"Distorted into clarity": A methodological case study illustrating the paradox of systematic review

Systematic review is typically viewed in the health sciences as the most objective-that is, rigorous, transparent, and reproducible-method for summarizing the results of research. Yet, recent scholarship has shown systematic review to involve feats of interpretation producing less certain, albeit valuable, results. We found this to be the case when we tried to overcome the resistance to synthesis of a set of qualitative and quantitative findings on stigma in HIV-positive women. These findings were difficult to combine largely because of fuzzy conceptualizations of stigma and the volume of unique quantitative findings. Our encounter with findings resistant to synthesis heightened our awareness of the extent to which all systematic reviews are accomplished by practices that paradoxically "distort [research findings] into clarity."