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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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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.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

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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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.

Libraries | Research Guides

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

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

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

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

• Next: Planning the Review >>
• Last Updated: Jan 17, 2024 10:05 AM
• URL: https://libguides.northwestern.edu/literaturereviews

• University of Texas Libraries

Literature Reviews

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

What is a Literature Review?

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

A literature review should: 

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

From  S age Research Methods

Purpose of a Literature Review

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

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

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

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

Limitations of a Literature Review

Some of the limitations of a literature review are:

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

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

Meryl Brodsky : Communication and Information Studies

Hannah Chapman Tripp : Biology, Neuroscience

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

Larayne Dallas : Engineering

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

Susan Macicak : Linguistics

Imelda Vetter : Dell Medical School

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

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

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

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• Knowledge Base
• Dissertation
• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

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.

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 summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write 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, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

When you write a dissertation or thesis, you will 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 scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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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 objectives and questions .

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

Start by creating a list of keywords related to your research topic. 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 if 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 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 use boolean operators to help narrow down your search:

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.

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

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?
• How does the publication contribute to your understanding of the topic? What are its key insights and arguments?
• 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 find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

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’s important to keep track of your sources with references to avoid plagiarism . It can be helpful to make an annotated bibliography, where you compile full reference 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.

You can use our free APA Reference Generator for quick, correct, consistent citations.

To begin organising your literature review’s argument and structure, you need to 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 organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

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 summarising sources in order.

Try to analyse 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 organise 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.

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

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, make sure to follow these tips:

• Summarise and synthesise: give an overview of the main points of each source and combine them into a coherent whole.
• Analyse and interpret: don’t just paraphrase other researchers – add your own interpretations, 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 transitions and topic sentences to draw connections, comparisons and contrasts.

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

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

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 dissertation , thesis, research paper , or proposal .

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

• To familiarise 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  dissertation . After the introduction , it grounds your research in a scholarly field and leads directly to your theoretical framework or methodology .

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How to Write a Literature Review

What is a literature review.

• What Is the Literature
• Writing the Review

A literature review is much more than an annotated bibliography or a list of separate reviews of articles and books. It is a critical, analytical summary and synthesis of the current knowledge of a topic. Thus it should compare and relate different theories, findings, etc, rather than just summarize them individually. In addition, it should have a particular focus or theme to organize the review. It does not have to be an exhaustive account of everything published on the topic, but it should discuss all the significant academic literature and other relevant sources important for that focus.

This is meant to be a general guide to writing a literature review: ways to structure one, what to include, how it supplements other research. For more specific help on writing a review, and especially for help on finding the literature to review, sign up for a Personal Research Session .

The specific organization of a literature review depends on the type and purpose of the review, as well as on the specific field or topic being reviewed. But in general, it is a relatively brief but thorough exploration of past and current work on a topic. Rather than a chronological listing of previous work, though, literature reviews are usually organized thematically, such as different theoretical approaches, methodologies, or specific issues or concepts involved in the topic. A thematic organization makes it much easier to examine contrasting perspectives, theoretical approaches, methodologies, findings, etc, and to analyze the strengths and weaknesses of, and point out any gaps in, previous research. And this is the heart of what a literature review is about. A literature review may offer new interpretations, theoretical approaches, or other ideas; if it is part of a research proposal or report it should demonstrate the relationship of the proposed or reported research to others' work; but whatever else it does, it must provide a critical overview of the current state of research efforts. 

Literature reviews are common and very important in the sciences and social sciences. They are less common and have a less important role in the humanities, but they do have a place, especially stand-alone reviews.

Types of Literature Reviews

There are different types of literature reviews, and different purposes for writing a review, but the most common are:

• Stand-alone literature review articles . These provide an overview and analysis of the current state of research on a topic or question. The goal is to evaluate and compare previous research on a topic to provide an analysis of what is currently known, and also to reveal controversies, weaknesses, and gaps in current work, thus pointing to directions for future research. You can find examples published in any number of academic journals, but there is a series of Annual Reviews of *Subject* which are specifically devoted to literature review articles. Writing a stand-alone review is often an effective way to get a good handle on a topic and to develop ideas for your own research program. For example, contrasting theoretical approaches or conflicting interpretations of findings can be the basis of your research project: can you find evidence supporting one interpretation against another, or can you propose an alternative interpretation that overcomes their limitations?
• Part of a research proposal . This could be a proposal for a PhD dissertation, a senior thesis, or a class project. It could also be a submission for a grant. The literature review, by pointing out the current issues and questions concerning a topic, is a crucial part of demonstrating how your proposed research will contribute to the field, and thus of convincing your thesis committee to allow you to pursue the topic of your interest or a funding agency to pay for your research efforts.
• Part of a research report . When you finish your research and write your thesis or paper to present your findings, it should include a literature review to provide the context to which your work is a contribution. Your report, in addition to detailing the methods, results, etc. of your research, should show how your work relates to others' work.

A literature review for a research report is often a revision of the review for a research proposal, which can be a revision of a stand-alone review. Each revision should be a fairly extensive revision. With the increased knowledge of and experience in the topic as you proceed, your understanding of the topic will increase. Thus, you will be in a better position to analyze and critique the literature. In addition, your focus will change as you proceed in your research. Some areas of the literature you initially reviewed will be marginal or irrelevant for your eventual research, and you will need to explore other areas more thoroughly. 

Examples of Literature Reviews

See the series of Annual Reviews of *Subject* which are specifically devoted to literature review articles to find many examples of stand-alone literature reviews in the biomedical, physical, and social sciences. 

Research report articles vary in how they are organized, but a common general structure is to have sections such as:

• Abstract - Brief summary of the contents of the article
• Introduction - A explanation of the purpose of the study, a statement of the research question(s) the study intends to address
• Literature review - A critical assessment of the work done so far on this topic, to show how the current study relates to what has already been done
• Methods - How the study was carried out (e.g. instruments or equipment, procedures, methods to gather and analyze data)
• Results - What was found in the course of the study
• Discussion - What do the results mean
• Conclusion - State the conclusions and implications of the results, and discuss how it relates to the work reviewed in the literature review; also, point to directions for further work in the area

Here are some articles that illustrate variations on this theme. There is no need to read the entire articles (unless the contents interest you); just quickly browse through to see the sections, and see how each section is introduced and what is contained in them.

The Determinants of Undergraduate Grade Point Average: The Relative Importance of Family Background, High School Resources, and Peer Group Effects , in The Journal of Human Resources , v. 34 no. 2 (Spring 1999), p. 268-293.

This article has a standard breakdown of sections:

• Introduction
• Literature Review
• Some discussion sections

First Encounters of the Bureaucratic Kind: Early Freshman Experiences with a Campus Bureaucracy , in The Journal of Higher Education , v. 67 no. 6 (Nov-Dec 1996), p. 660-691.

This one does not have a section specifically labeled as a "literature review" or "review of the literature," but the first few sections cite a long list of other sources discussing previous research in the area before the authors present their own study they are reporting.

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What is a literature review?

A literature review discusses published information in a particular subject area. Often part of the introduction to an essay, research report or thesis, the literature review is literally a "re" view or "look again" at what has already been written about the topic, wherein the author analyzes a segment of a published body of knowledge through summary, classification, and comparison of prior research studies, reviews of literature, and theoretical articles. Literature reviews provide the reader with a bibliographic history of the scholarly research in any given field of study. As such,  as new information becomes available, literature reviews grow in length or become focused on one specific aspect of the topic.

A literature review can be just a simple summary of the sources, but usually contains an organizational pattern and combines both summary and synthesis. A summary is a recap of the important information of the source, whereas a synthesis is a re-organization, or a reshuffling, of that information. The literature review might give a new interpretation of old material or combine new with old interpretations. Or it might trace the intellectual progression of the field, including major debates. Depending on the situation, the literature review may evaluate the sources and advise the reader on the most pertinent or relevant.

A literature review is NOT:

• An annotated bibliography – a list of citations to books, articles and documents that includes a brief description and evaluation for each citation. The annotations inform the reader of the relevance, accuracy and quality of the sources cited.
• A literary review – a critical discussion of the merits and weaknesses of a literary work.
• A book review – a critical discussion of the merits and weaknesses of a particular book.
• Teaching Information Literacy Reframed: 50+ Framework-Based Exercises for Creating Information-Literate Learners
• The UNC Writing Center – Literature Reviews
• The UW-Madison Writing Center: The Writer’s Handbook – Academic and Professional Writing – Learn How to Write a Literature Review

What is the difference between a literature review and a research paper?

The focus of a literature review is to summarize and synthesize the arguments and ideas of others without adding new contributions, whereas academic research papers present and develop new arguments that build upon the previously available body of literature.

How do I write a literature review?

There are many resources that offer step-by-step guidance for writing a literature review, and you can find some of them under Other Resources in the menu to the left. Writing the Literature Review: A Practical Guide suggests these steps:

• Chose a review topic and develop a research question
• Locate and organize research sources
• Select, analyze and annotate sources
• Evaluate research articles and other documents
• Structure and organize the literature review
• Develop arguments and supporting claims
• Synthesize and interpret the literature
• Put it all together

What is the purpose of writing a literature review?

Literature reviews serve as a guide to a particular topic: professionals can use literature reviews to keep current on their field; scholars can determine credibility of the writer in his or her field by analyzing the literature review.

As a writer, you will use the literature review to:

• See what has, and what has not, been investigated about your topic
• Identify data sources that other researches have used
• Learn how others in the field have defined and measured key concepts
• Establish context, or background, for the argument explored in the rest of a paper
• Explain what the strengths and weaknesses of that knowledge and ideas might be
• Contribute to the field by moving research forward
• To keep the writer/reader up to date with current developments in a particular field of study
• Develop alternative research projects
• Put your work in perspective
• Demonstrate your understanding and your ability to critically evaluate research in the field
• Provide evidence that may support your own findings
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Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy pp 1–15 Cite as

Methodological Approaches to Literature Review

• Dennis Thomas 2 ,
• Elida Zairina 3 &
• Johnson George 4  
• Living reference work entry
• First Online: 09 May 2023

436 Accesses

The literature review can serve various functions in the contexts of education and research. It aids in identifying knowledge gaps, informing research methodology, and developing a theoretical framework during the planning stages of a research study or project, as well as reporting of review findings in the context of the existing literature. This chapter discusses the methodological approaches to conducting a literature review and offers an overview of different types of reviews. There are various types of reviews, including narrative reviews, scoping reviews, and systematic reviews with reporting strategies such as meta-analysis and meta-synthesis. Review authors should consider the scope of the literature review when selecting a type and method. Being focused is essential for a successful review; however, this must be balanced against the relevance of the review to a broad audience.

• Literature review
• Systematic review
• Meta-analysis
• Scoping review
• Research methodology

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Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia

Elida Zairina

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia

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Thomas, D., Zairina, E., George, J. (2023). Methodological Approaches to Literature Review. In: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. Springer, Cham. https://doi.org/10.1007/978-3-030-50247-8_57-1

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

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
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What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

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What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

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

• Literature Review vs. Systematic Review
• Primary vs. Secondary Sources
• Databases and Articles
• Specific Journal or Article

Subject Guide

Definitions

It’s common to confuse systematic and literature reviews because both are used to provide a summary of the existent literature or research on a specific topic. Regardless of this commonality, both types of review vary significantly. The following table provides a detailed explanation as well as the differences between systematic and literature reviews. 

Kysh, Lynn (2013): Difference between a systematic review and a literature review. [figshare]. Available at:  http://dx.doi.org/10.6084/m9.figshare.766364

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

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

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

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Organizing Your Social Sciences Research Paper

• 5. The Literature Review
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
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• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
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• Evaluating Sources
• Primary Sources
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• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

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Evidence-Based Practice (EBP)

• The EBP Process
• Forming a Clinical Question
• Inclusion & Exclusion Criteria
• Acquiring Evidence
• Appraising the Quality of the Evidence
• Writing a Literature Review
• Finding Psychological Tests & Assessment Instruments

What Is a Literature Review?

A literature review is an integrated analysis of scholarly writings that are related directly to your research question. Put simply, it's  a critical evaluation of what's already been written on a particular topic . It represents the literature that provides background information on your topic and shows a connection between those writings and your research question.

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

What a Literature Review Is Not:

• A list or summary of sources
• An annotated bibliography
• A grouping of broad, unrelated sources
• A compilation of everything that has been written on a particular topic
• Literary criticism (think English) or a book review

Why Literature Reviews Are Important

• They explain the background of research on a topic
• They demonstrate why a topic is significant to a subject area
• They discover relationships between research studies/ideas
• They identify major themes, concepts, and researchers on a topic
• They identify critical gaps and points of disagreement
• They discuss further research questions that logically come out of the previous studies

To Learn More about Conducting and Writing a Lit Review . . .

Monash University (in Australia) has created several extremely helpful, interactive tutorials. 

• The Stand-Alone Literature Review, https://www.monash.edu/rlo/assignment-samples/science/stand-alone-literature-review
• Researching for Your Literature Review,  https://guides.lib.monash.edu/researching-for-your-literature-review/home
• Writing a Literature Review,  https://www.monash.edu/rlo/graduate-research-writing/write-the-thesis/writing-a-literature-review

Keep Track of Your Sources!

A citation manager can be helpful way to work with large numbers of citations. See UMSL Libraries' Citing Sources guide for more information. Personally, I highly recommend Zotero —it's free, easy to use, and versatile. If you need help getting started with Zotero or one of the other citation managers, please contact a librarian.

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• Next: Finding Psychological Tests & Assessment Instruments >>
• Last Updated: Nov 15, 2023 11:47 AM
• URL: https://libguides.umsl.edu/ebp

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

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

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 
• How to write a good literature review 
• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• Frequently asked questions 

What is a literature review?

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

What is the purpose of literature review?

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

• Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 
• Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 
• Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 
• Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 
• Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 
• Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

How to write a good literature review

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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Try it for free or upgrade to  Paperpal Prime , which unlocks unlimited access to premium features like academic translation, paraphrasing, contextual synonyms, consistency checks and more. It’s like always having a professional academic editor by your side! Go beyond limitations and experience the future of academic writing.  Get Paperpal Prime now at just US$19 a month!

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• Empirical Research: A Comprehensive Guide for Academics 
• How to Write a Scientific Paper in 10 Steps 
• Life Sciences Papers: 9 Tips for Authors Writing in Biological Sciences
• What is an Argumentative Essay? How to Write It (With Examples)

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ON YOUR 1ST ORDER

Different Types of Literature Review: Which One Fits Your Research?

By Laura Brown on 13th October 2023

You might not have heard that there are multiple kinds of literature review. However, with the progress in your academic career you will learn these classifications and may need to use different types of them. However, there is nothing to worry if you aren’t aware of them now, as here we are going to discuss this topic in detail.

There are approximately 14 types of literature review on the basis of their specific objectives, methodologies, and the way they approach and analyse existing literature in academic research. Of those 14, there are 4 major types. But before we delve into the details of each one of them and how they are useful in academics, let’s first understand the basics of literature review.

What is Literature Review?

A literature review is a critical and systematic summary and evaluation of existing research. It is an essential component of academic and research work, providing an overview of the current state of knowledge in a particular field.

In easy words, a literature review is like making a big, organised summary of all the important research and smart books or articles about a particular topic or question. It’s something scholars and researchers do, and it helps everyone see what we already know about that topic. It’s kind of like taking a snapshot of what we understand right now in a certain field.

It serves with some specific purpose in the research.

• Provides a comprehensive understanding of existing research on a topic.
• Identifies gaps, trends, and inconsistencies in the literature.
• Contextualise your own research within the broader academic discourse.
• Supports the development of theoretical frameworks or research hypotheses.

4 Major Types Of Literature Review

The four major types include, Narrative Review, Systematic Review, Meta-Analysis, and Scoping Review. These are known as the major ones because they’re like the “go-to” methods for researchers in academic and research circles. Think of them as the classic tools in the researcher’s toolbox. They’ve earned their reputation because they have a unique style for literature review introduction , clear steps and specific qualities that make them super handy for different research needs.

1. Narrative Review

Narrative reviews present a well-structured narrative that reads like a cohesive story, providing a comprehensive overview of a specific topic. These reviews often incorporate historical context and offer a broad understanding of the subject matter, making them valuable for researchers looking to establish a foundational understanding of their area of interest. They are particularly useful when a historical perspective or a broad context is necessary to comprehend the current state of knowledge in a field.

2. Systematic Review

Systematic reviews are renowned for their methodological rigour. They involve a meticulously structured process that includes the systematic selection of relevant studies, comprehensive data extraction, and a critical synthesis of their findings. This systematic approach is designed to minimise bias and subjectivity, making systematic reviews highly reliable and objective. They are considered the gold standard for evidence-based research as they provide a clear and rigorous assessment of the available evidence on a specific research question.

3. Meta Analysis

Meta analysis is a powerful method for researchers who prefer a quantitative and statistical perspective. It involves the statistical synthesis of data from various studies, allowing researchers to draw more precise and generalisable conclusions by combining data from multiple sources. Meta analyses are especially valuable when the aim is to quantitatively measure the effect size or impact of a particular intervention, treatment, or phenomenon.

4. Scoping Review

Scoping reviews are invaluable tools, especially for researchers in the early stages of exploring a topic. These reviews aim to map the existing literature, identifying gaps and helping clarify research questions. Scoping reviews provide a panoramic view of the available research, which is particularly useful when researchers are embarking on exploratory studies or trying to understand the breadth and depth of a subject before conducting more focused research.

Different Types Of Literature review In Research

There are some more approaches to conduct literature review. Let’s explore these classifications quickly.

5. Critical Review

Critical reviews provide an in-depth evaluation of existing literature, scrutinising sources for their strengths, weaknesses, and relevance. They offer a critical perspective, often highlighting gaps in the research and areas for further investigation.

6. Theoretical Review

Theoretical reviews are centred around exploring and analysing the theoretical frameworks, concepts, and models present in the literature. They aim to contribute to the development and refinement of theoretical perspectives within a specific field.

7. Integrative Review

Integrative reviews synthesise a diverse range of studies, drawing connections between various research findings to create a comprehensive understanding of a topic. These reviews often bridge gaps between different perspectives and provide a holistic overview.

8. Historical Review

Historical reviews focus on the evolution of a topic over time, tracing its development through past research, events, and scholarly contributions. They offer valuable context for understanding the current state of research.

9. Methodological Review

Among the different kinds of literature reviews, methodological reviews delve into the research methods and methodologies employed in existing studies. Researchers assess these approaches for their effectiveness, validity, and relevance to the research question at hand.

10. Cross-Disciplinary Review

Cross-disciplinary reviews explore a topic from multiple academic disciplines, emphasising the diversity of perspectives and insights that each discipline brings. They are particularly useful for interdisciplinary research projects and uncovering connections between seemingly unrelated fields.

11. Descriptive Review

Descriptive reviews provide an organised summary of existing literature without extensive analysis. They offer a straightforward overview of key findings, research methods, and themes present in the reviewed studies.

12. Rapid Review

Rapid reviews expedite the literature review process, focusing on summarising relevant studies quickly. They are often used for time-sensitive projects where efficiency is a priority, without sacrificing quality.

13. Conceptual Review

Conceptual reviews concentrate on clarifying and developing theoretical concepts within a specific field. They address ambiguities or inconsistencies in existing theories, aiming to refine and expand conceptual frameworks.

14. Library Research

Library research reviews rely primarily on library and archival resources to gather and synthesise information. They are often employed in historical or archive-based research projects, utilising library collections and historical documents for in-depth analysis.

Each type of literature review serves distinct purposes and comes with its own set of strengths and weaknesses, allowing researchers to choose the one that best suits their research objectives and questions.

Choosing the Ideal Literature Review Approach in Academics

In order to conduct your research in the right manner, it is important that you choose the correct type of review for your literature. Here are 8 amazing tips we have sorted for you in regard to literature review help so that you can select the best-suited type for your research.

• Clarify Your Research Goals: Begin by defining your research objectives and what you aim to achieve with the literature review. Are you looking to summarise existing knowledge, identify gaps, or analyse specific data?
• Understand Different Review Types: Familiarise yourself with different kinds of literature reviews, including systematic reviews, narrative reviews, meta-analyses, scoping reviews, and integrative reviews. Each serves a different purpose.
• Consider Available Resources: Assess the resources at your disposal, including time, access to databases, and the volume of literature on your topic. Some review types may be more resource-intensive than others.
• Alignment with Research Question: Ensure that the chosen review type aligns with your research question or hypothesis. Some types are better suited for answering specific research questions than others.
• Scope and Depth: Determine the scope and depth of your review. For a broad overview, a narrative review might be suitable, while a systematic review is ideal for an in-depth analysis.
• Consult with Advisors: Seek guidance from your academic advisors or mentors. They can provide valuable insights into which review type best fits your research goals and resources.
• Consider Research Field Standards: Different academic fields have established standards and preferences for different forms of literature review. Familiarise yourself with what is common and accepted in your field.
• Pilot Review: Consider conducting a small-scale pilot review of the literature to test the feasibility and suitability of your chosen review type before committing to a larger project.

Bonus Tip: Crafting an Effective Literature Review

Now, since you have learned all the literature review types and have understood which one to prefer, here are some bonus tips for you to structure a literature review of a dissertation .

• Clearly Define Your Research Question: Start with a well-defined and focused research question to guide your literature review.
• Thorough Search Strategy: Develop a comprehensive search strategy to ensure you capture all relevant literature.
• Critical Evaluation: Assess the quality and credibility of the sources you include in your review.
• Synthesise and Organise: Summarise the key findings and organise the literature into themes or categories.
• Maintain a Systematic Approach: If conducting a systematic review, adhere to a predefined methodology and reporting guidelines.
• Engage in Continuous Review: Regularly update your literature review to incorporate new research and maintain relevance.

Some Useful Tools And Resources For You

Effective literature reviews demand a range of tools and resources to streamline the process.

• Reference management software like EndNote, Zotero, and Mendeley helps organise, store, and cite sources, saving time and ensuring accuracy.
• Academic databases such as PubMed, Google Scholar, and Web of Science provide access to a vast array of scholarly articles, with advanced search and citation tracking features.
• Research guides from universities and libraries offer tips and templates for structuring reviews.
• Research networks like ResearchGate and Academia.edu facilitate collaboration and access to publications. Literature review templates and research workshops provide additional support.

Some Common Mistakes To Avoid

Avoid these common mistakes when crafting literature reviews.

• Unclear research objectives result in unfocused reviews, so start with well-defined questions.
• Biased source selection can compromise objectivity, so include diverse perspectives.
• Never miss on referencing; proper citation and referencing are essential for academic integrity.
• Don’t overlook older literature, which provides foundational insights.
• Be mindful of scope creep, where the review drifts from the research question; stay disciplined to maintain focus and relevance.

While Summing Up On Various Types Of Literature Review

As we conclude this classification of fourteen distinct approaches to conduct literature reviews, it’s clear that the world of research offers a multitude of avenues for understanding, analysing, and contributing to existing knowledge.

Whether you’re a seasoned scholar or a student beginning your academic journey, the choice of review type should align with your research objectives and the nature of your topic. The versatility of these approaches empowers you to tailor your review to the demands of your project.

Remember, your research endeavours have the potential to shape the future of knowledge, so choose wisely and dive into the world of literature reviews with confidence and purpose. Happy reviewing!

Laura Brown, a senior content writer who writes actionable blogs at Crowd Writer.

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

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

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Introduction

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

Tip 1: provide detailed information about frameworks and methods

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

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

Tip 2: include strengths and limitations for each article

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

Tip 3: write conceptual contribution of each reviewed article

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

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

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

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

Tip 5: create your personalised template for literature summaries

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

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

• Aromataris E ,
• Rasheed SP ,

Twitter @Ahtisham04, @parveenazamali

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

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

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Narrative reviews , or literature reviews, offer flexibility in regards to "how the research or clinical question is formulated (or the scope of the review established), how literature is evaluated and how the findings are organised and presented." ( Source )

Scoping reviews  "are an ideal tool to determine the scope or coverage of a body of literature on a given topic and give clear indication of the volume of literature and studies available as well as an overview (broad or detailed) of its focus." They require most of the same steps as systematic reviews. ( Source )

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Optimal timing of surgical intervention for penile fracture: a narrative review of the modern literature

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Ari P Bernstein, Nader Shayegh, Javier Piraino, Matthew Ziegelmann, Optimal timing of surgical intervention for penile fracture: a narrative review of the modern literature, Sexual Medicine Reviews , Volume 12, Issue 2, April 2024, Pages 230–239, https://doi.org/10.1093/sxmrev/qead056

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Penile fracture is traditionally considered a surgical emergency warranting immediate repair with the goal to maximize long-term erectile function and minimize penile curvature. Nonetheless, consensus on the optimal timing for penile fracture repair remains to be elucidated and is the subject of continued research efforts.

This review aims to summarize the contemporary literature pertaining to optimal timing of penile fracture repair and associated outcomes.

We queried PubMed/MEDLINE and Google Scholar for relevant articles published between 2012 and 2022 to evaluate the most recent literature on the queried topic of early vs delayed intervention for penile fracture. All examined review articles were published within the last decade but may have included analyses of studies published prior to 2012. Reference lists of articles and reviews were manually reviewed to identify additional relevant articles.

We identified 16 articles that met inclusion criteria: 12 primary articles and 4 systematic reviews or meta-analyses. Importantly, definitions of early and delayed intervention varied greatly among studies, making quantitative comparison challenging. In summary, 6 primary studies and 2 systematic review articles favored early intervention. There were also 6 primary studies and 2 systematic review articles suggesting equivocal outcomes between early and delayed repair. No articles demonstrated improved outcomes with delayed repair relative to early intervention.

Surgical intervention for penile fracture remains the gold standard, with superior long-term sexual and functional outcomes when compared with conservative management. Optimal timing of penile fracture repair remains to be elucidated with data limited by low incidence, resulting in small case series and a lack of randomized controlled trials. Nonetheless, recent data suggest that a brief delay in surgical intervention for patients presenting with penile fractures does not affect long-term sexual and functional outcomes.

Penile fracture is a relatively uncommon urologic injury typically caused by blunt trauma to the erect penis. A true fracture is defined as disruption to the tunica albuginea surrounding the corpora cavernosa, resulting in a loss of penile erectile tissue integrity. Patients typically report an audible “pop,” acute onset of penile pain, immediate detumescence, and significant swelling and discoloration of the penile shaft, which typically worsen with time. 1 , 2 The mechanism of injury for penile fracture in most cases occurs during penetrative intercourse at which point the penis unintentionally strikes the pubic symphysis or external perineum, causing forcible bending of the fully erect penis and intracavernosal pressures >1500 mm Hg. 3 Injury to the urethra and neurovascular bundle may occur alongside penile fracture and must be considered at the time of diagnosis. 1

Epidemiology

In the United States, penile fracture incidence is roughly 1.02 per 100 000 males per year. 4 However, the reluctance to seek medical treatment due to the sensitive nature of the injury exacerbates the underreporting of penile fractures. 3 A significantly larger number of patients who present for suspected penile fracture instead have disruption of superficial penile vessels (typically superficial penile veins), identified either on imaging or at the time of operative exploration. 4 There is geographic variation in the incidence of penile fracture. The highest incidence is found in Iran and other regions of the Middle East (roughly ≥1.14 per 100 000 males). 3 It is theorized that variations in penile fracture incidence are secondary to varying sexual practices. For example, the Taghaandan maneuver, where the erect penis is purposefully bent to achieve pleasure or detumescence, is more commonly practiced in areas of the Middle East. This maneuver may account in part for the increased penile fracture risk in these geographic areas. 5

Pathophysiology

During spontaneous erectile function, sexual stimulation elicits a cascade of events leading to penile tumescence and rigidity. 6 , 7 Processing within the central nerve system begins in the cerebral cortex. Signals are transmitted via the spinal cord and ultimately the peripheral nervous system at the lumbosacral nerve roots. At the level of the penile vasculature, nitric oxide and other chemical mediators are released from parasympathetic nerve terminals, causing smooth muscle relaxation and increased cavernosal blood flow within the penile corpora cavernosa resulting in penile tumescence. 7 As the corpora fill with blood, subtunical and emissary veins are compressed at the interface between the cavernosal tissue and the surrounding tunica albuginea (“veno-occlusive mechanism”) resulting in penile rigidity and maintenance of that rigidity. Contraction of the ischiocavernosus and bulbospongiosus muscles further increases penile rigidity, and in normal circumstances blood flow into the corporal body ceases secondary to the high pressure within the cavernosal bodies. Erectile dysfunction (ED) results from impairment at any point along this pathway—whether at the level of the central or peripheral nervous system, at the point of the arterial inflow, or with compromise to the veno-occlusive mechanism. 6

Penile fracture results from disruption of the penile tunica albuginea, most commonly as a result of penile buckling sustained during sexual intercourse. 8 Other mechanisms of injury include injury from masturbation or falls landing on an erect penis. Penile pain, rapid detumescence, and significant penile swelling and ecchymosis are the classic presenting symptoms. 9 The classic description is an “eggplant” deformity, which results from blood trapped within the Buck’s fascia ( Figure 1 ). Without repair, ED may occur secondary to ongoing inability to trap blood within the corporal body. Corporal scarring may occur with delayed or absent repair, disrupting the normal mechanisms for penile tumescence and maintaining a rigid erection. 10 Tunical scarring may also cause penile deformity (curvature or indentation) due to focal restriction, similar to that seen with Peyronie’s disease. Nonetheless, even with surgical intervention for penile fracture, long-term complications are possible, including ED and penile curvature. 3 , 11 ED and penile curvature may occur even with surgical repair, and there is significant variability in the rates of postoperative sexual dysfunction and penile deformity. 12 Patients with penile fracture may also experience anxiety with subsequent sexual activity, further exacerbating sexual dysfunction. 9

Eggplant deformity presentation.

Penile fracture can be diagnosed with a thorough history and physical examination. 8 Imaging is not required as part of the diagnostic workup for suspected penile fracture, but it can serve as a useful adjunct if available, especially in equivocal cases. 10 Examples include penile duplex ultrasound and magnetic resonance imaging, which can help to identify the presence and location of tunical disruption. The 2020 American Urological Association’s urotrauma guidelines state that “clinicians must suspect penile fracture when a patient presents with penile ecchymosis, swelling, pain, cracking, or snapping sound during intercourse or manipulation and immediate detumescence” (guideline statement 26). Guideline statement 27 dictates that “clinicians should perform prompt surgical exploration and repair in patients with acute signs and symptoms of penile fracture.” 13

In the remote past, suspected fractures were managed conservatively via a combination of nonoperative interventions including pain management, compression bandages, and sometimes catheterization if concern for urethral injury. 11 Conservative management has been largely abandoned as a recommended management strategy given the high degree of long-term sexual dysfunction and penile curvature, with complication rates as high as 80%. 11 In a 2013 study, Yamacake et al revealed a significantly lower percentage of patients (66% vs 88.6%) with erections sufficient for penetrative intercourse in a cohort of men with penile fracture managed conservatively vs operatively at a mean 19.2 months. 14 Similarly, in a 2016 meta-analysis of 58 studies composed of 3213 patients with penile fracture—of which, 95.4% underwent surgery and 4.6% were treated conservatively—Amer et al demonstrated that surgical intervention vs conservative management was associated with significantly less overall long-term complications, including ED, penile curvature, and painful erection (overall complications, 20.6% vs 46%; P  < .01). 15

Penile fractures are currently managed with surgical exploration via a ventral or circumferential degloving incision (surgeon choice), evacuation of hematoma, and repair of tunical defect with absorbable suture. 2 , 8 , 10 , 13 In cases where urethral injury is suspected, such as blood at the urethral meatus or gross hematuria, the urethra must be evaluated intraoperatively for injury. 13 Flexible cystourethroscopy and/or retrograde urethrography is an option.

Penile fracture is traditionally and nearly universally considered a surgical emergency warranting immediate repair, with the goal to maximize long-term erectile function and minimize penile curvature. Nonetheless, despite formal recommendations from the American Urological Association suggesting prompt surgical exploration, consensus on the optimal timing for penile fracture repair remains to be elucidated and is the subject of continued research efforts. Drivers for immediate vs delayed intervention include patient-related factors (eg, timing of presentation from inciting event), resource availability (eg, penile ultrasound and/or magnetic resonance imaging), and surgical expertise of providers on call. Earlier literature more consistently favored early intervention, with improved outcomes relative to delayed repair, though numerous more recently published studies have challenged these findings. 16-20 Specifically, the dogma of immediate intervention for penile fracture is being challenged, suggesting that long-term outcomes following delayed repair may be noninferior and so allow for a short purposeful delay in intervention for more experienced hands and operative room personnel to be available for surgical repair. 21

Review aims

In this review, we aim to summarize the most recent literature evaluating the timing for penile fracture repair (immediate vs delayed intervention) with respect to long-term functional outcomes, including erectile function and penile deformity. We review only cases of traumatic penile fracture, excluding cases of fractures induced by collagenase Clostridium histolyticum injection. We intend this review to enhance our understanding and promote consensus regarding the optimal management strategies for penile fracture.

We queried PubMed/MEDLINE and Google Scholar for relevant articles in the English language published between 2012 and 2022 to evaluate the most recent literature during the last decade on the queried topic of early vs delayed intervention for penile fracture. The search strategy included the following terms: (“penile fracture management” OR “penile fracture timing” OR “penile fracture intervention” OR “penile fracture delay” OR “penile fracture early vs delay”). Primary research articles and systematic reviews/meta-analyses were evaluated. Title screening was conducted to ensure concordance with the content of the review, focusing on articles with titles related to the comparative outcomes of early vs delayed intervention for penile fracture. All examined review articles were published within the last decade but may have included analyses of studies published prior to 2012. Reference lists were manually reviewed to identify additional relevant articles. See Figure 2 for flow sheet of study query.

Query flow diagram.

We identified 16 articles that met inclusion criteria: 12 primary articles and 4 systematic reviews or meta-analyses ( Tables 1 and 2 ). Importantly, definitions of early and delayed intervention varied greatly among studies, making quantitative comparison challenging. In summary, 6 primary studies and 2 systematic review articles favored early intervention ( Table 1 ). There were also 6 primary studies and 2 systematic review articles suggesting equivocal outcomes between early and delayed repair ( Table 2 ). No articles demonstrated improved outcomes with delayed repair relative to early intervention.

Studies favoring early intervention for penile fracture.

Abbreviation: IIEF-5, 5-item International Index of Erectile Function.

Studies demonstrating equivocal outcomes between early and delayed intervention for penile fracture.

Abbreviations: IIEF-5, 5-item International Index of Erectile Function; SHIM, Sexual Health Inventory For Men.

Primary data supporting early intervention for penile fracture

Six primary research studies between 2012 and 2022 demonstrated a clinical benefit to early intervention for penile fracture repair, supporting the American Urological Association’s guideline recommendations and the current dogma that classifies penile fracture as a surgical emergency warranting urgent repair.

Al Ansari et al retrospectively evaluated 109 men with penile fracture who underwent surgical intervention between 2005 and 2012: 98 received early surgical repair and 11 had delayed intervention (defined as >24 hours after presentation). 22 At a 3-month postoperative visit, patients were examined and given a self-reported ED questionnaire based on a single question (ie, “Do you have impaired erectile function, yes or no?”). Of the 98 patients, 4 (4.1%) in the early repair group self-reported ED at the 3-month interval as compared with 2 (18.2%) of the 11 patients who underwent delayed repair ( P  < .05). All patients with self-reported ED on follow-up underwent penile Doppler ultrasound, and in all instances, the ultrasound findings were consistent with venous leak. 22 Despite the significant difference in outcomes between groups, this study has several important shortcomings. Notably, the study’s short follow-up, small cohort, retrospective design, lack of discussion of the cohort’s preinjury erectile function, and use of a nonvalidated single question to measure ED limit this study’s generalizability.

In a large multicenter retrospective study performed by the European Association of Urology in 2018, the Young Academic Urologists Men’s Health Working Party found better erectile function outcomes with early repair of penile fracture. 23 The group evaluated 137 patients with penile fracture treated surgically across 7 European sites between 1996 and 2013, with the interest of identifying the impact of delayed intervention on long-term erectile function and penile curvature. Scores on the 5-item International Index of Erectile Function (IIEF-5) were obtained at the first and third postoperative months, with ED defined as a score <12. Median IIEF-5 scores were 21 (IQR, 12-23) and 23 (IQR, 15-24) at the first and third months, respectively. On multivariate analysis, time from hospital admission to surgical intervention was a significant predictor of ED. Discriminant function analysis revealed that surgical intervention performed >8.23 hours after emergency department arrival predicted worsened postoperative ED ( P = .0051 at first month, P = .0057 at third month). 23 The authors concluded that delayed time to surgery in this study was associated with worsened long-term erectile function. Importantly, as acknowledged by the authors, this study did not consider the time interval between the inciting trauma and presentation to a health care facility, which would have likely extended the time threshold for intervention based on discriminant analysis. Despite the study supporting early intervention, the threshold of just >8 hours after emergency department presentation is quite long, certainly long enough for an overnight consultation to be delayed until daytime hours for surgical intervention.

A 2018 study by Naouar et al included 42 patients with penile fracture who underwent surgical repair between 2000 and 2015 at a single center. 24 Patients were stratified into 2 groups based on time from injury to presentation: an early group (presentation <24 hours) and a delayed group (>24 hours). All patients underwent surgical repair immediately upon presentation. Mean time from injury to presentation was 3.6 hours in the early group vs 79.5 hours in the delayed group. At 6 months postoperatively, the authors found no difference between groups in terms of erectile function as measured by IIEF-5 scores ( P = .67). Penile curvature was self-reported in the delayed group at 6 months with a rate of 43.8%, with no reports of curvature in the early group. Additionally, the authors observed that 50% of patients in the delayed group reported persistent pain with intercourse at 6 months vs 3.8% in the early group ( P = .001). 24 While this study demonstrated equivocal long-term erectile function outcomes, there appeared to be a higher degree of complications in the delayed repair group, such as penile curvature and penile pain. Penile curvature was not evaluated objectively, and no commentary on severity is reported.

In 2020 Raheem and Natale set out to examine the impact of early vs delayed intervention for penile fracture on long-term erectile function and urinary outcomes. 25 The authors reviewed outcomes in 23 patients who underwent surgical management of penile fracture between 2010 and 2019. Erectile function was evaluated postoperatively by use of IIEF-5 scores. Of 23 patients, 8 (78%) underwent surgical repair within 24 hours of trauma (range, 6-18 hours) and were placed in the early repair group; 5 (22%) underwent repair >24 hours after trauma (range, 3-21 days) and were placed in the delayed repair group. There was a mean follow-up of 11.6 months in this study, resulting in longer follow-up than most studies currently available in the literature. Of patients who contributed to 6-month follow-up data, there was normal erectile function in 15 of 18 (83%) vs 1 of 5 (20%) in the early and delayed repair groups, respectively ( P < .05). At last follow-up, 7 patients (3 in early group, 4 in delayed group) developed severe and persistent ED (IIEF-5 score, 5-7), without a significant difference between groups. Eight total patients (17%) complained of penile curvature after surgery, though no difference was found between groups in rates of penile curvature. 25 This study further supports the benefits of early intervention for enhancing erectile function recovery in the short term, although the discrepancy between groups dissipates with longer-term follow-up. This study’s small cohort makes its findings difficult to extrapolate to larger populations, but the data are important given the long follow-up reported.

In a small 2022 series, Bulbul et al found similar evidence for improved outcomes with early intervention for penile fracture repair. 26 This group evaluated 31 patients who underwent surgical repair of penile fracture between 2007 and 2019, all within 24 hours of injury. IIEF-5 scores were utilized at the 1-year postoperative follow-up for erectile function assessment, and autophotography was utilized in cases of penile curvature. At 1 year, 5 (16.3%) patients had ED, of which 4 had mild to moderate severity per IIEF-5 score. Several other complications were seen at the 1-year time point, including 2 patients (6.5%) with self-reported penile curvature, 3 (9.7%) with painful erection, and 2 (6.5%) with bothersome palpable tunical scars. The median time from penile fracture to surgery was 13 hours (range, 8-18). On statistical analysis, there was no correlation between time from trauma to surgery and ED, though there was notably a correlation between time from trauma to surgery and development of overall complications ( P = .028). A cutoff value for time from trauma to surgery in predicting complications was determined to be 13.5 hours. 26 Of note, the complications in this study resolved with conservative management and therefore may be of little clinical significance. Nonetheless, this study demonstrated that delayed presentation/intervention for penile fracture was associated with a generally higher rate of complication, though not specifically with development of ED.

A final recent study from Ouanes et al in 2021 evaluated penile fracture outcomes with the aim of identifying factors that may influence long-term sexual function. The authors evaluated 138 patients who underwent surgical repair for penile fracture at a single institution between 1999 and 2018. 12 Time from injury to presentation and time from presentation to surgery were recorded for all patients. All patients had assessment of erectile function (via the IIEF-5), penile curvature, and painful intercourse at 12 months. Time from injury to presentation ranged from 1 hour to 5 days (mean, 16.8 hours), and time from presentation to surgery ranged from 3 to 18 hours (mean, 14.3 hours). At 12 months, the mean IIEF-5 was 22, with 24 patients (17.4%) complaining of subjective ED. In addition, 21 (15.3%) indicated penile curvature that interfered with sexual intercourse, and 18 (13%) cited painful intercourse. On multivariate analysis, the authors found presentation delay to predict postoperative ED ( P = .03), though not delay in surgery after presentation. Notably, neither presentation delay nor surgery delay was associated with penile curvature or painful intercourse. 12

Systematic reviews/meta-analyses supporting early intervention for penile fracture

Given the relatively small sample sizes of the primary research studies on penile fracture management, numerous systematic reviews and meta-analyses have been performed to try to bolster our understanding of this clinical condition and its optimal management.

In a 2016 meta-analysis of 58 studies comprising 3213 patients with penile fracture (of which 95.4% underwent surgery and 4.6% were treated conservatively), Amer et al demonstrated that surgical intervention was associated with significantly fewer overall long-term complications vs conservative management (20.6% vs 46%, P  < .01), including ED, penile curvature, and painful erection. 15 This finding is consistent with previous reports, which have largely led to the abandonment of conservative management in index cases. A pooled analysis of 14 studies within this meta-analysis comparing early vs delayed surgical intervention demonstrated significantly fewer overall complications with immediate surgery ( P < .01). The analysis also identified fewer cases of penile curvature in the early surgery group ( P < .01). Importantly, the authors found no significant difference in rates of ED between the early and delayed surgery groups ( P = .59). 15 The findings of this large meta-analysis unequivocally support intervention in place of conservative management; yet, they also support smaller primary research reports of lower overall complication rates with early vs delayed surgical intervention despite no difference in long-term ED rates.

The most recent high-quality systematic review on penile fracture management was published by Falcone et al in 2020. 27 This group identified 14 articles composed of 438 patients between 2012 and 2017 discussing surgical management of penile fracture with long-term functional outcomes. Timing of surgical repair was recorded (stratified by <48 or >48 hours after injury). The authors demonstrated that overall complication rates (ED, voiding symptoms, penile curvature, and urethral stricture) were lower in the early surgical intervention groups relative to the delayed groups and that outcomes were improved in high-volume tertiary care centers relative to community locations. 27 Unfortunately, the authors did not provide the specific statistical analyses comparing the aforementioned complication rates between early and delayed intervention, which is a limitation of this study. The authors concluded that penile fracture should be repaired surgically within 36 to 48 hours, a significantly higher time frame than previous reports. It is important to note that many other studies consider delayed repair to be earlier or within this 36- to 48-hour window.

These findings support early intervention for penile fracture cases, revealing that presentation delay is associated with development of ED. Interestingly, there was no association between surgery delay after presentation and ED. 26 It is possible that the relatively narrow range of time for surgery delay and the limited sample size prevent the identification of the true impact of surgery delay, although the findings nonetheless support early intervention from the presentation delay data alone. The authors also importantly found no influence of delayed intervention on penile curvature or painful intercourse, unlike some of the prior studies discussed.

Primary data supporting noninferiority of delayed intervention for penile fracture

In contrast to the aforementioned articles supporting early or immediate surgical repair for penile fracture, several primary and systematic reviews/meta-analyses have found that penile fracture repair can be safely delayed (at varying interval recommendations) without consequence in terms of long-term sexual function. These studies challenge the dogma of emergent intervention for patients presenting with penile fracture.

El-Assmy et al evaluated 180 patients presenting with penile fractures over a 12-year time frame who were treated surgically at a single institution. 16 Patients were stratified into 2 groups: early presentation (<24 hours) and delayed presentation (>24 hours). All patients underwent immediate surgical repair following presentation. Presentation timing in this patient cohort ranged from 1 hour to 7 days. At follow-up, the following outcomes were assessed: ED (Sexual Health Inventory for Men score for married men and single-question self-assessment for single men), penile curvature, and painful erection. All men with ED on the questionnaire underwent penile Doppler ultrasound. Mean follow-up was 105 and 113 months for the early and delayed groups, respectively. At follow-up, there were no significant differences observed in rates of ED, penile curvature, or painful erection ( P = .72, .33, and .77). Among the 11 patients with ED, 4 had normal penile Doppler ultrasound results. 16 This large primary study had a long follow-up with patients and a lower complication rate. Importantly, no differences were seen between the early and delayed groups for any complication, suggesting that perhaps the previously seen differences in other studies dissipate over time after surgical intervention.

A 2012 retrospective study of 18 patients undergoing surgical intervention for penile fracture between 2008 and 2011 at a single institution revealed similarly equivocal outcomes among patients with delayed presentation. 28 Timing between injury and presentation was recorded for all patients, and all underwent surgery expeditiously after presentation. Patients were seen at 1, 3, 6, and 12 months postoperatively and then yearly. Of the 18 patients, 2 (11.1%) reported painful erection at short-term follow-up appointments, which then resolved entirely by 6 to 12 months. One patient (5.5%) complained of mild penile curvature that did not impede sexual function. No patients cited subjective de novo ED (1 patient had persistent stable ED, which he had prior to injury). Of the 6 patients who underwent repair >24 hours after injury, none endured long-term complications. 28 This study included a small cohort and lacked objective assessment of sexual function via validated questionnaires or penile ultrasound, but results suggest a relative lack of clinical consequence to a delay in intervention from time of injury.

A group in 2015 conducted a similar study of 19 patients presenting with penile fracture who ultimately underwent surgical intervention. The authors did not stratify patients into early vs delayed intervention, though notably the time interval from injury to surgery in this study ranged from 10 to 160 hours (mean, 43). One patient underwent surgery 160 hours after trauma. Of the 19 patients, 18 were seen at the 3-month postoperative interval, with 2 (11.1%) reporting mild to mild-moderate IIEF-5 scores. All other patients had normal IIEF-5 scores. The 2 patients with impairment in erectile function at 3 months underwent surgery 17 and 88 hours after injury. 18 The authors concluded that delayed intervention did not appear to have a large impact on erectile function outcomes. Like many others, this study was limited by low numbers.

Kozacıoğlu et al evaluated 54 patients who underwent surgery for penile fracture between 2001 and 2014 at a single institution. 17 The patients all underwent surgery <24 hours after injury. Patients were stratified into 3 groups by time interval from presentation to surgery (0-6, 6.1-12, and 12.1-24 hours). Patients were seen postoperatively at 1 year and then at the time of study (mean total follow-up, 44 months), at which point IIEF-5 scores were calculated in addition to assessment of penile curvature. The authors demonstrated that at 1-year follow-up and at the time of study, there were no differences in mean IIEF-5 scores among the 3 patient groups. Few patients had penile curvature and mild pain with erection, although there were again no differences among groups at both time points. 17 The authors concluded that while surgery is a key component to penile fracture management, a delay within 24 hours of injury is not likely to result in long-term complications.

In a small prospective observational study, Haque et al evaluated 21 patients who underwent early vs delayed surgical repair for penile fracture between 2016 and 2018 at a single institution to compare long-term sexual function outcomes between groups. 19 All patients underwent immediate surgical repair. Patients were stratified into 2 groups: early presentation (<24 hours) and delayed presentation (>24 hours). They were seen 1, 3, 6, and 12 months postoperatively, during which they were examined and their symptoms were evaluated. IIEF-5 scores were collected at the 6- and 12-month visits. Eight patients had a delayed presentation (mean delay, 78.6 hours; range, 36-120). The authors found no evidence of ED in either group at 12 months. At 12 months, 2 and 3 patients out of 13 in the early group reported penile paresthesia and curvature, respectively, as opposed to 3 and 0 patients out of 8 in the delayed group. 19

A series of 13 patients undergoing penile fracture repair at a single hospital between 2009 and 2019 demonstrated similarly equivocal long-term outcomes between early and delayed presentation. 20 In this study, the time interval between trauma and hospital presentation ranged from 1 hour to 168 hours (mean, 29.3 hours). The authors noted that in an unspecified postoperative period, no patients experienced subjective ED, and only 1 patient who presented within 12 hours of injury developed penile pain with intercourse that resolved with time. 20

Systematic reviews/meta-analyses supporting noninferiority of delayed intervention for penile fracture

In a 2017 systematic review, Wong et al compared outcomes between early and delayed surgical repair of penile fractures, motivated by the recent aforementioned published series over the last decade reporting acceptable outcomes with delayed intervention. 21 Articles queried in this study ranged from 1975 to 2015, ultimately including only those evaluating early repair of penile fracture (<24 hours) vs delayed (>24 hours). Twelve articles (composed of 512 patients) met the inclusion criteria. The authors reported that combined rates of postoperative ED, tunical scarring, and penile curvature were 6.6%, 5.4%, and 1.8%, respectively, in the early repair group vs 4.5% for each in the delayed repair group. There was no statistical difference for ED and tunical scarring between the early and delayed groups, although a significantly lower rate of penile curvature occurred in the early repair group. Of note, all cases of curvature were reportedly mild and nonbothersome to patients. The authors concluded that a brief delay in repair may be acceptable in select patients, though broad conclusions are difficult to ascertain given the overall low-quality data. 21

In another systematic review, Yusuf et al in 2022 evaluated early vs delayed repair for penile fracture. 29 Ten studies met inclusion criteria and were composed of 531 patients. The authors did not specify the criteria for early vs delayed repair in their query. They found that ED rates were lower in the early vs delayed repair group at <12-month follow-up (odds ratio, 0.36; P = .03). However, this difference was no longer significant with follow-up >12 months, suggesting that perhaps the short-term benefits of early repair on sexual function dissipate with time. No significant difference was observed in rates of palpable penile plaque between the study groups. Penile pain and penile curvature incidences were significantly lower in the early repair group relative to the delayed repair group (odds ratio, 0.17; P < .01 for both complication analyses). Of note, patients with penile pain and curvature reported mild severity with minimal level of bother, and cases of curvature did not require operative intervention. 29 While some complications were more likely to occur following delayed repair, none reached clinically significant levels of bother, and for ED specifically, the difference between groups resolved with time. These results suggest that patients with delayed presentation of penile fractures should still be considered for operative repair with a reasonable chance for adequate long-term sexual function.

The shift from conservative management to surgical intervention for penile fractures paralleled a consistent body of evidence supporting improved patient outcomes with surgical repair. However, there is still controversy regarding the optimal timing of intervention for patients presenting with penile fracture. Unanimously agreed-on conclusions have been challenging to draw given the relative scarcity of quality data on the topic, studies limited by small patient numbers, often subjective assessment of sexual function outcomes, and lack of randomized controlled trials. Similarly, the psychological impact of previous penile fracture on future erectile function cannot be overstated; therefore, subjective assessment of erectile function in these patient cohorts may be confounded by psychogenic contribution. 11

Penile fractures are typically considered a surgical emergency, warranting operative intervention soon after presentation to the emergency room. Given current dogma, urologists on call may find themselves taking a patient with a penile fracture to the operating room off-hours and without the experienced personnel who are available during daytime hours. Delayed presentation is common in cases of penile fractures, often due to factors such as embarrassment, unawareness of the severity of the injury, or expectations of spontaneous resolution. 3 , 30 , 31 Patients who experience penile fractures often face unique challenges in promptly seeking medical attention, including the sensitive nature of the injury, discomfort, and fear of judgment, which may dissuade them from seeking immediate care. The existing approach to prompt surgical intervention must account for these psychological and sociocultural factors that can contribute to the delayed presentation of cases.

Few would argue that daytime operative intervention is preferable for truly nonemergent cases that present overnight. Supporters of brief delayed intervention for these patients argue that most, if not many, of these patients can safely be observed initially and taken for operative intervention during daytime hours on the same admission for the aforestated reasons, with little fear of long-term clinical consequence.

Based on our findings, it is likely that delaying operative intervention for several hours, such as overnight, is safe and does little to compromise long-term outcomes. Most studies in the current review used time from the traumatic event to operative intervention as the variable of interest, and even among the studies, there was significant heterogeneity in defining what was considered early vs delayed intervention. It is unlikely that we will ever have a study with enough statistical power to definitively answer this question, but based on the current review, it seems reasonable to proceed with operative repair for penile fractures in an expeditious but safe manner. Waiting overnight to ensure appropriate personnel for the procedure at hand is unlikely to cause a significant risk for long-term sequelae, provided there is no evidence of urethral disruption and associated urinary retention, which may warrant more urgent intervention. For example, in a busy tertiary care center with trauma and other surgical emergencies, overnight penile fracture presentations may not warrant the bumping of other more urgent operative indications. At the same time, unnecessary delays that extend well beyond the window of presentation should be avoided if possible. Sometimes a short delay in operative intervention may be unavoidable; therefore, providers should feel comfortable knowing that these short delays will not likely affect long-term outcomes.

Surgical intervention for penile fracture remains the gold standard with superior long-term sexual and functional outcomes when compared with conservative management. Optimal timing of penile fracture repair remains to be elucidated, with data limited by low incidence resulting in small case series and a lack of randomized controlled trials. Nonetheless, recent data suggest that a brief delay in surgical intervention for patients presenting with penile fractures does not affect long-term sexual and functional outcomes.

None declared.

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• Open access
• Published: 13 December 2023

Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review

• Jeongok Park   ORCID: orcid.org/0000-0003-4978-817X 1 ,
• Sang Bin You   ORCID: orcid.org/0000-0002-1424-4140 2 ,
• Gi Wook Ryu   ORCID: orcid.org/0000-0002-4533-7788 3 &
• Youngkyung Kim   ORCID: orcid.org/0000-0002-3696-5416 4  

Systematic Reviews volume  12 , Article number:  230 ( 2023 ) Cite this article

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Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature.

This scoping review was conducted using the framework proposed by Arksey and O’Malley and PRISMA-ScR. Overall, four databases—PubMed, Web of Science, EMBASE, and CINAHL—were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar.

A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs.

Conclusions

Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.

Peer Review reports

Medication errors are closely associated with patient safety and the quality of care [ 1 , 2 ]. In particular, medication errors, which denote a clinical issue of global importance for patient safety, negatively affect patient morbidity and mortality and lead to delays in discharge [ 3 , 4 ]. The National Health Service in the UK estimates that 237 million medication errors occur each year, of which 66 million cause clinically significant harm [ 5 ]. The US Food and Drug Administration reported that they received more than 100,000 reports each year associated with suspected medication errors [ 6 ]. Additionally, it was estimated that 40,000–98,000 deaths per year in the USA could be attributed to errors by healthcare providers (HCPs) [ 7 ]. Previous studies have revealed that medication errors account for 6–12% of hospital admissions [ 8 ].

Intravenous (IV) medication is a common treatment in hospitalized patient care [ 9 ]. It is used in wards, intensive care units (ICUs), emergency rooms, and outpatient clinics in hospitals [ 9 , 10 ]. As direct HCPs, nurses are integral in patient safety during the IV medication process which could result in unintended errors or violations of recommendations [ 3 ]. As many drugs injected via the IV route include high-risk drugs, such as chemotherapy agents, insulin, and opioids [ 10 ], inappropriate dose administration could lead to adverse events (AEs), such as death and life-threatening events [ 11 , 12 ].

IV medication process is a complex and multistage process. There are 12 stages in the IV medication process, which can be classified as follows: (1) obtain the drug for administration, (2) obtain the diluent, (3) reconstitute the drug in the diluent, (4) take the drug at the patient’s bedside, (5) check for the patient’s allergies, (6) check the route of drug administration, (7) check the drug dose, (8) check the patency of the cannula, (9) expel the air from the syringe, (10) administer the drug, (11) flush the cannula, and (12) sign the prescription chart [ 13 ]. IV medication errors can occur at any of these stages. It is imperative to administer the drug at the correct time and rate during the IV medication process [ 13 ]. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defined an error in IV medication rates as “too fast or too slow rate than that intended” [ 14 ]. Maintaining the correct rate of IV medication is essential for enhancing the effectiveness of IV therapy and reducing AEs [ 9 ].

Infusion pumps are devices designed to improve the accuracy of IV infusions, with drug flow, volume, and timing programmed by HCPs [ 15 ]. A smart pump is an infusion pump with a software package containing a drug library. During programming, the smart pump software warns users about entering drug parameters that deviate from the recommended parameters, such as the type, dose, and dosage unit of the drug [ 15 ]. In the absence of a device for administering IV medication, such as an infusion pump or smart pump, the IV rate is usually controlled by counting the number of fluid drops falling into the drip chamber [ 9 ].

According to the previous study, applying an incorrect rate was the most prevalent IV medication error, accounting for 536 of 925 (57.9%) total IV medication errors [ 16 ]. Although rate control of IV medications is critical to patient safety and quality care, few studies review and map the relevant literature on rate control of IV medications. Therefore, this study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing the existing literature.

The specific research questions of this study are as follows:

What are the general characteristics of the studies related to rate control of IV medications?

What are the attributes of errors associated with rate control of IV medications?

What are the facilitators and barriers to rate control of IV medications?

This scoping review followed the framework suggested by Arksey and O’Malley [ 17 ] and developed by Levac et al. [ 18 ] and Peters et al. [ 19 ]. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) developed in 2020 by the Joanna Briggs Institute (JBI) were used to ensure reliability in the reporting of methodology (Additional file 1 ) [ 19 ].

Search strategy

According to the JBI Manuals for Evidence Synthesis, a three-step search strategy was adopted [ 19 ]. First, a preliminary search in PubMed was conducted based on the title, abstract, keywords, and index terms of articles to develop our search strategy. In the preliminary search, we used keywords such as “patients,” “nurse,” “IV therapy,” “monitoring,” “rate,” and “medication error.” The search results indicated that studies on medical devices and system-related factors were excluded. Therefore, we decided to exclude the keywords “patients” and “nurse” and focus on “IV therapy,” “monitoring,” “rate,” and “medication error” to comprehensively include studies on factors associated with rate control of infusion medications. Secondly, we used all identified keywords and index terms across all included databases following consultations with a research librarian at Yonsei University Medical Library to elaborate our search strategy. Four databases—PubMed, CINAHL, EMBASE, and Web of Science—were searched using the keywords, index terms, and a comprehensive list of keyword variations to identify relevant studies published before January 2023. The details of the search strategy are described in Additional file 2 . All database search results were exported into Endnote version 20. Finally, we manually searched the reference lists of the included articles identified from the database search. Furthermore, we manually searched two journals related to medication errors and patient safety, and Google Scholar to comprehensively identify the relevant literature. When performing a search on Google Scholar, keywords such as “medication,” “rate,” “IV therapy,” “intravenous administration,” and “medication error” were appropriately combined using search modifiers.

Eligibility criteria

Inclusion criteria were established according to the participants, concept, and context (PCC) framework recommended by the JBI manuals for scoping reviews [ 19 ]. The participants include patients receiving IV therapy, HCPs involved in administering IV medications, and experts from non-healthcare fields related to rate control of IV medications. The concepts were facilitators and barriers to rate control of IV medications, and the contexts were the environments or situations in which errors in rate control of IV medications occurred. While screening the literature identified by the three-step search based on the inclusion criteria, we refined the exclusion criteria through discussion among researchers. The exclusion criteria were as follows: (1) not available in English, (2) not an original article, (3) studies of medication errors in general, (4) not accessible, or (5) prescription error.

Study selection

Once duplicates were automatically removed through Endnote, two independent researchers assessed the eligibility of all articles by screening the titles and abstracts based on the inclusion and exclusion criteria. Studies identified via database searches were screened by GWR and YK and studies identified via other methods were screened by SBY and YK. Full-text articles were obtained either when the studies met the inclusion criteria or when more information was needed to assess eligibility and the researchers independently reviewed the full-text articles. In case of any disagreement in the study selection process, a consensus was reached through discussion among three researchers (GWR, SBY, and YK) and a senior researcher (JP).

Data extraction

Through consensus among the researchers, a form for data extraction was developed to extract appropriate information following the JBI manuals for scoping reviews [ 19 ]. The following data were collected from each study: author information, publication year, country, study design, study period, aims, participants or events (defined as the occurrences related to patient care focused on in the study), contexts, methods, errors related to the control of IV medications (observed results or intervention outcomes), error severity, facilitators, and barriers according to the NCC MERP criteria. Three researchers (GWR SBY, and YK) independently conducted data charting and completed the data extraction form through discussion.

Data synthesis

The general characteristics of included studies such as publication year, country, study design, and study period were analyzed using descriptive statistics to identify trends or patterns. The aims, participants, events, contexts, and methods of the included studies were classified into several categories through a research meeting including a senior researcher (JP) to summarize and analyze the characteristics of the included studies comprehensively. Attributes of errors associated with rate control of IV medications were analyzed and organized through consensus among researchers based on extracted data. Facilitators and barriers to rate control of IV medications were independently classified according to NCC MERP criteria by three researchers (GWR, SBY, and YK) and iteratively modified. Discrepancies were resolved by discussion and re-reading the articles, with the final decision made in consultation with the senior researcher (JP).

A total of 1211 studies were selected through a database search. After reviewing the titles and abstracts of the studies, 42 studies were considered for a detailed assessment by the three researchers. In particular, 2 were not available in English, 3 were not original articles, 24 were studies of medication error in general without details on rate control of IV medications, 2 were regarding prescription errors, and 1 was not accessible. Finally, 10 studies were identified through a database search. Additionally, 23 studies were identified from a manual search. Among the 23, 5 were not original articles, and 6 were studies on medication error in general. Finally, 12 studies were identified via other methods. Hence, 22 studies were included in the data analysis (Fig.  1 , Additional file 3 ).

PRISMA flow chart for literature selection

Characteristics of the studies

General characteristics.

Table 1 presents the general characteristics of the included studies. Two of the included studies had a publication year before 2000 [ 20 , 21 ], and more than half of the studies ( n  = 15) were published in 2010 and later. A majority of the included studies were conducted in Western countries ( n  = 15) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], four were conducted in Asia [ 20 , 37 , 38 , 39 ], two were conducted in Australia [ 21 , 40 ], and one was conducted in Egypt [ 2 ]. In terms of the study design, most studies were project studies ( n  = 7) [ 22 , 24 , 27 , 28 , 30 , 34 , 39 ] or prospective observational studies ( n  = 5) [ 2 , 20 , 29 , 32 , 40 ], followed by retrospective studies ( n  = 3) [ 21 , 25 , 35 ], qualitative or mixed-methods studies ( n  = 3) [ 23 , 26 , 33 ], and descriptive cross-sectional studies ( n  = 2) [ 36 , 38 ]. Additionally, there was one controlled pre-posttest study [ 37 ] and one simulation laboratory experiment study [ 31 ]. The study period also varied greatly from 2 days [ 32 ] to 6 years [ 25 ].

The aims of the included studies were divided into two main categories. First, 13 studies identified the current status, causes, and factors influencing errors that could occur in healthcare settings [ 2 , 20 , 21 , 23 , 25 , 26 , 29 , 32 , 33 , 35 , 36 , 38 , 40 ]. Among these, three studies were on errors that may occur in specific healthcare procedures, such as anesthesia [ 20 ], vascular access [ 21 ], and pediatric chemotherapy [ 25 ]. Additionally, three studies explored possible errors associated with specific settings and medications, such as an obstetric emergency ward [ 2 ], cardiac critical care units [ 38 ], and high-alert medications [ 36 ], and three studies investigated the errors associated with the overall IV medication preparation or administration [ 23 , 33 , 40 ]. Moreover, three studies aimed at identifying potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and one study was about errors in medication preparation and administration that could occur in a setting using a specific system connected to electronic medical records [ 29 ]. Second, nine studies described the procedure of developing interventions or identified the effect of interventions [ 22 , 24 , 27 , 28 , 30 , 31 , 34 , 37 , 39 ].

Participants and events

Participants in the 22 studies included HCPs such as nurses, doctors, pharmacists, and patients. Notably, four of these studies were only for nurses [ 31 , 37 , 38 , 40 ] and there was also one study involving only pharmacists [ 36 ]. Furthermore, there were five studies wherein people from various departments or roles participated [ 23 , 26 , 27 , 28 , 39 ]. There were three studies wherein the patients were participants, and two studies included both patients and medical staff [ 29 , 33 ].

Among the included studies, nine studies focused on errors in IV medication preparation and administration as events [ 23 , 26 , 30 , 32 , 33 , 34 , 37 , 38 , 40 ] and five studies focused on the administration process only [ 30 , 32 , 34 , 37 , 40 ]. Four studies focused on problems in the administration of all types of drugs including errors associated with rate control of IV medications [ 2 , 22 , 28 , 29 ]. Additionally, four studies focused on events that occurred with IV medication infusion devices [ 24 , 27 , 35 , 39 ], two studies explored the events that occurred during chemotherapy [ 22 , 25 ], and some analyzed events with problems in vascular access [ 21 ], iatrogenic events among neonates [ 28 ], and critical events in anesthesia cases [ 20 ].

Contexts and methods

The contexts can be largely divided into healthcare settings, including hospitals and laboratory settings. Three hospital-based studies were conducted in the entire hospital [ 20 , 22 , 24 ], eight studies were conducted at several hospitals, and the number of hospitals involved varied from 2 to 132 [ 23 , 26 , 32 , 33 , 34 , 35 , 38 , 40 ]. Furthermore, four studies were conducted in different departments within one hospital [ 29 , 30 , 37 , 39 ], three studies were conducted in only one department [ 2 , 27 , 28 ], two studies considered other healthcare settings and were not limited to hospitals [ 21 , 25 ], and one study was conducted in a simulation laboratory setting that enabled a realistic simulation of an ambulatory chemotherapy unit [ 31 ].

Specifically, seven out of the nine studies developed or implemented interventions based on interdisciplinary or multidisciplinary collaboration [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Two studies developed and identified the effectiveness of interventions that created an environment for nurses to improve performance and correct errors associated with medication administration [ 31 , 39 ], and two intervention studies were on error reporting methods or observation tools and the processes of addressing reported errors [ 28 , 30 ]. There were also a study on a pharmacist-led educational program for nurses [ 37 ], a comprehensive intervention from drug prescription to administration to reduce chemotherapy-related medication errors [ 22 ], infusion safety intervention bundles [ 34 ], the implementation of a smart IV pump equipped with failure mode and effects analysis (FMEA) [ 24 ], and a smart system to prevent pump programming errors [ 27 ].

Data collection methods were classified as a review of reported incidents [ 20 , 21 , 22 , 25 , 35 ], a review of medical charts [ 26 ], observations [ 23 , 29 , 30 , 31 , 32 , 33 , 34 , 37 , 40 ], follow-up on every pump alert [ 27 ], and self-reporting questionnaires or surveys [ 36 , 38 ]. Some studies utilized retrospective reviews of reported incidents and self-report questionnaires [ 39 ]. Also, in the study by Kandil et al., observation, nursing records review, and medical charts review were all used [ 2 ].

Attributes of errors associated with rate control of IV medications

Table 2 presents the attributes of errors related to rate control of IV medications in observed results or intervention outcomes, and error severity. Notably, 6 of 13 studies presenting observed results reported errors related to IV medication infusion devices among the rate control errors [ 20 , 25 , 32 , 33 , 35 , 36 ]. Additionally, four studies reported errors in bolus dose administration or IV push and flushing lines among IV rate errors [ 2 , 23 , 36 , 40 ]. Among the 13, nine studies reported error severity, and among these, three studies used NCC MERP ratings [ 25 , 32 , 33 ]. In four studies, error severity was reported by describing several cases in detail [ 2 , 21 , 23 , 25 ], and two studies reported no injuries or damages due to errors [ 26 , 29 ]. Among the nine studies that developed interventions and identified their effectiveness, four presented the frequency of incorrect rate errors as an outcome variable [ 28 , 30 , 34 , 37 ]. Moreover, two studies suggested compliance rates for intervention as outcome variables [ 24 , 31 ].

Among the nine project or experiment studies, three showed a decrease in error rate as a result of the intervention [ 28 , 31 , 34 ]. Three studies developed interventions to reduce rate errors but did not report the frequency or incidence of rate errors [ 22 , 24 , 27 ]. A study reported the frequency of rate errors only after the intervention; the effect of the intervention could not be identified [ 30 ]. Also, three studies showed the severity of errors related to rate control of IV medications [ 24 , 30 , 34 ], two used NCC MERP severity ratings [ 30 , 34 ], and one reported that all errors caused by smart IV pumps equipped with FMEA resulted in either temporary harm or no harm [ 24 ].

Facilitators and barriers to rate control of IV medications

Table 3 presents the facilitators and barriers related to rate control of IV medications according to the NCC MERP taxonomy based on the 22 included studies. Sub-categories of human factors were classified as knowledge deficit, performance deficit, miscalculation of dosage or infusion rate, and stress. The sub-category of design factor was device. System-related contributing factors were classified as frequent interruptions and distractions, inadequate training, poor assignment or placement of HCPs or inexperienced personnel, policies and procedures, and communication systems between HCPs [ 14 ].

Human factors

Among the barriers extracted from the 22 studies, 11 factors belonged to the “knowledge deficit,” “performance deficit,” “miscalculation of dosage or infusion rate,” and “stress (high-volume workload)” in this category. Half of these factors are related to the “performance deficit.” Barriers identified in two or more studies were tubing misplacement [ 24 , 35 ] and non-compliance with protocols and guidelines [ 2 , 25 ], all of which belonged to the “performance deficit.” Additionally, the high workload and environmental characteristics of the ICU, which corresponded to the “stress,” were also identified as barriers to rate control of IV medications [ 23 , 37 ].

Most factors in this category were related to IV medication infusion devices such as infusion pumps and smart pumps. In the study by Lyons et al., the use of devices, such as patient-controlled analgesia pumps and syringe drivers, was a facilitator of rate control of IV medications [ 33 ]. In addition to the use of these devices, the expansion of capabilities [ 26 ], monitoring programming [ 27 ], and standardization [ 22 ] were also facilitators. Unexpected equipment faults, a barrier, were identified in five studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the complex design of the equipment [ 23 , 24 ] and incomplete drug libraries in smart pumps [ 33 , 35 ] were identified in two studies each. Factors such as the misassembly of an unfamiliar infusion pump [ 21 ] and smart pumps not connected to electronic systems [ 30 ] were also barriers.

Contributing factors (system related)

The factors belonging to the “frequent interruptions and distractions” in this category were all barriers. Specifically, running multiple infusions at once [ 24 , 27 ], air-in-line alarms, or cleaning air [ 24 ] were identified as barriers. Among the facilitators of the “training,” there were education and training on the use of smart IV pumps [ 24 ] and chemotherapy errors [ 22 ]. There are two factors in the “assignment or placement of a HCP or inexperienced personnel,” where ward-based pharmacists were facilitators [ 36 ], but nurses with less than 6 years of experience were barriers [ 40 ]. The sub-category with the most factors was “policies and procedures,” where the facilitators extracted in the four studies were double-checks through the process [ 22 , 24 , 28 , 36 ]. Among the barriers, two were related to keep-the-vein-open, which was identified in three studies [ 30 , 32 , 33 ]. The lack of automated infusion pumps [ 2 ], the absence of culture for use [ 32 , 33 ], and problems in the drug prescription process [ 33 ] were also identified as barriers. Communication with physicians in instances of doubt identified was the only identified facilitator in the “communication systems between HCPs” [ 28 ].

Resolutions for the barriers to rate control of IV medications

Table 4 presents the resolutions for the barriers to rate control of IV medications in the included studies. The suggested resolutions primarily belonged to the “contributing factors (system-related)” category. Resolutions in the “human factors” category were mainly related to the knowledge and performance of individual healthcare providers, and there were no studies proposing resolutions specifically addressing stress (high-volume workload), which is one of the barriers. Resolutions in the “design” category focused on the development [ 26 , 30 ], appropriate use [ 24 , 33 ], evaluation [ 26 ], improvement [ 24 , 26 , 30 ], and supply [ 23 ] of infusion pumps or smart pumps. Resolutions addressing aspects within the “contributing factors (system-related)” category can be classified into six main areas: interdisciplinary or inter-institution collaboration [ 23 , 25 , 28 , 30 , 34 , 35 , 36 , 37 ], training [ 24 , 37 , 40 ], implementation of policies or procedures [ 29 , 31 , 34 , 35 , 37 , 39 ], system improvement [ 25 , 30 , 32 ], creating a patient safety culture [ 25 , 37 , 38 ], and staffing [ 2 , 38 ].

This scoping review provides the most recent evidence on the attributes of errors, facilitators, and barriers related to rate control of IV medications. The major findings of this study were as follows: (1) there were a few intervention studies that were effective in decreasing the errors related to rate control of IV medications; (2) there was limited research focusing on the errors associated with IV medication infusion devices; (3) a few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications; and (4) the facilitators and barriers related to rate control of IV medications were identified by NCC MERP taxonomy as three categories (human factors, design, and system-related contributing factors).

Among the nine project or experiment studies, only two interventions showed statistically significant effectiveness for IV rate control [ 28 , 31 ]. Six studies did not report the specific statistical significance of the intervention [ 22 , 24 , 27 , 30 , 37 , 39 ], and one study found that the developed intervention had no statistically significant effect [ 34 ]. In another study, administration errors, including rate errors, increased in the experimental group and decreased in the control group [ 37 ]. IV rate control is a major process in medication administration that is comprehensively related to environmental and personal factors [ 3 , 41 ]. According to previous studies, interdisciplinary or multidisciplinary cooperation is associated with the improvement in patient safety and decreased medical errors [ 42 , 43 , 44 ]. Seven of the included studies were also project or experiment studies that developed interventions based on an interdisciplinary or multidisciplinary approach [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Additionally, an effective intervention was developed by a multidisciplinary care quality improvement team [ 28 ]. Therefore, it is crucial to develop effective interventions based on an interdisciplinary or multidisciplinary approach to establish practice guidelines with a high level of evidence related to IV rate control.

Of the 22 included studies, three identified potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and four described the application of interventions or explored the effects of the intervention developed to reduce errors that occur when using IV medication infusion devices [ 24 , 27 , 34 , 39 ]. IV medication infusion devices, such as infusion pumps and smart pumps, are widely used in healthcare environments and allow more rigorous control in the process of administering medications that are continuously infused [ 45 ]. Smart pumps are recognized as useful devices for providing safe and effective nursing care [ 15 ]. However, the use of IV medication infusion devices requires an approach different from traditional rate monitoring by counting the number of fluid drops falling into the drip chamber [ 9 ]. However, there exist many problems, such as bypassing the drug library, device maintenance, malfunction, tubing/connection, and programming in the use of IV medication infusion devices [ 32 , 35 ]. None of the four studies that described the application of interventions or explored the effects of the intervention demonstrated statistically significant effects. All four studies had no control group [ 24 , 27 , 34 , 39 ] and two studies had only post-test designs [ 24 , 27 ]. Therefore, further research needs to be conducted to analyze errors in rate control related to IV medication infusion devices and develop effective interventions.

A few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications. Among the 12 studies that reported the severity of errors associated with rate control of IV medications, five studies used NCC MERP, an internationally validated and reliable tool for assessing error severity, and one study used the Severity Assessment Code (SAC) developed by the New South Wales Health Department. Six studies did not use tools to assess error severity. The term “error severity” means the degree of potential or actual harm to patients [ 46 ]. Evaluating the severity of medication errors is a vital point in improving patient safety throughout the medication administration process. This evaluation allows for distinguishing errors based on their severity to establish the development of risk mitigation strategies focused on addressing errors with the great potential to harm patients [ 47 , 48 ]. Specifically, errors associated with rate control of IV medications were categorized as A to E on the NCC MERP and to groups 3 and 4 on the SAC. Additionally, errors associated with rate control of IV medications caused direct physical damage [ 2 , 21 ] and necessitated additional medication to prevent side effects or toxicity [ 23 ]. Therefore, as errors in rate control of IV medications are likely to cause actual or potential harm to the patient, research systematically evaluating and analyzing error severity should be conducted to provide the basis for developing effective risk reduction strategies in the rate control of IV medications.

Facilitators and barriers were identified as human, design, and system-related contributing factors. Among the human factors, “performance deficit” included failure to check equipment properly, tubing misplacement, inadequate monitoring, non-compliance with protocols and guidelines, and human handling errors with smart pumps. Nurses play a major role in drug administration; thus, their monitoring and practices related to IV medication infusion devices can influence patient health outcomes [ 3 , 49 ]. A major reason for the lack of monitoring was overwork, which was related to the complex working environment, work pressure, and high workload [ 3 , 11 , 49 ]. Moreover, two of the included studies identified high workload as a barrier to rate control of IV medications [ 23 , 37 ]. Therefore, to foster adequate monitoring of rate control of IV medications, a systematic approach to alleviating the complex working environment and work pressure should be considered.

Most facilitators and barriers in the devices category were related to IV medication infusion devices. In particular, expanding pump capabilities [ 26 ], monitoring pump programming [ 27 ], standardization [ 22 ], and using a pump [ 33 ] can facilitate rate control of IV medications. However, unexpected equipment faults are significant barriers, as identified in five studies among the included studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the design [ 23 , 24 ], user-friendliness [ 21 ], connectivity to electronic systems [ 30 ], and completeness of drug libraries [ 33 , 35 ] are factors that can affect rate control of IV medications. Therefore, it is important to improve, monitor, and manage IV medication infusion devices so that they do not become barriers. Moreover, because rate errors caused by other factors can be prevented by devices, active utilization and systematic management of devices at the system level are required.

Although there are many benefits of infusion and smart pumps for reducing errors in rate control of IV medications, they cannot be used in all hospitals because of the limitation of medical resources. The standard infusion set, which is a device for controlling the rate of IV medication by a controller [ 9 ], is widely used in outpatient as well as inpatient settings [ 32 ]. Devices for monitoring the IV infusion rate, such as FIVA™ (FIVAMed Inc, Halifax, Canada) and DripAssist (Shift Labs Inc, Seattle, USA), which can continuously monitor flow rate and volume with any gravity drip set, have been commercialized [ 33 ]. However, they have not been widely used in hospitals. Therefore, developing novel IV infusion rate monitoring devices that are simple to use, can be used remotely, and are affordable for developing and underdeveloped countries can help nurses to reduce their workloads in monitoring IV infusion rates and thus maintain patient safety.

Most facilitators and barriers were system-related contributing factors, most of which belonged to the “policies and procedures.” In four studies, the absence of hospital policies or culture related to rate control of IV medications was identified as a barrier [ 2 , 30 , 32 , 33 ]. Medication errors related to incorrect rate control are problems that should be approached from macroscopic levels, such as via institutional policies and safety cultures. Therefore, large-scale research including more diverse departments and institutions needs to be conducted.

The second most common categories in system-related contributing factors were “frequent interruptions and distractions” and “training.” Although nurses experienced frequent interruptions and distributions during work, only one of the included studies was on interventions that were developed to create an environment with reduced interruptions [ 31 ]. Additionally, four studies found that education for nurses who are directly associated with medication administration is mandatory [ 22 , 23 , 24 , 36 ]. Therefore, education and a work environment for safety culture should be created to improve IV rate control.

Based on resolutions for barriers to rate control of IV medications, key groups relevant to rate control of IV medications include HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices. HCPs directly involved in the preparation and administration of IV medications need to enhance their knowledge of drugs, raise awareness for the importance of rate control of IV medications, and improve performance related to IV infusion device monitoring. Engineers specializing in IV medication infusion devices should develop these devices by integrating various information technologies used in clinical settings. Additionally, they should identify issues related to these devices and continuously enhance both software and hardware. Healthcare administrators play a crucial role in establishing and leading interdisciplinary or inter-institution collaborations. They should foster leadership, build a patient safety culture within the organization, and implement training, interventions, and policies for correct rate control of IV medications. Decreasing medication errors, including errors in IV rate control, is closely linked to the various key groups [ 50 , 51 , 52 , 53 ], and multidisciplinary collaboration is emphasized for quality care [ 54 , 55 , 56 , 57 ]. Therefore, each key group should perform its role and cooperate for appropriate IV rate control within a structured system.

This review has some limitations that should be considered. As there was no randomized controlled trial in this review, the causal relationship between wrong rate errors and their facilitators or barriers could not be determined. Moreover, only limited literature may have been included in this review because we included literature published in English and excluded gray literature. Since we did not evaluate the quality of the study, there may be a risk of bias in data collection and analysis. Despite these limitations, this study provides a meaningful assessment of published studies related to rate control of IV medications. This contribution will provide an important basis for new patient safety considerations in IV medication administration when determining future policies and device development.

The findings of this review suggest that further research is needed to be conducted to develop effective interventions to improve the practice of IV rate control. Moreover, given the rapid growth of technology in medical settings, research on IV medication infusion devices should be conducted. Additionally, to establish effective risk reduction strategies, it is necessary to systematically evaluate and analyze the severity of errors related to the rate control of IV medications. Several facilitators and barriers to rate control of IV medications were identified in this review to ensure patient safety and quality care, interventions and policy changes related to education and the work environment are required. Additionally, the development of a device capable of monitoring the flow of IV medication is necessary. This review will be useful for HCPs, hospital administrators, and engineers specializing in IV medication infusion devices to minimize errors in rate control of IV medications and improve patient safety.

Availability of data and materials

The corresponding author can provide the datasets that were utilized and/or examined during the present study upon reasonable request.

Abbreviations

Adverse event

Healthcare provider

Intensive care unit

Intravenous

Joanna Briggs Institute

The National Coordinating Council for Medication Error Reporting and Prevention

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L Naseralallah D Stewart M Price V Paudyal 2023 Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review Int J Clin Pharm https://doi.org/10.1007/s11096-023-01626-5

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This research was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: RS-2020-KD000077) and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. 2020R1A6A1A03041989). This work also supported by the Brain Korea 21 FOUR Project funded by National Research Foundation (NRF) of Korea, Yonsei University College of Nursing.

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Jeongok Park

University of Pennsylvania School of Nursing, Philadelphia, PA, USA

Sang Bin You

Department of Nursing, Hansei University, 30, Hanse-Ro, Gunpo-Si, 15852, Gyeonggi-Do, Korea

Gi Wook Ryu

College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea

Youngkyung Kim

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Conceptualization: JP; study design: JP; data collection: GWR, YK, SBY; data analysis: JP, GWR, YK, SBY; administration: JP; funding acquisition: JP; writing—original draft: JP, GWR, YK; writing—review and editing: JP, YK.

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Additional file 1:.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.

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Search queries and strategies by electronic databases.

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Studies included in the data analysis.

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Park, J., You, S.B., Ryu, G.W. et al. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 12 , 230 (2023). https://doi.org/10.1186/s13643-023-02386-z

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Received : 15 May 2023

Accepted : 08 November 2023

Published : 13 December 2023

DOI : https://doi.org/10.1186/s13643-023-02386-z

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