Theory Analysis

Questions to consider before you get started reading this chapter:

· Are you interested in a particular theory that might be useful in your research or practice but not sure how valid it is?

· Are you planning to use a theory in your work but need to know where its strengths and weaknesses lie?

· Are you interested in a theory but parts of it do not seem to contribute to your understanding?

Introductory Note:

If any of these issues are confronting you, theory analysis is likely the best strategy to use for resolving them. Theory analysis is a formal way to break the theory into its component parts and examine them for consistency, logic, and usability.

We have been delightedly surprised at how many theories are undergoing analysis and revision over the last several years. This is a very encouraging trend. It reveals the rapid nature of the development of the science of nursing. There are also many more middle-range theories under development. They provide the discipline with a rich source of potential knowledge about how nursing works and how effective and efficient nursing care is. We encourage researchers, advanced practice nurses, staff nurses, and students to examine any theory they intend to teach or to use in practice to be sure that it is a valid theory and is reliable in its description, explanation, prediction, and prescription or control.

Definition and Description

Theory is usually constructed to express a unique, unifying idea about a phenomenon that answers previously unanswered questions and provides new insights into the nature of the phenomenon. A theory should provide a parsimonious, precise example, or model, of the real world or the world as it is experienced. Thus, theory is defined as a set of interrelated relational statements about a phenomenon that is useful for description, explanation, prediction, and prescription or control ( Chinn & Jacobs, 1987 ; Dickoff, James, & Wiedenbach, 1968a,  1968b ;  Hardy, 1974 ;  Hempel, 1965 ;  Reynolds, 1971 ).

A theory purporting to describe, explain, or predict something should provide the reader with a clear idea of what the phenomenon is and does, what events affect it, and how it affects other phenomena. Therefore, theory analysis is the systematic examination of the theory for meaning, logical adequacy, usefulness, generality, parsimony, and testability.

In theory analysis, as in all analysis strategies, the theory is broken down into parts. Each is examined individually as it relates to every other. In addition, the theoretical structure as a whole is examined to determine such things as validity and approximation to the real world.

Purpose and Uses

Theory analysis allows you to examine both the strengths and the weaknesses of a theory. In addition, a theory analysis may determine the need for additional development or refinement of the original theory.

Theory analysis provides a systematic, objective way of examining a theory that may lead to insights and formulations previously undiscovered. This then adds to the body of knowledge in the nursing discipline. As  Popper (1965)  pointed out in a classic work, science is interested in novel ideas and interesting theories because their very novelty or interest prompts the scientist to put them to empirical test. Theory analysis offers one way of determining what needs to be put to the test and often suggests how it can be done.

A formal theory analysis is relevant only if the theory has the possibility of being useful in an educational, clinical practice, or research setting. If the theory demonstrates no potential for usefulness, then the analysis becomes a futile exercise. It has been our experience that the primary purpose for conducting a theory analysis prior to using that theory in education or clinical practice is to discover the strong points the theory offers to guide practice. One wants to be sure the theory is well supported and effective if one is to use it in practice.

However, a theory analysis for the purposes of research usually focuses on the weak points or the unsubstantiated linkages among its concepts. The reason for this distinction is that the analysis provides evidence the researcher needs to justify conducting a study concerning new or unclear relationships within the original theory.

Understanding is the main aim of analysis. To truly understand something, we must put aside our own values and biases and look objectively at the object of analysis. Because a theory analysis is both systematic and objective, it provides a way to examine the content and structure of a theory without being influenced by subjective evaluation. Leaving our personal values out of the analysis allows us to see the theory more clearly, and the original theorist’s values will become more evident.

The main aim of evaluation, on the other hand, is decision and/or action. Here, our own values and biases become important to the outcome. Evaluation of theory should only be done after a thorough analysis is made. Then, we should feel free to evaluate the theory’s potential contribution to scientific knowledge and to make judgments about its worth in establishing a basis for making decisions or taking action ( Chinn & Kramer, 2014 ;  Fawcett, 1980 ,  1989 ,  1993 ,  1995 ,  2000 ,  2005 ;  Fawcett & DeSanto-Madeya, 2013 ).

 

Procedures for Theory Analysis

The steps in theory analysis were synthesized from the works of  Popper (1961 ,  1965 ),  Reynolds (1971) ,  Hardy (1974) ,  Fawcett (1980 ,  1989 ,  2000 ), and  Chinn and Jacobs (1987) . Despite their age, these authors’ works collectively formed the existing foundation of knowledge in theory development. Without their pioneering efforts, nursing theory development would be seriously behind and this book might not exist.

There are six steps in theory analysis: (1) identify the origins of the theory, (2) examine the meaning of the theory, (3) analyze the logical adequacy of the theory, (4) determine the usefulness of the theory, (5) define the degree of generalizability and the parsimony of the theory, and (6) determine the testability of the theory. Each of these steps will first be defined briefly and then discussed in detail.

The origins of a theory refer to its initial development. The analyst investigates what prompted its development, whether the theory is inductive or deductive in form, and whether evidence exists to support or refute the theory.

The meaning ( Hardy, 1974 ) of a theory has to do with the theory’s concepts and how they relate to each other. Essentially, the meaning is reflected in the language of the theory and calls for a careful examination of the specific language used by the original theorist.

The logical adequacy ( Hardy, 1974 ) of a theory denotes the logical structure of the concepts and statements independent of their meaning. The analyst looks for any logical fallacies in the structure of the theory and examines the accuracy with which predictions can be made from the theory.

The usefulness of a theory concerns how practical and helpful the theory is to the discipline in providing a sense of understanding or predictable outcomes. A theory that provides a practitioner with realistic guides to practice so that Intervention A consistently leads to Patient Behavior B, for instance, is obviously more useful than one that does not.

Generalizability, or transferability, explains the extent to which generalizations can be made from the theory. The more widely the theory can be applied, the more generalizable it becomes.

Parsimony refers to how simply and briefly a theory can be stated while still being complete in its explanation of the phenomenon in question. Many mathematical theories are parsimonious, for example, because they offer an explanation in only a few equations. Social science theories are rarely parsimonious, on the other hand, because they deal with such complex human phenomena that they defy mathematical expression.

Testability has to do with whether the theory can be supported by empirical data. If a theory cannot generate hypotheses that can be subjected to empirical research, it is not testable.

We believe that all of these six steps are important to a complete theory analysis. Some authors disagree.  Fawcett and DeSanto-Madeya (2013)  state that the last two steps determining parsimony and testability are really related to theory evaluation. Granted, when one completes the analysis and begins to evaluate the theory, one may place heavier values on some of the steps than on others. But, if a theory has poorly defined and inconsistently used concepts, for instance, it will not be capable of test, will not have parsimony, and will not be useful. The value assigned to a theory rests primarily on what the analysis reveals, but it also reflects one’s own feelings and biases to a certain extent. This is to be expected; no scientist can ever be completely objective. We will now more thoroughly discuss each of the analysis steps.

Origins

The first step is to determine what prompted the development of the theory. Sometimes the theorist will offer an explicit explanation. Otherwise, the analyst may only be able to surmise this from the context of the discussion. Understanding the origin of a theory and the purpose for which it was developed often proves very helpful to the analyst in understanding how the theory was put together and why. Begin by reading the theory carefully, identifying the major ideas or concepts, and isolating the relational statements. In addition, find out if the theory was developed deductively (from a more general law) or inductively (from data). If the theory was developed from another theory or from some other hypothesis, it can be considered deductive in origin. It can be considered inductive in origin if observations of relationships from qualitative or quantitative data, literature, or clinical practice generated the theory. Later when determining its logical adequacy, the inductive or deductive form of origin will be important. Finally, it is often helpful to identify any underlying assumptions on which the theory is built. These underlying assumptions can be important to interpretation and when considering the usefulness of the theory. Some authors will identify their assumptions explicitly. However, in many cases you may have to determine what the assumptions are from the context and description of the theory itself.

Meaning

Examining meaning and logical adequacy is the most lengthy process in a theory analysis but also the most valuable. Meaning, in theory analysis, refers to the semantics of the theory. An analyst must examine the language used in the theory by looking at the concepts and statements within it. The steps are as follows: identify the concepts, examine their definitions and use, identify the statements, and examine the relationships among concepts as demonstrated in the statements. (This is essentially statement analysis. If you feel you need to know more about how to examine the relationships, see  Chapter11 .)

Identify Concepts

Look for the major ideas in the theory. All relevant terms that reflect those ideas should be clearly stated and defined. It is often difficult to identify the major concepts in an elaborate verbal model. Probably the best approach is to read with a pencil and paper at hand. As new terms appear, write them down with their definitions, if given. This saves time in the long run and makes it very clear where definitions are missing. If you are working electronically, either highlight the concepts and their definitions or set up a database to capture the information. In either case, be sure to note the page numbers where you found the concepts and definitions to aid your writing later.

Determine whether each concept is primitive, concrete, or abstract. As described in  Chapters 3  and  10 , primitive terms are those names for concepts that derive their meanings from common experience in the discipline and can only be defined by using examples ( Wilson, 1969 ). Concrete concepts must be directly measurable and are restricted by time and space. Abstract concepts are not limited by time or space and may not be directly measurable. Classifying the concepts in this way will aid the analyst in assessing the concrete or abstract nature of the entire theory.

Examine Definitions and Use

There are four possible options in regard to definitions: a theoretical definition, an operational definition, a descriptive definition, and no definition.

A theoretical definition uses other theoretical terms to define a concept and place it within the context of the theory but does not specify any operational rules for classifying or measuring it. A theoretical definition is usually fairly abstract and may use lower-order concepts to define higher-order ones. The most important criterion, though, is the lack of measurement specification in the definition.

A theoretical definition may provide the theorist with a way of expressing the richness of the concept within the theory and the means for classifying a phenomenon as either an example of the concept or not, but an operational definition provides the means for measuring the concept in question.

Operational definitions are useful in research but often artificially limit the concept. It is useful to the analyst, however, if both types of definitions are formulated for the major theoretical concepts. It is also very important to be sure that the operational definitions accurately reflect the theoretical definitions.

A descriptive definition, one that simply lists or describes the attributes of a concept much as in a dictionary, says nothing about the context in which the concept is used, nor does it specify operational measures. Having a descriptive definition is better than the last option, no definitions at all, but provides very limited data to the analyst. When only limited definitions are available, the analyst may find it difficult to make a truly objective analysis and equally difficult to use the theory for the purpose intended. When a theory contains only descriptive definitions or no definitions, it is often in a very early stage of development. It will be valuable if the analyst can make thoughtful suggestions about how further development should proceed.

The major concern in considering the way in which the concepts are used is with consistency of use, that is, whether or not the theorist uses the concepts consistently, as they are defined, throughout the theory. This is vital information for anyone who proposes to apply the theory. If a theorist defines a concept in one way and then subtly, or not so subtly, alters the meaning as the theory develops, then all the formulations using that concept become suspect until the ambiguity of the definition can be cleared up. Otherwise, the analyst may attempt to predict outcomes from an early statement in a theory only to find that a later statement contradicts those same outcomes.

Additional research work regarding a theory may cause changes to be made in concept definitions or even in whole sections of a theory. It is to be expected that some refinements should be made. However, when such changes are necessitated, then the initial studies using the original concepts may not be useful in the support of the theory. They may need to be repeated and the initial relational statements retested for validity using the new concept definitions.

 

Advantages and Limitations

The major advantage of theory analysis is the insight into relationships among the concepts and their linkages to each other that the strategy provides. In addition, the analysis strategy allows the theorist to see the strengths of the theory as well as its weaknesses. The theorist is then free to decide whether or not the theory is useful for practice or research or whether the theory needs additional testing and validation before use. Where a theory has untested linkages discovered through analysis, it is a spur to the theorist to test those linkages. This both strengthens the theory and adds to the body of knowledge. The major limitation of theory analysis is that analysis examines only parts and their relationship to the whole. It can expose only what is missing but cannot generate new information. In addition, theory analysis requires evaluation and criticism of supporting evidence. Where the analyst may be limited in the critical skills of research evaluation, important information regarding the soundness of a theory may be disregarded or misinterpreted. This results in a limited analysis and may yield unsatisfactory results.

Utilizing the Results of Theory Analysis

Theory analysis provides a means of systematic examination of the structure and content of theory for new insights into a phenomenon or to determine its strengths and weaknesses. But what does one do with the analysis when it is completed? The results of theory analysis can be very useful in education, practice, research, and theory development.

Theory analysis can be used very effectively in the classroom. We have used it successfully to teach students how to examine theories critically. Assigning a theory to a group of students to analyze and then having them report to the class often generates meaningful discussion and debate among the students. Another use of the results of theory analysis is in preparing conceptual frameworks for students’ papers. Students have found theory analysis an excellent way to define gaps or inconsistencies in the knowledge about some phenomenon in which they are interested. Yet a third use of the results of theory analysis is in faculty development. As we proposed in the statement analysis chapter, having faculty discussions related to the results of theory analysis on a single topic of interest may generate many useful ideas to be used in curriculum design or in generating faculty research.

The results of theory analysis may provide the clinician with knowledge about the soundness of any theory being considered for adoption in practice. In addition, knowing which theoretical relationships are well supported provides guidelines for the choice of appropriate interventions and some indications of their efficacy. Given the current emphasis on evidence-based practice, the results of theory analysis will assist clinicians to determine whether or not a particular theory might be appropriate for their practice.

Theory analysis is particularly helpful in research because it provides a clear idea of the form and structure of the theory in addition to the relevance of content, and inconsistencies and gaps present. The missing links or inconsistencies are fruitful sources of new research ideas. They also point to the next hypotheses that need to be tested. In theory development, the inconsistencies, gaps, and missing links provide the stimulus to the theorist to keep on working. In addition, the results provide clues to the obvious next steps to be taken to refine the theory.

Summary

Theory analysis consists of systematically examining a theory for its origins, meaning, logical adequacy, usefulness, generalizability/parsimony, and testability. Each of these six steps stands alone in a theory analysis and yet each is related to the other. This paradoxical relationship is generated by the act of analysis itself. To do a thorough analysis, one must consider each of the steps, giving them all careful attention. Yet, the results of each of the steps are interdependent on the results of the others.

Like many of the strategies presented in this book, the steps of theory analysis are also iterative. That is, the analyst must go back and forth among the steps during the analysis in addition to moving sequentially through them.

For instance, the logical adequacy, usefulness, generalizability, parsimony, and testability of a theory will be affected if concepts are undefined and statements are only definitional in nature. If the meaning is adequately handled but the logical structure is missing or fallacious, then usefulness, generalizability, parsimony, and testability will be severely limited. If a theory is untestable and fails to generate hypotheses, it is not useful, generalizable, parsimonious, or particularly meaningful. So each step is independent and yet interdependent as well. It is this interdependence that makes the strategy so useful in theory construction. The analysis strategy provides a mechanism for determining the strengths and weaknesses of the theory prior to using it as a guide to practice or in research.

With theory analysis, linkages that have not been examined become obvious. This, in turn, should lead to additional testing, thus adding support to the theory or pointing out where modifications need to be made. The whole process is complex but the results are well worth the effort. It frequently leads to new insights about the theory being examined, thus adding to the body of knowledge.

Theory analysis, like all analysis strategies, is rigorous and takes time. It is also limited in that it does not generate new information outside the confines of the theory.

Finally, by pointing out where additional theoretical work is needed, theory analysis is a way of promoting additional theory construction. When pointing out where additional work is needed, however, it is helpful to remember that comparing anything to the ideal tends to stifle development ( Zetterberg, 1965 ). The best approach is to compare the analyzed theory to similar theories at the same stage of development. To what extent does this theory meet the criteria as compared to others similar to it? Because most theories are generated in the context of discovery, it is more helpful to be encouraging than to be severely critical.

Practice Exercise 1

Read  Younger’s (1991)  “A Theory of Mastery.” It is a psychosocial nursing theory and is substantially middle range in focus. It is therefore suitable to use for your practice exercise.

Conduct a theory analysis. When you have completed your own analysis, compare it to the one below. Keep in mind that your analysis will probably be more comprehensive than the one we have included here. Our intention is to give you only clues as to the major strengths and weaknesses of the theory. The example we have provided is merely a sample to demonstrate each step. Remember that although one person’s analysis may differ somewhat from another’s, they may both be equally valid.

Origins

Younger developed the theory of mastery in an effort to explain “how individuals who experience illness or other stressful health conditions and enter into a state of stress may emerge, not demoralized and vulnerable, but healthy and possibly stronger” (p. 77). In addition, she states that a second purpose was to explicate the theory base for the new instrument she is developing. The theory appears to be a deductive synthesis based on various philosophical and empirical works of others, but Younger is not explicit about whether it is a deductive system.

Meaning

1. The major concepts identified by Younger in addition to mastery are

· certainty

· change

· acceptance

· growth

In addition to the five major concepts, Younger mentions several related concepts. These are coping, adjustment, efficacy, resilience, hardiness, and control. In each case, she attempts to identify how the related concepts are different from mastery.

Not identified as a part of the theory or related concepts but discussed in the section on the definition of mastery are such concepts as quality of life, bonds of connectedness with others, stress, self-curing, self-caring, hypervigilance, compulsive repetition, sleep disturbance, fearfulness, passivity, and alienation. These concepts are part of the discussions about antecedents and consequences of mastery or the lack of achievement of mastery.

2. The major concepts certainty, change, acceptance, growth, and mastery are all carefully defined. Indeed, it appears from the discussion that all five have been subjected to concept analysis. As a result, these five concepts have excellent descriptive and theoretical definitions that are used consistently throughout the piece. There are no operational definitions given here. However, it appears that these may be forthcoming as one of the purposes of the article was to give a theory base for a new instrument.

3. The relational statements are harder to come by in this work than are the concepts. Each concept in the theory is described as a process that must be completed before mastery can be achieved. Below are the statements Younger makes explicitly (mainly on p. 87) about the relationships among the concepts:

c. A critical dose of certainty is necessary for change and acceptance.

c. Change and acceptance are necessary for growth to occur.

c. Change, acceptance, and growth feed back to increase certainty.

c. Change is sufficient for growth.

c. Change and acceptance are dynamically interrelated.

c. Acceptance, qualified, is sufficient for growth.

c. Stress initiates the process of mastery.

c. Mastery affects quality of life and wellness.

Each of the statements indicates a positive relationship. The boundaries are moderately wide. The theory is abstract but is sufficiently circumscribed to be considered a middle-range theory.

The statements are all made toward the end of the article and are not used again once they are made. Therefore, no judgment can be made about the degree to which the author uses them consistently. One must look to later works to make this judgment.

There is no empirical support given for any of the statements. There is some philosophical and historical background given as justification for them but no testing has been done as yet using this new theory.

Logical Adequacy

1. It is possible to make predictions independent of content. The matrix shown in  Figure 12–4  demonstrates where the predictions are specified and where they are implied. Some of the major concepts of the theory are included here, although there are several other relevant concepts mentioned in the narrative.

Figure 12–4

Matrix of concepts in theory of mastery.

Figure 12–4 Full Alternative Text

· certainty (CT), acceptance (A)

· stress (S), wellness (W)

· change (CG), growth (G)

· quality of life (QOL)

Obviously, there are many implied, but unspecified, relationships in the theory. Some of the implied relationships are supported in other research in the field but are not indicated in Younger’s article. Readers may also be interested in the analysis of the theory of mastery when it was merged with the theory of organismic integration ( Fearon-Lynch & Stover, 2015 ).

2. We did not locate any direct tests of the theory and so agreement of scientists is probable but not confirmed by the use of the theory in others’ work to date. However, the theory was successfully applied to development of the Mastery of Stress instrument, which measures the theory concepts of certainty, change, acceptance, and growth ( Younger, 1993 ). Although the theory is still untested, it is capable of test. Therefore, this criterion is met in principle but not in fact.

3. The theory makes sense as it is built on several sound philosophical and scientific traditions. It is appealing in its simplicity. However, it is a bit redundant of other similar theories. It is very close indeed to various theories of self-efficacy for instance.

4. There are no logical fallacies, although there are some logical relationships that as yet go unspecified and are only implied in the theory.

Usefulness

The theory has the potential to be useful. Even though it is somewhat similar to other theories of coping and self-efficacy, it is specifically focused on threats to health as a primary stressor. For this reason alone, it may prove very helpful to practitioners and researchers in nursing.

Generalizability or Transferability

The theory has relatively wide boundaries, but so far has not been tested or verified through research. Certainly it would apply to anyone experiencing stress, particularly health-related stress. Its potential for explanatory power is excellent.

Parsimony

The theory is relatively new and therefore is probably too parsimonious. It seems that there is a natural evolution or progression of new theories such that they often start small and parsimonious, grow substantially during the justification phases, and then are reduced to smaller and more parsimonious models over time. This theory may undergo substantial changes and revisions before it is considered to be adequately developed.

Testability

Given appropriate, reliable, and valid instruments to measure the concepts in this theory as they are defined, the theory is testable. The concepts are very carefully defined, so any instruments being considered for testing them should be examined carefully to be sure that they reflect the defining attributes of each of the c

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.

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].)

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:  mrhrrs@med.umich.edu

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.

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.

Source: BLALOCK JR, THEORY CONSTRUCTION FROM VERBAL TO MATHEMATICAL FORMULATIONS, 1st Ed., ©1969. Reprinted and Electronically reproduced by permission of Pearson Education, Inc., New York, NY.

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

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:  mrhrrs@med.umich.edu

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.

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.

Source: BLALOCK JR, THEORY CONSTRUCTION FROM VERBAL TO MATHEMATICAL FORMULATIONS, 1st Ed., ©1969. Reprinted and Electronically reproduced by permission of Pearson Education, Inc., New York, NY.

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

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.

Source: Permission granted by the Institute for Social Research of the University of Michigan to reproduce Figure 2–1 from Caplan et al. (1976). Copyright 1976 by the University of Michigan.

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

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.

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?