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Conducting a Literature Review

Benefits of conducting a literature review.

• Steps in Conducting a Literature Review
• Summary of the Process
• Additional Resources
• Literature Review Tutorial by American University Library
• The Literature Review: A Few Tips On Conducting It by University of Toronto
• Write a Literature Review by UC Santa Cruz University Library

While there might be many reasons for conducting a literature review, following are four key outcomes of doing the review.

Assessment of the current state of research on a topic . This is probably the most obvious value of the literature review. Once a researcher has determined an area to work with for a research project, a search of relevant information sources will help determine what is already known about the topic and how extensively the topic has already been researched.

Identification of the experts on a particular topic . One of the additional benefits derived from doing the literature review is that it will quickly reveal which researchers have written the most on a particular topic and are, therefore, probably the experts on the topic. Someone who has written twenty articles on a topic or on related topics is more than likely more knowledgeable than someone who has written a single article. This same writer will likely turn up as a reference in most of the other articles written on the same topic. From the number of articles written by the author and the number of times the writer has been cited by other authors, a researcher will be able to assume that the particular author is an expert in the area and, thus, a key resource for consultation in the current research to be undertaken.

Identification of key questions about a topic that need further research . In many cases a researcher may discover new angles that need further exploration by reviewing what has already been written on a topic. For example, research may suggest that listening to music while studying might lead to better retention of ideas, but the research might not have assessed whether a particular style of music is more beneficial than another. A researcher who is interested in pursuing this topic would then do well to follow up existing studies with a new study, based on previous research, that tries to identify which styles of music are most beneficial to retention.

Determination of methodologies used in past studies of the same or similar topics.  It is often useful to review the types of studies that previous researchers have launched as a means of determining what approaches might be of most benefit in further developing a topic. By the same token, a review of previously conducted studies might lend itself to researchers determining a new angle for approaching research.

Upon completion of the literature review, a researcher should have a solid foundation of knowledge in the area and a good feel for the direction any new research should take. Should any additional questions arise during the course of the research, the researcher will know which experts to consult in order to quickly clear up those questions.

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• Literature Review: The What, Why and How-to Guide
• Introduction

Literature Review: The What, Why and How-to Guide — Introduction

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings

What are Literature Reviews?

So, what is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries." Taylor, D.  The literature review: A few tips on conducting it . University of Toronto Health Sciences Writing Centre.

Goals of Literature Reviews

What are the goals of creating a Literature Review?  A literature could be written to accomplish different aims:

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

Baumeister, R. F., & Leary, M. R. (1997). Writing narrative literature reviews .  Review of General Psychology , 1 (3), 311-320.

What kinds of sources require a Literature Review?

• A research paper assigned in a course
• A thesis or dissertation
• A grant proposal
• An article intended for publication in a journal

All these instances require you to collect what has been written about your research topic so that you can demonstrate how your own research sheds new light on the topic.

Types of Literature Reviews

What kinds of literature reviews are written?

Narrative review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.

• Example : Predictors and Outcomes of U.S. Quality Maternity Leave: A Review and Conceptual Framework:  10.1177/08948453211037398  

Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L. K. (2013). Research in Communication Sciences and Disorders . Plural Publishing.

• Example : The effect of leave policies on increasing fertility: a systematic review:  10.1057/s41599-022-01270-w

Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M. C., & Ilardi, S. S. (2003). Handbook of Research Methods in Clinical Psychology . Blackwell Publishing.

• Example : Employment Instability and Fertility in Europe: A Meta-Analysis:  10.1215/00703370-9164737

Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). Qualitative meta-synthesis: A question of dialoguing with texts .  Journal of Advanced Nursing , 53 (3), 311-318.

• Example : Women’s perspectives on career successes and barriers: A qualitative meta-synthesis:  10.1177/05390184221113735

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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Conducting a literature review: why do a literature review, why do a literature review.

• How To Find "The Literature"
• Found it -- Now What?

Besides the obvious reason for students -- because it is assigned! -- a literature review helps you explore the research that has come before you, to see how your research question has (or has not) already been addressed.

You identify:

• core research in the field
• experts in the subject area
• methodology you may want to use (or avoid)
• gaps in knowledge -- or where your research would fit in

It Also Helps You:

• Publish and share your findings
• Justify requests for grants and other funding
• Identify best practices to inform practice
• Set wider context for a program evaluation
• Compile information to support community organizing

Great brief overview, from NCSU

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The purpose of a literature review is to collect relevant, timely research on your chosen topic, and synthesize it into a cohesive summary of existing knowledge in the field. This then prepares you for making your own argument on that topic, or for conducting your own original research.

Depending on your field of study, literature reviews can take different forms. Some disciplines require that you synthesize your sources topically, organizing your paragraphs according to how your different sources discuss similar topics. Other disciplines require that you discuss each source in individual paragraphs, covering various aspects in that single article, chapter, or book.

Within your review of a given source, you can cover many different aspects, including (if a research study) the purpose, scope, methods, results, any discussion points, limitations, and implications for future research. Make sure you know which model your professor expects you to follow when writing your own literature reviews.

Tip : Literature reviews may or may not be a graded component of your class or major assignment, but even if it is not, it is a good idea to draft one so that you know the current conversations taking place on your chosen topic. It can better prepare you to write your own, unique argument.

Benefits of Literature Reviews

• Literature reviews allow you to gain familiarity with the current knowledge in your chosen field, as well as the boundaries and limitations of that field.
• Literature reviews also help you to gain an understanding of the theory(ies) driving the field, allowing you to place your research question into context.
• Literature reviews provide an opportunity for you to see and even evaluate successful and unsuccessful assessment and research methods in your field.
• Literature reviews prevent you from duplicating the same information as others writing in your field, allowing you to find your own, unique approach to your topic.
• Literature reviews give you familiarity with the knowledge in your field, giving you the chance to analyze the significance of your additional research.

Choosing Your Sources

When selecting your sources to compile your literature review, make sure you follow these guidelines to ensure you are working with the strongest, most appropriate sources possible.

Topically Relevant

Find sources within the scope of your topic

Appropriately Aged

Find sources that are not too old for your assignment

Find sources whose authors have authority on your topic

Appropriately “Published”

Find sources that meet your instructor’s guidelines (academic, professional, print, etc.)

Tip:  Treat your professors and librarians as experts you can turn to for advice on how to locate sources. They are a valuable asset to you, so take advantage of them!

Organizing Your Literature Review

Synthesizing topically.

Some assignments require discussing your sources together, in paragraphs organized according to shared topics between them.

For example, in a literature review covering current conversations on Alison Bechdel’s  Fun Home , authors may discuss various topics including:

• her graphic style
• her allusions to various literary texts
• her story’s implications regarding LGBT experiences in 20 th  century America.

In this case, you would cluster your sources on these three topics. One paragraph would cover how the sources you collected dealt with Bechdel’s graphic style. Another, her allusions. A third, her implications.

Each of these paragraphs would discuss how the sources you found treated these topics in connection to one another. Basically, you compare and contrast how your sources discuss similar issues and points.

To determine these shared topics, examine aspects including:

• Definition of terms
• Common ground
• Issues that divide
• Rhetorical context

Summarizing Individually

Depending on the assignment, your professor may prefer that you discuss each source in your literature review individually (in their own, separate paragraphs or sections). Your professor may give you specific guidelines as far as what to cover in these paragraphs/sections.

If, for instance, your sources are all primary research studies, here are some aspects to consider covering:

• Participants
• Limitations
• Implications
• Significance

Each section of your literature review, in this case, will identify all of these elements for each individual article.

You may or may not need to separate your information into multiple paragraphs for each source. If you do, using proper headings in the appropriate citation style (APA, MLA, etc.) will help keep you organized.

If you are writing a literature review as part of a larger assignment, you generally do not need an introduction and/or conclusion, because it is embedded within the context of your larger paper.

If, however, your literature review is a standalone assignment, it is a good idea to include some sort of introduction and conclusion to provide your reader with context regarding your topic, purpose, and any relevant implications or further questions. Make sure you know what your professor is expecting for your literature review’s content.

Typically, a literature review concludes with a full bibliography of your included sources. Make sure you use the style guide required by your professor for this assignment.

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• Steps in Conducting a Literature Review

What is a literature review?

A literature review is an integrated analysis -- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.  That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.

A literature review may be a stand alone work or the introduction to a larger research paper, depending on the assignment.  Rely heavily on the guidelines your instructor has given you.

Why is it important?

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Discovers relationships between research studies/ideas.
• Identifies major themes, concepts, and researchers on a topic.
• Identifies critical gaps and points of disagreement.
• Discusses further research questions that logically come out of the previous studies.

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

Your literature review should be guided by your central research question.  The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

• Make sure your research question is not too broad or too narrow.  Is it manageable?
• Begin writing down terms that are related to your question. These will be useful for searches later.
• If you have the opportunity, discuss your topic with your professor and your class mates.

2. Decide on the scope of your review

How many studies do you need to look at? How comprehensive should it be? How many years should it cover? 

• This may depend on your assignment.  How many sources does the assignment require?

3. Select the databases you will use to conduct your searches.

Make a list of the databases you will search. 

Where to find databases:

• use the tabs on this guide
• Find other databases in the Nursing Information Resources web page
• More on the Medical Library web page
• ... and more on the Yale University Library web page

4. Conduct your searches to find the evidence. Keep track of your searches.

• Use the key words in your question, as well as synonyms for those words, as terms in your search. Use the database tutorials for help.
• Save the searches in the databases. This saves time when you want to redo, or modify, the searches. It is also helpful to use as a guide is the searches are not finding any useful results.
• Review the abstracts of research studies carefully. This will save you time.
• Use the bibliographies and references of research studies you find to locate others.
• Check with your professor, or a subject expert in the field, if you are missing any key works in the field.
• Ask your librarian for help at any time.
• Use a citation manager, such as EndNote as the repository for your citations. See the EndNote tutorials for help.

Review the literature

Some questions to help you analyze the research:

• What was the research question of the study you are reviewing? What were the authors trying to discover?
• Was the research funded by a source that could influence the findings?
• What were the research methodologies? Analyze its literature review, the samples and variables used, the results, and the conclusions.
• Does the research seem to be complete? Could it have been conducted more soundly? What further questions does it raise?
• If there are conflicting studies, why do you think that is?
• How are the authors viewed in the field? Has this study been cited? If so, how has it been analyzed?

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Literature Reviews

• What is a literature review?
• Steps in the Literature Review Process
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
• Librarian Support

What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

• Provide a comprehensive and updated review of the literature;
• Explain why this review has taken place;
• Articulate a position or hypothesis;
• Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

• Demonstrate how a study fills a gap in research
• Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

• Organizes or describes a topic
• Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

• It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
• It may be too focused. Some niche studies may miss the bigger picture.
• It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
• It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

Carolyn Cunningham : Human Development & Family Sciences, Psychology, Sociology

Larayne Dallas : Engineering

Janelle Hedstrom : Special Education, Curriculum & Instruction, Ed Leadership & Policy ​

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

For help in other subject areas, please see the guide to library specialists by subject .

Periodically, UT Libraries runs a workshop covering the basics and library support for literature reviews. While we try to offer these once per academic year, we find providing the recording to be helpful to community members who have missed the session. Following is the most recent recording of the workshop, Conducting a Literature Review. To view the recording, a UT login is required.

• October 26, 2022 recording
• Last Updated: Oct 26, 2022 2:49 PM
• URL: https://guides.lib.utexas.edu/literaturereviews

How To Write An A-Grade Literature Review

3 straightforward steps (with examples) + free template.

By: Derek Jansen (MBA) | Expert Reviewed By: Dr. Eunice Rautenbach | October 2019

Quality research is about building onto the existing work of others , “standing on the shoulders of giants”, as Newton put it. The literature review chapter of your dissertation, thesis or research project is where you synthesise this prior work and lay the theoretical foundation for your own research.

Long story short, this chapter is a pretty big deal, which is why you want to make sure you get it right . In this post, I’ll show you exactly how to write a literature review in three straightforward steps, so you can conquer this vital chapter (the smart way).

Overview: The Literature Review Process

• Understanding the “ why “
• Finding the relevant literature
• Cataloguing and synthesising the information
• Outlining & writing up your literature review
• Example of a literature review

But first, the “why”…

Before we unpack how to write the literature review chapter, we’ve got to look at the why . To put it bluntly, if you don’t understand the function and purpose of the literature review process, there’s no way you can pull it off well. So, what exactly is the purpose of the literature review?

Well, there are (at least) four core functions:

• For you to gain an understanding (and demonstrate this understanding) of where the research is at currently, what the key arguments and disagreements are.
• For you to identify the gap(s) in the literature and then use this as justification for your own research topic.
• To help you build a conceptual framework for empirical testing (if applicable to your research topic).
• To inform your methodological choices and help you source tried and tested questionnaires (for interviews ) and measurement instruments (for surveys ).

Most students understand the first point but don’t give any thought to the rest. To get the most from the literature review process, you must keep all four points front of mind as you review the literature (more on this shortly), or you’ll land up with a wonky foundation.

Okay – with the why out the way, let’s move on to the how . As mentioned above, writing your literature review is a process, which I’ll break down into three steps:

• Finding the most suitable literature
• Understanding , distilling and organising the literature
• Planning and writing up your literature review chapter

Importantly, you must complete steps one and two before you start writing up your chapter. I know it’s very tempting, but don’t try to kill two birds with one stone and write as you read. You’ll invariably end up wasting huge amounts of time re-writing and re-shaping, or you’ll just land up with a disjointed, hard-to-digest mess . Instead, you need to read first and distil the information, then plan and execute the writing.

Step 1: Find the relevant literature

Naturally, the first step in the literature review journey is to hunt down the existing research that’s relevant to your topic. While you probably already have a decent base of this from your research proposal , you need to expand on this substantially in the dissertation or thesis itself.

Essentially, you need to be looking for any existing literature that potentially helps you answer your research question (or develop it, if that’s not yet pinned down). There are numerous ways to find relevant literature, but I’ll cover my top four tactics here. I’d suggest combining all four methods to ensure that nothing slips past you:

Method 1 – Google Scholar Scrubbing

Google’s academic search engine, Google Scholar , is a great starting point as it provides a good high-level view of the relevant journal articles for whatever keyword you throw at it. Most valuably, it tells you how many times each article has been cited, which gives you an idea of how credible (or at least, popular) it is. Some articles will be free to access, while others will require an account, which brings us to the next method.

Method 2 – University Database Scrounging

Generally, universities provide students with access to an online library, which provides access to many (but not all) of the major journals.

So, if you find an article using Google Scholar that requires paid access (which is quite likely), search for that article in your university’s database – if it’s listed there, you’ll have access. Note that, generally, the search engine capabilities of these databases are poor, so make sure you search for the exact article name, or you might not find it.

Method 3 – Journal Article Snowballing

At the end of every academic journal article, you’ll find a list of references. As with any academic writing, these references are the building blocks of the article, so if the article is relevant to your topic, there’s a good chance a portion of the referenced works will be too. Do a quick scan of the titles and see what seems relevant, then search for the relevant ones in your university’s database.

Method 4 – Dissertation Scavenging

Similar to Method 3 above, you can leverage other students’ dissertations. All you have to do is skim through literature review chapters of existing dissertations related to your topic and you’ll find a gold mine of potential literature. Usually, your university will provide you with access to previous students’ dissertations, but you can also find a much larger selection in the following databases:

• Open Access Theses & Dissertations
• Stanford SearchWorks

Keep in mind that dissertations and theses are not as academically sound as published, peer-reviewed journal articles (because they’re written by students, not professionals), so be sure to check the credibility of any sources you find using this method. You can do this by assessing the citation count of any given article in Google Scholar. If you need help with assessing the credibility of any article, or with finding relevant research in general, you can chat with one of our Research Specialists .

Alright – with a good base of literature firmly under your belt, it’s time to move onto the next step.

Need a helping hand?

Step 2: Log, catalogue and synthesise

Once you’ve built a little treasure trove of articles, it’s time to get reading and start digesting the information – what does it all mean?

While I present steps one and two (hunting and digesting) as sequential, in reality, it’s more of a back-and-forth tango – you’ll read a little , then have an idea, spot a new citation, or a new potential variable, and then go back to searching for articles. This is perfectly natural – through the reading process, your thoughts will develop , new avenues might crop up, and directional adjustments might arise. This is, after all, one of the main purposes of the literature review process (i.e. to familiarise yourself with the current state of research in your field).

As you’re working through your treasure chest, it’s essential that you simultaneously start organising the information. There are three aspects to this:

• Logging reference information
• Building an organised catalogue
• Distilling and synthesising the information

I’ll discuss each of these below:

2.1 – Log the reference information

As you read each article, you should add it to your reference management software. I usually recommend Mendeley for this purpose (see the Mendeley 101 video below), but you can use whichever software you’re comfortable with. Most importantly, make sure you load EVERY article you read into your reference manager, even if it doesn’t seem very relevant at the time.

2.2 – Build an organised catalogue

In the beginning, you might feel confident that you can remember who said what, where, and what their main arguments were. Trust me, you won’t. If you do a thorough review of the relevant literature (as you must!), you’re going to read many, many articles, and it’s simply impossible to remember who said what, when, and in what context . Also, without the bird’s eye view that a catalogue provides, you’ll miss connections between various articles, and have no view of how the research developed over time. Simply put, it’s essential to build your own catalogue of the literature.

I would suggest using Excel to build your catalogue, as it allows you to run filters, colour code and sort – all very useful when your list grows large (which it will). How you lay your spreadsheet out is up to you, but I’d suggest you have the following columns (at minimum):

• Author, date, title – Start with three columns containing this core information. This will make it easy for you to search for titles with certain words, order research by date, or group by author.
• Categories or keywords – You can either create multiple columns, one for each category/theme and then tick the relevant categories, or you can have one column with keywords.
• Key arguments/points – Use this column to succinctly convey the essence of the article, the key arguments and implications thereof for your research.
• Context – Note the socioeconomic context in which the research was undertaken. For example, US-based, respondents aged 25-35, lower- income, etc. This will be useful for making an argument about gaps in the research.
• Methodology – Note which methodology was used and why. Also, note any issues you feel arise due to the methodology. Again, you can use this to make an argument about gaps in the research.
• Quotations – Note down any quoteworthy lines you feel might be useful later.
• Notes – Make notes about anything not already covered. For example, linkages to or disagreements with other theories, questions raised but unanswered, shortcomings or limitations, and so forth.

If you’d like, you can try out our free catalog template here (see screenshot below).

2.3 – Digest and synthesise

Most importantly, as you work through the literature and build your catalogue, you need to synthesise all the information in your own mind – how does it all fit together? Look for links between the various articles and try to develop a bigger picture view of the state of the research. Some important questions to ask yourself are:

• What answers does the existing research provide to my own research questions ?
• Which points do the researchers agree (and disagree) on?
• How has the research developed over time?
• Where do the gaps in the current research lie?

To help you develop a big-picture view and synthesise all the information, you might find mind mapping software such as Freemind useful. Alternatively, if you’re a fan of physical note-taking, investing in a large whiteboard might work for you.

Step 3: Outline and write it up!

Once you’re satisfied that you have digested and distilled all the relevant literature in your mind, it’s time to put pen to paper (or rather, fingers to keyboard). There are two steps here – outlining and writing:

3.1 – Draw up your outline

Having spent so much time reading, it might be tempting to just start writing up without a clear structure in mind. However, it’s critically important to decide on your structure and develop a detailed outline before you write anything. Your literature review chapter needs to present a clear, logical and an easy to follow narrative – and that requires some planning. Don’t try to wing it!

Naturally, you won’t always follow the plan to the letter, but without a detailed outline, you’re more than likely going to end up with a disjointed pile of waffle , and then you’re going to spend a far greater amount of time re-writing, hacking and patching. The adage, “measure twice, cut once” is very suitable here.

In terms of structure, the first decision you’ll have to make is whether you’ll lay out your review thematically (into themes) or chronologically (by date/period). The right choice depends on your topic, research objectives and research questions, which we discuss in this article .

Once that’s decided, you need to draw up an outline of your entire chapter in bullet point format. Try to get as detailed as possible, so that you know exactly what you’ll cover where, how each section will connect to the next, and how your entire argument will develop throughout the chapter. Also, at this stage, it’s a good idea to allocate rough word count limits for each section, so that you can identify word count problems before you’ve spent weeks or months writing!

PS – check out our free literature review chapter template…

3.2 – Get writing

With a detailed outline at your side, it’s time to start writing up (finally!). At this stage, it’s common to feel a bit of writer’s block and find yourself procrastinating under the pressure of finally having to put something on paper. To help with this, remember that the objective of the first draft is not perfection – it’s simply to get your thoughts out of your head and onto paper, after which you can refine them. The structure might change a little, the word count allocations might shift and shuffle, and you might add or remove a section – that’s all okay. Don’t worry about all this on your first draft – just get your thoughts down on paper.

Once you’ve got a full first draft (however rough it may be), step away from it for a day or two (longer if you can) and then come back at it with fresh eyes. Pay particular attention to the flow and narrative – does it fall fit together and flow from one section to another smoothly? Now’s the time to try to improve the linkage from each section to the next, tighten up the writing to be more concise, trim down word count and sand it down into a more digestible read.

Once you’ve done that, give your writing to a friend or colleague who is not a subject matter expert and ask them if they understand the overall discussion. The best way to assess this is to ask them to explain the chapter back to you. This technique will give you a strong indication of which points were clearly communicated and which weren’t. If you’re working with Grad Coach, this is a good time to have your Research Specialist review your chapter.

Finally, tighten it up and send it off to your supervisor for comment. Some might argue that you should be sending your work to your supervisor sooner than this (indeed your university might formally require this), but in my experience, supervisors are extremely short on time (and often patience), so, the more refined your chapter is, the less time they’ll waste on addressing basic issues (which you know about already) and the more time they’ll spend on valuable feedback that will increase your mark-earning potential.

Literature Review Example

In the video below, we unpack an actual literature review so that you can see how all the core components come together in reality.

Let’s Recap

In this post, we’ve covered how to research and write up a high-quality literature review chapter. Let’s do a quick recap of the key takeaways:

• It is essential to understand the WHY of the literature review before you read or write anything. Make sure you understand the 4 core functions of the process.
• The first step is to hunt down the relevant literature . You can do this using Google Scholar, your university database, the snowballing technique and by reviewing other dissertations and theses.
• Next, you need to log all the articles in your reference manager , build your own catalogue of literature and synthesise all the research.
• Following that, you need to develop a detailed outline of your entire chapter – the more detail the better. Don’t start writing without a clear outline (on paper, not in your head!)
• Write up your first draft in rough form – don’t aim for perfection. Remember, done beats perfect.
• Refine your second draft and get a layman’s perspective on it . Then tighten it up and submit it to your supervisor.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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38 Comments

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You’re welcome, Yinka. Thank you for the kind words. All the best writing your literature review.

Thank you for a very useful literature review session. Although I am doing most of the steps…it being my first masters an Mphil is a self study and one not sure you are on the right track. I have an amazing supervisor but one also knows they are super busy. So not wanting to bother on the minutae. Thank you.

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Thank you so much Derek for such useful information on writing up a good literature review. I am at a stage where I need to start writing my one. My proposal was accepted late last year but I honestly did not know where to start

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Thank you. I requested to download the free literature review template, however, your website wouldn’t allow me to complete the request or complete a download. May I request that you email me the free template? Thank you.

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Literature Review: Purpose of a Literature Review

• Literature Review
• Purpose of a Literature Review
• Work in Progress
• Compiling & Writing
• Books, Articles, & Web Pages
• Types of Literature Reviews
• Departmental Differences
• Citation Styles & Plagiarism
• Know the Difference! Systematic Review vs. Literature Review

The purpose of a literature review is to:

• Provide a foundation of knowledge on a topic
• Identify areas of prior scholarship to prevent duplication and give credit to other researchers
• Identify inconstancies: gaps in research, conflicts in previous studies, open questions left from other research
• Identify the need for additional research (justifying your research)
• Identify the relationship of works in the context of their contribution to the topic and other works
• Place your own research within the context of existing literature, making a case for why further study is needed.

Videos & Tutorials

VIDEO: What is the role of a literature review in research? What's it mean to "review" the literature? Get the big picture of what to expect as part of the process. This video is published under a Creative Commons 3.0 BY-NC-SA US license. License, credits, and contact information can be found here: https://www.lib.ncsu.edu/tutorials/litreview/

Elements in a Literature Review

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5 Reasons the Literature Review Is Crucial to Your Paper

3-minute read

• 8th November 2016

People often treat writing the literature review in an academic paper as a formality. Usually, this means simply listing various studies vaguely related to their work and leaving it at that.

But this overlooks how important the literature review is to a well-written experimental report or research paper. As such, we thought we’d take a moment to go over what a literature review should do and why you should give it the attention it deserves.

What Is a Literature Review?

Common in the social and physical sciences, but also sometimes required in the humanities, a literature review is a summary of past research in your subject area.

Sometimes this is a standalone investigation of how an idea or field of inquiry has developed over time. However, more usually it’s the part of an academic paper, thesis or dissertation that sets out the background against which a study takes place.

There are several reasons why we do this.

Reason #1: To Demonstrate Understanding

In a college paper, you can use a literature review to demonstrate your understanding of the subject matter. This means identifying, summarizing and critically assessing past research that is relevant to your own work.

Reason #2: To Justify Your Research

The literature review also plays a big role in justifying your study and setting your research question . This is because examining past research allows you to identify gaps in the literature, which you can then attempt to fill or address with your own work.

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Reason #3: Setting a Theoretical Framework

It can help to think of the literature review as the foundations for your study, since the rest of your work will build upon the ideas and existing research you discuss therein.

A crucial part of this is formulating a theoretical framework , which comprises the concepts and theories that your work is based upon and against which its success will be judged.

Reason #4: Developing a Methodology

Conducting a literature review before beginning research also lets you see how similar studies have been conducted in the past. By examining the strengths and weaknesses of existing research, you can thus make sure you adopt the most appropriate methods, data sources and analytical techniques for your own work.

Reason #5: To Support Your Own Findings

The significance of any results you achieve will depend to some extent on how they compare to those reported in the existing literature. When you come to write up your findings, your literature review will therefore provide a crucial point of reference.

If your results replicate past research, for instance, you can say that your work supports existing theories. If your results are different, though, you’ll need to discuss why and whether the difference is important.

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BENEFITS OF LITERATURE REVIEW TO RESEARCH

Introduction.

Literature review offers lots of benefits to researcher. However, for the purpose of this post I will like to be direct. Below are few benefits of Literature review to researchers:

• A thorough exploration of the literature review will help to articulate our own research problems, objectives, as well as formulating our research questions or hypothesis.
• It helps to know the existing GAPS
• It helps to notices the important concepts and variables and how they were operationalized
• It widens the researcher knowledge of the problem
• It gives researchers detailed knowledge of the method and design that he can adopt or use new ones.
• It helps the researcher to arrive at picking a suitable scope
• It suggested theories previously used

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Rethinking cluster under coopetition strategy: an integrative literature review and research agenda

• Open access
• Published: 24 April 2024

Cite this article

You have full access to this open access article

• Adriana Fumi Chim-Miki   ORCID: orcid.org/0000-0001-7685-2718 1 , 2 ,
• Rosana L. Coelho Fernandes   ORCID: orcid.org/0009-0007-6026-7857 2 &
• Jefferson Marlon Monticelli   ORCID: orcid.org/0000-0002-1605-7090 3  

This study aimed to integrate the dimensions and elements of intra-cluster coopetition, identify the emergence of a complementary theoretical perspective to cluster theory and create an integrative research agenda to support the rethinking cluster approach based on coopetition. It is an integrative Systematic Literature Review that generates insights to move the topic forward. Results showed coopetition as context, process, or outcome. The research focus was grouped into six dimensions of intra-cluster coopetition: Strategic Adjustment, Perceived Benefits, Mediated Coopetition, Social Interaction, Coopetitive Orientation, and Temporality of Coopetition. Four hundred eighty-six elements used by scholars created a second-order coding to represent the variables of coopetition in clusters. From the integrative literature overview, a theoretical framework emerges with four dimensions: Conditional factors, Policies, Market commonality, and Formal supporting structure. These dimensions act as drivers, markets, or intensifiers of the intra-cluster coopetition strategy. At the same time, the dimensions suffer the influence of external, internal, and ecosystem contexts. Our literature review builds theory to advance cluster coopetition research and complement the Porterian perspective. The framework suggests the main elements to manage clusters under the coopetition strategy. These findings rethink cluster theory and deliver the business co-evolution perspective, considering the cluster as a business ecosystem with an open system based on coopetition. Findings offer an inductive-deductive pattern system to further research that represents the evolutionary trend of the topic itself.

Avoid common mistakes on your manuscript.

1 Introduction

Coopetition is the interplay among organizations that complement each other through partnerships while competing for competitive advantage and market share (Bengtsson and Kock 2014 ). Studies highlighted several benefits of coopetition for organizations mainly result from the ability to obtain scarce resources, stimulate innovation, reduce costs, provide opportunities for technological growth, and increase innovation, competitiveness and sustainability (Estrada et al. 2016 ; Crick et al. 2020 ; Ferasso et al. 2022 ; Ramjaun et al. 2023 ). On the other hand, there is also research on threats, risks, and disadvantages of coopetition (Cygler and Sroka 2017 ; Estrada et al. 2016 ; Mantovani and Ruiz-Aliseda 2012 ; Ritala et al. 2008 ).

Scholars point out that coopetition is a paradigm to update competitiveness theories and a strategy subfield directed to shared goals (Yami et al. 2010 ; Köseoğlu et al. 2019 ). Theoretical Roots of coopetition are diverse but predominately of Game Theory, Resource-Based View (RBV), and Network Theory (Klimas et al. 2023 ). Coopetition emerges from a strategic relational view (Minà and Dagnino 2016 ), which means it is aligned with the Extended-RBV proposed by Barney ( 2018 ) that considers the relationships as a strategic resource to achieve sustainable competitive advantage. Köseoğlu et al. ( 2019 ) suggested that process and strategy are coopetition components used in strategic and tactical dimensions.

Coopetition has a multidimensional and multifaceted nature, which can be horizontal, that is, between direct competitors; vertical, for example, among the firm and its providers; or mixed, i.e., along a value chain (Czakon and Sołtysik 2016 ). Sometimes, coopetition is a deliberate strategy purposely designed with formal agreements structured by the players. Other times, it is a response to a market circumstance as an emerging behavior, an unintentional strategy (Czakon et al. 2020a , b ; Bengtsson and Kock 2014 ). Some contexts are more favorable to coopetition since it is an intrinsic behavior, such as the tourism destination (Della and Aria 2016 ; Kylanen and Mariani 2012 ), business ecosystems or innovation ecosystems (Lehtonen et al. 2020 ) and local productive arrangements or clusters (Dana et al. 2013 ).

1.1 Why coopetition and cluster?

According to Dana et al. ( 2013 ), coopetitive relationships between partners evolve inside clusters, helping clustered firms leverage sustainable coopetitive advantage. Porter ( 1998 ) defines clusters as geographic concentrations of interrelated companies that compete but cooperate, linked by common and complementary elements, such as suppliers, service providers, companies from related sectors, and even institutions, such as universities, trade associations, think tanks, government, etc. The cluster Porterian concept confirms that coopetition is an inherent behavior of clusters. Although the coopetition perspective was not a theoretical background of Porter’s theory ( 1998 ), he highlighted the interplay of competition and cooperation along cluster dimensions and among different participants within the productive arrangements that positively affect the partners’ productivity.

Porterian Theories are the main background of the cluster theory despite many underlying perspectives and theories supporting the intra and inter-cluster strategies. According to Porter ( 1998 ), the complementarity between the support institutions and the clusterized firms defines the cluster boundaries. That means the network defines the cluster. Stead and Stead ( 2019 ) suggested that the Porterian paradigm had an invaluable contribution to the strategic management field but needs to evolve to explain the current business environment. In this sense, scholars have been rethinking the cluster approach, for example, Harris ( 2021 ), Lazzeretti et al. ( 2019 ), and Tracey and Clark ( 2003 ).

Among the assumptions of the Rethinking Cluster approach, coopetition is pointed out as the strategy to foster economic advantage, allowing shared information, knowledge, markets, and marketing intelligence networks, as well as supply and distribution chains (Ferasso et al. 2022 ; Sellitto and Luchese 2018 ; Dana et al. 2013 ). The coopetition networks assume an essential role in constructing social capital that facilitates inter-organizational behavior typically characterized by competition. Coopetition provides forces which balance in symbiotic intra-cluster management, whose interplay requires a proactive attitude towards cooperation, building trust, and commitment (Felzensztein et al. 2018 ).

Coopetition in clusters is a spotlight topic among scholars due to the growing use of this strategy in various industries (Feraso et al. 2022 ), besides the importance of clusters for regional economic and social development (Porter 1998 ). Most studies analyzed coopetition at the individual, intra-organizational, inter-organizational, and inter-network levels (Czakon et al. 2020a , b ) or the level of society (Oliveira-Ribeiro et al. 2022 ). However, in the cluster, coopetition occurs at the intra and inter-cluster levels with particular conditions that can provide a complementary view to the Cluster theory (Porter 1991 ). This complementarity can help to build the Rethinking Cluster approach, but it is necessary to identify the status of intra-cluster coopetition knowledge and create a research agenda.

1.2 Rethinking cluster from coopetition theoretical lens: a critical integrative review

We developed an integrative systematic integrative literature review (SLR) on cluster coopetition to answer three research questions:

(Q1) What dimensions and elements of intra-cluster coopetition? (Q2) What complementary framework emerges from the cluster coopetition to cluster theory? (Q3) What dynamics of the research agenda can help the rethinking cluster from a coopetition perspective?

Our article has a twofold purpose. Firstly, the study aims to integrate the dimensions and elements of intra-cluster coopetition to identify the emergence of a complementary theoretical perspective to cluster theory. Second, this study seeks to create an integrative research agenda to support the rethinking cluster approach based on relational strategies based on coopetition.

Systematic reviews are essential for summarizing evidence accurately and reliably, providing information about the theory and practice for any discipline, and leading to a research agenda (Liberati et al. 2009 ; Tranfield et al. 2003 ). Our research reduces one literature gap and contributes to advancing cluster and coopetition theories. Systematic Literature Reviews (SLR) exist on coopetition but do not focus on clusters. For example, the literature review of Gernsheimer et al. ( 2021 ) focuses on antecedents, execution, interaction, results, and coopetition levels. Boucken et al. (2015) examined innovation strategy, supply chains, management, and the benefits and risks of coopetition. Dorn et al. ( 2016 ) organized the literature according to the nature of competition, governance and management, the results, and the characteristics of players and environments. Bengtsson and Raza-Ullah ( 2016 ) compared different conceptualizations of coopetition and levels and schools of thought. They reviewed the literature according to drivers, processes, and outcome structures. Devece et al. ( 2019 ) classified coopetition studies by theory, methods, and objectives. They identified two independent research trends: mathematical modeling studies using game theory and case study research on coopetition tension. Yadav et al. ( 2022 ) published a bibliometric review that updated the list of primary areas and dynamics of coopetition studies. Klimas et al. ( 2023 ) provided an integrative overview of the theoretical roots of competition, showing ten theories mainly related to strategic thinking.

Our SLR complements the previous systematic reviews and goes beyond. The study’s originality lies in (1) we focus on cluster coopetition to highlight the overlap of cluster and coopetition theoretical perspectives; (2) we identify drivers of intra-cluster coopetition to rethink cluster strategies; (3) We build theory to advance cluster coopetition research revisiting the Porterian perspective; (4) we provide an integrative research agenda to support the development of intra-cluster coopetition strategic management research.

2 Review method and literature screening

Our Integrative Systematic Literature Review (SLR) performed a process of identification, selection, and structured evaluation with a transparent and reproducible evidence assessment, as Tranfield et al. ( 2003 ) indicated. The search process followed the PRISMA and SPIDER protocols. PRISMA items guide the Identification, Screening, Eligibility, and Inclusion stages in SLR (Moher et al. 2009 ). In turn, the SPIDER method is a search strategy that comprises a Sample, Phenomenon of Interest, Project, Design, Evaluation, and type of Research (Cooke et al. 2012 ). Searches occurred in Jun/2023 and Dec/2023 in the Web of Science (WoS) and Scopus databases, the two largest world databases of social sciences research. We performed two searches to identify articles published in English between 1996 and December 2023 covering the emergence of the coopetition perspective. Including articles in Early Access, 102 were extracted from Scopus and 113 from Web of Science. However, there were 61 overlaps and 154 articles in the screening phase. Figure  1 shows the results of the searches and exclusions due to overlaps and other criteria.

Two researchers independently evaluated all articles to define their relevance to the final sample to ensure greater rigor and reliability in the screening process. In the case of different choices, we established a consensus. This procedure led to the exclusion of 97 articles, as they studied: statistical clusters (15 articles), virtual clusters (1), sectorial analysis (20), network analysis or group of firms (14), cooperatives (2), productive or supply chains (5), ecosystems or tourism destinations (6), not related with coopetition (24), literature reviews (12), and one article was not available. Finally, 54 articles remained since they fit the SLR scope. Following the SPIDER protocol, we previously defined the variables of the Content analyses in the articles, namely the study’s objectives, level of analysis, methodological design, coopetition variables, main results, contributions, and future research pointed out by the authors (Fig.  1 ).

Methodological design based on PRISMA and SPIDER protocols. Source : Elaborated by the authors based on Cooke et al. ( 2012 ) and Moher et al. ( 2009 )

3 Review results

3.1 an overview of studies on coopetition in clusters.

Table  1 indicated that cluster coopetition studies started in 2003, although coopetition literature emerged in 1996. That means a gap of seven years to crossline both perspectives: coopetition and the Porterian cluster. Until 2012, there was only one article for most of the years. Since 2013, the annual production has grown. However, the timeline confirmed that cluster coopetition is a theme that is still understudied.

The authors with more articles published on cluster coopetition are Crick (Crick et al. 2020 ; Crick and Crick 2021 , 2022 ), Dana (Dana and Granata 2013 ; Dana et al. 2013 ), and Felzensztein (Felzensztein et al. 2018 , 2019 ). Dana and Felzensztein published articles with the words ‘coopetition and cluster’ in the title, which indicates a direct focus on the subject. The first publication of Dana was in 2013, focusing more on clusters than coopetition, while Felzensztein started in 2018 and explored coopetition more. In turn, Crick focuses more on coopetition, specifically in wine clusters. The top four countries with more clusters studied on the coopetition lens were Brazil (9), New Zealand (8), Germany (4) and France (4). Regarding the affiliations’ authors, the Top most productive countries in cluster coopetition studies were Brazil (8), France (8), the UK (7), and New Zealand (6). Italy and the United States had surprising results. Even though Italy is the birthplace of the geographic concentration of companies as a business success factor, the country has only one publication on coopetition in a cluster (See Maso and Lattanzi 2014 ). In turn, the United States, despite being the country of the cluster concept creator, had only one article examining USA Clusters (see Crick and Crick 2021 ) and two published by USA researchers together with Singapore and Turkey (See Yuan et al. 2021 ; Harmancioglu and Tellis 2018 ).

Brazil and New Zealand have many clusters studied and researchers studying the topic. New Zealand is probably due to a research program analyzing the country’s clusters. According to Molina and Yoong ( 2003 ), this Program is part of the public policy to promote regional economic growth. The Pilot Program of Business Clusters was created in 2000 to assist firms in internationalization through collaborative networks. This program was a branch of the “New Zealand Updating Competitive Advantage Project” started in 1991 and was headed by Michael Porter, and for that reason, it became known as “Project Porter.” It pointed to the need for a new competitive economic order worldwide but in harmony with the country’s social aspirations (Molina and Yoong 2003 ). In Brazil, the reason for spotlighting the country in publications on coopetition in clusters with 25% of the sample papers is similar to New Zealand. The Brazilian government, since 2004, has a public policy that created a Permanent Working Group for Local Productive Arrangements, coordinated by the Ministry of Industry, Foreign Trade, and Services. The Brazilian public policy of clusters is toward achieving economic and regional development to reduce social and regional inequalities.

Different journals published these 54 articles on cluster coopetition covering management, knowledge, innovation, social networks, organization, business, commerce, service, research, agribusiness, marketing, entrepreneurship, and tourism. Empirical studies are predominant, with approximately 92% of publications and only five theoretical studies from Min et al. ( 2008 ), Hu and He ( 2013 ), Ketchen et al. ( 2004 ), M’Chirgui ( 2005 ), and Poisson-de-Haro and Myard ( 2018 ). Table  1 also showed a diversification of studied clusters using a wide range of research techniques with a prevalence of qualitative methodology. Only 28% are quantitative research. The topic follows the same research path on coopetition, which started with case studies as a more frequent technique (Gernsheimer et al. 2021 ).

The empirical papers analyzing clusters of the wine industry have more publications (8 articles), with multiple and longitudinal case studies in Argentina, Chile, France, and, mainly, New Zealand (Molina and Yoong 2003 ; Dana and Granata 2013 ; Dana et al. 2013 ; Granata et al. 2017 ; Felzensztein et al. 2019 ; Crick et al. 2020 ; Crick and Crick 2021 , 2022 ). Another high number of publications on cluster coopetition was in maritime activities (7 articles), including oil and marine services in Norway (Smiljic 2020 ), knowledge-intensive service activities on inducing innovation in maritime cluster in Portugal (Monteiro 2016 ), yacht industry in an emerging economy in Taiwan (Chung and Cheng 2019 ); salmon industry at Chile (Felzensztein et al. 2018 ); shipbroking industry in Denmark (Nowińska 2019 ), nautical tourism in Portugal (Monteiro et al. 2017 ), and nautical industry in Italy (Maso and Lattanzi 2014 ).

The furniture cluster in Brazil (Barros et al. 2016 ; Sellitto and Lucchese 2018) and Indonesia (Hartono and Sobari 2016 ) comes third in the research with three publications. Scholars preferred to analyze the intra-cluster level of analysis (87% of publications). Three articles performed an analysis inter-cluster (Harmancioglu and Tellis 2018 ; Cusin and Loubaresse 2018 ; Wolff et al. 2020 ), probably due to the difficulty of analyzing various clusters that are usually in different stages of development. Due to multi-dimensional studies, the literature on cluster coopetition has a high dispersion of variables, elements, and contributions.

3.2 Theoretical roots of cluster coopetition

Before the emergence of coopetition as a significant business strategy, firms relied on the separate concepts of competition and cooperation to characterize their relationships (M’Chirgui 2005 ). Until the mid-1980s, the analysis of inter-organizational relations predominantly focused on competition influenced by economic theories. In the latter half of the 1980s, some researchers began delving into studying cooperation between firms. In the 1990s, the first attempts were made to explore the interplay between cooperation and competition strategies. These strategies, namely cooperation and coopetition, go beyond the traditional competitive paradigm, giving rise to novel forms of intra-organizational governance and broadening the range of options for inter-organizational collaborations (Brandenburger and Nalebuff 1995 ; Padula and Dagnino 2007 ).

The neologism “coopetition”, coined from the fusion of cooperation and competition, first surfaced in literature through Cherington ( 1913 ) to explain the discourse of the Sealshipt Oyster System CEO. In describing the intricate network involving 35,000 oyster dealers, Pickett emphasized that they were not in direct competition but engaged in cooperative efforts to enhance business collectively. The concept gained early mention but garnered significant attention in later years, with its resurgence attributed to managerial practices (Cherington, 1976 ). R. Hunt published the idea again in the Los Angeles Times in 1937 but did not receive notoriety (Yami et al. 2010 ). However, the term became popular only decades later through managerial practices.

The managerial genesis of the term “coopetition” is often attributed to Ray Noords, the founder and CEO of Novell, who introduced it in the 1980s. Noords highlighted the need to compete and cooperate simultaneously, emphasizing the evolving dynamics of markets and firm configurations (Bengtsson and Kock, 2000 ). In the subsequent decade, “coopetition” transitioned from managerial discourse to an academic concept, becoming a subject of theoretical exploration. Brandenburger and Nalebuff ( 1995 ), in their influential article, employed game theory as a theoretical foundation to support the notion of “Sleeping with the enemy”—encouraging firms to learn how to collaborate with their rivals (Coy 2006 ).

Several theories can explain the theoretical roots of cluster coopetition. Based on our Integrative Literature Review, we classified these theories according to two criteria that follow theoretical perspectives: first, related to coopetition dynamics, i.e. coopetition as a process, context, or result; second, related to geographical coverage considering external, internal, and regional ecosystem conditions (Fig.  2 ). The relationship between coopetition dynamics and the geographical coverage of clusters is relevant to understanding the firm interplay coexisting in a particular territory.

Theoretical roots of cluster coopetition. Source : Elaborated by the authors

First, considering coopetition as a process related to cluster external conditions, we identified articles that used dynamic capabilities, networks, and resource-based view (RBV) to present different cases. For instance, dynamic capabilities have been used to explain how coopetition promotes collective purchases, shared distribution expenses, shared production, and education of consumers and other beer producers in microbreweries in Brazil (da Silva et al., 2023 ). Networks form the foundation for cultivating competitive advantages by elucidating the means to access and expand knowledge and resources beyond the confines of the firm through coopetitive strategies. For example, Chaudhry et al. ( 2023 ) explore the coopetition within networks of competing micro-sized, independent, family restaurants owned by entrepreneurs from ethnic minorities. RBV has a broad application in the literature on coopetition. Examining coopetition as a process within the external conditions of the cluster, RBV enabled the investigation of intercluster dynamics among rival global clusters, focusing on monthly counts of patents, startups, and new product commercialization (Harmancioglu and Tellis 2018 ).

Second, when regarding coopetition as a process tied to internal cluster conditions, we identified four theoretical perspectives: game theory, institutional theory, RBV and transaction-cost theory (TCT). From the game theory standpoint, scholars examine coopetition as a win-win game, exploring the equilibrium between value creation (targeting shared benefits) and value appropriation (aiming for individual gains). For instance, Ramjaun et al. ( 2023 ) analyzed the United Kingdom craft brewing sector. They discussed how competing small enterprises can reduce their material supply costs through increased efficiencies, bargaining power and economies of scale. Xu et al. ( 2023 ) developed research focused on institutional support’s moderating role in promoting interfirm coopetition on firm innovativeness within a cluster. Dana and Granata ( 2013 ) explored the Waipara case study in New Zealand to comprehend the evolution of wine production clusters over time, focusing specifically on the coopetition dynamics among cluster members. Barros et al. ( 2016 ) analyzed the relationship between firms in the furniture production cluster in Brazil. They found opportunistic behaviour and a lack of trust among participants. At the same time, firms know the benefits of cooperation, such as access to information and improvement of products, but do not apply in the cluster.

Third, relating coopetition as a process in regional ecosystem conditions, RBV is the prevailing theoretical perspective because it allows mobilizing resources and technologies as resources that can become the basis for creating a competitive advantage (Quintana-Garcia and Benavídes-Velasco, 2004 ). For example, Ge and Liu ( 2022 ) explored how actors of the industrial innovation ecosystem focused on China’s solar photovoltaic industry can catch up so rapidly without radical technological innovation through resource orchestration.

Fourth, approaching coopetition as a context, five theoretical perspectives guide most studies focused on the cluster external conditions: game theory, institutional theory, networks, RBV, and transaction-cost theory (TCT). Li and Jiang ( 2012 ) analyzed the mechanism of coopetition evolution based on Game theory. They identified that the cooperation strategy promotes a better equilibrium for the oligopolies among industrial clusters. König ( 2023 ) examined co-located industrial clusters and identified that changes in the institutional setting (for example, the regulatory environment) lead to more collaboration between competitors. Andrey ( 2013 ) studied entrepreneurial coopetition related to interpersonal relations and territorial embeddedness. The results clarified spatial networking boundaries considering different spatial, temporal, social, and cognitive factors. Crick et al. ( 2020 ) examined New Zealand wine producers participating in diverse value co-creation activities, encompassing wine hospitality and tourism, such as accommodation and restaurants, extending to wine sales, including those at cellar doors. Their findings revealed that competing businesses in the product markets necessitate the management of complementary resources both within and across clusters. TCT centres on a highly precarious business scenario, as competitors operate based on individual business incentives that could give rise to opportunistic behaviour, bounded rationality, and a restricted pool of potential partners. For instance, Cusin and Loubaresse ( 2018 ) researched a French cluster called Inno’vin. They underscore the significance of competition within the intercluster context and delineate the primary challenges associated with inter-cluster coopetition, explicitly focusing on the role of asymmetry.

Fifth, detailing the cluster internal conditions in coopetition viewed as a context, we identified four prominent theoretical streams: game theory, institutional theory, and networks. Mucha-Kus et al. ( 2021 ) researched Energy Communities in Poland, including energy clusters and cooperatives. These authors observed that members collaborate concurrently within a competitive environment to attain shared benefits. Ralandison ( 2021 ) observed two clusters of small and medium-sized enterprises involved in the essential oil industry in Madagascar. They proposed a model of paradox management inside and between the organizations to deal with integrated coopetition. Networks are the foundation for cultivating competitive advantages, elucidating how to access and expand knowledge and resources beyond the firm through coopetitive relationships. For instance, Chai and Yang ( 2011 ) evaluated the impact of social networks on building control mechanisms of a Chinese service cluster. They developed a framework to explain how social networks “Guanxi” could be encouraged by the cluster’s geographical proximity and the government’s intervention.

Sixth, we identified studies focused on coopetition as a context that explores regional ecosystem conditions. In this line, Hückstädt ( 2022 ) recognized that for cluster researchers to accomplish their shared research objectives, fulfil their overarching role in integrative knowledge production, and ensure the sustainability of their collaboration, they must engage in close cooperation. Simultaneously, they compete with each other for scientific recognition or third-party funding.

Seventh, RBV has consolidated studies that address cluster external conditions and coopetition as a result. For example, Ferasso et al. ( 2022 ) explained how strategies and knowledge are used within a medium-low-tech industrial cluster to achieve competitive advantages. Eight, networks and strategic learning have discussed cluster internal conditions. Darbi and Knott ( 2023 ) discussed strategy as a practice in a cluster of small informal businesses in Ghana. They demonstrated how extensive cooperation among competing firms evolved into a normalized practice within the cluster, embedded as a cultural assumption. Monteiro ( 2016 ) researched activities centered around knowledge-intensive business services that promote co-opetition dynamics capable of catalyzing innovation within the maritime cluster in Algarve, Portugal.

Finally, a few articles related to cluster coopetition consider regional ecosystem conditions as a result. Shen and Liu ( 2023 ) focused on an open innovation business ecosystem composed of 20 industry clusters in the Yangtze River Delta region to investigate the direct impact of partner matches on different business model innovations. The results showed the demand to develop dynamic capabilities between firms that cover a broad spectrum of cross-organizational innovation capacities. This includes strengthening organizational learning capabilities, creating interactive network platforms to enhance coordination capabilities, and participating in integrative activities to cultivate a collective mindset. As a result of the interplay between cooperative and competitive strategies, research typically differentiates between dyadic coopetition and network coopetition. However, cluster coopetition studies have disregarded regional ecosystem conditions, making this approach incomplete.

3.3 Coopetition dynamics

We synthesized the literature contributions in three groups: related to coopetition as context, process, or result. The immediate focus on coopetition results does not necessarily indicate appropriation of competitive advantages. Analysis of the context and process is also necessary to provide a better understanding of the cluster coopetition perspective.

3.3.1 Coopetition as a context

Coopetition is a context-dependent strategy (Czakon et al. 2020a , b ) that involves firms providing learning opportunities to stakeholders such as suppliers, clients, and others (Ritala and Hurmelinna-Laukkanen 2009 ). Coopetiton positioned as a network contributing value through environmental interaction is presented within a broader chain that adds value to the firm, incorporating elements like customers, suppliers, substitutes, and complements referred to as “The Value Net” (Brandenburger and Nalebuff 2011 ; Lado et al. 1997 ). This strategic approach relies on the ability of firms to collaboratively create and capture value to individually secure a significant share of that value (Gnyawali and Park 2011 ).

Some analyses of coopetition focused on the interplay among firms considering the context, i.e., an environment capable of adding value to companies (Monticelli et al. 2019 ). From this analysis perspective, the scholars revealed many assumptions of coopetition in clusters. For instance, gender and education affect coopetition (Santos et al. 2021 ); the micro-foundations of dynamic capabilities (da Silva et al. 2023 ); insight into coopetition in the entertainment industry (Yuan et al. 2021 ); expanding the coopetition theoretical framework in functional areas (Sellitto and Luchese 2018 ); understanding of coopetition embedded as a cultural context (Darbi and Knott 2023 ); confirming propositions about the effects of the internal and external environment of small and medium-sized companies on coopetition (Monticelli et al. 2018 ); analyze the relationships between actors and benefits in attracting customers (Barros et al. 2016 ); demonstrate the importance of local authorities supporting for interplay with foreign competitors (Maso and Lattanzi 2014 ); geographical proximity as a non-prerequisite for coopetition (Nowińska 2019 ); confirming synergies of coopetition in wine clusters and its context (Dana et al. 2013 ); indicating public and private policies to accelerate growth from coopetition (Leite et al. 2009 ); game model to supply chains (Min et al. 2008 ); and the influence of regulatory and support institutional contexts on the intracluster coopetition relationship (Xu et al. 2023 ; König 2023 ).

3.3.2 Coopetition as a process

Coopetition encompasses the simultaneous application of competitive and cooperative strategies among rival firms operating across various domains and levels of interaction (Ann Peng et al. 2018 ; Monticelli et al. 2019 ). The process is characterized as the dynamic progression of change that defines the equilibrium and intensity of cooperative and competitive interactions (Dahl 2014 ). Environmental shifts have the potential to either undermine firms or prompt varied behaviours and responses to a firm’s strategy, influencing the effectiveness of a coopetitive approach (Padula and Dagnino 2007 ). The optimization of coopetition is often contingent on the levels of market commonality and resource asymmetry between firms. Market commonality tends to be more pertinent to competitive dynamics, while resource asymmetry is typically more relevant to cooperative aspects (Hung and Chang 2012 ).

Articles analyzing the coopetition process provided significant learning. This group of studies has more contributions, indicating coopetition relationships, their main formative factors, dynamics, network management, the influence of time, and its orientation towards knowledge sharing, R&D projects, and innovation. Under this perspective of coopetition as a process, the literature presented contributions related to the dynamics of interaction, strategy, and knowledge sharing in medium-low technology clusters (Ferasso et al. 2022 ); understanding of coopetition relationships (Wolff et al. 2020 ), their causality (Bispo et al. 2020 ) analysis of how coopetition happens in clusters (Hoetoro 2014 ); the effects on coopetition networks under the leans of club‑theoretical perspective (Hückstädt 2022 ) and the management of coopetition intrinsic conflict in clusters (Mathews 2018 ). Coopetition is a dynamic process, so under this perspective, scholars’ contributions showed the mutability of clusters over time and their influence on coopetition relationships (Felzensztein et al. 2018 ).

Also, the insertion of the concept of coopetition into the initial model by Kim and Wicks (Chin et al. 2017 ); stages driven by specific environmental factors and it is facilitated by the social capital (Granata et al. 2017 ); potential elements to guide the process of coopetition in RandD projects (Nemeh and Yami 2016 ); main factors in the formation of coopetition involving complex systems (Hartono and Sobari 2016 ); construction of a benign competitive mechanism to promote innovation (Hu and He 2013 ); evolution of coopetition through equilibrium in the price competition game based on the Cournot model identifying the best strategy for oligopolies in the industrial cluster (Li et al. 2012 ); control mechanisms, and which reputation on the social network is crucial for intra-cluster coopetition (Chai and Yang 2011 ); knowledge sharing in clusters during the initiation and incubation stage (Molina and Yoong 2003 ); process of collaborative procurement among craft beer producers (Ramjaun et al. 2023 ); management of complementary relationships within and across clusters to enhance value co-creation activities (Crick et al. 2020 ); and dynamic co-opetition of industrial cluster evolution (Itoga et al. 2014 ).

3.3.3 Coopetition as a result

Coopetition is a strategy to maximize outcomes through joint efforts (Ann Peng et al. 2018 ; Monticelli et al. 2019 ). Both coopetition and collaboration stem from shared interests, prioritizing collective benefits over maximizing individual gains. However, it’s important to note that the resulting gains may be distributed unevenly between the involved parties (Padula and Dagnino 2007 ). Instances of disagreement can emerge, particularly regarding the allocation of outcomes. The returns from the relationship may not always align proportionally with the investments made by participants, considering factors such as learning and the bargaining power within the strategic relationship (Gnyawali and Ryan Charleton 2018 ).

Coopetition is a strategy to maximize outcomes through joint efforts (Ann Peng et al. 2018 ; Monticelli et al. 2019 ). Gernsheimer et al. ( 2021 ) highlighted that coopetition from the results perspective had been investigated mainly concerning innovation, firm performance, and, more recently, organizational learning and sustainability. We confirmed Gernsheimer’s et al. ( 2021 ) findings in studies on cluster coopetition but included results related to internationalization, public policies, and leadership. In clusters, scholars studied the positive relationship between absorptive capacity and coopetition level (Begnini et al. 2022 ); the integrative view of coopetition to R&D projects (Smiljic 2020 ); improvements of internationalization by coopetition (Felzensztein et al. 2019 ); benefits of coopetition strategy to the performance (Chung and Cheng 2019 ); coopetition dynamics for marketing products and startups (Harmancioglu and Tellis 2018 ); reduction of the uncertainty of the innovation process, public policies to sustainability, visibility of the sector and its stakeholders (Poisson-de-Haro and Myard 2018 ); advantages of inter-cluster coopetition and the intervention by public and private players (Cusin and Loubaresse 2018 ); coopetitive advantages to productivity and innovation (Monteiro 2016 ).

Some authors focused on the effects on performance from coopetition producing internal knowledge, innovation capacity and performance of Knowledge Intensive Business Services (Monteiro 2016 ), coopetition and leadership for differentiation and internationalization (Dana and Granata 2013 ). Also, the negative effect of cluster coopetition was studied as a result. For instance, the damage to extremely novel revolutionary innovation (Bouncken and Kraus 2013 ) and the negative impacts of coopetition on store performance in the retail and service clusters (Teller et al. 2016 ).

3.4 Dimensions and elements of coopetition in clusters

We use an open coding procedure, hence an inductive analytical approach (Mosonyi et al. 2020 ). In the articles, we identified the research focus. Results showed 45 different focuses in the 54 articles. We aggregated them into six dimensions based on a consensus among three coopetition scholars to reduce the subjective nature of the grouping process. In the sequence, we extracted 486 elements related to cluster coopetition used in the articles. Aggregating elements in previously defined dimensions followed a deductive pattern, generating second-order coding. They represent the variables of coopetition in clusters. Some elements are synonymous or have the same purpose; thus, we grouped them. Other times, the same element is in more than one category, depending on the perspective used by the author. This finding confirmed the complex, fragmented and multidimensional nature of the coopetition highlighted, for instance, by Gernsheimer et al. ( 2021 ).

Figure  3 summarizes the research dimensions derived from the focus on coopetition addressed by the authors: Strategic Fit, Perceived Benefits, Mediated Coopetition, Social Interaction, Coopetitive Orientation, and the Temporality of Coopetition. Also, we synthesize the themes that were studied more and their respective authors in each dimension (Fig.  3 ). The Strategic Fit dimension was the biggest, encompassing 18 research focuses. Followed by Perceived Benefits and Social Interactions, each with eight research focuses. Our results revealed a gap in studies focusing on the risks of coopetition in clusters. Coopetitive relationships trigger tensions, distrust, and opportunism, which are challenges to ensuring coopetition results (Gernsheimer et al. 2021 ). The agenda of scholars in coopetition included these challenges but not the agenda of scholars in cluster coopetition. Also, the mediate coopetition needs more studies since cluster governance is a type of mediation among cauterized firms.

3.4.1 Strategic fit dimension

Strategic Fit Dimension is the alignment of objectives among competitors who collaborate in certain areas with shared goals seeking to capture the benefits of coopetition (Czakon et al. 2020a , b ). The literature pointed out that it is necessary to establish previous guidelines to minimize collaboration problems between competitors (Min et al. 2008 ; Hu and He 2013 ; Nemeh and Yami 2016 ; Ferasso et al. 2022 ). The main variables to study the Strategic Fit at clusters in the coopetition studies were networks, shared information, multilevel interdependencies, R&D investment, innovation projects, support agencies, macrodynamic capabilities, patent collaborations, co-production, and co-commercialization.

3.4.2 Perceived benefits dimension

The final goal of collaboration between competitors is the perceived benefits of this relationship, understood as the results of coopetition (Chim-Miki and Batista-Canino 2016; Czakon et al. 2020a , b ). The RSL of Gernsheimer et al. ( 2021 ) found that such benefits were mainly investigated related to innovation and firm performance, but recent studies also focused on organizational learning and sustainability. We identified that the benefits of coopetition in clusters are perceived in access to capital, government support, strengthening the productive arrangement and its firms (Barros et al. 2016 ), the opportunity for joint activities, training management, and human resources, innovation performance (Poisson-de-Haro and Myard 2018 ; Nemeh and Yami 2016 ), improvement in production and market activities (Yuan et al. 2021 ). Therefore, the investigation of the perceived benefits of coopetition in clusters has some differences in the direction of research on coopetition, as pointed out by Gernsheimer et al. ( 2021 ). Innovation and performance are benefits also pursued by clustered firms, but the joint actions are aimed at strengthening the entire productive arrangement and sustainable regional growth besides the firms. The cluster is a way to achieve sustainability, as it can reduce economic asymmetries (Chung and Cheng 2019 ). Our results also suggested that organizational learning as a perceived benefit of cluster coopetition is a gap in the literature.

Research dimensions according to the addressed focus of coopetition. Source : Elaborated by the authors

3.4.3 Mediated coopetition dimension

Mediated coopetition is the intermediation performed by a third party to build trust, structure, and facilitate collaboration among competitors (Hidalgo et al. 2022 ; Gernsheimer et al. 2021 ; Dana and Granata 2013 ). In articles published on cluster coopetition, mediated coopetition occurs through a public agency or a public policy (Barros et al. 2016 ; Maso and Lattanzi 2014 ). The main elements used to study cluster-mediated coopetition were governance, the culture of cooperation, crise management, workforce quality (Barros et al. 2016 ), training programs, communication, consultancy, financial management, public policy, fiscal policies, investment opportunities, media network (Maso and Lattanzi 2014 ). Cluster-mediated coopetition is an underexplored theme. Only two published articles address the topic, focusing on coopetition mediated by a public agent. Therefore, there is a literature gap regarding coopetition mediation by a private agent, although many clusters have an independent and private outsourced manager, as highlighted by Dana and Granata ( 2013 ). This manager is not directly involved in the competitive relationship between members, which helps minimize the tension while overseeing the interests of the clusterized firms and cluster (Dana and Granata 2013 ; Monticelli et al., 2018 ).

3.4.4 Social interaction dimension

The social interaction dimension is characterized by two types of relationships: internal, among the clustered firms to promote integration among players and their objectives, and external, among the clustered firms and other institutions to stimulate its growth and the capture of competitive advantages (Dana and Granata 2013 ; Dana et al. 2013 ). It is a social network influenced by the sociocultural cluster (Chai and Yang 2011 ) and becomes a social-structural phenomenon (Darbi and Knott 2023 ). Understanding what the environment is like and how the various actors interact has been recognized as the critical element to stimulate co-competitive relationships, minimize the risks and natural mistrust of the dichotomy of collaboration between competitors and the differential to accelerate the positive results arising from this relationship (Dana and Granata 2013 ; Dana et al. 2013 ; Czakon et al. 2020a , b ). The critical point for social interaction is local solid norms, which facilitate both the integration of coopetitive strategies by company managers and conflict management (Mathews 2018 ) since managing coopetition is seen as tension management (Czakon et al. 2020a , b ). Darbi and Knott ( 2023 ) suggested immersive cooperation among clusterized firms became a usual practice embedded as a culture. Scholars used diverse elements associated with the social interaction dimension of intra-cluster coopetition, such as the cluster environment and its advantages (Hu and He 2013 ); coopetitive relationships (Hoetoro 2014 ); strategy, including internationalization; and management and human resources (Leite et al. 2009 ; Dana and Granata 2013 ; Dana et al. 2013 ; Hu and He 2013 ; Mathews 2018 ).

3.4.5 Coopetitive orientation dimension

Coopetitive orientation is intrinsic motivation or the ability to collaborate with rivals (Czakon et al. 2020a , b ). The coopetitive orientation focuses on balancing collaboration and competition, coopetition challenges, and trust-generating mechanisms in cluster studies. The article by Cusin and Loubaresse ( 2018 ) analyzes the coopetitive orientation at intra-cluster in a context of asymmetry, addressing elements of coverage area, cluster expansion, differentiation, regional identity (Felzensztein et al. 2019 ), attractiveness, visibility (Cusin and Loubaresse 2018 ); cluster life cycle (Hartono and Sobari 2016 ); cluster integration; number, satisfaction, and loyalty of clusterized firms; joint projects and actions (Nemeh and Yami 2016 ; Smiljic 2020 ); complementarity (Sellitto et al. 2018); stability of the management team, and relational proximity (Mathews 2018 ). At the intra-cluster level, this dimension represents factors that form and influence coopetition but can also include inhibitors.

3.4.6 Coopetition temporality dimension

The dimension temporality of coopetition focuses on the dynamics of inter-organizational relationships that continually reconfigure the relational interdependencies as partnerships evolve (Kylanen and Mariani 2012 ; Chim-Miki and Batista-Canino 2017 ). In cluster studies, scholars associated the temporality of coopetition with the evolution, maturation, and degree of consolidation of cooperative relationships over time (Dana et al. 2013 ; Dana and Granata 2013 ; Granata et al. 2017 ). For instance, Felzensztein et al. ( 2018 ) demonstrated that clusters change over time, and inter-collaboration and social networks are determined by internal conditions (degree of competition, for example) and external conditions (economic crisis, for example). These set of effects generate changes in intra-cluster collaboration as a cluster matures. Monteiro ( 2016 ) highlighted that coopetition relationships should be built and managed over time by improving the strategies toward innovations and technological diversity.

Indeed, the coopetitive orientation, social interaction, and mediated coopetition lead companies to develop a strategic fit to achieve the perceived benefits of coopetition in clusters, but the existence of risks of opportunism, conflicts of interest, and perception of injustice in the division of gains (Raza-Ullah et al. 2014 ; Bouncken et al. 2018 ; Crick 2020 ), for example, can prevent the achievement of positive results. All these relationship dynamics can also suffer from the influence of time.

4 A framework and research agenda to develop intra-cluster coopetition

4.1 building theory from the review: advancing cluster coopetition research.

To provide a framework from the literature-systematized and integrative overview of the main intra-cluster coopetition elements (Fig.  4 ). We created subgroups (macro dimensions) according to the authors’ approach: Factors, conditions, Policies, Market commonality, and Formal supporting structure. Figure  3 confirms coopetition as the ‘cluster glue.’ It is the intrinsic behavior and primary strategy since they are interrelated and concentrated firms that must cooperate despite their individual interests.

Framework of the coopetition strategy at the intra-cluster level

The Policy dimension included driver elements for the intra-cluster coopetition strategy (Fig.  4 ). They are external cluster conditions, such as public policies to promote regional development based on clusters, tax policies, governance models, intermediation of external businesses, and partnership programs. In contrast, the dimensions of conditional factors and market commonality are internal cluster conditions. The degree of complementarity and interdependence of the clusterized firms, the ability to share resources, reduce costs and take advantage of co-location synergy to improve their bargaining power, and talent retention are conditioning elements of intra-cluster coopetition. The market commonality indicates competition among clusterized firms related to customers, suppliers, and resources, such as capital, human talents, technology support, etc. The balance of market commonality impacts the creation of networks for joint market-oriented strategies, such as co-marketing, co-branding, co-commerce, and internal business (B2B). Also, it can reduce adverse effects, such as opportunism or market uncertainty. Finally, the intensifying elements of the intra-cluster coopetition strategy are the conditions of the regional ecosystem of the cluster. This dimension represents the formal cluster’s support organizations that enhance innovation networks, training, technological and information sharing, and collaborative research networks.

The cluster coopetition framework can be seen as a revisited Porterian theory (Table  2 ). The sum of intra-cluster coopetition strategy elements pointed out by the literature complements Porterian theory showing common and complementary factors and institutions, governance, and public policies (Porter 1998 ). The determinants of regional advantage according to the Diamond Model are (1) firm strategy, structure and rivalry; (2) demand conditions; (3) factor conditions; and (4) related and supporting industries. In turn, the determinants of cluster coopetitive advantage are (1) Market commonality, (2) Policies, (3) Factors conditions, and (4) Formal supporting structure. However, for Porter, “chance” and “government” are two factors that influence the four determinants of the Diamond model. In the evolutionary framework of this Porterian reinterpretation from the perspective of coopetition in clusters, the factors that influence it are contextual, internal, and external to the cluster and the ecosystem in which it is inserted. Both chance and government are present in the contextual cluster factors.

The coopetition networks define the cluster boundaries from the business and organizational links. The clusters’ organisational structure minimises competition problems without imposing vertical or formal networks (Porter 1998 ). They promote alliances, shared goals, and the coexistence of competition and cooperation. Therefore, coopetition is a core behaviour of clusters, and it is their strategic management.

4.2 Research agenda: a set of future approaches to intra-cluster coopetition perspective

Our literature review followed Post et al. ( 2020 ) indications: integrative theorizing and creating a research agenda to advance the field. In the reviewed articles, we identified 35 future research questions suggested by the authors, which still need to be answered according to our analysis. We label the questions according to the focus on public policy or management practices representing the internal and external cluster context (Table  3 ).

Besides the indications of the research questions, a research agenda can be shaped for intra-cluster coopetition considering the relationships between the six identified dimensions. A set of future approaches to the intra-cluster coopetition perspective guides the re-thinking cluster toward an integrated perspective on the dynamics of coopetition (Fig.  5 ).

Conceptual map for future research on intra-cluster coopetition perspective.

Source : Elaborated by the authors

Coopetition is a multidimensional and multilevel phenomenon. Its dimensions should be considered together (Köseoğlu et al. 2019 ), as the context, process, and result are inseparable. From the literature review, considering the previous studies and the trends, a set of future approaches to deepen the intra-cluster coopetition perspective emerges. Figure  5 indicates a connected research framework to generate an evolution of intra-cluster coopetition based on its dynamics. The strategic fit is the core of intra-cluster coopetition relationships. It is part but goes beyond what Porter ( 1998 ) highlighted as the complementarity between the support institutions and the clusterized firms that define the cluster boundaries. Nevertheless, most cluster studies have focused on the sources of strategic fit, leaving knowledge gaps on the factors that reduce the coupling among clusterized firms and between the firms and the cluster.

Coopetitive orientation is an antecedent behavior that facilitates strategic fit (Czakon et al. 2020a , b ). The willingness or predisposition to cooperate should be studied from various angles, such as the firm’s previous experience in alliances and the background of cluster managers in joint projects or networks (Cusin and Loubaresse 2018 ). The level of coopetition willingness across the cluster cycle-of-life phases and in different sectors also needs more understanding to create adequate strategies for each context.

Social interaction is a dimension that gains status at the intra-cluster level, but it has been little studied in all coopetition levels. Some studies suggest a positive effect of social ties on the consolidation of coopetition networks and the generation of mutual trust (Felzensztein et al. 2018 ). In coopetition, social ties can be related to belonging to a place or group, cultural similarity, or local behavior (Oliveira-Ribeiro et al. 2022 ; Chaudhry et al. 2023 ). Thus, it is necessary for more studies on the influence of the city, country, culture, and local social capital on intra-cluster coopetition networks to improve the strategic fit for joint projects and cooperative R&D.

Just as the strategic fic is the core, the mediated coopetition is the intra-cluster management model. It can be generated by the regulatory environment and institutional configuration (König 2023 ), by some firms that act as central nodes in the coopetition networks (Ge and Liu 2022 ) or by the cluster governance mechanisms (Ramjaun et al. 2023 ). Besides, a cluster assumes the existence of governance (Porter 1998 ). In the evolution of strategic management suggested by Stead and Stead ( 2019 ), which also complements Porterian theory, coopetition becomes an ecosystem behavior and extends across multisectoral and multistakeholder relationships. However, to obtain competitive advantages for the cluster and clusterized firms, it is necessary to manage this open system properly to minimize the intrinsic tension of coopetition (Dana and Granata 2013 ). Therefore, more studies are needed on the role of government, business associations, public policies, and other formal institutions constituting the mediation mechanisms of intra-cluster coopetition.

The benefits are the outputs and the competitive advantages of the coopetition strategy. It is the primary motivator for firms to cooperate (Leite et al. 2009 ; Sellitto and Luchese 2018 ). The literature still needs studies with models or tools for monitoring coopetition results. It is necessary to verify the positive effects at the cluster and firm level, including mechanisms that consider the different firm’s sizes since they have different levels of value created and appropriated (Ritala et al. 2008 ). Also, it is necessary to understand how the benefits of coopetition contribute to cluster sustainability, which includes studies on innovative capacity and knowledge generation intra-cluster.

The temporality of the coopetition and the risks are two dimensions that influence the entire intra-cluster strategy. Studies need to identify risks and create mechanisms to minimize them. Few studies addressed coopetition risks in the literature. In some conditions, the cluster network consolidation tends to grow over time (Dana et al. 2013 ; Dana and Granata 2013 ) and improve coopetition outputs (Monteiro 2016 ). However, only some longitudinal studies provide insights into understanding the coopetition strategies along the cluster cycle life. Three aspects can mature over time: the partners, the cluster management, and the regional context where the cluster is part. Studies need to verify these dynamics and their influence on intra-cluster coopetition.

5 Conclusions and contributions

Thus, as the second contribution, we proposed a theoretical framework from the literature-systematized and integrative overview with our dimensions: Conditional factors, Policies, Market commonality, and Formal supporting structure. These dimensions act as drivers, markets, or intensifiers of the intra-cluster coopetition strategy. At the same time, the dimensions suffer the influence of external, internal, and ecosystem contexts (Fig.  3 ). The framework suggests the main elements to manage clusters under the coopetition strategy. These findings rethinking cluster theory (Porter 1998 ) and build the business co-evolution perspective of Stead and Stead ( 2019 ). The cluster is a business ecosystem with an open system based on coopetition. Nevertheless, Porter ( 1998 ) states that the complementarity among clusterized firms and supporting institutions can provide cluster boundaries; in the rethinking cluster, there are no boundaries. Cluster coopetition is multilevel and multi-stakeholders, so it is impossible to establish boundaries; however, it is essential to develop a mechanism to manage the network, mediated coopetition, and monitor the outputs as feedback to engage the players and improve the strategy fit.

Our third contribution is to open new paths to rethinking clusters from a coopetition perspective from a dynamic viewpoint. We suggest a set of approaches to advancing the intra-cluster coopetition perspective. The systematization of this SLR, based on six coopetition dimensions, captured the dynamics among them, orienting the frameworks towards an integrated perspective on intra-cluster coopetition issues. Coopetitive orientation, social interaction, and mediated coopetition lead companies to develop a strategic fit to achieve the perceived benefits of coopetition. However, it is necessary to advance research on Coopetition Risks and temporality of coopetition. The research agenda of cluster scholars barely pointed out particular coopetition risks despite the dark side of coopetition being discussed in strategy studies. The categories were created based on studied themes plus emerging trends extracted from indications for future research. Thus, it was an inductive-deductive pattern system that represented the evolutionary trend of the topic itself.

Our research had limitations; although it was an in-depth analysis, it focused on articles published on the Web of Science and Scopus, not including doctoral thesis and other scientific bases. We suggest an additional literature review covering more databases. Also, complement the theoretical review with empirical approaches that consider the view from within the cluster, that is, clustered firms and cluster managers, to identify the elements of intra-cluster coopetition. Cluster coopetition is an essential strategy for the sustainable development of firms, regions, and countries. It is necessary to study how coopetition influences the new re-shoring strategies and new industrial policies. For this, the theme needs more research to develop a coopetition strategy to support the development of public policies, the cluster digital transformation, and management practices toward rethinking clusters.

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Conceptualization: Adriana Fumi Chim-Miki and Rosana Lacerda Coelho Fernandes; Methodology: Adriana Fumi Chim-Miki and Rosana Lacerda Coelho Fernandes; Formal analysis and investigation: Rosana Lacerda Coelho Fernandes, Adriana Fumi Chim-Miki, and Jefferson Marlon Monticelli; Writing - original draft preparation: Rosana Lacerda Coelho Fernandes and Adriana Fumi Chim-Miki; Writing - review and editing: Adriana Fumi Chim-Miki and Jefferson Marlon Monticelli; Funding acquisition: Adriana Fumi Chim-Miki; Resources: Adriana Fumi Chim-Miki; Supervision: Adriana Fumi Chim-Miki and Jefferson Marlon Monticelli.

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Chim-Miki, A.F., Fernandes, R.L.C. & Monticelli, J.M. Rethinking cluster under coopetition strategy: an integrative literature review and research agenda. Manag Rev Q (2024). https://doi.org/10.1007/s11301-024-00434-z

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Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.

Handbook of eHealth Evaluation: An Evidence-based Approach [Internet].

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

Literature reviews play a critical role in scholarship because science remains, first and foremost, a cumulative endeavour ( vom Brocke et al., 2009 ). As in any academic discipline, rigorous knowledge syntheses are becoming indispensable in keeping up with an exponentially growing eHealth literature, assisting practitioners, academics, and graduate students in finding, evaluating, and synthesizing the contents of many empirical and conceptual papers. Among other methods, literature reviews are essential for: (a) identifying what has been written on a subject or topic; (b) determining the extent to which a specific research area reveals any interpretable trends or patterns; (c) aggregating empirical findings related to a narrow research question to support evidence-based practice; (d) generating new frameworks and theories; and (e) identifying topics or questions requiring more investigation ( Paré, Trudel, Jaana, & Kitsiou, 2015 ).

Literature reviews can take two major forms. The most prevalent one is the “literature review” or “background” section within a journal paper or a chapter in a graduate thesis. This section synthesizes the extant literature and usually identifies the gaps in knowledge that the empirical study addresses ( Sylvester, Tate, & Johnstone, 2013 ). It may also provide a theoretical foundation for the proposed study, substantiate the presence of the research problem, justify the research as one that contributes something new to the cumulated knowledge, or validate the methods and approaches for the proposed study ( Hart, 1998 ; Levy & Ellis, 2006 ).

The second form of literature review, which is the focus of this chapter, constitutes an original and valuable work of research in and of itself ( Paré et al., 2015 ). Rather than providing a base for a researcher’s own work, it creates a solid starting point for all members of the community interested in a particular area or topic ( Mulrow, 1987 ). The so-called “review article” is a journal-length paper which has an overarching purpose to synthesize the literature in a field, without collecting or analyzing any primary data ( Green, Johnson, & Adams, 2006 ).

When appropriately conducted, review articles represent powerful information sources for practitioners looking for state-of-the art evidence to guide their decision-making and work practices ( Paré et al., 2015 ). Further, high-quality reviews become frequently cited pieces of work which researchers seek out as a first clear outline of the literature when undertaking empirical studies ( Cooper, 1988 ; Rowe, 2014 ). Scholars who track and gauge the impact of articles have found that review papers are cited and downloaded more often than any other type of published article ( Cronin, Ryan, & Coughlan, 2008 ; Montori, Wilczynski, Morgan, Haynes, & Hedges, 2003 ; Patsopoulos, Analatos, & Ioannidis, 2005 ). The reason for their popularity may be the fact that reading the review enables one to have an overview, if not a detailed knowledge of the area in question, as well as references to the most useful primary sources ( Cronin et al., 2008 ). Although they are not easy to conduct, the commitment to complete a review article provides a tremendous service to one’s academic community ( Paré et al., 2015 ; Petticrew & Roberts, 2006 ). Most, if not all, peer-reviewed journals in the fields of medical informatics publish review articles of some type.

The main objectives of this chapter are fourfold: (a) to provide an overview of the major steps and activities involved in conducting a stand-alone literature review; (b) to describe and contrast the different types of review articles that can contribute to the eHealth knowledge base; (c) to illustrate each review type with one or two examples from the eHealth literature; and (d) to provide a series of recommendations for prospective authors of review articles in this domain.

9.2. Overview of the Literature Review Process and Steps

As explained in Templier and Paré (2015) , there are six generic steps involved in conducting a review article:

• formulating the research question(s) and objective(s),
• searching the extant literature,
• screening for inclusion,
• assessing the quality of primary studies,
• extracting data, and
• analyzing data.

Although these steps are presented here in sequential order, one must keep in mind that the review process can be iterative and that many activities can be initiated during the planning stage and later refined during subsequent phases ( Finfgeld-Connett & Johnson, 2013 ; Kitchenham & Charters, 2007 ).

Formulating the research question(s) and objective(s): As a first step, members of the review team must appropriately justify the need for the review itself ( Petticrew & Roberts, 2006 ), identify the review’s main objective(s) ( Okoli & Schabram, 2010 ), and define the concepts or variables at the heart of their synthesis ( Cooper & Hedges, 2009 ; Webster & Watson, 2002 ). Importantly, they also need to articulate the research question(s) they propose to investigate ( Kitchenham & Charters, 2007 ). In this regard, we concur with Jesson, Matheson, and Lacey (2011) that clearly articulated research questions are key ingredients that guide the entire review methodology; they underscore the type of information that is needed, inform the search for and selection of relevant literature, and guide or orient the subsequent analysis. Searching the extant literature: The next step consists of searching the literature and making decisions about the suitability of material to be considered in the review ( Cooper, 1988 ). There exist three main coverage strategies. First, exhaustive coverage means an effort is made to be as comprehensive as possible in order to ensure that all relevant studies, published and unpublished, are included in the review and, thus, conclusions are based on this all-inclusive knowledge base. The second type of coverage consists of presenting materials that are representative of most other works in a given field or area. Often authors who adopt this strategy will search for relevant articles in a small number of top-tier journals in a field ( Paré et al., 2015 ). In the third strategy, the review team concentrates on prior works that have been central or pivotal to a particular topic. This may include empirical studies or conceptual papers that initiated a line of investigation, changed how problems or questions were framed, introduced new methods or concepts, or engendered important debate ( Cooper, 1988 ). Screening for inclusion: The following step consists of evaluating the applicability of the material identified in the preceding step ( Levy & Ellis, 2006 ; vom Brocke et al., 2009 ). Once a group of potential studies has been identified, members of the review team must screen them to determine their relevance ( Petticrew & Roberts, 2006 ). A set of predetermined rules provides a basis for including or excluding certain studies. This exercise requires a significant investment on the part of researchers, who must ensure enhanced objectivity and avoid biases or mistakes. As discussed later in this chapter, for certain types of reviews there must be at least two independent reviewers involved in the screening process and a procedure to resolve disagreements must also be in place ( Liberati et al., 2009 ; Shea et al., 2009 ). Assessing the quality of primary studies: In addition to screening material for inclusion, members of the review team may need to assess the scientific quality of the selected studies, that is, appraise the rigour of the research design and methods. Such formal assessment, which is usually conducted independently by at least two coders, helps members of the review team refine which studies to include in the final sample, determine whether or not the differences in quality may affect their conclusions, or guide how they analyze the data and interpret the findings ( Petticrew & Roberts, 2006 ). Ascribing quality scores to each primary study or considering through domain-based evaluations which study components have or have not been designed and executed appropriately makes it possible to reflect on the extent to which the selected study addresses possible biases and maximizes validity ( Shea et al., 2009 ). Extracting data: The following step involves gathering or extracting applicable information from each primary study included in the sample and deciding what is relevant to the problem of interest ( Cooper & Hedges, 2009 ). Indeed, the type of data that should be recorded mainly depends on the initial research questions ( Okoli & Schabram, 2010 ). However, important information may also be gathered about how, when, where and by whom the primary study was conducted, the research design and methods, or qualitative/quantitative results ( Cooper & Hedges, 2009 ). Analyzing and synthesizing data : As a final step, members of the review team must collate, summarize, aggregate, organize, and compare the evidence extracted from the included studies. The extracted data must be presented in a meaningful way that suggests a new contribution to the extant literature ( Jesson et al., 2011 ). Webster and Watson (2002) warn researchers that literature reviews should be much more than lists of papers and should provide a coherent lens to make sense of extant knowledge on a given topic. There exist several methods and techniques for synthesizing quantitative (e.g., frequency analysis, meta-analysis) and qualitative (e.g., grounded theory, narrative analysis, meta-ethnography) evidence ( Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005 ; Thomas & Harden, 2008 ).

9.3. Types of Review Articles and Brief Illustrations

EHealth researchers have at their disposal a number of approaches and methods for making sense out of existing literature, all with the purpose of casting current research findings into historical contexts or explaining contradictions that might exist among a set of primary research studies conducted on a particular topic. Our classification scheme is largely inspired from Paré and colleagues’ (2015) typology. Below we present and illustrate those review types that we feel are central to the growth and development of the eHealth domain.

9.3.1. Narrative Reviews

The narrative review is the “traditional” way of reviewing the extant literature and is skewed towards a qualitative interpretation of prior knowledge ( Sylvester et al., 2013 ). Put simply, a narrative review attempts to summarize or synthesize what has been written on a particular topic but does not seek generalization or cumulative knowledge from what is reviewed ( Davies, 2000 ; Green et al., 2006 ). Instead, the review team often undertakes the task of accumulating and synthesizing the literature to demonstrate the value of a particular point of view ( Baumeister & Leary, 1997 ). As such, reviewers may selectively ignore or limit the attention paid to certain studies in order to make a point. In this rather unsystematic approach, the selection of information from primary articles is subjective, lacks explicit criteria for inclusion and can lead to biased interpretations or inferences ( Green et al., 2006 ). There are several narrative reviews in the particular eHealth domain, as in all fields, which follow such an unstructured approach ( Silva et al., 2015 ; Paul et al., 2015 ).

Despite these criticisms, this type of review can be very useful in gathering together a volume of literature in a specific subject area and synthesizing it. As mentioned above, its primary purpose is to provide the reader with a comprehensive background for understanding current knowledge and highlighting the significance of new research ( Cronin et al., 2008 ). Faculty like to use narrative reviews in the classroom because they are often more up to date than textbooks, provide a single source for students to reference, and expose students to peer-reviewed literature ( Green et al., 2006 ). For researchers, narrative reviews can inspire research ideas by identifying gaps or inconsistencies in a body of knowledge, thus helping researchers to determine research questions or formulate hypotheses. Importantly, narrative reviews can also be used as educational articles to bring practitioners up to date with certain topics of issues ( Green et al., 2006 ).

Recently, there have been several efforts to introduce more rigour in narrative reviews that will elucidate common pitfalls and bring changes into their publication standards. Information systems researchers, among others, have contributed to advancing knowledge on how to structure a “traditional” review. For instance, Levy and Ellis (2006) proposed a generic framework for conducting such reviews. Their model follows the systematic data processing approach comprised of three steps, namely: (a) literature search and screening; (b) data extraction and analysis; and (c) writing the literature review. They provide detailed and very helpful instructions on how to conduct each step of the review process. As another methodological contribution, vom Brocke et al. (2009) offered a series of guidelines for conducting literature reviews, with a particular focus on how to search and extract the relevant body of knowledge. Last, Bandara, Miskon, and Fielt (2011) proposed a structured, predefined and tool-supported method to identify primary studies within a feasible scope, extract relevant content from identified articles, synthesize and analyze the findings, and effectively write and present the results of the literature review. We highly recommend that prospective authors of narrative reviews consult these useful sources before embarking on their work.

Darlow and Wen (2015) provide a good example of a highly structured narrative review in the eHealth field. These authors synthesized published articles that describe the development process of mobile health ( m-health ) interventions for patients’ cancer care self-management. As in most narrative reviews, the scope of the research questions being investigated is broad: (a) how development of these systems are carried out; (b) which methods are used to investigate these systems; and (c) what conclusions can be drawn as a result of the development of these systems. To provide clear answers to these questions, a literature search was conducted on six electronic databases and Google Scholar . The search was performed using several terms and free text words, combining them in an appropriate manner. Four inclusion and three exclusion criteria were utilized during the screening process. Both authors independently reviewed each of the identified articles to determine eligibility and extract study information. A flow diagram shows the number of studies identified, screened, and included or excluded at each stage of study selection. In terms of contributions, this review provides a series of practical recommendations for m-health intervention development.

9.3.2. Descriptive or Mapping Reviews

The primary goal of a descriptive review is to determine the extent to which a body of knowledge in a particular research topic reveals any interpretable pattern or trend with respect to pre-existing propositions, theories, methodologies or findings ( King & He, 2005 ; Paré et al., 2015 ). In contrast with narrative reviews, descriptive reviews follow a systematic and transparent procedure, including searching, screening and classifying studies ( Petersen, Vakkalanka, & Kuzniarz, 2015 ). Indeed, structured search methods are used to form a representative sample of a larger group of published works ( Paré et al., 2015 ). Further, authors of descriptive reviews extract from each study certain characteristics of interest, such as publication year, research methods, data collection techniques, and direction or strength of research outcomes (e.g., positive, negative, or non-significant) in the form of frequency analysis to produce quantitative results ( Sylvester et al., 2013 ). In essence, each study included in a descriptive review is treated as the unit of analysis and the published literature as a whole provides a database from which the authors attempt to identify any interpretable trends or draw overall conclusions about the merits of existing conceptualizations, propositions, methods or findings ( Paré et al., 2015 ). In doing so, a descriptive review may claim that its findings represent the state of the art in a particular domain ( King & He, 2005 ).

In the fields of health sciences and medical informatics, reviews that focus on examining the range, nature and evolution of a topic area are described by Anderson, Allen, Peckham, and Goodwin (2008) as mapping reviews . Like descriptive reviews, the research questions are generic and usually relate to publication patterns and trends. There is no preconceived plan to systematically review all of the literature although this can be done. Instead, researchers often present studies that are representative of most works published in a particular area and they consider a specific time frame to be mapped.

An example of this approach in the eHealth domain is offered by DeShazo, Lavallie, and Wolf (2009). The purpose of this descriptive or mapping review was to characterize publication trends in the medical informatics literature over a 20-year period (1987 to 2006). To achieve this ambitious objective, the authors performed a bibliometric analysis of medical informatics citations indexed in medline using publication trends, journal frequencies, impact factors, Medical Subject Headings (MeSH) term frequencies, and characteristics of citations. Findings revealed that there were over 77,000 medical informatics articles published during the covered period in numerous journals and that the average annual growth rate was 12%. The MeSH term analysis also suggested a strong interdisciplinary trend. Finally, average impact scores increased over time with two notable growth periods. Overall, patterns in research outputs that seem to characterize the historic trends and current components of the field of medical informatics suggest it may be a maturing discipline (DeShazo et al., 2009).

9.3.3. Scoping Reviews

Scoping reviews attempt to provide an initial indication of the potential size and nature of the extant literature on an emergent topic (Arksey & O’Malley, 2005; Daudt, van Mossel, & Scott, 2013 ; Levac, Colquhoun, & O’Brien, 2010). A scoping review may be conducted to examine the extent, range and nature of research activities in a particular area, determine the value of undertaking a full systematic review (discussed next), or identify research gaps in the extant literature ( Paré et al., 2015 ). In line with their main objective, scoping reviews usually conclude with the presentation of a detailed research agenda for future works along with potential implications for both practice and research.

Unlike narrative and descriptive reviews, the whole point of scoping the field is to be as comprehensive as possible, including grey literature (Arksey & O’Malley, 2005). Inclusion and exclusion criteria must be established to help researchers eliminate studies that are not aligned with the research questions. It is also recommended that at least two independent coders review abstracts yielded from the search strategy and then the full articles for study selection ( Daudt et al., 2013 ). The synthesized evidence from content or thematic analysis is relatively easy to present in tabular form (Arksey & O’Malley, 2005; Thomas & Harden, 2008 ).

One of the most highly cited scoping reviews in the eHealth domain was published by Archer, Fevrier-Thomas, Lokker, McKibbon, and Straus (2011) . These authors reviewed the existing literature on personal health record ( phr ) systems including design, functionality, implementation, applications, outcomes, and benefits. Seven databases were searched from 1985 to March 2010. Several search terms relating to phr s were used during this process. Two authors independently screened titles and abstracts to determine inclusion status. A second screen of full-text articles, again by two independent members of the research team, ensured that the studies described phr s. All in all, 130 articles met the criteria and their data were extracted manually into a database. The authors concluded that although there is a large amount of survey, observational, cohort/panel, and anecdotal evidence of phr benefits and satisfaction for patients, more research is needed to evaluate the results of phr implementations. Their in-depth analysis of the literature signalled that there is little solid evidence from randomized controlled trials or other studies through the use of phr s. Hence, they suggested that more research is needed that addresses the current lack of understanding of optimal functionality and usability of these systems, and how they can play a beneficial role in supporting patient self-management ( Archer et al., 2011 ).

9.3.4. Forms of Aggregative Reviews

Healthcare providers, practitioners, and policy-makers are nowadays overwhelmed with large volumes of information, including research-based evidence from numerous clinical trials and evaluation studies, assessing the effectiveness of health information technologies and interventions ( Ammenwerth & de Keizer, 2004 ; Deshazo et al., 2009 ). It is unrealistic to expect that all these disparate actors will have the time, skills, and necessary resources to identify the available evidence in the area of their expertise and consider it when making decisions. Systematic reviews that involve the rigorous application of scientific strategies aimed at limiting subjectivity and bias (i.e., systematic and random errors) can respond to this challenge.

Systematic reviews attempt to aggregate, appraise, and synthesize in a single source all empirical evidence that meet a set of previously specified eligibility criteria in order to answer a clearly formulated and often narrow research question on a particular topic of interest to support evidence-based practice ( Liberati et al., 2009 ). They adhere closely to explicit scientific principles ( Liberati et al., 2009 ) and rigorous methodological guidelines (Higgins & Green, 2008) aimed at reducing random and systematic errors that can lead to deviations from the truth in results or inferences. The use of explicit methods allows systematic reviews to aggregate a large body of research evidence, assess whether effects or relationships are in the same direction and of the same general magnitude, explain possible inconsistencies between study results, and determine the strength of the overall evidence for every outcome of interest based on the quality of included studies and the general consistency among them ( Cook, Mulrow, & Haynes, 1997 ). The main procedures of a systematic review involve:

• Formulating a review question and developing a search strategy based on explicit inclusion criteria for the identification of eligible studies (usually described in the context of a detailed review protocol).
• Searching for eligible studies using multiple databases and information sources, including grey literature sources, without any language restrictions.
• Selecting studies, extracting data, and assessing risk of bias in a duplicate manner using two independent reviewers to avoid random or systematic errors in the process.
• Analyzing data using quantitative or qualitative methods.
• Presenting results in summary of findings tables.
• Interpreting results and drawing conclusions.

Many systematic reviews, but not all, use statistical methods to combine the results of independent studies into a single quantitative estimate or summary effect size. Known as meta-analyses , these reviews use specific data extraction and statistical techniques (e.g., network, frequentist, or Bayesian meta-analyses) to calculate from each study by outcome of interest an effect size along with a confidence interval that reflects the degree of uncertainty behind the point estimate of effect ( Borenstein, Hedges, Higgins, & Rothstein, 2009 ; Deeks, Higgins, & Altman, 2008 ). Subsequently, they use fixed or random-effects analysis models to combine the results of the included studies, assess statistical heterogeneity, and calculate a weighted average of the effect estimates from the different studies, taking into account their sample sizes. The summary effect size is a value that reflects the average magnitude of the intervention effect for a particular outcome of interest or, more generally, the strength of a relationship between two variables across all studies included in the systematic review. By statistically combining data from multiple studies, meta-analyses can create more precise and reliable estimates of intervention effects than those derived from individual studies alone, when these are examined independently as discrete sources of information.

The review by Gurol-Urganci, de Jongh, Vodopivec-Jamsek, Atun, and Car (2013) on the effects of mobile phone messaging reminders for attendance at healthcare appointments is an illustrative example of a high-quality systematic review with meta-analysis. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs to health systems. These authors sought to assess whether mobile phone-based appointment reminders delivered through Short Message Service ( sms ) or Multimedia Messaging Service ( mms ) are effective in improving rates of patient attendance and reducing overall costs. To this end, they conducted a comprehensive search on multiple databases using highly sensitive search strategies without language or publication-type restrictions to identify all rct s that are eligible for inclusion. In order to minimize the risk of omitting eligible studies not captured by the original search, they supplemented all electronic searches with manual screening of trial registers and references contained in the included studies. Study selection, data extraction, and risk of bias assessments were performed inde­­pen­dently by two coders using standardized methods to ensure consistency and to eliminate potential errors. Findings from eight rct s involving 6,615 participants were pooled into meta-analyses to calculate the magnitude of effects that mobile text message reminders have on the rate of attendance at healthcare appointments compared to no reminders and phone call reminders.

Meta-analyses are regarded as powerful tools for deriving meaningful conclusions. However, there are situations in which it is neither reasonable nor appropriate to pool studies together using meta-analytic methods simply because there is extensive clinical heterogeneity between the included studies or variation in measurement tools, comparisons, or outcomes of interest. In these cases, systematic reviews can use qualitative synthesis methods such as vote counting, content analysis, classification schemes and tabulations, as an alternative approach to narratively synthesize the results of the independent studies included in the review. This form of review is known as qualitative systematic review.

A rigorous example of one such review in the eHealth domain is presented by Mickan, Atherton, Roberts, Heneghan, and Tilson (2014) on the use of handheld computers by healthcare professionals and their impact on access to information and clinical decision-making. In line with the methodological guide­lines for systematic reviews, these authors: (a) developed and registered with prospero ( www.crd.york.ac.uk/ prospero / ) an a priori review protocol; (b) conducted comprehensive searches for eligible studies using multiple databases and other supplementary strategies (e.g., forward searches); and (c) subsequently carried out study selection, data extraction, and risk of bias assessments in a duplicate manner to eliminate potential errors in the review process. Heterogeneity between the included studies in terms of reported outcomes and measures precluded the use of meta-analytic methods. To this end, the authors resorted to using narrative analysis and synthesis to describe the effectiveness of handheld computers on accessing information for clinical knowledge, adherence to safety and clinical quality guidelines, and diagnostic decision-making.

In recent years, the number of systematic reviews in the field of health informatics has increased considerably. Systematic reviews with discordant findings can cause great confusion and make it difficult for decision-makers to interpret the review-level evidence ( Moher, 2013 ). Therefore, there is a growing need for appraisal and synthesis of prior systematic reviews to ensure that decision-making is constantly informed by the best available accumulated evidence. Umbrella reviews , also known as overviews of systematic reviews, are tertiary types of evidence synthesis that aim to accomplish this; that is, they aim to compare and contrast findings from multiple systematic reviews and meta-analyses ( Becker & Oxman, 2008 ). Umbrella reviews generally adhere to the same principles and rigorous methodological guidelines used in systematic reviews. However, the unit of analysis in umbrella reviews is the systematic review rather than the primary study ( Becker & Oxman, 2008 ). Unlike systematic reviews that have a narrow focus of inquiry, umbrella reviews focus on broader research topics for which there are several potential interventions ( Smith, Devane, Begley, & Clarke, 2011 ). A recent umbrella review on the effects of home telemonitoring interventions for patients with heart failure critically appraised, compared, and synthesized evidence from 15 systematic reviews to investigate which types of home telemonitoring technologies and forms of interventions are more effective in reducing mortality and hospital admissions ( Kitsiou, Paré, & Jaana, 2015 ).

9.3.5. Realist Reviews

Realist reviews are theory-driven interpretative reviews developed to inform, enhance, or supplement conventional systematic reviews by making sense of heterogeneous evidence about complex interventions applied in diverse contexts in a way that informs policy decision-making ( Greenhalgh, Wong, Westhorp, & Pawson, 2011 ). They originated from criticisms of positivist systematic reviews which centre on their “simplistic” underlying assumptions ( Oates, 2011 ). As explained above, systematic reviews seek to identify causation. Such logic is appropriate for fields like medicine and education where findings of randomized controlled trials can be aggregated to see whether a new treatment or intervention does improve outcomes. However, many argue that it is not possible to establish such direct causal links between interventions and outcomes in fields such as social policy, management, and information systems where for any intervention there is unlikely to be a regular or consistent outcome ( Oates, 2011 ; Pawson, 2006 ; Rousseau, Manning, & Denyer, 2008 ).

To circumvent these limitations, Pawson, Greenhalgh, Harvey, and Walshe (2005) have proposed a new approach for synthesizing knowledge that seeks to unpack the mechanism of how “complex interventions” work in particular contexts. The basic research question — what works? — which is usually associated with systematic reviews changes to: what is it about this intervention that works, for whom, in what circumstances, in what respects and why? Realist reviews have no particular preference for either quantitative or qualitative evidence. As a theory-building approach, a realist review usually starts by articulating likely underlying mechanisms and then scrutinizes available evidence to find out whether and where these mechanisms are applicable ( Shepperd et al., 2009 ). Primary studies found in the extant literature are viewed as case studies which can test and modify the initial theories ( Rousseau et al., 2008 ).

The main objective pursued in the realist review conducted by Otte-Trojel, de Bont, Rundall, and van de Klundert (2014) was to examine how patient portals contribute to health service delivery and patient outcomes. The specific goals were to investigate how outcomes are produced and, most importantly, how variations in outcomes can be explained. The research team started with an exploratory review of background documents and research studies to identify ways in which patient portals may contribute to health service delivery and patient outcomes. The authors identified six main ways which represent “educated guesses” to be tested against the data in the evaluation studies. These studies were identified through a formal and systematic search in four databases between 2003 and 2013. Two members of the research team selected the articles using a pre-established list of inclusion and exclusion criteria and following a two-step procedure. The authors then extracted data from the selected articles and created several tables, one for each outcome category. They organized information to bring forward those mechanisms where patient portals contribute to outcomes and the variation in outcomes across different contexts.

9.3.6. Critical Reviews

Lastly, critical reviews aim to provide a critical evaluation and interpretive analysis of existing literature on a particular topic of interest to reveal strengths, weaknesses, contradictions, controversies, inconsistencies, and/or other important issues with respect to theories, hypotheses, research methods or results ( Baumeister & Leary, 1997 ; Kirkevold, 1997 ). Unlike other review types, critical reviews attempt to take a reflective account of the research that has been done in a particular area of interest, and assess its credibility by using appraisal instruments or critical interpretive methods. In this way, critical reviews attempt to constructively inform other scholars about the weaknesses of prior research and strengthen knowledge development by giving focus and direction to studies for further improvement ( Kirkevold, 1997 ).

Kitsiou, Paré, and Jaana (2013) provide an example of a critical review that assessed the methodological quality of prior systematic reviews of home telemonitoring studies for chronic patients. The authors conducted a comprehensive search on multiple databases to identify eligible reviews and subsequently used a validated instrument to conduct an in-depth quality appraisal. Results indicate that the majority of systematic reviews in this particular area suffer from important methodological flaws and biases that impair their internal validity and limit their usefulness for clinical and decision-making purposes. To this end, they provide a number of recommendations to strengthen knowledge development towards improving the design and execution of future reviews on home telemonitoring.

9.4. Summary

Table 9.1 outlines the main types of literature reviews that were described in the previous sub-sections and summarizes the main characteristics that distinguish one review type from another. It also includes key references to methodological guidelines and useful sources that can be used by eHealth scholars and researchers for planning and developing reviews.

Typology of Literature Reviews (adapted from Paré et al., 2015).

As shown in Table 9.1 , each review type addresses different kinds of research questions or objectives, which subsequently define and dictate the methods and approaches that need to be used to achieve the overarching goal(s) of the review. For example, in the case of narrative reviews, there is greater flexibility in searching and synthesizing articles ( Green et al., 2006 ). Researchers are often relatively free to use a diversity of approaches to search, identify, and select relevant scientific articles, describe their operational characteristics, present how the individual studies fit together, and formulate conclusions. On the other hand, systematic reviews are characterized by their high level of systematicity, rigour, and use of explicit methods, based on an “a priori” review plan that aims to minimize bias in the analysis and synthesis process (Higgins & Green, 2008). Some reviews are exploratory in nature (e.g., scoping/mapping reviews), whereas others may be conducted to discover patterns (e.g., descriptive reviews) or involve a synthesis approach that may include the critical analysis of prior research ( Paré et al., 2015 ). Hence, in order to select the most appropriate type of review, it is critical to know before embarking on a review project, why the research synthesis is conducted and what type of methods are best aligned with the pursued goals.

9.5. Concluding Remarks

In light of the increased use of evidence-based practice and research generating stronger evidence ( Grady et al., 2011 ; Lyden et al., 2013 ), review articles have become essential tools for summarizing, synthesizing, integrating or critically appraising prior knowledge in the eHealth field. As mentioned earlier, when rigorously conducted review articles represent powerful information sources for eHealth scholars and practitioners looking for state-of-the-art evidence. The typology of literature reviews we used herein will allow eHealth researchers, graduate students and practitioners to gain a better understanding of the similarities and differences between review types.

We must stress that this classification scheme does not privilege any specific type of review as being of higher quality than another ( Paré et al., 2015 ). As explained above, each type of review has its own strengths and limitations. Having said that, we realize that the methodological rigour of any review — be it qualitative, quantitative or mixed — is a critical aspect that should be considered seriously by prospective authors. In the present context, the notion of rigour refers to the reliability and validity of the review process described in section 9.2. For one thing, reliability is related to the reproducibility of the review process and steps, which is facilitated by a comprehensive documentation of the literature search process, extraction, coding and analysis performed in the review. Whether the search is comprehensive or not, whether it involves a methodical approach for data extraction and synthesis or not, it is important that the review documents in an explicit and transparent manner the steps and approach that were used in the process of its development. Next, validity characterizes the degree to which the review process was conducted appropriately. It goes beyond documentation and reflects decisions related to the selection of the sources, the search terms used, the period of time covered, the articles selected in the search, and the application of backward and forward searches ( vom Brocke et al., 2009 ). In short, the rigour of any review article is reflected by the explicitness of its methods (i.e., transparency) and the soundness of the approach used. We refer those interested in the concepts of rigour and quality to the work of Templier and Paré (2015) which offers a detailed set of methodological guidelines for conducting and evaluating various types of review articles.

To conclude, our main objective in this chapter was to demystify the various types of literature reviews that are central to the continuous development of the eHealth field. It is our hope that our descriptive account will serve as a valuable source for those conducting, evaluating or using reviews in this important and growing domain.

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• Cite this Page Paré G, Kitsiou S. Chapter 9 Methods for Literature Reviews. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
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• Concluding Remarks

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• Published: 24 April 2024

Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review

• Virginia Dickson-Swift 1 ,
• Joanne Adams 1 ,
• Evelien Spelten 1 ,
• Irene Blackberry 2 ,
• Carlene Wilson 3 , 4 , 5 &
• Eva Yuen 3 , 6 , 7 , 8  

BMC Women's Health volume  24 , Article number:  256 ( 2024 ) Cite this article

Metrics details

This scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available.

All original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners).

The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken.

A total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making.

The results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.

Peer Review reports

Introduction

Breast cancer is now the most commonly diagnosed cancer in the world overtaking lung cancer in 2021 [ 1 ]. Across the globe, breast cancer contributed to 25.8% of the total number of new cases of cancer diagnosed in 2020 [ 2 ] and accounts for a high disease burden for women [ 3 ]. Screening for breast cancer is an effective means of detecting early-stage cancer and has been shown to significantly improve survival rates [ 4 ]. A recent systematic review of international screening guidelines found that most countries recommend that women have biennial mammograms between the ages of 40–70 years [ 5 ] with some recommending that there should be no upper age limit [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ] and others suggesting that benefits of continued screening for women over 75 are not clear [ 13 , 14 , 15 ].

Some guidelines suggest that the decision to end screening should be determined based on the individual health status of the woman, their life expectancy and current health issues [ 5 , 16 , 17 ]. This is because the benefits of mammography screening may be limited after 7 years due to existing comorbidities and limited life expectancy [ 18 , 19 , 20 , 21 ], with some jurisdictions recommending breast cancer screening for women ≥ 75 years only when life expectancy is estimated as at least 7–10 years [ 22 ]. Others have argued that decisions about continuing with screening mammography should depend on individual patient risk and health management preferences [ 23 ]. This decision is likely facilitated by a discussion between a health care provider and patient about the harms and benefits of screening outside the recommended ages [ 24 , 25 ]. While mammography may enable early detection of breast cancer, it is clear that false-positive results and overdiagnosis Footnote 1 may occur. Studies have estimated that up to 25% of breast cancer cases in the general population may be over diagnosed [ 26 , 27 , 28 ].

The risk of being diagnosed with breast cancer increases with age and approximately 80% of new cases of breast cancer in high-income countries are in women over the age of 50 [ 29 ]. The average age of first diagnosis of breast cancer in high income countries is comparable to that of Australian women which is now 61 years [ 2 , 4 , 29 ]. Studies show that women aged ≥ 75 years generally have positive attitudes to mammography screening and report high levels of perceived benefits including early detection of breast cancer and a desire to stay healthy as they age [ 21 , 30 , 31 , 32 ]. Some women aged over 74 participate, or plan to participate, in screening despite recommendations from health professionals and government guidelines advising against it [ 33 ]. Results of a recent review found that knowledge of the recommended guidelines and the potential harms of screening are limited and many older women believed that the benefits of continued screening outweighed the risks [ 30 ].

Very few studies have been undertaken to understand the motivations of women to screen or to establish screening participation rates among women aged ≥ 75 and older. This is surprising given that increasing age is recognised as a key risk factor for the development of breast cancer, and that screening is offered in many locations around the world every two years up until 74 years. The importance of this topic is high given the ambiguity around best practice for participation beyond 74 years. A preliminary search of Open Science Framework, PROSPERO, Cochrane Database of Systematic Reviews and JBI Evidence Synthesis in May 2022 did not locate any reviews on this topic.

This scoping review has allowed for the mapping of a broad range of research to explore the breadth and depth of the literature, summarize the evidence and identify knowledge gaps [ 34 , 35 ]. This information has supported the development of a comprehensive overview of current knowledge of motivations of women to screen and screening participation rates among women outside the targeted age of many international screening programs.

Materials and methods

Research question.

The research question for this scoping review was developed by applying the Population—Concept—Context (PCC) framework [ 36 ]. The current review addresses the research question “What research has been undertaken in high-income countries (context) exploring the key motivations to screen for breast cancer and screening participation (concepts) among women ≥ 75 years of age (population)?

Eligibility criteria

Participants.

Women aged ≥ 75 years were the key population. Specifically, motivations to screen and screening intention and behaviour and the variables that discriminate those who screen from those who do not (non-screeners) were utilised as the key predictors and outcomes respectively.

From a conceptual perspective it was considered that motivation led to behaviour, therefore articles that described motivation and corresponding behaviour were considered. These included articles reporting on women who use public (government funded) and private (fee for service) breast cancer screening services and those who do not use screening services (i.e., non-screeners).

The scope included high-income countries using the World Bank definition [ 37 ]. These countries have broadly similar health systems and opportunities for breast cancer screening in both public and private settings.

Types of sources

All studies reporting original research in peer-reviewed journals from January 2009 were eligible for inclusion, regardless of design. This date was selected due to an evaluation undertaken for BreastScreen Australia recommending expansion of the age group to include 70–74-year-old women [ 38 ]. This date was also indicative of international debate regarding breast cancer screening effectiveness at this time [ 39 , 40 ]. Reviews were also included, regardless of type—scoping, systematic, or narrative. Only sources published in English and available through the University’s extensive research holdings were eligible for inclusion. Ineligible materials were conference abstracts, letters to the editor, editorials, opinion pieces, commentaries, newspaper articles, dissertations and theses.

This scoping review was registered with the Open Science Framework database ( https://osf.io/fd3eh ) and followed Joanna Briggs Institute (JBI) methodology for scoping reviews [ 35 , 36 ]. Although ethics approval is not required for scoping reviews the broader study was approved by the University Ethics Committee (approval number HEC 21249).

Search strategy

A pilot search strategy was developed in consultation with an expert health librarian and tested in MEDLINE (OVID) and conducted on 3 June 2022. Articles from this pilot search were compared with seminal articles previously identified by the members of the team and used to refine the search terms. The search terms were then searched as both keywords and subject headings (e.g., MeSH) in the titles and abstracts and Boolean operators employed. A full MEDLINE search was then carried out by the librarian (see Table  1 ). This search strategy was adapted for use in each of the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science and PsychInfo databases. The references of included studies have been hand-searched to identify any additional evidence sources.

Study/source of evidence selection

Following the search, all identified citations were collated and uploaded into EndNote v.X20 (Clarivate Analytics, PA, USA) and duplicates removed. The resulting articles were then imported into Covidence – Cochrane’s systematic review management software [ 41 ]. Duplicates were removed once importation was complete, and title and abstract screening was undertaken against the eligibility criteria. A sample of 25 articles were assessed by all reviewers to ensure reliability in the application of the inclusion and exclusion criteria. Team discussion was used to ensure consistent application. The Covidence software supports blind reviewing with two reviewers required at each screening phase. Potentially relevant sources were retrieved in full text and were assessed against the inclusion criteria by two independent reviewers. Conflicts were flagged within the software which allows the team to discuss those that have disagreements until a consensus was reached. Reasons for exclusion of studies at full text were recorded and reported in the scoping review. The Preferred Reporting Items of Systematic Reviews extension for scoping reviews (PRISMA-ScR) checklist was used to guide the reporting of the review [ 42 ] and all stages were documented using the PRISMA-ScR flow chart [ 42 ].

Data extraction

A data extraction form was created in Covidence and used to extract study characteristics and to confirm the study’s relevance. This included specific details such as article author/s, title, year of publication, country, aim, population, setting, data collection methods and key findings relevant to the review question. The draft extraction form was modified as needed during the data extraction process.

Data analysis and presentation

Extracted data were summarised in tabular format (see Table  2 ). Consistent with the guidelines for the effective reporting of scoping reviews [ 43 ] and the JBI framework [ 35 ] the final stage of the review included thematic analysis of the key findings of the included studies. Study findings were imported into QSR NVivo with coding of each line of text. Descriptive codes reflected key aspects of the included studies related to the motivations and behaviours of women > 75 years about breast cancer screening.

In line with the reporting requirements for scoping reviews the search results for this review are presented in Fig.  1 [ 44 ].

PRISMA Flowchart. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71

A total of fourteen [ 14 ] studies were included in the review with studies from the following countries, US n  = 12 [ 33 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], UK n  = 1 [ 23 ] and France n  = 1 [ 56 ]. Sample sizes varied, with most containing fewer than 50 women ( n  = 8) [ 33 , 45 , 46 , 48 , 51 , 52 , 55 ]. Two had larger samples including a French study with 136 women (a sub-set of a larger sample) [ 56 ], and one mixed method study in the UK with a sample of 26 women undertaking interviews and 479 women completing surveys [ 23 ]. One study did not report exact numbers [ 50 ]. Three studies [ 47 , 53 , 54 ] were undertaken by a group of researchers based in the US utilising the same sample of women, however each of the papers focused on different primary outcomes. The samples in the included studies were recruited from a range of locations including primary medical care clinics, specialist medical clinics, University affiliated medical clinics, community-based health centres and community outreach clinics [ 47 , 53 , 54 ].

Data collection methods varied and included: quantitative ( n  = 8), qualitative ( n  = 5) and mixed methods ( n  = 1). A range of data collection tools and research designs were utilised; pre/post, pilot and cross-sectional surveys, interviews, and secondary analysis of existing data sets. Seven studies focused on the use of a Decision Aids (DAs), either in original or modified form, developed by Schonberg et al. [ 55 ] as a tool to increase knowledge about the harms and benefits of screening for older women [ 45 , 47 , 48 , 49 , 52 , 54 , 55 ]. Three studies focused on intention to screen [ 33 , 53 , 56 ], two on knowledge of, and attitudes to, screening [ 23 , 46 ], one on information needs relating to risks and benefits of screening discontinuation [ 51 ], and one on perceptions about discontinuation of screening and impact of social interactions on screening [ 50 ].

The three themes developed from the analysis of the included studies highlighted that decisions about screening were primarily influenced by: (1) knowledge of the benefits and harms of screening and their relationship to age; (2) underlying attitudes to the importance of cancer screening in women's lives; and (3) exposure to decision aids designed to facilitate informed decision-making. Each of these themes will be presented below drawing on the key findings of the appropriate studies. The full dataset of extracted data can be found in Table  2 .

Knowledge of the benefits and harms of screening ≥ 75 years

The decision to participate in routine mammography is influenced by individual differences in cognition and affect, interpersonal relationships, provider characteristics, and healthcare system variables. Women typically perceive mammograms as a positive, beneficial and routine component of care [ 46 ] and an important aspect of taking care of themselves [ 23 , 46 , 49 ]. One qualitative study undertaken in the US showed that few women had discussed mammography cessation or the potential harms of screening with their health care providers and some women reported they would insist on receiving mammography even without a provider recommendation to continue screening [ 46 ].

Studies suggested that ageing itself, and even poor health, were not seen as reasonable reasons for screening cessation. For many women, guidance from a health care provider was deemed the most important influence on decision-making [ 46 ]. Preferences for communication about risk and benefits were varied with one study reporting women would like to learn more about harms and risks and recommended that this information be communicated via physicians or other healthcare providers, included in brochures/pamphlets, and presented outside of clinical settings (e.g., in community-based seniors groups) [ 51 ]. Others reported that women were sometimes sceptical of expert and government recommendations [ 33 ] although some were happy to participate in discussions with health educators or care providers about breast cancer screening harms and benefits and potential cessation [ 52 ].

Underlying attitudes to the importance of cancer screening at and beyond 75 years

Included studies varied in describing the importance of screening, with some attitudes based on past attendance and some based on future intentions to screen. Three studies reported findings indicating that some women intended to continue screening after 75 years of age [ 23 , 45 , 46 ], with one study in the UK reporting that women supported an extension of the automatic recall indefinitely, regardless of age or health status. In this study, failure to invite older women to screen was interpreted as age discrimination [ 23 ]. The desire to continue screening beyond 75 was also highlighted in a study from France that found that 60% of the women ( n  = 136 aged ≥ 75) intended to pursue screening in the future, and 27 women aged ≥ 75, who had never undergone mammography previously (36%), intended to do so in the future [ 56 ]. In this same study, intentions to screen varied significantly [ 56 ]. There were no sociodemographic differences observed between screened and unscreened women with regard to level of education, income, health risk behaviour (smoking, alcohol consumption), knowledge about the importance and the process of screening, or psychological features (fear of the test, fear of the results, fear of the disease, trust in screening impact) [ 56 ]. Further analysis showed that three items were statistically correlated with a higher rate of attendance at screening: (1) screening was initiated by a physician; (2) the women had a consultation with a gynaecologist during the past 12 months; and (3) the women had already undergone at least five screening mammograms. Analysis highlighted that although average income, level of education, psychological features or other types of health risk behaviours did not impact screening intention, having a mammogram previously impacted likelihood of ongoing screening. There was no information provided that explained why women who had not previously undergone screening might do so in the future.

A mixed methods study in the UK reported similar findings [ 23 ]. Utilising interviews ( n  = 26) and questionnaires ( n  = 479) with women ≥ 70 years (median age 75 years) the overwhelming result (90.1%) was that breast screening should be offered to all women indefinitely regardless of age, health status or fitness [ 23 ], and that many older women were keen to continue screening. Both the interview and survey data confirmed women were uncertain about eligibility for breast screening. The survey data showed that just over half the women (52.9%) were unaware that they could request mammography or knew how to access it. Key reasons for screening discontinuation were not being invited for screening (52.1%) and not knowing about self-referral (35.1%).

Women reported that not being invited to continue screening sent messages that screening was no longer important or required for this age group [ 23 ]. Almost two thirds of the women completing the survey (61.6%) said they would forget to attend screening without an invitation. Other reasons for screening discontinuation included transport difficulties (25%) and not wishing to burden family members (24.7%). By contrast, other studies have reported that women do not endorse discontinuation of screening mammography due to advancing age or poor health, but some may be receptive to reducing screening frequency on recommendation from their health care provider [ 46 , 51 ].

Use of Decision Aids (DAs) to improve knowledge and guide screening decision-making

Many women reported poor knowledge about the harms and benefits of screening with studies identifying an important role for DAs. These aids have been shown to be effective in improving knowledge of the harms and benefits of screening [ 45 , 54 , 55 ] including for women with low educational attainment; as compared to women with high educational attainment [ 47 ]. DAs can increase knowledge about screening [ 47 , 49 ] and may decrease the intention to continue screening after the recommended age [ 45 , 52 , 54 ]. They can be used by primary care providers to support a conversation about breast screening intention and reasons for discontinuing screening. In one pilot study undertaken in the US using a DA, 5 of the 8 women (62.5%) indicated they intended to continue to receive mammography; however, 3 participants planned to get them less often [ 45 ]. When asked whether they thought their physician would want them to get a mammogram, 80% said “yes” on pre-test; this figure decreased to 62.5% after exposure to the DA. This pilot study suggests that the use of a decision-aid may result in fewer women ≥ 75 years old continuing to screen for breast cancer [ 45 ].

Similar findings were evident in two studies drawing on the same data undertaken in the US [ 48 , 53 ]. Using a larger sample ( n  = 283), women’s intentions to screen prior to a visit with their primary care provider and then again after exposure to the DA were compared. Results showed that 21.7% of women reduced their intention to be screened, 7.9% increased their intentions to be screened, and 70.4% did not change. Compared to those who had no change or increased their screening intentions, women who had a decrease in screening intention were significantly less likely to receive screening after 18 months. Generally, studies have shown that women aged 75 and older find DAs acceptable and helpful [ 47 , 48 , 49 , 55 ] and using them had the potential to impact on a women’s intention to screen [ 55 ].

Cadet and colleagues [ 49 ] explored the impact of educational attainment on the use of DAs. Results highlight that education moderates the utility of these aids; women with lower educational attainment were less likely to understand all the DA’s content (46.3% vs 67.5%; P < 0.001); had less knowledge of the benefits and harms of mammography (adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; p < 0.001); and were less likely to have their screening intentions impacted (adjusted percentage, 11.4% vs 19.4%; p  = 0.01).

This scoping review summarises current knowledge regarding motivations and screening behaviours of women over 75 years. The findings suggest that awareness of the importance of breast cancer screening among women aged ≥ 75 years is high [ 23 , 46 , 49 ] and that many women wish to continue screening regardless of perceived health status or age. This highlights the importance of focusing on motivation and screening behaviours and the multiple factors that influence ongoing participation in breast screening programs.

The generally high regard attributed to screening among women aged ≥ 75 years presents a complex challenge for health professionals who are focused on potential harm (from available national and international guidelines) in ongoing screening for women beyond age 75 [ 18 , 20 , 57 ]. Included studies highlight that many women relied on the advice of health care providers regarding the benefits and harms when making the decision to continue breast screening [ 46 , 51 , 52 ], however there were some that did not [ 33 ]. Having a previous pattern of screening was noted as being more significant to ongoing intention than any other identified socio-demographic feature [ 56 ]. This is perhaps because women will not readily forgo health care practices that they have always considered important and that retain ongoing importance for the broader population.

For those women who had discontinued screening after the age of 74 it was apparent that the rationale for doing so was not often based on choice or receipt of information, but rather on factors that impact decision-making in relation to screening. These included no longer receiving an invitation to attend, transport difficulties and not wanting to be a burden on relatives or friends [ 23 , 46 , 51 ]. Ongoing receipt of invitations to screen was an important aspect of maintaining a capacity to choose [ 23 ]. This was particularly important for those women who had been regular screeners.

Women over 75 require more information to make decisions regarding screening [ 23 , 52 , 54 , 55 ], however health care providers must also be aware that the element of choice is important for older women. Having a capacity to choose avoids any notion of discrimination based on age, health status, gender or sociodemographic difference and acknowledges the importance of women retaining control over their health [ 23 ]. It was apparent that some women would choose to continue screening at a reduced frequency if this option was available and that women should have access to information facilitating self-referral [ 23 , 45 , 46 , 51 , 56 ].

Decision-making regarding ongoing breast cancer screening has been facilitated via the use of Decision Aids (DAs) within clinical settings [ 54 , 55 ]. While some studies suggest that women will make a decision regardless of health status, the use of DAs has impacted women’s decision to screen. While this may have limited benefit for those of lower educational attainment [ 48 ] they have been effective in improving knowledge relating to harms and benefits of screening particularly where they have been used to support a conversation with women about the value of screening [ 54 , 55 , 56 ].

Women have identified challenges in engaging in conversations with health care providers regarding ongoing screening, because providers frequently draw on projections of life expectancy and over-diagnosis [ 17 , 51 ]. As a result, these conversations about screening after age 75 years often do not occur [ 46 ]. It is likely that health providers may need more support and guidance in leading these conversations. This may be through the use of DAs or standardised checklists. It may be possible to incorporate these within existing health preventive measures for this age group. The potential for advice regarding ongoing breast cancer screening to be available outside of clinical settings may provide important pathways for conversations with women regarding health choices. Provision of information and advice in settings such as community based seniors groups [ 51 ] offers a potential platform to broaden conversations and align sources of information, not only with health professionals but amongst women themselves. This may help to address any misconception regarding eligibility and access to services [ 23 ]. It may also be aligned with other health promotion and lifestyle messages provided to this age group.

Limitations of the review

The searches that formed the basis of this review were carried in June 2022. Although the search was comprehensive, we have only captured those studies that were published in the included databases from 2009. There may have been other studies published outside of these periods. We also limited the search to studies published in English with full-text availability.

The emphasis of a scoping review is on comprehensive coverage and synthesis of the key findings, rather than on a particular standard of evidence and, consequently a quality assessment of the included studies was not undertaken. This has resulted in the inclusion of a wide range of study designs and data collection methods. It is important to note that three studies included in the review drew on the same sample of women (283 over > 75)[ 49 , 53 , 54 ]. The results of this review provide valuable insights into motivations and behaviours for breast cancer screening for older women, however they should be interpreted with caution given the specific methodological and geographical limitations.

Conclusion and recommendations

This scoping review highlighted a range of key motivations and behaviours in relation to breast cancer screening for women ≥ 75 years of age. The results provide some insight into how decisions about screening continuation after 74 are made and how informed decision-making can be supported. Specifically, this review supports the following suggestions for further research and policy direction:

Further research regarding breast cancer screening motivations and behaviours for women over 75 would provide valuable insight for health providers delivering services to women in this age group.

Health providers may benefit from the broader use of decision aids or structured checklists to guide conversations with women over 75 regarding ongoing health promotion/preventive measures.

Providing health-based information in non-clinical settings frequented by women in this age group may provide a broader reach of information and facilitate choices. This may help to reduce any perception of discrimination based on age, health status or socio-demographic factors.

Availability of data and materials

All data generated or analysed during this study is included in this published article (see Table  2 above).

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Acknowledgements

We would like to acknowledge Ange Hayden-Johns (expert librarian) who assisted with the development of the search criteria and undertook the relevant searches and Tejashree Kangutkar who assisted with some of the Covidence work.

This work was supported by funding from the Australian Government Department of Health and Aged Care (ID: Health/20–21/E21-10463).

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Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia

Virginia Dickson-Swift, Joanne Adams & Evelien Spelten

Care Economy Research Institute, La Trobe University, Wodonga, Australia

Irene Blackberry

Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia

Carlene Wilson & Eva Yuen

Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia

Carlene Wilson

School of Psychology and Public Health, La Trobe University, Bundoora, Australia

Institute for Health Transformation, Deakin University, Burwood, Australia

Centre for Quality and Patient Safety, Monash Health Partnership, Monash Health, Clayton, Australia

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Contributions

VDS conceived and designed the scoping review. VDS & JA developed the search strategy with librarian support, and all authors (VDS, JA, ES, IB, CW, EY) participated in the screening and data extraction stages and assisted with writing the review. All authors provided editorial support and read and approved the final manuscript prior to submission.

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Correspondence to Joanne Adams .

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Dickson-Swift, V., Adams, J., Spelten, E. et al. Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review. BMC Women's Health 24 , 256 (2024). https://doi.org/10.1186/s12905-024-03094-z

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Received : 06 September 2023

Accepted : 15 April 2024

Published : 24 April 2024

DOI : https://doi.org/10.1186/s12905-024-03094-z

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