specific
group of patients. The aggregation reverses that and returns to the
starting point—that a stroke is sudden and life-­altering and that re-
habilitation is needed. However, we perform research to determine
something more—how a stroke is life-­changing, how can we help
specific groups, what is the cause of certain reactions in specific con-
texts, and so on. In this particular case, several of the included stud-
ies focus on women’s experiences of recovering from a stroke, and
Kvigne, Kirkevold, and Gjengedal (2004) find that this is rooted in
their identity as mothers, wives and grandmothers, and suggest that
care is needed to take that into account. Lui and Mackenzie (1999)
look at the situation of Chinese patients and find that they take a
passive role in expressing their needs. Almost all the included studies
have some context or patient group-­specific findings which get gen-
eralized away in the meta-­aggregation. There are definite parallels
to the tendencies that Noblit and Hare (1988) warned against, such
that the results have become trite and atheoretical.
Another reason aggregation and search for meaning cannot work
together is related to facts about language, that the same term is
used differently in different contexts or different studies. In the case
of Noblit and Hare (1988), different uses of the term ‘desegregation’
in different contexts led to a failure to produce a usable aggregation.
Specifically, Noblit and Hare pointed to the importance of context in
creating an understanding of the phenomenon as well as the impor-
tance of a comparative approach to avoid the non-­sensical results of
aggregation. They also referred to the value of explicitly focusing on
different meanings of key concepts used in original research, which
makes aggregation of findings impossible, since different reports will
inevitably have used the term with different meanings. Noblit and
Hare handled this by pointing out that terms in language are met-
aphors and to understand the included studies one must translate
terms and metaphors among the included studies. Even if they all
use the same language, for example, English, there will be context-­
dependent variations in their use of language. Aggregation neglects
these facts about language and ignores the need for translation and
re-­conceptualization. Noblit and Hare summarize their experiences:
The aggregation approach to ethnographic synthe-
sis that we employed in the desegregation ethnog-
raphies was not merely context-­stripping. It actually
impeded explanation and thus negated a true inter-
pretive synthesis. The aggregation across-­
context
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procedure only defined and set puzzles. Further, the
focus on commonalities probably resulted in inade-
quate definitions of the puzzles themselves. Better
puzzle definition would have allowed context as part
of the explanation. It would have required an explana-
tion that ‘translates’ the practices and conditions of
one school into practices and conditions of the other
schools.  (1988, p. 23)
Meta-­aggregation can be likened to how some critics caricature
the quantitative method, but proponents of meta-­
aggregation see
these characteristics as advantages of the method. There is a tendency
to regard research as ‘valid’, ‘credible’ or even as ‘evidence’ if one can
show how a particular inductive process or method is followed, and
often that method is also supposed to make the research more ob-
jective. This view is also adopted, for example, by some advocates of
concept analysis (cf. Bergdahl & Berterö, 2016). Philosophers of sci-
ence such as Popper (2002), Feyerabend (2010) and Quine (1992) have
demonstrated how induction cannot be seen as a way to guarantee the
validity of scientific theory or results from a study. A researcher must
also take a critical stance towards the methods used. The researchers
must explain how the method can contribute to knowledge develop-
ment. Again, Noblit offers advice: ‘Everyone speaks from somewhere
and the reader deserves to know enough about the author to be able
to take their position into account. Hiding behind method or objectiv-
ity disables readers’ (2016, p, 13).
The inductive and generalizing view of science behind meta-­
aggregation also disregards models and theories that provide
contextual explanations and describe the relationship between
phenomena. Furthermore, some proponents of meta-­aggregation
(cf. Pearson et al., 2011) are not interested in contributing to the-
ory; they even state that this atheoretical stance is an advantage.
In some regard, this could be interpreted as their disinterest in con-
tributing to science. In meta-­synthesis, it is the synthesizing process
that enables the meta-­researchers to clarify which types of phe-
nomena exist and the causal relationships and intentional reasons
behind different phenomena (Sandelowski & Barroso, 2007). In that
way, meta-­synthesis aims to create theory and thereby contribute
to scientific knowledge. However, theory is key to all interpretation,
and by ignoring theory one strips away important context to instead
seek ‘findings’ that appear similar and use the same terms. However,
without taking the original researchers’ explicit or implicit theoret-
ical orientation into account, it is impossible to know what the dif-
ferent terms ‘mean’ in the original context. Since statements cannot
be true or false outside the context of a theory (cf. Popper, 2002;
Quine, 1992), aggregation of disjointed ‘results’ cannot constitute
scientific evidence, since there is no theoretical framework from
which one can test or even interpret individual statements.
Synthesis, on the other hand, is in line with modern views of sci-
ence; for example, Feyerabend (2010) encourages us to compare the-
ories in a manner similar to what is discussed by, for instance, Noblit
and Hare (1988). Feyerabend warns against a consensus culture and
strict adherence to standard methods. To Feyerabend, scientific
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6 of 8       BERGDAHL
objectivity is dependent on conflicting points of view or theories. In
other words, trying to find common threads is destructive when try-
ing to understand complex phenomena. In some regards, this boils
down to fundamental views of science, and the aggregating view is
in many ways an example of a view of science that in many respects
ignores the whole 20th-­century debate in philosophy of science.
7 |  I S M E TA-­A G G R EG ATI O N A P OS S I B LE
E TH I C A L D I LE M M A?
The hallmark of all scientific endeavour is a cyclical process of trial
and error; in qualitative research, it is exemplified by putting forward
creative interpretations and critically questioning and evaluating
these interpretations. After several iterations, the researcher may
arrive at an explanation that can be considered the best one pos-
sible in the current context. Popper used the word hypothesis rather
than interpretation but described the same process. Trial and error
are also described by Yin (2009) in case study research, by Miles and
Huberman (1994) and Krippendorff (2004) in the analysis of qualita-
tive data, by Föllesdal (1994) in the hermeneutic method, and the
same is apparent in action research and action science (Argyris &
Schön, 1978). If critical thinking and critical analysis or a test of an
idea, interpretation, hypothesis or theory are absent, I would argue
that this is not a scientific process and not a creation of scientific
knowledge or evidence.
Laging, Ford, Bauer, and Nay (2015) have used the JBI method
in what they call a ‘meta-­synthesis’, while they clearly follow the JBI
method of meta-­aggregation in their study of the factors influencing
nursing-­home staff decisions to transfer residents to hospital. They
claim to have found 19 categories and five ‘synthesized findings’ that
all concern deficiencies in nursing homes that might contribute to
the transfer of residents to hospital. Next, they turn the deficiencies
into practice recommendations by simply negating their findings.
‘Lack of consensus about nursing homes’ roles’ is to be solved by
clarifying the nursing homes’ roles; to handle ‘limited access to skill
and resources’, the solution is to somehow create greater access to
skill and resources, and so on. However, there is absolutely no ev-
identiary basis upon which one could conclude from the synthesis
process that such ‘solutions’ are possible, desirable or would result
in a decrease in unnecessary transitions to hospitals from nursing
homes. If such a conclusion had been written as a conjecture and
perhaps also argued for in some manner, the conclusion might have
been amenable to evaluation. Simply because a study follows a de-
scribed methodology does not, of course, mean that all findings in
that study are valid. Further, as Bondas and Hall (2007) have pointed
out, a lack of critical analysis of the findings in any of the original
reports may be amplified in meta-­synthesis reviews, particularly of
the aggregative variety.
It is important to remember that leading researchers and think-
ers in philosophy of science, as well as important voices in the de-
velopment of the qualitative method, hold critical thinking as the
main characteristic of science. We can see this in Popper’s (2002)
dedication to trial and error as necessary to an open society, in
Dewey’s (1980) emphasis on democratic processes, and in Denzin’s
(2010) and Noblit’s (2016) focus on criticism of power and working
towards equality and empowerment of weak groups. We can see
that it is not only qualitative thinkers that encourage us towards crit-
ical thinking, but also all strands of modern philosophy of science.
To some extent, the core of scientific thought is critical thinking,
not adherence to methodological frameworks, paradigms or con-
ceptual models (cf. Feyerabend, 2010). One must also keep in mind
that many of the qualitative traditions were created in opposition to
quantitative research traditions and to answer utterly different re-
search questions (cf. Sandelowski & Barroso, 2007). From that point
of view, it is something of a contradiction to ‘mirror’ quantitative re-
view techniques while claiming to hold to the traditions of qualita-
tive research. Furthermore, within social science (Elster, 2015) and
in nursing (Sandelowski & Barroso, 2007), there is also a relevant
critique of the very core foundations of quantitative science and the
use of statistical methods (cf. Hueter, 2016).
For practitioners or decision-­makers to act on, or encourage ac-
tion upon, recommendations that are not supported by a scientific
process characterized by critical thinking is, in my view, unethical
with regard to patient safety and ethics in science. Simply because
something is mentioned often does not mean that it is true or should
be regarded as knowledge or evidence. We must be very careful
with what we publish—and expect others to regard—as science or
evidence. I would argue that we need to establish some demarca-
tion criteria for what we regard as scientific results, and base these
criteria on the value or novelty of the achieved results not on how
well a predefined method is followed. In other words, we must
take the epistemological discussion very seriously and realize that
scientific methods cannot simply be reduced to steps. A tentative
idea would be to only see tested theory as evidence for practice,
which would be in line with both Popper’s deductive approach as
well as Feyerabend’s (2010) counter-­induction. In such a view, meta-­
synthesis would be a possible way to use existing research as a start-
ing point for theory development. The scientific method of trial and
error is the way to produce evidence for practice. Only the scientific
community has the standards and processes needed to ensure that
unethical or unscientific methods are not used. The lesson might be
that we need to raise the bar for the scientific publication of studies
and to rethink how we structure reports on qualitative studies. In my
opinion, we need to have a sound epistemological discussion, espe-
cially within the qualitative nursing research community. We need to
debate the core characteristics that determine whether we can call
a result scientific and whether that study has created knowledge or
merely provided an arbitrary classification.
8 | CO N C LU S I O N
Several studies that use the label ‘meta-­synthesis’ do not perform any
synthesis, and a systematic review without a synthesis should not
be called as such. Qualitative meta-­synthesis and meta-­aggregation
BERGDAHL
have very little in common and have a very different focus, as the
way they are presented is different and the results produced are dif-
ferent. In short, I argue that meta-­aggregation is so different from
qualitative meta-­synthesis and meta-­ethnography that it should be
regarded as an entirely separate approach, not as a legitimate type
of qualitative meta-­synthesis.
Meta-­
aggregation deviates from the trial and error meth-
ods needed to interpret phenomena to create a theory capable
of explaining the complex reality of nursing care. In fact, meta-­
aggregation as described by Pearson et al. (2011) and Lockwood
et al. (2015) has no intention of contributing to or creating theory. As
I see it, theory is the aim of science, and there can be no science or
scientific knowledge or evidence without theory. We must therefore
stop trying to find simplistic methods for ‘revealing truth’ or finding
‘essential meaning’. The subject of the use of theory and what should
be regarded as theory requires further investigation, especially with
regard to how theory and science relate to the concept of evidence.
Meta-­synthesis could serve to re-­interpret, compare and trans-
late different qualitative studies, using a different conceptual appa-
ratus, into a consolidated knowledge of fundamental importance to
nursing care practitioners. However, to achieve this end, we must
acknowledge that science is always complex, studies are unique and
context-­bound and that researchers need to use skill and creativity
to create theories and explanations that are relevant to nursing prac-
tice. Rendering the best of our qualitatively derived complexity into
the most simplistic aggregative conceptual forms will never serve
that purpose. Where researchers aggregating qualitative findings
turn rich descriptions into thin abstractions and generalizations de-
void of meaning, they have engaged in an activity that is of little
use to nursing practice knowledge and does not advance nursing
science.
ORCID
Elisabeth Bergdah  http://orcid.org/0000-0003-4917-7766
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How to cite this article: Bergdah E. Is meta-­synthesis turning
rich descriptions into thin reductions? A criticism of meta-­
aggregation as a form of qualitative synthesis. Nurs Inq.
2019;26:e12273. https://doi.org/10.1111/nin.12273