Its contribution to the mixed economy of methods for the systematic review of complex evidence should be explored further. We concluded that meta-narrative review adds value to the synthesis of heterogeneous bodies of literature, in which different groups of scientists have conceptualised and investigated the 'same' problem in different ways and produced seemingly contradictory findings. In some traditions, scientific revolutions were identifiable in which breakaway researchers had abandoned the prevailing paradigm and introduced a new set of concepts, theories and empirical methods. We were able to make sense of seemingly contradictory data by systematically exposing and exploring tensions between research paradigms as set out in their over-arching storylines. By first separating out, and then drawing together, these different meta-narratives, we produced a synthesis that embraced the many complexities and ambiguities of 'diffusion of innovations' in an organisational setting. Within each tradition, accounts of research depicted human characters emplotted in a story of (in the early stages) pioneering endeavour and (later) systematic puzzle-solving, variously embellished with scientific dramas, surprises and 'twists in the plot'. Moreover, they told very different over-arching stories of the progress of their research. Researchers in different traditions had conceptualised, explained and investigated diffusion of innovations differently and had used different criteria for judging the quality of empirical work. We identified 13 key meta-narratives from literatures as disparate as rural sociology, clinical epidemiology, marketing and organisational studies. We then drew variously on the different storylines to build up a rich picture of our field of study. We mapped these storylines by using both electronic and manual tracking to trace the influence of seminal theoretical and empirical work on subsequent research within a tradition. We took as our initial unit of analysis the unfolding 'storyline' of a research tradition over time. Final report, NIHR Service Delivery and Organisation programme, (2011). Drawing on Kuhn's notion of scientific paradigms, we developed a new method-meta-narrative review-for sorting and interpreting the 1024 sources identified in our exploratory searches. systematic review using the meta-narrative method and two case studies. There are several established and emerging approaches to such reviews, but unanswered questions remain, especially around how to begin to make sense of large data sets drawn from heterogeneous sources. Context played a key role in determining success and in how consumers and their families, providers, organisations and policy-makers stay connected to implementing the best care possible.Ĭonclusions: All phases of implementation of a new model of CBPHC call for collaborative partnerships with all stakeholders, the most important being the person receiving care in terms of what matters most to them.Producing literature reviews of complex evidence for policymaking questions is a challenging methodological area. Person-centred care is fundamental to integrated CBPHC at all levels in the health care delivery system, yet many implementation theories and frameworks neglect this cornerstone.ĭiscussion: The research identified perspectives central to integrated CBPHC that were missing in the literature. Four themes were generated that exposed the contradictions and synergies among the metanarratives. Five metanarratives emerged 1) theoretical constructs 2) multiple influencing factors 3) development of new frameworks 4) application of existing frameworks and 5) effectiveness of interventions within frameworks/models. Results: Thirty-five reviews met our inclusion criteria and were appraised, summarised, and synthesised. Methods: We conducted a systematic review and metanarrative synthesis of literature on implementation frameworks, theories and models in support of a research programme investigating CBPHC for older adults with chronic health problems. However, in the implementation of integrated community-based and integrated health care, it is still not well known which approaches work best. Introduction: Many studies have investigated the process of healthcare implementation to understand better how to bridge gaps between recommended practice, the needs and demands of healthcare consumers, and what they actually receive.
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