To encourage dissemination of the RAMESES publication standards, this article is co-published in the Journal of Advanced Nursing and is freely accessible on Wiley Online Library ( ). We hope that these standards will act as a resource that will contribute to improving the reporting of meta-narrative reviews. Meta-narrative review is a relatively new method for evidence synthesis and as experience and methodological developments occur, we anticipate that these standards will evolve to reflect further theoretical and methodological developments. For each item we have included an explanation for why it is important and guidance on how it might be reported. This project used multiple sources to draw together evidence and expertise in meta-narrative reviews. Within three rounds this panel had reached consensus on 20 key publication standards, with an overall response rate of 90%. Through analysis and discussion within the project team, we summarized the published literature, and common questions and challenges into briefing materials for the Delphi panel, comprising 33 members. We identified nine published meta-narrative reviews, provided real-time support to four ongoing reviews and captured questions raised in the RAMESES discussion list. ![]() We (a) collated and summarized existing literature on the principles of good practice in meta-narrative reviews (b) considered the extent to which these principles had been followed by published reviews, thereby identifying how rigor may be lost and how existing methods could be improved (c) used a three-round online Delphi method with an interdisciplinary panel of national and international experts in evidence synthesis, meta-narrative reviews, policy and/or publishing to produce and iteratively refine a draft set of methodological steps and publication standards (d) provided real-time support to ongoing meta-narrative reviews and the open-access RAMESES online discussion list so as to capture problems and questions as they arose and (e) synthesized expert input, evidence review and real-time problem analysis into a definitive set of standards. The project's aim is to produce preliminary publication standards for meta-narrative reviews. ![]() This publication standard was developed as part of the RAMESES (Realist And MEta-narrative Evidence Syntheses: Evolving Standards) project. No previous publication standards exist for the reporting of meta-narrative reviews. A meta-narrative review seeks to illuminate a heterogeneous topic area by highlighting the contrasting and complementary ways in which researchers have studied the same or a similar topic. Internet health literacy online health information patient education quality systematic review.Meta-narrative review is one of an emerging menu of new approaches to qualitative and mixed-method systematic review. The quality of online health information requires significant improvement which should be a mandate for policymakers and private and public organizations. Therefore, the Internet at the present time does not provide reliable health information for laypersons. This comprehensive systematic review demonstrated suboptimal quality of online health information. Quality varied by affiliation (governmental was higher than academic, which was higher than other media sources) and by health specialty (likely higher in internal medicine and anesthesiology). Only 18% of websites were HON Code certified. Using DISCERN, none of the websites received a category of excellent in quality, 37-79% were rated as good, and the rest were rated as poor quality. ![]() Out of 3393 references, we included 153 cross-sectional studies evaluating 11,785 websites using 14 quality assessment tools. The NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the methodological quality of the included studies. Descriptive statistics were used to synthesize data. Eleven databases and Internet searches were performed for relevant studies. The systematic review is based on a pre-established protocol and is reported according to the PRISMA statement. ![]() The purpose of this systematic review was to evaluate the overall quality of online health information targeting patients and the general public. It is crucial that this information is reliable and accurate. The Internet has become a leading source of health information accessed by patients and the general public.
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