BACKGROUND Patient and public involvement (PPI) has become enshrined as an important pillar of health services empirical research, including PPI roles during stages of research development and analysis and co-design approaches. Whilst user participation has been central to qualitative evidence synthesis (QES) for decades, as seen in the Cochrane consumer network and guidelines, meta-ethnography has been slow to incorporate user participation and published examples of this occurring within meta-ethnography are sparse. In this paper, drawing upon our own experience of conducting a meta-ethnography, we focus on what it means in practice to 'express a synthesis' (stage 7). We suggest the methodological importance of 'expression' in Noblit and Hare's seven stage process (Noblit, GW and Hare, RD. Meta-ethnography: synthesizing qualitative studies, 1988) has been overlooked, and in particular, opportunities for PPI user participation within it. METHODS Meta-ethnography comprises a seven-stage process of evidence synthesis. Noblit and Hare describe the final 7th stage of the meta-ethnography process as 'expression of synthesis', emphasizing co-construction of findings with the audience. In a previous study we conducted a meta-ethnography exploring patient and student experience of medical education within primary care contexts. We subsequently presented and discussed initial meta-ethnography findings with PPI (students and patients) in focus groups and interviews. We transcribed patient and student PPI interpretations of synthesis findings. As a research team, we then translated these into our existing meta-ethnography findings. RESULTS We describe, with examples, the process of involving PPI in stage 7 of meta-ethnography and discuss three methodological implications of incorporating PPI within an interpretative approach to QES: (1) we reflect on the construct hierarchy of user participants' interpretations and consider whether incorporating these additional 1st order, 2nd level constructs implies an additional logic of 3rd order 2nd level constructs of the QES team; (2) we discuss the link between PPI user participation and what Noblit and Hare may have meant by ideas of 'expression' and 'audience' as integral to stage 7; and (3) we link PPI user participation to Noblit and Hare's underlying theory of social explanation, i.e. how expression of the synthesis is underpinned by ideas of translation and that the synthesis must be 'translated in the audience's (user participants) particular language'. CONCLUSIONS The paper aims to complement recent attempts in the literature to refine and improve guidance on conducting a meta-ethnography, highlighting opportunities for PPI user participation in the processes of interpretation, translation and expression. We discuss the implications of user participation in meta-ethnography on ideas of 'generalisability'.

中文翻译：

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证据综合中的患者和公众参与（PPI）：PatMed研究如何将受众的反应嵌入到元民族志的表达中。

背景技术患者和公众参与（PPI）已被列为健康服务实证研究的重要支柱，包括研究开发，分析和协同设计方法阶段中的PPI角色。正如数十年来在Cochrane消费者网络和指南中所看到的那样，尽管用户参与一直是定性证据综合（QES）的核心，但是元民族志学在整合用户参与方面一直进展缓慢，而且在元民族志学中发生这种情况的已发表实例很少。在本文中，根据我们自己进行元民族志的经验，我们将重点放在“表达综合”在实践中的意义（第7阶段）。我们建议“表达”在Noblit和Hare的七个阶段过程中的方法学重要性（Noblit，GW和Hare，RD。元民族志：综合定性研究（1988年），尤其是PPI用户参与其中的机会。方法元民族志包括证据合成的七个阶段。Noblit和Hare将元民族志学过程的最后第七阶段描述为“综合表达”，强调了与听众共同构建发现。在之前的研究中，我们进行了元民族志研究，以探讨患者和学生在基层医疗环境中接受医学教育的经历。随后，我们在焦点小组和访谈中介绍并讨论了PPI（学生和患者）的原始人种志研究发现。我们转录了患者和学生对综合发现的PPI解释。作为研究小组，我们随后将其转化为我们现有的元民族志研究结果。结果我们描述，举例说明，将PPI纳入元民族志的第7阶段，并讨论将PPI纳入对QES的解释方法中的三种方法学含义：（1）我们反思用户参与者解释的结构层次，并考虑是否将这些附加一阶，二级构造意味着QES团队三阶二级构造的附加逻辑；（2）我们讨论了PPI用户参与与Noblit和Hare的“表达”和“观众”概念在第7阶段必不可少的含义之间的联系；（3）我们将PPI用户参与与Noblit和Hare的社会解释基础理论联系起来，即，综合表达如何以翻译观念为基础，并且综合必须“在受众中进行翻译” （用户参与者）特定语言”。结论本文旨在补充文献中最近的尝试，以完善和改进进行元民族志的指导，突出PPI用户参与解释，翻译和表达过程的机会。我们讨论了元民族志中用户参与对“一般性”思想的影响。