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Background: Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design.

Methods: We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed.

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Results: Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting.

Conclusions: The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

Reviews of qualitative studies allow for deeper understanding of concepts and findings beyond the single qualitative studies. Concerns on study reporting quality led to the publication of the COREQ-guidelines for qualitative studies in 2007, followed by the ENTREQ-guidelines for qualitative reviews in 2012. The aim of this meta-review is to: 1) investigate the uptake of the COREQ- and ENTREQ- checklists in qualitative reviews; and 2) compare the quality of reporting of the primary qualitative studies included within these reviews prior- and post COREQ-publication.

Since the publication of both checklists, a large number of reviews of qualitative studies have been published on a wide array of topics. Though it has been argued that reporting checklists for qualitative research would not necessarily result in better research [10], and neither checklists were developed following the now accepted methods for developing reporting standards [11], both the COREQ and the ENTREQ are now included in the EQUATOR network [12], and are required by many clinical journals for submission; the high number of citations (respectively over 5.600 and 700 in Web of Science) indeed indicate usage. To this date however, no studies have been conducted to explore the uptake of the COREQ and the ENTREQ in reviews, or the effect on the reporting quality, which for guidelines in other research methods has been the case [13,14,15,16,17,18]. Therefore, the aim of this meta-review is twofold: 1) to investigate the uptake of the COREQ and ENTREQ checklists in reviews of primary qualitative studies, and 2) to compare the quality of reporting of the original qualitative studies included in these reviews prior- and post-publication of the COREQ.

Studies were eligible for inclusion if they were 1) a review and 2) contained qualitative or mixed-methods research approaches. We created four datasets: reviews using the 1) COREQ, 2) ENTREQ, 3) both the COREQ and ENTREQ and 4) neither the COREQ or ENTREQ. To be included in the respective datasets, reviews using the COREQ were required to appraise their included studies with this checklist; those using the ENTREQ were required to mention adherence to it. Reviews were imported in Endnote (version 9.1) and duplicates were removed. One author (YdJ) screened the titles for obvious irrelevance. Two authors (YdJ and JM) independently selected studies for eligibility based on abstract and full-text; conflicts were resolved after discussion. The selection procedure is explained in more detail in the supplement, section A.

The total number of reviews on qualitative studies increased exponentially over time (Fig. 3A). Until the publication of the COREQ in September 2007, only 31 reviews were identified; this number increased to 141 at the publication of the ENTREQ in November 2012. Of the total of 1.664 reviews published since the COREQ publication, 284 (17%) used the COREQ to assess the reporting quality of their included studies, this proportion remaining stable over time (Fig. 3B and C). For the ENTREQ, 431 reviews (28%) used this checklist out of the 1.554 reviews published since its publication, with this proportion increasing over time (Fig. 3B and D).

Our study highlights several points that may further improve the quality of reporting. First, surprisingly, almost a fifth of the reviews that used the COREQ did not present the results of their quality appraisal. Given that four out of the 21 ENTREQ-items, but also four of the 27 PRISMA-items concern study appraisal, at least reporting appraisal results should be the minimum. Ideally however, to facilitate meta-reviews of this kind, and to increase transparency and reproducibility, reporting appraisal results per individual study at the level of signalling questions is essential. Next, though we did not explore the characteristics of the authors of our included reviews, it can reasonably be assumed that the exponential publication trend may be explained by an increasing number of unique authors. Whether or not articles should be scored instead of appraised in a descriptive way remains open for discussion. However, the use of these checklists might be beneficial for new or inexperienced authors designing a qualitative study: checklists may guide those unfamiliar with qualitative research with hints and directions to avoid commonly made mistakes [5, 10, 27, 35]. The same holds true for reviewers assessing a qualitative review for publication, particularly if the reviewer has content expertise but not methodological expertise. A final implication concerns the poor reporting of several signalling questions of the COREQ. Whether or not these items are intentionally or unintentionally underreported, our study clearly points towards items that might either actually improve qualitative research if reported, or be left out from the checklist in a possible later or updated version. By providing this information on a large number of qualitative studies, our study might thus facilitate the ongoing discussions by providing factual data on both the use of checklists, and the completeness of reporting.

The list of 19 guidelines recommended by the EQUATOR Network for presenting qualitative articles includes: 1) Standards for reporting qualitative research: a synthesis of recommendations, Enhancing transparency in reporting the synthesis of qualitative research; 2) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups, among others and other types of studies with specific populations and characteristics such as: 3) Minimum data elements that should be reported in chronic fatigue syndrome; 4) Reporting guidelines for implementation research on nurturing care interventions designed to promote early childhood development; 5) Evolving guidelines for publication of qualitative research studies in psychology and related fields; among others.(66. EQUATOR Network. Enhancing the QUAlity and Transparency of health Research (EQUATOR Network) [Internet]. EQUATOR Network. 2019. [cited 2020 Mai 20]. Available from: -network.org/

-network.org/... )

The individualized analysis of checklist items revealed gaps and advances in the quality of the research reports as well as in the peer review process of the journal. The maturation of nursing as a research field and the increase in the number of stricto sensu graduate courses imposes on the journals in the field the adoption of procedures to improve the selection of articles. Thus, using checklists for preparation and presentation of articles is now recommended for authors, reviewers and editorial teams, who must analyze whether the items in these guidelines were in fact met.

The second domain refers to the methodological aspects of the study. The results showed differences before and after the adoption of checklist by the journal. The percentage of items in this domain attended was observed: research team (50%, in both periods), study design (60.0% - 66.7%) and analysis and findings (55.6% - 66.7%). However, some items related to presentation of articles were not described by the authors: report of refusal to participate, need to repeat the interview and submission of the interview for approval by the interviewee after transcription, in addition to the criteria for interrupting data collection.

Regarding theoretical and methodological aspects, information is requested on the technical procedures for data analysis and/or the theoretical contribution used. In the first and second periods, 92.0% and 94.2%, respectively. The progress observed after the adoption of checklist accompanied the non-observance of information essential to studies, such as theoretical-philosophical support and data analysis techniques. For both, gaps were found in the description, being presented in only five (6.5%) of the analyzed articles.

The recommendation to use guidelines to present research reports to editorial teams of scientific journals aims at increasing the quality of articles published, as in the COREQ checklist. The presentation of the validated translation into Brazilian Portuguese offers an additional resource for Brazilian researchers and journal editors to qualify their production of scientific articles. The objectives of the study were achieved, since the translation of COREQ into Brazilian Portuguese was considered adequate, obtaining 99% agreement of its content by judges. When analyzing COREQ use by the journal, it is concluded that there is a statistically significant difference when comparing the period before and after the use of COREQ regarding Identification of the authors who conducted the research; Presentation of the activity/occupation of authors; Information about the time spent to conduct the interviews; Information on returning interviews to participants for comments and/or correction; and Presentation of the coding tree description, as well as distinction in the medians of observance of the domains and of COREQ in full. 2351a5e196