Review Qualitative synthesis: A guide to conducting a meta-ethnography Mairead Cahill 1 , Katie Robinson 2 , Judith Pettigrew 3 , Rose Galvin 4 and Mandy Stanley 5 Abstract Introduction: Qualitative meta-synthesis draws together data from multiple studies and can enrich understandings of client experiences and inform health policy. Meta-ethnography is the most commonly utilised qualitative synthesis approach in health- care; however, there is variation in the conduct and quality of many published meta-ethnographies. This paper aims to guide occupational therapists on the process of completing a meta-ethnography. Method: A systematic search of articles published from 1986–2016 was conducted. Studies which described an evaluation or critique of meta-ethnography as a research method, and consequently provided reflections or guidance on the method, were included. Two authors independently screened papers and nine relevant papers and one key text were identified. Two authors independently extracted data from identified sources. Results: The seven stages of meta-ethnography described by Noblit and Hare (1988) are presented and integrated with key advancements from subsequent publications. Stages include starting the meta-synthesis, consideration of relevant studies, reading the studies and deciding on how they should be put together, translating the studies into one another, synthesising translations and expressing the synthesis. Conclusion: Given the proliferation of qualitative methods in occupational therapy research, rigorous use of meta-ethnography has great potential to contribute to the research evidence base. Keywords Meta-ethnography, meta-synthesis, research methods, reporting, qualitative synthesis, qualitative health research Received: 13 July 2017; accepted: 6 November 2017 Introduction Qualitative research methods have been identified as con- gruent with the philosophy of occupational therapy (Hammell, 2001) and there has been growth in the use of research situated within the qualitative paradigm in the discipline (Stanley and Nayar, 2015). Drawing together the findings of multiple primary studies is becoming increasingly common and is considered an important source of evidence for healthcare and policy (Classen and Alvarez, 2015). A range of approaches to synthesising qualitative research have been described, including meta- narrative, critical interpretative synthesis, meta-study, meta-ethnography, grounded theory, thematic synthesis, textual narrative synthesis and framework synthesis, and ecological triangulation (Barnett-Page and Thomas, 2009). The existence of various approaches makes it confusing for the novice researcher when deciding how to operation- alise different meta-synthesis approaches (Tricco et al., 2016), and few comprehensive descriptions are available to guide researchers in the pragmatics of the synthesis process with the aim of producing a rigorous, clear report (Tong et al., 2012). In this paper we describe the processes involved in conducting a meta-ethnography, the most commonly used qualitative synthesis approach. We systematically searched for recent publications on the development of meta-ethnography, to inform and guide both novice and experienced occupational therapists and researchers in the use of this evolving approach. Meta-ethnography was one of the first synthesis meth- ods developed, and since its inception in the late 1980s it has become increasingly popular and influential in health- care research (Tong et al., 2012). Meta-ethnography is 1 PhD student, Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Republic of Ireland 2 Senior Lecturer, Department of Clinical Therapies, Faculty of Education and Health Sciences, Health Research Institute, University of Limerick, Republic of Ireland 3 Senior Lecturer, Department of Clinical Therapies, Faculty of Education and Health Sciences, University of Limerick, Republic of Ireland 4 Lecturer, Department of Clinical Therapies, Faculty of Education and Health, Health Research Institute, University of Limerick, Ireland 5 Senior Lecturer, School of Health Sciences, University of South Australia, Adelaide, Australia Corresponding author: Mairead Cahill, PhD student, Practice Education Co-ordinator (job-share), Discipline of Occupational Therapy, Department of Clinical Therapies, University of Limerick, Limerick, Republic of Ireland. Email: mairead.cahill@ul.ie British Journal of Occupational Therapy 1–9 ! The Author(s) 2018 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0308022617745016 http://journals.sagepub.com/home/bjot