evidence-synthesis

---
name: evidence-synthesis
description: Conduct a rigorous rapid evidence assessment or systematic-lite literature review for MEL/SRHR questions. Use when Ane asks for "evidence review", "literature review", "evidence synthesis", "REA", "what does the evidence say", "what do we know about", or similar. Produces a structured brief with question framing, method, findings by theme, confidence grading, and implications for programme or evaluation design. Does not invent citations.
---

# Evidence Synthesis

Rapid evidence assessment without shortcuts that collapse confidence. Every finding carries a source and a confidence grade. Gaps are named, not hidden.

## When to use

Trigger for evidence review work: programme design questions, evaluation framing, policy briefs, funder questions about what works, contribution analysis needing prior-evidence assembly.

Do not trigger for news scans, stakeholder mapping, or quick factual lookups. Those are different tasks.

## Required inputs

Ask in one batch. The first two are required.

1. **Question**: what Ane needs the evidence to answer, as a specific question (required)
2. **Purpose**: programme design, evaluation framing, policy advocacy, donor response, academic input (required; shapes depth and format)
3. **Scope constraints**: geography, population, intervention type, time range (optional; will default if missing)
4. **Sources Ane trusts or distrusts**: organisations, journals, or author groups to prioritise or treat cautiously (optional)
5. **Timeline**: how much time Ane has — determines whether rapid (2 hours), standard (1-2 days), or rigorous (1-2 weeks) synthesis (default: rapid)

## Method

### Step 1 — frame the question

Use the framework that fits:
- **PICO** for intervention-effectiveness questions: Population, Intervention, Comparison, Outcome
- **SPIDER** for qualitative or mixed-method questions: Sample, Phenomenon of Interest, Design, Evaluation, Research type
- **SPICE** for service evaluation questions: Setting, Perspective, Intervention, Comparison, Evaluation

Show the frame explicitly before searching.

### Step 2 — define inclusion and exclusion criteria

For rapid synthesis: minimum criteria are population, intervention or phenomenon, outcome, timeframe (default last 10 years), language, study type.

State each criterion. Explain any exclusion decision that would surprise a peer reviewer.

### Step 3 — select synthesis approach

Choose one, name the choice:
- **Thematic synthesis**: when findings group into recurring themes (Thomas & Harden 2008)
- **Narrative synthesis**: when studies are too heterogeneous to pool but a structured summary is needed (Popay et al. 2006)
- **Realist synthesis**: when the question is "what works, for whom, in what circumstances, and why" (Pawson et al. 2005)
- **Meta-analysis**: only when effect sizes from comparable quantitative studies can be pooled. Usually out of scope for rapid work.

### Step 4 — search and screen

If Ane provides sources, use them. If not, ask where to search:
- Grey literature: WHO, UNFPA, UNAIDS, IPPF, Cochrane, 3ie, relevant IGOs
- Academic: PubMed, Scopus, Global Health Database, Cochrane
- Ane's resource library: `3. Ane's RESURSE/` subfolders matching the topic

Never invent citations. If a search cannot be conducted in this session, ask Ane to paste the top sources or point to the library subfolder.

### Step 5 — extract findings

For each source, extract:
- Full citation (author, year, title, journal or publisher, DOI if available)
- Setting and population
- Intervention or phenomenon studied
- Key finding, in the source's own framing
- Study design and sample size
- Confidence flags: low sample, non-random, self-report, author conflicts, funder bias

### Step 6 — grade confidence

For each finding or theme, grade using a GRADE-adjacent scheme:
- **High**: consistent findings across multiple rigorous studies; mechanism understood
- **Moderate**: consistent findings but with methodological limitations or narrow context
- **Low**: few studies, or conflicting findings, or serious bias risk
- **Very low**: single source or methodologically weak studies only

Explain the grade in one clause. No inflation.

### Step 7 — apply the relevant lenses

For SRHR or gender-related questions, apply:
- **Feminist lens**: whose voices shaped the research questions? Are women and girls subjects of the research or objects? Cornwall & Rivas (2015) framing.
- **Decolonial lens**: where was the research conducted, who funded it, whose knowledge is centred? Chilisa (2020).
- **Intersectionality**: does the evidence disaggregate to current standard (age, gender identity, disability, geography)? Flag when it does not.

### Step 8 — identify gaps

Name what the evidence does not answer. Use `⚠️ Evidence gap:` format. Distinguish:
- Gaps in research (the study has not been done)
- Gaps in context (research exists but not from relevant settings)
- Gaps in population (research exists but excludes the target group)
- Gaps in method (research exists but with weak designs only)

## Output structure

Produce an evidence brief with these sections:

1. **Question** — as framed in Step 1, with the framework named
2. **Method** — inclusion criteria, search approach, synthesis approach, limitations of the rapid format
3. **Key findings** — organised by theme. Each finding:
   - One-sentence statement
   - Confidence grade
   - Supporting sources (author year)
4. **Lens observations** — feminist, decolonial, intersectional notes
5. **Implications** — what this means for the stated purpose (programme design, evaluation, etc.). Be concrete.
6. **Evidence gaps** — `⚠️ Evidence gap:` entries
7. **Sources** — full citations, alphabetical by first author

## Citation requirements

Every finding cites at least one source. Method references:
- Thomas & Harden (2008) for thematic synthesis
- Popay et al. (2006) for narrative synthesis
- Pawson et al. (2005) for realist synthesis
- GRADE Working Group for confidence grading

For SRHR-specific framings:
- Cornwall & Rivas (2015), Chilisa (2020) for lenses
- WHO (2010) WHO/RHR/10.12 + UNFPA HRBAP + UNFPA SoWP 2021/2024/2025 for rights-based framing

## Writing rules

Follow CLAUDE.md house style. In this skill specifically:
- Never summarise a finding in language stronger than the source supports.
- Never present contested findings as settled.
- Never use "evidence shows" without a specific citation.
- Flag when a finding is contested, and by whom.

## Limitations

Rapid syntheses are not systematic reviews. State this limitation in the Method section. Do not invent effect sizes or pool findings across incompatible studies. If Ane needs a systematic review, route to a proper review protocol (PRISMA) rather than inflating rapid-review scope.

## Edit-preservation protocol

If Ane references an existing output by path and asks to improve, iterate, or expand it, the protocol activates. Read the file first, edit scope-bounded via the Edit tool, preserve out-of-scope content byte-identical, and return the EDIT-PRESERVATION DELIVERY summary.

Apply mel_wiki/wiki/concepts/edit-preservation-protocol.md when target file exists.