Six main issues emerged from the studies of children's views: (1) children do not see it as their role to be interested in health; (2) children do not see messages about future health as personally relevant or credible; (3) fruit, vegetables and confectionery have very different meanings for children; (4) children actively seek ways to exercise their own choices with regard to food; (5) children value eating as a social occasion; and (6) children see the contradiction between what is promoted in theory and what adults provide in practice.

Up until this point, we had produced a synthesis which kept very close to the original findings of the included studies. The findings of each study had been combined into a whole via a listing of themes which described children's perspectives on healthy eating. However, we did not yet have a synthesis product that addressed directly the concerns of our review – regarding how to promote healthy eating, in particular fruit and vegetable intake, amongst children. Neither had we 'gone beyond' the findings of the primary studies and generated additional concepts, understandings or hypotheses. As noted earlier, the idea or step of 'going beyond' the content of the original studies has been identified by some as the defining characteristic of synthesis [32, 14].

Figure 2relationships between descriptive themes.

Figure 1line-by-line coding in EPPI-Reviewer.

In our example review, while it was relatively easy to identify 'data' in the studies – usually in the form of quotations from the children themselves – it was often difficult to identify key concepts or succinct summaries of findings, especially for studies that had undertaken relatively simple analyses and had not gone much further than describing and summarising what the children had said. To resolve this problem we took study findings to be all of the text labelled as 'results' or 'findings' in study reports – though we also found 'findings' in the abstracts which were not always reported in the same way in the text. Study reports ranged in size from a few pages to full final project reports.

In our example review we assessed our studies according to 12 criteria, which were derived from existing sets of criteria proposed for assessing the quality of qualitative research [46–49], principles of good practice for conducting social research with children [50], and whether studies employed appropriate methods for addressing our review questions.

Quality assessment

other principles from primary qualitative research methods may also be 'borrowed' such as deliberately seeking studies which might act as negative cases, aiming for maximum variability and, in essence, designing the resulting set of studies to be heterogeneous, in some ways, instead of achieving the homogeneity that is often the aim in statistical meta-analyses.

Methods

Frame of reference is described as “a structure used to transform theory into applicable information – to link theory to practice”.3 A frame of reference provides principles for selecting, synthesizing, and reformulating theories into a practical form that allows occupational therapists to use the information.4

In occupational therapy, models can be further divided into two types: conceptual models and practice models. Conceptual models, such as the Person-Environment-Occupation model, help occupational therapists to analyze and understand occupation. Practice models, such as the Occupational Performance Process Model, help therapists to know what to do in clinical practice

“a symbolic representation of concepts or variables, and interrelationships among them”.2

Theory is defined broadly as “a plausible or scientifically acceptable general principle or body of principles offered to explain phenomena”

In addition, the “Comparison” (C) is not typically part of aqualitative research question so becomes irrelevant, whereasboth “Intervention” (I) and “Outcome” (O) might need to bemanipulated to fit with the qualitative paradigm. Therefore,specification using PICO might become a subjective exer-cise when used for qualitative research questions, rather thanthe systematic search strategy tool intended when used forquantitative research questions.

P – Population/problem S – Sample Smaller groups of participants tend to be used inqualitative research than quantitative research, sothis term was deemed more appropriate.I – Intervention/exposure PI – Phenomenon of Interest Qualitative research aims to understand the howand why of certain behaviours, decisions, andindividual experiences. Therefore, an intervention/exposure per se is not always evident inqualitative research questions.C – Comparison D – Design The theoretical framework used in qualitativeresearch will determine the research method that isused. As inferential statistics are not used inqualitative research, details of the study design willhelp to make decisions about the robustness of thestudy and analysis. In addition, this might increasethe detection of qualitative studies in thedatabases in which titles and abstracts areunstructured.O – Outcomes E – Evaluation Qualitative research has the same end result asquantitative research methods: outcomemeasures. These differ depending on the researchquestion and might contain more unobservable andsubjective constructs when compared toquantitative research (e.g., attitudes and viewsand so forth), so evaluation was deemed moresuitable.R – Research type Three research types could be searched for:qualitative, quantitative, and mixed methods.Figure 1. The construction of the SPIDER search tool from the PICO search tool