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Evidence synthesis methodology for questions relating to barriers and enablers in health care: a scoping review protocol

Lizarondo, Lucylynn1; Stern, Cindy1; Puljak, Livia2; Zhu, Zheng3; Munn, Zachary1

Author Information
doi: 10.11124/JBIES-20-00177
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Evidence-based practice is the cornerstone of health care, requiring health care decisions to be informed by clinical expertise, consumer perspectives, and the best and most current research evidence.1,2 However, the use of rigorous research to inform clinical decision-making has been perceived by health care practitioners as both complex and challenging because research is not always presented in a manner that is easily digestible and the time required to access research is also often beyond what is available for busy clinicians.2,3 This has led to an increase in the demand for synthesized research evidence by health care practitioners.

Synthesized evidence products have become an important source of research information as they help practitioners cope with the growing volume of literature and its variable quality.4,5 Synthesized evidence has also been considered more robust and potentially more useful than findings from individual primary studies.4,5 With their growing popularity and the need to recognize the complexity of health care, various evidence synthesis and review methods have been developed to meet the demands of the different disciplines and domains within the field.6,7

The rise in evidence synthesis activity led to the emergence of various methodologies within and across disciplines.6,7 While such diversity in methods is required to cater to a wide range of questions that are important for clinicians, policy makers, and funders, researchers are also faced with a confusing collection of synthesis methods such as evidence maps, systematic reviews, scoping reviews, realist reviews, and umbrella reviews, to name a few.6,7 There is a lack of clarity across the range of currently available methods, which is further complicated by the varied terminology in use (e.g. knowledge synthesis, evidence review, systematic review).6-9

In recent years, a number of published papers have focused on developing a classification system or identifying typologies of evidence synthesis methods in an attempt to provide clarity and distinction between different types of methods. In 2009, Grant and Booth6 identified 14 review types and described the methodologies for searching, appraisal, synthesis, and analysis for each type. In 2016, Tricco et al.7 found 25 unique knowledge synthesis methods, half of which had guidance for the full evidence synthesis methods (i.e. searching, critical appraisal, and analysis/synthesis), with the remainder describing methods that could be used only for the analysis/synthesis. In 2018, Munn and colleagues8 proposed a typology specific for systematic reviews and provided key elements for formulating a question for each of the 10 systematic review types they identified. More recently, Sutton et al.9 identified 48 evidence review types that they categorized into seven families. All of these publications recognized the common inconsistencies or overlap between review types and the overall lack of guidance on how to select an evidence synthesis method.

The integration of rigorous research into health care practice is often hindered by specific barriers or facilitated by enablers within a specific health context or setting. For this reason, the number of primary studies focusing on identifying factors that support/facilitate (i.e. enablers) or impede (i.e. barriers) implementation of best practice has substantially increased to better understand the evidence–practice gap. This has led to the explosion of reviews focusing on barriers and enablers, and there appears to be no consensus on the evidence synthesis approach that should be applied, with the process for synthesizing results varying across existing reviews. For example, a systematic review examining the barriers and enablers to physical activity participation in patients with chronic obstructive pulmonary disease used a narrative synthesis approach.10 Another systematic review investigating barriers and enablers to guideline implementation strategies in obstetric care practice conducted a “best fit” framework synthesis of included studies.11 Other approaches to synthesis that are also commonly used include meta-synthesis21 and thematic analysis.12,13 Systematic reviews of barriers and enablers also tend to vary in terms of the type of primary studies they consider, with some reviews including qualitative studies only,20,21 whereas others included any type of research design (i.e. quantitative, qualitative, and mixed methods primary research).14 Other approaches to evidence synthesis, such as integrative reviews,15,16 realist synthesis,17 and scoping reviews,18,19 have also been used to determine barriers and enablers in health care.

Given the importance of understanding the barriers and enablers in facilitating the uptake of research into practice and the huge variability in synthesis methods, a more consistent approach to undertaking an evidence synthesis of primary studies investigating such factors in health care is warranted. To the authors’ knowledge, no literature has been published to provide guidance in this specific area of interest. A scoping review will be undertaken to map the range of methods and methodologies used in the synthesis of research around barriers and enablers in health care. This is intended to inform future developments in the methodology that can then improve the consistency in the process in which this type of evidence synthesis is undertaken. A search of PubMed and JBI Evidence Synthesis found no scoping reviews about evidence synthesis methodologies for questions relating to barriers and/or enablers.

Review objectives

  • i) Map the range of methods and methodologies used in the synthesis of research on barriers and/or enablers in health care.
  • ii) Propose recommendations for further research relevant to the methodology for evidence synthesis in this area.

Inclusion criteria


Evidence reviews on barriers and/or enablers (facilitators) that have included stakeholders at different levels of the health system including consumers of care, health practitioners, health organizations, policy makers, and the community will be considered in this scoping review.


The concepts of interest are the methodologies for conducting evidence reviews (e.g. systematic reviews, scoping reviews, integrative reviews) as well as the methods for conducting synthesis of data found during the review (e.g. narrative synthesis, thematic/content analysis, meta-synthesis). Additionally, this scoping review will examine the types of primary research included in the review, whether critical appraisal was performed and how, the methods used for analysis or synthesis and presentation of results, and any other relevant methods or processes involved in the conduct of barriers or enablers evidence reviews.


The context for this scoping review is broad and will include evidence synthesis of barriers and/or enablers related to health care, performed in any country, and conducted in any health care setting (e.g. community, hospital, health care centers).

Types of studies

This scoping review will consider evidence synthesis approaches that have included primary research studies and where all the following have been explicitly reported: research questions or objectives, a description of search methods (e.g. search strategy for a database) and inclusion/exclusion criteria, and information about data analysis or synthesis.

Evidence synthesis approaches can include, but will not be limited to, systematic reviews, integrative reviews, realist reviews, and scoping reviews. Literature reviews, which are often not explicit in their methods9 or lack an explicit intent to maximize the scope or analyze the data collected,6 will be excluded.


The proposed scoping review will be conducted in accordance with JBI methodology20 and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for scoping reviews (PRISMA-ScR).21

Search strategy

The search strategy will aim to find published studies, and a three-step strategy will be utilized. The search will be restricted to published reviews only. An initial limited search of PubMed and CINAHL has been undertaken to identify the initial set of search terms. This was followed by analysis of the text words contained in the title and abstract, and of the index terms used to describe each article. This informed the development of a search strategy, which will be tailored for each information source. A full search strategy for PubMed is detailed in Appendix I. Finally, the reference lists of the identified papers will be examined for additional relevant articles.

The databases that will be searched will include PubMed (NLM), Embase (Elsevier), CINAHL (EBSCOhost), PsycINFO (Ovid), Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, and EPPI-Centre Systematic Reviews.

Only studies published in the English language and those published from 2010 (to reflect current trends in knowledge synthesis) will be considered.

Study selection

Following the search, all identified reviews will be collated and uploaded into EndNote X8.2 (Clarivate Analytics, PA, USA), and duplicates removed. Titles and abstracts will then be screened by two authors independently against the inclusion criteria for the review. The full text of selected citations will be assessed in detail against the inclusion criteria by two independent reviewers. Reasons for exclusion of full-text studies that do not meet the inclusion criteria will be recorded and reported in the final scoping review. Any disagreements that arise between the reviewers at each stage of the study selection process will be resolved through discussion or with a third reviewer. The results of the search will be reported in full in the final report and presented in a PRISMA-ScR flow diagram.

Data extraction

Data will be extracted from included studies using a data extraction table that will be developed by the authors; a draft extraction table is attached in Appendix II.22 Data extraction will be performed by one reviewer and a sample (10% of included studies, randomly selected) will be validated by another reviewer. This validation approach will be used as it is anticipated that a large number of studies will be included in the review. This approach has been successfully used by the authors in their previous reviews where the scope was broad. Key data for extraction will include: type of review (e.g. systematic review, scoping review, integrative review), types of primary research design included (i.e. quantitative, qualitative, mixed methods), whether critical appraisal was undertaken (and how) by authors of the published review, and all information related to the process of synthesis. The draft extraction table may be refined further and updated during the review process.

Authors of research articles and other sources of literature may be contacted to request additional or missing data, where needed.

Data presentation

Data will be presented using tables and figures that align with the objectives of this scoping review. A narrative summary will accompany the tabulated data and figures with a view to proposing recommendations for further research related to the methodology for undertaking evidence synthesis of barrier and/or enabler studies.

Appendix I: Search strategy

PubMed (NLM); date searched: April 27, 2020

Appendix II: Data extraction form


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barriers; enablers; evidence review; evidence synthesis; facilitators

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