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Literature Syntheis 101

How To Synthesise The Existing Research (With Examples)

By: Derek Jansen (MBA) | Expert Reviewer: Eunice Rautenbach (DTech) | August 2023

One of the most common mistakes that students make when writing a literature review is that they err on the side of describing the existing literature rather than providing a critical synthesis of it. In this post, we’ll unpack what exactly synthesis means and show you how to craft a strong literature synthesis using practical examples.

This post is based on our popular online course, Literature Review Bootcamp . In the course, we walk you through the full process of developing a literature review, step by step. If it’s your first time writing a literature review, you definitely want to use this link to get 50% off the course (limited-time offer).

Overview: Literature Synthesis

  • What exactly does “synthesis” mean?
  • Aspect 1: Agreement
  • Aspect 2: Disagreement
  • Aspect 3: Key theories
  • Aspect 4: Contexts
  • Aspect 5: Methodologies
  • Bringing it all together

What does “synthesis” actually mean?

As a starting point, let’s quickly define what exactly we mean when we use the term “synthesis” within the context of a literature review.

Simply put, literature synthesis means going beyond just describing what everyone has said and found. Instead, synthesis is about bringing together all the information from various sources to present a cohesive assessment of the current state of knowledge in relation to your study’s research aims and questions .

Put another way, a good synthesis tells the reader exactly where the current research is “at” in terms of the topic you’re interested in – specifically, what’s known , what’s not , and where there’s a need for more research .

So, how do you go about doing this?

Well, there’s no “one right way” when it comes to literature synthesis, but we’ve found that it’s particularly useful to ask yourself five key questions when you’re working on your literature review. Having done so,  you can then address them more articulately within your actual write up. So, let’s take a look at each of these questions.

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1. Points Of Agreement

The first question that you need to ask yourself is: “Overall, what things seem to be agreed upon by the vast majority of the literature?”

For example, if your research aim is to identify which factors contribute toward job satisfaction, you’ll need to identify which factors are broadly agreed upon and “settled” within the literature. Naturally, there may at times be some lone contrarian that has a radical viewpoint , but, provided that the vast majority of researchers are in agreement, you can put these random outliers to the side. That is, of course, unless your research aims to explore a contrarian viewpoint and there’s a clear justification for doing so. 

Identifying what’s broadly agreed upon is an essential starting point for synthesising the literature, because you generally don’t want (or need) to reinvent the wheel or run down a road investigating something that is already well established . So, addressing this question first lays a foundation of “settled” knowledge.

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2. Points Of Disagreement

Related to the previous point, but on the other end of the spectrum, is the equally important question: “Where do the disagreements lie?” .

In other words, which things are not well agreed upon by current researchers? It’s important to clarify here that by disagreement, we don’t mean that researchers are (necessarily) fighting over it – just that there are relatively mixed findings within the empirical research , with no firm consensus amongst researchers.

This is a really important question to address as these “disagreements” will often set the stage for the research gap(s). In other words, they provide clues regarding potential opportunities for further research, which your study can then (hopefully) contribute toward filling. If you’re not familiar with the concept of a research gap, be sure to check out our explainer video covering exactly that .

what is synthesis literature review

3. Key Theories

The next question you need to ask yourself is: “Which key theories seem to be coming up repeatedly?” .

Within most research spaces, you’ll find that you keep running into a handful of key theories that are referred to over and over again. Apart from identifying these theories, you’ll also need to think about how they’re connected to each other. Specifically, you need to ask yourself:

  • Are they all covering the same ground or do they have different focal points  or underlying assumptions ?
  • Do some of them feed into each other and if so, is there an opportunity to integrate them into a more cohesive theory?
  • Do some of them pull in different directions ? If so, why might this be?
  • Do all of the theories define the key concepts and variables in the same way, or is there some disconnect? If so, what’s the impact of this ?

Simply put, you’ll need to pay careful attention to the key theories in your research area, as they will need to feature within your theoretical framework , which will form a critical component within your final literature review. This will set the foundation for your entire study, so it’s essential that you be critical in this area of your literature synthesis.

If this sounds a bit fluffy, don’t worry. We deep dive into the theoretical framework (as well as the conceptual framework) and look at practical examples in Literature Review Bootcamp . If you’d like to learn more, take advantage of our limited-time offer to get 60% off the standard price.

what is synthesis literature review

4. Contexts

The next question that you need to address in your literature synthesis is an important one, and that is: “Which contexts have (and have not) been covered by the existing research?” .

For example, sticking with our earlier hypothetical topic (factors that impact job satisfaction), you may find that most of the research has focused on white-collar , management-level staff within a primarily Western context, but little has been done on blue-collar workers in an Eastern context. Given the significant socio-cultural differences between these two groups, this is an important observation, as it could present a contextual research gap .

In practical terms, this means that you’ll need to carefully assess the context of each piece of literature that you’re engaging with, especially the empirical research (i.e., studies that have collected and analysed real-world data). Ideally, you should keep notes regarding the context of each study in some sort of catalogue or sheet, so that you can easily make sense of this before you start the writing phase. If you’d like, our free literature catalogue worksheet is a great tool for this task.

5. Methodological Approaches

Last but certainly not least, you need to ask yourself the question: “What types of research methodologies have (and haven’t) been used?”

For example, you might find that most studies have approached the topic using qualitative methods such as interviews and thematic analysis. Alternatively, you might find that most studies have used quantitative methods such as online surveys and statistical analysis.

But why does this matter?

Well, it can run in one of two potential directions . If you find that the vast majority of studies use a specific methodological approach, this could provide you with a firm foundation on which to base your own study’s methodology . In other words, you can use the methodologies of similar studies to inform (and justify) your own study’s research design .

On the other hand, you might argue that the lack of diverse methodological approaches presents a research gap , and therefore your study could contribute toward filling that gap by taking a different approach. For example, taking a qualitative approach to a research area that is typically approached quantitatively. Of course, if you’re going to go against the methodological grain, you’ll need to provide a strong justification for why your proposed approach makes sense. Nevertheless, it is something worth at least considering.

Regardless of which route you opt for, you need to pay careful attention to the methodologies used in the relevant studies and provide at least some discussion about this in your write-up. Again, it’s useful to keep track of this on some sort of spreadsheet or catalogue as you digest each article, so consider grabbing a copy of our free literature catalogue if you don’t have anything in place.

Looking at the methodologies of existing, similar studies will help you develop a strong research methodology for your own study.

Bringing It All Together

Alright, so we’ve looked at five important questions that you need to ask (and answer) to help you develop a strong synthesis within your literature review.  To recap, these are:

  • Which things are broadly agreed upon within the current research?
  • Which things are the subject of disagreement (or at least, present mixed findings)?
  • Which theories seem to be central to your research topic and how do they relate or compare to each other?
  • Which contexts have (and haven’t) been covered?
  • Which methodological approaches are most common?

Importantly, you’re not just asking yourself these questions for the sake of asking them – they’re not just a reflection exercise. You need to weave your answers to them into your actual literature review when you write it up. How exactly you do this will vary from project to project depending on the structure you opt for, but you’ll still need to address them within your literature review, whichever route you go.

The best approach is to spend some time actually writing out your answers to these questions, as opposed to just thinking about them in your head. Putting your thoughts onto paper really helps you flesh out your thinking . As you do this, don’t just write down the answers – instead, think about what they mean in terms of the research gap you’ll present , as well as the methodological approach you’ll take . Your literature synthesis needs to lay the groundwork for these two things, so it’s essential that you link all of it together in your mind, and of course, on paper.

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  • University of Oregon Libraries
  • Research Guides

How to Write a Literature Review

  • 6. Synthesize
  • Literature Reviews: A Recap
  • Reading Journal Articles
  • Does it Describe a Literature Review?
  • 1. Identify the Question
  • 2. Review Discipline Styles
  • Searching Article Databases
  • Finding Full-Text of an Article
  • Citation Chaining
  • When to Stop Searching
  • 4. Manage Your References
  • 5. Critically Analyze and Evaluate

Synthesis Visualization

Synthesis matrix example.

  • 7. Write a Literature Review

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  • Synthesis Worksheet

About Synthesis

Approaches to synthesis.

You can sort the literature in various ways, for example:

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How to Begin?

Read your sources carefully and find the main idea(s) of each source

Look for similarities in your sources – which sources are talking about the same main ideas? (for example, sources that discuss the historical background on your topic)

Use the worksheet (above) or synthesis matrix (below) to get organized

This work can be messy. Don't worry if you have to go through a few iterations of the worksheet or matrix as you work on your lit review!

Four Examples of Student Writing

In the four examples below, only ONE shows a good example of synthesis: the fourth column, or  Student D . For a web accessible version, click the link below the image.

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  • 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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Writing a Literature Review

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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Synthetic literature reviews: An introduction

By Steve Wallis and Bernadette Wright 26/05/2020

Whether you are writing a funding proposal or an academic paper, you will most likely be required to start with a literature review of some kind. Despite (or because of) the work involved, a literature review is a great opportunity to showcase your knowledge on a topic. In this post, we’re going to take it one step further. We’re going to tell you a very practical approach to conducting literature reviews that allows you to show that you are advancing scientific knowledge before your project even begins. Also – and this is no small bonus – this approach lets you show how your literature review will lead to a more successful project.

Literature review – start with the basics

A literature review helps you shape effective solutions to the problems you (and your organisation) are facing. A literature review also helps you demonstrate the value of your activities. You can show how much you add to the process before you spend any money collecting new data. Finally, your literature review helps you avoid reinventing the wheel by showing you what relevant research already exists, so that you can target your new research more efficiently and more effectively.

We all want to conduct good research and have a meaningful impact on people’s lives. To do this, a literature review is a critical step. For funders, a literature review is especially important because it shows how much useful knowledge the writer already has.

Past methods of literature reviews tend to be focused on ‘muscle power’, that is spending more time and more effort to review more papers and adhering more closely to accepted standards. Examples of standards for conducting literature reviews include the PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions and the guidelines for assessing the quality and applicability of systematic reviews developed by the Task Force on Systematic Review and Guidelines . Given the untold millions of papers in many disciplines, even a large literature review that adheres to the best guidelines does little to move us toward integrated knowledge in and across disciplines.

In short, we need we need to work smarter, not harder!

Synthetic literature reviews

One approach that can provide more benefit is the synthetic literature review. Synthetic meaning synthesised or integrated, not artificial. Rather than explaining and reflecting on the results of previous studies (as is typically done in literature reviews), a synthetic literature review strives to create a new and more useful theoretical perspective by rigorously integrating the results of previous studies.

Many people find the process of synthesis difficult, elusive, or mysterious. When presenting their views and making recommendations for research, they tend to fall back on intuition (which is neither harder nor smarter).

After defining your research topic (‘poverty’ for example), the next step is to search the literature for existing theories or models of poverty that have been developed from research. You can use Google Scholar or your institutional database, or the assistance of a research librarian. A broad topic such as ‘poverty’, however, will lead you to millions of articles. You’ll narrow that field by focusing more closely on your topic and adding search terms. For example, you might be more interested in poverty among Latino communities in central California. You might also focus your search according to the date of the study (often, but not always, more recent results are preferred), or by geographic location. Continue refining and focusing your search until you have a workable number of papers (depending on your available time and resources). You might also take this time to throw out the papers that seem to be less relevant.

Skim those papers to be sure that they are really relevant to your topic. Once you have chosen a workable number of relevant papers, it is time to start integrating them.

Next, sort them according to the quality of their data.

Next, read the theory presented in each paper and create a diagram of the theory. The theory may be found in a section called ‘theory’ or sometimes in the ‘introduction’. For research papers, that presented theory may have changed during the research process, so you should look for the theory in the ‘findings’, ‘results’, or ‘discussion’ sections.

That diagram should include all relevant concepts from the theory and show the causal connections between the concepts that have been supported by research (some papers will present two theories, one before and one after the research – use the second one – only the hypotheses that have been supported by the research).

For a couple of brief and partial example from a recent interdisciplinary research paper, one theory of poverty might say ‘Having more education will help people to stay out of poverty’, while another might say ‘The more that the economy develops, the less poverty there will be’.

We then use those statements to create a diagram as we have in Figure 1.

what is synthesis literature review

Figure 1. Two (simple, partial) theories of poverty. (We like to use dashed lines to indicate ’causes less’, and solid lines to indicate ’causes more’)

When you have completed a diagram for each theory, the next step is to synthesise (integrate) them where the concepts are the same (or substantively similar) between two or more theories. With causal diagrams such as these, the process of synthesis becomes pretty direct. We simply combine the two (or more) theories to create a synthesised theory, such as in Figure 2.

what is synthesis literature review

Figure 2. Two theories synthesised where they overlap (in this case theories of poverty)

Much like a road map, a causal diagram of a theory with more concepts and more connecting arrows is more useful for navigation. You can show that your literature review is better than previous reviews by showing that you have taken a number of fragmented theories (as in Figure 1) and synthesised them to create a more coherent theory (as in Figure 2).

To go a step further, you may use Integrative Propositional Analysis (IPA) to quantify the extent to which your research has improved the structure and potential usefulness of your knowledge through the synthesis. Another source is our new book from Practical Mapping for Applied Research and Program Evaluation (see especially Chapter 5). (For the basics, you can look at Chapter One for free on the publisher’s site by clicking on the ‘Preview’ tab here. )

Once you become comfortable with the process, you will certainly be working ‘smarter’ and showcasing your knowledge to funders!

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Literature reviews: synthesis.

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Synthesise Information

So, how can you create paragraphs within your literature review that demonstrates your knowledge of the scholarship that has been done in your field of study?  

You will need to present a synthesis of the texts you read.  

Doug Specht, Senior Lecturer at the Westminster School of Media and Communication, explains synthesis for us in the following video:  

Synthesising Texts  

What is synthesis? 

Synthesis is an important element of academic writing, demonstrating comprehension, analysis, evaluation and original creation.  

With synthesis you extract content from different sources to create an original text. While paraphrase and summary maintain the structure of the given source(s), with synthesis you create a new structure.  

The sources will provide different perspectives and evidence on a topic. They will be put together when agreeing, contrasted when disagreeing. The sources must be referenced.  

Perfect your synthesis by showing the flow of your reasoning, expressing critical evaluation of the sources and drawing conclusions.  

When you synthesise think of "using strategic thinking to resolve a problem requiring the integration of diverse pieces of information around a structuring theme" (Mateos and Sole 2009, p448). 

Synthesis is a complex activity, which requires a high degree of comprehension and active engagement with the subject. As you progress in higher education, so increase the expectations on your abilities to synthesise. 

How to synthesise in a literature review: 

Identify themes/issues you'd like to discuss in the literature review. Think of an outline.  

Read the literature and identify these themes/issues.  

Critically analyse the texts asking: how does the text I'm reading relate to the other texts I've read on the same topic? Is it in agreement? Does it differ in its perspective? Is it stronger or weaker? How does it differ (could be scope, methods, year of publication etc.). Draw your conclusions on the state of the literature on the topic.  

Start writing your literature review, structuring it according to the outline you planned.  

Put together sources stating the same point; contrast sources presenting counter-arguments or different points.  

Present your critical analysis.  

Always provide the references. 

The best synthesis requires a "recursive process" whereby you read the source texts, identify relevant parts, take notes, produce drafts, re-read the source texts, revise your text, re-write... (Mateos and Sole, 2009). 

What is good synthesis?  

The quality of your synthesis can be assessed considering the following (Mateos and Sole, 2009, p439):  

Integration and connection of the information from the source texts around a structuring theme. 

Selection of ideas necessary for producing the synthesis. 

Appropriateness of the interpretation.  

Elaboration of the content.  

Example of Synthesis

Original texts (fictitious): 

  

Synthesis: 

Animal experimentation is a subject of heated debate. Some argue that painful experiments should be banned. Indeed it has been demonstrated that such experiments make animals suffer physically and psychologically (Chowdhury 2012; Panatta and Hudson 2016). On the other hand, it has been argued that animal experimentation can save human lives and reduce harm on humans (Smith 2008). This argument is only valid for toxicological testing, not for tests that, for example, merely improve the efficacy of a cosmetic (Turner 2015). It can be suggested that animal experimentation should be regulated to only allow toxicological risk assessment, and the suffering to the animals should be minimised.   

Bibliography

Mateos, M. and Sole, I. (2009). Synthesising Information from various texts: A Study of Procedures and Products at Different Educational Levels. European Journal of Psychology of Education,  24 (4), 435-451. Available from https://doi.org/10.1007/BF03178760 [Accessed 29 June 2021].

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Literature Review How To

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What is Synthesis

What is Synthesis? Synthesis writing is a form of analysis related to comparison and contrast, classification and division. On a basic level, synthesis requires the writer to pull together two or more summaries, looking for themes in each text. In synthesis, you search for the links between various materials in order to make your point. Most advanced academic writing, including literature reviews, relies heavily on synthesis. (Temple University Writing Center)  

How To Synthesize Sources in a Literature Review

Literature reviews synthesize large amounts of information and present it in a coherent, organized fashion. In a literature review you will be combining material from several texts to create a new text – your literature review.

You will use common points among the sources you have gathered to help you synthesize the material. This will help ensure that your literature review is organized by subtopic, not by source. This means various authors' names can appear and reappear throughout the literature review, and each paragraph will mention several different authors. 

When you shift from writing summaries of the content of a source to synthesizing content from sources, there is a number things you must keep in mind: 

  • Look for specific connections and or links between your sources and how those relate to your thesis or question.
  • When writing and organizing your literature review be aware that your readers need to understand how and why the information from the different sources overlap.
  • Organize your literature review by the themes you find within your sources or themes you have identified. 
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Writing a literature review.

  • Background Information
  • Peer Review & Evaluation
  • Article Comparison
  • Creating an Outline

It is important to critically think about all of the sources you've read, both background information and scholarly journal articles, and synthesize that information into new conclusions that are unique to you. A synthesis requires critical thinking about the articles, determining where themes align, what they're saying that lines up, and what they're saying that might conflict with each other. What conclusions do these conflicts cause you to draw?

This page discusses how to synthesize information from your sources.

  • Literature Review: Synthesizing Multiple Sources from IUPUI's University Writing Center Walks through the process of creating a synthesis matrix.

Summarizing vs. Synthesizing

While a summary is a way of concisely relating important themes and elements from a larger work or works in a condensed form, a synthesis takes the information from a variety of works and combines them together to create something new.

Synthesis :

"Synthesis is similar to putting a puzzle together—piecing together information to create a whole. The outcome of this synthesis might be numeric, such as in an overall rating perhaps best typified in a quantitative weight and sum strategy, or through the use of meta-analysis, or the synthesis might be textual, such as in an analytic conclusion."

Synthesis. (2005). In Mathison, S. (Ed.),  Encyclopedia of evaluation . Thousand Oaks, CA: Sage Publications, Inc. doi: 10.4135/9781412950558

  • Approaches to Reviewing Research in Education from Sage Knowledge

How to Synthesize

Basic steps for synthesizing information:

  • Highlight the main themes/ideas of each article
  • Note which themes and ideas appear across multiple articles
  • Discuss how each article deals similarly or differently with each theme
  • Discuss how combining the information from all three articles can better address your research question than a single article alone
  • Write your deductions from combining this information in your own words using all three articles

Summary of 1 article:

By analyzing monthly cost data of 9 drugs that were approved by the FDA for Multiple Sclerosis from 1993 to 2013, Hartung, et al. determined that the cost of MS drugs is increasing far beyond inflation rates, which has a negative effect on MS patients (2015).

Summary of 2 articles:

The cost of MS drugs is increasing far beyond inflation rates, which has a negative effect on MS patients (Hartung, et al., 2015). For low income MS patients, like Shereese Hickson, this cost has proven to be more than they can pay (Hancock, 2018).

Synthesis of 2 articles:

The cost of MS drugs is increasing far beyond inflation rates, which has a negative effect on MS patients (Hartung, et al., 2015). The personal experience of Shereese Hickson shows what that negative impact looks like (Hancock, 2018). This illustrates how vulnerable populations, like low-income MS patients, can be at greater risk of experiencing the negative impacts of rising drug costs.

Hartung, D. M., Bourdette, D. N., Ahmed, S. M., & Whitham, R. H. (2015). The cost of multiple sclerosis drugs in the US and the pharmaceutical industry: Too big to fail? Neurology, 84 (21), 2185-2192. doi:10.1212/WNL.0000000000001608

Hancock, J. (2018). Chronically Ill, Traumatically Billed: $123,019 For 2 Multiple Sclerosis Treatments.  Kaiser Health News . Retrieved from  https://khn.org/news/chronically-ill-traumatically-billed-the-123k-medicine-for-ms/

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Writing the Literature Review

  • Getting Started
  • Step 1: Choose A Topic
  • Step 2: Find Information
  • Step 3: Evaluate
  • Step 4: Take Notes
  • Step 5: Synthesize
  • Step 6: Stay Organized
  • Write the Review

Synthesizing

What is "Synthesis"?

what is synthesis literature review

Synthesis?  

Synthesis refers to combining separate elements to create a whole.  When reading through your sources (peer reviewed journal articles, books, research studies, white papers etc.) you will pay attention to relationships between the studies, between groups in the studies, and look for any pattterns,  similarities or differences.  Pay attention to methodologies, unexplored themes, and things that may represent a "gap" in the literature.  These "gaps" will be things you will want to be sure to identify in your literature review.  

  • Using a Synthesis Matrix to Plan a Literature Review Introduction to synthesis matrices, and explanation of the difference between synthesis and analysis. (Geared towards Health Science/ Nursing but applicable for other literature reviews) ***Includes a synthesis matrix example***
  • Using a Spider Diagram Organize your thoughts with a spider diagram

Ready, Set...Synthesize

  • Create an outline that puts your topics (and subtopics) into a logical order
  • Look at each subtopic that you have identified and determine what the articles in that group have in common with each other
  • Look at the articles in those subtopics that you have identified and look for areas where they differ.
  • If you spot findings that are contradictory, what differences do you think could account for those contradictions?  
  • Determine what general conclusions can be reported about that subtopic, and how it relates to the group of studies that you are discussing
  • As you write, remember to follow your outline, and use transitions as you move between topics 

Galvan, J. L. (2006). Writing literature reviews (3rd ed.). Glendale, CA: Pyrczak Publishing

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Literature Reviews

  • Introduction
  • Tutorials and resources
  • Step 1: Literature search
  • Step 2: Analysis, synthesis, critique
  • Step 3: Writing the review

If you need any assistance, please contact the library staff at the Georgia Tech Library Help website . 

Analysis, synthesis, critique

Literature reviews build a story. You are telling the story about what you are researching. Therefore, a literature review is a handy way to show that you know what you are talking about. To do this, here are a few important skills you will need.

Skill #1: Analysis

Analysis means that you have carefully read a wide range of the literature on your topic and have understood the main themes, and identified how the literature relates to your own topic. Carefully read and analyze the articles you find in your search, and take notes. Notice the main point of the article, the methodologies used, what conclusions are reached, and what the main themes are. Most bibliographic management tools have capability to keep notes on each article you find, tag them with keywords, and organize into groups.

Skill #2: Synthesis

After you’ve read the literature, you will start to see some themes and categories emerge, some research trends to emerge, to see where scholars agree or disagree, and how works in your chosen field or discipline are related. One way to keep track of this is by using a Synthesis Matrix .

Skill #3: Critique

As you are writing your literature review, you will want to apply a critical eye to the literature you have evaluated and synthesized. Consider the strong arguments you will make contrasted with the potential gaps in previous research. The words that you choose to report your critiques of the literature will be non-neutral. For instance, using a word like “attempted” suggests that a researcher tried something but was not successful. For example: 

There were some attempts by Smith (2012) and Jones (2013) to integrate a new methodology in this process.

On the other hand, using a word like “proved” or a phrase like “produced results” evokes a more positive argument. For example:

The new methodologies employed by Blake (2014) produced results that provided further evidence of X.

In your critique, you can point out where you believe there is room for more coverage in a topic, or further exploration in in a sub-topic.

Need more help?

If you are looking for more detailed guidance about writing your dissertation, please contact the folks in the Georgia Tech Communication Center .

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what is synthesis literature review

How to Write a Literature Review - A Self-Guided Tutorial

  • Literature Reviews: A Recap
  • Reading Journal Articles
  • Does it describe a Literature Review?
  • 1. Identify the question
  • 2. Review discipline styles
  • Searching article databases - video
  • Finding the article full-text
  • Citation trails
  • When to stop searching
  • Citation Managers
  • 5. Critically analyze and evaluate
  • 6. Synthesize
  • 7. Write literature review
  • Additional Resources

You can meet with a librarian to talk about your literature review, or other library-related topics.

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You can sort the literature in various ways, for example:

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Synthesis Vizualization

Four examples of student writing.

In the four examples below, only ONE shows a good example of synthesis: the fourth column, or  Student D . For a web accessible version, click the link below the image.

Visualizing synthesis

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Synthesis Matrix Example

what is synthesis literature review

From Jennifer Lim

Synthesis Templates

Synthesis grids are organizational tools used to record the main concepts of your sources and can help you make connections about how your sources relate to one another.

  • Source Template Basic Literature Review Source Template from Walden University Writing Center to help record the main findings and concepts from different articles.
  • Sample Literature Review Grids This spreadsheet contains multiple tabs with different grid templates. Download or create your own copy to begin recording notes.
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  • How to Write a Literature Review | Guide, Examples, & Templates

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

  • Quick Run-through
  • Step 1 & 2

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

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

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

Literature review guide

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what is synthesis literature review

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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what is synthesis literature review

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

  • Summarize and synthesize: give an overview of the main points of each source and combine them into a coherent whole
  • Analyze and interpret: don’t just paraphrase other researchers — add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
  • Critically evaluate: mention the strengths and weaknesses of your sources
  • Write in well-structured paragraphs: use transition words and topic sentences to draw connections, comparisons and contrasts

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

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

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

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

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

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Research bias

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

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

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

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

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

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

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

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

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When you write a literature review or essay, you have to go beyond just summarizing the articles you’ve read – you need to synthesize the literature to show how it all fits together (and how your own research fits in).

Synthesizing simply means combining. Instead of summarizing the main points of each source in turn, you put together the ideas and findings of multiple sources in order to make an overall point.

At the most basic level, this involves looking for similarities and differences between your sources. Your synthesis should show the reader where the sources overlap and where they diverge.

Unsynthesized Example

Franz (2008) studied undergraduate online students. He looked at 17 females and 18 males and found that none of them liked APA. According to Franz, the evidence suggested that all students are reluctant to learn citations style. Perez (2010) also studies undergraduate students. She looked at 42 females and 50 males and found that males were significantly more inclined to use citation software ( p < .05). Findings suggest that females might graduate sooner. Goldstein (2012) looked at British undergraduates. Among a sample of 50, all females, all confident in their abilities to cite and were eager to write their dissertations.

Synthesized Example

Studies of undergraduate students reveal conflicting conclusions regarding relationships between advanced scholarly study and citation efficacy. Although Franz (2008) found that no participants enjoyed learning citation style, Goldstein (2012) determined in a larger study that all participants watched felt comfortable citing sources, suggesting that variables among participant and control group populations must be examined more closely. Although Perez (2010) expanded on Franz’s original study with a larger, more diverse sample…

Step 1: Organize your sources

After collecting the relevant literature, you’ve got a lot of information to work through, and no clear idea of how it all fits together.

Before you can start writing, you need to organize your notes in a way that allows you to see the relationships between sources.

One way to begin synthesizing the literature is to put your notes into a table. Depending on your topic and the type of literature you’re dealing with, there are a couple of different ways you can organize this.

Summary table

A summary table collates the key points of each source under consistent headings. This is a good approach if your sources tend to have a similar structure – for instance, if they’re all empirical papers.

Each row in the table lists one source, and each column identifies a specific part of the source. You can decide which headings to include based on what’s most relevant to the literature you’re dealing with.

For example, you might include columns for things like aims, methods, variables, population, sample size, and conclusion.

For each study, you briefly summarize each of these aspects. You can also include columns for your own evaluation and analysis.

summary table for synthesizing the literature

The summary table gives you a quick overview of the key points of each source. This allows you to group sources by relevant similarities, as well as noticing important differences or contradictions in their findings.

Synthesis matrix

A synthesis matrix is useful when your sources are more varied in their purpose and structure – for example, when you’re dealing with books and essays making various different arguments about a topic.

Each column in the table lists one source. Each row is labeled with a specific concept, topic or theme that recurs across all or most of the sources.

Then, for each source, you summarize the main points or arguments related to the theme.

synthesis matrix

The purposes of the table is to identify the common points that connect the sources, as well as identifying points where they diverge or disagree.

Step 2: Outline your structure

Now you should have a clear overview of the main connections and differences between the sources you’ve read. Next, you need to decide how you’ll group them together and the order in which you’ll discuss them.

For shorter papers, your outline can just identify the focus of each paragraph; for longer papers, you might want to divide it into sections with headings.

There are a few different approaches you can take to help you structure your synthesis.

If your sources cover a broad time period, and you found patterns in how researchers approached the topic over time, you can organize your discussion chronologically .

That doesn’t mean you just summarize each paper in chronological order; instead, you should group articles into time periods and identify what they have in common, as well as signalling important turning points or developments in the literature.

If the literature covers various different topics, you can organize it thematically .

That means that each paragraph or section focuses on a specific theme and explains how that theme is approached in the literature.

synthesizing the literature using themes

Source Used with Permission: The Chicago School

If you’re drawing on literature from various different fields or they use a wide variety of research methods, you can organize your sources methodologically .

That means grouping together studies based on the type of research they did and discussing the findings that emerged from each method.

If your topic involves a debate between different schools of thought, you can organize it theoretically .

That means comparing the different theories that have been developed and grouping together papers based on the position or perspective they take on the topic, as well as evaluating which arguments are most convincing.

Step 3: Write paragraphs with topic sentences

What sets a synthesis apart from a summary is that it combines various sources. The easiest way to think about this is that each paragraph should discuss a few different sources, and you should be able to condense the overall point of the paragraph into one sentence.

This is called a topic sentence , and it usually appears at the start of the paragraph. The topic sentence signals what the whole paragraph is about; every sentence in the paragraph should be clearly related to it.

A topic sentence can be a simple summary of the paragraph’s content:

“Early research on [x] focused heavily on [y].”

For an effective synthesis, you can use topic sentences to link back to the previous paragraph, highlighting a point of debate or critique:

“Several scholars have pointed out the flaws in this approach.” “While recent research has attempted to address the problem, many of these studies have methodological flaws that limit their validity.”

By using topic sentences, you can ensure that your paragraphs are coherent and clearly show the connections between the articles you are discussing.

As you write your paragraphs, avoid quoting directly from sources: use your own words to explain the commonalities and differences that you found in the literature.

Don’t try to cover every single point from every single source – the key to synthesizing is to extract the most important and relevant information and combine it to give your reader an overall picture of the state of knowledge on your topic.

Step 4: Revise, edit and proofread

Like any other piece of academic writing, synthesizing literature doesn’t happen all in one go – it involves redrafting, revising, editing and proofreading your work.

Checklist for Synthesis

  •   Do I introduce the paragraph with a clear, focused topic sentence?
  •   Do I discuss more than one source in the paragraph?
  •   Do I mention only the most relevant findings, rather than describing every part of the studies?
  •   Do I discuss the similarities or differences between the sources, rather than summarizing each source in turn?
  •   Do I put the findings or arguments of the sources in my own words?
  •   Is the paragraph organized around a single idea?
  •   Is the paragraph directly relevant to my research question or topic?
  •   Is there a logical transition from this paragraph to the next one?

Further Information

How to Synthesise: a Step-by-Step Approach

Help…I”ve Been Asked to Synthesize!

Learn how to Synthesise (combine information from sources)

How to write a Psychology Essay

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  • What are Literature Reviews?
  • Conducting & Reporting Systematic Reviews
  • Finding Systematic Reviews
  • Tutorials & Tools for Literature Reviews

Systematic Literature Reviews: Steps & Resources

what is synthesis literature review

These steps for conducting a systematic literature review are listed below . 

Also see subpages for more information about:

  • The different types of literature reviews, including systematic reviews and other evidence synthesis methods
  • Tools & Tutorials

Literature Review & Systematic Review Steps

  • Develop a Focused Question
  • Scope the Literature  (Initial Search)
  • Refine & Expand the Search
  • Limit the Results
  • Download Citations
  • Abstract & Analyze
  • Create Flow Diagram
  • Synthesize & Report Results

1. Develop a Focused   Question 

Consider the PICO Format: Population/Problem, Intervention, Comparison, Outcome

Focus on defining the Population or Problem and Intervention (don't narrow by Comparison or Outcome just yet!)

"What are the effects of the Pilates method for patients with low back pain?"

Tools & Additional Resources:

  • PICO Question Help
  • Stillwell, Susan B., DNP, RN, CNE; Fineout-Overholt, Ellen, PhD, RN, FNAP, FAAN; Melnyk, Bernadette Mazurek, PhD, RN, CPNP/PMHNP, FNAP, FAAN; Williamson, Kathleen M., PhD, RN Evidence-Based Practice, Step by Step: Asking the Clinical Question, AJN The American Journal of Nursing : March 2010 - Volume 110 - Issue 3 - p 58-61 doi: 10.1097/01.NAJ.0000368959.11129.79

2. Scope the Literature

A "scoping search" investigates the breadth and/or depth of the initial question or may identify a gap in the literature. 

Eligible studies may be located by searching in:

  • Background sources (books, point-of-care tools)
  • Article databases
  • Trial registries
  • Grey literature
  • Cited references
  • Reference lists

When searching, if possible, translate terms to controlled vocabulary of the database. Use text word searching when necessary.

Use Boolean operators to connect search terms:

  • Combine separate concepts with AND  (resulting in a narrower search)
  • Connecting synonyms with OR  (resulting in an expanded search)

Search:  pilates AND ("low back pain"  OR  backache )

Video Tutorials - Translating PICO Questions into Search Queries

  • Translate Your PICO Into a Search in PubMed (YouTube, Carrie Price, 5:11) 
  • Translate Your PICO Into a Search in CINAHL (YouTube, Carrie Price, 4:56)

3. Refine & Expand Your Search

Expand your search strategy with synonymous search terms harvested from:

  • database thesauri
  • reference lists
  • relevant studies

Example: 

(pilates OR exercise movement techniques) AND ("low back pain" OR backache* OR sciatica OR lumbago OR spondylosis)

As you develop a final, reproducible strategy for each database, save your strategies in a:

  • a personal database account (e.g., MyNCBI for PubMed)
  • Log in with your NYU credentials
  • Open and "Make a Copy" to create your own tracker for your literature search strategies

4. Limit Your Results

Use database filters to limit your results based on your defined inclusion/exclusion criteria.  In addition to relying on the databases' categorical filters, you may also need to manually screen results.  

  • Limit to Article type, e.g.,:  "randomized controlled trial" OR multicenter study
  • Limit by publication years, age groups, language, etc.

NOTE: Many databases allow you to filter to "Full Text Only".  This filter is  not recommended . It excludes articles if their full text is not available in that particular database (CINAHL, PubMed, etc), but if the article is relevant, it is important that you are able to read its title and abstract, regardless of 'full text' status. The full text is likely to be accessible through another source (a different database, or Interlibrary Loan).  

  • Filters in PubMed
  • CINAHL Advanced Searching Tutorial

5. Download Citations

Selected citations and/or entire sets of search results can be downloaded from the database into a citation management tool. If you are conducting a systematic review that will require reporting according to PRISMA standards, a citation manager can help you keep track of the number of articles that came from each database, as well as the number of duplicate records.

In Zotero, you can create a Collection for the combined results set, and sub-collections for the results from each database you search.  You can then use Zotero's 'Duplicate Items" function to find and merge duplicate records.

File structure of a Zotero library, showing a combined pooled set, and sub folders representing results from individual databases.

  • Citation Managers - General Guide

6. Abstract and Analyze

  • Migrate citations to data collection/extraction tool
  • Screen Title/Abstracts for inclusion/exclusion
  • Screen and appraise full text for relevance, methods, 
  • Resolve disagreements by consensus

Covidence is a web-based tool that enables you to work with a team to screen titles/abstracts and full text for inclusion in your review, as well as extract data from the included studies.

Screenshot of the Covidence interface, showing Title and abstract screening phase.

  • Covidence Support
  • Critical Appraisal Tools
  • Data Extraction Tools

7. Create Flow Diagram

The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow diagram is a visual representation of the flow of records through different phases of a systematic review.  It depicts the number of records identified, included and excluded.  It is best used in conjunction with the PRISMA checklist .

Example PRISMA diagram showing number of records identified, duplicates removed, and records excluded.

Example from: Stotz, S. A., McNealy, K., Begay, R. L., DeSanto, K., Manson, S. M., & Moore, K. R. (2021). Multi-level diabetes prevention and treatment interventions for Native people in the USA and Canada: A scoping review. Current Diabetes Reports, 2 (11), 46. https://doi.org/10.1007/s11892-021-01414-3

  • PRISMA Flow Diagram Generator (ShinyApp.io, Haddaway et al. )
  • PRISMA Diagram Templates  (Word and PDF)
  • Make a copy of the file to fill out the template
  • Image can be downloaded as PDF, PNG, JPG, or SVG
  • Covidence generates a PRISMA diagram that is automatically updated as records move through the review phases

8. Synthesize & Report Results

There are a number of reporting guideline available to guide the synthesis and reporting of results in systematic literature reviews.

It is common to organize findings in a matrix, also known as a Table of Evidence (ToE).

Example of a review matrix, using Microsoft Excel, showing the results of a systematic literature review.

  • Reporting Guidelines for Systematic Reviews
  • Download a sample template of a health sciences review matrix  (GoogleSheets)

Steps modified from: 

Cook, D. A., & West, C. P. (2012). Conducting systematic reviews in medical education: a stepwise approach.   Medical Education , 46 (10), 943–952.

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Systematic reviews & evidence synthesis methods.

  • Schedule a Consultation / Meet our Team
  • What is Evidence Synthesis?
  • Types of Evidence Synthesis
  • Evidence Synthesis Across Disciplines
  • Finding and Appraising Existing Systematic Reviews
  • 0. Develop a Protocol
  • 1. Draft your Research Question
  • 2. Select Databases
  • 3. Select Grey Literature Sources
  • 4. Write a Search Strategy
  • 5. Register a Protocol
  • 6. Translate Search Strategies
  • 7. Citation Management
  • 8. Article Screening
  • 9. Risk of Bias Assessment
  • 10. Data Extraction
  • 11. Synthesize, Map, or Describe the Results
  • Open Access Evidence Synthesis Resources

What are Evidence Syntheses?

According to the Royal Society, 'evidence synthesis' refers to the process of bringing together information from a range of sources and disciplines to inform debates and decisions on specific issues. They generally include a methodical and comprehensive literature synthesis focused on a well-formulated research question. Their aim is to identify and synthesize all of the scholarly research on a particular topic, including both published and unpublished studies. Evidence syntheses are conducted in an unbiased, reproducible way to provide evidence for practice and policy-making, as well as to identify gaps in the research. Evidence syntheses may also include a meta-analysis, a more quantitative process of synthesizing and visualizing data retrieved from various studies.

Evidence syntheses are much more time-intensive than traditional literature reviews and require a multi-person research team. See this PredicTER tool to get a sense of a systematic review timeline (one type of evidence synthesis). Before embarking on an evidence synthesis, it's important to clearly identify your reasons for conducting one. For a list of types of evidence synthesis projects, see the Types of Evidence Synthesis tab.

How Does a Traditional Literature Review Differ From an Evidence Synthesis?

One commonly used form of evidence synthesis is a systematic review. This table compares a traditional literature review with a systematic review.

Video: Reproducibility and transparent methods (Video 3:25)

Reporting Standards

There are some reporting standards for evidence syntheses. These can serve as guidelines for protocol and manuscript preparation and journals may require that these standards are followed for the review type that is being employed (e.g. systematic review, scoping review, etc).​

  • PRISMA checklist Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses.
  • PRISMA-P Standards An updated version of the original PRISMA standards for protocol development.
  • PRISMA - ScR Reporting guidelines for scoping reviews and evidence maps
  • PRISMA-IPD Standards Extension of the original PRISMA standards for systematic reviews and meta-analyses of individual participant data.
  • EQUATOR Network The EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network is an international initiative that seeks to improve the reliability and value of published health research literature by promoting transparent and accurate reporting and wider use of robust reporting guidelines. They provide a list of various standards for reporting in systematic reviews.

Video: Guidelines and reporting standards

PRISMA Flow Diagram

The PRISMA flow diagram depicts the flow of information through the different phases of an evidence synthesis. It maps the search (number of records identified), screening (number of records included and excluded), and selection (reasons for exclusion). Many evidence syntheses include a PRISMA flow diagram in the published manuscript.

See below for resources to help you generate your own PRISMA flow diagram.

  • PRISMA Flow Diagram Tool
  • PRISMA Flow Diagram Word Template
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Literature Review Basics

  • What is a Literature Review?
  • Synthesizing Research
  • Using Research & Synthesis Tables
  • Additional Resources

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About the Research and Synthesis Tables

Research Tables and Synthesis Tables are useful tools for organizing and analyzing your research as you assemble your literature review. They represent two different parts of the review process: assembling relevant information and synthesizing it. Use a Research table to compile the main info you need about the items you find in your research -- it's a great thing to have on hand as you take notes on what you read! Then, once you've assembled your research, use the Synthesis table to start charting the similarities/differences and major themes among your collected items.

We've included an Excel file with templates for you to use below; the examples pictured on this page are snapshots from that file.

  • Research and Synthesis Table Templates This Excel workbook includes simple templates for creating research tables and synthesis tables. Feel free to download and use!

Using the Research Table

Image of Model Research Excel Table

This is an example of a  research table,  in which you provide a basic description of the most important features of the studies, articles, and other items you discover in your research. The table identifies each item according to its author/date of publication, its purpose or thesis, what type of work it is (systematic review, clinical trial, etc.), the level of evidence it represents (which tells you a lot about its impact on the field of study), and its major findings. Your job, when you assemble this information, is to develop a snapshot of what the research shows about the topic of your research question and assess its value (both for the purpose of your work and for general knowledge in the field).

Think of your work on the research table as the foundational step for your analysis of the literature, in which you assemble the information you'll be analyzing and lay the groundwork for thinking about what it means and how it can be used.

Using the Synthesis Table

Image of Model Synthesis Excel Table

This is an example of a  synthesis table  or  synthesis matrix , in which you organize and analyze your research by listing each source and indicating whether a given finding or result occurred in a particular study or article ( each row lists an individual source, and each finding has its own column, in which X = yes, blank = no). You can also add or alter the columns to look for shared study populations, sort by level of evidence or source type, etc. The key here is to use the table to provide a simple representation of what the research has found (or not found, as the case may be). Think of a synthesis table as a tool for making comparisons, identifying trends, and locating gaps in the literature.

How do I know which findings to use, or how many to include?  Your research question tells you which findings are of interest in your research, so work from your research question to decide what needs to go in each Finding header, and how many findings are necessary. The number is up to you; again, you can alter this table by adding or deleting columns to match what you're actually looking for in your analysis. You should also, of course, be guided by what's actually present in the material your research turns up!

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Chapter 5: Writing a Summary and Synthesizing

5.5 Synthesis and Literature Reviews

Literature reviews : synthesis and research.

Why do we seek to understand the ways that authors or sources “converse” with one another? So that we can synthesize various perspectives on a topic to more deeply understand it.

In academic writing, this understanding of the “conversation” may become the content of an explanatory  synthesis  paper – a paper in which you, the writer, point out various various themes or key points from a conversation on a particular topic. Notice that the example of synthesis in “What Synthesis Is” acknowledges that guns and gun control inspire passionate responses in Americans, that more than one kind of weapon is involved in gun violence, that guns in America are both legally and illegally owned, and that there are many constituencies whose experience with guns needs to considered if sound gun-control policy is to be achieved. The writer of this synthesis isn’t “pretending” to be objective (“Although gun violence is a problem in American today, people who want to increase gun control clearly don’t understand the Second Amendment”); nor is the writer arguing a point or attempting to persuade the audience to accept one perspective. The writer is making a claim about gun control that demonstrates his or her deepest understanding of the issue.

Another assignment that you may complete that also applies your synthesis skills is a l iterature review .  Literature reviews are often found in the beginning of scholarly journal articles to contextualize the author’s own research. Sometimes, literature reviews are done for their own sake; some scholarly articles are  just  Literature reviews.

Literature reviews (sometimes shortened to “lit reviews”) synthesize previous research that has been done on a particular topic, summarizing important works in the history of research on that topic. The literature review provides context for the author’s own new research. It is the basis and background out of which the author’s research grows. Context = credibility in academic writing. When writers are able to produce a literature review, they demonstrate the breadth of their knowledge about how others have already studied and discussed their topic.

  • Literature reviews are most often  arranged by topic or theme , much like a traditional explanatory synthesis paper.
  • If one is looking at a topic that has a long history of research and scholarship, one may conduct a chronological  literature review, one that looks at how the research topic has been studied and discussed in various time periods (i.e., what was published ten years ago, five years ago, and within the last year, for example).
  • Finally, in some instances, one might seek to craft a literature review that is organized  by discipline or field. This type of literature review could offer information about how different academic fields have examined a particular topic (i.e., what is the current research being done by biologists on this topic? What is the current research being done by psychologists on this topic? What is the current research being done by [ insert academic discipline] on this topic?).

A Literature Review offers  only  a report on what others have already written about. The Literature Review does not reflect the author’s own argument or contributions to the field of research. Instead, it indicates that the author has read others’ important contributions and understands what has come before him or her. Sometimes, literature reviews are stand alone assignments or publications. Sometimes, they fit into a larger essay or article (especially in many of the scholarly articles that you will read throughout college. For more information on how literature reviews are a part of scholarly articles, see chapter 10.5 )

A Guide to Rhetoric, Genre, and Success in First-Year Writing by Melanie Gagich & Emilie Zickel is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

Table 9.1. Typology of Literature Reviews (adapted from Paré et al., 2015).

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

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

9.5. Concluding Remarks

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

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

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

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Covalent organic frameworks for CO 2 adsorption: fundamentals, structural features and synthesis

  • Published: 19 July 2023
  • Volume 31 , pages 33–48, ( 2024 )

Cite this article

  • Tooba Saeed 1 , 2 ,
  • Abdul Naeem 2 ,
  • Bashir Ahmad 1 ,
  • Shahzaib Ahmad 1 ,
  • Shaista Afridi 1 ,
  • Farida Khan 2 ,
  • Israf Ud Din 3 &
  • Nazish Huma Khan 4  

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A Correction to this article was published on 29 August 2023

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In the last ten years, covalent organic frameworks (COFs) which are crystalline, polymers with greater porosity and surface area, have attracted much research interest. The COF materials are made by covalently bonding organic molecules in a pattern that repeats to create a permeable crystal that is perfect for the sorption and storage of gas. They are expedient in the adsorption of contaminants such as CO 2 due to their appealing qualities including durability, improved reactivity, permanent porosity, and increased surface area. This study is an effort to report topology patterns, pore design, Synthetic Reactions of COFs, different methods for the synthesis of COFs and their applications for CO 2 adsorption. This review further focused on the current literature on the adsorption of CO 2 .

Graphical Abstract

what is synthesis literature review

The present review reports the properties, structure and synthetic reactions for the synthesis of COFs.

It elucidates different methods for the synthesis of COFs.

An extensive literature on the application of COFs as adsorbents for the removal of CO 2 .

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29 august 2023.

A Correction to this paper has been published: https://doi.org/10.1007/s10934-023-01507-2

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Acknowledgements

The authors would like to convey their gratefulness to the Department of Chemistry, Bacha Khan University Charsadda, Pakistan, National Centre of Excellence in Physical Chemistry, University of Peshawar, Pakistan and the Department of Chemistry, Prince Sattam Bin Abdul Aziz University, Saudi Arabia for supporting this study.

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Tooba Saeed, Bashir Ahmad, Shahzaib Ahmad & Shaista Afridi

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Tooba Saeed: Writing- Original draft preparation. Abdul Naeem: Conceptualization, Reviewing. Bashir Ahmad and Shahzaib Ahmad: Software and technical support, Editing Shaista Afridi, Farida Khan and Israf Ud Din: Drawing and Editing Nazish Huma Khan: Reviewing.

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Saeed, T., Naeem, A., Ahmad, B. et al. Covalent organic frameworks for CO 2 adsorption: fundamentals, structural features and synthesis. J Porous Mater 31 , 33–48 (2024). https://doi.org/10.1007/s10934-023-01504-5

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A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia

  • Bianca E. Kavanagh   ORCID: orcid.org/0000-0002-1656-2775 1 ,
  • Kayla B. Corney 2 ,
  • Hannah Beks   ORCID: orcid.org/0000-0002-2851-6450 1 ,
  • Lana J. Williams   ORCID: orcid.org/0000-0002-1377-1272 2 ,
  • Shae E. Quirk 2 , 3 , 4 &
  • Vincent L. Versace   ORCID: orcid.org/0000-0002-8514-1763 1  

BMC Health Services Research volume  23 , Article number:  1060 ( 2023 ) Cite this article

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Inadequate healthcare access and utilisation are implicated in the mental health burden experienced by those living in regional, rural, and remote Australia. Facilitators that better enable access and utilisation are also reported in the literature. To date, a synthesis on both the barriers and facilitators to accessing and utilising mental health services within the rural Australian context has not been undertaken. This scoping review aims to (1) synthesise the barriers and facilitators to accessing and utilising mental health services in regional, rural, and remote Australia, as identified using the Modified Monash Model; and (2) better understand the relationship between barriers and facilitators and their geographical context.

A systematic search of Medline Complete, EMBASE, PsycINFO, Scopus, and CINAHL was undertaken to identify peer-reviewed literature. Grey literature was collated from relevant websites. Study characteristics, including barriers and facilitators, and location were extracted. A descriptive synthesis of results was conducted.

Fifty-three articles were included in this scoping review. Prominent barriers to access and utilisation included: limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators included person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy and culturally-sensitive practice. The variability of the included studies precluded the geographical analysis from being completed.

Both healthcare providers and service users considered a number of barriers and facilitators to mental health service access and utilisation in the regional, rural, and remote Australian context. Barriers and facilitators should be considered when re-designing services, particularly in light of the findings and recommendations from the Royal Commission into Victoria’s Mental Health System, which may be relevant to other areas of Australia. Additional research generated from rural Australia is needed to better understand the geographical context in which specific barriers and facilitators occur.

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Introduction

The mental health of Australians who live in regional, rural, and remote Australia is an ongoing concern [ 1 ]. Poor healthcare access is one of the key determinants of adverse mental health outcomes, with access issues being more pronounced in regional, rural, and remote Australia (hereafter referred to as rural , in line with the Australian Government’s definition under the Rural Health Multidisciplinary Training [RHMT] Program [ 2 ]), compared to metropolitan Australia [ 3 ]. People living in rural Australia often face difficulties in obtaining healthcare, and this care is often delayed and more expensive for the patient [ 4 ]. These difficulties in accessing and utilising healthcare are implicated in the higher mental disorder burden experienced by those living in rural Australia, shown by the higher rates of suicide, compared with major cities [ 5 ]. Moreover, this group is less likely than those living in major cities to take-up and complete mental health treatment [ 6 ]. Workforce maldistribution plays a role in these health inequalities [ 7 , 8 , 9 , 10 ], with more clinical full time equivalent (FTE) mental health professionals working in major cities, compared with rural areas (i.e., 92 vs. 30–80 mental health nurses, 15 vs. 2–6 psychiatrists, and 90 vs. 15–55 psychologists per 100,000/population) [ 3 ]. Other areas of the health workforce are similarly maldistributed across the country (i.e., 403 vs. 223–309 clinical FTE medical practitioners and 531 vs. 382–469 clinical FTE allied health professionals per 100,000/population in major cities versus rural areas) [ 11 ].

There are a number of factors that are implicated — both directly and indirectly — in the access and utilisation of mental health services, and these factors may be pertinent to the level of remoteness experienced. This includes particular aspatial (i.e., social) and spatial (i.e., geographical) dimensions [ 12 , 13 ]. Aspatial dimensions consist of the factors that affect the affordability , acceptability , accommodation , and awareness of healthcare access. In the rural context of Australia, this tends to relate to social matters [ 14 , 15 ] including stoicism, low help-seeking behaviours, and confidentiality concerns [ 16 ]. Spatial dimensions are concerned with the availability and accessibility of service access, including geographical isolation [ 14 ], service delivery capacity [ 17 ] [ 18 ], and dual-roles [ 14 ] (i.e., the intersection of professional and personal relationships) in rural areas. While here we define access as factors that pertain to the attributes/expectations of the individual and their alignment with the provider/services [ 12 ], other models conceptualise access as the opportunity to identify healthcare needs, seek services, reach resources, obtain or use services, and have the need for services fulfilled [ 19 ]. Utilisation refers to the generation of a healthcare plan throughout a healthcare encounter, as well as its implementation and follow-through [ 20 ].

Conceivably, mitigating the barriers and augmenting the facilitators to the utilisation of mental health services may be particularly important when considering the obstacles that people from rural areas face when accessing services. One previous study on rurally-based Australian adolescents suggested that barriers to accessing services, such as social exclusion and ostracism by members of their community, also likely prevented the continued utilisation of services and negatively affected treatment outcomes [ 21 ]. Cheesmond et al. [ 22 ], in a review of residents in rural Australia, Canada, and the United States of America, highlighted a link between sociocultural rurality, rural identity, and help-seeking behaviour. Cheesmond et al. [ 22 ] suggested that specific place-sensitive approaches are needed to overcome barriers to help-seeking, and that a greater understanding of help-seeking in the rural context is required. This includes further exploration of rurality as a concept, conducting research within diverse environments, allowing participants to contextualise barriers to help-seeking, and exploring the co-existence of multiple help-seeking barriers. Parallel to this, a paucity of research has focussed on the facilitators to accessing and utilising mental health services in rural Australia.

To the authors’ knowledge, no previous reviews have specifically focussed on understanding the barriers and facilitators to accessing and utilising mental health services within the rural Australian context. A scoping review was chosen as the preferred approach to this work because of the emerging and cross-disciplined nature of the research. The aim of this scoping review is to: (1) explore the barriers and facilitators to accessing and utilising mental health services for Australians living in rural areas; and (2) better understand the relationship between barriers and facilitators and their geographical context.

This scoping review conforms to the guidelines put forward by Arksey and O’Malley [ 23 ], follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) [ 24 ], and a published protocol [ 25 ].

Eligibility criteria

The scope of this review was intentionally broad to allow explanation of the nature and extent of the literature describing the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia. Articles were eligible for inclusion if they met the following criteria:

Included individuals with a diagnosed mental disorder, experienced mental health issues, or were part of a mental health community service; or included healthcare providers that provided diagnostic, assessment, or treatment services for mental health issues.

Explained obstacles that impeded the uptake, quality, or level of mental health services being accessed or described facilitators that allowed the uptake, quality, or level of mental health services being received.

Included service users, healthcare providers, or services that were based in regional, rural, or remote Australia according to the Modified Monash Model (MMM) 2–7 ( regional centres to very remote communities ) [ 4 ] (i.e. the current RHMT definition of rural).

The population/concept/context (PCC) framework was used to generate the eligibility criteria for this scoping review and is described in Table  1 . The eligibility criteria for this review varied slightly from the published protocol [ 25 ]. In this review, we included pharmacists as healthcare providers, as it was identified that pharmacists play a key role in mental health services in some rural areas. We excluded mental health programs and health promotion activities that were considered to be a “structured activity” delivered by a service, reviews, viewpoints, declarations, tailpieces, frameworks, and commentaries. We also excluded articles that did not provide sufficient detail to describe the barriers or facilitators to accessing or utilising services, as well as articles that pooled results across participants from metropolitan and regional/rural/remote areas. The only exception to this was when authors referred to the study setting as regional/rural/remote, but upon further investigation using the health workforce locator [ 26 ] (see Sect.  2.8 Geographical analysis ), the location was deemed to be metropolitan according to the MMM [ 4 ] — this exception was allowed due to the differences in geographical models applied to Australian health research [ 27 , 28 ]. Separately, we decided to include articles that reported on the barriers and/or facilitators of a specific rural mental health service implementation activity or service model, as we felt that these articles offered important insights that may be translated to new service initiatives or research activities.

Information sources

The following databases were systematically searched: Medline Complete, EMBASE, PsycINFO, Scopus, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). Websites of the Australian federal and state government’s Department of Health, Primary Health Network (PHN), key rural and remote peak bodies/agencies known to the authors from their collective experience on the topic, and Google were also searched to ascertain grey literature. The search was performed on 11th January 2022 and a 2012-current date filter was employed using the ‘start’ and ‘end’ publication year functions. Additional sources were identified through ‘snowball’ searching of included studies. Where needed, additional location information was obtained via a study’s first or corresponding author.

The search strategy was developed in consultation with two scholarly services librarians (JS and BK) to identify peer-reviewed studies and grey literature records. Relevant keywords, search terms, and wildcard symbols were applied to each database. An adapted search string was searched in Google using the advanced search function. The “all these words” and “any of these words” search options were engaged, and PDF files were requested. All (n = 11) pages of the search results were assessed for eligibility by one reviewer (BEK), and the research term agreed on their inclusion.

The full search strategy and grey literature sources are presented in Additional Table  1 .

Selection of sources of evidence

One reviewer (BEK) applied the search strategy to the databases and websites. Two reviewers (BEK and KBC) independently screened all articles using Covidence [ 29 ]. Where discrepancies concerning the eligibility of an article occurred, a meeting was held to determine consensus; if consensus could not be reached, a third reviewer (LJW) was consulted to make the final decision.

Data charting process

To ensure that the data charting process was consistent with the research question, a charting form was developed and piloted by two authors (BEK and KBC). One author (BEK) then charted the data for each of the eligible articles, using Microsoft Excel.

The following data items were extracted from eligible studies: author and year, study objective, study design, location, sample size, characteristics of participants, mental health diagnosis/issue and assessment method, healthcare provider type/role, barriers, facilitators, mental health service, regional/rural/remote area of Australia, and summary of findings (Additional Table  2 ). For literature that included participants from both metropolitan and regional/rural/remote areas, only information that pertained to those from regional/rural/remote areas was extracted, except for instances where statistical differences between groups were reported for comparison. Likewise, in instances where articles included participants who were eligible (e.g., healthcare providers) as well as participants who were ineligible (e.g., no evidence of mental health diagnosis/engagement with services), only information from eligible participants was extracted. First or corresponding authors of studies that did not specifically state where the study was conducted were contacted to provide additional location information.

Synthesis of results

A descriptive synthesis was conducted by providing an overview of the included study characteristics, setting and target groups, and barries and facilitators. Links to aspatial and spatial access factors were also described, where relevant. The study characteristics are presented in Table  2 and the barriers and facilitators pertaining to each included study are presented in Additional Table  3 . A quality appraisal of the included studies was not undertaken as scoping reviews aim to offer an overview or map of the pertinent evidence [ 30 ].

Geographical analysis

Geographical coordinates provided by the health workforce locator [ 26 ] were used to determine the remoteness of the study locations according to the MMM categories. These data were inputted into STATA to determine the number and proportion of each of the MMM categories.

The database search yielded 1,278 articles, of which 555 articles were removed due to duplication. Subsequently, 723 titles and abstracts were screened, and 441 were excluded due to ineligibility. At the full text stage, 282 articles were screened, with 181 studies being excluded, resulting in 47 articles meeting the eligibility criteria. The grey literature search yielded 128 potentially relevant sources, of which six were eligible after removing three for duplication. In total, 53 articles were included in this scoping review. A snowball search of the references of included records was also conducted and two additional records were identified but were deemed ineligible as they reported on studies/samples that were already included in the review. Figure  1 displays the PRISMA flow throughout each screening stage.

figure 1

PRISMA flow diagram of studies considered in this review

Study characteristics

Of the 53 included studies, 25 articles described barriers and/or facilitators from the healthcare provider perspective, 13 were from the point of view of the service user, eight reported on combined perspectives of both the healthcare provider and service user, and seven reported on barriers/facilitators from neither the healthcare provider nor service user perspective directly but did consider the barriers/facilitators of the service environment (e.g., service evaluations).

Most studies (n = 29, 54.7%) employed qualitative methods, including interviews and/or focus groups; 12 studies utilised quantitative cross-sectional or longitudinal methods, seven were mixed-methods research designs, and two were service description and classification studies.

The highest proportion of studies were conducted in New South Wales (NSW) (n = 13) [ 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], followed by Australia broadly (n = 12) [ 33 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ], South Australia (SA) (n = 10) [ 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 ], Victoria (VIC) (n = 6) [ 65 , 66 , 67 , 68 , 69 , 70 ], Queensland (QLD) (n = 5) [ 71 , 72 , 73 , 74 , 75 ], Western Australia (WA) (n = 3) [ 76 , 77 , 78 ], Tasmania (TAS) (n = 2) [ 79 , 80 ], and Northern Territory (NT) (n = 1) [ 81 ]. One study pertained to areas within NSW, QLD, and VIC [ 82 ], and another study concerned NSW and WA [ 83 ]. No studies were centred on Australian Capital Territory (ACT). Table  2 depicts the characteristics of the included studies.

Setting and target groups

Mental health service setting.

Fourteen studies reported on general or community-based mental health services [ 18 , 33 , 43 , 48 , 53 , 54 , 57 , 64 , 72 , 74 , 77 , 78 , 83 ]. Four studies described mental health services provided within emergency departments (EDs) and/or urgent care centres (UCCs) [ 40 , 41 , 46 , 65 ]. The remaining studies described mental health services provided by counsellors and GPs [ 38 ], nurses, peer-workers [ 71 ], personal helpers and mentors [ 35 ], pharmacists [ 47 ], and a combination of several healthcare providers [ 59 ]. Seven studies reported on technology-based or -enhanced mental health services [ 51 , 60 , 61 , 62 , 63 , 75 , 76 ].

Target groups

The population group focus of studies varied. Of the studies that commented on, or specified that they targeted specific subpopulations, four studies discussed care pertinent to Indigenous or Aboriginal and/or Torres Strait Islander Peoples [ 66 , 67 , 68 , 81 ]. Four studies discussed mental health services for young people [ 55 , 63 , 73 , 82 ]. Three studies specifically included at least a proportion of service users who were under the age of 18 years old [ 55 , 61 , 79 ]. Two studies reported on mental health services for older people [ 50 , 58 ]. Other studies described barriers and or facilitators specific to sex workers [ 80 ], medical doctors [ 45 ], LGBTIQA + people [ 51 ], immigrants [ 49 ], and women [ 39 ] or men [ 70 ] with specific mental health issues. Three studies described mental health services that were specific for supporting people with depression [ 34 , 39 , 55 ]; two studies were focussed on suicide [ 68 , 70 ]; two studies described care for people with eating disorders [ 42 , 52 ]; and one study was centred on perinatal and infant support [ 75 ].

Barriers and facilitators

The included studies varied significantly. This included differences in the purpose and type of study, participant sample, and methodology, and reporting of findings. Barriers and facilitators were grouped into prominent concepts based on terminology used by the relevant literature and are presented in Table  3 . Barriers related to limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators related to person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy; and culturally-sensitive practice.

Prominent barrier concepts

Barriers affecting healthcare providers and service users.

Limited resources. Across the studies, the most considerable barrier was limited resources [ 18 , 33 , 34 , 35 , 36 , 38 , 39 , 42 , 45 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 71 , 74 , 75 , 78 , 79 , 80 , 82 ]. This key concept considered limited resources at the healthcare provider and service user level. Notably, lack of available general and specialist services, limited service capacity, workforce shortages, difficulty attracting and retaining staff, and staff turnover were frequently reported as considerable spatial barriers to service delivery, hampering access to services. Moreover, financial costs, disadvantage, or appointment fees [ 34 , 37 , 52 , 53 , 61 , 62 , 78 ], and lack of transport [ 34 , 50 , 52 , 53 , 58 , 62 , 71 , 78 ] restricted access to mental health services for the service user. These issues reflect the lower relative socio-economic advantage seen in rural areas of Australia [ 2 ].

System complexity and navigation. The complexity in using and navigating the system was a common aspatial barrier [ 18 , 33 , 36 , 40 , 41 , 42 , 45 , 46 , 51 , 52 , 53 , 57 , 58 , 59 , 61 , 63 , 65 , 66 , 69 , 73 , 74 , 78 , 80 ], which affected healthcare providers in coordinating patient care and service users in utilising such care. These issues were most frequently reflected in reports on extended wait times and delays in assessment and diagnosis [ 34 , 40 , 46 , 53 , 55 , 57 , 58 , 62 , 66 , 78 , 80 ].

Attitudinal or social matters. Many studies reported that attitudinal or social matters were a barrier for the service user [ 34 , 35 , 36 , 38 , 39 , 43 , 50 , 51 , 52 , 60 , 61 , 64 , 66 , 67 , 68 , 70 , 78 , 80 , 81 ], particularily concerning privacy or confidentiality concerns [ 39 , 51 , 60 , 61 , 62 , 63 , 66 , 67 , 78 ], affecting aspatial access to care. The need to be stoic was reported as a barrier to seeking psychological help among regional medical doctors, relating to their perceptions of regional practitioner identity [ 45 ], and among service users [ 50 , 67 , 70 ].

Technological limitations. Several studies cited limitations to services delivered via technological means [ 51 , 53 , 60 , 61 , 62 , 64 , 78 ]. Some studies acknowledged that technology can enhance physical mental health services, but cannot replace them [ 62 , 64 ], particularly for specific client groups, including the older population and Aboriginal and Torres Strait Islander people, who reportedly prefer face-to-face service delivery [ 78 ]. In addition, poor connectivity and high costs of technology use were reported as aspatial barriers to accessing technology-delivered mental health services and may also affect their utilisation [ 53 , 62 , 78 ].

Lack of awareness. Lack of awareness about mental health issues, needs, or services available was reported as an aspatial barrier in the current review [ 43 , 50 , 52 , 67 , 78 ]. This lack of awareness was reported at the healthcare provider level in one study, and was described as the healthcare provider having a limited understanding of the mental health needs in older people, resulting in a lack of referral to appropriate services [ 50 ]. At the service user level, a lack of awareness precluded individuals from recognising mental health problems [ 67 ], while a lack of awareness of services was a barrier to seeking help [ 52 , 78 ].

Barriers affecting service users

Distance to services. The spatial distance required to travel to physical services is a considerable issue for people residing in rural localities, and this distance has been shown to reduce service access and utilisation in the current review [ 52 , 62 , 63 , 64 , 67 , 71 , 78 ]. There is also an additional burden experienced by those with physical disability, or those who don’t have a support person to assist them [ 53 ].

Insufficient culturally-sensitive practice. A limited capacity to meet the needs of culturally and linguistically diverse (CALD) and Aboriginal and Torres Strait Islander communities was reported, affecting aspatial access and utilisation of services. This tended to be a result of service users not feeling culturally safe within the service environment, perceptions that health professionals had cultural assumptions about the service user, and inappropriate assessment tools [ 48 , 49 , 58 , 73 , 78 ].

Prominent facilitator concepts

Facilitators affecting healthcare providers and service users .

Person-centred and collaborative care. Many studies reported that person- (or client-) centred care that is non-judgemental and permits collaboration to be an important aspatial facilitator to mental health service access and utilisation [ 31 , 34 , 35 , 36 , 41 , 42 , 56 , 57 , 58 , 59 , 61 , 63 , 64 , 65 , 72 , 74 , 81 ]. It is noteworthy that person centred care was specifically reported in studies pertaining to the service user [ 61 ] and healthcare provider [ 63 , 64 ] in the current review, suggesting that this approach is recognised as important by both those delivering and using the service. Care that is regular and non-intrusive was seen as a way to facilitate service utilisation [ 34 , 57 ].

Technological facilitation. Technology-based services, including integrated mental health services, telehealth, live chat, SMS appointment reminders and coordination, and mental health web-pages, were reported to be useful in filling spatial and aspatial gaps in service delivery for physical services [ 51 , 53 , 58 , 60 , 61 , 62 , 63 , 75 , 76 , 78 ]. These services were reported to facilitate connection and information sharing [ 62 ], clinical supervision, contact with specialists [ 60 ], workforce upskilling, and security [ 75 ] for the healthcare provider. For the service user, technology-based services facilitated immediacy of consultations, cost savings, and anonymity, and reduced mental health hospitalisations and admissions, additional client appointments, the need to travel, stigma, and family stress [ 60 ].

Environment and ease of access. The mental health service environment and the ease of which one may access services — granted that all other access issues are overcome — were frequently reported as spatial facilitators [ 31 , 49 , 65 , 73 , 80 , 81 ]. Specifically, services that permitted a non-clinical and comfortable environment were deemed as important aspatial factors for young people [ 61 , 73 ]. Co-located services were also considered important for access, as this allows service integration and facilitated information sharing [ 31 , 41 , 63 ].

Community supports. The community was considered to be an important aspatial facilitator. This included healthcare providers being involved and connected with the community [ 56 , 65 , 66 ], as well as having a sense of community [ 59 ], as a way to facilitate care via information sharing, collaboration, and knowing community members and local issues. For the service user, community and place was seen as a source of strength as noted by one study [ 39 ].

Facilitators affecting service users

Mental health literacy. Several studies reported that having awareness of mental health issues and being confident in using services were aspatial facilitators to mental health service access and utilisation [ 52 , 57 , 59 , 66 , 70 ]. These factors are generally referred to as mental health literacy within the wider literature, which is a crucial component of healthcare [ 84 ].

Culturally-sensitive practice. Of the studies that reported on cultural elements of mental health service provision, it was noted that Indigenous and other culturally appropriate staff (i.e., a Koori Mental Health Liaison Officer or Aboriginal Mental Health Worker), as well as the involvement of Community Elders and spiritual healers [ 48 ] assisted with service access and utilisation [ 48 , 66 ]. Further, culturally appropriate décor and flexibility in meeting places [ 66 ], and the use of culturally acceptable models of mental health [ 48 ] were also seen as important aspatial dimensions.

Overall, thirty studies were described as being relevant to rural areas [ 18 , 31 , 33 , 34 , 35 , 36 , 38 , 39 , 42 , 43 , 48 , 49 , 50 , 53 , 57 , 58 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 73 , 76 , 78 , 83 ], three studies were pertinent to regional areas [ 39 , 56 , 79 ], two studies were concerned with remote areas [ 77 , 81 ], and the remaining studies involved combinations of regional/rural/remote populations of Australia [ 37 , 40 , 41 , 44 , 45 , 46 , 47 , 51 , 52 , 54 , 55 , 59 , 60 , 71 , 74 , 75 , 80 , 82 ]. Over one third of the studies (n = 21, 39.6%) reported or provided specific spatial data, which allowed the MMM [ 4 ] to be applied directly to the study location; n = 10 (47.6%) of these studies included multiple locations, resulting in a total of 41 MMM categories. Studies were conducted most frequently in MM5 small rural towns (n = 10, 24.4%) and MM3 large rural towns (n = 9, 22.0%) and least frequently in MM6 remote communities (n = 3, 7.3%). The first author’s location was used as a proxy location for 28 studies (52.8%). Of these studies, the most frequent location was MM1 metropolitan settings (n = 16, 57.1%), likely due to the high proportion of study locations being taken from the first author’s location, and that many universities and research centres are located in major cities. There were no studies conducted in MM5 small rural towns (n = 0, 0%). Three author locations (5.7%) could not be determined due to limited information provided. Table  4 displays details of the MMM categories according to spatial data reported or obtained and proxy locations. Due to the heterogeneity and lack of mutual exclusivity of the data, an analysis of the association between geographical area and specific barriers and facilitators was unable to be completed.

Discussion and implications

This scoping review identified the barriers and facilitators experienced by healthcare providers delivering mental health services and individuals accessing, or attempting to access mental health services in rural Australia. Prominent barriers included: limited resources; system complexity and navigation; attitudinal and social matters; technological limitations; distance to services; insufficient culturally-sensitive practice; and lack of awareness. Facilitators included person-centred and collaborative care; technological facilitation; environment and ease of access; community supports; mental health literacy and culturally-sensitive practice. We also aimed to understand these barriers and facilitators in relation to their geographical context; however, the variability in the data precluded the geographical analysis from being completed.

This study revealed a paucity of research conducted in MM6 remote and MM7 very remote communities in Australia when specific spatial data are considered, as well as in the ACT — however, it is noted that the majority of the ACT is classified as metropolitan, with 99.83% (387,887 residents) of the population residing in MM1 at the time of the 2016 census [ 2 ]. Moreover, when proxy study locations are used, many studies are conducted by researchers located in metropolitan areas. Only three studies specifically included service users who were under the age of 18 years old, representing a significant gap in understanding the mental health service needs of the younger population. Although it is acknowledged that there are considerable research ethics restrictions in place to protect children and young people, the onset of many mental health issues tends to occur between 14.5 and 18 years of age [ 85 ], highlighting the importance of understanding barriers and facilitators to accessing mental health services amongst the younger cohort. Due to the heterogeneity of the findings, the following discussion considers the most prominent barriers and facilitator concepts identified across the studies.

Review findings support limited resources as being one of the biggest restrictors of mental health service access and utilisation within rural Australia. Thes findings echo reports at the national scale, which show the mental health workforce is heavily concentrated in metropolitan areas compared to other remoteness areas, relative to the population [ 86 ]. Considerable efforts need to be made to reduce the resource inequalities, including the dearth of mental health professionals practicing outside of metropolitan cities. Recently, the National Mental Health Workforce Strategy Taskforce (the Strategy) was established to deliberate the quality, supply, distribution, structure, and methods to improve attracting, training, and retaining Australia’s mental health workforce [ 87 ]. The Consultation Draft of the Strategy highlights six objectives, including (1) careers in mental health are recognised as, attractive; (2) data underpins workforce planning; (3) the entire mental health workforce is utilised; (4) the mental health workforce is appropriately skilled; (5) the mental health workforce is retained in the sector; and (6) the mental health workforce is distributed to deliver support and treatment when and where consumers need it [ 88 ]. These objectives reflect the systemic resource issues cited in the current scoping review and emphasise the importance of a contemporary approach to increasing resources for mental health services in rural Australia. This contemporary approach is important, as it has previously been acknowledged that increasing graduates has not resolved workforce maldistribution in other areas of healthcare (i.e., medical physicians), but rather, an improved distribution of both human and other resources is needed [ 89 , 90 ].

For the service user, resource issues spanned both aspatial and spatial dimensions and include the affordability (i.e., perceived worth relative to cost) and accessibility of the service (i.e., the location of the service and ease of getting to that location) [ 12 , 13 ]. Transport issues were commonly reported to be a resource issue within the current review and the wider literature. Limited transport compounds access issues for specific subpopulations, such the elderly, particularly when they do not have personal transport and when there is no public transport available [ 50 ]. This issue is likely compounded by resource limitations, including the cost of travel, and is specifically related to spatial distance to services. Distance to services is a significant barrier to accessing healthcare. Wood et al. [ 91 ] in a systematic review, identified that there is a lack of research which measures spatial access specific to mental health services in Australia, and highlighted a need for consensus on what is reasonable access to healthcare services. Further, reports have noted that while distance alone is a significant barrier to accessing healthcare, accommodation may sometimes need to be sought depending on the time of the appointment, adding to the cost of attending the appointment [ 92 ] and further perpetuating the resource issues experienced by those living in rural areas of Australia. In addition, although not specifically reported in the current review, it is likely that the time required for traveling to and attending such appointments may require the individual to choose between tending to work or family needs or receiving the help needed.

Transport and other resource issues, as well as distance to services, may be mitigated through telehealth appointments, which have been central to the provision of healthcare since the beginning of the COVID-19 pandemic. However, the utilisation of telehealth requires many patients to have had a face-to-face consultation with their GP in the previous 12 months [ 93 ], which may preclude some Australians from rural areas from its use, considering the significant workforce maldistribution previously discussed. Moreover, rural areas of Australia also experience digital disadvantage as a result of lower internet connectivity — brought about by the high costs of installing internet infrastructure in rural and remote areas — and the socio-economic disadvantage experienced by those who live outside of metropolitan areas [ 94 ]. These issues are compounded by an ageing population, lower educational levels, a larger primary industry sector, a higher unemployment rate, and a higher Indigenous population in rural and remote Australia [ 94 ]. High cost, connectivity issues, and suitability for specific client groups should be key considerations in the delivery of technology-based mental health services. Notwithstanding these issues, the current review identified that technology-based services may be a useful adjunct to physical services, particularly in relation to reducing the need to travel, consultation immediacy, and clinician upskilling. This finding partially supports a recent systematic review, which found that youth located in rural and remote areas of Australia and Canada prefer to see mental health professionals in person, with telehealth provided as an additional option [ 95 ]. As such, the benefits and limitations to technology-based mental health services needs to be carefully considered by those designing services.

A key barrier to both access and utilisation in the current review was the complexity of using and navigating the mental health system. These issues typically occur at the system and organisation level and affect the way a service operates and its culture, making it challenging for service users to receive effective care. A complex mental health system and service fragmentation has been previously reported to lead to confusion and a lengthy amount time spent trying to navigate the system, with these issues being even greater amongst those who are younger, less autonomous, or who have less experience navigating the system [ 96 ]. System navigation initiatives may address this gap and have previously been implemented via the Partners in Recovery (PIR) program — established to facilitate care coordination for people with severe and persistent mental illness — with positive impacts for those who used the program [ 97 ]. However, the introduction of the National Disability Insurance Scheme has superseded the PIR program, and has rendered many former PIR program participants ineligible for support [ 98 , 99 ], representing a significant gap in mental health service navigation and care coordination support. Isaacs et al. [ 100 ], identified that it is more cost effective to support people with severe and persistent mental illness to access PIR supports than to not provide this support, due to the potential increased need for other services (e.g., hospital admissions, homelessness supports, residential supports). Indeed, the Australian Government’s Productivity Commission (Productivity Commission) recommended that life insurers should have greater flexibility to fund approved mental health services to reduce the likelihood of hospitalisation for mental health issues [ 101 ]. In addition, Isaacs et al. [ 100 ] reported that co-located services — which were reported as a facilitator in the current review — and the increased need of non-clinical support through mental health community support services, offered via non-governmental and not-for-profit organisations, were demonstrated to be important considerations for cost effective mental health care.

Attitudinal or social matters are frequently reported to be key barriers for rural Australians to accessing care and are considered to be an aspatial dimension [ 12 , 13 ]. These matters which include stigma, fear of judgement, stoicism, lack of trust, preference for keeping to oneself, and reluctance to seek help have been reported on the global scale as impacting upon help-seeking in rural areas in relation to rural identity [ 22 ]. Stoicism, in particular, is ordinarily viewed as a positive trait, with rural participants of a global review contextualising stoicism as an inflexible element to their core identity, however, this trait has repeatedly been reported as a barrier to the uptake of mental health services in this review [ 45 , 50 , 67 , 70 ] and in the wider literature [ 22 ]. In terms of addressing attitudinal and social matters, previous Australian research [ 16 ] has identified that intentions to seek help for a mental or emotional issue decreased with a higher classification of remoteness. Moreover, stoicism and attitudes towards seeking professional help were predictive of help-seeking intentions for participants from both rural and metropolitan areas, but sex, suicidality, and previous engagement with a mental health professional were additionally predictive of help-seeking intentions for rural Australians [ 16 ]. The current scoping review identified few studies that specifically reported on these issues in relation to barriers to accessing services [ 37 , 55 , 68 , 70 ], suggesting a need to increase research focus on these issues. Interestingly, Kaukiainen and Kõlves [ 16 ] study, found that attitudes towards seeking professional help mediated the relationship between stoicism and help-seeking intentions for participants from both rural and metropolitan locations, suggesting that attitudes towards seeking professional help may be a fruitful avenue to target to increase help-seeking intentions for all Australians [ 16 ]. Education programs delivered in secondary school or tertiary settings have been suggested as a way to improve attitudes towards help-seeking and stigma [ 102 ]. These avenues may also be useful to increase mental health literacy (i.e., the public knowledge and recognition of mental disorders and knowing where and how to seek help) [ 84 ] in the community, given that lack of awareness was a barrier and mental health literacy was a facilitator in the current review.

Providing person-centred and collaborative care was reported as a key facilitator in the current review. Person-centred care is generally defined as care that is holistic and incorporates the person’s context, individual expression, beliefs, and preferences, and includes families and caregivers, as well as prevention and promotion activities [ 103 ]. Indeed, person-centred care is a prominent practice model in mental health care, and this model of care may be particularly beneficial in rural Australia, given that it aims to decrease barriers between health service providers via shared knowledge. This model of care is collaborative by nature, although it should be noted that collaborative care is a distinct, though related model of care. Collaborative care refers to health professionals and patients working together to overcome a mental health problem [ 104 ]. This model of care has been shown to improve depression and anxiety outcomes across the short to long term (i.e., 0–24 months), and has benefits on medication use, patient satisfaction, and mental health quality of life [ 104 ]. The Productivity Commission recommended the trial of innovation funds to diffuse best practice in mental health service delivery and to eliminate practices that are no longer supported by evidence [ 101 ]. Such innovation funds may allow healthcare providers to maintain currency on practices such as person-centred and collaborative care. Importantly, the Royal Commission into Victoria’s Mental Health System (the Royal Commission) [ 90 ] identified person-centred care as a way to promote inclusion and prevent inequalities, and was specifically linked to providing culturally safe mental health care — which was noted as a facilitator to access and utilisation in the current review and has been highlighted as an important approach to eliminate health inequalities [ 105 ]. Moreover, the Royal Commission recommended the use of an integrated service approach — where service providers can work together to provide care [ 90 ]. This approach to care may mitigate service fragmentation and system complexity and navigation barriers, and also permit environments that are comfortable and allow ease of use — as identified as facilitators in the current review.

Community support, both in the sense of individuals feeling connected to the community and healthcare providers being seen within the community, was a key concept in the current review. For the service user, Johnson et al. [ 39 ] reported that accessing services under the scrutiny of the community was seen as a challenge, but that the community was also seen a source of strength. Crotty et al. [ 56 ] noted the duality for healthcare providers being involved with the community in both a social and professional sense, leading to both challenges and a feeling of togetherness. This sense of togetherness reflects the historical view that rural and remote communities have been connected over several generations [ 106 ]. Notably, in the current review, one study on healthcare provider perspectives on workforce retention reported that personal connections and a ‘natural’ connection to the community were key factors in the decision for staff working in remote areas to stay [ 33 ], suggesting the importance of embedded relationships in this setting. Preferences to stay in rural and remote towns have been associated with a sense of belonging and the quality of diverse and interesting activities, particularly for younger people [ 107 ], and these factors should be strengthened to permit the retention of the rural mental health workforce.

It is noteworthy that many of the studies were undertaken at metropolitan locations, suggesting that much of the research completed on rural locations was not necessarily conducted within this setting. However, it is acknowledged that many university locations are affiliated with major campuses, which are often located in metropolitan areas. Simultaneously, many rurally-based health and community services do not have the resources to undertake locally-generated research, and this consequently limits the evidence available for policymakers to make informed decisions regarding the health of the rural population — noting that place-based approaches are gaining traction [ 108 , 109 , 110 ]. This area is a key focus of the RHMT program [ 111 ]. The RHMT program aims to maximise investment in of Australia via academic networks, developing an evidence-base, and providing training in rural areas for health professionals. To date the RHMT program has seen that health graduates who undertook clinical placements in the most rural settings are working more in rural locations [ 112 ], and this is likely to have flow-on effects for healthcare providers to build connections to these areas, retain the workforce, and increase health outcomes for the community.

This review highlights the need for a contemporary approach to mental health services in rural Australia. This includes encouraging and educating the public about mental health issues and how to seek and engage in timely mental health care that is appropriate to one’s needs. Simultaneously, this review suggests a need to reconsider how the public navigates mental health services, and to redesign services that are easy to engage with, culturally safe, comfortable to use, and have technological capabilities. This may be more accurately achieved when services are designed with local issues and the community in mind via the integration of bottom-up place-based strategies and top-down place-sensitive approaches, particularly given that a one-size-fits-all approach to policy — and thus mental health service design — does not favour regions and localities [ 113 ]. It is critical that rural mental health services are invested in to remove barriers and improve health equity. The fiscal implications of such investment may be offset using this integrated approach, which leverages local and external assets, encourages workforce retention, and may reduce costs in other areas healthcare service delivery.

Strengths and limitations

The strengths of this scoping review include the use of peer-reviewed and grey literature, the full-span of the child-adult age range, and the wide variety of included studies. In addition, this scoping review applied a consistent approach to applying remoteness categories, albeit this application was not without issues. For example, Wand et al. [ 40 ] and Wand et al. [ 41 ] reports on work done in Maitland (MM1) and Dubbo (MM3). Maitland (NSW) is of particular interest in the context of remoteness settings as it has historically been described as a regional area. In the early 2000s when the Australian Bureau of Statistics was defining the most accessible category of the Accessibility/Remoteness Index of Australia (ARIA), Maitland (as well as other locations such as Wollongong, NSW and Geelong, Victoria) was included in the most accessible category [ 114 ].

Several limitations must also be considered. Firstly, many sources — particularly grey literature sources — included potentially relevant information; however, a lack of clear evidence that the data specifically pertained to those living in regional/rural/remote areas prevented many of these sources from being included. In addition, findings were limited by the available literature, especially among community service organisations, which have limited resources to generate research outputs. The search strategy was limited to 2012–2022 and did not include search terms specific to certain subgroups of the population who have been known to experience barriers to mental health services in rural areas (e.g., farmers and people from CALD backgrounds), and some search results may have been omitted as a result of this. It was not possible to discern whether findings related specifically to access or utilisation in many studies, and as such, a nuanced discussion of these dimensions is not provided. Further, the data were heterogeneous and results tended to be grouped across regional, rural, and/or remote contexts, precluding an analysis of the association between geographical area and barriers and facilitators from taking place. Future research may consider completing a comprehensive geographical analysis once additional data on the topic becomes available. Lastly, although data screening was completed by two reviewers, only one reviewer coded the extracted data into key concepts, and this may have introduced bias into the results, however the key concepts were agreed upon by the research team.

This scoping review found a number of barriers to accessing and utilising mental health services that may be overcome through initiatives that have been implemented or suggested by the government. Importantly, many of the spatial barriers associated with access and utilisation may be mitigated through innovative solutions, such as a combination of face-to-face and technology-based service provision, provided that careful consideration is given to the technological and resource limitations seen in the rural context of Australia. Parallel with this, several facilitators to accessing and utilising mental health services were noted, some of which may already be prominent in the provision of services, but could be further strengthened through additional training, service re-design, and community initiatives.

The included studies varied in their aim, setting, and study design, and many studies were grouped across MMM categories, disallowing a nuanced understanding of how barriers and facilitators operate within specific geographical contexts. This, paired with the finding that many studies were conducted at a metropolitan location, highlights the importance of conducting research within the rural setting. Additional research generated from rural areas, as well as consideration for how remoteness is measured, would assist in providing a more comprehensive understanding of the barriers and facilitators to mental health services within the geographic contexts they occur.

Data Availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Australian Capital Territory

Accessibility/Remoteness Index of Australia

Culturally and linguistically diverse

Cumulative Index of Nursing and Allied Health Literature

Emergency department

Full time equivalent

General practitioner

Lesbian, gay, bisexual, transgender, intersex, queer/questioning, asexual

Modified Monash Model

Population/concept/context

Primary Health Network

Partners in Recovery

Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews

New South Wales

Northern Territory

Rural Health Multidisciplinary Training

South Australia

Urgent care centre

Western Australia

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BEK, HB, and VLV are funded by the Rural Health Multidisciplinary Training (RHMT) program. LJW is supported by a National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship [1174060].

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Kavanagh, B.E., Corney, K.B., Beks, H. et al. A scoping review of the barriers and facilitators to accessing and utilising mental health services across regional, rural, and remote Australia. BMC Health Serv Res 23 , 1060 (2023). https://doi.org/10.1186/s12913-023-10034-4

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  • Mental health services
  • Rural Health Services

BMC Health Services Research

ISSN: 1472-6963

what is synthesis literature review

SYSTEMATIC REVIEW article

A systematic literature review: deep learning techniques for synthetic medical image generation and their applications in radiotherapy provisionally accepted.

  • 1 Center for Evolutionary Hologenomics, GLOBE Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark

The final, formatted version of the article will be published soon.

The aim of this systematic review is to determine whether Deep Learning (DL) algorithms can provide a clinically feasible alternative to classic algorithms for synthetic Computer Tomography (sCT). The following categories are presented in this study:• MR-based treatment planning and synthetic CT generation techniques.• Generation of synthetic CT images based on Cone Beam CT images.• Low-dose CT to High-dose CT generation.• Attenuation correction for PET images.To perform appropriate database searches, we reviewed journal articles published between January 2018 and June 2023. Current methodology, study strategies, and results with relevant clinical applications were analyzed as we outlined the state-of-the-art of deep learning based approaches to inter-modality and intra-modality image synthesis. This was accomplished by contrasting the provided methodologies with traditional research approaches. The key contributions of each category were highlighted, specific challenges were identified, and accomplishments were summarized. As a final step, the statistics of all the cited works from various aspects were analyzed, which revealed that DL-based sCTs have achieved considerable popularity, while also showing the potential of this technology. In order to assess the clinical readiness of the presented methods, we examined the current status of DL-based sCT generation.

Keywords: deep learning, Convolutional Neural Network, Radiotherapy, synthetic CT, photon therapy, Proton therapy, generative adversarial network

Received: 13 Feb 2024; Accepted: 11 Mar 2024.

Copyright: © 2024 Sherwani and Gopalakrishnan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mr. Moiz Khan Sherwani, Center for Evolutionary Hologenomics, GLOBE Institute, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Capital Region of Denmark, Denmark

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