Analysis and Evaluation of Frameworks and Theories

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Introductory Note:

If you have answered “yes” to the above two questions, then theory synthesis may be a strategy to achieve your goal. The strategy of theory synthesis exemplifies the process of transforming practice-related research about phenomena of interest into an integrated whole. Such an integrated whole allows the theorist to bring bits and pieces of knowledge together in a more useful and coherent form. This strategy is a means for making sense of a jumble of facts, or bringing order to the process of a specific nursing intervention. Because theory synthesis is intricately involved in organization of concepts and statements, readers using this strategy are urged to also read Chapters 7 and 8 on concept and statement synthesis, respectively. Readers may also find Chapter 11 on statement analysis a helpful resource in formulating statements during the process of theory synthesis.

nition and Description

The aim of theory synthesis is construction of a theory—an interrelated system of ideas developed through use of evidence. In this strategy, a theorist pulls together available information about a phenomenon. Concepts and statements are organized into a network or whole, a synthesized theory. Theory synthesis involves three steps or phases:

1. Specifying focal concepts to serve as anchors for the synthesized theory.

2. Reviewing the literature to identify factors related to the focal concepts and to specify the nature of relationships.

3. Organizing concepts and statements into an integrated and efficient representation of the phenomena of interest.

Theory synthesis results in a more complex and integrative representation of phenomena than concept or statement synthesis. This is true for several reasons. In contrast to concepts, which serve to highlight phenomena of interest, theories demonstrate the connections among concepts. Further, theories simultaneously embrace more aspects of phenomena and integrate them more thoroughly than statements. A statement may link only two or three concepts together ( Figure 9–1a ). (See Chapter 8 for a number of examples of synthesized theory statements.) By contrast, a theory may connect a number of concepts to each other and also specify complex direct and indirect linkages among concepts ( Figure 9–1b ). Theories offer benefits beyond linking together several concepts. A theory that is well designed moves beyond existing knowledge by pointing the way to new and surprising discoveries ( Causey, 1969; Hempel, 1966 , pp. 70–84). Thus, theory synthesis is not an end, but a means to new insights for use in research and practice.

Figure 9–1

Example of complexity of linkages in (a) statement versus (b) theory.

A set of two diagrams showing examples of a statement and a theory, along with their linking complexities.

Figure 9–1 Full Alternative Text

Theories that are synthesized may be presented in more than one way. When the relationships within and among statements are depicted in graphic form, this constitutes a model of the phenomenon (see Chapter 3 for a fuller discussion of concepts, statements, theories, and models). In this chapter, we will use the terms theory and theoretical modelinterchangeably because it is often quite useful to represent beginning theories in both graphic (model) and linguistic (theory) forms. Theorists often move back and forth between expressing theories in written sentences and visual devices, such as diagrams, during theory construction. In the final stages of theory building and refinement, theories may also be expressed in mathematical form ( Blalock, 1969 ). Here, given that this is an introductory book on theory construction, we will limit ourselves to linguistic and graphic expressions of theory.

Like other synthesis strategies, theory synthesis builds on a base of empirical evidence. In theory synthesis, a theorist may combine information from various sources during theory building: qualitative and quantitative observations, available data banks, and published research findings. In utilizing qualitative and statistical information in theory synthesis, it is helpful to first translate them into relational statements (see Chapter 8 on statement synthesis).

Because a theorist can use a variety of sources of data in theory synthesis, we will not present distinct methods for each source. Rather, we will attend to each source of data within an overall strategy for theory synthesis. A theorist may utilize evidence from each of these sources in the construction of a particular model. In theory synthesis, the source of data is less important than the salience of the evidence to the phenomenon represented by the model. Nonetheless, for some topics theorists may choose to use one source of data because of the nature and focus of the theory development project. For example, Halldorsdottir (2008) drew heavily on qualitative phenomenological studies to develop a synthesized theory of the nurse–patient relationship. In contrast, Hill (2002) focused on over 50 quantitative studies in a theory synthesis project that concentrated on feeding efficiency among preterm infants. They each used data pertinent to their purposes.

Readers also should keep in mind that a synthesized theory is limited in its generalizability or external validity by the extent and quality of evidence upon which it is based. Theoretical models drawn from a limited number of sources normally will be more restricted in focus and less generalizable than ones based on multiple and diverse sources. Synthesis strategies are more grounded in reality, however, than other strategies such as derivation because they are based on evidence. Synthesized theories, like synthesized statements, require testing or cross-validating to reaffirm their empirical validity.

A working knowledge of statistical concepts can be a valuable tool in a theory synthesis where theorists directly draw on quantitative data. Such knowledge may enable a theorist to directly utilize statistical information in theory construction. In addition, theorists who are conversant in statistics are better able to critically evaluate statements and conclusions in others’ reports of statistical findings. Nevertheless, because our focus in this chapter is on the process of theory synthesis, we will keep our use of statistical information to a minimum.

Example of The Use of Theory Synthesis Process

Because it is probably easiest to get a grasp on how theory synthesis works by demonstrating the process, we provide the following illustration. We draw on a literature review and qualitative study done by Ward (2002) on the topic of transformational leadership, a visionary style of leadership characterized by qualities such as power sharing that are conducive to organizational development. Our illustration is not intended as a comprehensive presentation on this topic. Readers who find the topic of particular interest are referred to Ward’s original article for more complete details. (Note: We have identified factors related to transformational leadership by assigning an alphabetical letter [A, B, etc.] to it. These letters are also included in the model constructed from Ward’s literature review [ Figure 9–2 ] so that readers may trace the translation made from linguistic to graphic representation of the findings.)

Figure 9–2

Model of transformational leadership. (For more complete information, see Ward [2002].)

A diagram depicting the factors of transformational leadership, along with their positivity, negativity, or lack thereof.

Figure 9–2 Full Alternative Text

From Ward’s article we extracted the following antecedents of transformational leadership. Included among these antecedents are having a personal support system (A), having certain personal characteristics such as self-confidence (B), and pursuit of a career pathway (C). Studies also indicated that increased worker retention (D), decreased absenteeism (E), and increased job satisfaction (F) are among organizational outcomes of transformational leadership (G). Because Ward does not mention if errors (H) are reduced by transformational leadership, we cannot make a conclusion about relationships to this important organizational outcome. Having identified a series of relationships pertinent to transformational leadership, we then constructed a diagram, Figure 9–2 , to represent the relationships as an interrelated network of ideas. The symbols +, −, and ? were used to designate, respectively, factors with positive, negative, and unknown relationships to transformational leadership. For simplicity, we treated the relationships as unidirectional and causal in our illustration. (See Chapter 11 on statement analysis for further discussion of the concepts of directionality and causality.)

Our example of a model of transformational leadership was based in most cases on reported research findings. Had we access to a data bank on transformational leadership, we might have generated further information pertinent to the model. Suppose we had done this and found that transformational leadership was correlated (r=.50)(r=.50) with positive lifestyle changes in employees, such as smoking reduction. We then would have added changes in lifestyle to the model as an outcome of transformational leadership. Statistical information translated into a statement of relationship may be entered into a theoretical model in the same way as relationships gleaned from the literature. Similarly, findings from qualitative research also may be added to the model.

Purpose and Uses

Based on the preceding illustration, it should be clear that the purpose of theory synthesis is to represent a phenomenon through an interrelated set of concepts and statements. Three specific aims for theory synthesis are listed in Table 9–1 . The first of these aims targets the events that may precede a phenomenon of interest in nursing and is related to predicting or understanding factors that lead up to the phenomenon. The second aim is concerned with what are outcomes of some health-related event, such as receiving a specific diagnosis or a nursing intervention. The second is also helpful in raising awareness of effects that are undesired consequences of a clinical phenomenon, such as postpartum depression. The third aim involves organizing relational statements into a system. It may entail collapsing related factors or variables into larger summary concepts. Conducting theory synthesis for this third aim is concerned with depicting relationships about a phenomenon and improving the overall form and quality with which a theory is expressed. The varied aims of theory synthesis are equally valid. The specific aim for which a theorist engages in theory synthesis will depend on the interests of the theorist and the use envisioned for the synthesized theory.

Table 9–1 Specific Aims of Theory Synthesis and Related Examples

Aim of Theory Synthesis	Example
To represent the factors that precede or influence a particular health concern	Factors that lead women to be screened for osteoporosis, or to leave abusive relationships
To represent outcomes or effects that occur after some health-related event or intervention	Functional outcomes that are improved and follow from nursing interventions with rural older adults
To put disparate, but related, scientific information into a more theoretically organized form	Modeling the factors that lead immigrant groups to adopt acculturated dietary practices

The type and amount of available evidence influences which of the three specific aims of theory synthesis will be most feasible in any given situation. For example, if only minimal information is available about the effects of some phenomenon, but a great deal is known about its antecedents or determinants, a theorist’s efforts may be more profitably spent on theory synthesis related to antecedents. Generally, there must be research evidence available about relationships among at least three factors for theory synthesis to be possible. If this is not the case, the theorist should consider another strategy, for example, statement synthesis or theory derivation. The richer the pool of research information available to the theorist, the greater the complexity and precision possible in a synthesized theory.

Theory synthesis may be used in a wide variety of scientific and practical situations. It may be used to produce a compact graphic representation of research findings on a topic of interest. Literature reviews about multiple and complex relationships may be made less tedious and more informative through theory synthesis. Particularly where a graphic display of a synthesized theory is made, complex relations may be communicated more effectively than through traditional written reviews. This particular use of theory synthesis is relevant in teaching complex content about a clinical topic, applying research to the design of clinical interventions, and developing a theoretical framework for a research project.

Theory synthesis requires that a theorist systematically assess relationships among factors pertinent to a topic of interest. The process aids in highlighting areas in need of further research as the theorist methodically identifies relationships among variables; notes the directionality of the relationships; specifies whether the relationship is positive, negative, neutral, or unknown; and notes the quality and amount of evidence in support of the relationship. This information can be helpful in locating specific questions in need of further investigation.

Procedures for Theory Synthesis

A common set of procedures comprises theory synthesis regardless of purpose. Although we outline the procedures as a set of steps or phases, their order is not absolute, nor will a theorist necessarily devote comparable time to each.

Specify Focal Concepts

A theorist begins theory synthesis by marking off a topic of interest. The theorist may do this by specifying (a) one focal concept or variable, such as transformational leadership, or (b) a framework of several focal concepts. In the former case, the theorist moves out from the focal concept, for example, transformational leadership, to other concepts or variables related to it. In the latter case, the theorist is concerned with a framework of focal concepts and how they may be interrelated. For example, the relationship of various teacher attitudes and behaviors to various nursing student attitudes and behaviors constitutes a framework of focal concepts for beginning theory synthesis. Finally, if the focal concept(s) is expressed by several terms at more than one level of abstraction, a higher-order concept(s) should be selected to capture those equivalent terms. (See Chapter 8 on statement synthesis.)

Identify Related Factors and Relationships

Guided by a single focal concept or a framework of concepts, a careful search and review of the literature is done next. During the review, note is taken of variables related to the focal concept or framework of concepts. Relationships identified are systematically recorded, and, where possible, indications are made of whether they are bi- or unidirectional; positive, neutral, negative, or unknown; and weak, ambiguous, or strong in supporting evidence. For example, double- or single-headed arrows; plus (+) or minus (−) signs; and varying number of asterisks, respectively, can be used to indicate these properties of relational statements.

Locating relationships in research may be facilitated by finding comprehensive and thorough review articles already written. If recent reviews on the focal concepts are not available, a thorough search of the research literature is in order. Relationship statements are not located in one uniform place in research articles and reports. They may occur in the abstract, literature review, hypotheses, results, or discussion of a study. In a structured abstract, however, key relationships will be stated as conclusions. If the results of a study are not summarized in statement form, a theorist may have to trace a statement from the hypothesis section through the results section in order to determine whether it was supported by actual findings of the study.

Identification of relationships can also be expanded to include other than literary sources of statements and concepts; for example, qualitative or quantitative observations made by the theorist may be translated into relational statements and then treated as any other statement in theory synthesis. Readers may find Chapter 8 on statement synthesis helpful in clarifying and combining statements. (Readers seeking software to facilitate theory synthesis may find the arcs© program, demonstrated in an article by Kim, Pressler, Jones, and Graves [2008] , of interest.) *

* Information about the software program arcs© is available from Dr. Marceline Harris, RN, PHD, University of Michigan; e-mail: [email protected]

Construct an Integrated Representation

Finally, when a theorist has collected a fairly representative listing of relational statements pertinent to one or more focal concepts, these may then be organized in terms of the overall pattern of relationships among variables. Theory developers may choose to express the synthesis work in expository form. Alternatively, diagrams may be employed to holistically depict interrelationships among concepts. Readers will recall that in our illustration variables were organized into those that appeared to be antecedents of transformational leadership and those that appeared to be outcomes of it (see Figure 9–2 ). For each topic of interest, a theorist must determine a reasonable basis for organizing statements.

Several mechanisms can facilitate organizing concepts into suitable networks of ideas. One such mechanism is to collapse several highly similar variables into a more comprehensive summary concept for use in the theory. For example, kissing, cuddling, and smiling at a baby might all be amalgamated into a summary concept of parental attachment behavior. Similarly, return to work, normal blood sugar, and adherence to a prescribed diet may be collapsed under the concept of adaptation to chronic disease. Collapsing discrete variables into summary variables can make a theory more easily understood by reducing needless complexity. A more parsimonious theory will also be achieved by this method. Readers may find Chapter 7 on concept synthesis helpful in constructing summary concepts.

Another mechanism is organizing statements into what Zetterberg (1965) called an “inventory of determinants” or an “inventory of results.” These refer, respectively, to the cataloging of antecedents and effects of a focal concept or variable. Structurally, these two types of inventories are quite similar. They differ only in whether the focal concept is viewed as an outcome of certain variables or a determinant of them ( Figure 9–3 ). Organizing statements into inventories of determinants and results is often helpful where a theorist is dealing with only one focal concept or variable. This was the mechanism that we used for transformational leadership.

Figure 9–3

Inventories of determinants and results.

A diagram showing variables 1 to 4 as determinants of focal variable and variables 5 to 8 as results of the focal variable.

Yet another mechanism is Blalock’s (1969) notion of theoretical “blocks.” With this approach, variables that are more proximally related are organized together into a block and their interrelationships specified. Each block of variables is then related to more distally related variables in other blocks ( Figure 9–4 ). Organizing variables and relationships into theoretical blocks is especially relevant if a theorist is constructing a “megamodel” comprising several “minimodels.” Schwirian’s (1981)classic synthesis of factors affecting nurses’ performance in practice is a classic example of organizing diverse relationships about a phenomenon into theoretical blocks.

Figure 9–4

Variables and statements organized into theoretical blocks.

A diagram showing the arrangement of variables and their inter-relationships in theoretical blocks.

Figure 9–4 Full Alternative Text

The mechanisms cited above are only suggestions and primarily are intended to stimulate thinking on how to depict a developing theory. The phenomena of interest to nurses are too diverse and complex to be reduced to just a few possibilities. A theorist must follow the evolving understanding that comes from carefully considering the existing evidence and their own creative processes in deciding how best to depict the phenomena of interest. For an example showing theory developers’ use of their own

Procedures for Theory Synthesis

Specify Focal Concepts

Identify Related Factors and Relationships

* Information about the software program arcs© is available from Dr. Marceline Harris, RN, PHD, University of Michigan; e-mail: [email protected]

Construct an Integrated Representation

Figure 9–3

Inventories of determinants and results.

A diagram showing variables 1 to 4 as determinants of focal variable and variables 5 to 8 as results of the focal variable.

Figure 9–4

Variables and statements organized into theoretical blocks.

A diagram showing the arrangement of variables and their inter-relationships in theoretical blocks.

Figure 9–4 Full Alternative Text

Illustrations of Theory Synthesis

A classic and exemplary illustration of the process of theory synthesis is the model of adherence among hypertensive patients presented by Caplan, Robinson, French, Caldwell, and Shinn (1976) . Caplan et al. began model construction by specifying their focal concepts as the dependent variables of interest: adherence and the lowering of blood pressure. They then worked backward to identify predictors or determinants of these focal variables. In constructing the model, they expressed the hope that it would “serve as a heuristic aid in thinking about determinants of adherence” (p. 22). Below are key statements, largely paraphrased for brevity, that culminated in the Caplan et al. model.

Evidence supports relationships between maintaining blood pressure in normal limits and the goal of longevity, if not a long satisfying life (relationship A). Adherence to medical regimens that involve taking medications is an effective means of controlling high blood pressure (relationship B). In attaining adherence, setting specific subgoals is important in goal attainment, and “rewards need to be anticipated, or explicitly identified in advance before the person begins to strive toward the goal” ( Caplan et al., 1976 , p. 26), to meet the desired level of adherence (relationship D). Further, patients’ actual adherent behaviors “serve as a feedback mechanism helping them set new goals based on past accomplishments” (relationship D; p. 30). Accomplishment enhances patients’ perceived competence to adhere (relationship E). Perceived competence to adhere leads to further adherence behavior (relationship C).

Caplan et al. (1976) represented these relational statements in the graphic form shown in Figure 9–5 . In this figure, letters are used to connect relational statements in linguistic form with their translation into graphic form. Of note in the model presented by Caplan et al. is the bidirectional relationship between adherent behavior and goal setting and attainment (D). Two subsequent expansions of this model were made by Caplan et al. (1976) , but for brevity we have not included those here.

Figure 9–5

Model of major hypothesized predictors of adherence and their effects on blood pressure. Arrows between boxes indicate causal relationships. The letters on each arrow are used for reference in the text.

A diagram showing the model of major hypothesized predictors of adherence and their effects on blood pressure.

Figure 9–5 Full Alternative Text

A number of theorists have published the results of their theory synthesis work in nursing. Several of these are shown in Table 9–2 . For example, Good and Moore (1996) drew their evidence base from practice guidelines on pain management for their theory synthesis. They used the strategy of statement synthesis to transform practice guidelines into statements suitable for theory synthesis. Three statements were synthesized from the guidelines. These were then organized in the resultant middle-range theory of balance of analgesia and side effects. They then stated assumptions and limits of the theory. The benefits of the integrated theory were a parsimonious presentation of diverse information related to the phenomena of pain management. The work of Hill (2002) related to feeding among preterm infants also provides a further detailed illustration of the theory synthesis process. Hill’s work also served to integrate extensive research related to feeding behaviors of preterm infants.

Table 9–2 Examples of Theory Syntheses

Author	Topic of Synthesized Theory
Good and Moore (1996)	Balance between analgesia and side effects in adults
Ruland and Moore (1998)	Peaceful end of life
Huth and Moore (1998)	Acute pain management in infants and children
Easton (1999)	Poststroke recovery
DeMarco (2002)	Nurses’ communication patterns in the workplace
Hill (2002)	Feeding efficiency of preterm infants
Whittemore and Roy (2002)	Adaptation to the chronic disease of diabetes
Milberg and Strang (2007)	Palliative home care staff from the perspective of the family
Halldorsdottir (2008)	Nurse–patient relationship
Yao and Algase (2008)	Wandering behavior in persons with dementia
Murrock and Higgins (2009)	Theory of music and its effects on physical activity and health
Siaki, Loescher, and Trego (2013)	Culturally sensitive risk perception theory
Zeng, Sun, Gary, Li, and Liu (2014)	Model of diabetes self-management on U.S. Chinese immigrants
Zandi, Vanaki, Shiva, Mohammadi, and Bacheri-Lankarani (2016)	Caring model for women becoming mothers by surrogacy

In a further example, interest in developing a theoretical basis for caring for women becoming mothers by surrogacy led Zandi et al. (2016) to use theory synthesis to construct the model, security giving in surrogacy motherhood. The focal concept in the model, security giving in surrogacy motherhood, was based on an earlier qualitative study. Building from this focal concept, they employed literature searches and identified statements related to illuminate the “caring role of nurses and what caring actions are needed to provide security” (p. 333) to women becoming mothers through surrogacy. Concepts and statements were synthesized in a theoretical model expressed in a rich description as well as diagrammatic form. This model provided a means of understanding the nurses’ role and better caring for women becoming mothers by surrogacy.

Advantages and Limitations

The strength of theory synthesis as a strategy is the resultant integration of large amounts of discrete information about a topic. By using both linguistic and graphic modalities, synthesized theories can integrate and efficiently present multiple and complex relationships. Theory synthesis is a useful strategy for summarizing research findings relevant to educational, research, and practice spheres.

Theorists may need to increase their fluency with statistical concepts in order to make accurate discriminations about structural relationships between and among concepts in their evidence base. These discriminations include clarifying causal pathways among sets of variables.

Theory synthesis is built on the premise that theory development is an incremental and cumulative process. Although this may be true at certain levels of scientific development, this may not characterize those major advances in scientific thought that have occurred by making radical reorganizations of or departures from accumulated knowledge ( Kuhn, 1962 ).

Utilizing the Results of Theory Synthesis

In the context of research, theory synthesis results lay bare the conceptual structure and linkages of extant knowledge about a phenomenon. This structural knowledge may then be used to ensure operational adequacy ( Fawcett, 1999 ) of indicators and research procedures in empirically testing synthesized theory. Consequently, even a well-designed theoretical model needs to be empirically validated. Model or theory testing is needed to provide the sound empirical base desired of theories in a scientific discipline and profession. Testing may show that a model needs to be modified. If parts of a model repeatedly do not perform under rigorous tests (e.g., do not show expected relationships), then theorists have several alternatives. They may delete nonperforming variables, introduce new variables, or rethink the whole model. For example, if the model of transformational leadership were tested, it might need to be reworked. Perhaps gender-specific concepts ( Eisler & Hersen, 2000 ) could be added to create separate models for men and women. As before, testing is needed to determine the merit of any changes in a model.

Development of synthesized theories may be useful in teaching complex content involving multiple concepts and their interrelationships. Often when such material is presented graphically as well as linguistically, it is easier both to teach and to learn. Students may also find it easier to retain complex relationships if they are given the opportunity to sketch out relationships embedded in text format.

Synthesized theories may help nurses in practice to examine the antecedents and consequences of a clinical phenomenon, or to plan patient services based on a coherent program theory. Designing preventive interventions may be facilitated by looking at the antecedents of a clinical problem. Tracing the way that each potential antecedent might be modified in an attempt to prevent undesired clinical problems, such as hospital readmissions after surgery, can suggest how present practice might be improved. In turn, elaborating the consequences of an intervention is useful in identifying outcomes for assessing the effectiveness of an intervention. Theory synthesis is applicable to clinical problems within the hospital context, as well as in home care and community agency settings. Theory synthesis can be used to identify antecedents of a clinical phenomenon for use in development of risk assessment tools. In this vein, Gephart, Effken, McGrath, and Reed (2013) used theory synthesis as the foundation for development of a risk index for necrotizing enterocolitis in preterm infants.

Theory Synthesis and Integrative Models and Theories

As knowledge from various disciplines converges around a phenomenon, it is tempting to build integrative models that incorporate multiple levels of analysis. For example, the UNICEF multilevel conceptual framework of the causes of child malnutrition ( Figure 9–6 ) is recognized worldwide (https://www.unicef.org/nutrition/training/2.5/4.html). In this framework, the causes of child malnutrition and mortality are depicted as starting at the societal level with regard to basic resources, then progressing to causes at the household level, and finally reaching the level of the individual child where disease conditioned by insufficient food reciprocally leads to poor food intake and further disease and finally malnutrition. Such models make major contributions to our understanding of nationally and globally significant health problems, but care is needed to appropriately construct such models. Sobal (1991), among others, has written eloquently about the issues in linking levels of analysis. While it is not our purpose to explicate these issues here, it is important to point them out. For example, concepts from one level of analysis may not be translatable to another level. To overcome this issue, Sobal has proposed creating suitable mediating processes that link otherwise incompatible terminology across levels of analysis (e.g., from the societal level across to the physiological level).

Figure 9–6

UNICEF conceptual framework.

Source: Adapted from UNICEF.org. Black et al. (2008). Accessed at https://www.unicef.org/nutrition/training/2.5/4.html

The diagram depicting a multilevel framework based on maternal and child malnutrition, conceptualized by UNICEF.

Figure 9–6 Full Alternative Text

A second issue that sometimes occurs when attempting to integrate existing theories is the indiscriminate plucking of a term from one theoretical context and embedding it into another. Hempel (1966) argued that terms in theories derive their meaning from their “systemic import” within a web of theoretical relationships (p. 98). Thus, wresting a term from one theory and embedding it into another without regard for these theoretical relationships is not sound theory integration. As carefully as the spider weaves its web, so must the theorist integrate competing or parallel theories.

On the other hand, combining theories can often strengthen approaches to understanding and improving clinical care. To this end, Fassler and Naleppa (2011) adapted the theory synthesis strategy to combine practice models in the field of social work.

Summary

Because theory synthesis is based on evidence, it enables a theorist to organize and integrate a wide variety of research information on a topic of interest. In theory synthesis, sets of concepts and discrete statements are organized into an interrelated system of statements with accompanying graphic representations. Theory synthesis may incorporate information from published research literature, direct statistical information, and qualitative research. Because theory synthesis may be used for several related purposes, deciding on the specific purpose depends on the balance among the theorist’s interests, the use planned for the synthesized theory, and the amount and type of information available on a topic.

Three steps or phases are involved in theory synthesis: (1) specifying focal concepts for the synthesized theory, (2) reviewing the literature to identify factors related to the focal concepts and the relationships among these, and (3) organizing concepts and statements into an integrated and efficient representation of the phenomena of interest.

Theory synthesis allows a large amount of information to be efficiently organized. If quantitative data are involved, the use of the strategy requires some statistical sophistication of the part of the theorist. The strategy assumes an incremental approach to scientific progress.

Practice Exercises

Exercise 1

Obesity researchers, such as Hill and Peters (1998) , have argued that modern life is at odds with our evolved human regulatory systems for taking in, storing, and expending energy. Specifically, factors such as the widespread availability of energy-dense foods and growing use of energy-sparing modern conveniences have led to the rapid onset of a national obesity epidemic in the United States ( Mokdad et al., 2001 ; Mokdad et al., 1999 ). One consequence of this has been growth in the number of people who are obese. Obesity, in turn, is predicted to lead to increased rates of many of its sequelae, such as cardiovascular disease, diabetes mellitus, gastric reflux syndrome, orthopedic problems, and certain cancers.

For this exercise, develop several statements regarding the antecedents and consequences of the obesity epidemic. Based on your statements, make a diagram synthesizing these statements into a model of the “epidemic of obesity.”

When you have completed this exercise, compare your theoretical model with Figure 9–7 . Although your model may not look exactly like ours, there should be some structural similarity to it.

Figure 9–7

Model of the epidemic of obesity.

A diagram showing the model of the epidemic of obesity.

Figure 9–7 Full Alternative Text

Exercise 2

Select one of the articles in Table 9–2 . After reading a copy of that article, try to answer the following questions:

· Are the source and type of evidence that were used in the synthesis process clear? Describe what those evidence sources were.

· How clearly did the authors describe their theory synthesis process (in comparison to the steps presented in this chapter)?

· How did the authors present their final theory synthesis: in text only, as a diagram, or both?

· How would you rate the quality of the synthesized theory in relation to clarity and usefulness for the authors’ expressed purposes?