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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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• Last Updated: Dec 8, 2023 10:11 AM
• URL: https://guides.lib.berkeley.edu/litreview

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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
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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

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• How to Write a Literature Review | Guide, Examples, & Templates

How to Write a Literature Review | Guide, Examples, & Templates

Published on January 2, 2023 by Shona McCombes . Revised on September 11, 2023.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research that you can later apply to your paper, thesis, or dissertation topic .

There are five key steps to writing a literature review:

• Search for relevant literature
• Evaluate sources
• Identify themes, debates, and gaps
• Outline the structure
• Write your literature review

A good literature review doesn’t just summarize sources—it analyzes, synthesizes , and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

What is the purpose of a literature review, examples of literature reviews, step 1 – search for relevant literature, step 2 – evaluate and select sources, step 3 – identify themes, debates, and gaps, step 4 – outline your literature review’s structure, step 5 – write your literature review, free lecture slides, other interesting articles, frequently asked questions, introduction.

• Quick Run-through
• Step 1 & 2

When you write a thesis , dissertation , or research paper , you will likely have to conduct a literature review to situate your research within existing knowledge. The literature review gives you a chance to:

• Demonstrate your familiarity with the topic and its scholarly context
• Develop a theoretical framework and methodology for your research
• Position your work in relation to other researchers and theorists
• Show how your research addresses a gap or contributes to a debate
• Evaluate the current state of research and demonstrate your knowledge of the scholarly debates around your topic.

Writing literature reviews is a particularly important skill if you want to apply for graduate school or pursue a career in research. We’ve written a step-by-step guide that you can follow below.

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See an example

Writing literature reviews can be quite challenging! A good starting point could be to look at some examples, depending on what kind of literature review you’d like to write.

• Example literature review #1: “Why Do People Migrate? A Review of the Theoretical Literature” ( Theoretical literature review about the development of economic migration theory from the 1950s to today.)
• Example literature review #2: “Literature review as a research methodology: An overview and guidelines” ( Methodological literature review about interdisciplinary knowledge acquisition and production.)
• Example literature review #3: “The Use of Technology in English Language Learning: A Literature Review” ( Thematic literature review about the effects of technology on language acquisition.)
• Example literature review #4: “Learners’ Listening Comprehension Difficulties in English Language Learning: A Literature Review” ( Chronological literature review about how the concept of listening skills has changed over time.)

You can also check out our templates with literature review examples and sample outlines at the links below.

Download Word doc Download Google doc

Before you begin searching for literature, you need a clearly defined topic .

If you are writing the literature review section of a dissertation or research paper, you will search for literature related to your research problem and questions .

Make a list of keywords

Start by creating a list of keywords related to your research question. Include each of the key concepts or variables you’re interested in, and list any synonyms and related terms. You can add to this list as you discover new keywords in the process of your literature search.

• Social media, Facebook, Instagram, Twitter, Snapchat, TikTok
• Body image, self-perception, self-esteem, mental health
• Generation Z, teenagers, adolescents, youth

Search for relevant sources

Use your keywords to begin searching for sources. Some useful databases to search for journals and articles include:

• Your university’s library catalogue
• Google Scholar
• Project Muse (humanities and social sciences)
• Medline (life sciences and biomedicine)
• EconLit (economics)
• Inspec (physics, engineering and computer science)

You can also use boolean operators to help narrow down your search.

Make sure to read the abstract to find out whether an article is relevant to your question. When you find a useful book or article, you can check the bibliography to find other relevant sources.

You likely won’t be able to read absolutely everything that has been written on your topic, so it will be necessary to evaluate which sources are most relevant to your research question.

For each publication, ask yourself:

• What question or problem is the author addressing?
• What are the key concepts and how are they defined?
• What are the key theories, models, and methods?
• Does the research use established frameworks or take an innovative approach?
• What are the results and conclusions of the study?
• How does the publication relate to other literature in the field? Does it confirm, add to, or challenge established knowledge?
• What are the strengths and weaknesses of the research?

Make sure the sources you use are credible , and make sure you read any landmark studies and major theories in your field of research.

You can use our template to summarize and evaluate sources you’re thinking about using. Click on either button below to download.

Take notes and cite your sources

As you read, you should also begin the writing process. Take notes that you can later incorporate into the text of your literature review.

It is important to keep track of your sources with citations to avoid plagiarism . It can be helpful to make an annotated bibliography , where you compile full citation information and write a paragraph of summary and analysis for each source. This helps you remember what you read and saves time later in the process.

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To begin organizing your literature review’s argument and structure, be sure you understand the connections and relationships between the sources you’ve read. Based on your reading and notes, you can look for:

• Trends and patterns (in theory, method or results): do certain approaches become more or less popular over time?
• Themes: what questions or concepts recur across the literature?
• Debates, conflicts and contradictions: where do sources disagree?
• Pivotal publications: are there any influential theories or studies that changed the direction of the field?
• Gaps: what is missing from the literature? Are there weaknesses that need to be addressed?

This step will help you work out the structure of your literature review and (if applicable) show how your own research will contribute to existing knowledge.

• Most research has focused on young women.
• There is an increasing interest in the visual aspects of social media.
• But there is still a lack of robust research on highly visual platforms like Instagram and Snapchat—this is a gap that you could address in your own research.

There are various approaches to organizing the body of a literature review. Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

The simplest approach is to trace the development of the topic over time. However, if you choose this strategy, be careful to avoid simply listing and summarizing sources in order.

Try to analyze patterns, turning points and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred.

If you have found some recurring central themes, you can organize your literature review into subsections that address different aspects of the topic.

For example, if you are reviewing literature about inequalities in migrant health outcomes, key themes might include healthcare policy, language barriers, cultural attitudes, legal status, and economic access.

Methodological

If you draw your sources from different disciplines or fields that use a variety of research methods , you might want to compare the results and conclusions that emerge from different approaches. For example:

• Look at what results have emerged in qualitative versus quantitative research
• Discuss how the topic has been approached by empirical versus theoretical scholarship
• Divide the literature into sociological, historical, and cultural sources

Theoretical

A literature review is often the foundation for a theoretical framework . You can use it to discuss various theories, models, and definitions of key concepts.

You might argue for the relevance of a specific theoretical approach, or combine various theoretical concepts to create a framework for your research.

Like any other academic text , your literature review should have an introduction , a main body, and a conclusion . What you include in each depends on the objective of your literature review.

The introduction should clearly establish the focus and purpose of the literature review.

Depending on the length of your literature review, you might want to divide the body into subsections. You can use a subheading for each theme, time period, or methodological approach.

As you write, you can follow these tips:

• 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 sentences to draw connections, comparisons and contrasts

In the conclusion, you should summarize the key findings you have taken from the literature and emphasize their significance.

When you’ve finished writing and revising your literature review, don’t forget to proofread thoroughly before submitting. Not a language expert? Check out Scribbr’s professional proofreading services !

This article has been adapted into lecture slides that you can use to teach your students about writing a literature review.

Scribbr slides are free to use, customize, and distribute for educational purposes.

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If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

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Research bias

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A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

There are several reasons to conduct a literature review at the beginning of a research project:

• To familiarize yourself with the current state of knowledge on your topic
• To ensure that you’re not just repeating what others have already done
• To identify gaps in knowledge and unresolved problems that your research can address
• To develop your theoretical framework and methodology
• To provide an overview of the key findings and debates on the topic

Writing the literature review shows your reader how your work relates to existing research and what new insights it will contribute.

The literature review usually comes near the beginning of your thesis or dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

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McCombes, S. (2023, September 11). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved April 15, 2024, from https://www.scribbr.com/dissertation/literature-review/

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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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Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

• Sage Research Methods Core Collection This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

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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.

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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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A Guide to Literature Reviews

Importance of a good literature review.

• Conducting the Literature Review
• Structure and Writing Style
• Types of Literature Reviews
• Citation Management Software This link opens in a new window
• Acknowledgements

A literature review is not only a summary of key sources, but  has an organizational pattern which combines both summary and synthesis, often within specific conceptual categories . A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:

• Give a new interpretation of old material or combine new with old interpretations,
• Trace the intellectual progression of the field, including major debates,
• Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant research, or
• Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date.

The purpose of a literature review is to:

• Place each work in the context of its contribution to understanding the research problem being studied.
• Describe the relationship of each work to the others under consideration.
• Identify new ways to interpret prior research.
• Reveal any gaps that exist in the literature.
• Resolve conflicts amongst seemingly contradictory previous studies.
• Identify areas of prior scholarship to prevent duplication of effort.
• Point the way in fulfilling a need for additional research.
• Locate your own research within the context of existing literature [very important].
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• Last Updated: Jan 22, 2024 3:26 PM
• URL: https://libguides.mcmaster.ca/litreview

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What is the Purpose of a Literature Review?

4-minute read

• 23rd October 2023

If you’re writing a research paper or dissertation , then you’ll most likely need to include a comprehensive literature review . In this post, we’ll review the purpose of literature reviews, why they are so significant, and the specific elements to include in one. Literature reviews can:

1. Provide a foundation for current research.

2. Define key concepts and theories.

3. Demonstrate critical evaluation.

4. Show how research and methodologies have evolved.

5. Identify gaps in existing research.

6. Support your argument.

Keep reading to enter the exciting world of literature reviews!

What is a Literature Review?

A literature review is a critical summary and evaluation of the existing research (e.g., academic journal articles and books) on a specific topic. It is typically included as a separate section or chapter of a research paper or dissertation, serving as a contextual framework for a study. Literature reviews can vary in length depending on the subject and nature of the study, with most being about equal length to other sections or chapters included in the paper. Essentially, the literature review highlights previous studies in the context of your research and summarizes your insights in a structured, organized format. Next, let’s look at the overall purpose of a literature review.

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Literature reviews are considered an integral part of research across most academic subjects and fields. The primary purpose of a literature review in your study is to:

Provide a Foundation for Current Research

Since the literature review provides a comprehensive evaluation of the existing research, it serves as a solid foundation for your current study. It’s a way to contextualize your work and show how your research fits into the broader landscape of your specific area of study.  

Define Key Concepts and Theories

The literature review highlights the central theories and concepts that have arisen from previous research on your chosen topic. It gives your readers a more thorough understanding of the background of your study and why your research is particularly significant .

Demonstrate Critical Evaluation 

A comprehensive literature review shows your ability to critically analyze and evaluate a broad range of source material. And since you’re considering and acknowledging the contribution of key scholars alongside your own, it establishes your own credibility and knowledge.

Show How Research and Methodologies Have Evolved

Another purpose of literature reviews is to provide a historical perspective and demonstrate how research and methodologies have changed over time, especially as data collection methods and technology have advanced. And studying past methodologies allows you, as the researcher, to understand what did and did not work and apply that knowledge to your own research.  

Identify Gaps in Existing Research

Besides discussing current research and methodologies, the literature review should also address areas that are lacking in the existing literature. This helps further demonstrate the relevance of your own research by explaining why your study is necessary to fill the gaps.

Support Your Argument

A good literature review should provide evidence that supports your research questions and hypothesis. For example, your study may show that your research supports existing theories or builds on them in some way. Referencing previous related studies shows your work is grounded in established research and will ultimately be a contribution to the field.  

Literature Review Editing Services 

Ensure your literature review is polished and ready for submission by having it professionally proofread and edited by our expert team. Our literature review editing services will help your research stand out and make an impact. Not convinced yet? Send in your free sample today and see for yourself! 

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Organizing Your Social Sciences Research Paper

• 5. The Literature Review
• Purpose of Guide
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• Choosing a Title
• Making an Outline
• Paragraph Development
• Research Process Video Series
• Executive Summary
• The C.A.R.S. Model
• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
• Content Alert Services
• Evaluating Sources
• Primary Sources
• Secondary Sources
• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
• Quantitative Methods
• Insiderness
• Using Non-Textual Elements
• Limitations of the Study
• Common Grammar Mistakes
• Writing Concisely
• Avoiding Plagiarism
• Footnotes or Endnotes?
• Further Readings
• Generative AI and Writing
• USC Libraries Tutorials and Other Guides
• Bibliography

A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . Fourth edition. Thousand Oaks, CA: SAGE, 2014.

Importance of a Good Literature Review

A literature review may consist of simply a summary of key sources, but in the social sciences, a literature review usually has an organizational pattern and combines both summary and synthesis, often within specific conceptual categories . A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:

• Give a new interpretation of old material or combine new with old interpretations,
• Trace the intellectual progression of the field, including major debates,
• Depending on the situation, evaluate the sources and advise the reader on the most pertinent or relevant research, or
• Usually in the conclusion of a literature review, identify where gaps exist in how a problem has been researched to date.

Given this, the purpose of a literature review is to:

• Place each work in the context of its contribution to understanding the research problem being studied.
• Describe the relationship of each work to the others under consideration.
• Identify new ways to interpret prior research.
• Reveal any gaps that exist in the literature.
• Resolve conflicts amongst seemingly contradictory previous studies.
• Identify areas of prior scholarship to prevent duplication of effort.
• Point the way in fulfilling a need for additional research.
• Locate your own research within the context of existing literature [very important].

Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper. 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . Los Angeles, CA: SAGE, 2011; Knopf, Jeffrey W. "Doing a Literature Review." PS: Political Science and Politics 39 (January 2006): 127-132; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012.

Types of Literature Reviews

It is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the primary studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally among scholars that become part of the body of epistemological traditions within the field.

In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews. Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are a number of approaches you could adopt depending upon the type of analysis underpinning your study.

Argumentative Review This form examines literature selectively in order to support or refute an argument, deeply embedded assumption, or philosophical problem already established in the literature. The purpose is to develop a body of literature that establishes a contrarian viewpoint. Given the value-laden nature of some social science research [e.g., educational reform; immigration control], argumentative approaches to analyzing the literature can be a legitimate and important form of discourse. However, note that they can also introduce problems of bias when they are used to make summary claims of the sort found in systematic reviews [see below].

Integrative Review Considered a form of research that reviews, critiques, and synthesizes representative literature on a topic in an integrated way such that new frameworks and perspectives on the topic are generated. The body of literature includes all studies that address related or identical hypotheses or research problems. A well-done integrative review meets the same standards as primary research in regard to clarity, rigor, and replication. This is the most common form of review in the social sciences.

Historical Review Few things rest in isolation from historical precedent. Historical literature reviews focus on examining research throughout a period of time, often starting with the first time an issue, concept, theory, phenomena emerged in the literature, then tracing its evolution within the scholarship of a discipline. The purpose is to place research in a historical context to show familiarity with state-of-the-art developments and to identify the likely directions for future research.

Methodological Review A review does not always focus on what someone said [findings], but how they came about saying what they say [method of analysis]. Reviewing methods of analysis provides a framework of understanding at different levels [i.e. those of theory, substantive fields, research approaches, and data collection and analysis techniques], how researchers draw upon a wide variety of knowledge ranging from the conceptual level to practical documents for use in fieldwork in the areas of ontological and epistemological consideration, quantitative and qualitative integration, sampling, interviewing, data collection, and data analysis. This approach helps highlight ethical issues which you should be aware of and consider as you go through your own study.

Systematic Review This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyze data from the studies that are included in the review. The goal is to deliberately document, critically evaluate, and summarize scientifically all of the research about a clearly defined research problem . Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?" This type of literature review is primarily applied to examining prior research studies in clinical medicine and allied health fields, but it is increasingly being used in the social sciences.

Theoretical Review The purpose of this form is to examine the corpus of theory that has accumulated in regard to an issue, concept, theory, phenomena. The theoretical literature review helps to establish what theories already exist, the relationships between them, to what degree the existing theories have been investigated, and to develop new hypotheses to be tested. Often this form is used to help establish a lack of appropriate theories or reveal that current theories are inadequate for explaining new or emerging research problems. The unit of analysis can focus on a theoretical concept or a whole theory or framework.

NOTE : Most often the literature review will incorporate some combination of types. For example, a review that examines literature supporting or refuting an argument, assumption, or philosophical problem related to the research problem will also need to include writing supported by sources that establish the history of these arguments in the literature.

Baumeister, Roy F. and Mark R. Leary. "Writing Narrative Literature Reviews."  Review of General Psychology 1 (September 1997): 311-320; Mark R. Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Kennedy, Mary M. "Defining a Literature." Educational Researcher 36 (April 2007): 139-147; Petticrew, Mark and Helen Roberts. Systematic Reviews in the Social Sciences: A Practical Guide . Malden, MA: Blackwell Publishers, 2006; Torracro, Richard. "Writing Integrative Literature Reviews: Guidelines and Examples." Human Resource Development Review 4 (September 2005): 356-367; Rocco, Tonette S. and Maria S. Plakhotnik. "Literature Reviews, Conceptual Frameworks, and Theoretical Frameworks: Terms, Functions, and Distinctions." Human Ressource Development Review 8 (March 2008): 120-130; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

Structure and Writing Style

I.  Thinking About Your Literature Review

The structure of a literature review should include the following in support of understanding the research problem :

• An overview of the subject, issue, or theory under consideration, along with the objectives of the literature review,
• Division of works under review into themes or categories [e.g. works that support a particular position, those against, and those offering alternative approaches entirely],
• An explanation of how each work is similar to and how it varies from the others,
• Conclusions as to which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of their area of research.

The critical evaluation of each work should consider :

• Provenance -- what are the author's credentials? Are the author's arguments supported by evidence [e.g. primary historical material, case studies, narratives, statistics, recent scientific findings]?
• Methodology -- were the techniques used to identify, gather, and analyze the data appropriate to addressing the research problem? Was the sample size appropriate? Were the results effectively interpreted and reported?
• Objectivity -- is the author's perspective even-handed or prejudicial? Is contrary data considered or is certain pertinent information ignored to prove the author's point?
• Persuasiveness -- which of the author's theses are most convincing or least convincing?
• Validity -- are the author's arguments and conclusions convincing? Does the work ultimately contribute in any significant way to an understanding of the subject?

II.  Development of the Literature Review

Four Basic Stages of Writing 1.  Problem formulation -- which topic or field is being examined and what are its component issues? 2.  Literature search -- finding materials relevant to the subject being explored. 3.  Data evaluation -- determining which literature makes a significant contribution to the understanding of the topic. 4.  Analysis and interpretation -- discussing the findings and conclusions of pertinent literature.

Consider the following issues before writing the literature review: Clarify If your assignment is not specific about what form your literature review should take, seek clarification from your professor by asking these questions: 1.  Roughly how many sources would be appropriate to include? 2.  What types of sources should I review (books, journal articles, websites; scholarly versus popular sources)? 3.  Should I summarize, synthesize, or critique sources by discussing a common theme or issue? 4.  Should I evaluate the sources in any way beyond evaluating how they relate to understanding the research problem? 5.  Should I provide subheadings and other background information, such as definitions and/or a history? Find Models Use the exercise of reviewing the literature to examine how authors in your discipline or area of interest have composed their literature review sections. Read them to get a sense of the types of themes you might want to look for in your own research or to identify ways to organize your final review. The bibliography or reference section of sources you've already read, such as required readings in the course syllabus, are also excellent entry points into your own research. Narrow the Topic The narrower your topic, the easier it will be to limit the number of sources you need to read in order to obtain a good survey of relevant resources. Your professor will probably not expect you to read everything that's available about the topic, but you'll make the act of reviewing easier if you first limit scope of the research problem. A good strategy is to begin by searching the USC Libraries Catalog for recent books about the topic and review the table of contents for chapters that focuses on specific issues. You can also review the indexes of books to find references to specific issues that can serve as the focus of your research. For example, a book surveying the history of the Israeli-Palestinian conflict may include a chapter on the role Egypt has played in mediating the conflict, or look in the index for the pages where Egypt is mentioned in the text. Consider Whether Your Sources are Current Some disciplines require that you use information that is as current as possible. This is particularly true in disciplines in medicine and the sciences where research conducted becomes obsolete very quickly as new discoveries are made. However, when writing a review in the social sciences, a survey of the history of the literature may be required. In other words, a complete understanding the research problem requires you to deliberately examine how knowledge and perspectives have changed over time. Sort through other current bibliographies or literature reviews in the field to get a sense of what your discipline expects. You can also use this method to explore what is considered by scholars to be a "hot topic" and what is not.

III.  Ways to Organize Your Literature Review

Chronology of Events If your review follows the chronological method, you could write about the materials according to when they were published. This approach should only be followed if a clear path of research building on previous research can be identified and that these trends follow a clear chronological order of development. For example, a literature review that focuses on continuing research about the emergence of German economic power after the fall of the Soviet Union. By Publication Order your sources by publication chronology, then, only if the order demonstrates a more important trend. For instance, you could order a review of literature on environmental studies of brown fields if the progression revealed, for example, a change in the soil collection practices of the researchers who wrote and/or conducted the studies. Thematic [“conceptual categories”] A thematic literature review is the most common approach to summarizing prior research in the social and behavioral sciences. Thematic reviews are organized around a topic or issue, rather than the progression of time, although the progression of time may still be incorporated into a thematic review. For example, a review of the Internet’s impact on American presidential politics could focus on the development of online political satire. While the study focuses on one topic, the Internet’s impact on American presidential politics, it would still be organized chronologically reflecting technological developments in media. The difference in this example between a "chronological" and a "thematic" approach is what is emphasized the most: themes related to the role of the Internet in presidential politics. Note that more authentic thematic reviews tend to break away from chronological order. A review organized in this manner would shift between time periods within each section according to the point being made. Methodological A methodological approach focuses on the methods utilized by the researcher. For the Internet in American presidential politics project, one methodological approach would be to look at cultural differences between the portrayal of American presidents on American, British, and French websites. Or the review might focus on the fundraising impact of the Internet on a particular political party. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed.

Other Sections of Your Literature Review Once you've decided on the organizational method for your literature review, the sections you need to include in the paper should be easy to figure out because they arise from your organizational strategy. In other words, a chronological review would have subsections for each vital time period; a thematic review would have subtopics based upon factors that relate to the theme or issue. However, sometimes you may need to add additional sections that are necessary for your study, but do not fit in the organizational strategy of the body. What other sections you include in the body is up to you. However, only include what is necessary for the reader to locate your study within the larger scholarship about the research problem.

Here are examples of other sections, usually in the form of a single paragraph, you may need to include depending on the type of review you write:

• Current Situation : Information necessary to understand the current topic or focus of the literature review.
• Sources Used : Describes the methods and resources [e.g., databases] you used to identify the literature you reviewed.
• History : The chronological progression of the field, the research literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Selection Methods : Criteria you used to select (and perhaps exclude) sources in your literature review. For instance, you might explain that your review includes only peer-reviewed [i.e., scholarly] sources.
• Standards : Description of the way in which you present your information.
• Questions for Further Research : What questions about the field has the review sparked? How will you further your research as a result of the review?

IV.  Writing Your Literature Review

Once you've settled on how to organize your literature review, you're ready to write each section. When writing your review, keep in mind these issues.

Use Evidence A literature review section is, in this sense, just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence [citations] that demonstrates that what you are saying is valid. Be Selective Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the research problem, whether it is thematic, methodological, or chronological. Related items that provide additional information, but that are not key to understanding the research problem, can be included in a list of further readings . Use Quotes Sparingly Some short quotes are appropriate if you want to emphasize a point, or if what an author stated cannot be easily paraphrased. Sometimes you may need to quote certain terminology that was coined by the author, is not common knowledge, or taken directly from the study. Do not use extensive quotes as a substitute for using your own words in reviewing the literature. Summarize and Synthesize Remember to summarize and synthesize your sources within each thematic paragraph as well as throughout the review. Recapitulate important features of a research study, but then synthesize it by rephrasing the study's significance and relating it to your own work and the work of others. Keep Your Own Voice While the literature review presents others' ideas, your voice [the writer's] should remain front and center. For example, weave references to other sources into what you are writing but maintain your own voice by starting and ending the paragraph with your own ideas and wording. Use Caution When Paraphrasing When paraphrasing a source that is not your own, be sure to represent the author's information or opinions accurately and in your own words. Even when paraphrasing an author’s work, you still must provide a citation to that work.

V.  Common Mistakes to Avoid

These are the most common mistakes made in reviewing social science research literature.

• Sources in your literature review do not clearly relate to the research problem;
• You do not take sufficient time to define and identify the most relevant sources to use in the literature review related to the research problem;
• Relies exclusively on secondary analytical sources rather than including relevant primary research studies or data;
• Uncritically accepts another researcher's findings and interpretations as valid, rather than examining critically all aspects of the research design and analysis;
• Does not describe the search procedures that were used in identifying the literature to review;
• Reports isolated statistical results rather than synthesizing them in chi-squared or meta-analytic methods; and,
• Only includes research that validates assumptions and does not consider contrary findings and alternative interpretations found in the literature.

Cook, Kathleen E. and Elise Murowchick. “Do Literature Review Skills Transfer from One Course to Another?” Psychology Learning and Teaching 13 (March 2014): 3-11; Fink, Arlene. Conducting Research Literature Reviews: From the Internet to Paper . 2nd ed. Thousand Oaks, CA: Sage, 2005; Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1998; Jesson, Jill. Doing Your Literature Review: Traditional and Systematic Techniques . London: SAGE, 2011; Literature Review Handout. Online Writing Center. Liberty University; Literature Reviews. The Writing Center. University of North Carolina; Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: SAGE, 2016; Ridley, Diana. The Literature Review: A Step-by-Step Guide for Students . 2nd ed. Los Angeles, CA: SAGE, 2012; Randolph, Justus J. “A Guide to Writing the Dissertation Literature Review." Practical Assessment, Research, and Evaluation. vol. 14, June 2009; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016; Taylor, Dena. The Literature Review: A Few Tips On Conducting It. University College Writing Centre. University of Toronto; Writing a Literature Review. Academic Skills Centre. University of Canberra.

Writing Tip

Break Out of Your Disciplinary Box!

Thinking interdisciplinarily about a research problem can be a rewarding exercise in applying new ideas, theories, or concepts to an old problem. For example, what might cultural anthropologists say about the continuing conflict in the Middle East? In what ways might geographers view the need for better distribution of social service agencies in large cities than how social workers might study the issue? You don’t want to substitute a thorough review of core research literature in your discipline for studies conducted in other fields of study. However, particularly in the social sciences, thinking about research problems from multiple vectors is a key strategy for finding new solutions to a problem or gaining a new perspective. Consult with a librarian about identifying research databases in other disciplines; almost every field of study has at least one comprehensive database devoted to indexing its research literature.

Frodeman, Robert. The Oxford Handbook of Interdisciplinarity . New York: Oxford University Press, 2010.

Another Writing Tip

Don't Just Review for Content!

While conducting a review of the literature, maximize the time you devote to writing this part of your paper by thinking broadly about what you should be looking for and evaluating. Review not just what scholars are saying, but how are they saying it. Some questions to ask:

• How are they organizing their ideas?
• What methods have they used to study the problem?
• What theories have been used to explain, predict, or understand their research problem?
• What sources have they cited to support their conclusions?
• How have they used non-textual elements [e.g., charts, graphs, figures, etc.] to illustrate key points?

When you begin to write your literature review section, you'll be glad you dug deeper into how the research was designed and constructed because it establishes a means for developing more substantial analysis and interpretation of the research problem.

Hart, Chris. Doing a Literature Review: Releasing the Social Science Research Imagination . Thousand Oaks, CA: Sage Publications, 1 998.

Yet Another Writing Tip

When Do I Know I Can Stop Looking and Move On?

Here are several strategies you can utilize to assess whether you've thoroughly reviewed the literature:

• Look for repeating patterns in the research findings . If the same thing is being said, just by different people, then this likely demonstrates that the research problem has hit a conceptual dead end. At this point consider: Does your study extend current research?  Does it forge a new path? Or, does is merely add more of the same thing being said?
• Look at sources the authors cite to in their work . If you begin to see the same researchers cited again and again, then this is often an indication that no new ideas have been generated to address the research problem.
• Search Google Scholar to identify who has subsequently cited leading scholars already identified in your literature review [see next sub-tab]. This is called citation tracking and there are a number of sources that can help you identify who has cited whom, particularly scholars from outside of your discipline. Here again, if the same authors are being cited again and again, this may indicate no new literature has been written on the topic.

Onwuegbuzie, Anthony J. and Rebecca Frels. Seven Steps to a Comprehensive Literature Review: A Multimodal and Cultural Approach . Los Angeles, CA: Sage, 2016; Sutton, Anthea. Systematic Approaches to a Successful Literature Review . Los Angeles, CA: Sage Publications, 2016.

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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

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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Why is it important to do a literature review in research?

The importance of scientific communication in the healthcare industry

The Importance and Role of Biostatistics in Clinical Research

 “A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research”. Boote and Baile 2005

Authors of manuscripts treat writing a literature review as a routine work or a mere formality. But a seasoned one knows the purpose and importance of a well-written literature review.  Since it is one of the basic needs for researches at any level, they have to be done vigilantly. Only then the reader will know that the basics of research have not been neglected.

The aim of any literature review is to summarize and synthesize the arguments and ideas of existing knowledge in a particular field without adding any new contributions.   Being built on existing knowledge they help the researcher to even turn the wheels of the topic of research.  It is possible only with profound knowledge of what is wrong in the existing findings in detail to overpower them.  For other researches, the literature review gives the direction to be headed for its success. 

The common perception of literature review and reality:

As per the common belief, literature reviews are only a summary of the sources related to the research. And many authors of scientific manuscripts believe that they are only surveys of what are the researches are done on the chosen topic.  But on the contrary, it uses published information from pertinent and relevant sources like

• Scholarly books
• Scientific papers
• Latest studies in the field
• Established school of thoughts
• Relevant articles from renowned scientific journals

and many more for a field of study or theory or a particular problem to do the following:

• Summarize into a brief account of all information
• Synthesize the information by restructuring and reorganizing
• Critical evaluation of a concept or a school of thought or ideas
• Familiarize the authors to the extent of knowledge in the particular field
• Encapsulate
• Compare & contrast

By doing the above on the relevant information, it provides the reader of the scientific manuscript with the following for a better understanding of it:

• It establishes the authors’  in-depth understanding and knowledge of their field subject
• It gives the background of the research
• Portrays the scientific manuscript plan of examining the research result
• Illuminates on how the knowledge has changed within the field
• Highlights what has already been done in a particular field
• Information of the generally accepted facts, emerging and current state of the topic of research
• Identifies the research gap that is still unexplored or under-researched fields
• Demonstrates how the research fits within a larger field of study
• Provides an overview of the sources explored during the research of a particular topic

Importance of literature review in research:

The importance of literature review in scientific manuscripts can be condensed into an analytical feature to enable the multifold reach of its significance.  It adds value to the legitimacy of the research in many ways:

• Provides the interpretation of existing literature in light of updated developments in the field to help in establishing the consistency in knowledge and relevancy of existing materials
• It helps in calculating the impact of the latest information in the field by mapping their progress of knowledge.
• It brings out the dialects of contradictions between various thoughts within the field to establish facts
• The research gaps scrutinized initially are further explored to establish the latest facts of theories to add value to the field
• Indicates the current research place in the schema of a particular field
• Provides information for relevancy and coherency to check the research
• Apart from elucidating the continuance of knowledge, it also points out areas that require further investigation and thus aid as a starting point of any future research
• Justifies the research and sets up the research question
• Sets up a theoretical framework comprising the concepts and theories of the research upon which its success can be judged
• Helps to adopt a more appropriate methodology for the research by examining the strengths and weaknesses of existing research in the same field
• Increases the significance of the results by comparing it with the existing literature
• Provides a point of reference by writing the findings in the scientific manuscript
• Helps to get the due credit from the audience for having done the fact-finding and fact-checking mission in the scientific manuscripts
• The more the reference of relevant sources of it could increase more of its trustworthiness with the readers
• Helps to prevent plagiarism by tailoring and uniquely tweaking the scientific manuscript not to repeat other’s original idea
• By preventing plagiarism , it saves the scientific manuscript from rejection and thus also saves a lot of time and money
• Helps to evaluate, condense and synthesize gist in the author’s own words to sharpen the research focus
• Helps to compare and contrast to  show the originality and uniqueness of the research than that of the existing other researches
• Rationalizes the need for conducting the particular research in a specified field
• Helps to collect data accurately for allowing any new methodology of research than the existing ones
• Enables the readers of the manuscript to answer the following questions of its readers for its better chances for publication
• What do the researchers know?
• What do they not know?
• Is the scientific manuscript reliable and trustworthy?
• What are the knowledge gaps of the researcher?

22. It helps the readers to identify the following for further reading of the scientific manuscript:

• What has been already established, discredited and accepted in the particular field of research
• Areas of controversy and conflicts among different schools of thought
• Unsolved problems and issues in the connected field of research
• The emerging trends and approaches
• How the research extends, builds upon and leaves behind from the previous research

A profound literature review with many relevant sources of reference will enhance the chances of the scientific manuscript publication in renowned and reputed scientific journals .

References:

http://www.math.montana.edu/jobo/phdprep/phd6.pdf

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• Research Process

Literature Review in Research Writing

• 4 minute read
• 422.3K views

Table of Contents

Research on research? If you find this idea rather peculiar, know that nowadays, with the huge amount of information produced daily all around the world, it is becoming more and more difficult to keep up to date with all of it. In addition to the sheer amount of research, there is also its origin. We are witnessing the economic and intellectual emergence of countries like China, Brazil, Turkey, and United Arab Emirates, for example, that are producing scholarly literature in their own languages. So, apart from the effort of gathering information, there must also be translators prepared to unify all of it in a single language to be the object of the literature survey. At Elsevier, our team of translators is ready to support researchers by delivering high-quality scientific translations , in several languages, to serve their research – no matter the topic.

What is a literature review?

A literature review is a study – or, more accurately, a survey – involving scholarly material, with the aim to discuss published information about a specific topic or research question. Therefore, to write a literature review, it is compulsory that you are a real expert in the object of study. The results and findings will be published and made available to the public, namely scientists working in the same area of research.

How to Write a Literature Review

First of all, don’t forget that writing a literature review is a great responsibility. It’s a document that is expected to be highly reliable, especially concerning its sources and findings. You have to feel intellectually comfortable in the area of study and highly proficient in the target language; misconceptions and errors do not have a place in a document as important as a literature review. In fact, you might want to consider text editing services, like those offered at Elsevier, to make sure your literature is following the highest standards of text quality. You want to make sure your literature review is memorable by its novelty and quality rather than language errors.

Writing a literature review requires expertise but also organization. We cannot teach you about your topic of research, but we can provide a few steps to guide you through conducting a literature review:

• Choose your topic or research question: It should not be too comprehensive or too limited. You have to complete your task within a feasible time frame.
• Set the scope: Define boundaries concerning the number of sources, time frame to be covered, geographical area, etc.
• Decide which databases you will use for your searches: In order to search the best viable sources for your literature review, use highly regarded, comprehensive databases to get a big picture of the literature related to your topic.
• Search, search, and search: Now you’ll start to investigate the research on your topic. It’s critical that you keep track of all the sources. Start by looking at research abstracts in detail to see if their respective studies relate to or are useful for your own work. Next, search for bibliographies and references that can help you broaden your list of resources. Choose the most relevant literature and remember to keep notes of their bibliographic references to be used later on.
• Review all the literature, appraising carefully it’s content: After reading the study’s abstract, pay attention to the rest of the content of the articles you deem the “most relevant.” Identify methodologies, the most important questions they address, if they are well-designed and executed, and if they are cited enough, etc.

If it’s the first time you’ve published a literature review, note that it is important to follow a special structure. Just like in a thesis, for example, it is expected that you have an introduction – giving the general idea of the central topic and organizational pattern – a body – which contains the actual discussion of the sources – and finally the conclusion or recommendations – where you bring forward whatever you have drawn from the reviewed literature. The conclusion may even suggest there are no agreeable findings and that the discussion should be continued.

Why are literature reviews important?

Literature reviews constantly feed new research, that constantly feeds literature reviews…and we could go on and on. The fact is, one acts like a force over the other and this is what makes science, as a global discipline, constantly develop and evolve. As a scientist, writing a literature review can be very beneficial to your career, and set you apart from the expert elite in your field of interest. But it also can be an overwhelming task, so don’t hesitate in contacting Elsevier for text editing services, either for profound edition or just a last revision. We guarantee the very highest standards. You can also save time by letting us suggest and make the necessary amendments to your manuscript, so that it fits the structural pattern of a literature review. Who knows how many worldwide researchers you will impact with your next perfectly written literature review.

Know more: How to Find a Gap in Research .

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The Importance of Literature Reviews in Dissertations

1. Introduction to Literature Reviews in Dissertations

A literature review is a fundamental component of a dissertation. It enables the researcher to survey existing research related to their chosen topic and outline the principles of that particular field from which further investigation can be based. Literature reviews should include an analysis, synthesis, summarization and interpretation of current knowledge on the subject being studied.

• Analysis : A critical appraisal or examination of another scholar’s work in order to evaluate its relevance for your own study needs.
• Synthesis : Combining multiple viewpoints into one cohesive narrative while considering what may be missing from the various sources.

The purpose of analyzing the relevant literature is twofold: firstly, it allows you to create your own original argument by understanding how previous researchers have contributed to this specific area; secondly, it helps you identify any shortcomings or gaps in existing studies – areas where new knowledge could potentially be created through further research. As such, writing a thorough and accurate literature review is essential for producing good quality dissertations.

2. Examining the Significance of Literature Reviews

Exploring the Purpose of Literature Reviews A literature review is an analysis and evaluation of existing research findings on a topic. It serves several purposes in research-oriented writing, including providing context for related work, summarizing prior studies to form a basis for new research and synthesizing results from multiple sources into one unified interpretation. Writing a thorough and comprehensive literature review takes effort but ultimately aids researchers in deepening their understanding of the subject matter.

Organizing Existing Knowledge: The main purpose of conducting a literature review is to bring order out chaos within already existing knowledge or information on the chosen topic. By doing this task methodically and conscientiously, it becomes easier to spot areas that need more attention or where further investigation might be necessary while also avoiding errors by not overlooking important works all too common when performing ad hoc searches. Additionally, since most reviews focus on synthesis rather than quantitative aggregation across numerous detailed reports, they provide insight into trends over time as well as what future directions should entail such as upcoming technologies and changes in best practices.

• Researched information must be effectively organized.
• “Gaps” can easily be identified.

3. Benefits and Challenges of Conducting a Literature Review

The literature review process has multiple advantages and challenges in the research realm. This section provides a reflection on some of those benefits and issues.

• Develops an overview of current scholarly knowledge; identifies relationships among different fields and topics, potential gaps in knowledge, emerging trends or controversies.

4. Best Practices for Formulating an Effective Literary Review Structure

When formulating an effective literary review structure, it is important to have a clear plan in mind. First and foremost, summarise the key texts that you will be engaging with; this serves as a starting point for writing your review. It is helpful to adhere to certain best practices when establishing a structured approach.

• Focus on relevant works: Narrow down the list of literature by selecting those materials directly related to your study’s research questions or objectives.
• Develop distinct sections: Divide up different strands of inquiry into separate subsections so that each discussion may stand alone in its own right without losing coherence within the broader argument.
• Be critical in assessments: Evaluate strengths and weaknesses from both primary sources as well as past studies which seek out ways they can inform additional scholarship going forward.

5. Strategies for Locating Relevant Sources for Your Literary Review

Identifying Relevant Sources

The first step of conducting an effective literature review is to identify sources that are highly relevant to the research topic. This can be done through a variety of strategies, such as:

• Exploring bibliographies provided in existing articles.
• Researching potential authors and their research topics via databases or search engines.

These two methods can often lead you to further related studies and additional authors who have conducted work on the same topic. For example, exploring a study’s reference page may direct you to similar works written by different authors which provide complementary information.

Verifying Source Reliability

Once some sources have been identified for use, another important step is verifying whether these are reliable sources for your particular project. It is essential when researching academic fields that all materials used have undergone rigorous peer-review processes and meet certain academic standards; this helps maintain trustworthiness in all areas of academia. In addition, it’s also important to consider how current any source material might be – timeliness matters depending on the field being researched! Some considerations while evaluating reliability include asking questions such as:

6. Acknowledging Sources within your literary review

When writing a literature review, it is important to remember and give due credit to all sources that you have used in the compilation of your work. It is especially crucial when you are citing published material by other authors as these documents are protected under copyright law. Therefore, one must be sure to include proper acknowledgement of every source utilized.

• Inclusion of accurate referencing not only protects against infringement but also adds credibility and authority to your review.
• Be mindful that some publications may require specific formatting for citations; therefore familiarize yourself with them before beginning the project or refer back if any doubt arises

The use of Citations:

A citation provides information regarding the source so readers can easily identify it within their library collection or online database search results. To cite a particular author’s publication accurately , follow this correct format : Name ( date) , title , place where it was published . For instance : Smith (1984), “A Study on Literary Themes,” New York: Penguin Books

7. Concluding Remarks on the Importance of Completing a Thorough Literature Review

In conclusion, completing a thorough literature review is of paramount importance to any research endeavor. The primary aim of this type of review is to assess the existing studies related to the topic in order gain an understanding and identify knowledge gaps. As such, it provides new researchers with valuable insights including:

• Contextual information on how current theories are built.
• A better understanding of key terms and concepts.
• An assessment for potential methodological approaches.

What Is The Significance Of The Study?

In the vast landscape of academia, every research study serves a purpose beyond just adding to the pile of existing knowledge. It’s about unraveling mysteries, solving problems, and making the world a little better. But before diving into any research, one crucial question needs answering: What is the significance of the study? Let’s embark on a journey to understand the importance of this question and how it shapes the landscape of research.

What Is The Importance Of Studying?

Table of Contents

Studying is a fundamental aspect of human learning and development, playing a crucial role in various aspects of life. Its importance spans across personal, academic, professional, and societal domains. Here’s a breakdown of why studying is essential:

• Academic Achievement: Studying is essential for academic success. It helps students grasp concepts, retain information, and demonstrate their understanding through assessments. Whether it’s preparing for exams, completing assignments, or engaging in class discussions, studying forms the backbone of academic achievement.
• Skill Development: Studying isn’t just about memorizing facts; it’s also about developing critical skills such as problem-solving, analytical thinking, and communication. Through studying, individuals hone these skills, which are invaluable in both academic and real-world settings.
• Personal Growth: Studying expands one’s horizons and fosters personal growth. It exposes individuals to new ideas, perspectives, and experiences, challenging them to think critically and question assumptions. Additionally, studying encourages self-discipline, time management, and perseverance, all of which are essential qualities for personal success.
• Career Advancement: In today’s competitive job market, continuous learning is essential for career advancement. Studying allows individuals to acquire new knowledge, skills, and qualifications, making them more competitive and marketable to employers. Whether it’s pursuing higher education, attending professional development courses, or staying updated on industry trends, studying is crucial for career growth.
• Intellectual Stimulation: Studying stimulates the mind and fosters intellectual curiosity. It allows individuals to delve into topics of interest, explore complex ideas, and engage in meaningful intellectual discourse. This intellectual stimulation not only enriches one’s understanding of the world but also enhances cognitive abilities and overall mental well-being.
• Societal Contribution: Studying plays a vital role in advancing society as a whole. Through research, innovation, and knowledge dissemination, studying drives progress in various fields, from science and technology to arts and humanities. Additionally, educated individuals are better equipped to contribute positively to their communities, advocate for social change, and address pressing global challenges.

The significance of a study lies in its ability to address a specific problem or question, contribute to existing knowledge, and have practical applications or implications for various stakeholders. Let’s delve into each aspect with relevant examples:

Addressing a Specific Problem or Question

• Example: A study on the impact of social media usage on mental health among teenagers addresses the pressing concern of rising mental health issues in young people attributed to excessive screen time and online interactions.

Contributing to Existing Knowledge

• Example: A research project investigating the effects of climate change on biodiversity builds upon previous studies by providing new insights into how changing environmental conditions affect different species and ecosystems. By adding to the body of knowledge on this topic, the study contributes to our understanding of the complex interactions between climate and biodiversity.

Practical Applications or Implications

• Example: A study on the effectiveness of mindfulness-based interventions in reducing workplace stress offers practical implications for employers and employees alike. By demonstrating the positive impact of mindfulness practices on employee well-being and productivity, the study informs organizational policies and practices aimed at promoting a healthier work environment.

Informing Policy Decisions

• Example: Research on the economic impact of renewable energy adoption provides policymakers with valuable insights into the potential benefits of transitioning to sustainable energy sources. By quantifying the economic advantages and environmental benefits of renewable energy investments, the study informs policy decisions related to energy planning and resource allocation.

Addressing Social or Health Issues

• Example: Research into how well vaccination campaigns work to lower the spread of diseases is important for public health. This kind of study looks at how good vaccination plans are at stopping diseases from spreading. It also figures out what stops people from getting vaccinated. With this information, health programs can do better at preventing outbreaks and keeping communities safe from diseases.

Fostering Innovation and Progress

• Example: Research on the development of artificial intelligence algorithms for medical diagnosis advances technological innovation in healthcare. By harnessing the power of machine learning and data analytics, the study enables more accurate and efficient diagnosis of medical conditions, leading to improved patient outcomes and advancements in medical practice.

What Is The Significance Of The Study And Statement Of The Problem?

The significance of the study and the statement of the problem are two critical components of any research endeavor, as they lay the foundation for the entire study. Let’s explore their significance individually:

Significance of the Study

• The significance of the study articulates why the research is important and why it matters. It provides justification for conducting the study and highlights its relevance in the broader context of academia, society, or a specific field.
• Significance is about identifying the value and impact of the research in terms of its potential contributions to knowledge, practical applications, policy implications, or societal relevance.
• Without a clear understanding of the significance of the study, researchers may struggle to convey the importance of their work to stakeholders, peers, and the broader community.
• A well-defined significance statement serves as a guiding principle throughout the research process, helping researchers stay focused on the overarching goals and objectives of their study.

Statement of the Problem

• The statement of the problem defines the specific issue or question that the research seeks to address. It clarifies the scope and boundaries of the study by identifying the key variables, concepts, or phenomena under investigation.
• The problem statement highlights the gap or deficiency in existing knowledge that the research aims to fill. It identifies the research gap by demonstrating what is currently unknown, unresolved, or underexplored in the literature.
• A well-crafted problem statement provides a clear and concise description of the research problem, making it easier for readers to understand the purpose and rationale behind the study.
• By defining the problem upfront, researchers can effectively plan their research design, methodology, and data collection strategies to address the identified research gap.
• The statement of the problem serves as a roadmap for the research, guiding the selection of research questions, hypotheses, and analytical approaches to be used in the study.

How Do You Write The Significance Of Research?

Writing the significance of research involves clearly articulating why the study is important, relevant, and worthy of attention. Here’s a step-by-step guide on how to write the significance of research:

• Identify the Problem or Issue

Begin by clearly defining the problem, question, or issue that the research seeks to address. This sets the stage for explaining why the research is necessary.

• Review Existing Literature

Conduct a thorough review of existing literature in the field to understand what has already been studied and what gaps or limitations exist in current knowledge.

• Highlight the Gap in Knowledge

Identify the specific gap or deficiency in existing research that the study aims to fill. This could be a lack of research on a particular topic, conflicting findings in the literature, or unanswered questions that need further exploration.

• Explain the Relevance and Importance

Clearly articulate why the research is important and relevant in the broader context. Consider the potential implications of the research for theory development, practical applications, policy decisions, or societal impact.

• Demonstrate Potential Contributions

Explain how the research will contribute to advancing knowledge in the field. This could involve providing new insights, validating existing theories, developing innovative methodologies, or addressing practical problems.

• Consider Stakeholder Perspectives

Identify the stakeholders or audiences who will benefit from the research findings. Consider their perspectives and interests when explaining the significance of the research.

• Emphasize Practical Applications

Highlight any practical applications or real-world implications of the research. This could include informing policy decisions, improving practices, addressing societal challenges, or benefiting specific industries or communities.

• Provide Justification for Conducting the Study

Offer a compelling rationale for why the research is worth undertaking. This could involve emphasizing the urgency of the problem, the potential benefits of finding a solution, or the intellectual merit of exploring a novel research question.

• Be Concise and Clear

Write the significance of research in a clear, concise, and compelling manner. Avoid jargon or technical language that may obscure the message and focus on communicating the importance of the research in accessible terms.

• Revise and Refine

Review and revise the significance of research to ensure clarity, coherence, and persuasiveness. Solicit feedback from peers, mentors, or colleagues to refine your argument and strengthen your rationale.

In the ever-evolving world of research, the significance of each study lies in its ability to push the boundaries of knowledge, address pressing issues, and make a meaningful impact on the world.

By understanding why a study matters, researchers can ensure that their work contributes meaningfully to the collective pursuit of knowledge and progress. 

So the next time you embark on a research journey, remember to ask yourself: What is the significance of the study? The answer could shape the course of history.

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Let us take a walk to the sustainable tourism practices: a qualitative study through the lens of tourism experts

• Research Article
• Published: 04 January 2024
• Volume 31 , pages 12892–12915, ( 2024 )

Cite this article

• Vikas Arya 1 ,
• Vilte Auruskeviciene   ORCID: orcid.org/0000-0002-1563-4052 2 ,
• Srishti Agarwal 3 ,
• Priyanka Kokatnur 3 ,
• Harish Kumar 4 &
• Rajeev Verma 5  

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The rising opportunities of sustainable tourism have brought many policies to control the exploitation of the environment and increase the reach of luxurious, safe, and authentic experiences to the different segments of tourists. This study seeks to prioritize the variables influencing the development of sustainable tourism and pinpoint key success factors that align with the Sustainable Development Goals (SDGs). It adopts a tri-dimensional framework encompassing economic, social, and environmental aspects, further delineated into eleven sub-dimensions, to provide a quantitative evaluation of sustainable tourism. We conducted interviews with 26 tourism industry experts hailing from eight countries, analyzing their responses using interval type-2 fuzzy sets. The results underscore the critical role of specific components in advancing sustainable tourism. In the economic dimension, “financial resources and tourism costs” emerge as vital factors. In the social dimension, “health and safety” takes center stage, while “green infrastructure” plays a pivotal role in the environmental dimension. These findings underscore the significance of these aspects in promoting sustainable tourism. Furthermore, this study explores the strategic importance of sustainable tourism equity in shaping tourism planning and development for emerging markets.

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All authors contributed to the study’s conception and design. Vikas Arya conducted the analysis of data and provided an interpretation of the findings. Vilte Auruskeviciene wrote the manuscript draft and ensured consistency in referencing and citation formatting. Srishti Agarwal collected data, collaborated with Vikas Arya to analyze the data, and contributed to the discussion of the findings. Priyanka Kokatnur contributed to the research methodology development and data collection. Harish Kumar provided insights to the theoretical and managerial aspects of the study and contributed to the discussion section. Rajeev Verma conducted a literature review and collaborated with Vilte Auruskeviciene to integrate the literature review into the manuscript. All authors provided comments on previous versions of the manuscript, and they all read and approved the final manuscript.

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Arya, V., Auruskeviciene, V., Agarwal, S. et al. Let us take a walk to the sustainable tourism practices: a qualitative study through the lens of tourism experts. Environ Sci Pollut Res 31 , 12892–12915 (2024). https://doi.org/10.1007/s11356-023-31503-7

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Pretreatment quality of life and survival in patients with lung cancer: a systematic review and meta-analysis

• Taro Okayama 1 ,
• Katsuyoshi Suzuki 1 ,
• Shinichiro Morishita 2 ,
• Junichiro Inoue 3 ,
• Takashi Tanaka 4 ,
• Jiro Nakano 5 &
• Takuya Fukushima 5  

BMC Cancer volume  24 , Article number:  495 ( 2024 ) Cite this article

Metrics details

Although many studies have explored the correlation between quality of life and survival, none have reported this relationship for specific cancers assessed at distinct time points. This meta-analysis aimed to investigate the impact of pretreatment Global Quality of Life (QOL) and functioning QOL, including physical, social, role, emotional, and cognitive QOLs, on mortality risk in patients with lung cancer.

A literature search was conducted across the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PubMed databases for articles published between their inception and December 2022. Subsequently, 11 studies were selected based on predefined eligibility criteria to investigate the relationship between pretreatment QOLs and mortality risk in patients with lung cancer.

Pretreatment global, physical, social, role, and emotional QOLs were significantly associated with mortality risk as follows: Global QOL (hazard ratio [HR] = 1.08 95% confidence interval [CI] = 1.03–1.13); Physical QOL (HR = 1.04 95% CI = 1.02–1.05); Social QOL (HR = 1.02 95% CI = 1.01–1.03; Role QOL (HR = 1.01 95% CI = 1.01–1.02); Emotional QOL (HR = 1.01 95% CI = 1.00–1.03).

Conclusions

These findings underscore the importance of early QOL assessment after diagnosis as well as early provision of physical, social, and psychological support accommodating each patient’s demands.

Trial registration

The International Prospective Register of Systematic Reviews registration number CRD42023398206, Registered on February 20, 2023.

Peer Review reports

The number of patients with lung cancer has been increasing in recent years owing to global aging of the population and advances in cancer treatments. Approximately 2.2 million cases and 1.8 million deaths (18% of all sites) [ 1 ] occur annually worldwide, which is significantly higher than the 930,000 annual deaths (9.4% of all sites) of secondary colorectal cancer. Advances in screening techniques and agents have extended the survival of patients with lung cancer, especially non-small cell lung cancer, although the 5-year survival rate for patients diagnosed in 2010–2014 remains 20–30% [ 2 ], the third lowest survival rate after that for pancreatic and liver cancer. More than half of the patients with lung cancer have distant metastases at diagnosis [ 3 ], and even when surgery is performed as the initial treatment, the recurrence rate is high [ 4 ].

In response to this situation, many patients receive palliative treatment, which means that QOL assessment is especially important for patients with lung cancer. The World Health Organization (WHO) defines QOL as " individuals' perception of their position in life in context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. " [ 5 ]. QOL assessment consists of Global QOL and functioning QOL, which pertains to specific functions such as Physical, Role, Cognitive, and Emotional. QOL assessment helps to understand the impact of disease and treatment on patients' overall lives [ 6 , 7 , 8 ], evaluate the effects of anticancer treatment and supportive care [ 9 , 10 ], detect side effects and complications [ 11 ], notice the differences between symptoms from the patient’s and healthcare provider’s points of view [ 12 ], and guide long-term follow-up [ 13 , 14 ]. In addition, QOL assessment is a useful tool for predicting prognosis.

Several systematic reviews, pooled analyses, and meta-analyses on QOL and survival have been published [ 15 , 16 , 17 , 18 , 19 , 20 ]. These studies have mostly shown positive results in predicting prognosis. However, various problems have been pointed out in these studies, such as no distinction between cancer types [ 15 ], no distinction of cases before, during, and after treatment [ 19 ], and the use of only the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) in QOL assessment [ 17 , 20 ]. In addition, the relationship between other functional domains of QOL and prognosis is not well understood because previous studies have focused on global and physical QOL, which are more related to prognosis. Qi et al. [ 21 ] in a study of 420 patients with advanced lung cancer reported that pretreatment QOL and body mass index were significant prognostic factors. Sloan et al. [ 22 ] reported that QOL at diagnosis can be an independent prognostic factor. However, Qi et al. and Sloan et al. assessed QOL using single items UNISCALE and one of the Lung Cancer Symptom Scales, respectively, which raises questions about detailed assessment. This means that the relationship between pretreatment QOL and the mortality risk in patients with lung cancer has not been adequately studied and a certain view has not been reached. This suggests that the relationship between pretreatment QOL and the mortality risk in patients with lung cancer has not been adequately studied.

Given the limitations of the previous studies, there is an urgent need to evaluate the relationship between various domains of QOL and survival in patients with lung cancer to enable application of appropriate interventions to improve prognosis. Thus, this systematic review and meta-analysis aims to clarify the significance of each QOL domain for mortality risk and provide information to inform future clinical practice and interventions.

This systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (registration number CRD42023398206) [ 23 ] and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines [ 24 ].

Data searches and sources

A systematic search was conducted using the PubMed/MEDLINE, CINAHL, and Scopus databases from inception to December 2022. The search strategies used in each database included QOL, EORTC QLQ-C30 [ 25 ], Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) [ 26 ], Functional Assessment of Cancer Therapy-General (FACT-G) [ 27 ], cancer, neoplasm, tumor, mortality, survival, relapse, and recurrence. The details of the search strategy used for each database are provided in the Supplementary Appendix .

Study eligibility criteria and study selection

The eligibility criteria were as follows: 1) original human studies, 2) observational studies, 3) studies published in English, 4) studies on patients with lung and malignant pleural mesothelioma, and 5) studies that examined the association between pretreatment QOL and mortality. The exclusion criteria were as follows: 1) studies involving patients other than those with lung or malignant pleural mesothelioma, 2) studies examining the association between QOL during or after treatment and mortality, and 3) studies examining the association between symptoms and mortality. After removing duplicates, seven reviewers independently assessed the study eligibility by reviewing the titles and abstracts of all potential citations according to the eligibility criteria. Full-text articles were retrieved for review if there was evidence that they met the eligibility criteria, or if there was insufficient information in the abstract or title to make a decision. The final inclusion of eligible observational studies was determined at consensus meetings attended by all the authors.

Data extraction

Two reviewers (TO and TF) extracted the data. The following data were extracted from each included study: 1) last name of the first author, 2) year of publication, 3) nationality, 4) number of patients, 5) sex, 6) age, 7) histology, 8) clinical stage, 9) cancer treatment, 10) QOL, 11) QOL domains, 12) follow-up period, 13) covariates adjusted in the multivariate analysis, 14) number of deaths, and 15) risk estimates for mortality (hazard ratio [HR] and 95% CI). When several different models of multivariate analysis were available, we used the results from multivariate models with the most complete adjustments for potential confounders.

Quality assessment

The quality of studies, including their risk of bias, was assessed using the Newcastle–Ottawa scale [ 28 ]. This tool includes the following eight domains: representativeness of the exposed cohort; selection of the non-exposed cohort; ascertainment of exposure; demonstration that the outcome of interest was not present at baseline; comparability of cohorts based on design or analysis; assessment of outcomes; whether follow-up was long enough for outcomes to occur; and adequacy of the cohort follow-up. Two trained reviewers (TO and TF) scored each item based on these criteria [ 28 ]. Potential disagreements were resolved through consensus meetings involving all authors.

Data analysis

Risk estimates of total mortality were analyzed in relation to pretreatment global, physical, emotional, role, cognitive, and social QOL. We used adjusted HRs and 95% CI in the multivariate analysis as measures of the effect size for all studies. Univariate HRs were used only when reported, but not multivariate HR. For inverse variance-weighted means, the natural log of HR was used, and the standard error was calculated using a random-effects model. Heterogeneity was assessed using the I 2 statistic. All statistical analyses were performed using the Review Manager version 5.1 (RevMan; The Cochrane Collaboration, London, UK).

The database search yielded 119,061 articles, which were reduced to 5066 articles after excluding duplicates. These 5066 articles were screened for titles and abstracts, after the exclusion of 5002 studies due to irrelevant study designs or discrepancies regarding the population or outcomes. A full-text review was conducted on the remaining 64 articles, and 53 studies were excluded due to irrelevant study design or outcomes, non-lung cancer, different languages, non-original articles, and finally 11 articles were determined to be suitable for meta-analysis (Fig.  1 ).

Study flow diagram of the selection process

Study characteristics

The characteristics of the 11 studies that met the inclusion criteria are summarized in Table  1 . These studies was published between 2000 and 2022. Their sample sizes ranged from the smallest (50 patients) in the study by Erdem et al. [ 29 ] to the largest 2892 patients in the study by Badaoui et al. [ 30 ]. These patients had non-small cell lung cancer [ 29 , 30 , 31 , 32 , 33 ], small cell lung cancer [ 34 ], or a combination of them [ 35 , 36 , 37 , 38 ]. These patients were treated with chemotherapy [ 29 , 30 , 34 , 38 ], radiation therapy [ 31 ], chemo-radiation therapy [ 32 ], surgery [ 33 , 39 ]. Some patients were treated differently within the trials [ 36 , 37 ], while others had no treatment records [ 35 ]. QOL was evaluated using the EORTC QLQ-C30 [ 29 , 30 , 31 , 32 , 33 , 36 , 38 ], FACT-G [ 34 , 35 ], or SF-36 [ 37 , 39 ]. The follow-up period ranged from 8.3 months [ 31 ] to 5 years [ 32 ], although this was not described in two studies [ 34 , 38 ]. Confounders in multivariate analysis were, in addition to the generally used variables, age, sex, body mass index, Eastern Cooperative Oncology Group Performance Status, smoking status, stage, comorbidities, and medical history, as well as the extent of resection [ 39 ], diffusing capacity of the lung for carbon monoxide [ 33 ] for surgery, PD-L1 expression level [ 30 ] for anticancer drugs, number of distant metastases, and history of brain metastases [ 34 ].

Risk of bias assessment

The risk of bias was assessed using the Newcastle–Ottawa scale. Among the included studies, five were considered of high quality (8 or 9 points), and six were of moderate quality (6 or 7 points). Details are presented in Table  2 .

Impact of global QOL on mortality risk

The effect of QOL on the mortality risk was estimated using a forest plot of the inverse HR and 95% CI. Global, physical, social, role and emotional QOL were significantly associated with mortality risk, which was proven as follows: Global QOL (HR = 1.08 95% CI = 1.03–1.13) (Fig.  2 ), physical QOL (HR = 1.04 95% CI = 1.02–1.05) (Fig.  2 ), social QOL (HR = 1.02 95% CI = 1.01–1.03) (Fig.  3 ), role QOL (HR = 1.01 95% CI = 1.01–1.02) (Fig.  3 ), emotional QOL (HR = 1.01 95% CI = 1.00–1.0) (Fig.  3 ). In contrast, cognitive QOL was not significant: HR = 1.01 95% CI = 1.00–1.02 (Fig.  3 ).

Meta-analysis for the effect of global and physical QOL on mortality risk

Meta-analysis for the effect of emotional, role, cognitive, and social QOL on mortality risk

This meta-analysis focused on the association between pretreatment health-related QOL and mortality risk in patients with lung cancer. The main findings of this study are summarized as follows: global QOL, physical QOL, emotional QOL, role QOL, and social QOL before treatment were factors affecting patient prognosis, and only cognitive QOL was not a significant factor.

Previous studies on the relationship between QOL and survival have debated whether global or physical QOL is a better predictor of survival. Zikos et al. [ 20 ] and Quinten et al. [ 17 ] reported that physical QOL is a superior predictor of survival. By contrast, Ediebah et al. [ 40 ] reported that global QOL was the strongest prognostic factor. In our study, HR for global QOL was proven to be the highest, followed by physical QOL.

However, it cannot be conclusively asserted that global QOL significantly predicts survival compared with physical QOL. Furthermore, when aiming to capture QOL not solely in terms of predicting survival but also to unveil the patient's vulnerability, the interpretation of global QOL results can be challenging due to its comprehensive nature. Considering this, we are inclined to believe that physical QOL holds more significance in illustrating the deterioration of a patient's physical function and establishing access to early intervention.

Regarding the relationship between physical functioning and QOL in cancer patients, a positive correlation has been reported between physical activity levels [ 41 , 42 , 43 ] and respiratory function [ 43 ]. However, there was a negative correlation between the performance status [ 44 ] and sedentary time [ 45 ]. Moreover, exercise tolerance [ 46 , 47 ], physical activity levels [ 48 ], grip strength [ 49 ], and sarcopenia [ 50 , 51 , 52 ] are independent prognostic factors, indicating that physical QOL before treatment often reflects a decline in physical function. This strongly supports the importance of early exercise interventions soon after diagnosis. Previous reports have indicated that exercise counseling and intervention for lung cancer patients from the early stages of diagnosis improves their physical function and QOL [ 53 , 54 , 55 ]. It is necessary to establish exercise prescriptions based on patients' physical functions and verify whether these exercise prescriptions prolong not only physical function, but also survival time.

However, the focus of previous studies has only been on global and physical QOL. Indeed, in the analyses by Ediebah et al. [ 40 ] and Quinten et al. [ 17 ], functional QOL was a significant predictor of overall survival in the univariate analysis, whereas only global QOL and physical QOL were used in the multivariate analysis. Although these multivariate analyses may be useful in that they avoid multicolinearity and predict the domains of QOL that are most strongly associated with prognosis, this may be the cause of the lack of consideration of social, emotional, role QOL and prognosis of lung cancer patients. By contrast, this study reported novel findings on a significant association between social, role, and emotional QOL and mortality risk. Social, emotional, and role QOL are interrelated with psychological factors, including anxiety and depression [ 56 , 57 , 58 , 59 , 60 ], support from family and friends [ 61 , 62 ], work and financial problems [ 63 , 64 ], and symptoms, including dyspnea, fatigue, and appetite loss [ 8 , 65 , 66 ], which would lead to outcomes relevant to prognosis, such as access to medical care and physical function deterioration. Although the HR may be small, the results of this study suggest the need to consider the possible prognostic relevance of these factors.

In the present study, cognitive QOL alone was not significantly associated with survival. Numerous studies on cognitive QOL in patients with lung cancer have reported less decline compared to other functional QOL [ 67 , 68 , 69 ]. This is likely because there is little variation in cognitive QOL values and that patients with cognitive decline tend to be excluded from clinical trials [ 60 , 68 ].

A comprehensive and individualized view of QOL is needed when confronting patients with lung cancer because social, emotional, and role QOL are related to prognosis in addition to global and physical QOL. First, a comprehensive assessment of QOL and domain-specific scores should be obtained. If there are physical QOL issues, this should be addressed based on the exercise prescription described above. In addition, comprehensive and individualized interventions are needed when there are social, emotional, and role QOL issues. Specifically, early social work, taking into account family, employment and social background, and psychological support from specialists are necessary. Such interventions may lead to functional and symptomatic improvements associated with QOL, which in turn may have a positive impact on treatment outcomes and prognosis. To explore better interventions to improve QOL and prolong survival, future research should focus on the social, emotional, and role QOL of patients with lung cancer before treatment to identify factors that affect QOL and further examine the effects of interventions on these factors.

This study had several limitations. This study integrated three different QOL assessments including EORTC QLQ-C30, SF-36, and FACT-G. Based on the previous study showing the correlation between the EORTC QLQ-C30 and the SF-36, which measure similar dimensions of QOL in patients with cancer [ 70 ], several QOL measures were integrated and analyzed. However, previous studies have demonstrated that QOL measures have reported low to moderate correlations between domains [ 71 , 72 ]. Therefore, it cannot be excluded that differences in QOL measures may have influenced the results of this study, and this is the first limitation of this study. Second, the present study did not discuss symptoms, as in previous studies, because the symptom QOL was not included in the analysis. Third, it was not possible to perform a subset analysis based on the disease stage and treatment because of the number of selected articles. Finally, there was a gap of 20 years or more between the studies adopted. Particularly for medicinal treatments with anticancer drugs, the difference in survival time before and after molecular targeted therapy may potentially influence the results.

We found that social, emotional and role QOL before treatment, not limited to Global QOL or physical QOL before treatment, were associated with mortality risk in patients with lung cancer. These results demonstrate the importance of comprehensive assessment of QOL and domain-specific scores to support patients with lung cancer. In addition to exercise prescription for physical QOL, early social work, taking into account family, employment and social background, and psychological support from specialists are necessary to improve QOL and prognosis.

Availability of data and materials

All data generated or analysed during this study are included in this published article and Supplementary appendix .

Abbreviations

• Quality of life

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30

Medical outcomes study 36-item short-form health survey

Cumulative Index to Nursing and Allied Health Literature

Functional Assessment of Cancer Therapy-General

Hazard ratio

Confidence interval

World Health Organization

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Taro Okayama and Takuya Fukushima contributed to the study's conception and design. The analysis was performed by Takuya Fukushima. Material preparation and data collection were conducted by Taro Okayama, Katsuyoshi Suzuki, Shinichiro Morishita, Junichiro Inoue, Takashi Tanaka, Jiro Nakano, and Takuya Fukushima. The first draft of the manuscript was written by Taro Okayama, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Okayama, T., Suzuki, K., Morishita, S. et al. Pretreatment quality of life and survival in patients with lung cancer: a systematic review and meta-analysis. BMC Cancer 24 , 495 (2024). https://doi.org/10.1186/s12885-024-12267-w

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Malaria prevention interventions beyond long-lasting insecticidal nets and indoor residual spraying in low- and middle-income countries: a scoping review

• Sarah Nalinya   ORCID: orcid.org/0000-0003-2380-2754 1 ,
• David Musoke 1 &
• Kevin Deane 2  

Malaria Journal volume  21 , Article number:  31 ( 2022 ) Cite this article

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Significant progress in malaria prevention during the past two decades has prompted increasing global dialogue on malaria elimination. Recent reviews on malaria strategies have focused mainly on long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), with little emphasis on other prevention methods. This article is a scoping review of literature on malaria prevention methods beyond LLINs and IRS in low- and middle-income countries (LMICs).

This scoping review found articles published between from 1994 to 2020. Studies were obtained from a search of the PubMed, the Cochrane Library and Social Science abstracts. Grey literature and manual search of secondary references was also done. The search strategy included all study designs but limited only to English. Three independent reviewers performed the selection and characterization of articles, and the data collected were synthesized qualitatively.

A total of 10,112 studies were identified among which 31 met the inclusion criteria. The results were grouped by the 3 emerging themes of: housing design; mosquito repellents; and integrated vector control. Housing design strategies included closing eves, screening of houses including windows, doors and ceilings, while mosquito repellents were mainly spatial repellents, use of repellent plants, and use of plant-based oils. Integrated vector control included larvae source management. Evidence consistently shows that improving housing design reduced mosquito entry and malaria prevalence. Spatial repellents also showed promising results in field experiments, while evidence on repellent plants is limited and still emerging. Recent literature shows that IVM has been largely ignored in recent years in many LMICs. Some malaria prevention methods such as spatial repellents and IVM are shown to have the potential to target both indoor and outdoor transmission of malaria, which are both important aspects to consider to achieve malaria elimination in LMICs.

The scoping review shows that other malaria prevention strategies beyond LLINs and IRS have increasingly become important in LMICs. These methods have a significant role in contributing to malaria elimination in endemic countries if they are adequately promoted alongside other conventional approaches.

Malaria continues to be a significant global health issue, with an estimated 229 million malaria cases and 409,000 deaths in 2019 in 85 endemic countries, a reduction from 238 million cases and 736,000 deaths in 2000 [ 1 ]. Whilst there has been recent progress in the reduction of malaria morbidity and mortality, the last 5 years have seen a limited reduction in the incidence of the disease. Indeed, the global malaria incidence in 2018 was nearly the same as in 2014, with slowing of improvements in the malaria mortality rate [ 2 ], and increases in cases between 2015 and 2017 in 55 countries [ 3 ]. This stalling and in some cases reversal of progress, emphasizes the need for a renewed focus on controlling malaria if the vision of an ‘Africa Free of Malaria’ [ 4 ] is to be realized, and if the disease is to be eradicated across the globe.

Central to malaria prevention efforts are the use of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), alongside improved treatment regimens and expanded testing programmes [ 3 ]. The efficacy of these approaches is well established, and they are viewed as fundamental to malaria eradication. However, in the World Health Organization (WHO)-African region, which accounts for 93% of all malaria cases, coverage of these methods currently remains below national and international targets [ 5 , 6 ]. There are a wide range of well-documented barriers to uptake of LLINs and IRS including: a lack of availability [ 5 , 7 , 8 ]; economic costs where free distribution programmes are absent [ 5 , 9 , 10 ]; a lack of education or knowledge about the protective effect of LLINs [ 5 , 7 , 11 , 12 , 13 , 14 ]; low seasonal use of LLINs during the dry season or other times of the year where it is believed malaria risk is low [ 5 ]; concerns regarding discomfort of LLINs due to lack of airflow [ 5 , 13 ], heat and skin irritation [ 13 ]; problems associated with hanging nets up or having the space to do so [ 5 , 10 ]; challenges related to use of LLINs by those who sleep outdoors [ 9 ]; alternative uses for insecticide-treated nets (ITNs) including for protecting seedlings, as fishing nets and curtains [ 10 , 11 , 15 ]; concerns around ineffectiveness of IRS [ 14 , 16 ]; negative experiences of previous spraying [ 16 ]; residual effects of spraying [ 16 ]; and the need to remove household goods for spraying [ 16 ]. Whilst there is no doubt that when used appropriately, LLINs and IRS have a significant impact on the incidence of malaria, the stalling of progress noted above raises questions concerning the direction of malaria prevention efforts, and particularly with respect to whether policy makers should focus more attention on alternative or complementary interventions.

Evidence from across Africa suggests that the success of LLINs and IRS in targeting species that primarily rest indoors has led to a change in patterns of transmission, with species that are more flexible in feeding and resting behaviours now more prominent vectors. For example, Anopheles gambiae sensu stricto ( s.s .) has been historically considered the major malaria vector in Africa [ 17 , 18 , 19 , 20 ]. However, the widespread use of LLINs and IRS has led to a significant decline of this species in many areas, shifting the majority of transmission to Anopheles arabiensis [ 21 , 22 , 23 , 24 ]. The result is an increase in transmission from outdoor biting, a mode of transmission that IRS and ITN do not target. In addition, key malaria vectors have increasingly become resistant to the insecticide used to treat bed nets and in IRS [ 25 , 26 , 27 ], presenting a further challenge to a malaria reduction strategy that is highly reliant on these two methods. Another concern is that despite the clear correlation between high malaria rates and low socio-economic status, with malaria disproportionately impacting the poor, it is not clear that the reasons for this are fully understood and incorporated into policy making and intervention design. In the recent Lancet commission, the focus on the role of poverty and interventions to address poverty-related risk was underwhelming [ 28 ], with attention primarily focused on the need for increased spending, political commitment and improved programme management [ 3 ]. Indeed, a recent review concluded that “no progress has been made in the analysis of social categories—territory, social class, gender, ethnic group, macroeconomic policies—or other socioeconomic characteristics that determine risk of illness or death from malaria” [ 29 ], emphasizing potential limitations in the way that malaria transmission is understood and thus the development of interventions that can potentially address distal factors.

The irregular uptake of the core malaria prevention interventions, combined with uneven progress, changing dynamics of vector transmission, and lack of focus on the social determinants of malaria transmission, casts doubt on whether increased funding and focus on the further rollout of LLINs and IRS, that is ‘more of the same’, will be sufficient to meet international goals regarding eradication, and highlights the importance of considering alternative interventions beyond these two methods. This scoping review, therefore, aimed at documenting the range of alternative interventions that have been implemented in the field to reduce malaria transmission, and to summarise the current state of evidence regarding the efficacy of these interventions, potential barriers, and the suitability of these interventions for widespread implementation in low- and middle-income countries (LMICs). The review also provides national, regional and global stakeholders with an expanded literature on promising interventions where more evidence is required, and an assessment of the extent to which the social determinants of malaria are addressed by these alternative interventions.

Search strategy

This literature search followed a scoping review methodology because there is limited published literature that evaluates malaria prevention methods that do not involve the use LLINs and IRS. Therefore, two key research questions guided the literature search:

What interventions that do not involve the use of LLINs and IRS have been used to reduce malaria transmission in LMICs?

How are these interventions are linked to the social determinants of malaria in those communities?

Published articles were searched through different databases such as PubMed, Cochrane Library, Sociological Abstracts and Google Scholar (Additional file 1 : Table S2). The search was limited to articles published in English. The key concepts used in the search included “novel/new approaches to malaria prevention”, “unconventional methods for malaria prevention”, “social determinants of malaria” and “low-and-middle income countries.” More articles were sought via a manual search of the references from the retrieved articles. Keywords of the key concepts were modified accordingly following the first search cycle to minimise any misunderstanding caused by their meanings when unaccompanied by the relevant key concepts. This was done to find articles on malaria prevention that do not involve LLINs and IRS. The key concepts were paired using Boolean operators. A separate search for each concept was conducted using keywords in the databases. They were (“malaria prevention”, OR “malaria control”, OR “malaria interventions”) AND “social-determinants” AND “low-and middle-income countries”. The results for each concept were paired using the “AND” operator to find articles focusing on all the key concepts. In addition, grey literature was searched aimed at finding relevant articles that were not published in commercial publication databases and targeting a limited audience [ 30 ]. This search enabled us to obtain articles from government and non-government organisations which funded or implemented malaria prevention initiatives in LMICs. Whilst, as noted above, Africa accounts for the majority of malaria cases, the literature search was expanded to include all low- and-middle-income countries (including Asia) to capture all possible interventions given that different countries and regions can learn from the experiences of others. The search produced articles which focused on the prevention of malaria while also addressing the social determinants of malaria.

Study selection criteria

Articles were included in this scoping review following the Population, Concept, Content (PCC) format [ 31 ]. Therefore, the articles had to meet all the three inclusion criteria below:

Population: They were conducted in a low- and middle- income country (LMIC).

Concept: They focused on malaria prevention interventions other than LLINs or IRS and considered the wider social determinants of malaria. These interventions included vector control, environmental management and personal protection.

Content: Published and unpublished articles including clinical trials, case–control studies, cross-sectional studies, and other epidemiological studies were included in this review. The interventions in the studies that were considered had that the following outcomes: they all had an effect or impact on the malaria burden in the community or field site, benefited the participants/community through improving their knowledge, attitude and practices of malaria prevention; led to reduction of malaria transmission in the community through directly or indirectly addressing the social determinants of malaria; and were affordable hence had the potential to be sustainable in low income settings. Affordability of an intervention was defined both as a measure of the available resources the intervention consumes, and also as a share of the resources left after spending on essential goods such as food [ 32 ]. An assessment of how the required resources could have influenced the use of a given malaria prevention intervention at household level was conducted. Studies with interventions that were assessed to be affordable using both measures were included in the scoping review.

Articles meeting the above criteria were included regardless of their publication year, methodology or scope. Articles which focused on interventions which were not primarily aimed at malaria prevention were excluded.

Data extraction and synthesis

Data extraction was conducted in five steps. First, the retrieved articles were screened using their titles and abstracts. The selected articles were further screened by reading full texts, then those that fully met the inclusion criteria were selected to be included in the review. Data from each included article was recorded on a data extraction form (Additional file 1 : Table S3). The recorded data included the first author, year of publication, area of study, methodology, study participants, intervention of focus, and major results. The synthesis of quantitative results consisted of extracting results and recommendations from similar studies and comparing them, depending on the context in which they were implemented. The data from qualitative studies was categorised and coded using Atlas.ti 8 [ 33 ] and a coding framework was developed for this study (Additional file 1 : Table S4). The resulting codes and their meaning units were thematically analysed to obtain emerging themes. All relevant results of were summarized in tabular form under the themes that emerged.

Methodological quality appraisal

Since the objective of this review was to scope and map existing literature on malaria prevention methods beyond LLINs and IRS, methodological quality or bias risk of the included articles was not assessed. This is consistent with guidance on conducting scoping reviews [ 34 ].

Replicability of the search

Although a rigorous plan was followed while conducting a comprehensive search for articles to include in this scoping review, claims of replicability of the results cannot be made. Although future studies may be able to replicate the search methods used in this review, it is very likely that their results would be different, which is common when searching electronic databases [ 30 ].

The initial search resulted in a total of 10,112 articles. After eliminating duplicates, the remaining 9744 articles were screened using their titles and abstracts among which 197 articles qualified and were further screened by reading the full articles. These articles were then subjected to the PCC inclusion criteria of which 23 were selected to be included in this scoping review. A manual search from the reference list of the selected articles resulted to an additional 8 articles hence 31 articles were reviewed (Fig.  1 ). Characteristics of the included studies are in Table 1 .

PRISMA flow diagram

The findings of this review present evidence on three categories of malaria prevention strategies: (1) Housing design focused on modification of eaves, ceilings and house screening; (2) Mosquito repellents related to spatial repellents, repellent plants and essential oils; and (30 Integrated vector control specifically larval source management and environmental management.

Improving of housing design

Since the majority of malaria transmission in LMICs occurs predominantly indoors [ 35 , 36 ], housing condition is an important risk factor for malaria transmission. Three studies [ 37 , 38 , 39 ] conducted in different malaria-endemic settings showed that improvement in the general housing design such as closing eaves and house screening results in reduction of indoor mosquito densities hence significant reductions in malaria transmission. This section presents on evidence on three aspects of housing design: modification of eaves; house screening; and ceilings.

Modification of eaves

Seven studies from four African countries were identified that focused on how the modification of eaves can reduce the rate of malaria transmission [ 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. Although there was a variation of the materials used to cover the eaves, all studies showed that partially or fully closing eaves reduced mosquito entry, hence indoor biting, by 4–12 times. All the experimental studies showed that modification of eaves reduced indoor biting rates by 77% to ≥ 99%. Four of the studies [ 42 , 44 , 45 , 46 ] showed that closing eaves with insecticide-treated inserts had the potential to protect neighbouring households which did not use the technology, hence reducing the need for individual or household compliance. Although eave modification alone may not be sufficient for malaria elimination, there is promising evidence supporting the intervention as a low-cost method that can be integrated in malaria prevention programmes especially in rural or resource-restricted communities [ 47 ].

House screening

Screening windows and doors is another house improvement method for which strong evidence exists as an effecting malaria prevention method. This method has been successfully used for many years to reduce mosquito bites hence malaria infections in various settings such as United States, Greece and Italy [ 48 ]. More recent studies in Africa have shown that full screening of windows and doors alone significantly reduced indoor mosquito densities; and provided valuable protection against malaria transmission in rural communities [ 49 , 50 , 51 ]. The strength of house screening is that it is a relatively cheap malaria prevention method since most screens usually last for a substantial period before they would require repair or replacement. Screening also does not depend as much on individual behaviour as interventions, such as LLINs.

In this review, a ceiling is defined as any overhead interior finished surface concealing the underside of the roof structure or the floor of a storey above. It can be made of various materials such as concrete, wood or papyrus. Presence of ceilings in houses has demonstrated to provide significant protection against mosquito entry, hence reduced indoor mosquito densities in sub-Saharan Africa [ 51 , 52 ]. It is important to consider this modification because less than half of houses in a typical urban area in a LMIC have ceilings [ 53 ], implying an even lower proportion in rural areas. Four studies conducted in East and West Africa showed that ceilings reduced mosquito entry, and this led to reduced risk of acquiring malaria [ 40 , 53 , 54 , 55 ]. The strength of ceilings is that it is associated with other desirable properties, such as cooler indoor temperatures and modern aesthetics [ 56 , 57 ]. This increases acceptability and willingness to pay despite the high installation costs [ 40 ]. In addition, using locally available materials such as papyrus and plywood to make ceilings as showed in [ 40 , 54 ] can greatly reduce the initial installation cost hence making it a relatively inexpensive method to be used alongside other malaria prevention measures.

Mosquito repellents

Although the majority of malaria transmission in LMICs occurs indoors, the increasing importance of outdoor transmission cannot be ignored. In order for malaria to be successfully eliminated from LMICs, both indoor and outdoor transmission needs to be addressed. Mosquito repellents are one of the novel strategies for malaria prevention that have the potential to target both indoor and outdoor malaria transmission. The following section presents and examines existing literature on mosquito repellents specifically spatial repellents, repellent plants and essential oils.

Spatial repellents

Spatial repellents for mosquito control are pyrethroids possessing sub-lethal properties such as repulsion, deterrence, feeding inhibition and reduction of fertility. Although these repellents may not kill the vectors, they decrease their malaria-transmission capacity. Spatial repellents are distinguished from LLINs and IRS insecticide formulations by having a lower dosage and their ability to vaporise at ambient temperatures [ 58 ]. Unlike LLINs and IRS, spatial repellents do not require surface contact with the vectors and can have an effect over large areas [ 59 ]. Spatial repellents are mainly incorporated in devices such as mosquito coils, liquid vaporizers, vaporizer mats and ambient emanators [ 60 ]. The use of spatial repellents as a vector control strategy has been supported due to its various advantages. First, spatial repellents have been found to protect people against both indoor and outdoor biting [ 61 , 62 ] and thus can be used to target outdoor transmission where LLINs and IRS may not be applicable. In addition, when used consistently and appropriately, spatial repellents do not require high levels of personal compliance and they protect both users and non-users [ 61 ]. The recent development of improved active ingredients in spatial repellents such as metofluthrin has increased the value of this strategy [ 63 ].

Evidence regarding the effectiveness and feasibility of spatial repellents originates from five studies conducted in Africa and Asia. Experimental studies conducted in Indonesia [ 64 ] and Tanzania [ 63 , 65 , 66 , 67 ] showed various rates of reduced indoor biting ranging from 89 to 100% when spatial repellents were used. The studies also recorded reductions in outdoor biting from 90 to 66%. The different studies incorporated spatial repellents in different devices such as locally-made decorative baskets, emanators, plastic strips, hessian strips and locally-made chairs. Studies [ 66 , 67 ] showed that spatial repellents were readily acceptable in the community and using local materials made them easy to scale as supplementary vector control interventions. The limitations associated with LLINs and IRS as vector control methods [ 23 ] have increased the attention towards use of repellents as a potential strategy to bridge the existing gaps [ 68 ]. Indeed, evidence has shown how spatial repellents can be creatively applied to low-cost home essentials commonly used in LMICs.

Repellent plants

Repellent plants are an economical method of repelling mosquitoes especially suitable for rural areas which may not afford commercial repellents or modern house screening methods. Some plants such as wild sage, lantana ( Lantana camara ); neem ( Azadirachta indica ); lemongrass ( Cymbopogon citratus ); and several of the Ocimum genus are used locally in many communities to repel mosquitoes [ 69 ]. The efficacy of repellent plants has been demonstrated by two studies. One study conducted in Tanzania showed that planting Lantana camara around homes significantly reduced indoor densities of Anopheles gambiae   s.s. by 56% and Anopheles funestus   s.s. by 83% [ 69 ]. Another study conducted in Kenya registered reductions in entry of of  An. gambiae  sensu lato ( s.l .) into houses by 22.7% [ 70 ].

Plant-based essential oils

Essential oils from Cymbopogon  grasses such as lemon grass have also been used as potent mosquito repellents. Studies from Asia and Central America have shown that essential oils from lemon grass can provide protection against mosquito bites by up to 95% [ 71 ]. Other plants from which repellent oils have been extracted include garlic ( Allium sativum ) and cinnamon ( Cinnamomum osmophloeum ), which have been shown to have insecticidal properties against larvae and adults of different mosquito species [ 72 ]. Although plant-based repellents are less effective than synthetic alternatives, they are more culturally acceptable in many community settings [ 73 ].

Mosquito repellents have not been formally integrated in the malaria control strategy in most countries [ 74 ]. However, evidence suggests that the different forms of mosquito repellents would be highly acceptable in communities if they were integrated into the formal integrated vector control strategy [ 75 ]. Mosquito repellents have the potential to become an important strategy for malaria vector control since outdoor malaria transmission is increasingly becoming important [ 76 ].

• Integrated vector management

Integrated vector management (IVM) involves the combination of a range of multiple interventions to control vector-borne diseases [ 77 ]. These methods include vector control measures which target adult mosquitoes, such as IRS [ 78 ], and environmental management measures, such as larval source management to eliminate the mosquito breeding sites; and personal protective measures such as window screening, LLINs and mosquito repellents [ 2 ]. Throughout history, programmes with an IVM approach have resulted in significant reductions in vector populations and malaria burden across different settings [ 79 , 80 , 81 ]. There is evidence that IVM can complement the existing core malaria prevention strategies (LLINs and IRS) by avoiding reliance on any single intervention to reduce the burden of malaria [ 82 , 83 , 84 ]. A report by Chanda and colleagues describes a highly successful IVM programme implemented in Zambia [ 85 ] which serves in various ways as an important success story in LMICs. However, progress of implementing IVM in developing countries is still slow, and some of the IVM strategies of larval source management and environmental management have been given little attention as malaria control tools.

Larval source management

Larval source management (LSM) involves the management of water bodies which can harbour the larval stage of mosquitoes to prevent the successful completion of their lifecycle. LSM was one of the major vector control interventions used in the USA, Canada and throughout Europe for over a century [ 86 , 87 , 88 ]. However, despite the extensive use and success of LSM in developed countries, it has been largely ignored as a core malaria control strategy in Africa and other LMICs over the past 50 years.

Recent studies have demonstrated that an increased global focus on LLINs and IRS has led to a significant decline in malaria vectors which rest and feed indoors in many LMICs, which has in turn increased the apparent importance of malaria vectors that rest and feed outdoors [ 24 , 89 , 90 ]. It is, therefore, essential to also explore interventions that target outdoor resting and biting malaria vectors if LMICs are to realise their target to eliminate malaria. In addition to addressing outdoor biting, the advantage of LSM is that it targets larvae which cannot escape from their breeding sites, and unlike adult vectors, cannot easily avoid control measures [ 22 ]. LSM could also have an important role in eradicating malaria in areas which are malaria 'hot spots', after the application of existing tools directed at indoor-feeding vectors. LSM has also been seen as more sustainable than the conventional vector control interventions because it can be implemented by local communities with no need for high recurrent costs [ 91 , 92 , 93 ]. This therefore develops local skills and adaptation, thus creating an opportunity for community empowerment for health control [ 94 ]. Although LSM cannot be implemented as a stand-alone intervention, it should be given more attention as an IVM tool.

Environmental management

Environmental management is another IVM strategy that involves seemly simple measures such as proper construction of drains, desilting drains, controlling vegetation cover, and ensuring proper solid waste and wastewater disposal. Such measures are aimed at good keeping of the environment, controlling flooding and water stagnation, thus minimizing the opportunities for breeding of vectors [ 95 , 96 ]. Education of communities about environmental management is also essential to facilitate community participation in such activities. Although environmental management was highly promoted in the control of malaria in developed countries [ 97 , 98 , 99 , 100 ], its importance in the control of malaria in Africa significantly reduced when emphasis shifted to LLINs and IRS [ 101 ].

Evidence has shown that reducing opportunities for mosquito breeding through environmental management is followed by a significant decrease in mosquito populations in the surrounding communities [ 102 , 103 , 104 , 105 ]. For example, a community participatory environmental management study conducted in Tanzania which consisted of drain cleaning activities resulted in a significant reduction in malaria infections [ 97 ]. Similar results were observed in an earlier environmental management study conducted in Nepal in which clearing vegetation and draining stagnant water led to a 35% reduction in malaria cases in the intervention communities [ 102 ]. As the malaria global strategy shifts from control to elimination, the success of both recent and earlier environmental management interventions has prompted the WHO to refocus on the strategy as one of the cost-effective and sustainable tools for malaria prevention [ 106 ].

Environmental management offers practical opportunities for sustainable malaria control in LMICs not on its own, but as part of an IVM approach [ 96 ]. Political will and commitment, community participation, sufficient initial financial resources, and multi-sectoral collaboration [ 107 ] are key for successful environmental management implementation. Environmental management is argued to be cost-effective, easy for communities to implement and maintain, and has minimal negative effects on humans or the environment [ 108 ]. Therefore, participatory environmental management, if strategically included in an IVM programme along with other strategies such as LLINs, could contribute to further reduction in the malaria burden.

This scoping review of 31 studies focused on methods of prevention of malaria beyond LLINs and IRS in LMICs. One of the objectives of the review was to consider how these interventions take in consideration the wider social determinants of health such as income, education and social norms in preventing malaria. The methods established in the review are: improving housing design; use of repellents; and IVM. As many endemic countries shift from malaria control to elimination, it is important to examine literature on malaria prevention beyond the core methods. The review found that such alternative malaria prevention methods have the potential to supplement LLINs and IRS, if given the attention they deserve. The evidence shows that methods such as improving housing design and IVM have been shown to be cost-effective, sustainable and socially acceptable in many communities if adapted to suit local contexts. There is also need for malaria prevention interventions to consider the social determinants of health which greater influence community practices. Considering the social determinants of health ensures that interventions do not solely rely on individual behaviour and characteristics to be successful. For example, minimising mosquito breeding sites will reduce mosquito populations hence malaria transmission in entire communities regardless of individual behaviour. Unfortunately, although evidence strongly links malaria with the social determinants of health [ 109 ] specifically poverty and its associated factors, the current major malaria prevention interventions have not fully considered this relationship. This situation, therefore, necessitates governments and other stakeholders at national and global levels to further explore the socio, economic, cultural, and other determinants that are likely to influence the uptake of various malaria prevention methods in endemic countries.

Housing is one component of the relationship between malaria and poverty that has been substantially studied in LMICs [ 41 , 43 , 48 ]. Several studies have shown that housing improvements not only significantly contribute to the reduction of malaria prevalence but also have additional benefits, such as indoor temperature regulation and aesthetic qualities, which increases community acceptability and cost effectiveness of this strategy [ 38 ]. Fortunately, the use of locally available building materials may be a low-cost solution for resource-restricted communities. The findings of this study concur with those in recent systematic review which showed that improving the social determinants of health including housing reduces the prevalence of malaria in LMICs [ 110 ]. While studies have provided the necessary evidence for refocusing on social interventions such as housing improvements [ 110 ], most of the research on such low-cost housing improvements has been done as pilots on a small-scale [ 53 ], leaving questions of how such interventions can be efficiently scaled-up. This calls for further research and more commitment to a larger-scale field trials to determine the cost-effectiveness of house improvement in various community settings in LMICs.

Spatial repellents are an important malaria prevention strategy that was found worth exploring. This is because outdoor transmission of malaria has become increasingly important, partly due to the change in the important mosquito species and/or their feeding behaviour in response to LLINs and IRS. In addition, recent studies have emphasized the role of social determinants of health especially livelihoods, such as fishing or farming carried out at night and socio-cultural activities such as funerals which expose people to mosquitoes while outdoors [ 111 , 112 , 113 ]. The increasing importance of outdoor malaria transmission in many communities is gradually rendering the available and scalable malaria control interventions insufficient for malaria elimination [ 43 ]. However, the interventions which target outdoor biting are currently under-explored in many malaria endemic communities. The evidence suggests that spatial repellents are flexible and can be creatively incorporated in local and socially acceptable items such as decorative baskets and chairs. More epidemiological and entomological research is needed on what drives the risk of malaria transmission outdoors and the relative risk of the different night outdoor social and livelihood activities. The feasibility, acceptability and sustainability of the different interventions regarding outdoor transmission of malaria should be further studied, as this is a significant gap in the literature.

This review has shown that there is emerging evidence that some local plants and their essential oils repel mosquitoes. Although the evidence is still limited, the available studies have shown promise that some plants locally available in different communities have the potential to repel mosquitoes on their own, or their essential oils could be used as natural, low-cost mosquito repellents and insecticides [ 114 ]. As further research is conducted to fully establish how plants with mosquito-repellent properties can be fully exploited, the large divide between a more community-based approach and the commercial approach of pharmaceutical companies should be bridged. Although it is established that mosquito resistance to a wide range of phyto-components in the mosquito repellent plants is rare, the commercial approach normally concentrates on one or two extracts of a given plant hence risking resistance [ 115 ]. Global malaria programmes should, therefore, encourage further research and subsequent implementation of natural and low-cost mosquito repellent plants and essential oils in the appropriate communities in LMICs.

There is strong evidence to suggest that environmental management and LSM are important interventions for outdoor biting [ 116 , 117 , 118 ] and are critical in the elimination of malaria in many countries. In addition, once effectively implemented and monitored, these interventions have many aspects that are more sustainable than the current conventional malaria prevention interventions [ 119 ]. Similar to the other malaria prevention interventions presented in this review, environmental management and LSM do not rely on individual or daily compliance to be successful. Environmental management also engages with the social determinants of health, placing focus on improving infrastructure and enhancing land management in poorer areas, interventions which will also likely have additional health-related benefits. It also engages with the geographies of malaria and poverty, acknowledging that increased risk of malaria is related to where one lives, and that spatial and social distributions of malaria may overlap [ 96 ]. However, for a number of reasons these interventions have been under-emphasized and, therefore, underused in malaria programming for LMICs. For example, many LMICs still lack local capacity to implement and monitor such context-specific and relatively long-term environmental management interventions [ 120 ]. There is urgent need to re-incorporate these interventions as key components of the IVM strategy. The inclusion of environmental management and LSM in the Global Malaria Action Plan of the Roll Back Malaria Partnership [ 121 ] promises renewed interest in these interventions as many LMICs countries move towards malaria elimination. Programmatic implementation and assessment of locally appropriate systems for delivering these environmental management interventions that target outdoor control of mosquitoes in LMICs are therefore necessary for the further reduction of malaria in LMICs.

It is worth noting that many of the none-core methods explored in this scoping review require little or no individual behaviour change, an issue that much of the literature concerning the use of LLINs and ITNs has attempted to unpack. When considering the social determinants of health, this helps to shift focus away from stigmatising research that focuses on why poorer populations may make ‘worse’ health-related decisions. However, some of the alternative interventions noted in this review are more holistic and can be more difficult to implement, monitor and evaluate because they require bottom-up approaches to communities. As a result, these interventions may require greater political commitment, multi-sectoral collaboration and longer implementation periods. Such complexities may be the reason why interventions such as LSM and environmental management have lost the interest of governments and donors in favour of biomedical and top-down approaches that are easier to quantify, monitor and evaluate [ 109 ]. Further progress in malaria control may require malaria control programmes to devise means of incorporating these various community centred but effective strategies instead of avoiding them.

This scoping review found promising evidence on improving housing design, use of mosquito repellents, and integrated vector control to contribute to malaria prevention efforts in LMICs. Furthermore, the social determinants of malaria transmission need to be addressed in order to tackle the bold vision of global eradication. These include poor housing conditions that expose communities to mosquitoes, and poverty that limits communities’ ability to take-up and sustain malaria control measures. There is also need for governments, academia and other stakeholders to strengthen malaria research to lead into sustainable interventions. As the ‘one size fits all’ approach to malaria prevention has shown to be insufficient in LMICs, country-specific and well-coordinated integrated malaria prevention approaches need to be adopted to make significant progress towards malaria elimination and subsequently global eradication.

Availability of data and materials

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Abbreviations

Indoor residual spraying

Insecticide-treated mosquito nets

Long-lasting insecticidal nets

Low- and middle-income country

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Acknowledgements

We acknowledge all partners who have supported our malaria research in Uganda in recent years.

The study was funded through the Queen Mary University of London, Global Engagement Research Initiation Scheme 2019–20.

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KD and DM conceived of the study. SN conducted the initial review with the support of DM and KD. SN, DM and KD were involved in writing the manuscript. All authors read and approved the final manuscript.

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Summary of databases searched, data extraction template and coding framework of the study.

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Nalinya, S., Musoke, D. & Deane, K. Malaria prevention interventions beyond long-lasting insecticidal nets and indoor residual spraying in low- and middle-income countries: a scoping review. Malar J 21 , 31 (2022). https://doi.org/10.1186/s12936-022-04052-6

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Reviewing literature for research: Doing it the right way

Shital amin poojary.

Department of Dermatology, K J Somaiya Medical College, Mumbai, Maharashtra, India

Jimish Deepak Bagadia

In an era of information overload, it is important to know how to obtain the required information and also to ensure that it is reliable information. Hence, it is essential to understand how to perform a systematic literature search. This article focuses on reliable literature sources and how to make optimum use of these in dermatology and venereology.

INTRODUCTION

A thorough review of literature is not only essential for selecting research topics, but also enables the right applicability of a research project. Most importantly, a good literature search is the cornerstone of practice of evidence based medicine. Today, everything is available at the click of a mouse or at the tip of the fingertips (or the stylus). Google is often the Go-To search website, the supposed answer to all questions in the universe. However, the deluge of information available comes with its own set of problems; how much of it is actually reliable information? How much are the search results that the search string threw up actually relevant? Did we actually find what we were looking for? Lack of a systematic approach can lead to a literature review ending up as a time-consuming and at times frustrating process. Hence, whether it is for research projects, theses/dissertations, case studies/reports or mere wish to obtain information; knowing where to look, and more importantly, how to look, is of prime importance today.

Literature search

Fink has defined research literature review as a “systematic, explicit and reproducible method for identifying, evaluating, and synthesizing the existing body of completed and recorded work produced by researchers, scholars and practitioners.”[ 1 ]

Review of research literature can be summarized into a seven step process: (i) Selecting research questions/purpose of the literature review (ii) Selecting your sources (iii) Choosing search terms (iv) Running your search (v) Applying practical screening criteria (vi) Applying methodological screening criteria/quality appraisal (vii) Synthesizing the results.[ 1 ]

This article will primarily concentrate on refining techniques of literature search.

Sources for literature search are enumerated in Table 1 .

Sources for literature search

PubMed is currently the most widely used among these as it contains over 23 million citations for biomedical literature and has been made available free by National Center for Biotechnology Information (NCBI), U.S. National Library of Medicine. However, the availability of free full text articles depends on the sources. Use of options such as advanced search, medical subject headings (MeSH) terms, free full text, PubMed tutorials, and single citation matcher makes the database extremely user-friendly [ Figure 1 ]. It can also be accessed on the go through mobiles using “PubMed Mobile.” One can also create own account in NCBI to save searches and to use certain PubMed tools.

PubMed home page showing location of different tools which can be used for an efficient literature search

Tips for efficient use of PubMed search:[ 2 , 3 , 4 ]

Use of field and Boolean operators

When one searches using key words, all articles containing the words show up, many of which may not be related to the topic. Hence, the use of operators while searching makes the search more specific and less cumbersome. Operators are of two types: Field operators and Boolean operators, the latter enabling us to combine more than one concept, thereby making the search highly accurate. A few key operators that can be used in PubMed are shown in Tables ​ Tables2 2 and ​ and3 3 and illustrated in Figures ​ Figures2 2 and ​ and3 3 .

Field operators used in PubMed search

Boolean operators used in PubMed search

PubMed search results page showing articles on donovanosis using the field operator [TIAB]; it shows all articles which have the keyword “donovanosis” in either title or abstract of the article

PubMed search using Boolean operators ‘AND’, ‘NOT’; To search for articles on treatment of lepra reaction other than steroids, after clicking the option ‘Advanced search’ on the home page, one can build the search using ‘AND’ option for treatment and ‘NOT’ option for steroids to omit articles on steroid treatment in lepra reaction

Use of medical subject headings terms

These are very specific and standardized terms used by indexers to describe every article in PubMed and are added to the record of every article. A search using MeSH will show all articles about the topic (or keywords), but will not show articles only containing these keywords (these articles may be about an entirely different topic, but still may contain your keywords in another context in any part of the article). This will make your search more specific. Within the topic, specific subheadings can be added to the search builder to refine your search [ Figure 4 ]. For example, MeSH terms for treatment are therapy and therapeutics.

PubMed search using medical subject headings (MeSH) terms for management of gonorrhea. Click on MeSH database ( Figure 1 ) →In the MeSH search box type gonorrhea and click search. Under the MeSH term gonorrhea, there will be a list of subheadings; therapy, prevention and control, click the relevant check boxes and add to search builder →Click on search →All articles on therapy, prevention and control of gonorrhea will be displayed. Below the subheadings, there are two options: (1) Restrict to medical subject headings (MeSH) major topic and (2) do not include MeSH terms found below this term in the MeSH hierarchy. These can be used to further refine the search results so that only articles which are majorly about treatment of gonorrhea will be displayed

Two additional options can be used to further refine MeSH searches. These are located below the subheadings for a MeSH term: (1) Restrict to MeSH major topic; checking this box will retrieve articles which are majorly about the search term and are therefore, more focused and (2) Do not include MeSH terms found below this term in the MeSH hierarchy. This option will again give you more focused articles as it excludes the lower specific terms [ Figure 4 ].

Similar feature is available with Cochrane library (also called MeSH), EMBASE (known as EMTREE) and PsycINFO (Thesaurus of Psychological Index Terms).

Saving your searches

Any search that one has performed can be saved by using the ‘Send to’ option and can be saved as a simple word file [ Figure 5 ]. Alternatively, the ‘Save Search’ button (just below the search box) can be used. However, it is essential to set up an NCBI account and log in to NCBI for this. One can even choose to have E-mail updates of new articles in the topic of interest.

Saving PubMed searches. A simple option is to click on the dropdown box next to ‘Send to’ option and then choose among the options. It can be saved as a text or word file by choosing ‘File’ option. Another option is the “Save search” option below the search box but this will require logging into your National Center for Biotechnology Information account. This however allows you to set up alerts for E-mail updates for new articles

Single citation matcher

This is another important tool that helps to find the genuine original source of a particular research work (when few details are known about the title/author/publication date/place/journal) and cite the reference in the most correct manner [ Figure 6 ].

Single citation matcher: Click on “Single citation matcher” on PubMed Home page. Type available details of the required reference in the boxes to get the required citation

Full text articles

In any search clicking on the link “free full text” (if present) gives you free access to the article. In some instances, though the published article may not be available free, the author manuscript may be available free of charge. Furthermore, PubMed Central articles are available free of charge.

Managing filters

Filters can be used to refine a search according to type of article required or subjects of research. One can specify the type of article required such as clinical trial, reviews, free full text; these options are available on a typical search results page. Further specialized filters are available under “manage filters:” e.g., articles confined to certain age groups (properties option), “Links” to other databases, article specific to particular journals, etc. However, one needs to have an NCBI account and log in to access this option [ Figure 7 ].

Managing filters. Simple filters are available on the ‘search results’ page. One can choose type of article, e.g., clinical trial, reviews etc. Further options are available in the “Manage filters” option, but this requires logging into National Center for Biotechnology Information account

The Cochrane library

Although reviews are available in PubMed, for systematic reviews and meta-analysis, Cochrane library is a much better resource. The Cochrane library is a collection of full length systematic reviews, which can be accessed for free in India, thanks to Indian Council of Medical Research renewing the license up to 2016, benefitting users all over India. It is immensely helpful in finding detailed high quality research work done in a particular field/topic [ Figure 8 ].

Cochrane library is a useful resource for reliable, systematic reviews. One can choose the type of reviews required, including trials

An important tool that must be used while searching for research work is screening. Screening helps to improve the accuracy of search results. It is of two types: (1) Practical: To identify a broad range of potentially useful studies. Examples: Date of publication (last 5 years only; gives you most recent updates), participants or subjects (humans above 18 years), publication language (English only) (2) methodological: To identify best available studies (for example, excluding studies not involving control group or studies with only randomized control trials).

Selecting the right quality of literature is the key to successful research literature review. The quality can be estimated by what is known as “The Evidence Pyramid.” The level of evidence of references obtained from the aforementioned search tools are depicted in Figure 9 . Systematic reviews obtained from Cochrane library constitute level 1 evidence.

Evidence pyramid: Depicting the level of evidence of references obtained from the aforementioned search tools

Thus, a systematic literature review can help not only in setting up the basis of a good research with optimal use of available information, but also in practice of evidence-based medicine.

Source of Support: Nil.

Conflict of Interest: None declared.

• Open access
• Published: 15 April 2024

Implementing spiritual care education into the teaching of palliative medicine: an outcome evaluation

• Yann-Nicolas Batzler 1 ,
• Nicola Stricker 2 , 3 ,
• Simone Bakus 4 ,
• Manuela Schallenburger 1 , 6 ,
• Jacqueline Schwartz 1 &
• Martin Neukirchen 1 , 5  

BMC Medical Education volume  24 , Article number:  411 ( 2024 ) Cite this article

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Metrics details

The concept of “total pain” plays an important role in palliative care; it means that pain is not solely experienced on a physical level, but also within a psychological, social and spiritual dimension. Understanding what spirituality entails, however, is a challenge for health care professionals, as is screening for the spiritual needs of patients.

This is a novel, interprofessional approach in teaching undergraduate medical students about spiritual care in the format of a seminar. The aim of this study is to assess if an increase in knowledge about spiritual care in the clinical context is achievable with this format.

In a mandatory seminar within the palliative care curriculum at our university, both a physician and a hospital chaplain teach strategies in symptom control from different perspectives (somatic domain – spiritual domain). For evaluation purposes of the content taught on the spiritual domain, we conducted a questionnaire consisting of two parts: specific outcome evaluation making use of the comparative self-assessment (CSA) gain and overall perception of the seminar using Likert scale.

In total, 52 students participated. Regarding specific outcome evaluation, the greatest gain was achieved in the ability to define total pain (84.8%) and in realizing its relevance in clinical settings (77.4%). The lowest, but still fairly high improvement was achieved in the ability to identify patients who might benefit from spiritual counselling (60.9%). The learning benefits were all significant as confirmed by confidence intervals. Overall, students were satisfied with the structure of the seminar. The content was delivered clearly and comprehensibly reaching a mean score of 4.3 on Likert scale (4 = agree). The content was perceived as overall relevant to the later work in medicine (mean 4.3). Most students do not opt for a seminar solely revolving around spiritual care (mean 2.6).

Conclusions

We conclude that implementing spiritual care education following an interprofessional approach into existing medical curricula, e.g. palliative medicine, is feasible and well perceived among medical students. Students do not wish for a seminar which solely revolves around spiritual care but prefer a close link to clinical practice and strategies.

Peer Review reports

Introduction

Education in palliative care was introduced in 2009 as a compulsory subject in German medical curricula. In the 1960s, Dame Cicely Saunders established palliative medicine and hospices as we know them today. Back then, Cicely Saunders propagated the concept of “total pain”, which means that pain or suffering in general is not solely experienced on a physical level, but also within a psychological, social and spiritual dimension (see. Fig.  1 ) [ 1 , 2 , 3 , 4 ]. Understanding the importance of spirituality in everyday clinical practice and what it entails, however, is a challenge for health care professionals (HCP) in all medical disciplines across the world [ 5 , 6 ]. Palliative care is a relatively young medical discipline which oftentimes is not sufficiently taught in medical curricula [ 1 , 7 ] and, therefore, knowledge regarding the importance of spirituality, which at many faculties is integrated into palliative care education, is scarce [ 1 , 7 ]. As a result, HCP tend to neglect the spiritual needs of patients [ 7 , 8 ]. But, if there is no fundamental knowledge in regards of spirituality and spiritual care among physicians, how can they target total pain adequately?

The European Association of palliative care (EAPC) describes spirituality as following:

“Spirituality is the dynamic dimension of human life that relates to the way persons (individual and community) experience, express and/or seek meaning, purpose and transcendence, and the way they connect to the moment, to self, to others, to nature, to the significant and/or the sacred.” [ 1 , 9 ].

It must be clear to all HCP that spirituality is a unique and subjective phenomenon that differs substantially from patient to patient [ 2 , 10 ]. Furthermore, to fully address the spiritual needs of patients, self-reflection, thorough consideration of one’s own attitude towards death, and finding meaning in life, are essential [ 8 , 9 ]. Several studies have shown the impact which the addressing of spiritual needs in the context of total pain can have on ameliorating the symptoms of patients, leading to a better quality of life and care [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Thus, once spiritual needs become imminent, it is necessary to engage in an interdisciplinary and multi-professional collaboration with specially trained professionals in the field of spiritual care [ 8 , 10 , 14 , 15 , 19 ]. Summing up, it is very important to raise awareness about the positive impact of spiritual care among HCPs [ 8 , 15 ]. To increase such knowledge and accrue such skills, the teaching of spiritual care in medical curricula is essential [ 20 ]. Throughout different regions in the world, in-person didactic teaching on spiritual care is the most commonly used technique [ 5 ]. Usually, the teaching is based on case studies and many include screening strategies assessing spiritual needs [ 5 ]. Often, education on spirituality and spiritual care is part of curricula in palliative care [ 5 , 21 ]. In German medical curricula, there is no compulsory subject solely revolving around spiritual care [ 22 ]. However, regarding the concept of total pain, implementing spiritual care into palliative care teaching, however, seems like a plausible proposition.

This study was conducted in order to assess the way medical students perceive the concept of implementing spiritual care into the teaching on symptom control in palliative care. Furthermore, we aimed to determine whether an actual increase of knowledge about spiritual care in the clinical context was achievable within this seminar.

Material and methods

This study is a single-centre prospective study conducted at University Hospital Duesseldorf, Germany. Ethical approval was obtained by the local ethics committee (reference number 2022–2274).

Curricular structure

At our facility, palliative care education is structured as followed: Five lectures (somatic symptoms, psychological symptoms, social symptoms and advance care planning, spiritual symptoms and end-of-life care and care for relatives, clinical ethics) and four seminars (symptom control, breaking bad news, clinical ethics I and II). Since 2022, the lecture on spiritual symptoms and end-of-life-care is held by both a physician and a hospital chaplain within the palliative care curriculum at Düsseldorf medical faculty. Beforehand, this lecture was solely held by a hospital chaplain. As internal evaluations implied, this concept was not well perceived by medical students as the relevance to daily clinical work was not apparent to them. They did not understand how spiritual care can support somatic strategies of symptom control and how both approaches are intertwined. Furthermore, they were unsure of how to assess patients’ spiritual needs. We therefore opted for the above-mentioned approach which allows lecturing relevant medical implications alongside spiritual care. As evaluations showed, this embeds spiritual care in a more clinical and tangible manner and students seem to better realize the relevance that spiritual care has in daily clinical practice. For example, students repeatedly stated that they were now able to understand the importance of ongoing collaborations for patients’ comfort care, e.g., in more sufficiently relieving anxiety or social distress.

Since this novel concept was perceived positively by medical students, we transposed it to our seminar titled “symptom control” which is now also held by a hospital chaplain and a physician. In the seminars, content from the lectures is further deepened and there is more room for discussions, e.g. concerning assessment of spiritual needs, possibilities of spiritual care, and inter-professional collaboration. There is also an emphasis on determining which patients might benefit from spiritual care making use of the SPIR tool (patient’s self-description as a S piritual person— P lace of spirituality in patient’s life – patient’s I ntegration in a spiritual community – R ole of health care professional in the domain of spirituality), which tackles different dimensions of spirituality [ 23 ].

In the seminar, a 33-year-old fictitious patient (inspired by a real patient) served as an example case. Her situation is used to address strategies for symptom control on both somatic and spiritual domains. To achieve this, a reflective question is discussed with the students followed by a joint development of possible therapeutic strategies on both the somatic and spiritual domain (see Fig.  2 ).

Case discussion in the seminar

Our approach can be described as novel, since training in spiritual care often involves the mere shadowing of chaplains [ 5 , 24 , 25 , 26 ]. An interprofessional, educational approach was mainly used with physicians or nurses in training [ 5 , 27 , 28 , 29 ], but not with medical students.

Evaluation methods

A structured, paper-based questionnaire was developed in repeated interdisciplinary and multi-professional discussions in the Interdisciplinary Centre for Palliative Care Medicine, University Hospital Düsseldorf, Germany. The basis for the questionnaire were the learning goals that are to be achieved within the seminar, as well as a didactic evaluation. The questionnaire was pretested among medical students, and unclear statements were altered. The questionnaire consists of two parts. The first part is made up of five statements regarding knowledge about total pain, assessing spiritual needs, and defining spiritual care (see Table  1 ) on both the knowledge and skills level. These statements cover the field of specific outcome evaluation. Making use of the comparative self-assessment (CSA) method to determine if a gain in knowledge was achieved, each student evaluated their knowledge before and after the seminar using the German school grading system (1 = “excellent” to 6 = “unsatisfactory”). The CSA gain is a well described and implemented method in evaluating actual knowledge gains in education [ 30 , 31 , 32 , 33 , 34 ]. This evaluation tool has the benefit of not taking into account experiences made beforehand as they are not contributing to the effect size [ 31 ]. CSA gain is calculated as followed:

Furthermore, CSA gain was calculated with a 95% confidence interval and standard error using individual learning gain (ILG) values. These values were calculated using the following formulas:

ILG = 0 if pre = post and

ILG = (pre − post)/(pre − 1) × 100 if pre > post [ 31 ].

The second part of the questionnaire consists of four questions regarding the perception of the seminar (structure, teaching spiritual care alongside symptom control in palliative care). A 5-Point-Likert scale was used for evaluation (1 = strongly disagree, 2 = disagree, 3 = neither, 4 = agree, 5 = strongly agree).

Study participation and analysis

Participation in the study was anonymous, voluntary, and could be withdrawn at any time without explanation. Eligible participants were undergraduate medical students at the beginning of their fifth year of medical education (Germany: total of min. six years), who completed the mandatory palliative care course. The purpose and content of the study were presented orally, and, furthermore, written information and consent documents were handed out. After completion of the seminar, the questionnaire was handed out making use of a post-then design in which the students were asked to retrospectively rate their knowledge before and after the seminar. There were no exclusion criteria other than refusing to participate. Due to the small number of students per seminar ( n  = 15–20), no demographic characteristics besides sex were assessed.

Data analysis was performed using Microsoft Excel 2020 (version 16.42, Microsoft Corp., Redmond, WA, USA) and IBM SPSS Statistic version 28.0.1.1 (IBM, Armonk, NY, USA).

Throughout the course of one semester in 2023, the questionnaires were rolled out in each of six separate seminars. Out of 108 eligible attending students, 52 students participated in total (48.1%). 25% ( n  = 13) of the participants were of female, 75% ( n  = 39) of male sex. Within the answered questionnaires, there was no missing data.

Regarding the specific outcome evaluation, CSA gains showed a relevant increase especially in the field of knowledge (see Table  2 and Fig.  3 ). The greatest improvement (84.8%) was achieved in the ability of defining total pain and realizing its importance in clinical settings (77.4%). After the seminar, medical students were increasingly able to name tools such as SPIR in order to engage in spiritual needs assessment (CSA gain 68,8%). A lower increase in knowledge was achieved in realizing how spiritual care itself can benefit patients’ needs (66.7%). The lowest gain was detected in actually identifying patients who might benefit from spiritual care (60.9%), which represents a skill to be learned rather than knowledge to be gained.

CSA gains for each item

Statistical analysis using 95% confidence intervals confirmed the gains in knowledge, which were significant for all items (Table  2 ).

In regard to the second part of the questionnaire, students were overall satisfied with the new structure of the seminar (Table  3 and Fig.  4 ). The content was comprehensible and delivered clearly gaining a mean score of 4.3 (median 4, SD 0.6, min. 2, max. 5). The content was perceived as overall relevant to the later work in medicine (mean 4.3, median 4, SD 0.6, min. 3, max. 5). It seems as if medical students regard the implementation of spiritual care education into the seminar “symptom control”, which focuses on alleviating symptoms on multidimensional levels, as expedient. They feel that implementing education on spiritual care into this seminar makes sense (mean 4.2, median 4, SD 0.8, min. 1, max. 5). Furthermore, most students do not opt for a seminar solely revolving around spiritual care (mean 2.6, median 2, SD 1.3, min. 1, max. 5).

Perception of the seminar, Likert scale (1 = strongly disagree, 2 = disagree, 3 = neither, 4 = agree, 5 = strongly agree)

Our data show that implementing spiritual care education into existing medical curricula, in our example palliative care, is feasible and well perceived among medical students. The timing of our seminar is in accordance to other studies that found that spiritual care should be implemented in mandatory undergraduate courses [ 6 ]. Students do not wish for a seminar solely revolving around spiritual care but prefer a connection to clinical practice and strategies in symptom management. This enables them to understand the relevance of spiritual care in a daily clinical setting.

To evaluate training programs, Kirkpatrick proposed a four-level approach (level 1: reaction, level 2: learning, level 3: behaviour, level 4: results) [ 35 ]. We followed levels 1 (reaction—satisfaction) and 2 (learning—gains in knowledge) making use of the conducted questionnaire. Level 3 (change in behaviour – acquired skills) was briefly addressed with item 5 in the first part of the questionnaire. As level 4 is an indicator of direct results of the training at an organizational level, we were not able to incorporate items on this level. A different study among undergraduate nursing students assessed the effectiveness of teaching spiritual care in mandatory classes: There was an increase in knowledge, e.g., in defining spirituality, compared to students who obtained no information on spiritual care [ 36 ]. This is comparable to our study, as there were gains in knowledge after completing the mandatory seminar. We reached higher individual learning gains on the knowledge level than on the skills level, as was also the case in a number of other studies we conducted [ 31 ]. This is mainly because, due to the format of the seminar, no bedside teaching takes place and scenarios that might occur in everyday clinical practice can only be discussed and serve as examples.

The concept of total pain is essential in palliative care; however, it should not only be taken into consideration in a palliative setting, but whenever patients experience high burdens on various dimensions such as pain, anxiety, grief or existential distress [ 2 , 4 , 17 , 37 , 38 ]. We were able to thoroughly educate students on total pain and its relevance in clinical settings. Spirituality plays an important role in a holistic approach. However, literature shows that HCP often don’t know how to implement spiritual assessments and how to deal with spiritual needs [ 1 , 5 , 6 , 8 ]. A systematic review on teaching methods found the usage of practical tools and the involvement of chaplains to be effective facilitators in the teaching of spiritual care [ 5 ]. A scoping review found that spiritual care should be taught in both mono- and multi-disciplinary educational settings [ 6 ]. With our multi-professional approach, we were able to introduce students to tools in assessing spiritual needs, such as SPIR [ 23 ]. Within this item, there was a definite gain in knowledge of these tools which make assessing spiritual needs of patients more feasible. This is in accordance with findings of a number other studies [ 5 ]. In our study, however, students are still unsure if they are fully able to determine which patients might actually benefit from spiritual care, even though this item still reached a learning gain of 60.9%. As concluded by other authors, there is need for ongoing education [ 5 ].

Even though our seminar entails many different aspects of the total pain concept (somatic symptom management, spirituality, and spiritual care) medical students found the content to be clearly structured and comprehensible. More importantly, they understood the relevance of spirituality for their future clinical work and perceived the multi-professional teaching as highly satisfactory. In sensitizing them in this, we hope that they keep in mind the importance of ongoing collaborations between different professions.

Our study has some limitations. Even though the questionnaire was pretested among medical students before the actual study, no validated questionnaire was used. The response rate of almost 50% is relatively low and it can be assumed that those who participated were mostly students who were interested in the topic. This might have led to bias as positive effects might have been overestimated. Due to the small study population and to protect the privacy of participating students, no demographic data besides sex was collected. Demographic data, however, might contribute to a better understanding of spirituality or palliative medicine beforehand such as age, professional expertise, or own spiritual resources. This also meant that adjusting for confounding factors was not possible. This study solely dealt with medical students and no patients were involved. It would be of interest to assess as to whether the content taught in this seminar ultimately impacts the wellbeing or stress levels of patients in everyday clinical practice. A study focusing on patients would complement the findings of this study, as suggested by other researchers [ 5 ]. Furthermore, the study was only performed in one centre; therefore, it can only serve as an example on how spiritual care education might be successfully implemented into medical curricula.

Spirituality plays an important role for many people and should always be taken into consideration when treating patients. This especially applies to palliative care where the addressing of spiritual needs is of crucial importance [ 18 ]. However, many HCP don’t know how to address topics revolving around spirituality which makes it hard to determine which patients might benefit from spiritual care. Therefore, education on the nature of spiritual care, on what it entails and on how it can support patients in everyday clinical practice should be thoroughly integrated into medical curricula. We opted to implement spirituality and spiritual care into an existing seminar and lecture within the medical curriculum at our faculty. This was well received among students. As a result, we found a clear increase in knowledge about total pain and about the tools one might use to assess spiritual needs. This knowledge needs to be further strengthened in practical clinical scenarios.

Availability of data and materials

All data and materials are available within this publication.

Abbreviations

Health care professional

European Association of palliative care

• Spiritual care

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We thank Dr Jessica JT Fischer for excellent English language editing.

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YB, NS, MS, JS, MN designed the study. YB analysed and interpreted the data. YB drafted the first version of the manuscript, which was critically revised by NS, MS, JS, and MN in several rounds of feedback. All authors have approved the submitted version and have agreed to be accountable for their contributions as well as for accuracy and integrity for any part of the work.

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Ethical approval was obtained from the Ethics Committee of Heinrich-Heine-University Düsseldorf (Study No. 2022–2274). Written informed consent was obtained from all participants, which were all over 18 years and informed about the study before starting the questionnaire. Researchers assured participants that the contents of the surveys would be used solely for research purposes.

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Batzler, YN., Stricker, N., Bakus, S. et al. Implementing spiritual care education into the teaching of palliative medicine: an outcome evaluation. BMC Med Educ 24 , 411 (2024). https://doi.org/10.1186/s12909-024-05415-0

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DOI : https://doi.org/10.1186/s12909-024-05415-0

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