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• Volume 24, Issue 2
• Five tips for developing useful literature summary tables for writing review articles
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• http://orcid.org/0000-0003-0157-5319 Ahtisham Younas 1 , 2 ,
• http://orcid.org/0000-0002-7839-8130 Parveen Ali 3 , 4
• 1 Memorial University of Newfoundland , St John's , Newfoundland , Canada
• 2 Swat College of Nursing , Pakistan
• 3 School of Nursing and Midwifery , University of Sheffield , Sheffield , South Yorkshire , UK
• 4 Sheffield University Interpersonal Violence Research Group , Sheffield University , Sheffield , UK
• Correspondence to Ahtisham Younas, Memorial University of Newfoundland, St John's, NL A1C 5C4, Canada; ay6133{at}mun.ca

https://doi.org/10.1136/ebnurs-2021-103417

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Introduction

Literature reviews offer a critical synthesis of empirical and theoretical literature to assess the strength of evidence, develop guidelines for practice and policymaking, and identify areas for future research. 1 It is often essential and usually the first task in any research endeavour, particularly in masters or doctoral level education. For effective data extraction and rigorous synthesis in reviews, the use of literature summary tables is of utmost importance. A literature summary table provides a synopsis of an included article. It succinctly presents its purpose, methods, findings and other relevant information pertinent to the review. The aim of developing these literature summary tables is to provide the reader with the information at one glance. Since there are multiple types of reviews (eg, systematic, integrative, scoping, critical and mixed methods) with distinct purposes and techniques, 2 there could be various approaches for developing literature summary tables making it a complex task specialty for the novice researchers or reviewers. Here, we offer five tips for authors of the review articles, relevant to all types of reviews, for creating useful and relevant literature summary tables. We also provide examples from our published reviews to illustrate how useful literature summary tables can be developed and what sort of information should be provided.

Tip 1: provide detailed information about frameworks and methods

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Tabular literature summaries from a scoping review. Source: Rasheed et al . 3

The provision of information about conceptual and theoretical frameworks and methods is useful for several reasons. First, in quantitative (reviews synthesising the results of quantitative studies) and mixed reviews (reviews synthesising the results of both qualitative and quantitative studies to address a mixed review question), it allows the readers to assess the congruence of the core findings and methods with the adapted framework and tested assumptions. In qualitative reviews (reviews synthesising results of qualitative studies), this information is beneficial for readers to recognise the underlying philosophical and paradigmatic stance of the authors of the included articles. For example, imagine the authors of an article, included in a review, used phenomenological inquiry for their research. In that case, the review authors and the readers of the review need to know what kind of (transcendental or hermeneutic) philosophical stance guided the inquiry. Review authors should, therefore, include the philosophical stance in their literature summary for the particular article. Second, information about frameworks and methods enables review authors and readers to judge the quality of the research, which allows for discerning the strengths and limitations of the article. For example, if authors of an included article intended to develop a new scale and test its psychometric properties. To achieve this aim, they used a convenience sample of 150 participants and performed exploratory (EFA) and confirmatory factor analysis (CFA) on the same sample. Such an approach would indicate a flawed methodology because EFA and CFA should not be conducted on the same sample. The review authors must include this information in their summary table. Omitting this information from a summary could lead to the inclusion of a flawed article in the review, thereby jeopardising the review’s rigour.

Tip 2: include strengths and limitations for each article

Critical appraisal of individual articles included in a review is crucial for increasing the rigour of the review. Despite using various templates for critical appraisal, authors often do not provide detailed information about each reviewed article’s strengths and limitations. Merely noting the quality score based on standardised critical appraisal templates is not adequate because the readers should be able to identify the reasons for assigning a weak or moderate rating. Many recent critical appraisal checklists (eg, Mixed Methods Appraisal Tool) discourage review authors from assigning a quality score and recommend noting the main strengths and limitations of included studies. It is also vital that methodological and conceptual limitations and strengths of the articles included in the review are provided because not all review articles include empirical research papers. Rather some review synthesises the theoretical aspects of articles. Providing information about conceptual limitations is also important for readers to judge the quality of foundations of the research. For example, if you included a mixed-methods study in the review, reporting the methodological and conceptual limitations about ‘integration’ is critical for evaluating the study’s strength. Suppose the authors only collected qualitative and quantitative data and did not state the intent and timing of integration. In that case, the strength of the study is weak. Integration only occurred at the levels of data collection. However, integration may not have occurred at the analysis, interpretation and reporting levels.

Tip 3: write conceptual contribution of each reviewed article

While reading and evaluating review papers, we have observed that many review authors only provide core results of the article included in a review and do not explain the conceptual contribution offered by the included article. We refer to conceptual contribution as a description of how the article’s key results contribute towards the development of potential codes, themes or subthemes, or emerging patterns that are reported as the review findings. For example, the authors of a review article noted that one of the research articles included in their review demonstrated the usefulness of case studies and reflective logs as strategies for fostering compassion in nursing students. The conceptual contribution of this research article could be that experiential learning is one way to teach compassion to nursing students, as supported by case studies and reflective logs. This conceptual contribution of the article should be mentioned in the literature summary table. Delineating each reviewed article’s conceptual contribution is particularly beneficial in qualitative reviews, mixed-methods reviews, and critical reviews that often focus on developing models and describing or explaining various phenomena. Figure 2 offers an example of a literature summary table. 4

Tabular literature summaries from a critical review. Source: Younas and Maddigan. 4

Tip 4: compose potential themes from each article during summary writing

While developing literature summary tables, many authors use themes or subthemes reported in the given articles as the key results of their own review. Such an approach prevents the review authors from understanding the article’s conceptual contribution, developing rigorous synthesis and drawing reasonable interpretations of results from an individual article. Ultimately, it affects the generation of novel review findings. For example, one of the articles about women’s healthcare-seeking behaviours in developing countries reported a theme ‘social-cultural determinants of health as precursors of delays’. Instead of using this theme as one of the review findings, the reviewers should read and interpret beyond the given description in an article, compare and contrast themes, findings from one article with findings and themes from another article to find similarities and differences and to understand and explain bigger picture for their readers. Therefore, while developing literature summary tables, think twice before using the predeveloped themes. Including your themes in the summary tables (see figure 1 ) demonstrates to the readers that a robust method of data extraction and synthesis has been followed.

Tip 5: create your personalised template for literature summaries

Often templates are available for data extraction and development of literature summary tables. The available templates may be in the form of a table, chart or a structured framework that extracts some essential information about every article. The commonly used information may include authors, purpose, methods, key results and quality scores. While extracting all relevant information is important, such templates should be tailored to meet the needs of the individuals’ review. For example, for a review about the effectiveness of healthcare interventions, a literature summary table must include information about the intervention, its type, content timing, duration, setting, effectiveness, negative consequences, and receivers and implementers’ experiences of its usage. Similarly, literature summary tables for articles included in a meta-synthesis must include information about the participants’ characteristics, research context and conceptual contribution of each reviewed article so as to help the reader make an informed decision about the usefulness or lack of usefulness of the individual article in the review and the whole review.

In conclusion, narrative or systematic reviews are almost always conducted as a part of any educational project (thesis or dissertation) or academic or clinical research. Literature reviews are the foundation of research on a given topic. Robust and high-quality reviews play an instrumental role in guiding research, practice and policymaking. However, the quality of reviews is also contingent on rigorous data extraction and synthesis, which require developing literature summaries. We have outlined five tips that could enhance the quality of the data extraction and synthesis process by developing useful literature summaries.

• Aromataris E ,
• Rasheed SP ,

Twitter @Ahtisham04, @parveenazamali

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

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Write a Literature Review

• Find This link opens in a new window

Not every source you found should be included in your annotated bibliography or lit review. Only include the most relevant and most important sources.

Get Organized

• Lit Review Prep Use this template to help you evaluate your sources, create article summaries for an annotated bibliography, and a synthesis matrix for your lit review outline.

Summarize your Sources

Summarize each source: Determine the most important and relevant information from each source, such as the findings, methodology, theories, etc.  Consider using an article summary, or study summary to help you organize and summarize your sources.

Paraphrasing

Use your own words, do not copy and paste the abstract.  See Purdue Owl's advice on paraphrasing to ensure you don't plagiarize.

Annotated Bibliographies

Annotated bibliographies can help you clearly see and understand the research before diving into organizing and writing your literature review.  Although typically part of the "summarize" step of the literature review, annotations should not merely be summaries of each article - they should be critical evaluations of the source, and help determine a source's usefulness for your lit review.

Definition:

A list of citations on a particular topic followed by an evaluation of the source’s argument and other relevant material including its intended audience, sources of evidence, and methodology

• Explore your topic.
• Appraise issues or factors associated with your professional practice and research topic.
• Help you get started with the literature review.
• Think critically about your topic, and the literature.

Steps to Creating an Annotated Bibliography:

• Find Your Sources
• Read Your Sources
• Identify the Most Relevant Sources
• Cite your Sources
• Write Annotations

Annotated Bibliography Resources

• Purdue Owl Guide
• Cornell Annotated Bibliography Guide
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• Last Updated: Oct 11, 2023 12:20 PM
• URL: https://libraryguides.goucher.edu/literature-review

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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.

Literature Reviews

What this handout is about.

This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Introduction

OK. You’ve got to write a literature review. You dust off a novel and a book of poetry, settle down in your chair, and get ready to issue a “thumbs up” or “thumbs down” as you leaf through the pages. “Literature review” done. Right?

Wrong! The “literature” of a literature review refers to any collection of materials on a topic, not necessarily the great literary texts of the world. “Literature” could be anything from a set of government pamphlets on British colonial methods in Africa to scholarly articles on the treatment of a torn ACL. And a review does not necessarily mean that your reader wants you to give your personal opinion on whether or not you liked these sources.

What is a literature review, then?

A literature review discusses published information in a particular subject area, and sometimes information in a particular subject area within a certain time period.

A literature review can be just a simple summary of the sources, but it usually has an organizational pattern and combines both summary and synthesis. 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. It might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. And depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

But how is a literature review different from an academic research paper?

The main focus of an academic research paper is to develop a new argument, and a research paper is likely to contain a literature review as one of its parts. In a research paper, you use the literature as a foundation and as support for a new insight that you contribute. The focus of a literature review, however, is to summarize and synthesize the arguments and ideas of others without adding new contributions.

Why do we write literature reviews?

Literature reviews provide you with a handy guide to a particular topic. If you have limited time to conduct research, literature reviews can give you an overview or act as a stepping stone. For professionals, they are useful reports that keep them up to date with what is current in the field. For scholars, the depth and breadth of the literature review emphasizes the credibility of the writer in his or her field. Literature reviews also provide a solid background for a research paper’s investigation. Comprehensive knowledge of the literature of the field is essential to most research papers.

Who writes these things, anyway?

Literature reviews are written occasionally in the humanities, but mostly in the sciences and social sciences; in experiment and lab reports, they constitute a section of the paper. Sometimes a literature review is written as a paper in itself.

Let’s get to it! What should I do before writing the literature review?

If your assignment is not very specific, seek clarification from your instructor:

• Roughly how many sources should you include?
• What types of sources (books, journal articles, websites)?
• Should you summarize, synthesize, or critique your sources by discussing a common theme or issue?
• Should you evaluate your sources?
• Should you provide subheadings and other background information, such as definitions and/or a history?

Find models

Look for other literature reviews in your area of interest or in the discipline and read them to get a sense of the types of themes you might want to look for in your own research or ways to organize your final review. You can simply put the word “review” in your search engine along with your other topic terms to find articles of this type on the Internet or in an electronic database. The bibliography or reference section of sources you’ve already read are also excellent entry points into your own research.

Narrow your topic

There are hundreds or even thousands of articles and books on most areas of study. The narrower your topic, the easier it will be to limit the number of sources you need to read in order to get a good survey of the material. Your instructor will probably not expect you to read everything that’s out there on the topic, but you’ll make your job easier if you first limit your scope.

Keep in mind that UNC Libraries have research guides and to databases relevant to many fields of study. You can reach out to the subject librarian for a consultation: https://library.unc.edu/support/consultations/ .

And don’t forget to tap into your professor’s (or other professors’) knowledge in the field. Ask your professor questions such as: “If you had to read only one book from the 90’s on topic X, what would it be?” Questions such as this help you to find and determine quickly the most seminal pieces in the field.

Consider whether your sources are current

Some disciplines require that you use information that is as current as possible. In the sciences, for instance, treatments for medical problems are constantly changing according to the latest studies. Information even two years old could be obsolete. However, if you are writing a review in the humanities, history, or social sciences, a survey of the history of the literature may be what is needed, because what is important is how perspectives have changed through the years or within a certain time period. Try sorting through some 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 consider what is currently of interest to scholars in this field and what is not.

Strategies for writing the literature review

Find a focus.

A literature review, like a term paper, is usually organized around ideas, not the sources themselves as an annotated bibliography would be organized. This means that you will not just simply list your sources and go into detail about each one of them, one at a time. No. As you read widely but selectively in your topic area, consider instead what themes or issues connect your sources together. Do they present one or different solutions? Is there an aspect of the field that is missing? How well do they present the material and do they portray it according to an appropriate theory? Do they reveal a trend in the field? A raging debate? Pick one of these themes to focus the organization of your review.

Convey it to your reader

A literature review may not have a traditional thesis statement (one that makes an argument), but you do need to tell readers what to expect. Try writing a simple statement that lets the reader know what is your main organizing principle. Here are a couple of examples:

The current trend in treatment for congestive heart failure combines surgery and medicine. More and more cultural studies scholars are accepting popular media as a subject worthy of academic consideration.

Consider organization

You’ve got a focus, and you’ve stated it clearly and directly. Now what is the most effective way of presenting the information? What are the most important topics, subtopics, etc., that your review needs to include? And in what order should you present them? Develop an organization for your review at both a global and local level:

First, cover the basic categories

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper. The following provides a brief description of the content of each:

• Introduction: Gives a quick idea of the topic of the literature review, such as the central theme or organizational pattern.
• Body: Contains your discussion of sources and is organized either chronologically, thematically, or methodologically (see below for more information on each).
• Conclusions/Recommendations: Discuss what you have drawn from reviewing literature so far. Where might the discussion proceed?

Organizing the body

Once you have the basic categories in place, then you must consider how you will present the sources themselves within the body of your paper. Create an organizational method to focus this section even further.

To help you come up with an overall organizational framework for your review, consider the following scenario:

You’ve decided to focus your literature review on materials dealing with sperm whales. This is because you’ve just finished reading Moby Dick, and you wonder if that whale’s portrayal is really real. You start with some articles about the physiology of sperm whales in biology journals written in the 1980’s. But these articles refer to some British biological studies performed on whales in the early 18th century. So you check those out. Then you look up a book written in 1968 with information on how sperm whales have been portrayed in other forms of art, such as in Alaskan poetry, in French painting, or on whale bone, as the whale hunters in the late 19th century used to do. This makes you wonder about American whaling methods during the time portrayed in Moby Dick, so you find some academic articles published in the last five years on how accurately Herman Melville portrayed the whaling scene in his novel.

Now consider some typical ways of organizing the sources into a review:

• Chronological: If your review follows the chronological method, you could write about the materials above according to when they were published. For instance, first you would talk about the British biological studies of the 18th century, then about Moby Dick, published in 1851, then the book on sperm whales in other art (1968), and finally the biology articles (1980s) and the recent articles on American whaling of the 19th century. But there is relatively no continuity among subjects here. And notice that even though the sources on sperm whales in other art and on American whaling are written recently, they are about other subjects/objects that were created much earlier. Thus, the review loses its chronological focus.
• 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 biological studies of sperm whales if the progression revealed a change in dissection practices of the researchers who wrote and/or conducted the studies.
• By trend: A better way to organize the above sources chronologically is to examine the sources under another trend, such as the history of whaling. Then your review would have subsections according to eras within this period. For instance, the review might examine whaling from pre-1600-1699, 1700-1799, and 1800-1899. Under this method, you would combine the recent studies on American whaling in the 19th century with Moby Dick itself in the 1800-1899 category, even though the authors wrote a century apart.
• Thematic: Thematic reviews of literature are organized around a topic or issue, rather than the progression of time. However, progression of time may still be an important factor in a thematic review. For instance, the sperm whale review could focus on the development of the harpoon for whale hunting. While the study focuses on one topic, harpoon technology, it will still be organized chronologically. The only difference here between a “chronological” and a “thematic” approach is what is emphasized the most: the development of the harpoon or the harpoon technology.But more authentic thematic reviews tend to break away from chronological order. For instance, a thematic review of material on sperm whales might examine how they are portrayed as “evil” in cultural documents. The subsections might include how they are personified, how their proportions are exaggerated, and their behaviors misunderstood. A review organized in this manner would shift between time periods within each section according to the point made.
• Methodological: A methodological approach differs from the two above in that the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the “methods” of the researcher or writer. For the sperm whale project, one methodological approach would be to look at cultural differences between the portrayal of whales in American, British, and French art work. Or the review might focus on the economic impact of whaling on a community. A methodological scope will influence either the types of documents in the review or the way in which these documents are discussed. Once you’ve decided on the organizational method for the body of the review, the sections you need to include in the paper should be easy to figure out. They should arise out of 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.

Sometimes, though, you might 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. Put in only what is necessary. Here are a few other sections you might want to consider:

• Current Situation: Information necessary to understand the topic or focus of the literature review.
• History: The chronological progression of the field, the literature, or an idea that is necessary to understand the literature review, if the body of the literature review is not already a chronology.
• Methods and/or Standards: The criteria you used to select the sources in your literature review or the way in which you present your information. For instance, you might explain that your review includes only peer-reviewed articles and journals.

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?

Begin composing

Once you’ve settled on a general pattern of organization, you’re ready to write each section. There are a few guidelines you should follow during the writing stage as well. Here is a sample paragraph from a literature review about sexism and language to illuminate the following discussion:

However, other studies have shown that even gender-neutral antecedents are more likely to produce masculine images than feminine ones (Gastil, 1990). Hamilton (1988) asked students to complete sentences that required them to fill in pronouns that agreed with gender-neutral antecedents such as “writer,” “pedestrian,” and “persons.” The students were asked to describe any image they had when writing the sentence. Hamilton found that people imagined 3.3 men to each woman in the masculine “generic” condition and 1.5 men per woman in the unbiased condition. Thus, while ambient sexism accounted for some of the masculine bias, sexist language amplified the effect. (Source: Erika Falk and Jordan Mills, “Why Sexist Language Affects Persuasion: The Role of Homophily, Intended Audience, and Offense,” Women and Language19:2).

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show 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 review’s focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

Falk and Mills do not use any direct quotes. That is because the survey nature of the literature review does not allow for in-depth discussion or detailed quotes from the text. Some short quotes here and there are okay, though, if you want to emphasize a point, or if what the author said just cannot be rewritten in your own words. Notice that Falk and Mills do quote certain terms that were coined by the author, not common knowledge, or taken directly from the study. But if you find yourself wanting to put in more quotes, check with your instructor.

Summarize and synthesize

Remember to summarize and synthesize your sources within each paragraph as well as throughout the review. The authors here recapitulate important features of Hamilton’s study, but then synthesize it by rephrasing the study’s significance and relating it to their own work.

Keep your own voice

While the literature review presents others’ ideas, your voice (the writer’s) should remain front and center. Notice that Falk and Mills weave references to other sources into their own text, but they still maintain their own voice by starting and ending the paragraph with their own ideas and their own words. The sources support what Falk and Mills are saying.

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. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil’s. For more information, please see our handout on plagiarism .

Revise, revise, revise

Draft in hand? Now you’re ready to revise. Spending a lot of time revising is a wise idea, because your main objective is to present the material, not the argument. So check over your review again to make sure it follows the assignment and/or your outline. Then, just as you would for most other academic forms of writing, rewrite or rework the language of your review so that you’ve presented your information in the most concise manner possible. Be sure to use terminology familiar to your audience; get rid of unnecessary jargon or slang. Finally, double check that you’ve documented your sources and formatted the review appropriately for your discipline. For tips on the revising and editing process, see our handout on revising drafts .

Works consulted

We consulted these works while writing this handout. This is not a comprehensive list of resources on the handout’s topic, and we encourage you to do your own research to find additional publications. Please do not use this list as a model for the format of your own reference list, as it may not match the citation style you are using. For guidance on formatting citations, please see the UNC Libraries citation tutorial . We revise these tips periodically and welcome feedback.

Anson, Chris M., and Robert A. Schwegler. 2010. The Longman Handbook for Writers and Readers , 6th ed. New York: Longman.

Jones, Robert, Patrick Bizzaro, and Cynthia Selfe. 1997. The Harcourt Brace Guide to Writing in the Disciplines . New York: Harcourt Brace.

Lamb, Sandra E. 1998. How to Write It: A Complete Guide to Everything You’ll Ever Write . Berkeley: Ten Speed Press.

Rosen, Leonard J., and Laurence Behrens. 2003. The Allyn & Bacon Handbook , 5th ed. New York: Longman.

Troyka, Lynn Quittman, and Doug Hesse. 2016. Simon and Schuster Handbook for Writers , 11th ed. London: Pearson.

You may reproduce it for non-commercial use if you use the entire handout and attribute the source: The Writing Center, University of North Carolina at Chapel Hill

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• How to Write a Summary | Guide & Examples

How to Write a Summary | Guide & Examples

Published on November 23, 2020 by Shona McCombes . Revised on May 31, 2023.

Summarizing , or writing a summary, means giving a concise overview of a text’s main points in your own words. A summary is always much shorter than the original text.

There are five key steps that can help you to write a summary:

• Read the text
• Break it down into sections
• Identify the key points in each section
• Write the summary
• Check the summary against the article

Writing a summary does not involve critiquing or evaluating the source . You should simply provide an accurate account of the most important information and ideas (without copying any text from the original).

Table of contents

When to write a summary, step 1: read the text, step 2: break the text down into sections, step 3: identify the key points in each section, step 4: write the summary, step 5: check the summary against the article, other interesting articles, frequently asked questions about summarizing.

There are many situations in which you might have to summarize an article or other source:

• As a stand-alone assignment to show you’ve understood the material
• To keep notes that will help you remember what you’ve read
• To give an overview of other researchers’ work in a literature review

When you’re writing an academic text like an essay , research paper , or dissertation , you’ll integrate sources in a variety of ways. You might use a brief quote to support your point, or paraphrase a few sentences or paragraphs.

But it’s often appropriate to summarize a whole article or chapter if it is especially relevant to your own research, or to provide an overview of a source before you analyze or critique it.

In any case, the goal of summarizing is to give your reader a clear understanding of the original source. Follow the five steps outlined below to write a good summary.

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The AI-powered Citation Checker helps you avoid common mistakes such as:

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You should read the article more than once to make sure you’ve thoroughly understood it. It’s often effective to read in three stages:

• Scan the article quickly to get a sense of its topic and overall shape.
• Read the article carefully, highlighting important points and taking notes as you read.
• Skim the article again to confirm you’ve understood the key points, and reread any particularly important or difficult passages.

There are some tricks you can use to identify the key points as you read:

• Start by reading the abstract . This already contains the author’s own summary of their work, and it tells you what to expect from the article.
• Pay attention to headings and subheadings . These should give you a good sense of what each part is about.
• Read the introduction and the conclusion together and compare them: What did the author set out to do, and what was the outcome?

To make the text more manageable and understand its sub-points, break it down into smaller sections.

If the text is a scientific paper that follows a standard empirical structure, it is probably already organized into clearly marked sections, usually including an introduction , methods , results , and discussion .

Other types of articles may not be explicitly divided into sections. But most articles and essays will be structured around a series of sub-points or themes.

Now it’s time go through each section and pick out its most important points. What does your reader need to know to understand the overall argument or conclusion of the article?

Keep in mind that a summary does not involve paraphrasing every single paragraph of the article. Your goal is to extract the essential points, leaving out anything that can be considered background information or supplementary detail.

In a scientific article, there are some easy questions you can ask to identify the key points in each part.

If the article takes a different form, you might have to think more carefully about what points are most important for the reader to understand its argument.

In that case, pay particular attention to the thesis statement —the central claim that the author wants us to accept, which usually appears in the introduction—and the topic sentences that signal the main idea of each paragraph.

Prevent plagiarism. Run a free check.

Now that you know the key points that the article aims to communicate, you need to put them in your own words.

To avoid plagiarism and show you’ve understood the article, it’s essential to properly paraphrase the author’s ideas. Do not copy and paste parts of the article, not even just a sentence or two.

The best way to do this is to put the article aside and write out your own understanding of the author’s key points.

Examples of article summaries

Let’s take a look at an example. Below, we summarize this article , which scientifically investigates the old saying “an apple a day keeps the doctor away.”

Davis et al. (2015) set out to empirically test the popular saying “an apple a day keeps the doctor away.” Apples are often used to represent a healthy lifestyle, and research has shown their nutritional properties could be beneficial for various aspects of health. The authors’ unique approach is to take the saying literally and ask: do people who eat apples use healthcare services less frequently? If there is indeed such a relationship, they suggest, promoting apple consumption could help reduce healthcare costs.

The study used publicly available cross-sectional data from the National Health and Nutrition Examination Survey. Participants were categorized as either apple eaters or non-apple eaters based on their self-reported apple consumption in an average 24-hour period. They were also categorized as either avoiding or not avoiding the use of healthcare services in the past year. The data was statistically analyzed to test whether there was an association between apple consumption and several dependent variables: physician visits, hospital stays, use of mental health services, and use of prescription medication.

Although apple eaters were slightly more likely to have avoided physician visits, this relationship was not statistically significant after adjusting for various relevant factors. No association was found between apple consumption and hospital stays or mental health service use. However, apple eaters were found to be slightly more likely to have avoided using prescription medication. Based on these results, the authors conclude that an apple a day does not keep the doctor away, but it may keep the pharmacist away. They suggest that this finding could have implications for reducing healthcare costs, considering the high annual costs of prescription medication and the inexpensiveness of apples.

However, the authors also note several limitations of the study: most importantly, that apple eaters are likely to differ from non-apple eaters in ways that may have confounded the results (for example, apple eaters may be more likely to be health-conscious). To establish any causal relationship between apple consumption and avoidance of medication, they recommend experimental research.

An article summary like the above would be appropriate for a stand-alone summary assignment. However, you’ll often want to give an even more concise summary of an article.

For example, in a literature review or meta analysis you may want to briefly summarize this study as part of a wider discussion of various sources. In this case, we can boil our summary down even further to include only the most relevant information.

Using national survey data, Davis et al. (2015) tested the assertion that “an apple a day keeps the doctor away” and did not find statistically significant evidence to support this hypothesis. While people who consumed apples were slightly less likely to use prescription medications, the study was unable to demonstrate a causal relationship between these variables.

Citing the source you’re summarizing

When including a summary as part of a larger text, it’s essential to properly cite the source you’re summarizing. The exact format depends on your citation style , but it usually includes an in-text citation and a full reference at the end of your paper.

You can easily create your citations and references in APA or MLA using our free citation generators.

APA Citation Generator MLA Citation Generator

Finally, read through the article once more to ensure that:

• You’ve accurately represented the author’s work
• You haven’t missed any essential information
• The phrasing is not too similar to any sentences in the original.

If you’re summarizing many articles as part of your own work, it may be a good idea to use a plagiarism checker to double-check that your text is completely original and properly cited. Just be sure to use one that’s safe and reliable.

If you want to know more about ChatGPT, AI tools , citation , and plagiarism , make sure to check out some of our other articles with explanations and examples.

• ChatGPT vs human editor
• ChatGPT citations
• Is ChatGPT trustworthy?
• Using ChatGPT for your studies
• What is ChatGPT?
• Chicago style
• Paraphrasing

 Plagiarism

• Types of plagiarism
• Self-plagiarism
• Avoiding plagiarism
• Academic integrity
• Consequences of plagiarism
• Common knowledge

A summary is a short overview of the main points of an article or other source, written entirely in your own words. Want to make your life super easy? Try our free text summarizer today!

A summary is always much shorter than the original text. The length of a summary can range from just a few sentences to several paragraphs; it depends on the length of the article you’re summarizing, and on the purpose of the summary.

You might have to write a summary of a source:

• As a stand-alone assignment to prove you understand the material
• For your own use, to keep notes on your reading
• To provide an overview of other researchers’ work in a literature review
• In a paper , to summarize or introduce a relevant study

To avoid plagiarism when summarizing an article or other source, follow these two rules:

• Write the summary entirely in your own words by paraphrasing the author’s ideas.
• Cite the source with an in-text citation and a full reference so your reader can easily find the original text.

An abstract concisely explains all the key points of an academic text such as a thesis , dissertation or journal article. It should summarize the whole text, not just introduce it.

An abstract is a type of summary , but summaries are also written elsewhere in academic writing . For example, you might summarize a source in a paper , in a literature review , or as a standalone assignment.

All can be done within seconds with our free text summarizer .

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McCombes, S. (2023, May 31). How to Write a Summary | Guide & Examples. Scribbr. Retrieved July 5, 2024, from https://www.scribbr.com/working-with-sources/how-to-summarize/

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YSN Doctoral Programs: Steps in Conducting a Literature Review

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• Steps in Conducting a Literature Review

What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

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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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What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 

How to write a good literature review 

• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• How to write a literature review faster with Paperpal? 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

1. Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 

2. Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 

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3. Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 

4. Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 

5. Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 

6. Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

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Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

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Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

Whether you’re exploring a new research field or finding new angles to develop an existing topic, sifting through hundreds of papers can take more time than you have to spare. But what if you could find science-backed insights with verified citations in seconds? That’s the power of Paperpal’s new Research feature!  

How to write a literature review faster with Paperpal?

Paperpal, an AI writing assistant, integrates powerful academic search capabilities within its writing platform. With the Research feature, you get 100% factual insights, with citations backed by 250M+ verified research articles, directly within your writing interface with the option to save relevant references in your Citation Library. By eliminating the need to switch tabs to find answers to all your research questions, Paperpal saves time and helps you stay focused on your writing.   

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
• Review and Save: Paperpal summarizes the information, while citing sources and listing relevant reads. You can quickly scan the results to identify relevant references and save these directly to your built-in citations library for later access. 
• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a good literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. By combining effortless research with an easy citation process, Paperpal Research streamlines the literature review process and empowers you to write faster and with more confidence. Try Paperpal Research now and see for yourself.  

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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• UConn Library
• 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
• << Previous: Getting Started
• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
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• v.9(7); 2013 Jul

Ten Simple Rules for Writing a Literature Review

Marco pautasso.

1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France

2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France

Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .

When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.

Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

Rule 1: Define a Topic and Audience

How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:

• interesting to you (ideally, you should have come across a series of recent papers related to your line of work that call for a critical summary),
• an important aspect of the field (so that many readers will be interested in the review and there will be enough material to write it), and
• a well-defined issue (otherwise you could potentially include thousands of publications, which would make the review unhelpful).

Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).

Rule 2: Search and Re-search the Literature

After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:

• keep track of the search items you use (so that your search can be replicated [10] ),
• keep a list of papers whose pdfs you cannot access immediately (so as to retrieve them later with alternative strategies),
• use a paper management system (e.g., Mendeley, Papers, Qiqqa, Sente),
• define early in the process some criteria for exclusion of irrelevant papers (these criteria can then be described in the review to help define its scope), and
• do not just look for research papers in the area you wish to review, but also seek previous reviews.

The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,

The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .

• discussing in your review the approaches, limitations, and conclusions of past reviews,
• trying to find a new angle that has not been covered adequately in the previous reviews, and
• incorporating new material that has inevitably accumulated since their appearance.

When searching the literature for pertinent papers and reviews, the usual rules apply:

• be thorough,
• use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and
• look at who has cited past relevant papers and book chapters.

Rule 3: Take Notes While Reading

If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.

Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.

Rule 4: Choose the Type of Review You Wish to Write

After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.

There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .

Rule 5: Keep the Review Focused, but Make It of Broad Interest

Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.

While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.

Rule 6: Be Critical and Consistent

Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:

• the major achievements in the reviewed field,
• the main areas of debate, and
• the outstanding research questions.

It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.

Rule 7: Find a Logical Structure

Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .

How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .

Rule 8: Make Use of Feedback

Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.

Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .

Rule 9: Include Your Own Relevant Research, but Be Objective

In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.

In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.

Rule 10: Be Up-to-Date, but Do Not Forget Older Studies

Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.

Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.

Acknowledgments

Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.

Funding Statement

This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.

University Libraries

Literature review.

• What is a Literature Review?
• What is Its Purpose?
• 1. Select a Topic
• 2. Set the Topic in Context
• 3. Types of Information Sources
• 4. Use Information Sources
• 5. Get the Information
• 6. Organize / Manage the Information
• 7. Position the Literature Review
• 8. Write the Literature Review

A literature review is a comprehensive summary of previous research on a topic. The literature review surveys scholarly articles, books, and other sources relevant to a particular area of research.  The review should enumerate, describe, summarize, objectively evaluate and clarify this previous research.  It should give a theoretical base for the research and help you (the author) determine the nature of your research.  The literature review acknowledges the work of previous researchers, and in so doing, assures the reader that your work has been well conceived.  It is assumed that by mentioning a previous work in the field of study, that the author has read, evaluated, and assimiliated that work into the work at hand.

A literature review creates a "landscape" for the reader, giving her or him a full understanding of the developments in the field.  This landscape informs the reader that the author has indeed assimilated all (or the vast majority of) previous, significant works in the field into her or his research. 

 "In writing the literature review, the purpose is to convey to the reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. The literature review must be defined by a guiding concept (eg. 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.( http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review )

Recommended Reading

• Next: What is Its Purpose? >>
• Last Updated: Oct 2, 2023 12:34 PM

What Is A Literature Review?

A plain-language explainer (with examples).

By:  Derek Jansen (MBA) & Kerryn Warren (PhD) | June 2020 (Updated May 2023)

If you’re faced with writing a dissertation or thesis, chances are you’ve encountered the term “literature review” . If you’re on this page, you’re probably not 100% what the literature review is all about. The good news is that you’ve come to the right place.

Literature Review 101

• What (exactly) is a literature review
• What’s the purpose of the literature review chapter
• How to find high-quality resources
• How to structure your literature review chapter
• Example of an actual literature review

What is a literature review?

The word “literature review” can refer to two related things that are part of the broader literature review process. The first is the task of  reviewing the literature  – i.e. sourcing and reading through the existing research relating to your research topic. The second is the  actual chapter  that you write up in your dissertation, thesis or research project. Let’s look at each of them:

Reviewing the literature

The first step of any literature review is to hunt down and  read through the existing research  that’s relevant to your research topic. To do this, you’ll use a combination of tools (we’ll discuss some of these later) to find journal articles, books, ebooks, research reports, dissertations, theses and any other credible sources of information that relate to your topic. You’ll then  summarise and catalogue these  for easy reference when you write up your literature review chapter. 

The literature review chapter

The second step of the literature review is to write the actual literature review chapter (this is usually the second chapter in a typical dissertation or thesis structure ). At the simplest level, the literature review chapter is an  overview of the key literature  that’s relevant to your research topic. This chapter should provide a smooth-flowing discussion of what research has already been done, what is known, what is unknown and what is contested in relation to your research topic. So, you can think of it as an  integrated review of the state of knowledge  around your research topic. 

What’s the purpose of a literature review?

The literature review chapter has a few important functions within your dissertation, thesis or research project. Let’s take a look at these:

Purpose #1 – Demonstrate your topic knowledge

The first function of the literature review chapter is, quite simply, to show the reader (or marker) that you  know what you’re talking about . In other words, a good literature review chapter demonstrates that you’ve read the relevant existing research and understand what’s going on – who’s said what, what’s agreed upon, disagreed upon and so on. This needs to be  more than just a summary  of who said what – it needs to integrate the existing research to  show how it all fits together  and what’s missing (which leads us to purpose #2, next). 

Purpose #2 – Reveal the research gap that you’ll fill

The second function of the literature review chapter is to  show what’s currently missing  from the existing research, to lay the foundation for your own research topic. In other words, your literature review chapter needs to show that there are currently “missing pieces” in terms of the bigger puzzle, and that  your study will fill one of those research gaps . By doing this, you are showing that your research topic is original and will help contribute to the body of knowledge. In other words, the literature review helps justify your research topic.  

Purpose #3 – Lay the foundation for your conceptual framework

The third function of the literature review is to form the  basis for a conceptual framework . Not every research topic will necessarily have a conceptual framework, but if your topic does require one, it needs to be rooted in your literature review. 

For example, let’s say your research aims to identify the drivers of a certain outcome – the factors which contribute to burnout in office workers. In this case, you’d likely develop a conceptual framework which details the potential factors (e.g. long hours, excessive stress, etc), as well as the outcome (burnout). Those factors would need to emerge from the literature review chapter – they can’t just come from your gut! 

So, in this case, the literature review chapter would uncover each of the potential factors (based on previous studies about burnout), which would then be modelled into a framework. 

Purpose #4 – To inform your methodology

The fourth function of the literature review is to  inform the choice of methodology  for your own research. As we’ve  discussed on the Grad Coach blog , your choice of methodology will be heavily influenced by your research aims, objectives and questions . Given that you’ll be reviewing studies covering a topic close to yours, it makes sense that you could learn a lot from their (well-considered) methodologies.

So, when you’re reviewing the literature, you’ll need to  pay close attention to the research design , methodology and methods used in similar studies, and use these to inform your methodology. Quite often, you’ll be able to  “borrow” from previous studies . This is especially true for quantitative studies , as you can use previously tried and tested measures and scales. 

How do I find articles for my literature review?

Finding quality journal articles is essential to crafting a rock-solid literature review. As you probably already know, not all research is created equally, and so you need to make sure that your literature review is  built on credible research . 

We could write an entire post on how to find quality literature (actually, we have ), but a good starting point is Google Scholar . Google Scholar is essentially the academic equivalent of Google, using Google’s powerful search capabilities to find relevant journal articles and reports. It certainly doesn’t cover every possible resource, but it’s a very useful way to get started on your literature review journey, as it will very quickly give you a good indication of what the  most popular pieces of research  are in your field.

One downside of Google Scholar is that it’s merely a search engine – that is, it lists the articles, but oftentimes  it doesn’t host the articles . So you’ll often hit a paywall when clicking through to journal websites. 

Thankfully, your university should provide you with access to their library, so you can find the article titles using Google Scholar and then search for them by name in your university’s online library. Your university may also provide you with access to  ResearchGate , which is another great source for existing research. 

Remember, the correct search keywords will be super important to get the right information from the start. So, pay close attention to the keywords used in the journal articles you read and use those keywords to search for more articles. If you can’t find a spoon in the kitchen, you haven’t looked in the right drawer. 

Need a helping hand?

How should I structure my literature review?

Unfortunately, there’s no generic universal answer for this one. The structure of your literature review will depend largely on your topic area and your research aims and objectives.

You could potentially structure your literature review chapter according to theme, group, variables , chronologically or per concepts in your field of research. We explain the main approaches to structuring your literature review here . You can also download a copy of our free literature review template to help you establish an initial structure.

In general, it’s also a good idea to start wide (i.e. the big-picture-level) and then narrow down, ending your literature review close to your research questions . However, there’s no universal one “right way” to structure your literature review. The most important thing is not to discuss your sources one after the other like a list – as we touched on earlier, your literature review needs to synthesise the research , not summarise it .

Ultimately, you need to craft your literature review so that it conveys the most important information effectively – it needs to tell a logical story in a digestible way. It’s no use starting off with highly technical terms and then only explaining what these terms mean later. Always assume your reader is not a subject matter expert and hold their hand through a journe y of the literature while keeping the functions of the literature review chapter (which we discussed earlier) front of mind.

Example of a literature review

In the video below, we walk you through a high-quality literature review from a dissertation that earned full distinction. This will give you a clearer view of what a strong literature review looks like in practice and hopefully provide some inspiration for your own. 

Wrapping Up

In this post, we’ve (hopefully) answered the question, “ what is a literature review? “. We’ve also considered the purpose and functions of the literature review, as well as how to find literature and how to structure the literature review chapter. If you’re keen to learn more, check out the literature review section of the Grad Coach blog , as well as our detailed video post covering how to write a literature review . 

Psst… there’s more!

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

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16 Comments

Thanks for this review. It narrates what’s not been taught as tutors are always in a early to finish their classes.

Thanks for the kind words, Becky. Good luck with your literature review 🙂

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Timothy T. Chol [email protected]

Thank you very much for the guiding in literature review I learn and benefited a lot this make my journey smooth I’ll recommend this site to my friends

This was so useful. Thank you so much.

Hi, Concept was explained nicely by both of you. Thanks a lot for sharing it. It will surely help research scholars to start their Research Journey.

The review is really helpful to me especially during this period of covid-19 pandemic when most universities in my country only offer online classes. Great stuff

Great Brief Explanation, thanks

So helpful to me as a student

GradCoach is a fantastic site with brilliant and modern minds behind it.. I spent weeks decoding the substantial academic Jargon and grounding my initial steps on the research process, which could be shortened to a couple of days through the Gradcoach. Thanks again!

This is an amazing talk. I paved way for myself as a researcher. Thank you GradCoach!

Well-presented overview of the literature!

This was brilliant. So clear. Thank you

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Article Summaries, Reviews & Critiques

Writing an article summary.

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When writing a summary, the goal is to compose a concise and objective overview of the original article. The summary should focus only on the article's main ideas and important details that support those ideas.

Guidelines for summarizing an article:

• State the main ideas.
• Identify the most important details that support the main ideas.
• Summarize in your own words.
• Do not copy phrases or sentences unless they are being used as direct quotations.
• Express the underlying meaning of the article, but do not critique or analyze.
• The summary should be about one third the length of the original article. 

Your summary should include:

• Give an overview of the article, including the title and the name of the author.
• Provide a thesis statement that states the main idea of the article.
• Use the body paragraphs to explain the supporting ideas of your thesis statement.
• One-paragraph summary - one sentence per supporting detail, providing 1-2 examples for each.
• Multi-paragraph summary - one paragraph per supporting detail, providing 2-3 examples for each.
• Start each paragraph with a topic sentence.
• Use transitional words and phrases to connect ideas.
• Summarize your thesis statement and the underlying meaning of the article.

 Adapted from "Guidelines for Using In-Text Citations in a Summary (or Research Paper)" by Christine Bauer-Ramazani, 2020

Additional Resources

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How to Write a Summary - Guide & Examples  (from Scribbr.com)

Writing a Summary  (from The University of Arizona Global Campus Writing Center)

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A Guide to Using AI Tools to Summarize Literature Reviews

Table of Contents

Needless to say, millions of scientific articles are getting published every year making it difficult for a researcher to read and comprehend all the relevant publications.

Back then, researchers used to manually conduct literature reviews by sifting through hundreds of research papers to get the significant information required for the research.

Fast forward to 2023 — things have turned out quite distinct and favorable. With the inception of AI tools, the literature review process is streamlined and researchers can summarize hundreds of research articles in mere moments. They can save time and effort by using AI tools to summarize literature reviews.

This article articulates the role of the top AI tools used to summarize literature reviews. You can also learn how AI is used as a powerful tool for summarizing scientific articles and understanding the impact of AI on academic research.

Understanding the Role of AI Tools in Literature Reviews

Before we talk about the benefits of AI tools to summarize literature reviews, let’s understand the concept of AI and how it streamlines the literature review process.

Artificial intelligence tools are trained on large language models and they are programmed to mimic human tasks like problem-solving, making decisions, understanding patterns, and more. When Artificial Intelligence and machine learning algorithms are implemented in literature reviews, they help in processing vast amounts of information, identifying highly relevant studies, and generating quick and concise summaries — TL;DR summaries.

AI has revolutionized the process of literature review by assisting researchers with powerful AI-based tools to read, analyze, compare, contrast, and extract relevant information from research articles.

By using natural language processing algorithms, AI tools can effectively identify key concepts, main arguments, and relevant findings from multiple research articles at once. This assists researchers in quickly understanding the overview of the existing literature on a respective topic, saving their valuable time and effort.

Key Benefits of Using AI Tools to Summarize Literature Review

1. best alternative to traditional literature review.

Traditional literature reviews or manual literature reviews can be incredibly time-consuming and often require weeks or even months to complete. Researchers have to sift through myriad articles manually, read them in detail, and highlight or extract relevant information. This process can be overwhelming, especially when dealing with a large number of studies.

However, with the help of AI tools, researchers can greatly save time and effort required to discover, analyze, and summarize relevant studies. AI tools with their NLP and machine learning algorithms can quickly analyze multiple research articles and generate succinct summaries. This not only improves efficiency but also allows researchers to focus on the core analysis and interpretation of the compiled insights.

2. AI tools aid in swift research discovery!

AI tools also help researchers save time in the discovery phase of literature reviews. These AI-powered tools use semantic search analysis to identify relevant studies that might go unnoticed in traditional literature review methods. Also, AI tools can analyze keywords, citations , and other metadata to prompt or suggest pertinent articles that align and correlate well with the researcher’s search query.

3. AI Tools ensure to stay up to date with the most research ideas!

Another advantage of using AI-powered tools in literature reviews is their ability to handle the ever-increasing volume of published scientific research. With the exponential growth of scientific literature, it has become increasingly challenging for researchers to keep up with the latest scientific research and biomedical innovations.

However, AI tools can automatically scan and discover new publications, ensuring that researchers stay up-to-date with the most recent developments in their field of study.

4. Improves efficiency and accuracy of Literature Reviews

The use of AI tools in literature review reduces the occurrences of human errors that may occur during traditional literature review or manual document summarization. So, literature review AI tools improve the overall efficiency and accuracy of literature reviews, ensuring that researchers can access relevant information promptly by minimizing human errors.

List of AI Tools to Streamline Literature Reviews

We have several AI-powered tools to summarize literature reviews. They utilize advanced algorithms and natural language processing techniques to analyze and summarize lengthy scientific articles.

Let's take a look at some of the most popular AI tools to summarize literature reviews.

SciSpace Literature Review

Semantic scholar, paper digest.

SciSpace Literature Review is the best AI tool for summarizing literature review. It is the go-to tool that summarizes articles in seconds. It uses natural language processing models GPT 3.5 and GPT 4.0 to generate concise summaries. It is an effective and efficient AI-powered tool to streamline the literature review process and summarize multiple research articles at once. Once you enter a keyword, research topic, or question, it initiates your literature review process by providing instant insights from the top 5 highly relevant papers at the top.

These insights are backed by citations that allow you to refer to the source. All the resultant relevant papers appear in an easy-to-digest tabular format explaining each of the sections used in the paper in different columns. You can also customize the table by adding or removing the columns according to your research needs. This is the unique feature of this literature review AI tool.

SciSpace Literature review stands out as the best AI tool to summarize literature review by providing concise TL;DR text and summaries for all the sections used in the research paper. This way, it makes the review process easier for any researcher, and could comprehend more research papers in less time.

Try SciSpace Literature Review now!

Semantic Scholar is an AI-powered search engine that helps researchers find relevant research papers based on the keyword or research topic. It works similar to Google Scholar.It helps you discover and understand scientific research by providing suitable research papers. The database has over 200 million research articles, you can filter out the results based on the field of study, author, date of publication, and journals or conferences.

They have recently released the Semantic Reader — an AI-powered tool for scientific readers that enhances the reading process. This is available in the beta version.

Try Semantic Scholar here

Paper Digest — another valuable text summarizer tool (AI-powered tool) that summarizes the literature review and helps you get to the core insights of the research paper in a few minutes! This powerful tool works pretty straightforwardly and generates summaries of research papers. You just need to input the article URL or DOI and click on “Digest” to get the summaries. It comes for free and is currently in the beta version.

You can access Paper Digest here !

SciSummary is another AI tool that summarizes scientific articles and literature review. It uses natural language processing algorithm to generate concise summaries. You need to upload the document on the dashboard or send the article link via email and your summaries will be generated and delivered to your inbox. This is the best AI-powered tool that helps you read and understand lengthy and complicated research papers. It has different pricing plans (both free and premium) which start at $4.99/month, you can choose the plans according to your needs.

You can access SciSummary here

Step-by-Step Guide to Using AI Tools to Summarize Literature Reviews

Here’s a short step-by-step guide that clearly articulates how to use AI tools for summary generation!

• Select the AI-powered tool that best suits your research needs.
• Once you've chosen a tool, you must provide input, such as an article link, DOI, or PDF, to the tool.
• The AI tool will then process the input using its algorithms and techniques, generating a summary of the literature.
• The generated summary will contain the most important information, including key points, methodologies, and conclusions in a succinct format.
• Review and assess the generated summaries to ensure accuracy and relevance.

Challenges of using AI tools for summarization

AI tools are designed to generate precise summaries, however, they may sometimes miss out on important facts or misinterpret specific information.

Here are the potential challenges and risks researchers should be wary of when using AI tools to summarize literature reviews!

1. Lack of contextual intelligence

AI-powered tools cannot ensure that they completely understand the context of the research papers. This leads to inappropriate or misleading summaries of similar academic papers.

To combat this, researchers should feed additional context to the AI prompt or use AI tools with more advanced training models that can better understand the complexities of the research papers.

2. AI tools cannot ensure foolproof summaries

While AI tools can immensely speed up the summarization process, but, they may not be able to capture the complete essence of a research paper or accurately decrypt complex concepts.

Therefore, AI tools are just to be considered as technology aids rather than replacements for human analysis or understanding of key information.

3. Potential bias in the generated summaries

AI-powered tools are largely trained on the existing data, and if the training data is biased, it can eventually lead to biased summaries.

Researchers should be cautious and ensure that the training data is diverse and representative of various sources, different perspectives, and research domains.

4. Quality of the input article affects the summary output

The quality of the research article that we upload or input data also has a direct effect on the accuracy of the generated summaries.

If the input article is poorly written or contains errors, the AI tool might not be able to generate coherent and accurate summaries. Researchers should select high-quality academic papers and articles to obtain reliable and informative summaries.

Concluding!

AI summarization tools have a substantial impact on academic research. By leveraging AI tools, researchers can streamline the literature review process, enabling them to stay up-to-date with the latest advancements in their field of study and make informed decisions based on a comprehensive understanding of current knowledge.

By understanding the role of AI tool to summarize literature review, exploring different AI tools for summarization, following a systematic review process, and assessing the impact of these tools on their academic research, researchers can harness AI tools in enhancing their literature review processes.

If you are also keen to explore the best AI-powered tool for summarizing the literature review process, head over to SciSpace Literature Review and start analyzing the research papers right away — SciSpace Literature Review

Frequently Asked Questions

Give an overview of the main points from each paper and integrate them into a coherent whole, by outlining the importance, limitations, and unique insights from the reviewed literature.

SciSpace Literature Review is the best AI tool for summarizing research articles. It can summarize articles in seconds and provide detailed and focused insights.

Some of the best AI tools for summarizing literature reviews includes: SciSpace, Semantic Scholar, Paper Digest, and SciSummary.

For a Ph.D.dissertation, a literature review summary typically comprises a chapter (around 8000 words), while for a Master’s thesis, it is usually around 2000 - 3000 words.

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Get Organized

• Lit Review Prep Use this template to help you evaluate your sources, create article summaries for an annotated bibliography, and a synthesis matrix for your lit review outline.

Synthesize your Information

Synthesize: combine separate elements to form a whole.

Synthesis Matrix

A synthesis matrix helps you record the main points of each source and document how sources relate to each other.

After summarizing and evaluating your sources, arrange them in a matrix or use a citation manager to help you see how they relate to each other and apply to each of your themes or variables.  

By arranging your sources by theme or variable, you can see how your sources relate to each other, and can start thinking about how you weave them together to create a narrative.

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Conducting a Literature Review

• Literature Review
• Developing a Topic
• Planning Your Literature Review
• Developing a Search Strategy
• Managing Citations
• Critical Appraisal Tools
• Writing a Literature Review

Before You Begin to Write.....

Do you have enough information? If you are not sure,

Ask yourself these questions:

• Has my search been wide enough to insure I've found all the relevant material?
• Has it been narrow enough to exclude irrelevant material?
• Is the number of sources I've used appropriate for the length of my paper?

You may have enough information for your literature review when:

• You've used multiple databases and other resources (web portals, repositories, etc.) to get a variety of perspectives on the research topic.
• The same citations are showing up in a variety of databases.
• Your advisor and other trusted experts say you have enough!

You have to stop somewhere and get on with the writing process!

Writing Tips

A literature review is not a list describing or summarizing one piece of literature after another. It’s usually a bad sign to see every paragraph beginning with the name of a researcher. Instead, organize the literature review into sections that present themes or identify trends, including relevant theory. You are not trying to list all the material published, but to synthesize and evaluate it according to the guiding concept of your thesis or research question

If you are writing an  annotated bibliography , you may need to summarize each item briefly, but should still follow through themes and concepts and do some critical assessment of material. Use an overall introduction and conclusion to state the scope of your coverage and to formulate the question, problem, or concept your chosen material illuminates. Usually you will have the option of grouping items into sections—this helps you indicate comparisons and relationships. You may be able to write a paragraph or so to introduce the focus of each section

Layout of Writing a Literature Review

Generally, the purpose of a review is to analyze critically a segment of a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles.

Writing the introduction:

In the introduction, you should:

• Define or identify the general topic, issue, or area of concern, thus providing an appropriate context for reviewing the literature.
• Point out overall trends in what has been published about the topic; or conflicts in theory, methodology, evidence, and conclusions; or gaps in research and scholarship; or a single problem or new perspective of immediate interest.
• Establish the writer’s reason (point of view) for reviewing the literature; explain the criteria to be used in analyzing and comparing literature and the organization of the review (sequence); and, when necessary, state why certain literature is or is not included (scope).

Writing the body:

In the body, you should:

• Group research studies and other types of literature (reviews, theoretical articles, case studies, etc.) according to common denominators such as qualitative versus quantitative approaches, conclusions of authors, specific purpose or objective, chronology, etc.
• Summarize individual studies or articles with as much or as little detail as each merits according to its comparative importance in the literature, remembering that space (length) denotes significance.
• Provide the reader with strong “umbrella” sentences at beginnings of paragraphs, “signposts” throughout, and brief “so what” summary sentences at intermediate points in the review to aid in understanding comparisons and analyses.

WRITING TIP:  As you are writing the literature review you will mention the author names and the publication years in your text, but you will still need to compile comprehensive list citations for each entry at the end of your review. Follow  APA, MLA, or Chicago style guidelines , as your course requires.

Writing the conclusion:

In the conclusion, you should:

• Summarize major contributions of significant studies and articles to the body of knowledge under review, maintaining the focus established in the introduction.
• Evaluate the current “state of the art” for the body of knowledge reviewed, pointing out major methodological flaws or gaps in research, inconsistencies in theory and findings, and areas or issues pertinent to future study.
• Conclude by providing some insight into the relationship between the central topic of the literature review and a larger area of study such as a discipline, a scientific endeavor, or a profession.
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Citation Styles

• Chicago Style
• Annotated Bibliographies

What is a Lit Review?

How to write a lit review.

• Video Introduction to Lit Reviews

Main Objectives

Examples of lit reviews, additional resources.

• Zotero (Citation Management)

What is a literature review?

• Either a complete piece of writing unto itself or a section of a larger piece of writing like a book or article
• A thorough and critical look at the information and perspectives that other experts and scholars have written about a specific topic
• A way to give historical perspective on an issue and show how other researchers have addressed a problem
• An analysis of sources based on your own perspective on the topic
• Based on the most pertinent and significant research conducted in the field, both new and old

• A descriptive list or collection of summaries of other research without synthesis or analysis
• An annotated bibliography
• A literary review (a brief, critical discussion about the merits and weaknesses of a literary work such as a play, novel or a book of poems)
• Exhaustive; the objective is not to list as many relevant books, articles, reports as possible
• To convey to your reader what knowledge and ideas have been established on a topic
• To explain what the strengths and weaknesses of that knowledge and those ideas might be
• To learn how others have defined and measured key concepts    
• To keep the writer/reader up to date with current developments and historical trends in a particular field or discipline
• To establish context for the argument explored in the rest of a paper
• To provide evidence that may be used to support your own findings
• To demonstrate your understanding and your ability to critically evaluate research in the field
• To suggest previously unused or underused methodologies, designs, and quantitative and qualitative strategies
• To identify gaps in previous studies and flawed methodologies and/or theoretical approaches in order to avoid replication of mistakes
• To help the researcher avoid repetition of earlier research
• To suggest unexplored populations
• To determine whether past studies agree or disagree and identify strengths and weaknesses on both sides of a controversy in the literature

• Choose a topic that is interesting to you; this makes the research and writing process more enjoyable and rewarding.
• For a literature review, you'll also want to make sure that the topic you choose is one that other researchers have explored before so that you'll be able to find plenty of relevant sources to review.

• Your research doesn't need to be exhaustive. Pay careful attention to bibliographies. Focus on the most frequently cited literature about your topic and literature from the best known scholars in your field. Ask yourself: "Does this source make a significant contribution to the understanding of my topic?"
• Reading other literature reviews from your field may help you get ideas for themes to look for in your research. You can usually find some of these through the library databases by adding literature review as a keyword in your search.
• Start with the most recent publications and work backwards. This way, you ensure you have the most current information, and it becomes easier to identify the most seminal earlier sources by reviewing the material that current researchers are citing.

The organization of your lit review should be determined based on what you'd like to highlight from your research. Here are a few suggestions:

• Chronology : Discuss literature in chronological order of its writing/publication to demonstrate a change in trends over time or to detail a history of controversy in the field or of developments in the understanding of your topic.  
• Theme: Group your sources by subject or theme to show the variety of angles from which your topic has been studied. This works well if, for example, your goal is to identify an angle or subtopic that has so far been overlooked by researchers.  
• Methodology: Grouping your sources by methodology (for example, dividing the literature into qualitative vs. quantitative studies or grouping sources according to the populations studied) is useful for illustrating an overlooked population, an unused or underused methodology, or a flawed experimental technique.

• Be selective. Highlight only the most important and relevant points from a source in your review.
• Use quotes sparingly. Short quotes can help to emphasize a point, but thorough analysis of language from each source is generally unnecessary in a literature review.
• Synthesize your sources. Your goal is not to make a list of summaries of each source but to show how the sources relate to one another and to your own work.
• Make sure that your own voice and perspective remains front and center. Don't rely too heavily on summary or paraphrasing. For each source, draw a conclusion about how it relates to your own work or to the other literature on your topic.
• Be objective. When you identify a disagreement in the literature, be sure to represent both sides. Don't exclude a source simply on the basis that it does not support your own research hypothesis.
• At the end of your lit review, make suggestions for future research. What subjects, populations, methodologies, or theoretical lenses warrant further exploration? What common flaws or biases did you identify that could be corrected in future studies?

• Double check that you've correctly cited each of the sources you've used in the citation style requested by your professor (APA, MLA, etc.) and that your lit review is formatted according to the guidelines for that style.

Your literature review should:

• Be focused on and organized around your topic.
• Synthesize your research into a summary of what is and is not known about your topic.
• Identify any gaps or areas of controversy in the literature related to your topic.
• Suggest questions that require further research.
• Have your voice and perspective at the forefront rather than merely summarizing others' work.
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• Literature Review Tutorials and Samples - Wilson Library at University of La Verne
• Literature Reviews: Introduction - University Library at Georgia State
• Literature Reviews - The Writing Center at UNC Chapel Hill
• Writing a Literature Review - Boston College Libraries
• Write a Literature Review - University Library at UC Santa Cruz
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Choosing a Review Type

For guidance related to choosing a review type, see:

• "What Type of Review is Right for You?" - Decision Tree (PDF) This decision tree, from Cornell University Library, highlights key difference between narrative, systematic, umbrella, scoping and rapid reviews.
• Reviewing the literature: choosing a review design Noble, H., & Smith, J. (2018). Reviewing the literature: Choosing a review design. Evidence Based Nursing, 21(2), 39–41. https://doi.org/10.1136/eb-2018-102895
• What synthesis methodology should I use? A review and analysis of approaches to research synthesis Schick-Makaroff, K., MacDonald, M., Plummer, M., Burgess, J., & Neander, W. (2016). What synthesis methodology should I use? A review and analysis of approaches to research synthesis. AIMS Public Health, 3 (1), 172-215. doi:10.3934/publichealth.2016.1.172 More information less... ABSTRACT: Our purpose is to present a comprehensive overview and assessment of the main approaches to research synthesis. We use "research synthesis" as a broad overarching term to describe various approaches to combining, integrating, and synthesizing research findings.
• Right Review - Decision Support Tool Not sure of the most suitable review method? Answer a few questions and be guided to suitable knowledge synthesis methods. Updated in 2022 and featured in the Journal of Clinical Epidemiology 10.1016/j.jclinepi.2022.03.004

Types of Evidence Synthesis / Literature Reviews

Literature reviews are comprehensive summaries and syntheses of the previous research on a given topic.  While narrative reviews are common across all academic disciplines, reviews that focus on appraising and synthesizing research evidence are increasingly important in the health and social sciences.  

Most evidence synthesis methods use formal and explicit methods to identify, select and combine results from multiple studies, making evidence synthesis a form of meta-research.  

The review purpose, methods used and the results produced vary among different kinds of literature reviews; some of the common types of literature review are detailed below.

Common Types of Literature Reviews 1

Narrative (literature) review.

• A broad term referring to reviews with a wide scope and non-standardized methodology
• Search strategies, comprehensiveness of literature search, time range covered and method of synthesis will vary and do not follow an established protocol

Integrative Review

• A type of literature review based on a systematic, structured literature search
• Often has a broadly defined purpose or review question
• Seeks to generate or refine and theory or hypothesis and/or develop a holistic understanding of a topic of interest
• Relies on diverse sources of data (e.g. empirical, theoretical or methodological literature; qualitative or quantitative studies)

Systematic Review

• Systematically and transparently collects and categorize existing evidence on a question of scientific, policy or management importance
• Follows a research protocol that is established a priori
• Some sub-types of systematic reviews include: SRs of intervention effectiveness, diagnosis, prognosis, etiology, qualitative evidence, economic evidence, and more.
• Time-intensive and often takes months to a year or more to complete 
• The most commonly referred to type of evidence synthesis; sometimes confused as a blanket term for other types of reviews

Meta-Analysis

• Statistical technique for combining the findings from disparate quantitative studies
• Uses statistical methods to objectively evaluate, synthesize, and summarize results
• Often conducted as part of a systematic review

Scoping Review

• Systematically and transparently collects and categorizes existing evidence on a broad question of scientific, policy or management importance
• Seeks to identify research gaps, identify key concepts and characteristics of the literature and/or examine how research is conducted on a topic of interest
• Useful when the complexity or heterogeneity of the body of literature does not lend itself to a precise systematic review
• Useful if authors do not have a single, precise review question
• May critically evaluate existing evidence, but does not attempt to synthesize the results in the way a systematic review would 
• May take longer than a systematic review

Rapid Review

• Applies a systematic review methodology within a time-constrained setting
• Employs methodological "shortcuts" (e.g., limiting search terms and the scope of the literature search), at the risk of introducing bias
• Useful for addressing issues requiring quick decisions, such as developing policy recommendations

Umbrella Review

• Reviews other systematic reviews on a topic
• Often defines a broader question than is typical of a traditional systematic review
• Most useful when there are competing interventions to consider

1. Adapted from:

Eldermire, E. (2021, November 15). A guide to evidence synthesis: Types of evidence synthesis. Cornell University LibGuides. https://guides.library.cornell.edu/evidence-synthesis/types

Nolfi, D. (2021, October 6). Integrative Review: Systematic vs. Scoping vs. Integrative. Duquesne University LibGuides. https://guides.library.duq.edu/c.php?g=1055475&p=7725920

Delaney, L. (2021, November 24). Systematic reviews: Other review types. UniSA LibGuides. https://guides.library.unisa.edu.au/SystematicReviews/OtherReviewTypes

Further Reading: Exploring Different Types of Literature Reviews

• A typology of reviews: An analysis of 14 review types and associated methodologies Grant, M. J., & Booth, A. (2009). A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information and Libraries Journal, 26 (2), 91-108. doi:10.1111/j.1471-1842.2009.00848.x More information less... ABSTRACT: The expansion of evidence-based practice across sectors has lead to an increasing variety of review types. However, the diversity of terminology used means that the full potential of these review types may be lost amongst a confusion of indistinct and misapplied terms. The objective of this study is to provide descriptive insight into the most common types of reviews, with illustrative examples from health and health information domains.
• Clarifying differences between review designs and methods Gough, D., Thomas, J., & Oliver, S. (2012). Clarifying differences between review designs and methods. Systematic Reviews, 1 , 28. doi:10.1186/2046-4053-1-28 More information less... ABSTRACT: This paper argues that the current proliferation of types of systematic reviews creates challenges for the terminology for describing such reviews....It is therefore proposed that the most useful strategy for the field is to develop terminology for the main dimensions of variation.
• Are we talking the same paradigm? Considering methodological choices in health education systematic review Gordon, M. (2016). Are we talking the same paradigm? Considering methodological choices in health education systematic review. Medical Teacher, 38 (7), 746-750. doi:10.3109/0142159X.2016.1147536 More information less... ABSTRACT: Key items discussed are the positivist synthesis methods meta-analysis and content analysis to address questions in the form of "whether and what" education is effective. These can be juxtaposed with the constructivist aligned thematic analysis and meta-ethnography to address questions in the form of "why." The concept of the realist review is also considered. It is proposed that authors of such work should describe their research alignment and the link between question, alignment and evidence synthesis method selected.
• Meeting the review family: Exploring review types and associated information retrieval requirements Sutton, A., Clowes, M., Preston, L., & Booth, A. (2019). Meeting the review family: Exploring review types and associated information retrieval requirements. Health Information & Libraries Journal, 36(3), 202–222. doi: 10.1111/hir.12276

Integrative Reviews

"The integrative review method is an approach that allows for the inclusion of diverse methodologies (i.e. experimental and non-experimental research)." (Whittemore & Knafl, 2005, p. 547).

• The integrative review: Updated methodology Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52 (5), 546–553. doi:10.1111/j.1365-2648.2005.03621.x More information less... ABSTRACT: The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process....An integrative review is a specific review method that summarizes past empirical or theoretical literature to provide a more comprehensive understanding of a particular phenomenon or healthcare problem....Well-done integrative reviews present the state of the science, contribute to theory development, and have direct applicability to practice and policy.

• Conducting integrative reviews: A guide for novice nursing researchers Dhollande, S., Taylor, A., Meyer, S., & Scott, M. (2021). Conducting integrative reviews: A guide for novice nursing researchers. Journal of Research in Nursing, 26(5), 427–438. https://doi.org/10.1177/1744987121997907
• Rigour in integrative reviews Whittemore, R. (2007). Rigour in integrative reviews. In C. Webb & B. Roe (Eds.), Reviewing Research Evidence for Nursing Practice (pp. 149–156). John Wiley & Sons, Ltd. https://doi.org/10.1002/9780470692127.ch11

Scoping Reviews

Scoping reviews are evidence syntheses that are conducted systematically, but begin with a broader scope of question than traditional systematic reviews, allowing the research to 'map' the relevant literature on a given topic.

• Scoping studies: Towards a methodological framework Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8 (1), 19-32. doi:10.1080/1364557032000119616 More information less... ABSTRACT: We distinguish between different types of scoping studies and indicate where these stand in relation to full systematic reviews. We outline a framework for conducting a scoping study based on our recent experiences of reviewing the literature on services for carers for people with mental health problems.
• Scoping studies: Advancing the methodology Levac, D., Colquhoun, H., & O'Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5 (1), 69. doi:10.1186/1748-5908-5-69 More information less... ABSTRACT: We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework.
• Methodology for JBI scoping reviews Peters, M. D. J., Godfrey, C. M., McInerney, P., Baldini Soares, C., Khalil, H., & Parker, D. (2015). The Joanna Briggs Institute reviewers’ manual: Methodology for JBI scoping reviews [PDF]. Retrieved from The Joanna Briggs Institute website: http://joannabriggs.org/assets/docs/sumari/Reviewers-Manual_Methodology-for-JBI-Scoping-Reviews_2015_v2.pdf More information less... ABSTRACT: Unlike other reviews that address relatively precise questions, such as a systematic review of the effectiveness of a particular intervention based on a precise set of outcomes, scoping reviews can be used to map the key concepts underpinning a research area as well as to clarify working definitions, and/or the conceptual boundaries of a topic. A scoping review may focus on one of these aims or all of them as a set.

Systematic vs. Scoping Reviews: What's the Difference? 

YouTube Video 4 minutes, 45 seconds

Rapid Reviews

Rapid reviews are systematic reviews that are undertaken under a tighter timeframe than traditional systematic reviews. 

• Evidence summaries: The evolution of a rapid review approach Khangura, S., Konnyu, K., Cushman, R., Grimshaw, J., & Moher, D. (2012). Evidence summaries: The evolution of a rapid review approach. Systematic Reviews, 1 (1), 10. doi:10.1186/2046-4053-1-10 More information less... ABSTRACT: Rapid reviews have emerged as a streamlined approach to synthesizing evidence - typically for informing emergent decisions faced by decision makers in health care settings. Although there is growing use of rapid review "methods," and proliferation of rapid review products, there is a dearth of published literature on rapid review methodology. This paper outlines our experience with rapidly producing, publishing and disseminating evidence summaries in the context of our Knowledge to Action (KTA) research program.
• What is a rapid review? A methodological exploration of rapid reviews in Health Technology Assessments Harker, J., & Kleijnen, J. (2012). What is a rapid review? A methodological exploration of rapid reviews in Health Technology Assessments. International Journal of Evidence‐Based Healthcare, 10 (4), 397-410. doi:10.1111/j.1744-1609.2012.00290.x More information less... ABSTRACT: In recent years, there has been an emergence of "rapid reviews" within Health Technology Assessments; however, there is no known published guidance or agreed methodology within recognised systematic review or Health Technology Assessment guidelines. In order to answer the research question "What is a rapid review and is methodology consistent in rapid reviews of Health Technology Assessments?", a study was undertaken in a sample of rapid review Health Technology Assessments from the Health Technology Assessment database within the Cochrane Library and other specialised Health Technology Assessment databases to investigate similarities and/or differences in rapid review methodology utilised.
• Rapid Review Guidebook Dobbins, M. (2017). Rapid review guidebook. Hamilton, ON: National Collaborating Centre for Methods and Tools.
• NCCMT Summary and Tool for Dobbins' Rapid Review Guidebook National Collaborating Centre for Methods and Tools. (2017). Rapid review guidebook. Hamilton, ON: McMaster University. Retrieved from http://www.nccmt.ca/knowledge-repositories/search/308
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A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022

• Laura Ellen Ashcraft   ORCID: orcid.org/0000-0001-9957-0617 1 , 2 ,
• David E. Goodrich 3 , 4 , 5 ,
• Joachim Hero 6 ,
• Angela Phares 3 ,
• Rachel L. Bachrach 7 , 8 ,
• Deirdre A. Quinn 3 , 4 ,
• Nabeel Qureshi 6 ,
• Natalie C. Ernecoff 6 ,
• Lisa G. Lederer 5 ,
• Leslie Page Scheunemann 9 , 10 ,
• Shari S. Rogal 3 , 11   na1 &
• Matthew J. Chinman 3 , 4 , 6   na1  

Implementation Science volume  19 , Article number:  43 ( 2024 ) Cite this article

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Studies of implementation strategies range in rigor, design, and evaluated outcomes, presenting interpretation challenges for practitioners and researchers. This systematic review aimed to describe the body of research evidence testing implementation strategies across diverse settings and domains, using the Expert Recommendations for Implementing Change (ERIC) taxonomy to classify strategies and the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) framework to classify outcomes.

We conducted a systematic review of studies examining implementation strategies from 2010-2022 and registered with PROSPERO (CRD42021235592). We searched databases using terms “implementation strategy”, “intervention”, “bundle”, “support”, and their variants. We also solicited study recommendations from implementation science experts and mined existing systematic reviews. We included studies that quantitatively assessed the impact of at least one implementation strategy to improve health or health care using an outcome that could be mapped to the five evaluation dimensions of RE-AIM. Only studies meeting prespecified methodologic standards were included. We described the characteristics of studies and frequency of implementation strategy use across study arms. We also examined common strategy pairings and cooccurrence with significant outcomes.

Our search resulted in 16,605 studies; 129 met inclusion criteria. Studies tested an average of 6.73 strategies (0-20 range). The most assessed outcomes were Effectiveness ( n =82; 64%) and Implementation ( n =73; 56%). The implementation strategies most frequently occurring in the experimental arm were Distribute Educational Materials ( n =99), Conduct Educational Meetings ( n =96), Audit and Provide Feedback ( n =76), and External Facilitation ( n =59). These strategies were often used in combination. Nineteen implementation strategies were frequently tested and associated with significantly improved outcomes. However, many strategies were not tested sufficiently to draw conclusions.

This review of 129 methodologically rigorous studies built upon prior implementation science data syntheses to identify implementation strategies that had been experimentally tested and summarized their impact on outcomes across diverse outcomes and clinical settings. We present recommendations for improving future similar efforts.

Peer Review reports

Contributions to the literature

While many implementation strategies exist, it has been challenging to compare their effectiveness across a wide range of trial designs and practice settings

This systematic review provides a transdisciplinary evaluation of implementation strategies across population, practice setting, and evidence-based interventions using a standardized taxonomy of strategies and outcomes.

Educational strategies were employed ubiquitously; nineteen other commonly used implementation strategies, including External Facilitation and Audit and Provide Feedback, were associated with positive outcomes in these experimental trials.

This review offers guidance for scholars and practitioners alike in selecting implementation strategies and suggests a roadmap for future evidence generation.

Implementation strategies are “methods or techniques used to enhance the adoption, implementation, and sustainment of evidence-based practices or programs” (EBPs) [ 1 ]. In 2015, the Expert Recommendations for Implementing Change (ERIC) study organized a panel of implementation scientists to compile a standardized set of implementation strategy terms and definitions [ 2 , 3 , 4 ]. These 73 strategies were then organized into nine “clusters” [ 5 ]. The ERIC taxonomy has been widely adopted and further refined [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. However, much of the evidence for individual or groups of ERIC strategies remains narrowly focused. Prior systematic reviews and meta-analyses have assessed strategy effectiveness, but have generally focused on a specific strategy, (e.g., Audit and Provide Feedback) [ 14 , 15 , 16 ], subpopulation, disease (e.g., individuals living with dementia) [ 16 ], outcome [ 15 ], service setting (e.g., primary care clinics) [ 17 , 18 , 19 ] or geography [ 20 ]. Given that these strategies are intended to have broad applicability, there remains a need to understand how well implementation strategies work across EBPs and settings and the extent to which implementation knowledge is generalizable.

There are challenges in assessing the evidence of implementation strategies across many EBPs, populations, and settings. Heterogeneity in population characteristics, study designs, methods, and outcomes have made it difficult to quantitatively compare which strategies work and under which conditions [ 21 ]. Moreover, there remains significant variability in how researchers operationalize, apply, and report strategies (individually or in combination) and outcomes [ 21 , 22 ]. Still, synthesizing data related to using individual strategies would help researchers replicate findings and better understand possible mediating factors including the cost, timing, and delivery by specific types of health providers or key partners [ 23 , 24 , 25 ]. Such an evidence base would also aid practitioners with implementation planning such as when and how to deploy a strategy for optimal impact.

Building upon previous efforts, we therefore conducted a systematic review to evaluate the level of evidence supporting the ERIC implementation strategies across a broad array of health and human service settings and outcomes, as organized by the evaluation framework, RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) [ 26 , 27 , 28 ]. A secondary aim of this work was to identify patterns in scientific reporting of strategy use that could not only inform reporting standards for strategies but also the methods employed in future. The current study was guided by the following research questions Footnote 1 :

What implementation strategies have been most commonly and rigorously tested in health and human service settings?

Which implementation strategies were commonly paired?

What is the evidence supporting commonly tested implementation strategies?

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) model [ 29 , 30 , 31 ] to develop and report on the methods for this systematic review (Additional File 1). This study was considered to be non-human subjects research by the RAND institutional review board.

Registration

The protocol was registered with PROSPERO (PROSPERO 2021 CRD42021235592).

Eligibility criteria

This review sought to synthesize evidence for implementation strategies from research studies conducted across a wide range of health-related settings and populations. Inclusion criteria required studies to: 1) available in English; 2) published between January 1, 2010 and September 20, 2022; 3) based on experimental research (excluded protocols, commentaries, conference abstracts, or proposed frameworks); 4) set in a health or human service context (described below); 5) tested at least one quantitative outcome that could be mapped to the RE-AIM evaluation framework [ 26 , 27 , 28 ]; and 6) evaluated the impact of an implementation strategy that could be classified using the ERIC taxonomy [ 2 , 32 ]. We defined health and human service setting broadly, including inpatient and outpatient healthcare settings, specialty clinics, mental health treatment centers, long-term care facilities, group homes, correctional facilities, child welfare or youth services, aging services, and schools, and required that the focus be on a health outcome. We excluded hybrid type I trials that primarily focused on establishing EBP effectiveness, qualitative studies, studies that described implementation barriers and facilitators without assessing implementation strategy impact on an outcome, and studies not meeting standardized rigor criteria defined below.

Information sources

Our three-pronged search strategy included searching academic databases (i.e., CINAHL, PubMed, and Web of Science for replicability and transparency), seeking recommendations from expert implementation scientists, and assessing existing, relevant systematic reviews and meta-analyses.

Search strategy

Search terms included “implementation strateg*” OR “implementation intervention*” OR “implementation bundl*” OR “implementation support*.” The search, conducted on September 20, 2022, was limited to English language and publication between 2010 and 2022, similar to other recent implementation science reviews [ 22 ]. This timeframe was selected to coincide with the advent of Implementation Science and when the term “implementation strategy” became conventionally used [ 2 , 4 , 33 ]. A full search strategy can be found in Additional File 2.

Title and abstract screening process

Each study’s title and abstract were read by two reviewers, who dichotomously scored studies on each of the six eligibility criteria described above as yes=1 or no=0, resulting in a score ranging from 1 to 6. Abstracts receiving a six from both reviewers were included in the full text review. Those with only one score of six were adjudicated by a senior member of the team (MJC, SSR, DEG). The study team held weekly meetings to troubleshoot and resolve any ongoing issues noted through the abstract screening process.

Full text screening

During the full text screening process, we reviewed, in pairs, each article that had progressed through abstract screening. Conflicts between reviewers were adjudicated by a senior member of the team for a final inclusion decision (MJC, SSR, DEG).

Review of study rigor

After reviewing published rigor screening tools [ 34 , 35 , 36 ], we developed an assessment of study rigor that was appropriate for the broad range of reviewed implementation studies. Reviewers evaluated studies on the following: 1) presence of a concurrent comparison or control group (=2 for traditional randomized controlled trial or stepped wedge cluster randomized trial and =1 for pseudo-randomized and other studies with concurrent control); 2) EBP standardization by protocol or manual (=1 if present); 3) EBP fidelity tracking (=1 if present); 4) implementation strategy standardization by operational description, standard training, or manual (=1 if present); 5) length of follow-up from full implementation of intervention (=2 for twelve months or longer, =1 for six to eleven months, or =0 for less than six months); and 6) number of sites (=1 for more than one site). Rigor scores ranged from 0 to 8, with 8 indicating the most rigorous. Articles were included if they 1) included a concurrent control group, 2) had an experimental design, and 3) received a score of 7 or 8 from two independent reviewers.

Outside expert consultation

We contacted 37 global implementation science experts who were recognized by our study team as leaders in the field or who were commonly represented among first or senior authors in the included abstracts. We asked each expert for recommendations of publications meeting study inclusion criteria (i.e., quantitatively evaluating the effectiveness of an implementation strategy). Recommendations were recorded and compared to the full abstract list.

Systematic reviews

Eighty-four systematic reviews were identified through the initial search strategy (See Additional File 3). Systematic reviews that examined the effectiveness of implementation strategies were reviewed in pairs for studies that were not found through our initial literature search.

Data abstraction and coding

Data from the full text review were abstracted in pairs, with conflicts resolved by senior team members (DEG, MJC) using a standard Qualtrics abstraction form. The form captured the setting, number of sites and participants studied, evidence-based practice/program of focus, outcomes assessed (based on RE-AIM), strategies used in each study arm, whether the study took place in the U.S. or outside of the U.S., and the findings (i.e., was there significant improvement in the outcome(s)?). We coded implementation strategies used in the Control and Experimental Arms. We defined the Control Arm as receiving the lowest number of strategies (which could mean zero strategies or care as usual) and the Experimental Arm as the most intensive arm (i.e., receiving the highest number of strategies). When studies included multiple Experimental Arms, the Experimental Arm with the least intensive implementation strategy(ies) was classified as “Control” and the Experimental Arm with the most intensive implementation strategy(ies) was classified as the “Experimental” Arm.

Implementation strategies were classified using standard definitions (MJC, SSR, DEG), based on minor modifications to the ERIC taxonomy [ 2 , 3 , 4 ]. Modifications resulted in 70 named strategies and were made to decrease redundancy and improve clarity. These modifications were based on input from experts, cognitive interview data, and team consensus [ 37 ] (See Additional File 4). Outcomes were then coded into RE-AIM outcome domains following best practices as recommended by framework experts [ 26 , 27 , 28 ]. We coded the RE-AIM domain of Effectiveness as either an assessment of the effectiveness of the EBP or the implementation strategy. We did not assess implementation strategy fidelity or effects on health disparities as these are recently adopted reporting standards [ 27 , 28 ] and not yet widely implemented in current publications. Further, we did not include implementation costs as an outcome because reporting guidelines have not been standardized [ 38 , 39 ].

Assessment and minimization of bias

Assessment and minimization of bias is an important component of high-quality systematic reviews. The Cochrane Collaboration guidance for conducting high-quality systematic reviews recommends including a specific assessment of bias for individual studies by assessing the domains of randomization, deviations of intended intervention, missing data, measurement of the outcome, and selection of the reported results (e.g., following a pre-specified analysis plan) [ 40 , 41 ]. One way we addressed bias was by consolidating multiple publications from the same study into a single finding (i.e., N =1), so-as to avoid inflating estimates due to multiple publications on different aspects of a single trial. We also included high-quality studies only, as described above. However, it was not feasible to consistently apply an assessment of bias tool due to implementation science’s broad scope and the heterogeneity of study design, context, outcomes, and variable measurement, etc. For example, most implementation studies reviewed had many outcomes across the RE-AIM framework, with no one outcome designated as primary, precluding assignment of a single score across studies.

We used descriptive statistics to present the distribution of health or healthcare area, settings, outcomes, and the median number of included patients and sites per study, overall and by country (classified as U.S. vs. non-U.S.). Implementation strategies were described individually, using descriptive statistics to summarize the frequency of strategy use “overall” (in any study arm), and the mean number of strategies reported in the Control and Experimental Arms. We additionally described the strategies that were only in the experimental (and not control) arm, defining these as strategies that were “tested” and may have accounted for differences in outcomes between arms.

We described frequencies of pair-wise combinations of implementation strategies in the Experimental Arm. To assess the strength of the evidence supporting implementation strategies that were used in the Experimental Arm, study outcomes were categorized by RE-AIM and coded based on whether the association between use of the strategies resulted in a significantly positive effect (yes=1; no=0). We then created an indicator variable if at least one RE-AIM outcome in the study was significantly positive (yes=1; no=0). We plotted strategies on a graph with quadrants based on the combination of median number of studies in which a strategy appears and the median percent of studies in which a strategy was associated with at least one positive RE-AIM outcome. The upper right quadrant—higher number of studies overall and higher percent of studies with a significant RE-AIM outcome—represents a superior level of evidence. For implementation strategies in the upper right quadrant, we describe each RE-AIM outcome and the proportion of studies which have a significant outcome.

Search results

We identified 14,646 articles through the initial literature search, 17 articles through expert recommendation (three of which were not included in the initial search), and 1,942 articles through reviewing prior systematic reviews (Fig. 1 ). After removing duplicates, 9,399 articles were included in the initial abstract screening. Of those, 48% ( n =4,075) abstracts were reviewed in pairs for inclusion. Articles with a score of five or six were reviewed a second time ( n =2,859). One quarter of abstracts that scored lower than five were reviewed for a second time at random. We screened the full text of 1,426 articles in pairs. Common reasons for exclusion were 1) study rigor, including no clear delineation between the EBP and implementation strategy, 2) not testing an implementation strategy, and 3) article type that did not meet inclusion criteria (e.g., commentary, protocol, etc.). Six hundred seventeen articles were reviewed for study rigor with 385 excluded for reasons related to study design and rigor, and 86 removed for other reasons (e.g., not a research article). Among the three additional expert-recommended articles, one met inclusion criteria and was added to the analysis. The final number of studies abstracted was 129 representing 143 publications.

Expanded PRISMA Flow Diagram

The expanded PRISMA flow diagram provides a description of each step in the review and abstraction process for the systematic review

Descriptive results

Of 129 included studies (Table 1 ; see also Additional File 5 for Summary of Included Studies), 103 (79%) were conducted in a healthcare setting. EBP health care setting varied and included primary care ( n =46; 36%), specialty care ( n =27; 21%), mental health ( n =11; 9%), and public health ( n =30; 23%), with 64 studies (50%) occurring in an outpatient health care setting. Studies included a median of 29 sites and 1,419 target population (e.g., patients or students). The number of strategies varied widely across studies, with Control Arms averaging approximately two strategies (Range = 0-20, including studies with no strategy in the comparison group) and Experimental Arms averaging eight strategies (Range = 1-21). Non-US studies ( n =73) included more sites and target population on average, with an overall median of 32 sites and 1,531 patients assessed in each study.

Organized by RE-AIM, the most evaluated outcomes were Effectiveness ( n = 82, 64%) and Implementation ( n = 73, 56%); followed by Maintenance ( n =40; 31%), Adoption ( n =33; 26%), and Reach ( n =31; 24%). Most studies ( n = 98, 76%) reported at least one significantly positive outcome. Adoption and Implementation outcomes showed positive change in three-quarters of studies ( n =78), while Reach ( n =18; 58%), Effectiveness ( n =44; 54%), and Maintenance ( n =23; 58%) outcomes evidenced positive change in approximately half of studies.

The following describes the results for each research question.

Table 2 shows the frequency of studies within which an implementation strategy was used in the Control Arm, Experimental Arm(s), and tested strategies (those used exclusively in the Experimental Arm) grouped by strategy type, as specified by previous ERIC reports [ 2 , 6 ].

Control arm

In about half the studies (53%; n =69), the Control Arms were “active controls” that included at least one strategy, with an average of 1.64 (and up to 20) strategies reported in control arms. The two most common strategies used in Control Arms were: Distribute Educational Materials ( n =52) and Conduct Educational Meetings ( n =30).

Experimental arm

Experimental conditions included an average of 8.33 implementation strategies per study (Range = 1-21). Figure 2 shows a heat map of the strategies that were used in the Experimental Arms in each study. The most common strategies in the Experimental Arm were Distribute Educational Materials ( n =99), Conduct Educational Meetings ( n =96), Audit and Provide Feedback ( n =76), and External Facilitation ( n =59).

Implementation strategies used in the Experimental Arm of included studies. Explore more here: https://public.tableau.com/views/Figure2_16947070561090/Figure2?:language=en-US&:display_count=n&:origin=viz_share_link

Tested strategies

The average number of implementation strategies that were included in the Experimental Arm only (and not in the Control Arm) was 6.73 (Range = 0-20). Footnote 2 Overall, the top 10% of tested strategies included Conduct Educational Meetings ( n =68), Audit and Provide Feedback ( n =63), External Facilitation ( n =54), Distribute Educational Materials ( n =49), Tailor Strategies ( n =41), Assess for Readiness and Identify Barriers and Facilitators ( n =38) and Organize Clinician Implementation Team Meetings ( n =37). Few studies tested a single strategy ( n =9). These strategies included, Audit and Provide Feedback, Conduct Educational Meetings, Conduct Ongoing Training, Create a Learning Collaborative, External Facilitation ( n =2), Facilitate Relay of Clinical Data To Providers, Prepare Patients/Consumers to be Active Participants, and Use Other Payment Schemes. Three implementation strategies were included in the Control or Experimental Arms but were not Tested including, Use Mass Media, Stage Implementation Scale Up, and Fund and Contract for the Clinical Innovation.

Table 3  shows the five most used strategies in Experimental Arms with their top ten most frequent pairings, excluding Distribute Educational Materials and Conduct Educational Meetings, as these strategies were included in almost all Experimental and half of Control Arms. The five most used strategies in the Experimental Arm included Audit and Provide Feedback ( n =76), External Facilitation ( n =59), Tailor Strategies ( n =43), Assess for Readiness and Identify Barriers and Facilitators ( n =43), and Organize Implementation Teams ( n =42).

Strategies frequently paired with these five strategies included two educational strategies: Distribute Educational Materials and Conduct Educational Meetings. Other commonly paired strategies included Develop a Formal Implementation Blueprint, Promote Adaptability, Conduct Ongoing Training, Purposefully Reexamine the Implementation, and Develop and Implement Tools for Quality Monitoring.

We classified the strength of evidence for each strategy by evaluating both the number of studies in which each strategy appeared in the Experimental Arm and the percentage of times there was at least one significantly positive RE-AIM outcome. Using these factors, Fig. 3 shows the number of studies in which individual strategies were evaluated (on the y axis) compared to the percentage of times that studies including those strategies had at least one positive outcome (on the x axis). Due to the non-normal distribution of both factors, we used the median (rather than the mean) to create four quadrants. Strategies in the lower left quadrant were tested in fewer than the median number of studies (8.5) and were less frequently associated with a significant RE-AIM outcome (75%). The upper right quadrant included strategies that occurred in more than the median number of studies (8.5) and had more than the median percent of studies with a significant RE-AIM outcome (75%); thus those 19 strategies were viewed as having stronger evidence. Of those 19 implementation strategies, Conduct Educational Meetings, Distribute Educational Materials, External Facilitation, and Audit and Provide Feedback continued to occur frequently, appearing in 59-99 studies.

Experimental Arm Implementation Strategies with significant RE-AIM outcome. Explore more here: https://public.tableau.com/views/Figure3_16947017936500/Figure3?:language=en-US&publish=yes&:display_count=n&:origin=viz_share_link

Figure 4 graphically illustrates the proportion of significant outcomes for each RE-AIM outcome for the 19 commonly used and evidence-based implementation strategies in the upper right quadrant. These findings again show the widespread use of Conduct Educational Meetings and Distribute Educational Materials. Implementation and Effectiveness outcomes were assessed most frequently, with Implementation being the mostly commonly reported significantly positive outcome.

RE-AIM outcomes for the 19 Top-Right Quadrant Implementation Strategies . The y-axis is the number of studies and the x-axis is a stacked bar chart for each RE-AIM outcome with R=Reach, E=Effectiveness, A=Adoption, I=Implementation, M=Maintenance. Blue denotes at least one significant RE-AIM outcome; Light blue denotes studies which used the given implementation strategy and did not have a significant RE-AIM . Explore more here: https://public.tableau.com/views/Figure4_16947017112150/Figure4?:language=en-US&publish=yes&:display_count=n&:origin=viz_share_link

This systematic review identified 129 experimental studies examining the effectiveness of implementation strategies across a broad range of health and human service studies. Overall, we found that evidence is lacking for most ERIC implementation strategies, that most studies employed combinations of strategies, and that implementation outcomes, categorized by RE-AIM dimensions, have not been universally defined or applied. Accordingly, other researchers have described the need for universal outcomes definitions and descriptions across implementation research studies [ 28 , 42 ]. Our findings have important implications not only for the current state of the field but also for creating guidance to help investigators determine which strategies and in what context to examine.

The four most evaluated strategies were Distribute Educational Materials, Conduct Educational Meetings, External Facilitation, and Audit and Provide Feedback. Conducting Educational Meetings and Distributing Educational Materials were surprisingly the most common. This may reflect the fact that education strategies are generally considered to be “necessary but not sufficient” for successful implementation [ 43 , 44 ]. Because education is often embedded in interventions, it is critical to define the boundary between the innovation and the implementation strategies used to support the innovation. Further specification as to when these strategies are EBP core components or implementation strategies (e.g., booster trainings or remediation) is needed [ 45 , 46 ].

We identified 19 implementation strategies that were tested in at least 8 studies (more than the median) and were associated with positive results at least 75% of the time. These strategies can be further categorized as being used in early or pre-implementation versus later in implementation. Preparatory activities or pre-implementation, strategies that had strong evidence included educational activities (Meetings, Materials, Outreach visits, Train for Leadership, Use Train the Trainer Strategies) and site diagnostic activities (Assess for Readiness, Identify Barriers and Facilitators, Conduct Local Needs Assessment, Identify and Prepare Champions, and Assess and Redesign Workflows). Strategies that target the implementation phase include those that provide coaching and support (External and Internal Facilitation), involve additional key partners (Intervene with Patients to Enhance Uptake and Adherence), and engage in quality improvement activities (Audit and Provide Feedback, Facilitate the Relay of Clinical Data to Providers, Purposefully Reexamine the Implementation, Conduct Cyclical Small Tests of Change, Develop and Implement Tools for Quality Monitoring).

There were many ERIC strategies that were not represented in the reviewed studies, specifically the financial and policy strategies. Ten strategies were not used in any studies, including: Alter Patient/Consumer Fees, Change Liability Laws, Change Service Sites, Develop Disincentives, Develop Resource Sharing Agreements, Identify Early Adopters, Make Billing Easier, Start a Dissemination Organization, Use Capitated Payments, and Use Data Experts. One of the limitations of this investigation was that not all individual strategies or combinations were investigated. Reasons for the absence of these strategies in our review may include challenges with testing certain strategies experimentally (e.g., changing liability laws), limitations in our search terms, and the relative paucity of implementation strategy trials compared to clinical trials. Many “untested” strategies require large-scale structural changes with leadership support (see [ 47 ] for policy experiment example). Recent preliminary work has assessed the feasibility of applying policy strategies and described the challenges with doing so [ 48 , 49 , 50 ]. While not impossible in large systems like VA (for example: the randomized evaluation of the VA Stratification Tool for Opioid Risk Management) the large size, structure, and organizational imperative makes these initiatives challenging to experimentally evaluate. Likewise, the absence of these ten strategies may have been the result of our inclusion criteria, which required an experimental design. Thus, creative study designs may be needed to test high-level policy or financial strategies experimentally.

Some strategies that were likely under-represented in our search strategy included electronic medical record reminders and clinical decision support tools and systems. These are often considered “interventions” when used by clinical trialists and may not be indexed as studies involving ‘implementation strategies’ (these tools have been reviewed elsewhere [ 51 , 52 , 53 ]). Thus, strategies that are also considered interventions in the literature (e.g., education interventions) were not sought or captured. Our findings do not imply that these strategies are ineffective, rather that more study is needed. Consistent with prior investigations [ 54 ], few studies meeting inclusion criteria tested financial strategies. Accordingly, there are increasing calls to track and monitor the effects of financial strategies within implementation science to understand their effectiveness in practice [ 55 , 56 ]. However, experts have noted that the study of financial strategies can be a challenge given that they are typically implemented at the system-level and necessitate research designs for studying policy-effects (e.g., quasi-experimental methods, systems-science modeling methods) [ 57 ]. Yet, there have been some recent efforts to use financial strategies to support EBPs that appear promising [ 58 ] and could be a model for the field moving forward.

The relationship between the number of strategies used and improved outcomes has been described inconsistently in the literature. While some studies have found improved outcomes with a bundle of strategies that were uniquely combined or a standardized package of strategies (e.g., Replicating Effective Programs [ 59 , 60 ] and Getting To Outcomes [ 61 , 62 ]), others have found that “more is not always better” [ 63 , 64 , 65 ]. For example, Rogal and colleagues documented that VA hospitals implementing a new evidence-based hepatitis C treatment chose >20 strategies, when multiple years of data linking strategies to outcomes showed that 1-3 specific strategies would have yielded the same outcome [ 39 ]. Considering that most studies employed multiple or multifaceted strategies, it seems that there is a benefit of using a targeted bundle of strategies that are purposefully aligns with site/clinic/population norms, rather than simply adding more strategies [ 66 ].

It is difficult to assess the effectiveness of any one implementation strategy in bundles where multiple strategies are used simultaneously. Even a ‘single’ strategy like External Facilitation is, in actuality, a bundle of narrowly constructed strategies (e.g., Conduct Educational Meetings, Identify and Prepare Champions, and Develop a Formal Implementation Blueprint). Thus, studying External Facilitation does not allow for a test of the individual strategies that comprise it, potentially masking the effectiveness of any individual strategy. While we cannot easily disaggregate the effects of multifaceted strategies, doing so may not yield meaningful results. Because strategies often synergize, disaggregated results could either underestimate the true impact of individual strategies or conversely, actually undermine their effectiveness (i.e., when their effectiveness comes from their combination with other strategies). The complexity of health and human service settings, imperative to improve public health outcomes, and engagement with community partners often requires the use of multiple strategies simultaneously. Therefore, the need to improve real-world implementation may outweigh the theoretical need to identify individual strategy effectiveness. In situations where it would be useful to isolate the impact of single strategies, we suggest that the same methods for documenting and analyzing the critical components (or core functions) of complex interventions [ 67 , 68 , 69 , 70 ] may help to identify core components of multifaceted implementation strategies [ 71 , 72 , 73 , 74 ].

In addition, to truly assess the impacts of strategies on outcomes, it may be necessary to track fidelity to implementation strategies (not just the EBPs they support). While this can be challenging, without some degree of tracking and fidelity checks, one cannot determine whether a strategy’s apparent failure to work was because it 1) was ineffective or 2) was not applied well. To facilitate this tracking there are pragmatic tools to support researchers. For example, the Longitudinal Implementation Strategy Tracking System (LISTS) offers a pragmatic and feasible means to assess fidelity to and adaptations of strategies [ 75 ].

Implications for implementation science: four recommendations

Based on our findings, we offer four recommended “best practices” for implementation studies.

Prespecify strategies using standard nomenclature. This study reaffirmed the need to apply not only a standard naming convention (e.g., ERIC) but also a standard reporting of for implementation strategies. While reporting systems like those by Proctor [ 1 ] or Pinnock [ 75 ] would optimize learning across studies, few manuscripts specify strategies as recommended [ 76 , 77 ]. Pre-specification allows planners and evaluators to assess the feasibility and acceptability of strategies with partners and community members [ 24 , 78 , 79 ] and allows evaluators and implementers to monitor and measure the fidelity, dose, and adaptations to strategies delivered over the course of implementation [ 27 ]. In turn, these data can be used to assess the costs, analyze their effectiveness [ 38 , 80 , 81 ], and ensure more accurate reporting [ 82 , 83 , 84 , 85 ]. This specification should include, among other data, the intensity, stage of implementation, and justification for the selection. Information regarding why strategies were selected for specific settings would further the field and be of great use to practitioners. [ 63 , 65 , 69 , 79 , 86 ].

Ensure that standards for measuring and reporting implementation outcomes are consistently applied and account for the complexity of implementation studies. Part of improving standardized reporting must include clearly defining outcomes and linking each outcome to particular implementation strategies. It was challenging in the present review to disentangle the impact of the intervention(s) (i.e., the EBP) versus the impact of the implementation strategy(ies) for each RE-AIM dimension. For example, often fidelity to the EBP was reported but not for the implementation strategies. Similarly, Reach and Adoption of the intervention would be reported for the Experimental Arm but not for the Control Arm, prohibiting statistical comparisons of strategies on the relative impact of the EBP between study arms. Moreover, there were many studies evaluating numerous outcomes, risking data dredging. Further, the significant heterogeneity in the ways in which implementation outcomes are operationalized and reported is a substantial barrier to conducting large-scale meta-analytic approaches to synthesizing evidence for implementation strategies [ 67 ]. The field could look to others in the social and health sciences for examples in how to test, validate, and promote a common set of outcome measures to aid in bringing consistency across studies and real-world practice (e.g., the NIH-funded Patient-Reported Outcomes Measurement Information System [PROMIS], https://www.healthmeasures.net/explore-measurement-systems/promis ).

Develop infrastructure to learn cross-study lessons in implementation science. Data repositories, like those developed by NCI for rare diseases, U.S. HIV Implementation Science Coordination Initiative [ 87 ], and the Behavior Change Technique Ontology [ 88 ], could allow implementation scientists to report their findings in a more standardized manner, which would promote ease of communication and contextualization of findings across studies. For example, the HIV Implementation Science Coordination Initiative requested all implementation projects use common frameworks, developed user friendly databases to enable practitioners to match strategies to determinants, and developed a dashboard of studies that assessed implementation determinants [ 89 , 90 , 91 , 92 , 93 , 94 ].

Develop and apply methods to rigorously study common strategies and bundles. These findings support prior recommendations for improved empirical rigor in implementation studies [ 46 , 95 ]. Many studies were excluded from our review based on not meeting methodological rigor standards. Understanding the effectiveness of discrete strategies deployed alone or in combination requires reliable and low burden tracking methods to collect information about strategy use and outcomes. For example, frameworks like the Implementation Replication Framework [ 96 ] could help interpret findings across studies using the same strategy bundle. Other tracking approaches may leverage technology (e.g., cell phones, tablets, EMR templates) [ 78 , 97 ] or find novel, pragmatic approaches to collect recommended strategy specifications over time (e.g.., dose, deliverer, and mechanism) [ 1 , 9 , 27 , 98 , 99 ]. Rigorous reporting standards could inform more robust analyses and conclusions (e.g., moving toward the goal of understanding causality, microcosting efforts) [ 24 , 38 , 100 , 101 ]. Such detailed tracking is also required to understand how site-level factors moderate implementation strategy effects [ 102 ]. In some cases, adaptive trial designs like sequential multiple assignment randomized trials (SMARTs) and just-in-time adaptive interventions (JITAIs) can be helpful for planning strategy escalation.

Limitations

Despite the strengths of this review, there were certain notable limitations. For one, we only included experimental studies, omitting many informative observational investigations that cover the range of implementation strategies. Second, our study period was centered on the creation of the journal Implementation Science and not on the standardization and operationalization of implementation strategies in the publication of the ERIC taxonomy (which came later). This, in conjunction with latency in reporting study results and funding cycles, means that the employed taxonomy was not applied in earlier studies. To address this limitation, we retroactively mapped strategies to ERIC, but it is possible that some studies were missed. Additionally, indexing approaches used by academic databases may have missed relevant studies. We addressed this particular concern by reviewing other systematic reviews of implementation strategies and soliciting recommendations from global implementation science experts.

Another potential limitation comes from the ERIC taxonomy itself—i.e., strategy listings like ERIC are only useful when they are widely adopted and used in conjunction with guidelines for specifying and reporting strategies [ 1 ] in protocol and outcome papers. Although the ERIC paper has been widely cited (over three thousand times, accessed about 186 thousand times), it is still not universally applied, making tracking the impact of specific strategies more difficult. However, our experience with this review seemed to suggest that ERIC’s use was increasing over time. Also, some have commented that ERIC strategies can be unclear and are missing key domains. Thus, researchers are making definitions clearer for lay users [ 37 , 103 ], increasing the number of discrete strategies for specific domains like HIV treatment, acknowledging strategies for new functions (e.g., de-implementation [ 104 ], local capacity building), accounting for phases of implementation (dissemination, sustainment [ 13 ], scale-up), addressing settings [ 12 , 20 ], actors roles in the process, and making mechanisms of change to select strategies more user-friendly through searchable databases [ 9 , 10 , 54 , 73 , 104 , 105 , 106 ]. In sum, we found the utility of the ERIC taxonomy to outweigh any of the taxonomy’s current limitations.

As with all reviews, the search terms influenced our findings. As such, the broad terms for implementation strategies (e.g., “evidence-based interventions”[ 7 ] or “behavior change techniques” [ 107 ]) may have led to inadvertent omissions of studies of specific strategies. For example, the search terms may not have captured tests of policies, financial strategies, community health promotion initiatives, or electronic medical record reminders, due to differences in terminology used in corresponding subfields of research (e.g., health economics, business, health information technology, and health policy). To manage this, we asked experts to inform us about any studies that they would include and cross-checked their lists with what was identified through our search terms, which yielded very few additional studies. We included standard coding using the ERIC taxonomy, which was a strength, but future work should consider including the additional strategies that have been recommended to augment ERIC, around sustainment [ 13 , 79 , 106 , 108 ], community and public health research [ 12 , 109 , 110 , 111 ], consumer or service user engagement [ 112 ], de-implementation [ 104 , 113 , 114 , 115 , 116 , 117 ] and related terms [ 118 ].

We were unable to assess the bias of studies due to non-standard reporting across the papers and the heterogeneity of study designs, measurement of implementation strategies and outcomes, and analytic approaches. This could have resulted in over- or underestimating the results of our synthesis. We addressed this limitation by being cautious in our reporting of findings, specifically in identifying “effective” implementation strategies. Further, we were not able to gather primary data to evaluate effect sizes across studies in order to systematically evaluate bias, which would be fruitful for future study.

Conclusions

This novel review of 129 studies summarized the body of evidence supporting the use of ERIC-defined implementation strategies to improve health or healthcare. We identified commonly occurring implementation strategies, frequently used bundles, and the strategies with the highest degree of supportive evidence, while simultaneously identifying gaps in the literature. Additionally, we identified several key areas for future growth and operationalization across the field of implementation science with the goal of improved reporting and assessment of implementation strategies and related outcomes.

Availability and materials

All data for this study are included in this published article and its supplementary information files.

We modestly revised the following research questions from our PROSPERO registration after reading the articles and better understanding the nature of the literature: 1) What is the available evidence regarding the effectiveness of implementation strategies in supporting the uptake and sustainment of evidence intended to improve health and healthcare outcomes? 2) What are the current gaps in the literature (i.e., implementation strategies that do not have sufficient evidence of effectiveness) that require further exploration?

Tested strategies are those which exist in the Experimental Arm but not in the Control Arm. Comparative effectiveness or time staggered trials may not have any unique strategies in the Experimental Arm and therefore in our analysis would have no Tested Strategies.

Abbreviations

Centers for Disease Control

Cumulated Index to Nursing and Allied Health Literature

Dissemination and Implementation

Evidence-based practices or programs

Expert Recommendations for Implementing Change

Multiphase Optimization Strategy

National Cancer Institute

National Institutes of Health

The Pittsburgh Dissemination and Implementation Science Collaborative

Sequential Multiple Assignment Randomized Trial

United States

Department of Veterans Affairs

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Acknowledgements

The authors would like to acknowledge the early contributions of the Pittsburgh Dissemination and Implementation Science Collaborative (Pitt DISC). LEA would like to thank Dr. Billie Davis for analytical support. The authors would like to acknowledge the implementation science experts who recommended articles for our review, including Greg Aarons, Mark Bauer, Rinad Beidas, Geoffrey Curran, Laura Damschroder, Rani Elwy, Amy Kilbourne, JoAnn Kirchner, Jennifer Leeman, Cara Lewis, Dennis Li, Aaron Lyon, Gila Neta, and Borsika Rabin.

Dr. Rogal’s time was funded in part by a University of Pittsburgh K award (K23-DA048182) and by a VA Health Services Research and Development grant (PEC 19-207). Drs. Bachrach and Quinn were supported by VA HSR Career Development Awards (CDA 20-057, PI: Bachrach; CDA 20-224, PI: Quinn). Dr. Scheunemann’s time was funded by the US Agency for Healthcare Research and Quality (K08HS027210). Drs. Hero, Chinman, Goodrich, Ernecoff, and Mr. Qureshi were funded by the Patient-Centered Outcomes Research Institute (PCORI) AOSEPP2 Task Order 12 to conduct a landscape review of US studies on the effectiveness of implementation strategies with results reported here ( https://www.pcori.org/sites/default/files/PCORI-Implementation-Strategies-for-Evidence-Based-Practice-in-Health-and-Health-Care-A-Review-of-the-Evidence-Full-Report.pdf and https://www.pcori.org/sites/default/files/PCORI-Implementation-Strategies-for-Evidence-Based-Practice-in-Health-and-Health-Care-Brief-Report-Summary.pdf ). Dr. Ashcraft and Ms. Phares were funded by the Center for Health Equity Research and Promotion, (CIN 13-405). The funders had no involvement in this study.

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Shari S. Rogal and Matthew J. Chinman are co-senior authors.

Authors and Affiliations

Center for Health Equity Research and Promotion, Corporal Michael Crescenz VA Medical Center, Philadelphia, PA, USA

Laura Ellen Ashcraft

Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA

David E. Goodrich, Angela Phares, Deirdre A. Quinn, Shari S. Rogal & Matthew J. Chinman

Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

David E. Goodrich, Deirdre A. Quinn & Matthew J. Chinman

Clinical & Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA

David E. Goodrich & Lisa G. Lederer

RAND Corporation, Pittsburgh, PA, USA

Joachim Hero, Nabeel Qureshi, Natalie C. Ernecoff & Matthew J. Chinman

Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA

Rachel L. Bachrach

Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA

Division of Geriatric Medicine, University of Pittsburgh, Department of Medicine, Pittsburgh, PA, USA

Leslie Page Scheunemann

Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Pittsburgh, Department of Medicine, Pittsburgh, PA, USA

Departments of Medicine and Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Shari S. Rogal

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LEA, SSR, and MJC conceptualized the study. LEA, SSR, MJC, and JOH developed the study design. LEA and JOH acquired the data. LEA, DEG, AP, RLB, DAQ, LGL, LPS, SSR, NQ, and MJC conducted the abstract, full text review, and rigor assessment. LEA, DEG, JOH, AP, RLB, DAQ, NQ, NCE, SSR, and MJC conducted the data abstraction. DEG, SSR, and MJC adjudicated conflicts. LEA and SSR analyzed the data. LEA, SSR, JOH, and MJC interpreted the data. LEA, SSR, and MJC drafted the work. All authors substantially revised the work. All authors approved the submitted version and agreed to be personally accountable for their contributions and the integrity of the work.

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Ashcraft, L.E., Goodrich, D.E., Hero, J. et al. A systematic review of experimentally tested implementation strategies across health and human service settings: evidence from 2010-2022. Implementation Sci 19 , 43 (2024). https://doi.org/10.1186/s13012-024-01369-5

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WHO, WHEN, HOW: a scoping review on flexible at-home respite for informal caregivers of older adults

• Maude Viens 1 , 2 ,
• Alexandra Éthier 1 , 2 ,
• Véronique Provencher 1 , 2 &
• Annie Carrier 1 , 2  

BMC Health Services Research volume  24 , Article number:  767 ( 2024 ) Cite this article

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As the world population is aging, considerable efforts need to be put towards developing and maintaining evidenced-based care for older adults. Respite services are part of the selection of homecare offered to informal caregivers. Although current best practices around respite are rooted in person centeredness, there is no integrated synthesis of its flexible components. Such a synthesis could offer a better understanding of key characteristics of flexible respite and, as such, support its implementation and use.

To map the literature around the characteristics of flexible at-home respite for informal caregivers of older adults, a scoping study was conducted. Qualitative data from the review was analyzed using content analysis. The characterization of flexible at-home respite was built on three dimensions: WHO , WHEN and HOW . To triangulate the scoping results, an online questionnaire was distributed to homecare providers and informal caregivers of older adults.

A total of 42 documents were included in the review. The questionnaire was completed by 105 participants. The results summarize the characteristics of flexible at-home respite found in the literature. Flexibility in respite can be understood through three dimensions: (1) WHO is tendering it, (2) WHEN it is tendered and (3) HOW it is tendered. Firstly, human resources ( WHO ) must be compatible with the homecare sector as well as being trained and qualified to offer respite to informal caregivers of older adults. Secondly, flexible respite includes considerations of time, duration, frequency, and predictability ( WHEN ). Lastly, flexible at-home respite exhibits approachability, appropriateness, affordability, availability, and acceptability ( HOW ). Overall, flexible at-home respite adjusts to the needs of the informal caregiver and care recipient in terms of WHO , WHEN , and HOW .

This review is a step towards a more precise definition of flexible at-home respite. Flexibility of homecare, in particular respite, must be considered when designing, implementing and evaluating services.

Peer Review reports

It is an undeniable fact that the world population is aging [ 1 ]. The World Health Organization [ 1 ] estimates that from 2015 to 2050, the percentage of people over 60 years of age will nearly double (from 12 to 22%). Governments must therefore put in place policies, laws and funding infrastructures to provide evidence-based social services and healthcare that are in line with best practices to allow people to age in place [ 2 ]. Aging in place refers to “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level” [ 3 ]. Relevant literature indicates that people do not want to age or end their lives in institutionalized care; most wish to receive care in their home and remain in their community with their informal caregivers [ 4 ].

There is then a need to adequately support informal caregivers (caregiver) in the crucial role that they have in allowing older adults to age in their own home. A caregiver is “a person who provides some type of unpaid, ongoing assistance with activities of daily living or instrumental activities of daily living” [ 5 ]. In their duties, caregivers of older adults are responsible for a considerable amount of homecare [ 6 ]: Transportation, management of appointments and bills, domestic chores, etc. Private and public organizations offer a plethora of services to support caregivers of older adults (e.g., support groups, housekeeping, etc.), including respite. Respite is a service for caregivers consisting in “the temporary provision of care for a person, at home or in an institution, by people other than the primary caregiver” [ 7 ]. Maayan and collaborators [ 7 ] characterize all respite services according to three dimensions: (1) WHERE : The place; in a private home, a daycare centre or a residential setting, (2) WHEN : The duration and planning; ranging from a couple of hours to a number of weeks, planned or unplanned, and finally, (3) WHO : The person providing the service; this may be trained or untrained individuals, paid staff or volunteers. Respite is widely recognized as necessary to support caregivers of older adults [ 8 , 9 ]. Indeed, a large number of studies identify the need and use for respite [ 9 , 10 , 11 , 12 ]. For example, Dal Santo and colleagues (2007) found that caregivers of older adults ( n  = 1643) used respite to manage stressful caregiving situations, but also to have a “time away”, without having to worry about their caregiving role [ 13 ]. At-home respite seems to be favoured over other forms of respite, even with the perceived drawbacks, such as the privacy breach of having a care worker in one’s home [ 14 , 15 ].

Studies suggest that caregivers of older adults seek flexibility as a main component of respite [ 16 , 17 , 18 ]. Flexibility, in line with person-centered care, allows respite that addresses their needs, rather than being services that are prescribed according to other criteria [ 16 , 17 ]. Thus, flexibility, both in accessing and in the respite itself, is essential [ 19 , 20 , 21 , 22 , 23 ]. Although there seems to be a consensus around the broader definition of respite, there is no literature reviewing the characteristics of flexible at-home respite. Some studies and reports from organizations and governments document the flexible characteristics of their models, but there are few literature reviews that address them, specifically [ 18 , 22 , 24 ]. Both reviews by Shaw et al. [ 18 ] and Neville et al. [ 19 ] concede that an operational definition of respite ( WHEN , WHERE , WHO ) is not clear. Neville et al. [ 19 ] conclude that “respite has the potential to be delivered in flexible and positive ways”, without addressing these ways. The absence of a unified definition for flexible at-home respite contributes to the challenges of implementing and evaluating services, as well as measuring their effect. Although respite services are deemed necessary, they are seldom used [ 19 , 25 , 26 , 27 ]; as little as 6% of all caregivers receiving any kind support services in Canada actually use them. In scientific literature, the under-usage of respite services is a shared reality around the world [ 28 ]. One of the main reasons for this under-usage is the overall lack of flexibility in both obtaining and using respite [ 29 , 30 ]. Synthesizing the characteristics of flexible at-home respite services is the first steppingstone to a common operational definition. This could contribute to increasing respite use through the implementation or enrichment of programs in ways that answer the dyad’s (caregiver and older adult) needs.

Consequently, to support the implementation and evaluation of homecare programs, the objective of this study was to synthesize the knowledge on the characteristics of flexible at-home respite services offered to caregivers of older adults.

A scoping review [ 32 , 33 , 34 ] was conducted, as part of a larger multi-method participatory research known as the AMORA project [ 31 ] to characterize flexible at-home respite. Scoping reviews allow to map the extent of literature on a specific topic [ 32 , 34 ]. The six steps proposed by Levac et al. [ 32 ] were followed: [ 1 ] Identifying the research question; [ 2 ] searching and [ 3 ] selecting pertinent documents; [ 4 ] extracting ( or charting ) relevant data; [ 5 ] collating, summarizing and reporting findings; [ 6 ] consultation with stakeholders. The sixth step is optional.

Identifying the research question

The research question was: “What are the characteristics of flexible at-home respite services offered to caregivers of older adults?” As the research was conducted, this question was divided into three sub-questions:

WHO is tendering flexible respite?

WHEN is flexible respite tendered?

HOW is flexible respite tendered?

Identifying relevant documents

The search strategy consisted of two methods. First, the key words (1) respite (2) informal caregivers (3) older adults in the title or abstract allowed to identify relevant documents (Table  1 ). Initially included, the term “ flexib *” was removed from the search, given the low number generated (60 versus 1,179 documents without). The first author and a librarian specialized in health sciences research documentation conducted the literature research in July of 2021 and updated it in December of 2022 in 6 databases ( Ageline , Cochrane , CINAHL , Medline , PsychInfo , and Abstracts in Social Gerontology ). The expanded research strategy then consisted of the identification of relevant documents from the selected bibliography and one article that was found by searching for unavailable references (alternative article).

Study selection

To review the most recent literature on flexible at-home respite service characteristics, the research team focused on writings within a 20-year span, as have other reviews (e.g., [ 35 , 36 ]); documents thus had to be published between 2001 and 2022. The research team selected documents written in French or English, only. Included documents had to come from either (1) scientific literature (i.e., articles in an academic journal presenting an empirical study or reviews) or (2) reports and briefs from government, homecare organizations or research centres. All study designs were included. The research team convened that at-home respite is an (1) individual (i.e., not in a group) service (although, theoretically, two persons living in the same household could receive it) from (2) a professional or a volunteer that occurs (3) in the home and that (4) it requires no transport for the dyad. To select documents related to flexible at-home respite, the research team identified those in which the respite displayed an ability to adapt to the dyad’s needs on at least one characteristic of the service, as presented by Maayan and collaborators ( WHERE [Not relevant to this review, as it focuses on at-home respite] , WHO , WHEN ). The team concluded that these three dimensions lacked the precision to globally characterize the service. Indeed, they did not describe access to or activities occurring during respite, or, as the team called it, the HOW (Fig.  1 ). Excluded documents were those covering several services at once, preventing the differentiation of elements that were specific to at-home respite services. As this is a scoping review, the research team did not include a critical appraisal of individual sources of evidence [ 32 , 34 ].

Following the step-by-step Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines [ 37 ], the research team met to define the selection strategy. First, they screened the documents by their titles and abstracts, before determining their eligibility, based on their full text. Considering the limited human and financial resources, at each step of the PRISMAScR, a second team member assessed 10% of the documents independently to co-validate the selection; the goal was to reach 80% of agreement between both team members regarding document inclusion or exclusion. If an agreement was not reached, they would meet to obtain a consensus. The research team used Zotero reference management software to store documents as well as a cloud-based website to collaborate on the selection.

Conceptual mapping of results: HOW , WHEN , WHO

Charting the data

The first author charted (or extracted) both quantitative and qualitative data. To quantitatively characterize documents, contextual data (country of origin, year of publication, type of documents, etc.) was extracted in a Microsoft Excel table. For the qualitative data, the research team created an extraction table in Microsoft Word that included the three dimensions of respite ( WHO , WHEN and HOW) and one “ other ” dimension, as to not force any excerpts under the three dimensions. To co-validate the data charting, the second and third authors replicated 10% of the process. Expressly, the first author extracted elements related to a flexible characteristic of the at-home respite ( WHO , WHEN , HOW or other ). Considering limited resources, the third and second authors both co-validated the extraction of 10% of the documents. Authors met to reach a consensus where a disagreement arose.

Collating, summarizing, and reporting the results

The research team used content analysis to “attain a condensed and broad description of the phenomenon” [ 38 ]. To do so, data was prepared (familiarization with the data and extraction of pertinent excerpts) and organized (classification of excerpts) to build a characterization of flexible at-home respite. In this scoping review, a deductive content analysis began with three main categories ( WHO , WHEN , HOW ), with the addition of the temporary “ other ” category. Content analysis aimed to divide these categories into several generic categories, which subdivided into sub-categories (Fig.  2 ), inductively. This allowed to define the three main categories. While the WHO and the WHEN categories describe the service itself (time, duration, qualified staff, etc.), the HOW category is specific to the interface between the organization offering respite and the dyad (assessing the needs of the dyad, coordinating care, etc.). An interface is a situation where two “subjects” interact and affect each other [ 39 ]. In the context of homecare services, Levesque, Harris and Russell (2013) have defined that interface as access [ 40 ]. Therefore, to define the generic categories of the HOW , the team used the five dimensions of their access to care framework: Approachability, appropriateness, affordability, availability and acceptability [ 40 ]. Approachability relates to users recognizing the existence and accessibility of a service [ 40 ]. Appropriateness encompasses the alignment between services and users’ needs, considering timeliness and assessment of needs [ 40 ]. Affordability pertains to users’ economic capacity to allocate resources for accessing suitable services [ 40 ]. Availability signifies that services can be reached, both physically and in a timely manner [ 40 ]. Acceptability involves cultural and social factors influencing users’ willingness to accept services [ 40 ]. In other words, the HOW category focuses on the organizational or professional aspects of the service and how they can be adapted to the dyad.

To co-validate the classification, the research team met until they were all satisfied with the categorization. The first author then completed the classification. After classifying 20% of the documents, the second author would comment the classification. When the authors reached an agreement, the first author would move on to the classification of another 20%. First and second authors would meet when disagreements about classification and categories arose, to confer and adjust. Finally, all categories were discussed with the third author, until a consensus was reached. Once categorization was achieved, the team prepared a synthesis report. In this report, the team defined the main categories ( WHO , WHEN, HOW , other ) and their generic and sub-categories (Fig.  2 ) with pertinent excerpts from the reviewed literature. In summary, the results of the scoping review characterize flexible at-home respite under three attributes: WHO , WHEN and HOW .

Content analysis: Types of categories according to Elo and Kyngäs (2007) ( with examples from results )

Consultation

Rather than conducting a focus group as suggested by Levac and collaborators [ 32 ], the team chose to triangulate the results with those from a survey as a consultation strategy. Specifically, the research team took advantage of a survey being conducted with relevant stakeholders in the larger study (AMORA project), as it allowed to respect the scoping review’s allocated resources. The survey aimed to define flexible at-home respite and the factors affecting its implementation and delivery. A committee including a researcher, a doctoral student and a representative of an organization funding homecare services in Québec (Canada), developed the survey following the three stages proposed by Corbière and Fraccaroli [ 41 ]. It originally included a total of 21 items: Thirteen [ 13 ] close-ended and 8 open-ended questions. Of these 8, 2 addressed the characteristics of an ideal at-home service and suggestions regarding respite and were used here for triangulation purposes. The questionnaire was published online, in French, on the Microsoft Forms ® platform in the summer of 2020. Recruitment of participants (caregivers and people from the homecare sector) was done via email, by contacting regional organizations (Eastern Townships, Québec, Canada). In addition, the 18 senior consultation tables spread throughout the territory of the province of Québec were solicited; working in collaboration with governmental instances in charge of services to older adults and caregivers, these tables bring together representatives for associations, groups or organizations concerned with their living conditions.

The goal was to triangulate the scoping review’s results, i.e., to identify what was common between the literature and real-world experiences, and, as such, to bring contextual value to the results. Accordingly, the team analyzed data using mixed categorization [ 42 ]. The categories from the scoping review served as a starting point (closed categorization), leaving room to create new categories, as the analysis progressed (open categorization). Once all the data (scoping and survey) was categorized, the team identified the characteristics according to sources. To do so, the team tabulated the reoccurrence of each category in the survey, in the scoping review, or in both. They then integrated the results to provide one unified categorization of flexible at-home respite. The AMORA project was approved by the research ethics committee of the Integrated University Health and Social Services Centre (CIUSSS) of the Eastern Townships (project number: 2021–3703).

Of the 1,301 papers retrieved through the database searches, 1,146 were not eligible based on title and abstract, while 116 were excluded after reading their full texts, resulting in 39 included documents (Fig.  3 ). Documents were mainly excluded because they did not provide details about the respite service and its flexibility. The expanded search yielded three additional documents, resulting in a total of 42 documents, included in this scoping review. This section details (1) the characteristics of the selected documents and (2) the characterization of flexible at-home respite.

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) flow chart of the scoping review process [ 37 ]

Characteristics of selected documents

The majority (86%) of the documents in the review (Table  2 ) are from after 2005, with only 14% of the documents published before 2005, and are from 9 countries; United States ( n  = 18; 42%), United Kingdom ( n  = 11; 26%), Australia ( n  = 4; 10%), Canada ( n  = 2; 5%), Ireland ( n  = 2; 5%), France ( n  = 2; 5%), Belgium ( n  = 2; 5%), Germany ( n  = 1; 2%), New Zealand ( n  = 1). The types of documents were diverse: 68% ( n  = 28) were empirical studies, 31% ( n  = 13) theoretical papers and 1% ( n  = 2) government briefs. Most ( n  = 23; 56%) of the documents did not specify their research approach, while 10 and 9 took, respectively, a qualitative (23%) or quantitative approach (21%). Most documents address respite in the context of caregiving for someone living with Alzheimer’s disease or other neurocognitive disorders ( n  = 25; 60%), while some targeted older adults in general ( n  = 14; 34%), people in palliative care ( n  = 4; 9%) or other older adult populations (for example, veterans) ( n  = 3; 1%). Respite was usually tendered by community organizations specialized in homecare ( n  = 32; 78%). Although the majority of the documents ( n  = 31; 75%) did not address the type of region (rural, urban, or mixed) surrounding the caregivers, those who did ( n  = 11; 26%) mainly reported being in a mixed environment ( n  = 9; 21%).

Characteristics of survey participants

Although all 100 participants completed the questionnaire, 71 participants answered at least 1 of the 2 open-ended questions: Each question had 66 and 41 answers. Of those 71 participants, most of them were women ( n  = 60; 85%). All participants were aged on average 55 years old (SD = 15). They were mostly from the Eastern Townships area ( n  = 56; 79%). Most participants were either caregivers ( n  = 24; 34%) or homecare workers ( n  = 28; 39%), while some were service administrators ( n  = 11; 15%), and some reported being both caregivers as well as working in the formal caregiving sector ( n  = 7; 10%). Only one person reported themselves as an older adult having a caregiver.

Characterization of flexible at-home respite

The characterization of flexible at-home respite will be presented below in three main categories which are WHO , WHEN , and HOW . Of note, 10 (24%) of the included documents had three categories of flexible components, 16 (38%) had 2 categories and 1 category. Almost all documents discussed the HOW of flexible at-home respite ( n  = 40, 95%). Out of the 33 categories constructed with the scoping review, only 6 (18%) were not reported in the questionnaire: (1) planned respite ( WHEN ), (2) screening of dyads ( HOW ), (3) determining frequency of respite ( HOW ), (4) coordination of care ( HOW ), (5) voucher approach ( HOW ) and (6) acceptability to low-income households ( HOW ). Moreover, the questionnaire added three characteristics that were not present in the scoping review: (1) respite needs to be approachable, (2) the organization must be prompt** and adhocratic** and (3) able to deliver respite regardless of the season** (availability). Generic or sub-categories present only in the scoping review are identified with 1 asterisk (*), while those present only in the questionnaire have 2 (**).

In the selected documents, the WHO dimension of flexible at-home respite services can be broken down into three qualifiers: (1) Compatible , (2) qualified and (3) trained (Table  3 ). This dimension includes all human resources contributing to homecare (administrative staff, governing bodies, paid and volunteer care workers). First, the workforce behind flexible respite is compatible , meaning it has personal characteristics and profiles relevant to homecare for caregivers of older adults [ 17 , 53 , 62 , 63 , 68 ]. Gendron and Adam explain this by describing how the role of the care worker in Baluchon Alzheimer™ goes beyond training: “The nature of their work with [Baluchon Alzheimer™] requires particular human and professional qualities that are quite as important as academic credentials” [ 53 ]. Personal characteristics such as flexibility [ 53 , 62 , 63 , 68 ], empathy and patience [ 17 , 53 , 62 ] are deemed essential attributes. Secondly, the workforce is qualified : It has the necessary skills, abilities and knowledge from past professional [ 14 , 45 , 62 , 70 ] and personal experience [ 62 ] to work, or volunteer, with caregivers of older adults. For a program like Baluchon Alzheimer™, “the backgrounds of the baluchonneuses vary […]; all have experience in gerontology” [ 53 ]. Other areas of qualification in the included documents are a nursing background [ 18 , 45 ] or knowledge related to dementia [ 69 ]. Finally, flexible at-home respite requires a trained workforce engaged in the process of acquiring knowledge and learning the skills to provide respite services to caregivers of older adults. For example, homecare organizations can offer specific training on various topics, depending on their target clientele: Dementia [ 44 ], palliative care [ 59 ], or homecare in general [ 44 ].

The WHEN dimension of flexible at-home respite contains 4 temporal features: (1) Time , (2) duration , (3) frequency and (4) predictability (Table  4 ). First, flexible respite is available on a wide range of possible time slots. For example, the service is “available 24 hours, but typically from 9 am to 10 pm” [ 64 ]. Secondly, flexible respite is accessible on a wide range of possible durations . The Community Dementia Support Service (CDSS) is an example of flexibility in duration by “[being] totally flexible, being available from 2 to 15 hours per week” [ 69 ]. Thirdly, the service is offered in different frequencies : It can be either recurrent or occasional, or a combination of both [ 18 , 64 , 66 ]. The last feature of the WHEN dimension is flexibility in predictability ; the respite service can be planned* or not. A study on respite services in South Australia found that most providers (93%) planned the respite care with the dyad, but that emergency or crisis services were still offered by 35% of them [ 50 ].

At-home respite is flexible when it demonstrates approachability : Caregivers can identify that some form of respite exists and can be reached (Table  5 ). For the respite service to be approachable, the organization needs to be reaching out to dyads; it proactively makes sure that caregivers of older adults have information on services, know of their existence and that they can be used. For example, the El Portal program put in place “advisory groups that included the local clergy, representatives from businesses, caregivers, and service providers who were used for outreach work” [ 66 ]. The organization also screens* dyads to assess their eligibility for respite, as well as for other services from the same program or organization. For example, the North Carolina (U.S.A.) Project C.A.R.E. has an initial assessment that considers the range of homecare services available, rather than just assessing for eligibility for a program [ 57 ]. In addition, flexible respite requires the organization to set attainable and inclusive requirements for eligibility, as to not discourage use [ 24 , 57 , 61 , 66 ]. Finally, the organization communicates consistently with the dyad. As Shanley explains in their literature review, “there are clear and open ways for carers to express concerns about the service, and an open mechanism is available for dealing with these concerns constructively” [ 17 ]. In addition, the survey participants discussed two other characteristics. First, for respite to be approachable, the organization is prompt**, respecting a reasonable delay between the request and the beginning of the service (wait list). Second, it is adhocratic**, meaning the organization does not depend on complex systems of rules and procedures to operate i.e., bureaucracy.

The second access dimension of flexible at-home respite is appropriateness (Table  6 ): The fit between respite services and the dyad’s needs, its timeliness, the amount of care spent in assessing their needs and determining the correct respite service. For the respite service to be appropriate, the organization assesses needs by collecting details about the dyad’s needs; this can include, but is not limited to, clinical, psychological, or social evaluation. The organization then proposes respite services from a wide range of options or packages: A multi-respite package, as presented by Arksey et al., can simply be the combination of at least two different respite services [ 44 ]. For the service to be appropriate, the organization also paces the respite. Apprehension towards service appropriateness can be mitigated by a gradual introduction to homecare, for example when the respite is presented as a trial [ 68 ]. The organization determines the service with the dyad and defines its different characteristics ( WHEN * , WHO ) so interventions correspond to their needs. The organization then determines the appropriate activities to do with the dyad during the respite. For example, the caregiver of older adults can be encouraged to use respite time for leisure (sleep, physical activity, etc.) [ 45 ], while the care worker supports the beneficiary in engaging in an activity such as a walk or a board game [ 14 ]. Furthermore, the organization coordinates* the services for the dyad and acts as a “respite broker” to arrange all aspects of care; this is especially relevant for programs that include a “care budget” that can be used at the caregivers’ discretion [ 58 ]. Finally, for the respite to be appropriate, the organization assures that it is in continuity with other health services, by connecting the dyads to pertinent resources. As described by Shaw, respite should be “embedded in a context that includes assessment, carer education, case management and counselling” [ 18 ].

The third access dimension of flexible at-home respite is affordability , referring to the economic capacity of the dyad to spend resources to use appropriate respite services (Table  7 ). The included documents only explored the direct cost of respite: The amount of money a dyad must pay to receive services. For the respite to be affordable, its direct cost is either (1) adapted, where the cost is modulated according to the dyad’s financial resources, for example on a sliding scale, based on income or (2) nonexistent [ 44 ].

Next, flexible at-home respite must demonstrate availability (Table  8 ): Services can be reached both physically and in a timely manner. Firstly, the organization offers respite in the dyads’ geographic area. Shanley described an at-home mobile respite program designed to reach rural and remote areas, where two care workers visit different locations for set periods of time [ 17 ]. Moreover, one sub-characteristic identified exclusively by the survey participants was seasonality. Indeed, the dyad has access to respite, regardless of the season**. Thus, the geography category is broken down between the access to service (1) in rural or remote areas and (2) notwithstanding the season. Flexibility in availability also requires that the dyads have access to unlimited respite time; the organization does not assign a finite bank of hours. Finally, the organization proposes diverse payment methods to the dyads. The consumer-directed approach is a way that homecare organizations offer flexibility. A care budget is allocated to the caregiver to purchase hours from homecare agencies or to hire their own respite workers. This includes payments to family members or friends to provide respite care [ 79 ]. An example of a type of consumer-directed approach is the use of vouchers*: Credit notes or coupons to purchase service hours from homecare agencies [ 44 ].

Finally, access to flexible at-home respite also relates to acceptability (Table  9 ): The cultural and social factors determining the possibility for the dyad to accept respite and the perception of the appropriateness of seeking services. For the respite to be acceptable, the organization targets and caters to the cultural diversity represented in their local population. The organization is also able to identify and to accommodate underserved groups. In the included documents, underserved groups lacked access to respite for two reasons: (1) Geographic isolation or (2) the requirements to be eligible to “traditional homecare” does not apply to them, for example, for younger people with dementia and people with HIV/AIDS [ 17 ]. The organization can target and cater to low-income households*. Rosenthal Gelman and his collaborators detail a program where, after realizing that low-income caregivers have greater unmet needs, special funds were set aside for respite care vouchers to be distributed [ 70 ].

This scoping review conducted with Levac and colleagues’ method [ 32 ] synthesized the knowledge on the characteristics of flexible at-home respite services offered to caregivers of older adults, from 42 documents. The results provide a synthesis of the characteristics of flexible at-home respite discussed in the literature. The three dimensions of flexibility in respite relate to (1) WHO is tendering it, (2) WHEN it is tendered and (3) HOW it is tendered. First, human resources ( WHO ) must be compatible with the homecare sector as well as being trained and qualified to offer respite to caregivers of older adults. The second feature of flexible respite is temporality ( WHEN ): The time, duration, frequency, and predictability of the service. The last dimension, access ( HOW ), refers to the interface between the respite and the users. Flexible at-home respite exhibits approachability, appropriateness, affordability, availability, and acceptability. In the light of what we learned, flexible at-home respite could be characterized as a service that has the ability to adjust to the needs of the dyad on all three dimensions ( W HO , WHEN , HOW ). However, this seems to be more of an ideal than a reflection of reality.

The survey provided complementary results to the review; the concordance between the two is strong (27/33 = 82%). Six [ 6 ] characteristics were missing from the survey results, including planned respite and the voucher approach ( HOW ). Moreover, the survey added three elements to the review results: The organization’s adhocracy ( HOW ) and promptness ( HOW ) as well as its ability to offer services, regardless of the season ( HOW ). These mismatches might reflect the Québec (and possibly Canadian) landscape of homecare. For example, in the Québec homecare system, respite is mostly planned, it is therefore not surprising that people only mention that unplanned respite is lacking. The “voucher system” was not mentioned in the survey, probably in part because it does not exist in the province of Québec. Additionally, navigating the healthcare system to have free or affordable homecare can be treacherous [ 80 ]. In short, older adults have to go through (1) evaluation(s) by a social worker from a hospital or another public healthcare organization and (2) various administrative tasks ( adhocratic ) [ 2 ], before possibly being put on a waiting list ( prompt ) [ 81 ]. In addition, Canada can experience harsh winters ( seasonality ) that can make transport, which is an integral part of homecare, particularly laborious. Although those categories could reflect the particularity of homecare in Canada, a promising follow up on this review would be to compare the characteristics of flexible respite from one territory to another. It would contribute to providing a more operational definition of flexible at-home respite.

The remainder of this discussion will focus on two main points before touching on the limitations and strengths of this review. First, flexibility in at-home respite seems exceptional. Second, respite care workers are as skilled as they are underappreciated.

This review, in coherence with the literature, highlights the fact that respite services generally lack flexibility: This is the conclusion of several studies on respite [ 7 , 64 , 82 ]. A pattern seems to emerge in the countries represented in the review: Community organizations specialized in homecare (public and/or privately funded) offer respite on predetermined time slots, usually prescribed between traditional office hours (9 AM to 6 PM) [ 50 ]. This lack of flexibility could be explained in part by the rigidity of the structure of homecare services and the fact that its funding does not allow for customizable and punctual services [ 17 , 62 , 73 ]. Nevertheless, there were some examples of flexible respite models, such as Baluchon Alzheimer™ and consumer-directed approaches. Baluchon Alzheimer™ offers long-term at-home respite (4 to 14 days) by qualified and trained baluchonneuses . Prior to the relay of the caregivers, the baluchonneuse takes the time to learn about the dyad, including their environment and routine [ 53 , 62 ]. Caregivers report feeling refreshed upon their return and appreciate the diaries (or logbooks) that the baluchonneuse meticulously fills out [ 53 ]. Another example would be consumer-directed approaches, where caregivers are attributed a budget to hire their own care worker. Allowing caregivers to choose their care worker (either from a self-employed carer or family and friends) can increase the quality of care and satisfaction, while providing relatively affordable care, especially in a situation of labour shortage [ 51 , 79 ]. Even though these two models are a demonstration of how respite can be adapted to the caregiver-senior dyad, for the most part, flexibility is lacking on all three dimensions of respite ( WHO , WHEN , HOW ).

Secondly, the results from the scoping review highlight how homecare as a profession is often overlooked. Indeed, the reviewed documents state the necessary set of skills to offer respite; the level described is one of highly specialized care professionals with important liability. These skills must also transcend advanced knowledge and qualifications, to include interpersonal capabilities [ 17 , 53 , 62 , 63 , 68 ]. Furthermore, care workers must also be flexible to offer a wide range of service time and duration, in addition to being ready to provide “on-the-go” respite [ 53 , 68 ]. Yet, the occupation of homecare worker is an underappreciated and underpaid position [ 83 ]. Community care, like respite, is generally not a priority for social and healthcare funding [ 24 ]. This can be explained in part by the neoliberal approach to care in which the target is to minimize spending and maximize (measurable) outcomes [ 84 ]. Homecare outcomes are often overlooked in favour of service delivery evaluation, in part because they are difficult to measure [ 44 ]. This approach can also lead to prioritizing third party contracting instead of including respite in the range of public services, as to save on expenses related to employment (insurance and other benefits) [ 85 ]. Another contributor is that funding is used for service administration and not to adequately provide services or remunerate care workers [ 86 ]. Finally, care workers are mostly women, known for doing the invisible work that is at the heart of respite care (emotional support, etc.) [ 87 ]. A telling example from the reviewed documents is that Baluchon Alzheimer™ refers to their care workers as baluchonneuses (feminine form) and not baluchoneurs (masculine form) [ 53 ]. Consequently, the homecare sector is faced with recruitment and retention challenges [ 44 , 64 , 88 ]. Authors of the documents included in the review addressed the fact that flexibility in service meant that service providers had to function with excess capacity; for example, by building an “employee bank” to cover all the hours of the day and emergency calls [ 44 ]. Ultimately, staff turnover and shortage caused in part by the work being underappreciated could create a vicious cycle, leading to inflexibility in respite. In short, overlooking and underestimating the crucial and specialized work of homecare workers can contribute to staff turnover, which in turn could result in a lack of flexibility of at-home respite.

Limitations and strengths

The review’s methodological approach has some limitations and strengths. First, according to Levac, Colquhoun and O’Brien [ 32 ], research teams could conduct a sixth step in their scoping study, consisting in consulting experts through a focus group or workshop. This last phase aims at providing further insight into the review’s results and to begin the knowledge translation process. The team did not conduct a traditional consultation phase. Instead, they triangulated the review’s results through a questionnaire. This method was of interest, because of the natural concordance between the results and the considerable number of participants ( n  = 100). The survey still allowed to refine the characterization of respite, but further knowledge transfer to homecare actors and caregivers is necessary. Although innovative, there is a need to further investigate the validity of this approach as a consultation phase. Secondly, the theme of flexible at-home respite may have narrowed the search and identification of relevant documentation, and therefore caused the team to overlook some of the literature. Empirical studies and reviews on respite seldom include a detailed description of services [ 89 , 90 , 91 ]. This made it challenging to understand what services are like, operationally, for the dyad and to judge their flexibility. In addition, it complexified the extraction of relevant data, as descriptions were sparse and scattered throughout the documents. The team worked to mitigate these limitations in the documentation research and data charting phase. To begin, they sorted through all the literature on at-home respite for caregivers of older adults. In other words, the team not only searched for, but also included any explicit mention of flexibility. After selection, the extraction tables allowed enough versatility to include all the flexible characteristics of service, regardless of their placement in the text (introduction, methodology or discussion) or length. Another limitation is that, due to resource constraints, only 10% of the document selection and extraction was assessed by two reviewers, although a minimum of 80% of agreement was met and discussions were used to reach consensus where a disagreement arose. To conclude, strengths of this review include the extensiveness and diversity of the documents and its rigorous methodology, co-validated by a peer and an experienced researcher, with assistance from a specialized librarian.

This review has both scientific and practical implications. From a scientific point of view, the results contribute to the body of knowledge on flexible respite service models for caregivers of seniors, an under-documented topic. To our knowledge, this is the first review that aims to characterize flexible at-home respite. Our results suggest the relevance of further documenting the factors influencing the implementation and delivery of flexible respite services, as well as the consequences of the lack of flexibility in respite services, which may lead to service underuse. Moreover, researchers could focus on documenting respite programs in countries that are not represented in this review. There were notably no documents from the continents of Asia and Africa. Unfortunately, good practices can go unreported in peer-reviewed publications; therefore, a review focusing on government reports and publications aimed at professionals could shed some light on promising respite models. From a practical point of view, this review serves as a starting point for the implementation of flexible home respite that is tailored to the caregivers’ and older adults’ needs. Our characterization of flexible at-home respite can be used to guide the improvement of existing respite services and to design new resources that reflect best practices in homecare, ultimately contributing to successful aging in place for older adults.

Data availability

The data supporting this study’s findings are available from the corresponding author, upon reasonable request.

Abbreviations

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews

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Acknowledgements

The team thanks the Université de Sherbrooke’s library and archives service for their support. The team also want to thank everyone who participated in the survey.

This article describes a part of a larger study on flexible respite funded by the Fonds de la recherche du Québec (#309508) – Santé and the Conseil de recherches en sciences humaines du Canada (#892-2019-3075). Annie Carrier and Véronique Provencher are Fonds de recherche du Québec – Santé Junior 1 and Junior 2 researchers (#296437 and #297008, respectively). Alexandra Éthier is a Canadian Institutes of Health Research - Research Graduate Scholarships – Doctoral Program recipient (#476590 − 71729).

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MV conducted the review and co-wrote the article with AE. AE co-validated the study selection and co-wrote the article. AC co-validated the study selection, data charting and reviewed the article. VP reviewed the article. All authors read and approved the final manuscript.

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Viens, M., Éthier, A., Provencher, V. et al. WHO, WHEN, HOW: a scoping review on flexible at-home respite for informal caregivers of older adults. BMC Health Serv Res 24 , 767 (2024). https://doi.org/10.1186/s12913-024-11058-0

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Now Published: Systematic literature review on religious leader well-being, burnout, and trauma

Our second publication from the Helping the Helpers project is a systematic literature review of 82 empirical studies that look at burnout, trauma impacts, and/or well-being among religious leaders. We were able to highlight relational, systemic/organizational, and diversity issues that are crucial for gaining a more holistic understanding of these issues. The citation and abstract are below.

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