peer reviewed articles for literature review

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Approaching literature review for academic purposes: The Literature Review Checklist

Debora f.b. leite.

I Departamento de Ginecologia e Obstetricia, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SP, BR

II Universidade Federal de Pernambuco, Pernambuco, PE, BR

III Hospital das Clinicas, Universidade Federal de Pernambuco, Pernambuco, PE, BR

Maria Auxiliadora Soares Padilha

Jose g. cecatti.

A sophisticated literature review (LR) can result in a robust dissertation/thesis by scrutinizing the main problem examined by the academic study; anticipating research hypotheses, methods and results; and maintaining the interest of the audience in how the dissertation/thesis will provide solutions for the current gaps in a particular field. Unfortunately, little guidance is available on elaborating LRs, and writing an LR chapter is not a linear process. An LR translates students’ abilities in information literacy, the language domain, and critical writing. Students in postgraduate programs should be systematically trained in these skills. Therefore, this paper discusses the purposes of LRs in dissertations and theses. Second, the paper considers five steps for developing a review: defining the main topic, searching the literature, analyzing the results, writing the review and reflecting on the writing. Ultimately, this study proposes a twelve-item LR checklist. By clearly stating the desired achievements, this checklist allows Masters and Ph.D. students to continuously assess their own progress in elaborating an LR. Institutions aiming to strengthen students’ necessary skills in critical academic writing should also use this tool.

INTRODUCTION

Writing the literature review (LR) is often viewed as a difficult task that can be a point of writer’s block and procrastination ( 1 ) in postgraduate life. Disagreements on the definitions or classifications of LRs ( 2 ) may confuse students about their purpose and scope, as well as how to perform an LR. Interestingly, at many universities, the LR is still an important element in any academic work, despite the more recent trend of producing scientific articles rather than classical theses.

The LR is not an isolated section of the thesis/dissertation or a copy of the background section of a research proposal. It identifies the state-of-the-art knowledge in a particular field, clarifies information that is already known, elucidates implications of the problem being analyzed, links theory and practice ( 3 - 5 ), highlights gaps in the current literature, and places the dissertation/thesis within the research agenda of that field. Additionally, by writing the LR, postgraduate students will comprehend the structure of the subject and elaborate on their cognitive connections ( 3 ) while analyzing and synthesizing data with increasing maturity.

At the same time, the LR transforms the student and hints at the contents of other chapters for the reader. First, the LR explains the research question; second, it supports the hypothesis, objectives, and methods of the research project; and finally, it facilitates a description of the student’s interpretation of the results and his/her conclusions. For scholars, the LR is an introductory chapter ( 6 ). If it is well written, it demonstrates the student’s understanding of and maturity in a particular topic. A sound and sophisticated LR can indicate a robust dissertation/thesis.

A consensus on the best method to elaborate a dissertation/thesis has not been achieved. The LR can be a distinct chapter or included in different sections; it can be part of the introduction chapter, part of each research topic, or part of each published paper ( 7 ). However, scholars view the LR as an integral part of the main body of an academic work because it is intrinsically connected to other sections ( Figure 1 ) and is frequently present. The structure of the LR depends on the conventions of a particular discipline, the rules of the department, and the student’s and supervisor’s areas of expertise, needs and interests.

Interestingly, many postgraduate students choose to submit their LR to peer-reviewed journals. As LRs are critical evaluations of current knowledge, they are indeed publishable material, even in the form of narrative or systematic reviews. However, systematic reviews have specific patterns 1 ( 8 ) that may not entirely fit with the questions posed in the dissertation/thesis. Additionally, the scope of a systematic review may be too narrow, and the strict criteria for study inclusion may omit important information from the dissertation/thesis. Therefore, this essay discusses the definition of an LR is and methods to develop an LR in the context of an academic dissertation/thesis. Finally, we suggest a checklist to evaluate an LR.

WHAT IS A LITERATURE REVIEW IN A THESIS?

Conducting research and writing a dissertation/thesis translates rational thinking and enthusiasm ( 9 ). While a strong body of literature that instructs students on research methodology, data analysis and writing scientific papers exists, little guidance on performing LRs is available. The LR is a unique opportunity to assess and contrast various arguments and theories, not just summarize them. The research results should not be discussed within the LR, but the postgraduate student tends to write a comprehensive LR while reflecting on his or her own findings ( 10 ).

Many people believe that writing an LR is a lonely and linear process. Supervisors or the institutions assume that the Ph.D. student has mastered the relevant techniques and vocabulary associated with his/her subject and conducts a self-reflection about previously published findings. Indeed, while elaborating the LR, the student should aggregate diverse skills, which mainly rely on his/her own commitment to mastering them. Thus, less supervision should be required ( 11 ). However, the parameters described above might not currently be the case for many students ( 11 , 12 ), and the lack of formal and systematic training on writing LRs is an important concern ( 11 ).

An institutional environment devoted to active learning will provide students the opportunity to continuously reflect on LRs, which will form a dialogue between the postgraduate student and the current literature in a particular field ( 13 ). Postgraduate students will be interpreting studies by other researchers, and, according to Hart (1998) ( 3 ), the outcomes of the LR in a dissertation/thesis include the following:

• To identify what research has been performed and what topics require further investigation in a particular field of knowledge;
• To determine the context of the problem;
• To recognize the main methodologies and techniques that have been used in the past;
• To place the current research project within the historical, methodological and theoretical context of a particular field;
• To identify significant aspects of the topic;
• To elucidate the implications of the topic;
• To offer an alternative perspective;
• To discern how the studied subject is structured;
• To improve the student’s subject vocabulary in a particular field; and
• To characterize the links between theory and practice.

A sound LR translates the postgraduate student’s expertise in academic and scientific writing: it expresses his/her level of comfort with synthesizing ideas ( 11 ). The LR reveals how well the postgraduate student has proceeded in three domains: an effective literature search, the language domain, and critical writing.

Effective literature search

All students should be trained in gathering appropriate data for specific purposes, and information literacy skills are a cornerstone. These skills are defined as “an individual’s ability to know when they need information, to identify information that can help them address the issue or problem at hand, and to locate, evaluate, and use that information effectively” ( 14 ). Librarian support is of vital importance in coaching the appropriate use of Boolean logic (AND, OR, NOT) and other tools for highly efficient literature searches (e.g., quotation marks and truncation), as is the appropriate management of electronic databases.

Language domain

Academic writing must be concise and precise: unnecessary words distract the reader from the essential content ( 15 ). In this context, reading about issues distant from the research topic ( 16 ) may increase students’ general vocabulary and familiarity with grammar. Ultimately, reading diverse materials facilitates and encourages the writing process itself.

Critical writing

Critical judgment includes critical reading, thinking and writing. It supposes a student’s analytical reflection about what he/she has read. The student should delineate the basic elements of the topic, characterize the most relevant claims, identify relationships, and finally contrast those relationships ( 17 ). Each scientific document highlights the perspective of the author, and students will become more confident in judging the supporting evidence and underlying premises of a study and constructing their own counterargument as they read more articles. A paucity of integration or contradictory perspectives indicates lower levels of cognitive complexity ( 12 ).

Thus, while elaborating an LR, the postgraduate student should achieve the highest category of Bloom’s cognitive skills: evaluation ( 12 ). The writer should not only summarize data and understand each topic but also be able to make judgments based on objective criteria, compare resources and findings, identify discrepancies due to methodology, and construct his/her own argument ( 12 ). As a result, the student will be sufficiently confident to show his/her own voice .

Writing a consistent LR is an intense and complex activity that reveals the training and long-lasting academic skills of a writer. It is not a lonely or linear process. However, students are unlikely to be prepared to write an LR if they have not mastered the aforementioned domains ( 10 ). An institutional environment that supports student learning is crucial.

Different institutions employ distinct methods to promote students’ learning processes. First, many universities propose modules to develop behind the scenes activities that enhance self-reflection about general skills (e.g., the skills we have mastered and the skills we need to develop further), behaviors that should be incorporated (e.g., self-criticism about one’s own thoughts), and each student’s role in the advancement of his/her field. Lectures or workshops about LRs themselves are useful because they describe the purposes of the LR and how it fits into the whole picture of a student’s work. These activities may explain what type of discussion an LR must involve, the importance of defining the correct scope, the reasons to include a particular resource, and the main role of critical reading.

Some pedagogic services that promote a continuous improvement in study and academic skills are equally important. Examples include workshops about time management, the accomplishment of personal objectives, active learning, and foreign languages for nonnative speakers. Additionally, opportunities to converse with other students promotes an awareness of others’ experiences and difficulties. Ultimately, the supervisor’s role in providing feedback and setting deadlines is crucial in developing students’ abilities and in strengthening students’ writing quality ( 12 ).

HOW SHOULD A LITERATURE REVIEW BE DEVELOPED?

A consensus on the appropriate method for elaborating an LR is not available, but four main steps are generally accepted: defining the main topic, searching the literature, analyzing the results, and writing ( 6 ). We suggest a fifth step: reflecting on the information that has been written in previous publications ( Figure 2 ).

First step: Defining the main topic

Planning an LR is directly linked to the research main question of the thesis and occurs in parallel to students’ training in the three domains discussed above. The planning stage helps organize ideas, delimit the scope of the LR ( 11 ), and avoid the wasting of time in the process. Planning includes the following steps:

• Reflecting on the scope of the LR: postgraduate students will have assumptions about what material must be addressed and what information is not essential to an LR ( 13 , 18 ). Cooper’s Taxonomy of Literature Reviews 2 systematizes the writing process through six characteristics and nonmutually exclusive categories. The focus refers to the reviewer’s most important points of interest, while the goals concern what students want to achieve with the LR. The perspective assumes answers to the student’s own view of the LR and how he/she presents a particular issue. The coverage defines how comprehensive the student is in presenting the literature, and the organization determines the sequence of arguments. The audience is defined as the group for whom the LR is written.
• Designating sections and subsections: Headings and subheadings should be specific, explanatory and have a coherent sequence throughout the text ( 4 ). They simulate an inverted pyramid, with an increasing level of reflection and depth of argument.
• Identifying keywords: The relevant keywords for each LR section should be listed to guide the literature search. This list should mirror what Hart (1998) ( 3 ) advocates as subject vocabulary . The keywords will also be useful when the student is writing the LR since they guide the reader through the text.
• Delineating the time interval and language of documents to be retrieved in the second step. The most recently published documents should be considered, but relevant texts published before a predefined cutoff year can be included if they are classic documents in that field. Extra care should be employed when translating documents.

Second step: Searching the literature

The ability to gather adequate information from the literature must be addressed in postgraduate programs. Librarian support is important, particularly for accessing difficult texts. This step comprises the following components:

• Searching the literature itself: This process consists of defining which databases (electronic or dissertation/thesis repositories), official documents, and books will be searched and then actively conducting the search. Information literacy skills have a central role in this stage. While searching electronic databases, controlled vocabulary (e.g., Medical Subject Headings, or MeSH, for the PubMed database) or specific standardized syntax rules may need to be applied.

In addition, two other approaches are suggested. First, a review of the reference list of each document might be useful for identifying relevant publications to be included and important opinions to be assessed. This step is also relevant for referencing the original studies and leading authors in that field. Moreover, students can directly contact the experts on a particular topic to consult with them regarding their experience or use them as a source of additional unpublished documents.

Before submitting a dissertation/thesis, the electronic search strategy should be repeated. This process will ensure that the most recently published papers will be considered in the LR.

• Selecting documents for inclusion: Generally, the most recent literature will be included in the form of published peer-reviewed papers. Assess books and unpublished material, such as conference abstracts, academic texts and government reports, are also important to assess since the gray literature also offers valuable information. However, since these materials are not peer-reviewed, we recommend that they are carefully added to the LR.

This task is an important exercise in time management. First, students should read the title and abstract to understand whether that document suits their purposes, addresses the research question, and helps develop the topic of interest. Then, they should scan the full text, determine how it is structured, group it with similar documents, and verify whether other arguments might be considered ( 5 ).

Third step: Analyzing the results

Critical reading and thinking skills are important in this step. This step consists of the following components:

• Reading documents: The student may read various texts in depth according to LR sections and subsections ( defining the main topic ), which is not a passive activity ( 1 ). Some questions should be asked to practice critical analysis skills, as listed below. Is the research question evident and articulated with previous knowledge? What are the authors’ research goals and theoretical orientations, and how do they interact? Are the authors’ claims related to other scholars’ research? Do the authors consider different perspectives? Was the research project designed and conducted properly? Are the results and discussion plausible, and are they consistent with the research objectives and methodology? What are the strengths and limitations of this work? How do the authors support their findings? How does this work contribute to the current research topic? ( 1 , 19 )
• Taking notes: Students who systematically take notes on each document are more readily able to establish similarities or differences with other documents and to highlight personal observations. This approach reinforces the student’s ideas about the next step and helps develop his/her own academic voice ( 1 , 13 ). Voice recognition software ( 16 ), mind maps ( 5 ), flowcharts, tables, spreadsheets, personal comments on the referenced texts, and note-taking apps are all available tools for managing these observations, and the student him/herself should use the tool that best improves his/her learning. Additionally, when a student is considering submitting an LR to a peer-reviewed journal, notes should be taken on the activities performed in all five steps to ensure that they are able to be replicated.

Fourth step: Writing

The recognition of when a student is able and ready to write after a sufficient period of reading and thinking is likely a difficult task. Some students can produce a review in a single long work session. However, as discussed above, writing is not a linear process, and students do not need to write LRs according to a specific sequence of sections. Writing an LR is a time-consuming task, and some scholars believe that a period of at least six months is sufficient ( 6 ). An LR, and academic writing in general, expresses the writer’s proper thoughts, conclusions about others’ work ( 6 , 10 , 13 , 16 ), and decisions about methods to progress in the chosen field of knowledge. Thus, each student is expected to present a different learning and writing trajectory.

In this step, writing methods should be considered; then, editing, citing and correct referencing should complete this stage, at least temporarily. Freewriting techniques may be a good starting point for brainstorming ideas and improving the understanding of the information that has been read ( 1 ). Students should consider the following parameters when creating an agenda for writing the LR: two-hour writing blocks (at minimum), with prespecified tasks that are possible to complete in one section; short (minutes) and long breaks (days or weeks) to allow sufficient time for mental rest and reflection; and short- and long-term goals to motivate the writing itself ( 20 ). With increasing experience, this scheme can vary widely, and it is not a straightforward rule. Importantly, each discipline has a different way of writing ( 1 ), and each department has its own preferred styles for citations and references.

Fifth step: Reflecting on the writing

In this step, the postgraduate student should ask him/herself the same questions as in the analyzing the results step, which can take more time than anticipated. Ambiguities, repeated ideas, and a lack of coherence may not be noted when the student is immersed in the writing task for long periods. The whole effort will likely be a work in progress, and continuous refinements in the written material will occur once the writing process has begun.

LITERATURE REVIEW CHECKLIST

In contrast to review papers, the LR of a dissertation/thesis should not be a standalone piece or work. Instead, it should present the student as a scholar and should maintain the interest of the audience in how that dissertation/thesis will provide solutions for the current gaps in a particular field.

A checklist for evaluating an LR is convenient for students’ continuous academic development and research transparency: it clearly states the desired achievements for the LR of a dissertation/thesis. Here, we present an LR checklist developed from an LR scoring rubric ( 11 ). For a critical analysis of an LR, we maintain the five categories but offer twelve criteria that are not scaled ( Figure 3 ). The criteria all have the same importance and are not mutually exclusive.

First category: Coverage

1. justified criteria exist for the inclusion and exclusion of literature in the review.

This criterion builds on the main topic and areas covered by the LR ( 18 ). While experts may be confident in retrieving and selecting literature, postgraduate students must convince their audience about the adequacy of their search strategy and their reasons for intentionally selecting what material to cover ( 11 ). References from different fields of knowledge provide distinct perspective, but narrowing the scope of coverage may be important in areas with a large body of existing knowledge.

Second category: Synthesis

2. a critical examination of the state of the field exists.

A critical examination is an assessment of distinct aspects in the field ( 1 ) along with a constructive argument. It is not a negative critique but an expression of the student’s understanding of how other scholars have added to the topic ( 1 ), and the student should analyze and contextualize contradictory statements. A writer’s personal bias (beliefs or political involvement) have been shown to influence the structure and writing of a document; therefore, the cultural and paradigmatic background guide how the theories are revised and presented ( 13 ). However, an honest judgment is important when considering different perspectives.

3. The topic or problem is clearly placed in the context of the broader scholarly literature

The broader scholarly literature should be related to the chosen main topic for the LR ( how to develop the literature review section). The LR can cover the literature from one or more disciplines, depending on its scope, but it should always offer a new perspective. In addition, students should be careful in citing and referencing previous publications. As a rule, original studies and primary references should generally be included. Systematic and narrative reviews present summarized data, and it may be important to cite them, particularly for issues that should be understood but do not require a detailed description. Similarly, quotations highlight the exact statement from another publication. However, excessive referencing may disclose lower levels of analysis and synthesis by the student.

4. The LR is critically placed in the historical context of the field

Situating the LR in its historical context shows the level of comfort of the student in addressing a particular topic. Instead of only presenting statements and theories in a temporal approach, which occasionally follows a linear timeline, the LR should authentically characterize the student’s academic work in the state-of-art techniques in their particular field of knowledge. Thus, the LR should reinforce why the dissertation/thesis represents original work in the chosen research field.

5. Ambiguities in definitions are considered and resolved

Distinct theories on the same topic may exist in different disciplines, and one discipline may consider multiple concepts to explain one topic. These misunderstandings should be addressed and contemplated. The LR should not synthesize all theories or concepts at the same time. Although this approach might demonstrate in-depth reading on a particular topic, it can reveal a student’s inability to comprehend and synthesize his/her research problem.

6. Important variables and phenomena relevant to the topic are articulated

The LR is a unique opportunity to articulate ideas and arguments and to purpose new relationships between them ( 10 , 11 ). More importantly, a sound LR will outline to the audience how these important variables and phenomena will be addressed in the current academic work. Indeed, the LR should build a bidirectional link with the remaining sections and ground the connections between all of the sections ( Figure 1 ).

7. A synthesized new perspective on the literature has been established

The LR is a ‘creative inquiry’ ( 13 ) in which the student elaborates his/her own discourse, builds on previous knowledge in the field, and describes his/her own perspective while interpreting others’ work ( 13 , 17 ). Thus, students should articulate the current knowledge, not accept the results at face value ( 11 , 13 , 17 ), and improve their own cognitive abilities ( 12 ).

Third category: Methodology

8. the main methodologies and research techniques that have been used in the field are identified and their advantages and disadvantages are discussed.

The LR is expected to distinguish the research that has been completed from investigations that remain to be performed, address the benefits and limitations of the main methods applied to date, and consider the strategies for addressing the expected limitations described above. While placing his/her research within the methodological context of a particular topic, the LR will justify the methodology of the study and substantiate the student’s interpretations.

9. Ideas and theories in the field are related to research methodologies

The audience expects the writer to analyze and synthesize methodological approaches in the field. The findings should be explained according to the strengths and limitations of previous research methods, and students must avoid interpretations that are not supported by the analyzed literature. This criterion translates to the student’s comprehension of the applicability and types of answers provided by different research methodologies, even those using a quantitative or qualitative research approach.

Fourth category: Significance

10. the scholarly significance of the research problem is rationalized.

The LR is an introductory section of a dissertation/thesis and will present the postgraduate student as a scholar in a particular field ( 11 ). Therefore, the LR should discuss how the research problem is currently addressed in the discipline being investigated or in different disciplines, depending on the scope of the LR. The LR explains the academic paradigms in the topic of interest ( 13 ) and methods to advance the field from these starting points. However, an excess number of personal citations—whether referencing the student’s research or studies by his/her research team—may reflect a narrow literature search and a lack of comprehensive synthesis of ideas and arguments.

11. The practical significance of the research problem is rationalized

The practical significance indicates a student’s comprehensive understanding of research terminology (e.g., risk versus associated factor), methodology (e.g., efficacy versus effectiveness) and plausible interpretations in the context of the field. Notably, the academic argument about a topic may not always reflect the debate in real life terms. For example, using a quantitative approach in epidemiology, statistically significant differences between groups do not explain all of the factors involved in a particular problem ( 21 ). Therefore, excessive faith in p -values may reflect lower levels of critical evaluation of the context and implications of a research problem by the student.

Fifth category: Rhetoric

12. the lr was written with a coherent, clear structure that supported the review.

This category strictly relates to the language domain: the text should be coherent and presented in a logical sequence, regardless of which organizational ( 18 ) approach is chosen. The beginning of each section/subsection should state what themes will be addressed, paragraphs should be carefully linked to each other ( 10 ), and the first sentence of each paragraph should generally summarize the content. Additionally, the student’s statements are clear, sound, and linked to other scholars’ works, and precise and concise language that follows standardized writing conventions (e.g., in terms of active/passive voice and verb tenses) is used. Attention to grammar, such as orthography and punctuation, indicates prudence and supports a robust dissertation/thesis. Ultimately, all of these strategies provide fluency and consistency for the text.

Although the scoring rubric was initially proposed for postgraduate programs in education research, we are convinced that this checklist is a valuable tool for all academic areas. It enables the monitoring of students’ learning curves and a concentrated effort on any criteria that are not yet achieved. For institutions, the checklist is a guide to support supervisors’ feedback, improve students’ writing skills, and highlight the learning goals of each program. These criteria do not form a linear sequence, but ideally, all twelve achievements should be perceived in the LR.

CONCLUSIONS

A single correct method to classify, evaluate and guide the elaboration of an LR has not been established. In this essay, we have suggested directions for planning, structuring and critically evaluating an LR. The planning of the scope of an LR and approaches to complete it is a valuable effort, and the five steps represent a rational starting point. An institutional environment devoted to active learning will support students in continuously reflecting on LRs, which will form a dialogue between the writer and the current literature in a particular field ( 13 ).

The completion of an LR is a challenging and necessary process for understanding one’s own field of expertise. Knowledge is always transitory, but our responsibility as scholars is to provide a critical contribution to our field, allowing others to think through our work. Good researchers are grounded in sophisticated LRs, which reveal a writer’s training and long-lasting academic skills. We recommend using the LR checklist as a tool for strengthening the skills necessary for critical academic writing.

AUTHOR CONTRIBUTIONS

Leite DFB has initially conceived the idea and has written the first draft of this review. Padilha MAS and Cecatti JG have supervised data interpretation and critically reviewed the manuscript. All authors have read the draft and agreed with this submission. Authors are responsible for all aspects of this academic piece.

ACKNOWLEDGMENTS

We are grateful to all of the professors of the ‘Getting Started with Graduate Research and Generic Skills’ module at University College Cork, Cork, Ireland, for suggesting and supporting this article. Funding: DFBL has granted scholarship from Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) to take part of her Ph.D. studies in Ireland (process number 88881.134512/2016-01). There is no participation from sponsors on authors’ decision to write or to submit this manuscript.

No potential conflict of interest was reported.

1 The questions posed in systematic reviews usually follow the ‘PICOS’ acronym: Population, Intervention, Comparison, Outcomes, Study design.

2 In 1988, Cooper proposed a taxonomy that aims to facilitate students’ and institutions’ understanding of literature reviews. Six characteristics with specific categories are briefly described: Focus: research outcomes, research methodologies, theories, or practices and applications; Goals: integration (generalization, conflict resolution, and linguistic bridge-building), criticism, or identification of central issues; Perspective: neutral representation or espousal of a position; Coverage: exhaustive, exhaustive with selective citations, representative, central or pivotal; Organization: historical, conceptual, or methodological; and Audience: specialized scholars, general scholars, practitioners or policymakers, or the general public.

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Methodology

• What Is Peer Review? | Types & Examples

What Is Peer Review? | Types & Examples

Published on December 17, 2021 by Tegan George . Revised on June 22, 2023.

Peer review, sometimes referred to as refereeing , is the process of evaluating submissions to an academic journal. Using strict criteria, a panel of reviewers in the same subject area decides whether to accept each submission for publication.

Peer-reviewed articles are considered a highly credible source due to the stringent process they go through before publication.

There are various types of peer review. The main difference between them is to what extent the authors, reviewers, and editors know each other’s identities. The most common types are:

• Single-blind review
• Double-blind review
• Triple-blind review

Collaborative review

Open review.

Relatedly, peer assessment is a process where your peers provide you with feedback on something you’ve written, based on a set of criteria or benchmarks from an instructor. They then give constructive feedback, compliments, or guidance to help you improve your draft.

Table of contents

What is the purpose of peer review, types of peer review, the peer review process, providing feedback to your peers, peer review example, advantages of peer review, criticisms of peer review, other interesting articles, frequently asked questions about peer reviews.

Many academic fields use peer review, largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the manuscript. For this reason, academic journals are among the most credible sources you can refer to.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure.

Peer assessment is often used in the classroom as a pedagogical tool. Both receiving feedback and providing it are thought to enhance the learning process, helping students think critically and collaboratively.

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Depending on the journal, there are several types of peer review.

Single-blind peer review

The most common type of peer review is single-blind (or single anonymized) review . Here, the names of the reviewers are not known by the author.

While this gives the reviewers the ability to give feedback without the possibility of interference from the author, there has been substantial criticism of this method in the last few years. Many argue that single-blind reviewing can lead to poaching or intellectual theft or that anonymized comments cause reviewers to be too harsh.

Double-blind peer review

In double-blind (or double anonymized) review , both the author and the reviewers are anonymous.

Arguments for double-blind review highlight that this mitigates any risk of prejudice on the side of the reviewer, while protecting the nature of the process. In theory, it also leads to manuscripts being published on merit rather than on the reputation of the author.

Triple-blind peer review

While triple-blind (or triple anonymized) review —where the identities of the author, reviewers, and editors are all anonymized—does exist, it is difficult to carry out in practice.

Proponents of adopting triple-blind review for journal submissions argue that it minimizes potential conflicts of interest and biases. However, ensuring anonymity is logistically challenging, and current editing software is not always able to fully anonymize everyone involved in the process.

In collaborative review , authors and reviewers interact with each other directly throughout the process. However, the identity of the reviewer is not known to the author. This gives all parties the opportunity to resolve any inconsistencies or contradictions in real time, and provides them a rich forum for discussion. It can mitigate the need for multiple rounds of editing and minimize back-and-forth.

Collaborative review can be time- and resource-intensive for the journal, however. For these collaborations to occur, there has to be a set system in place, often a technological platform, with staff monitoring and fixing any bugs or glitches.

Lastly, in open review , all parties know each other’s identities throughout the process. Often, open review can also include feedback from a larger audience, such as an online forum, or reviewer feedback included as part of the final published product.

While many argue that greater transparency prevents plagiarism or unnecessary harshness, there is also concern about the quality of future scholarship if reviewers feel they have to censor their comments.

In general, the peer review process includes the following steps:

• First, the author submits the manuscript to the editor.
• Reject the manuscript and send it back to the author, or
• Send it onward to the selected peer reviewer(s)
• Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made.
• Lastly, the edited manuscript is sent back to the author. They input the edits and resubmit it to the editor for publication.

In an effort to be transparent, many journals are now disclosing who reviewed each article in the published product. There are also increasing opportunities for collaboration and feedback, with some journals allowing open communication between reviewers and authors.

It can seem daunting at first to conduct a peer review or peer assessment. If you’re not sure where to start, there are several best practices you can use.

Summarize the argument in your own words

Summarizing the main argument helps the author see how their argument is interpreted by readers, and gives you a jumping-off point for providing feedback. If you’re having trouble doing this, it’s a sign that the argument needs to be clearer, more concise, or worded differently.

If the author sees that you’ve interpreted their argument differently than they intended, they have an opportunity to address any misunderstandings when they get the manuscript back.

Separate your feedback into major and minor issues

It can be challenging to keep feedback organized. One strategy is to start out with any major issues and then flow into the more minor points. It’s often helpful to keep your feedback in a numbered list, so the author has concrete points to refer back to.

Major issues typically consist of any problems with the style, flow, or key points of the manuscript. Minor issues include spelling errors, citation errors, or other smaller, easy-to-apply feedback.

Tip: Try not to focus too much on the minor issues. If the manuscript has a lot of typos, consider making a note that the author should address spelling and grammar issues, rather than going through and fixing each one.

The best feedback you can provide is anything that helps them strengthen their argument or resolve major stylistic issues.

Give the type of feedback that you would like to receive

No one likes being criticized, and it can be difficult to give honest feedback without sounding overly harsh or critical. One strategy you can use here is the “compliment sandwich,” where you “sandwich” your constructive criticism between two compliments.

Be sure you are giving concrete, actionable feedback that will help the author submit a successful final draft. While you shouldn’t tell them exactly what they should do, your feedback should help them resolve any issues they may have overlooked.

As a rule of thumb, your feedback should be:

• Easy to understand
• Constructive

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Below is a brief annotated research example. You can view examples of peer feedback by hovering over the highlighted sections.

Influence of phone use on sleep

Studies show that teens from the US are getting less sleep than they were a decade ago (Johnson, 2019) . On average, teens only slept for 6 hours a night in 2021, compared to 8 hours a night in 2011. Johnson mentions several potential causes, such as increased anxiety, changed diets, and increased phone use.

The current study focuses on the effect phone use before bedtime has on the number of hours of sleep teens are getting.

For this study, a sample of 300 teens was recruited using social media, such as Facebook, Instagram, and Snapchat. The first week, all teens were allowed to use their phone the way they normally would, in order to obtain a baseline.

The sample was then divided into 3 groups:

• Group 1 was not allowed to use their phone before bedtime.
• Group 2 used their phone for 1 hour before bedtime.
• Group 3 used their phone for 3 hours before bedtime.

All participants were asked to go to sleep around 10 p.m. to control for variation in bedtime . In the morning, their Fitbit showed the number of hours they’d slept. They kept track of these numbers themselves for 1 week.

Two independent t tests were used in order to compare Group 1 and Group 2, and Group 1 and Group 3. The first t test showed no significant difference ( p > .05) between the number of hours for Group 1 ( M = 7.8, SD = 0.6) and Group 2 ( M = 7.0, SD = 0.8). The second t test showed a significant difference ( p < .01) between the average difference for Group 1 ( M = 7.8, SD = 0.6) and Group 3 ( M = 6.1, SD = 1.5).

This shows that teens sleep fewer hours a night if they use their phone for over an hour before bedtime, compared to teens who use their phone for 0 to 1 hours.

Peer review is an established and hallowed process in academia, dating back hundreds of years. It provides various fields of study with metrics, expectations, and guidance to ensure published work is consistent with predetermined standards.

• Protects the quality of published research

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. Any content that raises red flags for reviewers can be closely examined in the review stage, preventing plagiarized or duplicated research from being published.

• Gives you access to feedback from experts in your field

Peer review represents an excellent opportunity to get feedback from renowned experts in your field and to improve your writing through their feedback and guidance. Experts with knowledge about your subject matter can give you feedback on both style and content, and they may also suggest avenues for further research that you hadn’t yet considered.

• Helps you identify any weaknesses in your argument

Peer review acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process. This way, you’ll end up with a more robust, more cohesive article.

While peer review is a widely accepted metric for credibility, it’s not without its drawbacks.

• Reviewer bias

The more transparent double-blind system is not yet very common, which can lead to bias in reviewing. A common criticism is that an excellent paper by a new researcher may be declined, while an objectively lower-quality submission by an established researcher would be accepted.

• Delays in publication

The thoroughness of the peer review process can lead to significant delays in publishing time. Research that was current at the time of submission may not be as current by the time it’s published. There is also high risk of publication bias , where journals are more likely to publish studies with positive findings than studies with negative findings.

• Risk of human error

By its very nature, peer review carries a risk of human error. In particular, falsification often cannot be detected, given that reviewers would have to replicate entire experiments to ensure the validity of results.

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

• Normal distribution
• Measures of central tendency
• Chi square tests
• Confidence interval
• Quartiles & Quantiles
• Cluster sampling
• Stratified sampling
• Thematic analysis
• Discourse analysis
• Cohort study
• Ethnography

Research bias

• Implicit bias
• Cognitive bias
• Conformity bias
• Hawthorne effect
• Availability heuristic
• Attrition bias
• Social desirability bias

Peer review is a process of evaluating submissions to an academic journal. Utilizing rigorous criteria, a panel of reviewers in the same subject area decide whether to accept each submission for publication. For this reason, academic journals are often considered among the most credible sources you can use in a research project– provided that the journal itself is trustworthy and well-regarded.

In general, the peer review process follows the following steps: 

• Reject the manuscript and send it back to author, or 
• Send it onward to the selected peer reviewer(s) 
• Next, the peer review process occurs. The reviewer provides feedback, addressing any major or minor issues with the manuscript, and gives their advice regarding what edits should be made. 
• Lastly, the edited manuscript is sent back to the author. They input the edits, and resubmit it to the editor for publication.

Peer review can stop obviously problematic, falsified, or otherwise untrustworthy research from being published. It also represents an excellent opportunity to get feedback from renowned experts in your field. It acts as a first defense, helping you ensure your argument is clear and that there are no gaps, vague terms, or unanswered questions for readers who weren’t involved in the research process.

Peer-reviewed articles are considered a highly credible source due to this stringent process they go through before publication.

Many academic fields use peer review , largely to determine whether a manuscript is suitable for publication. Peer review enhances the credibility of the published manuscript.

However, peer review is also common in non-academic settings. The United Nations, the European Union, and many individual nations use peer review to evaluate grant applications. It is also widely used in medical and health-related fields as a teaching or quality-of-care measure. 

A credible source should pass the CRAAP test  and follow these guidelines:

• The information should be up to date and current.
• The author and publication should be a trusted authority on the subject you are researching.
• The sources the author cited should be easy to find, clear, and unbiased.
• For a web source, the URL and layout should signify that it is trustworthy.

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Literature reviews as independent studies: guidelines for academic practice

• Original Paper
• Open access
• Published: 14 October 2022
• Volume 16 , pages 2577–2595, ( 2022 )

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• Sascha Kraus   ORCID: orcid.org/0000-0003-4886-7482 1 , 2 ,
• Matthias Breier 3 ,
• Weng Marc Lim 4 , 8 , 22 ,
• Marina Dabić 5 , 6 ,
• Satish Kumar 7 , 8 ,
• Dominik Kanbach 9 , 10 ,
• Debmalya Mukherjee 11 ,
• Vincenzo Corvello 12 ,
• Juan Piñeiro-Chousa 13 ,
• Eric Liguori 14 ,
• Daniel Palacios-Marqués 15 ,
• Francesco Schiavone 16 , 17 ,
• Alberto Ferraris 18 , 21 ,
• Cristina Fernandes 19 , 20 &
• João J. Ferreira 19  

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Review articles or literature reviews are a critical part of scientific research. While numerous guides on literature reviews exist, these are often limited to the philosophy of review procedures, protocols, and nomenclatures, triggering non-parsimonious reporting and confusion due to overlapping similarities. To address the aforementioned limitations, we adopt a pragmatic approach to demystify and shape the academic practice of conducting literature reviews. We concentrate on the types, focuses, considerations, methods, and contributions of literature reviews as independent, standalone studies. As such, our article serves as an overview that scholars can rely upon to navigate the fundamental elements of literature reviews as standalone and independent studies, without getting entangled in the complexities of review procedures, protocols, and nomenclatures.

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1 Introduction

A literature review – or a review article – is “a study that analyzes and synthesizes an existing body of literature by identifying, challenging, and advancing the building blocks of a theory through an examination of a body (or several bodies) of prior work (Post et al. 2020 , p. 352). Literature reviews as standalone pieces of work may allow researchers to enhance their understanding of prior work in their field, enabling them to more easily identify gaps in the body of literature and potential avenues for future research. More importantly, review articles may challenge established assumptions and norms of a given field or topic, recognize critical problems and factual errors, and stimulate future scientific conversations around that topic. Literature reviews Footnote 1 come in many different formats and purposes:

Some review articles conduct a critical evaluation of the literature, whereas others elect to adopt a more exploratory and descriptive approach.

Some reviews examine data, methodologies, and findings, whereas others look at constructs, themes, and theories.

Some reviews provide summaries by holistically synthesizing the existing research on a topic, whereas others adopt an integrative approach by assessing related and interdisciplinary work.

The number of review articles published as independent or standalone studies has been increasing over time. According to Scopus (i.e., search database ), reviews (i.e., document type ) were first published in journals (i.e., source type ) as independent studies in 1945, and they subsequently appeared in three digits yearly from the late 1980s to the late 1990s, four digits yearly from the early 2000s to the late 2010s, and five digits in the year 2021 (Fig.  1 ). This increase is indicative that reviewers and editors in business and management research alike see value and purpose in review articles to such a level that they are now commonly accepted as independent, standalone studies. This development is also reflected in the fact that some academic journals exclusively publish review articles (e.g., the Academy of Management Annals , or the  International Journal of Management Reviews ), and journals publishing in various fields often have special issues dedicated to literature reviews on certain topic areas (e.g., the Journal of Management and the Journal of International Business Studies ).

Full-year publication trend of review articles on Scopus (1945–2021)

One of the most important prerequisites of a high-quality review article is that the work follows an established methodology, systematically selects and analyzes articles, and periodically covers the field to identify latest developments (Snyder 2019 ). Additionally, it needs to be reproducible, well-evidenced, and transparent, resulting in a sample inclusive of all relevant and appropriate studies (Gusenbauer and Haddaway 2020; Hansen et al. 2021 ). This observation is in line with Palmatier et al. ( 2018 ), who state that review articles provide an important synthesis of findings and perspectives in a given body of knowledge. Snyder ( 2019 ) also reaffirmed this rationale, pointing out that review articles have the power to answer research questions beyond that which can be achieved in a single study. Ultimately, readers of review articles stand to gain a one-stop, state-of-the-art synthesis (Lim et al. 2022a ; Popli et al. 2022) that encapsulates critical insights through the process of re-interpreting, re-organizing, and re-connecting a body knowledge (Fan et al. 2022 ).

There are many reasons to conduct review articles. Kraus et al. ( 2020 ) explicitly mention the benefits of conducting systematic reviews by declaring that they often represent the first step in the context of larger research projects, such as doctoral dissertations. When carrying out work of this kind, it is important that a holistic overview of the current state of literature is achieved and embedded into a proper synthesis. This allows researchers to pinpoint relevant research gaps and adequately fit future conceptual or empirical studies into the state of the academic discussion (Kraus et al., 2021 ). A review article as an independent or standalone study is a viable option for any academic – especially young scholars, such as doctoral candidates – who wishes to delve into a specific topic for which a (recent) review article is not available.

The process of conducting a review article can be challenging, especially for novice scholars (Boell and Cecez-Kecmanovic 2015 ). Therefore, it is not surprising that numerous guides have been written in an attempt to improve the quality of review studies and support emerging scholars in their endeavors to have their work published. These guides for conducting review articles span a variety of academic fields, such as engineering education (Borrego et al. 2014 ), health sciences (Cajal et al. 2020 ), psychology (Laher and Hassem 2020 ), supply chain management (Durach et al. 2017 ), or business and entrepreneurship (Kraus et al. 2020 ; Tranfield et al. 2003 ) – the latter were among the first scholars to recognize the need to educate business/management scholars on the roles of review studies in assembling, ascertaining, and assessing the intellectual territory of a specific knowledge domain. Furthermore, they shed light on the stages (i.e., planning the review, conducting the review, reporting, and dissemination) and phases (i.e., identifying the need for a review, preparation of a proposal for a review, development of a review protocol, identification of research, selection of studies, study quality assessment, data extraction and monitoring progress, data synthesis, the report and recommendations, and getting evidence into practice) of conducting a systematic review. Other scholars have either adapted and/or developed new procedures (Kraus et al. 2020 ; Snyder 2019 ) or established review protocols such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram (Moher et al. 2015 ). The latter provides a checklist that improves transparency and reproducibility, thus reducing questionable research practices. The declarative and procedural knowledge of a checklist allows users to derive value from (and, in some cases, produce) methodological literature reviews.

Two distinct and critical gaps or issues provide impetus for our article. First, while the endeavors of the named scholars are undoubtedly valuable contributions, they often encourage other scholars to explain the methodology of their review studies in a non-parsimonious way ( 1st issue ). This can become problematic if this information distracts and deprives scholars from providing richer review findings, particularly in instances in which publication outlets impose a strict page and/or word limit. More often than not, the early parts (i.e., stages/phases, such as needs, aims, and scope) of these procedures or protocols are explained in the introduction, but they tend to be reiterated in the methodology section due to the prescription of these procedures or protocols. Other parts of these procedures or protocols could also be reported more parsimoniously, for example, by filtering out documents, given that scientific databases (such as Scopus or Web of Science ) have since been upgraded to allow scholars to select and implement filtering criteria when conducting a search (i.e., criterion-by-criterion filtering may no longer be necessary). More often than not, the procedures or protocols of review studies can be signposted (e.g., bracket labeling) and disclosed in a sharp and succinct manner while maintaining transparency and replicability.

Other guides have been written to introduce review nomenclatures (i.e., names/naming) and their equivalent philosophical underpinnings. Palmatier et al. ( 2018 ) introduced three clearly but broadly defined nomenclatures of literature reviews as independent studies: domain-based reviews, theory-based reviews, and method-based reviews. However, such review nomenclatures can be confusing due to their overlapping similarities ( 2nd issue ). For example, Lim et al. ( 2022a ) highlighted their observation that the review nomenclatures associated with domain-based reviews could also be used for theory-based and method-based reviews.

The two aforementioned issues – i.e., the lack of a parsimonious understanding and the reporting of the review methodology , and the confusion emerging from review nomenclatures – are inarguably the unintended outcomes of diving into an advanced (i.e., higher level) understanding of literature review procedures, protocols, and nomenclatures from a philosophical perspective (i.e., underpinnings) without a foundational (i.e., basic level) understanding of the fundamental (i.e., core) elements of literature reviews from a pragmatic perspective. Our article aims to shed light on these issues and hopes to provide clarity for future scholarly endeavors.

Having a foundational understanding of literature reviews as independent studies is (i) necessary when addressing the aforementioned issues; (ii) important in reconciling and scaffolding our understanding, and (iii) relevant and timely due to the proliferation of literature reviews as independent studies. To contribute a solution toward addressing this gap , we aim to demystify review articles as independent studies from a pragmatic standpoint (i.e., practicality). To do so, we deliberately (i) move away from review procedures, protocols, and nomenclatures, and (ii) invest our attention in developing a parsimonious, scaffolded understanding of the fundamental elements (i.e., types, focuses, considerations, methods, and contributions) of review articles as independent studies.

Three contributions distinguish our article. It is worth noting that pragmatic guides (i.e., foundational knowledge), such as the present one, are not at odds with extant philosophical guides (i.e., advanced knowledge), but rather they complement them. Having a foundational knowledge of the fundamental elements of literature reviews as independent studies is valuable , as it can help scholars to (i) gain a good grasp of the fundamental elements of literature reviews as independent studies ( 1st contribution ), and (ii) mindfully adopt or adapt existing review procedures, protocols, and nomenclatures to better suit the circumstances of their reviews (e.g., choosing and developing a well-defined review nomenclature, and choosing and reporting on review considerations and steps more parsimoniously) ( 2nd contribution ). Therefore, this pragmatic guide serves as (iii) a foundational article (i.e., preparatory understanding) for literature reviews as independent studies ( 3rd contribution ). Following this, extant guides using a philosophical approach (i.e., advanced understanding) could be relied upon to make informed review decisions (e.g., adoption, adaptation) in response to the conventions of extant review procedures, protocols, and nomenclatures (Fig.  2 ).

Foundational and advanced understanding of literature reviews as independent studies

2 Fundamental elements of literature reviews as independent studies

A foundational understanding of literature reviews as independent studies can be acquired through the appreciation of five fundamental elements – i.e., types, focuses, considerations, methods, and contributions – which are illustrated in Fig.  3 and summarized in the following sections.

Fundamental elements of literature reviews as independent studies

There are two types of literature reviews as independent studies: systematic literature reviews ( SLRs ) and non-systematic literature reviews ( non-SLRs ). It is important to recognize that SLRs and non-SLRs are not review nomenclatures (i.e., names/naming) but rather review types (i.e., classifications).

In particular, SLRs are reviews carried out in a systematic way using an adopted or adapted procedure or protocol to guide data curation and analysis, thus enabling transparent disclosure and replicability (Lim et al. 2022a ; Kraus et al. 2020 ). Therefore, any review nomenclature guided by a systematic methodology is essentially an SLR. The origin of this type of literature review can be traced back to the evidence-based medicine movement in the early 1990s, with the objective being to overcome the issue of inconclusive findings in studies for medical treatments (Boell and Cecez-Kecmanovic 2015 ).

In contrast, non-SLRs are reviews conducted without any systematic procedure or protocol; instead, they weave together relevant literature based on the critical evaluations and (subjective) choices of the author(s) through a process of discovery and critique (e.g., pointing out contradictions and questioning assertions or beliefs); they are shaped by the exposure, expertise, and experience (i.e., the “3Es” in judgement calls) of the author(s). Therefore, non-SLRs are essentially critical reviews of the literature (Lim and Weissmann 2021 ).

2.2 Focuses

Unlike Palmatier et al. ( 2018 ) who considered domain-based reviews, theory-based reviews, and method-based reviews as review nomenclatures, we consider domain , theory , and method as three substantive focuses that can take center stage in literature reviews as independent studies. This is in line with our attempt to move away from review nomenclatures when providing a foundational understanding of literature reviews as independent studies.

A review that is domain-focused can examine: (i) a  concept (e.g., customer engagement; Lim et al. 2022b ; digital transformation; Kraus et al. 2021 ; home sharing; Lim et al. 2021 ; sharing economy; Lim 2020 ), (ii) a context (e.g., India; Mukherjee et al. 2022a ), (iii) a discipline (e.g., entrepreneurship; Ferreira et al. 2015 ; international business; Ghauri et al. 2021 ), (iv) a field (e.g., family business; Lahiri et al. 2020 ; Rovelli et al. 2021 ; female entrepreneurship; Ojong et al. 2021 ), or (v) an outlet (e.g., Journal of Business Research ; Donthu et al. 2020 ; Management International Review ; Mukherjee et al. 2021 ; Review of Managerial Science ; Mas-Tur et al. 2020 ), which typically offer broad, overarching insights.

Domain-focused hybrids , such as the between-domain hybrid (e.g., concept-discipline hybrid, such as digital transformation in business and management; Kraus et al. 2022 ; religion in business and entrepreneurship; Kumar et al. 2022a ; personality traits in entrepreneurship; Salmony and Kanbach 2022 ; and policy implications in HR and OB research; Aguinis et al., 2022 ) and the within-domain hybrid (e.g., the concept-concept hybrid, such as customer engagement and social media; Lim and Rasul 2022 ; and global business and organizational excellence; Lim 2022 ; and the discipline-discipline hybrid, such as neuromarketing; Lim 2018 ) are also common as they can provide finer-grained insights.

A review that is theory-focused can explore a standalone theory (e.g., theory of planned behavior; Duan and Jiang 2008 ), as well as a theory in conjunction with a domain , such as the concept-theory hybrid (e.g., behavioral control and theory of planned behavior; Lim and Weissmann 2021 ) and the theory-discipline hybrid (e.g., theory of planned behavior in hospitality, leisure, and tourism; Ulker-Demirel and Ciftci 2020 ), or a theory in conjunction with a method (e.g., theory of planned behavior and structural equation modeling).

A review that is method-focused can investigate a standalone method (e.g., structural equation modeling; Deng et al. 2018 ) or a method in conjunction with a domain , such as the method-discipline hybrid (e.g., fsQCA in business and management; Kumar et al. 2022b ).

2.3 Planning the review, critical considerations, and data collection

The considerations required for literature reviews as independent studies depend on their type: SLRs or non-SLRs.

For non-SLRs, scholars often rely on the 3Es (i.e., exposure, expertise, and experience) to provide a critical review of the literature. Scholars who embark on non-SLRs should be well versed with the literature they are dealing with. They should know the state of the literature (e.g., debatable, underexplored, and well-established knowledge areas) and how it needs to be deciphered (e.g., tenets and issues) and approached (e.g., reconciliation proposals and new pathways) to advance theory and practice. In this regard, non-SLRs follow a deductive reasoning approach, whereby scholars initially develop a set of coverage areas for reviewing a domain, theory, or method and subsequently draw on relevant literature to shed light and support scholarly contentions in each area.

For SLRs, scholars often rely on a set of criteria to provide a well-scoped (i.e., breadth and depth), structured (i.e., organized aspects), integrated (i.e., synthesized evidence) and interpreted/narrated (i.e., describing what has happened, how and why) systematic review of the literature. Footnote 2 In this regard, SLRs follow an inductive reasoning approach, whereby a set of criteria is established and implemented to develop a corpus of scholarly documents that scholars can review. They can then deliver a state-of-the-art overview, as well as a future agenda for a domain, theory, or method. Such criteria are often listed in philosophical guides on SLR procedures (e.g., Kraus et al. 2020 ; Snyder 2019 ) and protocols (e.g., PRISMA), and they may be adopted/adapted with justifications Footnote 3 . Based on their commonalities they can be summarized as follows:

Search database (e.g., “Scopus” and/or “Web of Science”) can be defined based on justified evidence (e.g., by the two being the largest scientific databases of scholarly articles that can provide on-demand bibliographic data or records; Pranckutė 2021 ). To avoid biased outcomes due to the scope covered by the selected database, researchers could utilize two or more different databases (Dabić et al. 2021 ).

Search keywords may be developed by reading scholarly documents and subsequently brainstorming with experts. The expanding number of databases, journals, periodicals, automated approaches, and semi-automated procedures that use text mining and machine learning can offer researchers the ability to source new, relevant research and forecast the citations of influential studies. This enables them to determine further relevant articles.

Boolean operators (e.g., AND, OR) should be strategically used in developing the  string   of search keywords (e.g., “engagement” AND “customer” OR “consumer” OR “business”). Furthermore, the correct and precise application of quotation marks is important but is very frequently sidestepped, resulting in incorrect selection processes and differentiated results.

Search period (e.g., between a specified period [e.g., 2000 to 2020] or up to the latest full year at the time or writing [e.g., up to 2021]) can be defined based on the justified scope of study (e.g., contemporary evolution versus historical trajectory).

Search field (e.g., “article title, abstract, keywords”) can be defined based on justified assumptions (e.g., it is assumed that the focus of relevant documents will be mentioned in the article title, abstract, and/or keywords).

Subject area (e.g., “business, management, and accounting”) can be defined based on justified principles (e.g., the focus of the review is on the marketing discipline, which is located under the “business, management, and accounting” subject area in Scopus).

Publication stage (e.g., “final”) can be defined based on justified grounds (e.g., enabling greater accuracy in replication).

Document type (e.g., “article” and/or “review”), which reflects the type of scientific/practical contributions (e.g., empirical, synthesis, thought), can be defined based on justified rationales (e.g., articles selected because they are peer-reviewed; editorials not selected because they are not peer-reviewed).

Source type (e.g., “journal”) can be defined based on justified reasons (e.g., journals selected because they publish finalized work; conference proceedings not selected because they are work in progress, and in business/management, they are usually not being considered as full-fledged “publications”).

Language (e.g., “English”) can be determined based on justified limitations (e.g., nowadays, there are not many reasons to use another language besides the academic lingua franca English). Different spellings should also be considered, as the literature may contain both American and British spelling variants (e.g., organization and organisation). Truncation and wildcards in searches are recommended to capture both sets of spellings. It is important to note that each database varies in its symbology.

Quality filtering (e.g., “A*” and “A” or “4*”, “4”, and “3”) can be defined based on justified motivations (e.g., the goal is to unpack the most originally and rigorously produced knowledge, which is the hallmark of premier journals, such as those ranked “A*” and “A” by the Australian Business Deans Council [ABDC] Journal Quality List [JQL] and rated “4*”, “4”, and “3” by the Chartered Association of Business Schools [CABS] Academic Journal Guide [AJG]).

Document relevance (i.e., within the focus of the review) can be defined based on justified judgement (e.g., for a review focusing on customer engagement, articles that mention customer engagement as a passing remark without actually investigating it would be excluded).

Others: Screening process should be accomplished by beginning with the deduction of duplicate results from other databases, tracked using abstract screening to exclude unfitting studies, and ending with the full-text screening of the remaining documents.

Others: Exclusion-inclusion criteria interpretation of the abstracts/articles is obligatory when deciding whether or not the articles dealt with the matter. This step could involve removing a huge percentage of initially recognized articles.

Others: Codebook building pertains to the development of a codebook of the main descriptors within a specific field. An inductive approach can be followed and, in this case, descriptors are not established beforehand. Instead, they are established through the analysis of the articles’ content. This procedure is made up of several stages: (i) the extraction of important content from titles, abstracts, and keywords; (ii) the classification of this content to form a reduced list of the core descriptors; and (iii) revising the codebook in iterations and combining similar categories, thus developing a short list of descriptors (López-Duarte et al. 2016 , p. 512; Dabić et al. 2015 ; Vlacic et al. 2021 ).

2.4 Methods

Various methods are used to analyze the pertinent literature. Often, scholars choose a method for corpus analysis before corpus curation. Knowing the analytical technique beforehand is useful, as it allows researchers to acquire and prepare the right data in the right format. This typically occurs when scholars have decided upon and justified pursuing a specific review nomenclature upfront (e.g., bibliometric reviews) based on the problem at hand (e.g., broad domain [outlet] with a large corpus [thousands of articles], such as a premier journal that has been publishing for decades) (Donthu et al. 2021 ). However, this may not be applicable in instances where (i) scholars do not curate a corpus of articles (non-SLRs), and (ii) scholars only know the size of the corpus of articles once that corpus is curated (SLRs). Therefore, scholars may wish to decide on a method of analyzing the literature depending on (i) whether they rely on a corpus of articles (i.e., yes or no), and (ii) the size of the corpus of articles that they rely on to review the literature (i.e., n  = 0 to ∞).

When analytical techniques (e.g., bibliometric analysis, critical analysis, meta-analysis) are decoupled from review nomenclatures (e.g., bibliometric reviews, critical reviews, meta-analytical reviews), we uncover a toolbox of the following methods for use when analyzing the literature:

Bibliometric analysis measures the literature and processes data by using algorithm, arithmetic, and statistics to analyze, explore, organize, and investigate large amounts of data. This enables scholars to identify and recognize potential “hidden patterns” that could help them during the literature review process. Bibliometrics allows scholars to objectively analyze a large corpus of articles (e.g., high hundreds or more) using quantitative techniques (Donthu et al. 2021 ). There are two overarching categories for bibliometric analysis: performance analysis and science mapping. Performance analysis enables scholars to assess the productivity (publication) and impact (citation) of the literature relating to a domain, method, or theory using various quantitative metrics (e.g., average citations per publication or year, h -index, g -index, i -index). Science mapping grants scholars the ability to map the literature in that domain, method, or theory based on bibliographic data (e.g., bibliographic coupling generates thematic clusters based on similarities in shared bibliographic data [e.g., references] among citing articles; co-citation analysis generates thematic clusters based on commonly cited articles; co-occurrence analysis generates thematic clusters based on bibliographic data [e.g., keywords] that commonly appear together; PageRank analysis generates thematic clusters based on articles that are commonly cited in highly cited articles; and topic modeling generates thematic clusters based on the natural language processing of bibliographic data [e.g., article title, abstract, and keywords]). Footnote 4 Given the advancement in algorithms and technology, reviews using bibliometric analysis are considered to be smart (Kraus et al. 2021 ) and technologically-empowered (Kumar et al. 2022b ) SLRs, in which a review has harnessed the benefits of (i) the machine learning of the bibliographic data of scholarly research from technologically-empowered scientific databases, and (ii) big data analytics involving various science mapping techniques (Kumar et al. 2022c ).

Content analysis allows scholars to analyze a small to medium corpus of articles (i.e., tens to low hundreds) using quantitative and qualitative techniques. From a quantitative perspective , scholars can objectively carry out a content analysis by quantifying a specific unit of analysis . A useful method of doing so involves adopting, adapting, or developing an organizing framework . For example, Lim et al. ( 2021 ) employed an organizing (ADO-TCM) framework to quantify content in academic literature based on: (i) the categories of knowledge; (ii) the relationships between antecedents, decisions, and outcomes; and (iii) the theories, contexts, and methods used to develop the understanding for (i) and (ii). The rapid evolution of software for content analysis allows scholars to carry out complex elaborations on the corpus of analyzed articles, so much so that the most recent software enables the semi-automatic development of an organizing framework (Ammirato et al. 2022 ). From a qualitative perspective , scholars can conduct a content analysis or, more specifically, a thematic analysis , by subjectively organizing the content into themes. For example, Creevey et al. ( 2022 ) reviewed the literature on social media and luxury, providing insights on five core themes (i.e., luxury brand strategy, luxury brand social media communications, luxury consumer attitudes and perceptions, engagement, and the influence of social media on brand performance-related outcomes) generated through a content (thematic) analysis. Systematic approaches for inductive concept development through qualitative research are similarly applied in literature reviews in an attempt to reduce the subjectivity of derived themes. Following the principles of the approach by Gioia et al. ( 2012 ), Korherr and Kanbach ( 2021 ) develop a taxonomy of human-related capabilities in big data analytics. Building on a sample of 75 studies for the literature review, 33 first-order concepts are identified. These are categorized into 15 second-order themes and are finally merged into five aggregate dimensions. Using the same procedure, Leemann and Kanbach ( 2022 ) identify 240 idiosyncratic dynamic capabilities in a sample of 34 studies for their literature review. They then categorize these into 19 dynamic sub-capabilities. The advancement of technology also makes it possible to conduct content analysis using computer assisted qualitative data analysis (CAQDA) software (e.g., ATLAS.ti, Nvivo, Quirkos) (Lim et al. 2022a ).

Critical analysis allows scholars to subjectively use their 3Es (i.e., exposure, expertise, and experience) to provide a critical evaluation of academic literature. This analysis is typically used in non-SLRs, and can be deployed in tandem with other analyses, such as bibliometric analysis and content analysis in SLRs, which are used to discuss consensual, contradictory, and underexplored areas of the literature. For SLRs, scholars are encouraged to engage in critical evaluations of the literature so that they can truly contribute to advancing theory and practice (Baker et al. 2022 ; Lim et al. 2022a ; Mukherjee et al. 2022b ).

Meta-analysis allows scholars to objectively establish a quantitative estimate of commonly studied relationships in the literature (Grewal et al. 2018 ). This analysis is typically employed in SLRs intending to reconcile a myriad of relationships (Lim et al. 2022a ). The relationships established are often made up of conflicting evidence (e.g., a positive or significant effect in one study, but a negative or non-significant effect in another study). However, through meta-analysis, scholars are able to identify potential factors (e.g., contexts or sociodemographic information) that may have led to the conflict.

Others: Multiple correspondence analysis helps to map the field, assessing the associations between qualitative content within a matrix of variables and cases. Homogeneity Analysis by Means of Alternating Least Squares ( HOMALS ) is also considered useful in allowing researchers to map out the intellectual structure of a variety of research fields (Gonzalez-Loureiro et al. 2015 ; Gonzalez-Louriero 2021; Obradović et al. 2021 ). HOMALS can be performed in R or used along with a matrix through SPSS software. In summary, the overall objective of this analysis is to discover a low dimensional representation of the original high dimensional space (i.e., the matrix of descriptors and articles). To measure the goodness of fit, a loss function is used. This function is used minimally, and the HOMALS algorithm is applied to the least squares loss functions in SPSS. This analysis provides a proximity map, in which articles and descriptors are shown in low-dimensional spaces (typically on two axes). Keywords are paired and each couple that appears together in a large number of articles is shown to be closer on the map and vice-versa.

When conducting a literature review, software solutions allow researchers to cover a broad range of variables, from built-in functions of statistical software packages to software orientated towards meta-analyses, and from commercial to open-source solutions. Personal preference plays a huge role, but the decision as to which software will be the most useful is entirely dependent on how complex the methods and the dataset are. Of all the commercial software providers, we have found the built-in functions of (i) R and VOSviewer most useful in performing bibliometric analysis (Aria and Cuccurullo 2017 ; R Core Team 2021 ; Van Eck and Waltman 2014 ) and (ii) Stata most useful in performing meta-analytical tasks.

Many different analytical tools have been used. These include simple document counting, citation analysis, word frequency analysis, cluster analysis, co-word analysis, and cooperation analysis (Daim et al. 2006 ). Software has also been produced for bibliometric analysis, such as the Thomson Data Analyzer (TDA), which Thomson Reuters created, and CiteSpace developed by Chen ( 2013 ). VOSviewer helps us to construct and visualize bibliometric networks, which can include articles, journals, authors, countries, and institutions, among others (Van Eck and Waltman 2014 ). These can be organized based on citations, co-citations, bibliographic coupling, or co-authorship relations. In addition, VOSviewer provides text mining functions, which can be used to facilitate a better understanding of co-occurrence networks with regards to the key terms taken from a body of scientific literature (Donthu et al. 2021 ; Wong 2018 ). Other frequently used tools include for bibliometric analysis include Bibliometrix/Biblioshiny in R, CitNetExplorer, and Gephi, among others.

2.5 Contributions

Well-conducted literature reviews may make multiple contributions to the literature as standalone, independent studies.

Generally, there are three primary contributions of literature reviews as independent studies: (i) to provide an overview of current knowledge in the domain, method, or theory, (ii) to provide an evaluation of knowledge progression in the domain, method, or theory, including the establishment of key knowledge, conflicting or inconclusive findings, and emerging and underexplored areas, and (iii) to provide a proposal for potential pathways for advancing knowledge in the domain, method, or theory (Lim et al. 2022a , p. 487). Developing theory through literature reviews can take many forms, including organizing and categorizing the literature, problematizing the literature, identifying and exposing contradictions, developing analogies and metaphors, and setting out new narratives and conceptualizations (Breslin and Gatrell 2020 ). Taken collectively, these contributions offer crystalized, evidence-based insights that both ‘mine’ and ‘prospect’ the literature, highlighting extant gaps and how they can be resolved (e.g., flags paradoxes or theoretical tensions, explaining why something has not been done, what the challenges are, and how these challenges can be overcome). These contributions can be derived through successful bibliometric analysis, content analysis, critical analysis, and meta-analysis.

Additionally, the deployment of specific methods can bring in further added value. For example, a performance analysis in a bibliometric analysis can contribute to: (i) objectively assessing and reporting research productivity and impact ; (ii) ascertaining reach for coverage claims ; (iii) identifying social dominance and hidden biases ; (iv) detecting anomalies ; and (v) evaluating ( equitable ) relative performance ; whereas science mapping in bibliometric analysis can contribute to: (i) objectively discovering thematic clusters of knowledge ; (ii) clarifying nomological networks ; (iii) mapping social patterns ; (iv) tracking evolutionary nuances ; and (v) recognizing knowledge gaps (Mukherjee et al. 2022b , p. 105).

3 Conclusion

Independent literature reviews will continue to be written as a result of their necessity, importance, relevance, and urgency when it comes to advancing knowledge (Lim et al. 2022a ; Mukherjee et al. 2022b ), and this can be seen in the increasing number of reviews being published over the last several years. Literature reviews advance academic discussion. Journal publications on various topics and subject areas are becoming more frequent sites for publication. This trend will only heighten the need for literature reviews. This article offers directions and control points that address the needs of three different stakeholder groups: producers (i.e., potential authors), evaluators (i.e., journal editors and reviewers), and users (i.e., new researchers looking to learn more about a particular methodological issue, and those teaching the next generation of scholars). Future producers will derive value from this article’s teachings on the different fundamental elements and methodological nuances of literature reviews. Procedural knowledge (i.e., using control points to assist in decision-making during the manuscript preparation phase) will also be of use. Evaluators will be able to make use of the procedural and declarative knowledge evident in control points as well. As previously outlined, the need to cultivate novelty within research on business and management practices is vital. Scholars must also be supported to choose not only safe mining approaches; they should also be encouraged to attempt more challenging and risky ventures. It is important to note that abstracts often seem to offer a lot of potential, stating that authors intend to make large conceptual contributions, broadening the horizons of the field.

Our article offers important insights also for practitioners. Noteworthily, our framework can support corporate managers in decomposing and better understanding literature reviews as ad-hoc and independent studies about specific topics that matter for their organization. For instance, practitioners can understand more easily what are the emerging trends within their domain of interest and make corporate decisions in line with such trends.

This article arises from an intentional decoupling from philosophy, in favor of adopting a more pragmatic approach. This approach can assist us in clarifying the fundamental elements of literature reviews as independent studies. Five fundamental elements must be considered: types, focuses, considerations, methods, and contributions. These elements offer a useful frame for scholars starting to work on a literature review. Overview articles (guides) such as ours are thus invaluable, as they equip scholars with a solid foundational understanding of the integral elements of a literature review. Scholars can then put these teachings into practice, armed with a better understanding of the philosophy that underpins the procedures, protocols, and nomenclatures of literature reviews as independent studies.

Data availability

Our manuscript has no associate data.

Our focus here is on standalone literature reviews in contrast with literature reviews that form the theoretical foundation for a research article.

Scoping reviews, structured reviews, integrative reviews, and interpretive/narrative reviews are commonly found in review nomenclature. However, the philosophy of these review nomenclatures essentially reflects what constitutes a good SLR. That is to say, a good SLR should be well scoped, structured, integrated, and interpreted/narrated. This observation reaffirms our position and the value of moving away from review nomenclatures to gain a foundational understanding of literature reviews as independent studies.

Given that many of these considerations can be implemented simultaneously in contemporary versions of scientific databases, scholars may choose to consolidate them into a single (or a few) step(s), where appropriate, so that they can be reported more parsimoniously. For a parsimonious but transparent and replicable exemplar, see Lim ( 2022 ).

Where keywords are present (e.g., author keywords or keywords derived from machine learning [e.g., natural language processing]), it is assumed that each keyword represents a specific meaning (e.g., topic [concept, context], method), and that a collection of keywords grouped under the same cluster represents a specific theme.

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Kraus, S., Breier, M., Lim, W.M. et al. Literature reviews as independent studies: guidelines for academic practice. Rev Manag Sci 16 , 2577–2595 (2022). https://doi.org/10.1007/s11846-022-00588-8

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Eight problems with literature reviews and how to fix them

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Traditional approaches to reviewing literature may be susceptible to bias and result in incorrect decisions. This is of particular concern when reviews address policy- and practice-relevant questions. Systematic reviews have been introduced as a more rigorous approach to synthesizing evidence across studies; they rely on a suite of evidence-based methods aimed at maximizing rigour and minimizing susceptibility to bias. Despite the increasing popularity of systematic reviews in the environmental field, evidence synthesis methods continue to be poorly applied in practice, resulting in the publication of syntheses that are highly susceptible to bias. Recognizing the constraints that researchers can sometimes feel when attempting to plan, conduct and publish rigorous and comprehensive evidence syntheses, we aim here to identify major pitfalls in the conduct and reporting of systematic reviews, making use of recent examples from across the field. Adopting a ‘critical friend’ role in supporting would-be systematic reviews and avoiding individual responses to police use of the ‘systematic review’ label, we go on to identify methodological solutions to mitigate these pitfalls. We then highlight existing support available to avoid these issues and call on the entire community, including systematic review specialists, to work towards better evidence syntheses for better evidence and better decisions.

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19 october 2020.

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We thank C. Shortall from Rothamstead Research for useful discussions on the topic.

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Neal R. Haddaway & Biljana Macura

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Alison Bethel

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Lynn V. Dicks

School of Biological Sciences, University of East Anglia, Norwich, UK

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Julia Koricheva

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Haddaway, N.R., Bethel, A., Dicks, L.V. et al. Eight problems with literature reviews and how to fix them. Nat Ecol Evol 4 , 1582–1589 (2020). https://doi.org/10.1038/s41559-020-01295-x

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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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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Peer Reviewed Literature

What is peer review, terminology, peer review what does that mean, what types of articles are peer-reviewed, what information is not peer-reviewed, what about google scholar.

• How do I find peer-reviewed articles?
• Scholarly vs. Popular Sources

Research Librarian

For more help on this topic, please contact our Research Help Desk: [email protected] or 781-768-7303. Stay up-to-date on our current hours . Note: all hours are EST.

This Guide was created by Carolyn Swidrak (retired).

Research findings are communicated in many ways.  One of the most important ways is through publication in scholarly, peer-reviewed journals.

Research published in scholarly journals is held to a high standard.  It must make a credible and significant contribution to the discipline.  To ensure a very high level of quality, articles that are submitted to scholarly journals undergo a process called peer-review.

Once an article has been submitted for publication, it is reviewed by other independent, academic experts (at least two) in the same field as the authors.  These are the peers.  The peers evaluate the research and decide if it is good enough and important enough to publish.  Usually there is a back-and-forth exchange between the reviewers and the authors, including requests for revisions, before an article is published. 

Peer review is a rigorous process but the intensity varies by journal.  Some journals are very prestigious and receive many submissions for publication.  They publish only the very best, most highly regarded research. 

The terms scholarly, academic, peer-reviewed and refereed are sometimes used interchangeably, although there are slight differences.

Scholarly and academic may refer to peer-reviewed articles, but not all scholarly and academic journals are peer-reviewed (although most are.)  For example, the Harvard Business Review is an academic journal but it is editorially reviewed, not peer-reviewed.

Peer-reviewed and refereed are identical terms.

From  Peer Review in 3 Minutes  [Video], by the North Carolina State University Library, 2014, YouTube (https://youtu.be/rOCQZ7QnoN0).

Peer reviewed articles can include:

• Original research (empirical studies)
• Review articles
• Systematic reviews
• Meta-analyses

There is much excellent, credible information in existence that is NOT peer-reviewed.  Peer-review is simply ONE MEASURE of quality. 

Much of this information is referred to as "gray literature."

Government Agencies

Government websites such as the Centers for Disease Control (CDC) publish high level, trustworthy information.  However, most of it is not peer-reviewed.  (Some of their publications are peer-reviewed, however. The journal Emerging Infectious Diseases, published by the CDC is one example.)

Conference Proceedings

Papers from conference proceedings are not usually peer-reviewed.  They may go on to become published articles in a peer-reviewed journal. 

Dissertations

Dissertations are written by doctoral candidates, and while they are academic they are not peer-reviewed.

Many students like Google Scholar because it is easy to use.  While the results from Google Scholar are generally academic they are not necessarily peer-reviewed.  Typically, you will find:

• Peer reviewed journal articles (although they are not identified as peer-reviewed)
• Unpublished scholarly articles (not peer-reviewed)
• Masters theses, doctoral dissertations and other degree publications (not peer-reviewed)
• Book citations and links to some books (not necessarily peer-reviewed)
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Scholarly Articles: How can I tell?

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Literature Review

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The literature review section of an article is a summary or analysis of all the research the author read before doing his/her own research. This section may be part of the introduction or in a section called Background. It provides the background on who has done related research, what that research has or has not uncovered and how the current research contributes to the conversation on the topic. When you read the lit review ask:

• Does the review of the literature logically lead up to the research questions?
• Do the authors review articles relevant to their research study?
• Do the authors show where there are gaps in the literature?

The lit review is also a good place to find other sources you may want to read on this topic to help you get the bigger picture.

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Arts and creativity interventions for improving health and wellbeing in older adults: a systematic literature review of economic evaluation studies

• Grainne Crealey 1 ,
• Laura McQuade 2 ,
• Roger O’Sullivan 2 &
• Ciaran O’Neill 3  

BMC Public Health volume  23 , Article number:  2496 ( 2023 ) Cite this article

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Metrics details

As the population ages, older people account for a larger proportion of the health and social care budget. A significant body of evidence suggests that arts and creativity interventions can improve the physical, mental and social wellbeing of older adults, however the value and/or cost-effectiveness of such interventions remains unclear.

We systematically reviewed the economic evidence relating to such interventions, reporting our findings according to PRISMA guidelines. We searched bibliographic databases (MEDLINE, EMBASE, Econlit and Web of Science and NHSEED), trial registries and grey literature. No language or temporal restrictions were applied. Two screening rounds were conducted independently by health economists experienced in systematic literature review. Methodological quality was assessed, and key information extracted and tabulated to provide an overview of the published literature. A narrative synthesis without meta-analysis was conducted.

Only six studies were identified which provided evidence relating to the value or cost-effectiveness of arts and creativity interventions to improve health and wellbeing in older adults. The evidence which was identified was encouraging, with five out of the six studies reporting an acceptable probability of cost-effectiveness or positive return on investment (ranging from £1.20 to over £8 for every £1 of expenditure). However, considerable heterogeneity was observed with respect to study participants, design, and outcomes assessed. Of particular concern were potential biases inherent in social value analyses.

Conclusions

Despite many studies reporting positive health and wellbeing benefits of arts and creativity interventions in this population, we found meagre evidence on their value or cost-effectiveness. Such evidence is costly and time-consuming to generate, but essential if innovative non-pharmacological interventions are to be introduced to minimise the burden of illness in this population and ensure efficient use of public funds. The findings from this review suggests that capturing data on the value and/or cost-effectiveness of such interventions should be prioritised; furthermore, research effort should be directed to developing evaluative methods which move beyond the confines of current health technology assessment frameworks, to capture a broader picture of ‘value’ more applicable to arts and creativity interventions and public health interventions more generally.

PROSPERO registration

CRD42021267944 (14/07/2021).

Peer Review reports

The number and proportion of older adults in the population has increased in virtually every country in the world over past decades [ 1 ]. In 2015, there were around 901 million people aged 60 years and over worldwide, by 2030, this will have increased to 1.4 billion [ 2 ]. An ageing population is one of the greatest successes of public health but it has implications for economies in numerous ways: slower labour force growth; working-age people will have to make greater provisions in welfare payments for older people who are no longer economically active; provisions for increased long-term care; and, society must adjust to the changing needs, expectations and capabilities of an expanding group of its citizens.

The Covid-19 pandemic shone an uncompromising light on the health and social care sector, highlighting the seriousness of gaps in policies, systems and services. It also focused attention on the physical and mental health consequences of loneliness and social isolation. To foster healthy ageing and improve the lives of older people, their families and communities, sustained and equitable investment in health and wellbeing is required [ 3 ]. The prevailing model of health and social care which is based ostensibly on formal care provision is unlikely to be sustainable over the longer term. New models, which promote healthy ageing and recognise the need for increasing reliance on self-care are required, as will be evidence of their effectiveness, cost-effectiveness and scalability.

Arts and creativity interventions (ACIs) can have positive effects on health and well-being, as several reviews have shown [ 4 , 5 ]. For older people, ACI’s can enhance wellbeing [ 6 , 7 , 8 , 9 ], quality of life [ 10 , 11 ] and cognitive function [ 12 , 13 , 14 , 15 , 16 ]. They can also foster social cohesion [ 17 , 18 , 19 ] and reduce social disparities and injustices [ 20 ]; promote healthy behaviour; prevent ill health (including enhancing well-being and mental health) [ 21 , 22 , 23 , 24 , 25 ], reducing cognitive decline [ 26 , 27 ], frailty [ 28 , 29 , 30 , 31 , 32 , 33 ] and premature mortality [ 34 , 35 , 36 , 37 , 38 ]); support people with stroke [ 39 , 40 , 41 , 42 ]; degenerative neurological disorders and dementias and support end of life care [ 43 , 44 ]. Moreover, ACIs can benefit not only individuals, but also others, such as supporting the well-being of formal and informal carers, enriching our knowledge of health, and improving clinical skills [ 4 , 5 ].

The benefits of ACIs have also been acknowledged at a governmental level by those responsible for delivering health and care services: The UK All-Party Parliamentary Special Interest group on Arts, Health and Wellbeing produced a comprehensive review of creative intervention for health and wellbeing [ 45 ]. This report contained three key messages: that the arts can keep us well, aid recovery and support longer better lived lives; they can help meet major challenges facing health and social care; and that the arts can save money for the health service and social care.

Despite robust scientific evidence and governmental support, no systematic literature review has collated the evidence with respect to the value, cost or cost-effectiveness of such interventions. Our objective was to assess the economic impact of ACIs aimed at improving the health and wellbeing of older adults; to determine the range and quality of available studies; identify gaps in the evidence-base; and guide future research, practice and policy.

A protocol for this review was registered at PROSPERO, an international prospective register of systematic reviews (Registration ID CRD42021267944). We used pre-determined criteria for considering studies to include in the review, in terms of types of studies, participant and intervention characteristics.

The review followed the five-step approach on how to prepare a Systematic Review of Economic Evaluations (SR-EE) for informing evidence-based healthcare decisions [ 46 , 47 , 48 ]. Subsequent to developing and registering the protocol, the International Society for Pharmacoeconomic Outcomes and Research (ISPOR) published a good practice task force report for the critical appraisal of systematic reviews with costs and cost-effectiveness outcomes (SR-CCEOs) [ 49 ]. This was also used to inform the conduct of this review.

Eligibility criteria

Full economic evaluations are regarded as the optimal type of evidence for inclusion in a SR-EE [ 46 ], hence cost-minimisation analyses (CMA), cost-effectiveness analyses (CEA), cost-utility analyses (CUA) and cost–benefit analyses (CBA) were included. Social value analyses were also included as they are frequently used to inform decision-making and commissioning of services within local government. Additionally, they represent an important intermediate stage in our understanding of the costs and consequences of public health interventions, where significant challenges exist with regard to performing full evaluations [ 50 , 51 , 52 , 53 ].

Development of search strategies

The population (P), intervention (I), comparator (C) and outcomes (O) (PICO) tool provided a framework for development of the search strategy. Studies were included if participants were aged 50 years or older (or if the average age of the study population was 50 years or over). Interventions could relate to performance art (dance, singing, theatre, drama etc.), creative and visual arts (painting, sculpture, art making and design), or creative writing (writing narratives, poetry, storytelling). The intervention had to be active (for example, creating art as opposed to viewing art; playing an instrument as opposed to listening to music). The objective of the intervention had to be to improve health and wellbeing; it had to be delivered under the guidance of a professional; delivered in a group setting and delivered on more than one occasion. No restrictions were placed on the type of comparator(s) or the type of outcomes captured in the study. We deliberately limited the study to professionally led activities to provide a sharper distinction between social events where arts and creativity may occur and arts and creativity interventions per se. We set no language restriction nor a restriction on the date from which studies were reported.

Search methods

PRESS (peer-review electronic search strategies) guidelines informed the design our search strategy [ 54 , 55 ] and an information specialist adapted the search terms (outlined in Table S 1 ) for the following electronic bibliographic databases: MEDLINE, PubMed, EMBASE, Econlit and Web of Science and NHSEED. We also inspected references of all relevant studies; and searched trials registers (ClinicalTrials.gov). Search terms used included cost, return on investment, economic, arts, music, storytelling, dancing, writing and older adult as well as social return on investment (SROI). The last search was performed on 09/11/2022. As many economic evaluations of ACIs (especially SROIs) are commissioned by government bodies or charitable organisations, a search of the grey literature was undertaken.

Handling searches

A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow chart was used to document study selection, illustrating the numbers of records retrieved and selection flow through the screening rounds [ 56 , 57 , 58 ]; all excluded records (with rationale for exclusion) were documented.

Selection of studies

Two screening rounds were conducted independently by two health economists experienced in undertaking reviews (GC, CO’N). The first round screened the title and abstract of articles based on the eligibility criteria; those selected at this stage entered a second round of full text screening with eligibility based on the inclusion and exclusion criteria. Any disagreements were discussed among the two reviewers, with access to a third reviewer available to resolve disagreements, though this proved unnecessary.

Data extraction and management

Two reviewers extracted relevant information independently using an proforma developed specifically for the purposes of this study, which included all 35 items suggested by Wijnen et al. (2016) [ 48 ]. Information was extracted in relation to the following factors: (1) general information including study title, author, year, funding source, country, setting and study design; (2) recruitment details, sample size, demographic characteristics (age, gender) and baseline health data (diagnosis, comorbidities); (3) interventions, effectiveness and cost data; (4) type of economic evaluation, perspective, payer, beneficiary, time horizon, measure of benefit and scale of intervention; (5) quality assessment, strength of evidence, any other important information; (6) results; (7) analysis of uncertainty and (8) conclusions. The quality assessment/risk of bias checklists were included in the data extraction proforma, and picklists were used to enhance uniformity of responses. The data extraction form was piloted by two reviewers (GC and CON) on one paper and discussion used to ensure consistent application thereafter.

Assessment of study quality

Two reviewers (GC & CON) independently assessed study quality, with recourse to a third reviewer for resolution of differences though this proved unnecessary. Quality assessment was based on the type of economic evaluation undertaken. Full and partial trial-based economic evaluations were assessed using the CHEC-extended checklist [ 59 ]. SROI analyses were assessed using a SROI-specific quality framework developed for the purpose of systematic review [ 60 ].

Data analysis methods

Due to the small number of evaluations detected, possible sources of heterogeneity and a lack of consensus on appropriate methods for pooling cost-effectiveness estimates [ 61 ] a narrative synthesis analysis was undertaken.

Database searches returned 11,619 records; from this, 402 duplicates were removed leaving 11,214 reports. From these 113 reports were assessment against the inclusion and exclusion criteria resulting in 4 studies for inclusion in the review. Over 40 websites were searched for relevant content returning 2 further studies for inclusion. The PRISMA 2020 diagram is presented in Fig.  1 . A high sensitivity search strategy was adopted to ensure all relevant studies were identified, resulting in a large number of studies being excluded at the first stage of screening.

PRISMA 2020 flow diagram for new systematic reviews which include searches of databases, registers and other sources

A total of six studies were identified; key characteristics are presented in Table 1 . Identified studies were published between 2011 and 2020. Two studies used a health technology assessment (HTA) framework alongside clinical trials [ 62 , 63 ] to assess the cost-effectiveness of community singing interventions. Both evaluations scored highly on the CHEC-extended checklist (Table 2 ), with findings reported in line with the CHEERS (Consolidated Health Economic Estimation Reporting Standards) checklist 2022 [ 64 ].

Four further studies employed an SROI framework to assess art and/or craft interventions: two studies were published in the peer-reviewed literature [ 65 , 66 ] and a further two in the grey literature [ 67 , 68 ]. All four adhered closely to the suggested steps for performing an SROI and consequently secured high scores (Table 3 ). No quality differential was discerned between those studies published in the academic literature when compared with those from the grey literature.

Five of the studies were undertaken in the UK [ 63 , 66 , 67 , 68 , 69 ] and one in the US [ 63 ]. Four of the studies were designed for older adults with no cognitive impairment [ 62 , 63 , 67 , 68 ]; one was designed for participants with or without dementia [ 65 ], and another was specifically for older adults with dementia and their caregivers [ 66 ]. Three of the studies were delivered in a community setting [ 62 , 63 , 67 ], two in care homes [ 65 , 68 ] and one across a range of settings (hospital, community and residential) [ 66 ]. The length and duration of the ACIs varied; some lasted 1–2 h (with multiple classes available to participants) [ 65 ], whereas others were structured programmes with sessions lasting 90 min over a 14-week period [ 62 ]. The number of participants included in studies varied; the largest study contained data from 390 participants [ 63 ], whereas other studies measured engagement using numbers of care homes or housing associations included [ 67 , 68 ].

Costs were captured from a narrower perspective (i.e., the payer—health service) for those economic evaluations which followed a health technology assessment (HTA) framework [ 62 , 63 ]. Costs associated with providing the programme and health and social care utilisation costs were captured using cost diaries. Valuation of resource usage was in line with the reference case specified for each jurisdiction.

Social value analyses included in the review [ 65 , 66 , 67 , 68 ] captured a broader picture of cost; programme provision costs included were similar in nature to those identified using an HTA framework, however, the benefits captured went beyond the individual to capture costs to a wide range of stakeholders such as family members, activity co-ordinations and care home personnel. Costs were apportioned using financial proxies from a range of sources including HACT Social Value Bank [ 69 ] and market-based valuation methods.

The range of outcomes captured and valued across HTAs and SROIs was extensive: including, but not limited to, wellbeing, quality of life, physical health, cognitive functioning, communication, control over daily life choices, engagement and empowerment, social isolation, mobility, community inclusion, depressive symptoms, sadness, anxiety, loneliness, positive affect and interest in daily life. In the programmes assessed using an HTA framework, outcomes were captured using standardised and validated instruments, for both control and intervention groups across multiple time points. Statistical methods were used to assess changes in outcomes over time. Programmes assessed using SROI relied primarily on qualitative methods (such as reflective diaries and in-depth interviews) combined with routinely collected administrative data.

The evidence from the singing interventions was encouraging but not conclusive. The ‘Silver Song Club’ programme [ 62 ] reported a 64% probability of being cost-effective at a willingness-to-pay threshold of £30,000. This study was also included in the Public Health England (PHE) decision tool to support local commissioners in designing and implementing services to support older people’s healthy ageing, reporting a positive societal return on investment [ 70 ]. Evidence from the ‘Community of Voices’ trial [ 63 ] suggested that although intervention group members experienced statistically significant improvements in loneliness and interest in life compared to control participants, no significant group differences were observed for cognitive or physical outcomes or for healthcare costs.

A positive return on investment was reported by all social value analyses undertaken. The ‘Imagine Arts’ programme, reported a positive SROI of £1.20 for every £1 of expenditure [ 65 ]. A higher yield of between £3.20-£6.62 for each £1 invested was reported in the ‘Dementia and Imagination’ programme [ 66 ]. The ‘Craft Café’ programme, reported an SROI of £8.27 per £1 invested [ 68 ], and the ‘Creative Caring’ programme predicted a SROI of between £3 to £4 for every £1 spent [ 67 ]. The time period over which return on investment was calculated differed for each evaluation from less than one year to 4 years.

The primary finding from our review concerns the paucity of evidence relating to the value, cost and/or cost-effectiveness of ACIs aimed at improving health and wellbeing in this population. Despite few restrictions being applied to our search, only six studies were found which met our inclusion criteria. This is not indicative of research into ACIs in this population, as evidenced by the identification of ninety-three studies where arts and creativity interventions were found to support better health and wellbeing outcomes in another recent review [ 5 ]. An alternative explanation is that funders do not see the added value of undertaking such evaluations in this area. That is, for funders, the cost of evaluating an ACIs is likely to be deemed unjustified given the relatively small welfare loss a misallocation of resources to them might produce. While at first glance this may seem reasonable, it disadvantages ACIs in competing with other interventions for funding and arguably exposes an implicit prejudice in the treatment of interventions from which it may be difficult to extract profit in general. That is, the paucity of evidence, may reflect inherent biases within our political economy that favour the generation of marketable solutions to health issues from which value can be appropriated as profit. Pharmaceuticals are an obvious example of such solutions, where the literature is replete with examples of evaluations sponsored by pharmaceutical companies or where public funds are used to test the claims made by pharmaceutical companies in respect of the value of their products. If the potential of ACIs to improve health and well-being is to be robustly established, ACIs must effectively compete for funding with other interventions including those from pharma. This requires a larger, more robust evidence base than is currently available and investment in the creation of such an evidence base. As there is currently no ‘for-profit’ industry to generate such an evidence base, public funding of evaluations will be central to its creation.

Our second finding concerns the values reported in the meagre evidence we did find. In five of the six studies we identified, evidence indicated that ACIs targeted at older people offered value for money [ 62 , 65 , 66 , 67 , 68 ]. One study provided mixed evidence [ 63 ], however, in this study a ‘payer’ perspective was adopted when applying an HTA framework which, by virtue of the perspective adopted, excluded a range of benefits attributable to ACIs and public health interventions more generally. Among the four studies that adopted a SROI approach, estimated returns per £1 invested ranged from £1.20 to £8.27. Given the evident heterogeneity among studies in terms of context and methods, care is warranted in comparing estimates with each other or with other SROIs. Care is also required in accepting at face value the estimates reported given methodological issues that pertain to the current state of the art with respect to SROI. With these caveats in mind noted, the values reported for ACIs using the SROI approach are comparable with those from other SROI studies in other contexts including those as diverse as a first aid intervention [ 71 ], investment in urban greenways [ 72 ] and the provision of refuge services to those experiencing domestic violence [ 73 ] (a return on investment of £3.50-£4, £2.88-£5.81 and £4.94 respectively). Similarly, with respect to the study that adopted a cost-effectiveness approach, Coulton and colleagues (2015) reported a 64% probability of the intervention being cost-effective at a threshold of £30,000 [ 62 ]. Again, it is difficult to compare studies directly, but this is similar to that reported for interventions as diverse as a falls prevention initiative [ 74 ] and the treatment of depression using a collaborative approach [ 75 ] both in the UK. That the evidence base is meagre notwithstanding, there is, in other words, a prima facie case that ACIs are capable of offering value for money when targeted at older persons.

Our third finding relates to the state of the art with respect to SROIs in this area. Over the past 40 years, considerable time, effort and resources have been expended in the development of cost-effectiveness techniques in health and social care. While considerable heterogeneity can exist around their conduct, national guidance exists in many jurisdictions on the conduct of cost-effectiveness analyses (CEA) – such as the NICE reference case in the UK [ 76 ]– as well as in the reporting of these as set out in the CHEERS 2022 guidance [ 64 ]. This has helped raise the quality of published evaluations and the consistency with which they are reported. Despite the existence of a step-by-step guidance document on how to perform SROIs [ 77 ] which outlines how displacement effects, double counting, effect attribution and drop-off should be addressed, a significant body of work still remains to ensure that the methodology addresses a range of known biases in a robust manner. Where there is no comparator to the intervention being evaluated (as was the case in the SROIs reported here) it may be difficult to convince funders that the implicit incremental costs and benefits reported are indeed incremental and attributable to the intervention. Equally, where a comparator is present, greater consensus and standardisation is required regarding the identification, generation and application of, for example, financial proxies. Currently, SROI ratios combine value across a wide range of stakeholders, which is understandable if the objective is to capture all aspects of social benefit generated. This ratio, however, may not reflect the priorities and statutory responsibilities of healthcare funders. Whist all of the aforementioned issues can be addressed, investment is required to develop the SROI methodology further to more closely meet the needs of commissioning bodies.

Notwithstanding these challenges, social value analyses play a pivotal role within the procurement processes employed by government, local authorities and other non-departmental public bodies and should not be dismissed simply because the ‘burden of proof’ falls short of that required to secure remuneration within the health sector. As most SROIs are published in the grey literature, this means they often avoid peer scrutiny prior to publication and the potential quality assurance this can offer. It is noteworthy however that two of the SROIs included in this review [ 65 , 66 ] were published in the academic literature, suggesting that the academic community are engaging with this method which is to be applauded.

Moving forward, it is unlikely we will be able to meet all of the health and wellbeing needs of our ageing population solely in a primary or secondary care setting. New models of care are required, as are new models of funding to support interventions which can be delivered in non-healthcare settings. New hybrid models of evaluation will be required to provide robust economic evidence to assist in the allocation of scarce resources across health and non-healthcare settings; such evaluative frameworks must have robust theoretical underpinnings and be capable of delivering evidence from a non-clinical setting in a timely and cost-effective manner.

In the absence of a definitive evaluation framework for ACIs being currently available, we have a number of recommendations. First, and most importantly, all impact assessments should have a control group or credible counterfactual. This is currently not required when performing an SROI making it difficult to determine if all of the benefits ascribed to an intervention are in fact attributable. This recommendation is in line with the conclusion of a report by the London School of Economics [ 78 ] for the National Audit Office (NAO) which concluded that ‘any impact evaluation (and subsequent value for money calculation) requires construction of a counterfactual’. Second, a detailed technical appendix should accompany all impact assessments to allow independent review by a subject specialist. While this would assist peer review, it would allow providing greater transparency where peer review was not undertaken prior to publication. Furthermore, it would enable recalculation of SROI ratios to exclude ‘value’ attributable to stakeholders which are not relevant to a particular funder. Third, equity considerations should be addressed explicitly in all evaluations (this is currently not required in HTAs). Fourth, both costs and outcomes should be captured from a ‘broad’ perspective (adopting a ‘narrow’ healthcare perspective may underestimate the full economic impact), with non-healthcare sector costs being detailed as part of the analysis. Finally, data should be collected post-implementation to ensure that resources continue to be allocated efficiently.

As with any review, there are limitations which should be noted. A search of the grey literature was included as evaluations of applied public health interventions are not always reported in the academic literature. Systematically identifying grey literature and grey data can be problematic [ 79 , 80 , 81 , 82 , 83 ] as it is not collected, organised or stored in a consistent manner. Hence it is possible that we have not identified all relevant studies. Furthermore, as applied public health interventions can be performed in a non-healthcare setting we included SROIs in our review of economic evaluations. Current guidance on the systematic review of economic evaluations has been developed primarily for review of HTA as opposed to public health interventions and hence SROIs would be excluded, or if included would score poorly due to the inherent biases arising from no comparator or counterfactual being included.

This systematic review found that participation in group-based arts and creativity programmes was generally cost-effective and/or produced a positive return on investment whilst having a positive impact on older people’s physical, psychological, and social health and wellbeing outcomes. Unfortunately, the small number of studies identified, coupled with differences in methods used to assess economic impact hinders our ability to conclusively determine which types of art and creativity-based activities are more cost-effective or represent best value for money.

As well as the need for a greater focus on prevention of poor health as we age, new hybrid models of healthcare delivery are necessary to meet the needs of our ageing population. These models will integrate traditional medical care with other services such as home health aides (some of which may include artificial intelligence), telemedicine and social support networks. Alongside these, ACIs have the potential to provide a low cost, scalable, easily implementable and cost-effective solution to reduce the burden of illness in this age group and support healthy ageing.

Evidence on the cost-effectiveness of a range of ACIs is of utmost importance for policy and decision makers as it can both inform the development of policies that support the provision of ACIs in the context of ageing, but also identify the most cost-effective approaches for delivering such interventions. The development of hybrid models of evaluation, capable of capturing cost-effectiveness and social value, is becoming increasingly necessary as healthcare delivery for this age group moves beyond the realms of primary and secondary care and into the community. The development and refinement of such models will ensure a more comprehensive assessment of the impact of a diverse range of interventions providing a more nuanced understanding of the impact of an intervention. This will help inform decision making and ensure interventions are implemented in a cost-effective and socially beneficial manner.

Availability of data and materials

All data generated or analysed during this study are included in the published article and its supplementary information files.

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Acknowledgements

We would like to thank Ms. Louise Bradley (Information Resource Officer, Institute of Public Health) for her assistance in refining search strategies and literature search.

This study was supported by the Institute of Public Health (IPH), 200 South Circular Road, Dublin 8, Ireland, D08 NH90. This study was a collaboration between two health economists (GC, CO’N) and two members of staff from the funding organisation (LM, RO’S). Input from IPH staff was fundamental in defining the scope of work and research question, refining search terms and review and editing of the manuscript. Staff from IPH were not involved in quality assurance or review of papers included in the manuscript.

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Crealey, G., McQuade, L., O’Sullivan, R. et al. Arts and creativity interventions for improving health and wellbeing in older adults: a systematic literature review of economic evaluation studies. BMC Public Health 23 , 2496 (2023). https://doi.org/10.1186/s12889-023-17369-x

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Palliative care needs of people and/or their families with serious and/or chronic health conditions in low- or middle-income country (LMIC) humanitarian settings—a systematic scoping review protocol

• Michelle McGannan   ORCID: orcid.org/0000-0002-9809-9568 1 ,
• Liz Grant   ORCID: orcid.org/0000-0001-7248-7792 2 ,
• David Fearon   ORCID: orcid.org/0000-0002-0295-3118 1 ,
• Marshall Dozier   ORCID: orcid.org/0000-0002-5151-1252 3 &
• Victoria Barber-Fleming   ORCID: orcid.org/0000-0002-8047-0234 4  

Systematic Reviews volume  13 , Article number:  105 ( 2024 ) Cite this article

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Metrics details

Palliative care in low- or middle-income country (LMIC) humanitarian settings is a new area, experiencing a degree of increased momentum over recent years. The review contributes to this growing body of knowledge, in addition to identifying gaps for future research. The overall aim is to systematically explore the evidence on palliative care needs of patients and/or their families in LMIC humanitarian settings.

Arksey and O’Malley’s (Int J Soc Res Methodol. 8:19-32, 2005) scoping review framework forms the basis of the study design, following further guidance from Levac et al. (Implement Sci 5:1-9, 2010), the Joanna Briggs Institute (JBI) Peters et al. (JBI Reviewer’s Manual JBI: 406-452, 2020), and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) from Tricco et al. (Ann Intern Med 169:467-73, 2018). This incorporates a five-step approach and the population, concept, and context (PCC) framework. Using already identified key words/terms, searches for both published research and gray literature from January 2012 to October 2022 will be undertaken using databases (likely to include Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, Embase, Global Health, Scopus, Applied Social Science Index and Abstracts (ASSIA), Web of Science, Policy Commons, JSTOR, Library Network International Monetary Fund and World Bank, Google Advanced Search, and Google Scholar) in addition to selected pre-print sites and websites. Data selection will be undertaken based on the inclusion and exclusion criteria and will be reviewed at each stage by two reviewers, with a third to resolve any differences. Extracted data will be charted in a table. Ethical approval is not required for this review.

Findings will be presented in tables and diagrams/charts, followed by a narrative description. The review will run from late October 2022 to early 2023. This is the first systematic scoping review specifically exploring the palliative care needs of patients and/or their family, in LMIC humanitarian settings. The paper from the review findings will be submitted for publication in 2023.

Peer Review reports

An estimated 274 million people are in need of humanitarian protection and assistance in 2022 [ 1 ], and while palliative care has rarely been undertaken in these situations [ 2 ], since 2016 a recognition of the need for palliative care integration into humanitarian settings has been growing [ 3 ] with the importance of this becoming increasingly recognized [ 4 ]. Palliative care has been incorporated into the Humanitarian Sphere Handbook [ 5 ], in addition to the WHO publication: “Integrating palliative care and symptom relief into the response to humanitarian crises and emergencies” in 2018 [ 2 ]. The first Field Manual for Palliative Care in Humanitarian Crises was published in 2020 [ 6 ].

The growing momentum in this area includes an ever-expanding body of literature, ranging across the spectrum from primary research studies to reports and anecdotal reflections. Since 2017, a small number of systematic or scoping reviews have been undertaken — these have included studies focusing on palliative care in LMIC humanitarian emergency/crisis settings [ 3 , 7 ]; death, dying, and end-of-life care for refugees, now residing in both high-income countries (HIC) and LMIC settings [ 8 ]; end-of-life care in natural disasters, including pandemics in both LMIC and HIC settings [ 9 ]; culturally sensitive palliative care in humanitarian contexts, in both HIC and LMIC settings [ 10 ]; exploring palliative care for forced migrant families and children now in HIC and LMIC settings [ 11 ]; and underrepresentation of palliative care guidelines in infectious disease outbreaks in both HIC and LMIC contexts [ 12 ]. None of the systematic or scoping reviews located has specifically explored the palliative care needs of the patient and/or their family in multiple LMIC humanitarian settings as the sole topic, thereby highlighting an apparent gap. Upon reviewing the PROSPERO — International Prospective Register of Systematic Reviews, and the Joanna Briggs Institute Systematic Review Register, there did not appear to be any systematic or scoping review protocols directly related to this specific topic.

This systematic scoping review will provide a current depiction of the palliative care needs of patients and/or their families in LMIC humanitarian settings. This type of review has been chosen as it ensures a broader scope, enabling less restrictive inclusion criteria and the bringing together of evidence from disparate sources [ 13 ].

Clarifying terms/definitions for the purpose of the review

The WHO in 2002 ([ 14 ] p. 84) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” In 2018, the WHO publication “Integrating palliative care and symptom relief into the response to humanitarian emergencies and crises” outlined how the “prevention and relief of suffering should be made accessible for anyone suffering physically, psychologically, socially or spiritually and not only for those with life- threatening conditions” ([ 2 ] p. 17). De Boer et al. [ 12 ] outlined how palliative care is for people with chronic or life-limiting illness, and the Field Manual for Palliative Care in Humanitarian Crises describes how palliative care has become a distinct subspecialty with the emphasis on care provision for people and their families with severe and life-limiting illness, regardless of the imminence of death [ 4 ].

For the purpose of this review, we will define palliative care as the care (outlined in the WHO 2002 definition [ 14 ]) provided for the needs of people with serious and/or chronic conditions and/or their families. The use of the term “serious and/or chronic conditions” is reflective of the discussions in the literature outlined above regarding defining palliative care in humanitarian contexts.

Palliative care needs will be defined as “multidimensional problems, symptoms, distress and concerns which can benefit from palliative care” [ 15 , 16 ]. LMIC humanitarian settings will include public health emergency, acute refugee context, protracted refugee context, and natural disaster, taken from the four sub-studies outlined by the Humanitarian Health Ethics Research Group [ 17 ]. We are adding two additional categories — conflict [ 2 , 18 ] and internally displaced people. As this is a rapidly growing area, a category of “other” will also be included.

Study design

Arksey and O’Malley’s [ 19 ] scoping review framework, with additions from Levac et al. [ 20 ], will be used to guide the broad outline of the methodology. The five steps from their frameworks will be broadly followed: (1) Identify the research question, (2) identify relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting the results. Additional methodology from the Joanna Briggs Institute (JBI) [ 13 ] and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) from Tricco et al. [ 21 ] will also be incorporated to enhance rigor.

Stage 1: Identify the research question

The JBI [ 13 ] recommended the use of the PCC pneumonic — “participants, concept and context” to guide both the development of the research question and the inclusion criteria. The PCC listed are as follows:

Participants

People who have serious and/or chronic health conditions which have the capacity to benefit from palliative care as outlined by the WHO [ 14 ], as reported by themselves, their relatives or a health professional, and/or their family members.

The palliative care needs of people with serious and/or chronic conditions and/or their family members.

LMIC (including low-, lower-middle-, and upper-middle-income country settings as identified by the World Bank [ 16 ]) humanitarian settings including, but not limited to, public health emergency, acute refugee context (including refugee and forced migration, acute (ongoing) conflict), protracted refugee context and natural disaster (various disasters, including earthquake, hurricane, tsunami, famine) [ 17 ], conflict [ 2 , 18 ], and internally displaced people.

Research questions

What are the palliative care needs of people with serious and/or chronic conditions in LMIC humanitarian contexts?

What are the palliative care needs of the families of people with serious and/or chronic conditions in LMIC humanitarian contexts?

Inclusion criteria

Published research/peer-reviewed studies (including, but not limited to, qualitative, quantitative, mixed-methods, case studies,), gray literature (including, but not limited to, unpublished reports, studies, and data obtained following either requests to key informants/experts in the field and/or from pertinent websites) guidelines and textbook chapters, conference abstracts (for both oral presentations and posters), and posters that meet the below criteria will be considered for inclusion:

Literature reporting individual palliative care needs for patient and/or family (including, but not limited to, symptoms, problems, concerns, and distress in the psychological, physical, social, and spiritual domains of life) which have the capacity to benefit from palliative care as outlined by the WHO (2002) [ 14 ] as reported by themselves, their relatives, or a health professional

Literature relating to serious and/or chronic health conditions, diseases, and injuries, which demonstrate palliative care needs. This can include, but is not limited to, cancers, organ failure (heart, lung, renal, and liver) dementia, and other diseases (such as, but not limited to, HIV, stroke, and neurological diseases) and injuries.

Date: From January 2012 to October 2022 (due to the dynamic nature of this field, it is envisaged that the majority of the literature will be relatively recent, and a 10-year period would maximize the opportunity to capture relevant data that remains current. Two previous systematic reviews [ 3 , 7 ] appear to show only a very small amount of data relevant to this study in earlier years).

Language: English and Arabic (Arabic is included as the second language due to the number of humanitarian crises in Arabic-speaking regions, which may result in Arabic language data — while data will only be extracted from literature in these languages, if literature in other languages is found, this only will be reported/cited but not included in the analysis due to practical issues relating to translation).

Population: Adults and children with serious and/or chronic health conditions which have the capacity to benefit from palliative care as outlined by the WHO (2002) [ 14 ], as reported by themselves, their relatives, or a health professional and/or their families

Literature from any LMIC (including low-, lower-middle-, and upper-middle-income country settings as identified/listed by the World Bank 2022 [ 16 ]) humanitarian setting (including, but not limited to, public health emergency, acute refugee context (including refugee and forced migration), acute (ongoing) conflict, protracted refugee context and natural disaster (various disasters, including, but not limited to, earthquake, hurricane, tsunami, famine), conflict, and internally displaced people).

Development of the inclusion criteria has been guided by Sepúlveda et al. (2002) [ 22 ] as cited by Afolabi et al. (2021) [ 15 ], Doherty et al. (2020) [ 23 ], Nouvet et al. (2018) [ 3 ], Amir et al. (2020) [ 17 ], WHO (2018) [ 2 ], and Krakauer et al. (2020) [ 18 ] and a small number of adapted inclusion criteria used by Afolabi et al. (2021) [ 15 ].

Exclusion criteria

Studies/literature relating solely to palliative care in high-income country (HIC) humanitarian contexts (i.e., palliative care in Covid in HIC settings)

Literature relating to palliative care in LMIC settings which are not classified as humanitarian settings (as identified in inclusion criteria)

Literature in languages other than English and Arabic will be reported/cited but not included in data analysis due to translation issues.

Papers that only include opinion — editorials and letters

Due to the limited work undertaken in this very new area, plus several key studies reporting on mixed populations of adults and children, literature relating to both adults and children will be included. This will ensure pertinent data is not excluded.

Conference abstracts will also be included to increase the opportunity to capture pertinent data in this novel field. If additional data or clarification is required from included conference abstracts/posters or full-text studies/literature, attempts will be made to contact the authors.

Stage 2: Identify relevant studies

The comprehensive strategy will comprise electronic database searches, examination of included text reference lists to identify further resources [ 13 , 19 ], and searching the gray literature [ 13 ].

Databases to be searched are likely to include CINAHL, MEDLINE, Embase, Global Health, Scopus, Applied Social Science Index and Abstracts (ASSIA), Web of Science, Policy Commons, JSTOR, Library Network International Monetary Fund and World Bank ( https://library.worldbankimflib.org/ ), Google Advanced Search, and Google Scholar. Pre-print databases to be searched are as follows: Preprints.org , medRxiv ( https://www.medrxiv.org/ ), and F1000Research ( https://f1000research.com/ ). Existing networks will be utilized [ 19 ], including communication to key experts to identify further unpublished reports/studies/data. Relevant websites will also be examined (these can be found listed in Additional file 1 ).

The search strategy for the majority of databases will combine three sets of terms/key words — palliative care descriptors, humanitarian setting descriptors, and LMIC descriptors, including all LMIC countries as defined by the World Bank [ 16 ]. This approach was adapted from the search strategy used by Nouvet et al. [ 3 ] for their systematic review of palliative care in humanitarian crises, where palliative care and humanitarian descriptor sets were used. However, following testing, some of the key words/terms were reviewed, aiming to ensure as far as possible that key indicator papers were located, in addition to attempting to reduce the volume of potentially irrelevant literature and to obtain a more manageable number of citations. For example, Ebola was included as a humanitarian descriptor due to the data written on this humanitarian crisis in LMIC; Covid-19 was also included, although combined with palliative care as a search term in the humanitarian descriptors due to the vast amount of literature on this subject alone. Individual words/terms within each set will be separated by the Boolean descriptor “or” with the Boolean operator “and” used to combine the sets. However, for a number of database, pre-print database, and website searches, it is likely that only two descriptor sets will be used (palliative care and humanitarian) with reduced key words, as this approach appeared more effective during preliminary testing. An example of key words/terms can be found in Additional file 2 . It is likely that the search strategy will be adapted for each database/website, to enhance specificity, with further filters applied to improve sensitivity of citations retrieved.

The results of a draft search history, undertaken using Ovid MEDLINE database on 30th July 2022, can be found in Additional file 3 . There were no language filters used, and the dates in the search were from 2012 to 2022. This search strategy will be adapted for other databases.

Stage 3: Study selection

This is an iterative team process involving searching, refinement of the search strategy (if necessary) and reviewing literature for inclusion [ 20 ]. Initial searches of databases will be undertaken, with results exported into the EndNote bibliographic system and duplicates removed. Two reviewers will independently review titles and abstracts against the inclusion and exclusion criteria.

If abstracts are not available, full-text data will be reviewed at this stage; it is predicted this will be for a minority of data, probably websites and some gray literature. The number of papers screened and rejected based on title and abstract screening, in addition to the number of papers retrieved for full text screening, will be recorded. Reviewers will meet at the beginning, middle, and end of the title and abstract review stage, to discuss any issues related to study selection and, if needed, to refine the search strategy [ 20 ]. Unresolved disagreements will be resolved by a third reviewer [ 13 ].

Two reviewers will then independently review full-text literature, gray literature, guidelines, textbook chapters, conference abstracts, and posters for inclusion or exclusion, with input from a third reviewer in the event of any disagreements [ 13 , 20 ] using a table developed by the research team from the eligibility criteria. A summary of this process can be found in Fig. 1 .

Scoping review flow diagram, showing phases for data extraction and selection (adapted PRISMA-ScR reporting flow diagram, taken from Moher et al. (2009) [ 28 ])

Reference lists of included documents will be searched, and any relevant abstracts identified will be reviewed following the process outlined above. The websites will also be searched, and any relevant abstracts/data will be reviewed using the process outlined above.

Stage 4: Charting the data

Data will then be extracted and charted in a table, which aims to provide a summary of the results which is both descriptive and logical [ 13 ]. This will be created by the review team collaboratively, ensuring the inclusion of variables to answer the research question(s) [ 20 ]. It is currently proposed that this will be developed from a combination of the JBI list [ 13 ] with specific pertinent areas added (as outlined in Fig. 2 ).

Data extraction chart variables

Following a pilot of the table [ 13 ], data entry will commence, with the chart being updated as agreed by the reviewers, as charting is an iterative process [ 20 ]. It is aimed to incorporate both academic and gray literature in the same table, as limited data in this area is predicted.

Stage 5: Collating, summarizing, and reporting the results

Extracted data will be initially presented in an overall summary table focusing on the main characteristics of each piece of literature; it is currently planned that this will include origin/humanitarian setting, adult, child or adult/child mixed population, aim, methods, and key findings. Further numerical data, probably relating to literature category, palliative care domain, and humanitarian setting, will be presented visually using tables, diagrams, and/or charts.

Using the principles of framework synthesis, where data in a scoping review is sorted/charted against an a priori framework ([ 24 , 25 , 26 ] as cited by 3), it is planned that literature on palliative care needs will then be extracted and categorized into palliative care domain/sub-domain and mapped to a specific humanitarian setting in a table (see table in Additional file 4 ).

Following the tables and charts, a narrative description will outline how the results relate to the research question(s) [ 13 ]. This plan for presenting the results may undergo further revisions during the review process when there is greater awareness of the data available [ 27 ].

Following the full search and review, the results will be reported as outlined in stage 5, subject to review depending on the data extracted. It is aimed to publish the review in a peer-reviewed journal, thereby adding to the growing body of evidence on palliative care in humanitarian contexts.

Research ethics approval is not required for this scoping review.

The inclusion of conference abstracts and posters may be a potential limitation, as there is a risk that data may be missing, due to the brevity of the format; authors will be contacted to request further data if possible. However, their inclusion can be justified due to the limited full-text peer-reviewed research in this area.

As patient and family palliative care needs in humanitarian contexts may be a challenging area to identify from article and data titles, literature may be unintentionally omitted; although with the broad search strategy employed in this review, every effort will be made to mitigate this risk.

The inclusion of data relating to both adult and child participants is a strength of this study. The reporting will clearly identify adult, child, or mixed adult/child data (including proportion of adult and child participants where identification is possible).

This is the first systematic scoping review to specifically explore the palliative care needs of the patient and/or their family, in LMIC humanitarian settings. This format is being utilized to ensure a broad scope is undertaken, enabling the inclusion of literature from disparate sources. This review will form part of a wider research project, exploring palliative care learning needs and evidence-based palliative care curricula for humanitarian health workers, and will contribute to the rapidly growing body of knowledge in this area. It is further anticipated that the findings will highlight research gaps.

Availability of data and materials

Not applicable

Abbreviations

Low- or middle-income country

Joanna Briggs Institute

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

Cumulative Index of Nursing and Allied Health

Applied Social Science Index and Abstracts

High-income countries

World Health Organization

Participants, concept, and context

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Acknowledgements

Dr. Ruth McQuillan (University of Edinburgh) who provided valuable critique of an earlier version of the protocol.

The review is not funded by any funding bodies. Victoria Barber-Fleming’s role in this research is independent of her PhD research project which is funded by the Legal & General Group (research grant to establish the independent Advanced Care Research Centre at University of Edinburgh). The funders had no role in conduct of the study, interpretation, or the decision to submit for publication. The views expressed are those of the authors and not necessarily those of Legal & General.

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MM, LG, and DF developed the concept. MM, LG, and MD developed the protocol. MM, LG, MD, and VB-F developed the search strategy. MM drafted the manuscript, under the supervision of LG. All authors have made intellectual contributions to the development of this protocol. All authors read and gave approval to the publishing of this protocol manuscript. MM is the guarantor.

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Examples of key words/terms

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Draft search history

Additional file 4.

Proposed table mapping palliative care needs in relation to domains/sub-domains and humanitarian settings

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McGannan, M., Grant, L., Fearon, D. et al. Palliative care needs of people and/or their families with serious and/or chronic health conditions in low- or middle-income country (LMIC) humanitarian settings—a systematic scoping review protocol. Syst Rev 13 , 105 (2024). https://doi.org/10.1186/s13643-024-02521-4

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Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings

• Carmen H. Logie   ORCID: orcid.org/0000-0002-8035-433X 1 , 2 , 3 , 4 ,
• Frannie MacKenzie   ORCID: orcid.org/0000-0002-3517-8330 1 ,
• Kalonde Malama   ORCID: orcid.org/0000-0001-7655-5916 1 ,
• Nicole Lorimer   ORCID: orcid.org/0000-0001-5759-3247 1 ,
• Anoushka Lad   ORCID: orcid.org/0000-0003-3851-6822 1 ,
• Michelle Zhao   ORCID: orcid.org/0000-0002-6249-8364 1 ,
• Manjulaa Narasimhan   ORCID: orcid.org/0000-0003-0598-6887 5 ,
• Sasha Fahme   ORCID: orcid.org/0000-0003-0265-2582 6 , 7 ,
• Bülent Turan   ORCID: orcid.org/0000-0003-2008-227X 8 ,
• Julia Kagunda   ORCID: orcid.org/0000-0002-7229-9932 9 , 10 ,
• Kelika Konda   ORCID: orcid.org/0000-0003-2836-0174 11 , 12 ,
• Aryssa Hasham   ORCID: orcid.org/0009-0004-9216-1772 1 &
• Amaya Perez-Brumer   ORCID: orcid.org/0000-0003-2441-4358 11 , 13  

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Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC.

Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs.

The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles ( n  = 38) discussed sexual health domains including: GBV ( n  = 23); HIV/STI ( n  = 19); and CSE ( n  = 12). Over one-third ( n  = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care ( n  = 13); contraception ( n  = 13); fertility ( n  = 1); and safe abortion ( n  = 1). Eight included both reproductive and sexual health. Most grey literature ( n  = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels.

Conclusions

This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC.

Plain English summary

Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.

Peer Review reports

As of mid-2022, the global number of forcibly displaced individuals reached an estimate of 103 million [ 1 ], a significant majority of this population (53.2 million individuals) are internally displaced [ 1 ]. While approximately one-third, totaling 32.5 million people, hold recognized refugee status, another 4.9 million individuals are actively seeking asylum in another country [ 1 , 2 ]. Forcibly displaced persons may experience poorer sexual and reproductive (SRH) outcomes than non-displaced persons due to the interplay of complex social ecological factors [ 3 ]. For instance, forcibly displaced persons may be exposed to sexual and gender-based violence (GBV) before, during, and/or following displacement, and/or upon resettlement. Further, they may experience reduced access to SRH services, including contraception and sexually transmitted infection (STI) prevention and treatment, due to poverty, socio-cultural differences, language, and literacy barriers [ 4 , 5 , 6 , 7 ]. Social and structural barriers such as intersectional stigma related to forcibly displaced status, gender, age, and limited SRH literacy can further constrain SRH engagement [ 8 , 9 ].

Low- and middle-income countries (LMIC) host 74% of the globally forcibly displaced population, and it is estimated that the majority of refugees and nearly half (48%) of internally displaced people live in urban areas [ 1 , 2 , 10 ]. There is the potential that forcibly displaced persons residing in urban settings LMIC may live in poorer housing conditions with less economic and social support than those living in refugee camps or refugee settlement environments managed by humanitarian agencies [ 11 , 12 ]. For instance, challenges facing forcibly displaced persons living in urban LMIC contexts can include transportation costs, higher living costs that may result in overcrowded living conditions, poverty, and language barriers to accessing relevant employment, education, health and other services [ 13 , 14 , 15 ]. It is plausible that these factors can also reduce the accessibility and utilization of SRH services. Inadequate SRH service provision is associated with increased gender-based violence (GBV), elevated risks for acquisition and transmission of HIV and other STIs, unintended pregnancies, and unsafe abortions [ 8 , 16 ]. Further, urbanization among refugees may contribute to poverty and exacerbate gender inequities, both associated with increased likelihood of GBV [ 3 , 17 , 18 ]. With rising urbanization among forcibly displaced persons, there is a need for greater understanding of the sexual and reproductive health (SRH) outcomes and priorities to inform tailored intervention and programs.

Existing systematic reviews have reported evidence-based approaches to improve antenatal, postnatal, and newborn health, HIV prevention and treatment outcomes, and uptake of family planning resources and services, for forcibly displaced persons at large [ 19 , 20 ]. There is evidence that interpersonal, health-system, and socio-cultural factors shape access to SRH care among forcibly displaced peoples [ 21 ]. Literature has also documented relationships between climate migration and GBV, decreased maternal and neonatal health, and increased barriers to accessing and using SRH services [ 22 ]. While these important reviews document factors that shape SRH among forcibly displaced peoples at large, there remains a notable lack of research focused on forcibly displaced persons regarding SRH issues including GBV prevention, STI transmission and treatment, menstruation hygiene management, and disrupted access to SRH care [ 19 , 22 ]. Further, findings have not distinguished between urban or refugee camp/settlement contexts, resulting in a lack of clarity regarding specific needs, priorites, and SRH outcomes among forcibly displaced persons in urban LMIC contexts.

The objective of this scoping review is to identify, critically appraise, and synthesize the literature on sexual and reproductive health needs, outcomes, and priorities of forcibly displaced persons living in urban LMICs. A comprehensive understanding of these dimensions and existing research gaps can inform future practice, research, and policy.

The Joanna Briggs Institute methodology for scoping reviews was followed throughout this review [ 23 ]. A complete and comprehensive explanation of the methods used can be found in the published study protocol [ 24 ].

Search strategy

Completed in January 2023, we searched eight databases, MEDLINE, EMBASE, PsycINFO, CINAHL, IBSS, ASSIA, SSCI, and Global Medicus Index, for literature published between 1998 and 2022 on SRH needs among forcibly displaced persons in LMIC. The search structure first grouped terms for each of urban, refugees, sexual health, low and middle-income countries, and reproductive health using the Boolean operator OR. Following this, terms for urban and refugees were combined using the Boolean operator AND, and terms for sexual health and reproductive health were combined using the Boolean operator OR. Lastly, the search terms for urban refugees, sexual health or reproductive health, and low and middle-income countries were combined using the Boolean operator AND – ((urban OR cities OR municipal) AND (refugee* OR displace* OR asylum)) AND ((sexual health OR gender-based violence OR sexually transmitted disease*) OR (reproductive health OR prenatal OR contraception)) AND (low income countries OR middle income countries OR developing nations). A detailed search strategy for all databases can be found in the Supplementary File 1 . A grey literature search was also conducted in accordance with a search guide developed by Godin et al. [ 25 ].

Study selection

The study population was a) any forcibly displaced person, following UNHCR’s definition that includes refugee, migrant, asylum seeker, or internally displaced persons forced to flee due to persecution, conflict, human rights violations, or other serious events disrupting order [ 1 , 2 ], b) living in a LMIC as defined by the World Bank Atlas Method [ 26 ] and c) living in an urban context, including urban, semi-urban, city, metropolis, or if study location is listed as urban in the UN World Urbanization Prospects database of country-specific definitions of ‘urban’ [ 27 ]. SRH was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception counselling and provision; fertility care; safe abortion care) [ 28 , 29 ].

We included peer-reviewed or gray literature studies using quantitative, qualitative, or mixed-methods designs focused on any dimension of sexual/reproductive health written in the English language. Studies were excluded if they a) did not include forcibly displaced persons; b) included migrants by choice; c) did not focus on SRH; d) were not based in urban contexts; e) had metadata not in English; and f) there was no full-text article available. Key subject terms were searched among websites of governmental, non-governmental, and international organizations working with forcibly displaced persons.

Data extraction and analysis

Once both the database search and grey literature search were completed, data from included records were extracted by a reviewer into a spreadsheet. All records were uploaded on to Covidence systematic review software (VeritasHealth Innovation, Melbourne, Australia) and duplicates were removed. On Covidence, each record’s title and abstract were screened by at least 2 study team members for inclusion eligibility. The full texts of all included articles were further screened by two study team members. At this point, the reference list of each included article was manually hand searched. If a relevant article was found via hand search, it was entered into Covidence and put through the screening process as outlined. All discrepancies were reviewed by a third team member and/or discussed with all reviewers. Extracted data points included the record’s general characteristics, population, concept, context, main outcome measure, and key findings relevant to this review. Every record’s data extraction was examined by a second team member for accuracy. All data were then summarized and collated into the accompanying narrative summaries.

Our peer-reviewed article search returned 1151 results across eight databases and 2275 grey literature reports. In total, 92 documents including 55 peer-reviewed articles and 37 grey literature pieces met the inclusion criteria for this scoping review. Among the peer-reviewed articles, PRISMA Flow Chart in Fig.  1 shows the selection process for 53 peer-reveiewed articles (Fig.  1 ). Six additional peer-reviewed articles were hand searched, 2 of which met the inclusion criteria and were included.

PRISMA flow diagram of a scoping review on urban forcibly displaced persons' sexual and reproductive health in low and middle-income countries

The peer-reviewed articles were mapped onto dimensions of sexual health and reproductive health [ 29 ] (Table  1 ). The majority of peer-reviewed articles ( n  = 40; 72.7%) discussed sexual health domains including: GBV prevention, support and care ( n  = 23); HIV and STI prevention and control ( n  = 21); and comprehensive sexuality education ( n  = 12). Under the sexual health domain, no articles were located that discussed sexual function and psychosexual counselling. More than one-third ( n  = 20; 36.3%) discussed reproductive health areas including: antenatal, intrapartum and postnatal care ( n  = 13); contraception counselling & provision ( n  = 13); fertility care ( n  = 1); and safe abortion care ( n  = 1). While not within the SRH framework [ 28 , 29 ], menstrual hygiene management was included as a SRH issue in this review as it was discussed in three articles. Eight articles discussed intervention areas that included both reproductive and sexual health domains. Sexual and reproductive health dimensions covered in peer-reviewed articles are displayed in Table  2 .

Sexual and gender-based violence (GBV)

Among the 17 studies that examined GBV [ 32 , 33 , 36 , 37 , 40 , 41 , 42 , 45 , 46 , 52 , 61 , 68 , 69 , 73 , 74 , 75 , 76 ] in urban contexts, all explored GBV as it was experienced by women and girls, and one examined experiences of both adolescent boys and girls [ 52 ]. Most articles explored experiences of adult women: two explored GBV among adolescent girls [ 75 , 76 ] and one explored GBV experiences among young women [ 68 ].

Prevalence and health correlates of intimate partner violence

Of the 17 articles that examined GBV, most ( n  = 11; 64.7%) specifically examined intimate partner violence (IPV) [ 32 , 33 , 40 , 41 , 42 , 45 , 52 , 61 , 69 , 73 , 76 ]. Prevalence ranged from 11.1%-86.0% and varied by age, type of IPV, and external factors. All studies examined the experience of adults, with the exception of two that looked at adolescents, and these found the highest prevalences of IPV at 85.8% and 86.0% [ 52 , 76 ]. Two articles examined the prevalence of different types of IPV. One study found partner control followed by economic abuse and emotional abuse to be the most common forms of IPV at 73%, 53.3%, and 50.3% respectively [ 33 ]. Another study found slapping and throwing objects to be the most common forms of physical IPV [ 41 ].

More than half of these articles reported associations between IPV and health and wellbeing ( n  = 6), incuding mental, physical, and other SRH outcomes. For instance, there were associations between experiencing IPV and mental health concerns such as post-traumatic stress disorder symptoms [ 61 ] and frequent alcohol use [ 52 ]. One study with refugee women in Amman, Irbid and Zarqa, Jordan found an association between psychological IPV and higher rates of health problems including heart, gastrointestinal, liver, respiratory, and urinary problems, recurrent dizziness, fibromyalgia, joint pain, and back pain [ 32 ]. Another study with refugee women in Semnan, Iran found IPV exposure was associated with a range of SRH outcomes, including early marriage, sexual coercion, unwanted pregnancy, and a high number of children [ 40 ].

The different ways that IPV was measured across studies make it difficult to synthesize these findings, however across studies it appears that a) urban forcibly displaced girls and women are disproportionately exposed to polvictimization (multiple forms of violence); b) there is a range of health challenges linked with IPV exposure, including and extending beyond SRH; and c) married women reported a high prevalence of IPV, including during pregnancy.

Risk factors associated with GBV exposure

Seven of the 17 articles that examined GBV explored risks associated with GBV exposure (41.2%) [ 36 , 37 , 42 , 46 , 52 , 68 , 75 ]. Three studies collected data from women only [ 36 , 42 , 46 ] while the other four collected data from both women and men [ 37 , 52 , 68 , 75 ]. One study found that women were more likely to share stories about sexual harassment while men more likely to discuss other forms of GBV [ 68 ].

GBV exposure risks varied across social categories, including age, education, changing social structures and norms, and disruption to social networks and livelihoods. For instance, studies with adolescent girls and young women, including refugees in Beirut, Beqaa, and Tripoli, Lebanon [ 68 ] and displaced people in Izmir, Turkey [ 75 ], reported that early marriage was associated with risks for further GBV [ 68 , 75 ]. Among those experiencing early marriage, factors that increased risks for GBV included limited educational opportunities, financial strains, and being alone outside the home [ 75 ]. Further, urbanization may change parents’ perspectives on child marriage after arriving in Lebanon, as they may be more likely to view early marriage as a pathway to protecting their daughters and reducing parental responsibility [ 39 ].

Among internally displaced adult women, displacement and subsequent loss of social support networks elevated risks for GBV [ 36 , 37 ]. For instance, in a study conducted in Port-au-Prince, Haiti, destruction of livelihood elevated risks for GBV [ 36 ]. Findings paralleled another study in Abidjan, Côte d’Ivoire that documented that poverty, food and housing instability, and changing gender roles and norms increased GBV exposure [ 37 ]. Partner characteristics and relationship dynamics were also associated with GBV, including partner alcohol misuse [ 41 , 42 ]. Among pregnant refugees in Sidon, Lebanon, odds of IPV were higher among those whose husbands did not want the pregnancy [ 42 ].

Polyvictimization was also reported [ 73 , 74 , 76 ]. For instance, forcibly displaced women with a history of childhood abuse may be more likely to experience adulthood violence [ 76 ], and as adult, forcibly displaced women may report multiple forms (e.g., physical violence, abductions, forced imprisonment, sexual violence, early/forced marriage) and contexts of violence (country of origin, host country) [ 74 ]. Together these studies on GBV suggest that multi-level factors, including structural (poverty, livelihood and educational barriers), social (gender inequitable norms, disrupted social networks), and relational (relationship power dynamics, partner alcohol use) level factors increase vulnerability to multiple forms of GBV among urban forcibly displaced persons.

HIV and other sexually transmitted infections (STIs)

Among the 20 articles examining HIV and STIs, 17 focused only on HIV, one article focused on HIV and transactional sex [ 50 ], one on STIs [ 49 ], and one on both HIV and STIs [ 54 ].

HIV and STI testing and prevention

Half of the HIV/STI articles focused on HIV testing and prevention ( n  = 10, 50%) [ 13 , 44 , 47 , 50 , 51 , 53 , 56 , 70 , 71 , 77 ]. Most of these were quantitative ( n  = 7) with three qualitative studies. Studies explored experiences among urban forcibly displaced men and women in Uganda [ 13 , 47 , 50 , 51 , 53 , 77 ], Nepal [ 44 ], and Peru [ 56 ], and refugee men who have sex with men (MSM) in Lebanon [ 70 , 71 ]. Testing uptake, recorded in six studies, ranged from 29–62% and varied by gender and population [ 44 , 47 , 50 , 70 , 71 , 77 ]. For instance, a study with refugees engaged in transactional sex in Kampala, Uganda found that engaging in transactional sex was associated with lower HIV testing among men, and was not associated with HIV testing among women [ 50 ].

Among articles that examined HIV testing [ 13 , 44 , 47 , 51 , 53 , 56 ], transportation costs, overcrowded living conditions, low literacy, and inequitable gender norms were identified as testing barriers [ 13 , 53 ]. Intersecting stigma—including stigma related to HIV, refugees, sexually active adolescents, and sex workers—also presented barriers to HIV testing among urban refugee youth in Kampala, Uganda [ 44 , 47 , 51 ]. Among urban Venezuelan forcibly displaced women in 6 cities in Peru (Metropolitan Lima, Callao, Tumbes, Cusco, Trujillo, Arequipa), not having health insurance was a barrier to HIV and STI testing [ 56 ]. Among MSM in Beirut, Lebanon, lack of comfort with doctors, not seeing a doctor in the past year, and not knowing where to access testing posed as barriers to testing [ 70 , 71 ] Among forcibly displaced urban refugee youth in Kampala, Uganda, factors associated with STI testing were lower food insecurity and lower adolescent SRH stigma [ 49 ].

Several studies focused on HIV vulnerabilities among forcibly displaced persons in urban Uganda [ 52 , 66 , 78 ]. For instance, a study in Gulu with internally displaced men and women reported an HIV prevalence of 12.8%, and risk factors associated with HIV infection included non-consensual sexual debut, past-year STI symptoms, and practicing dry sex (which was defined as sexual intercourse without foreplay or lubrication so that the vagina is dry upon penetration) [ 66 ]. Another study in Kampala, Uganda with refugee youth found that depression, alcohol use, and GBV were associated with HIV vulnerabilities, including recent transactional sex and multiple sex partners [ 52 ]. There may also be gender differences in HIV vulnerabilities; among urban refugee adolescents in Kampala, Uganda, young men reported higher condom self-efficacy than young women [ 62 , 63 ]. A study in Beirut, Lebanon found that over half (56.7%) of refugee MSM reported unprotected anal intercourse with men who were HIV positive or did not know their HIV serostatus, and over a third (36%) had engaged in transactional sex [ 70 , 71 ]. A qualitative study with internally displaced women in Northern Uganda found that the shift away from traditional belief systems, collapse of livelihoods, commuting away from home at night, and inadequate access to SRH information and services elevated HIV vulnerabilities among adolescent girls [ 78 ]. Another qualitative study, with forcibly displaced adult women in Medellin, Colombia, found that social and family fragmentation, GBV, abrupt changes in daily lives, and inequitable gender norms elevated HIV and STI acquisition risks [ 54 ]. These studies taken together reveal the ways that conflict-related life disruptions (e.g., belief systems, livelihoods, social networks), alongside structural factors (e.g., gender inequities, SGBV across the lifecourse, barriers to accessing SRH services) and relational factors (e.g., sexual practices, low condom efficacy), may increase exposure to HIV and STIs and reduce access to testing.

HIV treatment and care

Four articles focused on antiretroviral therapy (ART) and HIV care among urban refugee adult men and women [ 58 , 59 , 60 , 64 ]. Two quantitative studies in Kuala Lumpur, Malaysia that compared HIV treatment and clinical outcomes between refugees, displaced people, asylum seekers, and host community members found no differences in viral suppression among groups [ 58 , 59 ]. Qualitative studies explored challenges associated with achieving optimal treatment adherence [ 60 , 64 ]. One of these studies that included forcibly displaced persons in Kuala Lumpur, Malaysia found that limited access to food, pharmacy stock-outs, and difficulty navigating a new health system were barriers to optimal treatment adherence [ 60 ]. The few studies on HIV treatment and care that were included in this review span wide-ranging contexts, presenting challenges in drawing conclusions from this evidence-base and signal the need for more research with urban forcibly displaced persons living with HIV.

Antenatal care, postnatal care, and contraception

Among the 13 articles that explored antenatal and postnatal care and contraception, six focused on antenatal and postnatal care (46.2%) [ 30 , 34 , 35 , 38 , 65 , 72 ] and seven on contraception and family planning (53.8%) [ 31 , 43 , 55 , 56 , 62 , 63 , 67 ]. Most of these studies were conducted with adult forcibly displaced women ( n  = 9); one was conducted with healthcare workers and policy makers alongside adult women [ 34 ]. The remaining three studies were conducted with forcibly displaced adolescents, one of which explored experiences of only women [ 55 ].

Antenatal and postnatal care

Two of the 13 articles that examined antenatal and postnatal care used quantitative methods to explore uptake of antenatal care [ 30 , 35 ]. One study found that 82.9% of pregnant refugees had received some antenatal care in 14 high refugee density sites, including Beirut, in Lebanon [ 35 ], while another study found that pregnant refugees in Tehran, Iran attended an average of 3.73 out of 8 possible antenatal appointments [ 30 ]. Four articles explored barriers to accessing care and related risks [ 34 , 38 , 65 , 72 ]. One of these studies with pregnant refugees in South Tehran, Iran found that financial constraints, lack of health insurance, transportation challenges, stigma, cultural concerns, legal and immigration issues, and healthcare staff behaviour presented barriers to utilizing prenatal services [ 38 ]. Moreover, an article with pregnant forced migrant mothers in Mumbai, India reported that they could not access the antenatal care they need due to unfamiliarity with the local context and a lack of knowledge regarding where to access antenatal care, putting them at a greater risk for poor health outcomes [ 65 ]. From these limited studies, structural level challenges (e.g., health insurance barriers, healthcare mistreatment, immigration issues) alongside socio-cultural challenges (e.g., stigma, cultural and religious concerns) posed barriers to antenatal and postnatal care.

Contraception

Among the seven articles that explored family planning, five used quantitative methods to explore the access and utilization of contraceptives [ 55 , 56 , 62 , 63 , 67 ]. One study found that only 20.2% of migrant and refugee women in six urban cities in Peru had access to modern contraceptives [ 56 ]. Contraceptive access was reported to be influenced by family and relationship status as well as dynamics. For instance, among migrant and refugee women in six urban sites in Peru, lower socio-economic status was associated with reduced likelihood of emergency contraceptive use, and those who were married or lived with a partner were more likely to use modern and emergency contraceptives [ 56 ]. A qualitative study with forcibly displaced women in West Bekaa, Lebanon described that beliefs about wanting a large family size were often in tension with the financial hardships they experienced in displacement, men held the dominant role in making decisions about family planning, and contraceptive access was hindered by the unaffordability of the privatised health system [ 43 ]. Another qualitative study found that internally displaced women in Maputo, Mozambique experienced social isolation excluding them from the contraceptive revolution in their host community [ 31 ]. Together these studies paint a complex picture of contraceptive access and needs, where some factors associated with low contraception uptake may include structural barriers (e.g., low socio-economic status), relational factors, (e.g., relationship status), and socio-cultural values and priorities (e.g., wishes for larger family sizes) shaped by community norms and experiences of conflict.

Grey literature findings

Among the 37 included grey literature reports, over three-quarters ( n  = 29) examined GBV [ 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 ]; these studies are detailed in Table  3 . Emergent GBV themes centered on vulnerabilities to experiencing sexual, physical, and psychological abuse. Reports describe forcibly displaced persons in urban humanitarian contexts were at elevated risk for GBV exposure due to various social, cultural, and political dynamics, such as income insecurity, overcrowded living conditions, inequitable gender dynamics, inequitable power dynamics with administrative authorities, and limited awareness of rights [ 86 , 88 , 90 , 91 , 92 , 93 , 94 , 97 , 101 , 104 , 105 , 108 ]. Perpetrators of GBV included landlords, neighbors and employers, all of whom displaced people may be dependent on, and in lower positions of power [ 104 , 105 ]. The main reported targets of violence were women, sexual minorities, and transgender people [ 83 , 85 , 86 , 87 , 94 , 95 , 96 , 100 , 107 , 108 ]. These reports, taken together, emphasize the importance of integrated policies, research, and SRH services to reduce GBV and promote health equity among individuals at risk, including sexually and gender diverse persons. Additionally, the reports emphasize the critical need for support services to aid GBV survivors [ 79 , 82 , 85 , 98 , 103 ].

Other themes identified from the grey literature include sex work, disability, contraception needs, and the needs of people living with HIV. Two reports addressed sex work among displaced people who may fear social and legal consequences (including stigma and prosecution) if their sex work was disclosed; accordingly, mobile clinics were suggested as an appropriate entry point for SRH services tailored for forcibly displaced sex workers [ 80 , 109 ]. Another report described barriers to accessing SRH services, including HIV/STI testing and family planning, for forcibly displaced persons with disabilities, noting stigma faced by forcibly displaced people with disabilities [ 106 ]. Multiple studies described SRH service gaps, notably a lack of choice regarding a variety of family planning methods for forcibly displaced women, and limited access to HIV care for forcibly displaced people living with HIV [ 113 , 115 , 116 ]. Recommendations for improving access to SRH services for urban forcibly displaced people included: (1) improved collaboration between various systems and authorities that forcibly displaced people interface with; (2) wider dissemination of SRH knowledge to forcibly displaced persons; (3) the need to create safe, inclusive, and culturally-aware SRH spaces; and (4) the importance of empowering women and girls in humanitarian contexts to mitigate gender inequity as a barrier to SRH access [ 110 , 111 , 112 , 114 ].

Findings from this scoping review underscore that forcibly displaced individuals in urban LMIC settings face multiple barriers to SRH. These barriers encompass structural (e.g., loss of livelihoods, lack of health insurance), social (e.g., limited access to community support), interpersonal (e.g., gender inequitable relationship dynamics), and intrapersonal (e.g., poor mental health) factors. These barriers align with a social ecological [ 117 , 118 ] approach to health that accounts for the complex interplay between different spheres of influence, and can inform tailored interventions that target one or more levels for change (see Fig.  2 ). Our findings also identify understudied sexual health (i.e., sexual function and psychosexual counseling) and reproductive health (i.e., fertility care, safe abortion care) domains with this population.

Conceptual framework of multi-level sexual and reproductive health care barriers and challenges among urban forcibly displaced persons in low and middle-income countries

We found across included studies that displacement processes were discussed as exacerbating SRH vulnerabilities among forcibly displaced persons in urban LMIC settings [ 31 , 36 , 37 , 54 , 57 , 60 , 65 , 78 ]. These included the role of displacement in the breakdown of social support networks and loss of livelihoods in increasing exposure to GBV while also reducing access to sexual health services such as HIV/STI testing. However, the paucity of studies precludes synthesizing experiences by SRH domain (e.g., safe abortion), setting (e.g., slums/informal settlement), or population (e.g., adolescent). A similar limitation was identified by Singh et al. in their 2018 systematic review on the utilization of SRH services in humanitarian crises at large [ 119 ]. This observation signals a persistent lack of substantial progress in advancing the field as a whole, and in turn the contextually specific needs of urban forcibly displaced persons. We also found a limited focus on safe abortion and STIs beyond HIV. This suggests a need for additional attention to these understudied SRH issues.

Our findings indicate that stigma experienced by urban forcibly displaced persons presents barriers to SRH prevention, access, and care. Stigma is intersectional, targeting various identities such as refugee status and gender and spans across social-ecological levels, including being manifested at structural (e.g., laws and policies), health institution (e.g., healthcare mistreatment), community (e.g., stigma toward refugees), interpersonal (e.g. gender-based stigma), and intrapersonal (e.g., self-stigma) levels. Moreover, stigma is rooted in drivers and facilitators that could be effectively addressed through targeted stigma-reduction interventions [ 120 ]. Stigma within healthcare facilities can reinforce a wider mistrust of health systems among refugee and displaced persons [ 17 , 51 ]. There is scarcity of SRH interventions focused on stigma reduction with this population.

We documented that resource scarcities (e.g., food, housing, economic) were associated with worse SRH outcomes among urban forcibly displaced persons [ 37 , 60 , 75 , 76 ]. This reflects the long-standing insufficient funding and resources for SRH (and health care more generally) in humanitarian settings [ 48 ]. Once a forcibly displaced person leaves a formal refugee settlement/camp to migrate to urban regions, many forgo formal financial support offered by UNHCR or other refugee settlement-based organizations to refugees living in settlements, such as food, land/housing, or economic stipends. They may then experience financial challenges, such as transportation costs to accessing healthcare, high rent in cities and/or substandard housing in urban informal settlements, in addition to lack of health insurance in some contexts. These resource scarcity barriers to SRH care are further exacerbated by individual-level barriers such as low literacy and language barriers, and systemic-level barriers such as insufficient staffing and medication stock-outs.

Our study has limitations. We focused on a select range of SRH outcomes as defined by a SRH conceptual framework [ 28 , 29 ] and may have overlooked other important issues relevant to SRH outside of this (e.g., fistulae). Our criteria for language inclusion may have omitted some relevant articles. As there was so many different contexts, article types, refugee types (e.g., displaced, refugee), and populations (e.g., adolescents, pregnant adult women), we could not conduct a meta-analysis, and even when synthesizing key findings this heterogeneity presented challenges in contextualizing SRH findings within each setting and its socio-cultural norms, geography, country income, and laws and other social determinants of health. It is plausible that urban refugees may share health status outcomes with host communities while living in urban informal settlements or slums due to the nature of shared socio-cultural and economic conditions in slums [ 121 ], yet these similarities and/or differences in SRH outcomes with host communities were beyond the scope of this review. Further, the studies included in our analysis exhibited a significant underrepresentation of large global regions, namely Africa, Latin America, and the Caribbean. This limited inclusion of studies from these regions hampers our understanding of the specific needs and priorities of urban forcibly displaced persons residing in these urban contexts (Figs.  3 and  4 ). Despite these limitations, this review’s strengths include its unique focus on urban forcibly displaced persons in LMIC contexts, where the majority of forcibly displaced persons live. Our review also reinforces the need to include multiply marginalized communities in future SRH research—including urban forcibly displaced sex workers, people who use drugs, and lesbian, gay, bisexual, and transgender persons [ 122 , 123 , 124 ].

Map of countries of included peer-reviewed studies in this scoping review of urban forcibly displaced persons' sexual and reproductive health in low and middle-income countries. Included countries are represented with colours reflecting the number of studies from each country reported in the figure legend

Map of countries of included grey literature studies in this scoping review of urban forcibly displaced persons' sexual and reproductive health in low and middle-income countries. Included countries are represented with colours reflecting the number of studies from each country reported in the figure legend

Urgent research and interventions are needed to address SRH challenges faced by urban forcibly displaced persons; these strategies can ultimately advance health equity and well-being not only for forcibly displaced persons, but in the case of those living in slums, interventions may have multiplier effects [ 121 ]. Future research can identify targets for stigma reduction (e.g., healthcare workers, refugee women) and implement evidence-based intersectional stigma reduction strategies to mitigate barriers to accessing SRH care [ 125 ]. Effectively advancing SRH in humanitarian settings requires resources for implementing and evaluating multi-level interventions integrated within existing health systems, as well as community-level, family-level, and individual-level approaches. Such interventions can specifically address health literacy and language needs of urban forcibly displaced persons, transportation-related challenges (e.g., via mobile clinics), and, when needed, extend health insurance coverage to forcibly displaced individuals. Additionally, innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, over-the-counter oral contraception, abortion self-management) hold significant promise in addressing some of these aforementioned SRH barriers and can be explored and tested with urban forcibly displaced persons. These self-care strategies may help to overcome challenges related to privacy, transportation, and healthcare provider mistrust [ 48 , 126 ], yet they also require an enabling social and health environment, so can be offered in tandem with strategies focused on advancing social and health equity [ 126 ].

This review identified barriers to SRH care spanning social-ecological levels [ 117 , 118 ] among urban forcibly displaced persons in LMIC contexts. The process of displacement, resource insecurity, and stigma exacerbate and drive SRH vulnerabilities for urban forcibly displaced persons in LMIC contexts. However, there remain critical knowledge gaps regarding a range of SRH issues across diverse LMIC settings, with particular knowledge gaps regarding socially marginalized populations. Our findings signal that in urban LMIC settings, there may be unique barriers to accessing SRH information, resources and care faced by forcibly displaced persons (e.g., no financial support from UNHCR or other refugee agencies, social isolation, language barriers at clinics) compared to formal refugee settlements where persons may have more access to refugee communities, translators at clinics, and financial stipends (e.g., housing, land, food supplements). Future research and action are required to address the unique and often unmet SRH needs among urban forcibly displaced persons to advance health and rights.

Availability of data and materials

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

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CHL received funding from the Canada Research Chairs Program and the Canadian Institutes of Health Research (CIHR). They played no role in the research process, focus, analysis or other aspects of research.

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CHL conceptualized the study and led the writing. FM substantially contributed to writing the manuscript as well as screening, data extraction and synthesis. FM, KM, NL, AL, KD, MZ, conducted the searches, screening and extraction. APB contributed to drafting and editing the manuscript. MN, SF, BT, JK, KK and ABP contributed to editing the manuscript and providing interpretation of findings. CHL, AH, and FM contributed to the revision process. All authors approved the final version of the manuscript.All authors approved the final version of the manuscript.

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Logie, C.H., MacKenzie, F., Malama, K. et al. Sexual and reproductive health among forcibly displaced persons in urban environments in low and middle-income countries: scoping review findings. Reprod Health 21 , 51 (2024). https://doi.org/10.1186/s12978-024-01780-7

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