Background Over ten years since the first qualitative evidence synthesis (QES) was published in the Cochrane Library, QES and mixed-methods reviews (MMR) with a qualitative component have become increasingly common and influential in healthcare research and policy development. The quality of such reviews and the completeness with which they are reported is therefore of paramount importance. Aim This review aimed to assess the reporting quality of published QESs and MMRs with a qualitative component in the Cochrane Library. Methods All published QESs and MMRs were identified from the Cochrane Library. A bespoke framework developed by key international experts based on the Effective Practice and Organisation of Care (EPOC), Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and meta-ethnography reporting guidance (eMERGe) was used to code the quality of reporting of QESs and MMRs. Results Thirty-one reviews were identified, including 11 MMRs. The reporting quality of the QESs and MMRs published by Cochrane varied considerably. Based on the criteria within our framework, just over a quarter (8, 26%) of the reviews achieved a score of at least 80%, 18 (58%) required fuller detail in their reporting (scoring between 65%-79%) and 5 (16%) achieved a score of less than 65%. Conclusion This assessment offers important insights into the reporting practices prevalent in these review types and underscores the need for ongoing surveillance. The variability in reporting quality within QESs and MMRs reinforces the need to develop Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) specifically for QES.

The use of visual methods in qualitative evidence synthesis (QES) adds a valuable dimension to the synthesis process by enhancing understanding and knowledge generation. This paper provides an overview of common visual methods that support various stages of QES, with a worked example from a Cochrane QES using meta-ethnography. The paper also addresses the involvement of stakeholders, and considerations of equity, diversity, inclusion, and reflexivity in the selection and application of visual methods. The authors utilised a combination of remote and in-person visual methods to initiate and develop their synthesis, involving stakeholders throughout the process. Methods used by the review authors included paper labels, cartoons, infographics, virtual whiteboards, and diagrams. The use of visual methods in the QES facilitated data visualisation, remote analysis meetings, interpretation of extensive data, and meaningful patient and public involvement. QES authors are encouraged to consider the use of visual methods, particularly when involving the public in the synthesis process. Keywords: Qualitative Evidence Synthesis, QES, Meta-ethnography, visual methods

This paper introduces version one of an assessment tool developed to address the challenges posed by the assessment of data thickness and richness in primary qualitative studies for Qualitative Evidence Syntheses (QES). The tool has been in development since 2014. Three pilot versions from three review teams have been used in six Cochrane reviews. Key members from the original three review teams came together to create a consensus-based definitive version 1 of the tool for publication. Four review authors piloted the version 1 tool. The definitive version 1 assessment tool consists of two components: assessing the thickness of contextual data and assessing the richness of conceptual data. A sliding scale with four points is used to rate these aspects, offering nuanced and qualitative judgments. The accompanying guidance emphasizes the importance of assessing data that addresses the review question. Paragraph locked by Heather Melanie R Ames The paper provides guidance on how to apply the tool, emphasizing the importance of reaching a consensus among review authors, and fostering a shared understanding of what constitutes rich and thick data in the context of the review. The potential challenges related to the time and resource constraints of this additional review process are acknowledged. Version 1 of the data thickness/richness assessment tool represents a significant development in QES methodology, filling a critical gap in tools for evaluating the richness of conceptual data and the level of contextual detail in primary qualitative studies. It enhances the transparency and rigor of the sampling process and offers valuable insights for assessing the thickness and richness of data in primary qualitative studies that addresses the review requestion, objectives and context as specified in the review protocol. The authors invite feedback from the research community to further test, refine and improve this tool based on wider user experiences.