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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

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

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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Literature Reviews

Steps in the literature review process.

• What is a literature review?
• Define your research question
• Determine inclusion and exclusion criteria
• Choose databases and search
• Review Results
• Synthesize Results
• Analyze Results
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• Artificial Intelligence (AI) Tools
• You may need to some exploratory searching of the literature to get a sense of scope, to determine whether you need to narrow or broaden your focus
• Identify databases that provide the most relevant sources, and identify relevant terms (controlled vocabularies) to add to your search strategy
• Finalize your research question
• Think about relevant dates, geographies (and languages), methods, and conflicting points of view
• Conduct searches in the published literature via the identified databases
• Check to see if this topic has been covered in other discipline's databases
• Examine the citations of on-point articles for keywords, authors, and previous research (via references) and cited reference searching.
• Save your search results in a citation management tool (such as Zotero, Mendeley or EndNote)
• De-duplicate your search results
• Make sure that you've found the seminal pieces -- they have been cited many times, and their work is considered foundational 
• Check with your professor or a librarian to make sure your search has been comprehensive
• Evaluate the strengths and weaknesses of individual sources and evaluate for bias, methodologies, and thoroughness
• Group your results in to an organizational structure that will support why your research needs to be done, or that provides the answer to your research question  
• Develop your conclusions
• Are there gaps in the literature?
• Where has significant research taken place, and who has done it?
• Is there consensus or debate on this topic?
• Which methodological approaches work best?
• For example: Background, Current Practices, Critics and Proponents, Where/How this study will fit in 
• Organize your citations and focus on your research question and pertinent studies
• Compile your bibliography

Note: The first four steps are the best points at which to contact a librarian. Your librarian can help you determine the best databases to use for your topic, assess scope, and formulate a search strategy.

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Conduct a literature review

What is a literature review.

A literature review is a summary of the published work in a field of study. This can be a section of a larger paper or article, or can be the focus of an entire paper. Literature reviews show that you have examined the breadth of knowledge and can justify your thesis or research questions. They are also valuable tools for other researchers who need to find a summary of that field of knowledge.

Unlike an annotated bibliography, which is a list of sources with short descriptions, a literature review synthesizes sources into a summary that has a thesis or statement of purpose—stated or implied—at its core.

How do I write a literature review?

Step 1: define your research scope.

• What is the specific research question that your literature review helps to define?
• Are there a maximum or minimum number of sources that your review should include?

Ask us if you have questions about refining your topic, search methods, writing tips, or citation management.

Step 2: Identify the literature

Start by searching broadly. Literature for your review will typically be acquired through scholarly books, journal articles, and/or dissertations. Develop an understanding of what is out there, what terms are accurate and helpful, etc., and keep track of all of it with citation management tools . If you need help figuring out key terms and where to search, ask us .

Use citation searching to track how scholars interact with, and build upon, previous research:

• Mine the references cited section of each relevant source for additional key sources
• Use Google Scholar or Scopus to find other sources that have cited a particular work

Step 3: Critically analyze the literature

Key to your literature review is a critical analysis of the literature collected around your topic. The analysis will explore relationships, major themes, and any critical gaps in the research expressed in the work. Read and summarize each source with an eye toward analyzing authority, currency, coverage, methodology, and relationship to other works. The University of Toronto's Writing Center provides a comprehensive list of questions you can use to analyze your sources.

Step 4: Categorize your resources

Divide the available resources that pertain to your research into categories reflecting their roles in addressing your research question. Possible ways to categorize resources include organization by:

• methodology
• theoretical/philosophical approach

Regardless of the division, each category should be accompanied by thorough discussions and explanations of strengths and weaknesses, value to the overall survey, and comparisons with similar sources. You may have enough resources when:

• You've used multiple databases and other resources (web portals, repositories, etc.) to get a variety of perspectives on the research topic.
• The same citations are showing up in a variety of databases.

Additional resources

Undergraduate student resources.

• Literature Review Handout (University of North Carolina at Chapel Hill)
• Learn how to write a review of literature (University of Wisconsin-Madison)

Graduate student and faculty resources

• Information Research Strategies (University of Arizona)
• Literature Reviews: An Overview for Graduate Students (NC State University)
• Oliver, P. (2012). Succeeding with Your Literature Review: A Handbook for Students [ebook]
• Machi, L. A. & McEvoy, B. T. (2016). The Literature Review: Six Steps to Success [ebook]
• Graustein, J. S. (2012). How to Write an Exceptional Thesis or Dissertation: A Step-by-Step Guide from Proposal to Successful Defense [ebook]
• Thomas, R. M. & Brubaker, D. L. (2008). Theses and Dissertations: A Guide to Planning, Research, and Writing

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

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

• Getting Started
• How to Pick a Topic
• Strategies to Find Sources
• Evaluating Sources & Lit. Reviews
• Tips for Writing Literature Reviews
• Writing Literature Review: Useful Sites
• Citation Resources
• Other Academic Writings

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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• Last Updated: Sep 21, 2022 2:16 PM
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How to Write a Literature Review: Six Steps to Get You from Start to Finish

Writing-a-literature-review-six-steps-to-get-you-from-start-to-finish.

Tanya Golash-Boza, Associate Professor of Sociology, University of California

February 03, 2022

Writing a literature review is often the most daunting part of writing an article, book, thesis, or dissertation. “The literature” seems (and often is) massive. I have found it helpful to be as systematic as possible when completing this gargantuan task.

Sonja Foss and William Walters* describe an efficient and effective way of writing a literature review. Their system provides an excellent guide for getting through the massive amounts of literature for any purpose: in a dissertation, an M.A. thesis, or preparing a research article for publication  in any field of study. Below is a  summary of the steps they outline as well as a step-by-step method for writing a literature review.

How to Write a Literature Review

Step One: Decide on your areas of research:

Before you begin to search for articles or books, decide beforehand what areas you are going to research. Make sure that you only get articles and books in those areas, even if you come across fascinating books in other areas. A literature review I am currently working on, for example, explores barriers to higher education for undocumented students.

Step Two: Search for the literature:

Conduct a comprehensive bibliographic search of books and articles in your area. Read the abstracts online and download and/or print those articles that pertain to your area of research. Find books in the library that are relevant and check them out. Set a specific time frame for how long you will search. It should not take more than two or three dedicated sessions.

Step Three: Find relevant excerpts in your books and articles:

Skim the contents of each book and article and look specifically for these five things:

1. Claims, conclusions, and findings about the constructs you are investigating

2. Definitions of terms

3. Calls for follow-up studies relevant to your project

4. Gaps you notice in the literature

5. Disagreement about the constructs you are investigating

When you find any of these five things, type the relevant excerpt directly into a Word document. Don’t summarize, as summarizing takes longer than simply typing the excerpt. Make sure to note the name of the author and the page number following each excerpt. Do this for each article and book that you have in your stack of literature. When you are done, print out your excerpts.

Step Four: Code the literature:

Get out a pair of scissors and cut each excerpt out. Now, sort the pieces of paper into similar topics. Figure out what the main themes are. Place each excerpt into a themed pile. Make sure each note goes into a pile. If there are excerpts that you can’t figure out where they belong, separate those and go over them again at the end to see if you need new categories. When you finish, place each stack of notes into an envelope labeled with the name of the theme.

Step Five: Create Your Conceptual Schema:

Type, in large font, the name of each of your coded themes. Print this out, and cut the titles into individual slips of paper. Take the slips of paper to a table or large workspace and figure out the best way to organize them. Are there ideas that go together or that are in dialogue with each other? Are there ideas that contradict each other? Move around the slips of paper until you come up with a way of organizing the codes that makes sense. Write the conceptual schema down before you forget or someone cleans up your slips of paper.

Step Six: Begin to Write Your Literature Review:

Choose any section of your conceptual schema to begin with. You can begin anywhere, because you already know the order. Find the envelope with the excerpts in them and lay them on the table in front of you. Figure out a mini-conceptual schema based on that theme by grouping together those excerpts that say the same thing. Use that mini-conceptual schema to write up your literature review based on the excerpts that you have in front of you. Don’t forget to include the citations as you write, so as not to lose track of who said what. Repeat this for each section of your literature review.

Once you complete these six steps, you will have a complete draft of your literature review. The great thing about this process is that it breaks down into manageable steps something that seems enormous: writing a literature review.

I think that Foss and Walter’s system for writing the literature review is ideal for a dissertation, because a Ph.D. candidate has already read widely in his or her field through graduate seminars and comprehensive exams.

It may be more challenging for M.A. students, unless you are already familiar with the literature. It is always hard to figure out how much you need to read for deep meaning, and how much you just need to know what others have said. That balance will depend on how much you already know.

For people writing literature reviews for articles or books, this system also could work, especially when you are writing in a field with which you are already familiar. The mere fact of having a system can make the literature review seem much less daunting, so I recommend this system for anyone who feels overwhelmed by the prospect of writing a literature review.

*Destination Dissertation: A Traveler's Guide to a Done Dissertation

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How to Conduct a Literature Review (Health Sciences and Beyond)

What is a literature review, traditional (narrative) literature review, integrative literature review, systematic reviews, meta-analysis, scoping review.

• Developing a Research Question
• Selection Criteria
• Database Search
• Documenting Your Search
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Related Guides

• Systematic Reviews by Roy Brown Last Updated Oct 17, 2023 725 views this year
• Write a Literature Review by John Glover Last Updated Oct 16, 2023 3610 views this year

A literature review provides an overview of what's been written about a specific topic. There are many different types of literature reviews. They vary in terms of comprehensiveness, types of study included, and purpose. 

The other pages in this guide will cover some basic steps to consider when conducting a traditional health sciences literature review. See below for a quick look at some of the more popular types of literature reviews.

For additional information on a variety of review methods, the following article provides an excellent overview.

Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x. Review. PubMed PMID: 19490148.

• Next: Developing a Research Question >>
• Last Updated: Mar 15, 2024 12:22 PM
• URL: https://guides.library.vcu.edu/health-sciences-lit-review

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What Will You Do Differently?

Please help your librarians by filling out this two-minute survey of today's class session..

Professor, this one's for you .

Introduction

Literature reviews take time. here is some general information to know before you start.  .

•  VIDEO -- This video is a great overview of the entire process.  (2020; North Carolina State University Libraries) --The transcript is included --This is for everyone; ignore the mention of "graduate students" --9.5 minutes, and every second is important  
• OVERVIEW -- Read this page from Purdue's OWL. It's not long, and gives some tips to fill in what you just learned from the video.  
• NOT A RESEARCH ARTICLE -- A literature review follows a different style, format, and structure from a research article.  

Steps to Completing a Literature Review

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How to Conduct a Literature Review: A Guide for Graduate Students

• Let's Get Started!
• Traditional or Narrative Reviews
• Systematic Reviews
• Typology of Reviews
• Literature Review Resources
• Developing a Search Strategy
• What Literature to Search
• Where to Search: Indexes and Databases
• Finding articles: Libkey Nomad
• Finding Dissertations and Theses
• Extending Your Searching with Citation Chains
• Forward Citation Chains - Cited Reference Searching
• Keeping up with the Literature
• Managing Your References
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Bookmark This Guide!

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Librarians at ISU are subject experts who can help with your research and course needs. There are experts available for every discipline at ISU who are ready to assist you with your information needs!

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Find Your Librarian

   “Google can bring you back 100,000 answers. A librarian can bring you back the right one.” - Neil Gaiman

The literature review is an important part of your thesis or dissertation. It is a survey of existing literature that provides context for your research contribution, and demonstrates your subject knowledge. It is also the way to tell the story of how your research extends knowledge in your field.

The first step to writing a successful literature review is knowing how to find and evaluate literature in your field. This guide is designed to introduce you to tools and give you skills you can use to effectively find the resources needed for your literature review.

Before getting started, familiarize yourself with some essential resources provided by the Graduate College:

• Dissertation and Thesis Information
• Center for Communication Excellence
• Graduate College Handbook

Below are some questions that you can discuss with your advisor as you begin your research:

Questions to ask as you think about your literature review:

What is my research question.

Choosing a valid research question is something you will need to discuss with your academic advisor and/or POS committee. Ideas for your topic may come from your coursework, lab rotations, or work as a research assistant. Having a specific research topic allows you to focus your research on a project that is manageable. Beginning work on your literature review can help narrow your topic.

What kind of literature review is appropriate for my research question?

Depending on your area of research, the type of literature review you do for your thesis will vary. Consult with your advisor about the requirements for your discipline. You can view theses and dissertations from your field in the library's Digital Repository can give you ideas about how your literature review should be structured.

What kind of literature should I use?

The kind of literature you use for your thesis will depend on your discipline. The Library has developed a list of Guides by Subject with discipline-specific resources. For a given subject area, look for the guide titles "[Discipline] Research Guide." You may also consult our liaison librarians for information about the literature available your research area.

How will I make sure that I find all the appropriate information that informs my research?

Consulting multiple sources of information is the best way to insure that you have done a comprehensive search of the literature in your area. The What Literature to Search tab has information about the types of resources you may need to search. You may also consult our liaison librarians for assistance with identifying resources..

How will I evaluate the literature to include trustworthy information and eliminate unnecessary or untrustworthy information?

While you are searching for relevant information about your topic you will need to think about the accuracy of the information, whether the information is from a reputable source, whether it is objective and current. Our guides about Evaluating Scholarly Books and Articles and Evaluating Websites will give you criteria to use when evaluating resources.

How should I organize my literature? What citation management program is best for me?

Citation management software can help you organize your references in folders and/or with tags. You can also annotate and highlight the PDFs within the software and usually the notes are searchable. To choose a good citation management software, you need to consider which one can be streamlined with your literature search and writing process. Here is a guide page comparing EndNote, Mendeley & Zotero. The Library also has guides for three of the major citation management tools:

• EndNote & EndNote Web Guide
• Mendeley Guide
• Getting Started with Zotero

What steps should I take to ensure academic integrity?

The best way to ensure academic integrity is to familiarize yourself with different types of intentional and unintentional plagiarism and learn about the University's standards for academic integrity. Start with this guide . The Library also has a guide about your rights and responsibilities regarding copyrighted images and figures that you include in your thesis.

Where can I find writing and editing help?

Writing and editing help is available at the Graduate College's Center for Communication Excellence . The CCE offers individual consultations, peer writing groups, workshops and seminars to help you improve your writing.

Where can I find I find formatting standards? Technical support?

The Graduate College has a Dissertation/ Thesis website with extensive examples and videos about formatting theses and dissertations. The site also has templates and formatting instructions for Word and LaTex .

What citation style should I use?

The Graduate College thesis guidelines require that you "use a consistent, current academic style for your discipline." The Library has a Citation Style Guides resource you can use for guidance on specific citation styles. If you are not sure, please consult your advisor or liaison librarians for help.

Adapted from The Literature Review: For Dissertations, by the University of Michigan Library. Available: https://guides.lib.umich.edu/dissertationlitreview

Center for Communication Excellence/ Library Workshop Slides

Slides from the CCE/ Library Workshop "A Citation Here...A Citation There...Pretty Soon You'll Have a Lit Review" held on February 21, 2024 are below:

• CCE Workshop February 21, 2024
• Next: Types of Literature Reviews >>

The library's collections and services are available to all ISU students, faculty, and staff and Parks Library is open to the public .

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Conducting a Literature Review

Literature Reviews

• How to Write a Literature Review
• Writing a Literature Review Learning how to write a literature review is critical tool for an academic, and perhaps even a professional career. Being able to summarize and synthesize prior research relating to a certain topic not only demonstrates having a goof grasp on available information for a certain topic, but it also assists with the leaning process. Although literature reviews are important for one's academic career they are often misunderstood and underdeveloped. This article is intended to provide both undergraduate and graduate students skills and perspectives on how to develop and strengthen their skills in writing a literature review.
• Conceptual Issues in Framing Theory: A Systematic Examination of a Decade's Literature Although many scholars have pointed out problems in framing research, there has been very few systematic examinations of the published literature. To examine the common conceptual debates, the present study content analyzes framing literature from 93 peer-reviewed journals for a decade. Two methods were employed for the sample: First, every journal identified as a 'communication journal' in the Journal Citation Report was included; second, keyword searches in electronic databases were used. The main findings showed that framing studies have concentrated more on message design and 'unique' frames. Consistent with existing debates, results highlight the lack of research about production of frames and mixed frames. This examination of a decade's published literature reveals better direction for future research.
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Literature Review: Conducting & Writing

• Steps for Conducting a Lit Review

1. Choose a topic. Define your research question.

2. decide on the scope of your review., 3. select the databases you will use to conduct your searches., 4. conduct your searches and find the literature. keep track of your searches, 5. review the literature..

• Finding "The Literature"
• Organizing/Writing
• APA Style This link opens in a new window
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• Sample Literature Reviews

Disclaimer!!

Conducting a literature review is usually recursive, meaning that somewhere along the way, you'll find yourself repeating steps out-of-order.

That is actually a good sign.  

Reviewing the research should lead to more research questions and those questions will likely lead you to either revise your initial research question or go back and find more literature related to a more specific aspect of your research question.

Your literature review should be guided by a central research question.  Remember, it is not a collection of loosely related studies in a field but instead represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

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

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

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

Make a list of the databases you will search.  Remember to include comprehensive databases such as WorldCat and Dissertations & Theses, if you need to.

Where to find databases:

• Find Databases by Subject UWF Databases categorized by discipline
• Find Databases via Research Guides Librarians create research guides for all of the disciplines on campus! Take advantage of their expertise and see what discipline-specific search strategies they recommend!
• Review the abstracts of research studies carefully. This will save you time.
• Write down the searches you conduct in each database so that you may duplicate them if you need to later (or avoid dead-end searches   that you'd forgotten you'd already tried).
• Use the bibliographies and references of research studies you find to locate others.
• Ask your professor or a scholar in the field if you are missing any key works in the field.
• Use RefWorks to keep track of your research citations. See the RefWorks Tutorial if you need help.

Some questions to help you analyze the research:

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

Tips: 

• Again, review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
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• Last Updated: Mar 22, 2024 9:37 AM
• URL: https://libguides.uwf.edu/litreview

Literature Review

• Steps for Conducting a Lit Review
• Finding "The Literature"
• Organizing/Writing
• Sample Literature Reviews
• FAMU Writing Center

1. Choose a topic. Define your research question.

Your literature review should be guided by a central research question.  Remember, it is not a collection of loosely related studies in a field but instead represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way.

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

2. Decide on the scope of your review.

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

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

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

Make a list of the databases you will search. 

• Look at the Library's research guides in your discipline to select discipline-specific databases.  Don't forget to look at books!
• Make an appointment with or contact your   subject librarian to make sure you aren't missing major databases.

4. Conduct your searches and find the literature. Keep track of your searches!

Tips: 

• Review the abstracts of research studies carefully. This will save you time.
• Write down the searches you conduct in each database so that you may duplicate them if you need to later (or avoid dead-end searches   that you'd forgotten you'd already tried).
• Use the bibliographies and references of research studies you find to locate others.
• Ask your professor or a scholar in the field if you are missing any key works in the field.
• Use RefWorks to keep track of your research citations. See the RefWorks Tutorial if you need help.

5. Review the literature.

Some questions to help you analyze the research:

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

Composing your literature review

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

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

Use evidence

In the example above, the writers refer to several other sources when making their point. A literature review in this sense is just like any other academic research paper. Your interpretation of the available sources must be backed up with evidence to show that what you are saying is valid.

Be selective

Select only the most important points in each source to highlight in the review. The type of information you choose to mention should relate directly to the review's focus, whether it is thematic, methodological, or chronological.

Use quotes sparingly

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

Summarize and synthesize

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

Keep your own voice

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

Use caution when paraphrasing

When paraphrasing a source that is not your own, be sure to represent the author's information or opinions accurately and in your own words. In the preceding example, Falk and Mills either directly refer in the text to the author of their source, such as Hamilton, or they provide ample notation in the text when the ideas they are mentioning are not their own, for example, Gastil's. For more information, please see our handout on plagiarism .

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• Last Updated: Oct 20, 2022 11:24 AM
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What is a Literature Review?

Description.

A literature review, also called a review article or review of literature, surveys the existing research on a topic. The term "literature" in this context refers to published research or scholarship in a particular discipline, rather than "fiction" (like American Literature) or an individual work of literature. In general, literature reviews are most common in the sciences and social sciences.

Literature reviews may be written as standalone works, or as part of a scholarly article or research paper. In either case, the purpose of the review is to summarize and synthesize the key scholarly work that has already been done on the topic at hand. The literature review may also include some analysis and interpretation. A literature review is  not  a summary of every piece of scholarly research on a topic.

Why are literature reviews useful?

Literature reviews can be very helpful for newer researchers or those unfamiliar with a field by synthesizing the existing research on a given topic, providing the reader with connections and relationships among previous scholarship. Reviews can also be useful to veteran researchers by identifying potentials gaps in the research or steering future research questions toward unexplored areas. If a literature review is part of a scholarly article, it should include an explanation of how the current article adds to the conversation. (From: https://researchguides.drake.edu/englit/criticism)

How is a literature review different from a research article?

Research articles: "are empirical articles that describe one or several related studies on a specific, quantitative, testable research question....they are typically organized into four text sections: Introduction, Methods, Results, Discussion." Source: https://psych.uw.edu/storage/writing_center/litrev.pdf)

Steps for Writing a Literature Review

1. Identify and define the topic that you will be reviewing.

The topic, which is commonly a research question (or problem) of some kind, needs to be identified and defined as clearly as possible.  You need to have an idea of what you will be reviewing in order to effectively search for references and to write a coherent summary of the research on it.  At this stage it can be helpful to write down a description of the research question, area, or topic that you will be reviewing, as well as to identify any keywords that you will be using to search for relevant research.

2. Conduct a Literature Search

Use a range of keywords to search databases such as PsycINFO and any others that may contain relevant articles.  You should focus on peer-reviewed, scholarly articles . In SuperSearch and most databases, you may find it helpful to select the Advanced Search mode and include "literature review" or "review of the literature" in addition to your other search terms.  Published books may also be helpful, but keep in mind that peer-reviewed articles are widely considered to be the “gold standard” of scientific research.  Read through titles and abstracts, select and obtain articles (that is, download, copy, or print them out), and save your searches as needed. Most of the databases you will need are linked to from the Cowles Library Psychology Research guide .

3. Read through the research that you have found and take notes.

Absorb as much information as you can.  Read through the articles and books that you have found, and as you do, take notes.  The notes should include anything that will be helpful in advancing your own thinking about the topic and in helping you write the literature review (such as key points, ideas, or even page numbers that index key information).  Some references may turn out to be more helpful than others; you may notice patterns or striking contrasts between different sources; and some sources may refer to yet other sources of potential interest.  This is often the most time-consuming part of the review process.  However, it is also where you get to learn about the topic in great detail. You may want to use a Citation Manager to help you keep track of the citations you have found. 

4. Organize your notes and thoughts; create an outline.

At this stage, you are close to writing the review itself.  However, it is often helpful to first reflect on all the reading that you have done.  What patterns stand out?  Do the different sources converge on a consensus?  Or not?  What unresolved questions still remain?  You should look over your notes (it may also be helpful to reorganize them), and as you do, to think about how you will present this research in your literature review.  Are you going to summarize or critically evaluate?  Are you going to use a chronological or other type of organizational structure?  It can also be helpful to create an outline of how your literature review will be structured.

5. Write the literature review itself and edit and revise as needed.

The final stage involves writing.  When writing, keep in mind that literature reviews are generally characterized by a  summary style  in which prior research is described sufficiently to explain critical findings but does not include a high level of detail (if readers want to learn about all the specific details of a study, then they can look up the references that you cite and read the original articles themselves).  However, the degree of emphasis that is given to individual studies may vary (more or less detail may be warranted depending on how critical or unique a given study was).   After you have written a first draft, you should read it carefully and then edit and revise as needed.  You may need to repeat this process more than once.  It may be helpful to have another person read through your draft(s) and provide feedback.

6. Incorporate the literature review into your research paper draft. (note: this step is only if you are using the literature review to write a research paper. Many times the literature review is an end unto itself).

After the literature review is complete, you should incorporate it into your research paper (if you are writing the review as one component of a larger paper).  Depending on the stage at which your paper is at, this may involve merging your literature review into a partially complete Introduction section, writing the rest of the paper around the literature review, or other processes.

These steps were taken from: https://psychology.ucsd.edu/undergraduate-program/undergraduate-resources/academic-writing-resources/writing-research-papers/writing-lit-review.html#6.-Incorporate-the-literature-r

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The Literature Review: A Few Tips On Conducting It

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What is a review of the literature?

A literature review is an account of what has been published on a topic by accredited scholars and researchers. Occasionally you will be asked to write one as a separate assignment (sometimes in the form of an annotated bibliography —see the bottom of the next page), but more often it is part of the introduction to an essay, research report, or thesis. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries

Besides enlarging your knowledge about the topic, writing a literature review lets you gain and demonstrate skills in two areas

• information seeking : the ability to scan the literature efficiently, using manual or computerized methods, to identify a set of useful articles and books
• critical appraisal : the ability to apply principles of analysis to identify unbiased and valid studies.

A literature review must do these things

• be organized around and related directly to the thesis or research question you are developing
• synthesize results into a summary of what is and is not known
• identify areas of controversy in the literature
• formulate questions that need further research

Ask yourself questions like these:

• What is the specific thesis, problem, or research question that my literature review helps to define?
• What type of literature review am I conducting? Am I looking at issues of theory? methodology? policy? quantitative research (e.g. on the effectiveness of a new procedure)? qualitative research (e.g., studies of loneliness among migrant workers)?
• What is the scope of my literature review? What types of publications am I using (e.g., journals, books, government documents, popular media)? What discipline am I working in (e.g., nursing psychology, sociology, medicine)?
• How good was my information seeking ? Has my search been wide enough to ensure I’ve found all the relevant material? Has it been narrow enough to exclude irrelevant material? Is the number of sources I’ve used appropriate for the length of my paper?
• Have I critically analysed the literature I use? Do I follow through a set of concepts and questions, comparing items to each other in the ways they deal with them? Instead of just listing and summarizing items, do I assess them, discussing strengths and weaknesses?
• Have I cited and discussed studies contrary to my perspective?
• Will the reader find my literature review relevant, appropriate, and useful ?

Ask yourself questions like these about each book or article you include:

• Has the author formulated a problem/issue?
• Is it clearly defined? Is its significance (scope, severity, relevance) clearly established?
• Could the problem have been approached more effectively from another perspective?
• What is the author’s research orientation (e.g., interpretive, critical science, combination)?
• What is the author’s theoretical framework (e.g., psychological, developmental, feminist)?
• What is the relationship between the theoretical and research perspectives?
• Has the author evaluated the literature relevant to the problem/issue? Does the author include literature taking positions she or he does not agree with?
• In a research study, how good are the basic components of the study design (e.g., population, intervention, outcome)? How accurate and valid are the measurements? Is the analysis of the data accurate and relevant to the research question? Are the conclusions validly based upon the data and analysis?
• In material written for a popular readership, does the author use appeals to emotion, one-sided examples, or rhetorically-charged language and tone? Is there an objective basis to the reasoning, or is the author merely “proving” what he or she already believes?
• How does the author structure the argument? Can you “deconstruct” the flow of the argument to see whether or where it breaks down logically (e.g., in establishing cause-effect relationships)?
• In what ways does this book or article contribute to our understanding of the problem under study, and in what ways is it useful for practice? What are the strengths and limitations?
• How does this book or article relate to the specific thesis or question I am developing?

Final Notes:

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

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

This handout and many others are available in Writing in the Health Sciences: a comprehensive guide .

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What is a Literature Review?

A literature review is an essay that surveys, summarizes, links together, and assesses research in a given field. It surveys the literature by reviewing a large body of work on a subject; it summarizes by noting the main conclusions and findings of the research; it links together works in the literature by showing how the information fits into the overall academic discussion and how the information relates to one another; it assesses the literature by noting areas of weakness, expansion, and contention. This is the essentials of literature review construction by discussing the major sectional elements, their purpose, how they are constructed, and how they all fit together.

All literature reviews have major sections:

• Introduction: that indicates the general state of the literature on a given topic;
• Methodology: an overview of how, where, and what subject terms used to conducted your search so it may be reproducable
• Findings: a summary of the major findings in that field;
• Discussion: a general progression from wider studies to smaller, more specifically-focused studies;
• Conclusion: for each major section that again notes the overall state of the research, albeit with a focus on the major synthesized conclusions, problems in the research, and even possible avenues of further research.

In Literature Reviews, it is Not Appropriate to:

• State your own opinions on the subject (unless you have evidence to support such claims).  
• State what you think nurses should do (unless you have evidence to support such claims).
• Provide long descriptive accounts of your subject with no reference to research studies.
• Provide numerous definitions, signs/symptoms, treatment and complications of a particular illness without focusing on research studies to provide evidence and the primary purpose of the literature review.
• Discuss research studies in isolation from each other.

Remember, a literature review is not a book report. A literature review is focus, succinct, organized, and is free of personal beliefs or unsubstantiated tidbits.

• Types of Literature Reviews A detailed explanation of the different types of reviews and required citation retrieval numbers

Outline of a Literture Review

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

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

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• Cite this Page Paré G, Kitsiou S. Chapter 9 Methods for Literature Reviews. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
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Methods and guidance on conducting, reporting, publishing and appraising living systematic reviews: a scoping review protocol

Affiliations.

• 1 Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50937, Germany.
• 2 Department of Medicine, American University of Beirut, Beirut, Lebanon.
• 3 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
• 4 Editorial and Methods Department, Cochrane Central Executive, Cochrane, London, SW1Y 4QX, UK.
• 5 Rafic Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
• 6 F1000 Research Ltd, London, SE1 8BU, UK.
• 7 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
• 8 Stockholm Environment Institute, Stockholm, Sweden.
• 9 Mercator Research Institute on Global Commons and Climate Change, Berlin, Germany.
• 10 Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa.
• PMID: 35186269
• PMCID: PMC8822136
• DOI: 10.12688/f1000research.55108.1

Background: The living systematic review (LSR) approach is based on an ongoing surveillance of the literature and continual updating. A few guidance documents address the conduct, reporting, publishing and appraisal of systematic reviews (SRs), but the methodology described is either not up-to date or not suitable for LSRs and misses additional LSR-specific considerations. The objective of this scoping review is to systematically collate methodological literature and guidance on how to conduct, report, publish and appraise the quality of LSRs. The scoping review will allow the mapping of the existing evidence on the topic to support LSRs authors seeking guidance and identify related gaps. Methods: To achieve our objectives, we will conduct a scoping review to survey and evaluate existing evidence, using the standard scoping review methodology. We will search MEDLINE, EMBASE, and Cochrane using the OVID interface. The search strategy was developed by a researcher experienced in developing literature search strategies with the help of an information specialist. As for searching grey literature, we will seek existing guidelines and handbooks on LSRs from organizations that conduct evidence syntheses using the Lens.org website. Two review authors will extract and catalogue the study data on LSR methodological aspects into a standardized and pilot-tested data extraction form. The main categories will reflect proposed methods for (i) conducting LSRs, (ii) reporting of LSRs, (iii) publishing and (iv) appraising the quality of LSRs. Data synthesis and conclusion: By collecting these data from methodological surveys and papers, as well as existing guidance documents and handbooks on LSRs, we might identify specific issues and components lacking within current LSR methodology. Thus, the systematically obtained findings of the scoping review could be used as basis for the revision of existing methods tools on LSR, for instance a PRISMA statement extension for LSRs.

Keywords: Living systematic reviews; appraisal; conducting LSRs; methods and guidance; reporting; scoping review.

Copyright: © 2021 Iannizzi C et al.

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Conflict of interest statement

Competing interests: JMB is a Publishing Executive for F1000 Research Ltd. JMB was involved in editing and drafting of the article, but had no involvement following submission of the final version for publication, nor in the post-publication peer review of the article.

Figure 1.. Framework on the methodological plan,…

Figure 1.. Framework on the methodological plan, from search to data synthesis, for this scoping…

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• Methods and guidance on conducting, reporting, publishing, and appraising living systematic reviews: a scoping review. Iannizzi C, Akl EA, Anslinger E, Weibel S, Kahale LA, Aminat AM, Piechotta V, Skoetz N. Iannizzi C, et al. Syst Rev. 2023 Dec 14;12(1):238. doi: 10.1186/s13643-023-02396-x. Syst Rev. 2023. PMID: 38098023 Free PMC article.
• Methodological quality and reporting quality of COVID-19 living systematic review: a cross-sectional study. Luo J, Chen Z, Liu D, Li H, He S, Zeng L, Yang M, Liu Z, Xiao X, Zhang L. Luo J, et al. BMC Med Res Methodol. 2023 Jul 31;23(1):175. doi: 10.1186/s12874-023-01980-y. BMC Med Res Methodol. 2023. PMID: 37525117 Free PMC article.
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Arnés-García, D.; Lucena-Torres, L.; Bustos-Merlo, A.; Rosales-Castillo, A.; Hidalgo-Tenorio, C. Infective Endocarditis Due to Corynebacterium jeikeium : Four Case Reports and Narrative Review of the Literature. Microorganisms 2024 , 12 , 1337. https://doi.org/10.3390/microorganisms12071337

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Arnés-García, Daniel, Laura Lucena-Torres, Antonio Bustos-Merlo, Antonio Rosales-Castillo, and Carmen Hidalgo-Tenorio. 2024. "Infective Endocarditis Due to Corynebacterium jeikeium : Four Case Reports and Narrative Review of the Literature" Microorganisms 12, no. 7: 1337. https://doi.org/10.3390/microorganisms12071337

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• Published: 26 June 2024

Climate change and heat stress resilient outdoor workers: findings from systematic literature review

• Peymaneh Habibi 1 ,
• Jaleh Razmjouei 2 ,
• Amirhossein Moradi 3 ,
• Farank Mahdavi 1 ,
• Saeed Fallah-Aliabadi 4 , 5 &
• Ahad Heydari 6  

BMC Public Health volume  24 , Article number:  1711 ( 2024 ) Cite this article

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Global warming has led to an increase in the number and intensity of extreme heat events, posing a significant threat to the health and safety of workers, especially those working outdoors, as they often have limited access to cooling strategies. The present systematic literature review (a) summarizes the current knowledge on the impacts of climate change on outdoor workers, (b) provides historical background on this issue, (c) explores factors that reduce and increase thermal stress resilience, (d) discusses the heat mitigation strategies, and (e) provides an overview of existing policy and legal frameworks on occupational heat exposure among outdoor workers.

Materials and methods

In this systematic review, we searched scientific databases including Scopus ( N  = 855), Web of Science ( N  = 828), and PubMed ( N  = 202). Additionally, we identified relevant studies on climate change and heat-stress control measures through Google Scholar ( N  = 116) using specific search terms. In total, we monitored 2001 articles pertaining to worker populations (men = 2921; women = 627) in various outdoor climate conditions across 14 countries. After full-text assessment, 55 studies were selected for inclusion, and finally, 29 eligible papers were included for data extraction.

Failure to implement effective control strategies for outdoor workers will result in decreased resilience to thermal stress. The findings underscore a lack of awareness regarding certain adaptation strategies and interventions aimed at preventing and enhancing resilience to the impact of climate change on heat stress prevalence among workers in outdoor tropical and subtropical environments. However, attractive alternative solutions from the aspects of economic and ecological sustainability in the overall assessment of heat stress resilience can be referred to acclimatization, shading, optimized clothing properties and planned breaks.

The integration of climate change adaptation strategies into occupational health programs can enhance occupational heat resilience among outdoor workers. Conducting cost-benefit evaluations of health and safety measures for thermal stress adaptation strategies among outdoor workers is crucial for professionals and policymakers in low- and middle-income tropical and subtropical countries. In this respect, complementary measures targeting hydration, work-rest regimes, ventilated garments, self-pacing, and mechanization can be adopted to protect outdoor workers. Risk management strategies, adaptive measures, heat risk awareness, practical interventions, training programs, and protective policies should be implemented in hot-dry and hot-humid climates to boost the tolerance and resilience of outdoor workers.

Peer Review reports

Introduction

Extreme weather events and severe heat pose significant hazards to the safety and health of workers, leading to increased accidents, mortality, and morbidity during hot climate conditions [ 1 , 2 , 3 ]. Global warming presents a new and formidable challenge for most countries [ 4 , 5 ]. Global climate change substantially affects physiological and perceptual responses through both direct and indirect effects on core body temperature [ 6 ], heart rate, skin temperature, and thermal comfort [ 7 , 8 , 9 ]. Working in hot and humid environments during long shifts with high physical activity can jeopardize the safety and health of worker populations [ 7 , 10 ]. Increased exposure to thermal stress among workers in outdoor environments has been documented in tropical and subtropical countries with hot seasons [ 11 ]. Exposure to hot working environments, and the resulting elevated physiological and perceptual responses, can lead to occupational heat stress, reducing safety, health, and work capacity [ 12 ], and increasing the risk of heat-related illnesses (HRI) [ 13 ]. The increment in the levels of ambient temperature, radiation and shifts in the distribution of daily peak temperature can cause indirect and direct effects on outdoor workers [ 14 , 15 ]. High temperatures and high humidity can exacerbate the effects of physical workload on individuals working outdoors during long shifts in developing and tropical countries [ 16 ]. Working in high-temperature and high-humidity environments can have adverse health effects on workers, particularly agricultural workers, construction workers, drivers, sellers, brick-making workers, and daily wage workers [ 17 , 18 ]. High hot-humid and hot-dry temperatures can lead to occupational heat strain when core body temperature rises above 38 °C [ 19 ]. Exposure to heat radiation, either when working outdoors with exposure to the sun or around hot machinery, can greatly increase physiological pressure and lead to reduced work capacity [ 20 ].These physiological mechanisms worsen under high climate conditions and climate change, emphasizing the need to identify strategies to increase occupational heat stress resilience and develop solutions and policies to protect the health and safety of outdoor workers [ 21 , 22 ]. Projected future global warming conditions will dangerously affect the anticipated occupational heat stress resilience of outdoor workers worldwide. There is insufficient knowledge regarding strategies to increase occupational heat stress resilience, necessitating protective measures against heat stress and climate change to reduce health risks and fatalities for future outdoor workers in hot and humid work environments. The findings of this study can inform planning for increasing occupational heat stress resilience, developing heat acclimation strategies, and identifying risk factors to mitigate heat stress caused by global warming, particularly in middle- and low-income communities.

Search strategy

This systematic literature review was conducted following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines [ 23 ]. We searched scientific databases, including PubMed, Scopus, and Web of Science, and identified additional records through Google Scholar. We used Mesh terms in PubMed to identify synonyms for ‘climate change’ and ‘thermal resistance.’ We also consulted specialists to identify relevant keywords. Our search syntax was developed and applied to title, abstract, or keyword queries in selected databases. To ensure the specificity and accuracy of our search strategy, we tested the number needed to read (NNR) in the Web of Science database. We also investigated the references of included studies and searched key journals via Scopus to identify potentially relevant articles. The full search strategy in three main databases has been mentioned in Appendix 1. Our search syntax was as follows:

PubMed: (“heat wave”[tiab] OR “heat stress”[tiab] OR “climate change*”[tiab] OR (climate[tiab] AND change[tiab]) OR “extreme weather”[tiab] OR “extreme heat”[tiab] OR “global warming”[tiab] OR “hot day*”[tiab] OR “warm day*”[tiab]) AND (“heat tolerance“[tiab] OR “heat resilien*“[tiab] OR (heat[tiab] AND resilien*[tiab]) OR (heat[tiab] AND tolera*[tiab]) OR “Heat resistan*”[tiab] OR thermotolerance[tiab] OR “heat endurance”[tiab] OR (heat[tiab] AND endur*[tiab])) AND (worker*[tiab] OR Firefighter*[tiab] OR “fire fighter*”[tiab] OR firem*[tiab] OR “fire m*”[tiab] OR nurs*[tiab] OR operator*[tiab] OR driver*[tiab] OR farmer[tiab]* OR welder*[tiab] OR miner*[tiab] OR employee[tiab] OR laborer*[tiab] OR labour*[tiab]).

Inclusion criteria

The research question components (PECO) were as follows: P (workers), E (Exposure), C (heat stress), and O (increase occupational heat stress resilience). We included studies that (a) measured physiological and perceptual responses in workplaces and resting environments of workers; (b) studied working populations, including both males and females (healthy and unhealthy populations); (c) assessed the impact of climate change on occupational heat strain, as well as the health, safety, and well-being of workers including work-related variables (income, work type, time), environmental variables (wet-bulb globe temperature (WBGT), relative humidity), physiological variables (heart rate, respiratory, rate of perceived exertion (RPE)), and demographic variables (age, sex, body mass index (kg/m 2 ); (d) focused on air temperature, relative humidity (RH), heat waves, solar radiation, climate change, UV radiation, and thermal stress; (e) considered local and international contexts, countries, and workplaces; and (f) investigated workers’ perceptions of climate change, occupational heat strain, and their knowledge and attitudes toward adaptation strategies.

Exclusion criteria

Studies were excluded if they (a) studied climate change-related phenomena such as storms, cyclones, rainfall, rising sea levels, and drought; (b) evaluated the impact of climate change on plants, crop yields, pest dynamics, soil processes, water availability, and animals; (c) had inaccessible full-texts; or (d) focused on indoor workplaces.

Screening and selection

We entered all identified studies into EndNote and removed duplicates. One team member (PH) screened studies based on their titles and abstracts, and two members of the research team (AH and PH) independently selected relevant studies by reviewing the full texts. Disagreements regarding study inclusion were resolved through team discussion. We also conducted searches in three key journals: environmental research, urban climate, and global environmental change, but did not identify any additional studies.

Data extraction and quality assessment

Two team members (AH and PH) independently assessed the eligibility of included studies based on our inclusion and exclusion criteria. They also evaluated the methodological quality of selected studies using the quality assessment tool for studies with diverse designs (QATSDD), which consists of 16 items and is a reliable and valid tool for assessing the methodological quality of various types of studies [ 24 ]. Any disagreements regarding study inclusion were resolved through team discussion.

Search results

The numbers of identified studies and the studies reviewed during the screening and selection stages are presented in Fig.  1 . The initial search yielded 2001 articles including the additional articles sourced from Scholar Google. After full-text assessment, 55 studies were selected for inclusion, and finally, 29 eligible papers were included for data extraction. No additional studies meeting our eligibility criteria were identified after the full-text investigation. Similarly, no studies were identified through searches of key journals and the references of included studies. Table  1 provides details on the selected studies, including author/year, study location, document type, population/sample size, climate conditions, assessment of physical, perceptual, and physiological factors, authors’ conclusions, and quality ratings. Table  2 presents suggestions for increasing and decreasing occupational heat stress resilience among outdoor workers.

Flow diagram of the screening process of included studies the strategies to increase occupational heat stress resilience among outdoor workers

Descriptive analysis

Out of the 29 selected studies, 18 addressed global warming’s impact on occupational heat stress resilience, risk management strategies, and adaptation strategies for warming conditions. Most of these studies emphasized that climate change will exacerbate the health impacts of extreme heat. The prevalence of negative effects due to climate change will intensify workers’ health risks in future work scenarios, particularly in regions with hot and humid climates and poor economic conditions. As of our selection period until 2023, 20 studies (68.96%) were published between 2016 and 2023. Of the 29 assessed papers, 18 (62.06%) directly investigated the effects of climate change and adaptation strategies for outdoor workers in various countries, including Australia, the USA, China, Japan, Africa, Korea, Slovenia, Taiwan, Indonesia, Ghana, Korea, India, Iran, and Pakistan. The predominant themes identified in these papers revolved around strategies to increase occupational heat stress resilience. In conclusion, the study’s findings were categorized into main themes, including risk factors that decrease occupational heat stress resilience and suggestions for increasing occupational heat stress resilience among outdoor workers.

Thematic content analysis

This systematic review provides a summary of evidence published to date regarding strategies to enhance occupational heat stress resilience, especially in hot outdoor workplaces. Despite variations in study design and analytical approaches, the evidence presented in this systematic review consistently highlights a strong association between thermal stress resulting from global warming and occupational heat stress. Broad findings from these studies indicate that exposure to heatwaves and global warming is linked to adverse health impacts on workers.

Furthermore, several studies underscore the need for sentinel effects and leading indicators to facilitate surveillance of climate-related occupational heat stress effects, as well as strategies and interventions for preventing the impact of climate change on outdoor workers. Finally, the review identifies interventions and adaptation strategies for outdoor workers, including the provision of accessible cool drinking water [ 13 , 26 , 41 , 44 , 47 ], optimized work-rest schedules [ 12 , 13 , 16 , 26 , 36 , 43 , 44 , 47 ], the availability of proper resting shade [ 16 , 47 , 49 ], training and awareness programs [ 20 , 38 , 40 ], self-paced work [ 13 , 38 , 40 , 44 , 47 ], and the use of supportive protective equipment [ 41 ].

Factors that reduce resilience to climate change among outdoor workers

Resilience to climate change among outdoor workers can be reduced by various factors, categorized into personal risk factors, environmental risk factors, and occupational-related heat exposure risk factors during work.

Individual-related heat exposure risk factors

Personal factors associated with reduced resilience to climate change, identifiable from outdoor workers’ data, include dehydration [ 20 , 25 , 28 , 32 , 34 , 37 , 40 , 46 , 47 , 48 ], unique medical characteristics [ 41 , 47 ], pregnancy [ 38 , 40 , 47 ], BMI [ 29 , 30 , 37 , 40 , 47 , 49 ], obesity and body fat [ 29 , 30 , 32 , 34 , 47 ], overall health status [ 33 , 34 , 37 , 47 ], lack of sleep [ 33 , 34 , 40 , 47 ], experience of a previous HRI [ 32 , 34 , 44 , 45 , 46 , 47 ], presence of certain concurrent diseases and chronic disease [ 35 , 47 ], kidney disease [ 20 , 26 , 38 , 43 , 46 , 47 ], consumption of caffeine and alcohol [ 26 , 28 , 30 , 34 , 37 , 40 , 41 , 46 , 47 ], smoking [ 30 ], use of drugs [ 26 , 37 , 40 , 41 , 47 ], age [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ], older workers with low education [ 38 , 40 , 43 , 44 , 46 , 47 ], physical fitness [ 26 , 32 , 40 , 47 ], metabolism rate [ 40 , 47 ], type of clothing [ 40 , 47 ], prior heat injury [ 40 , 46 , 47 ], physical activity and heavy workload [ 16 , 27 , 31 , 34 , 38 , 39 , 40 , 46 , 47 , 48 ], gender [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ], education level [ 16 , 39 , 41 , 44 , 46 , 47 ], wearing PPE [ 16 , 26 , 27 , 31 , 38 , 39 , 44 , 46 , 47 ], and non-acclimatization [ 29 , 32 , 37 , 40 , 41 , 43 , 44 , 47 ]. Physiological risk factors most frequently expressed by outdoor workers included excessive heart rate [ 30 , 45 , 47 , 49 ], oral [ 47 , 49 ], skin [ 45 , 46 , 47 , 49 ], core temperature [ 26 , 27 , 29 , 31 , 32 , 34 , 45 , 46 , 47 , 48 , 49 ], sweating [ 39 , 47 ], and blood pressure [ 45 , 46 , 47 , 49 ]. This is often followed by heat exhaustion [ 47 , 48 ] or tiredness [ 47 ], headaches [ 47 ], heat rash [ 47 ], and fainting [ 47 ]. Older adults are more vulnerable to chronic dehydration [ 28 , 45 ], especially those living with multiple chronic diseases [ 43 , 47 ]. Aging is also associated with reductions in sweat production [ 8 ]. Consequently, studies have generally reported greater elevations in body heat storage and core temperature in older compared to younger adults during environmental heat exposure [ 26 , 37 , 46 , 47 ]. Additionally, personal factors correlated with occupational heat strain include the adequacy of water intake [ 41 , 47 ].

Environmental-related heat exposure risk factors

The environmental factors contributing to thermal stress include high air temperature [ 12 , 16 , 26 , 27 , 31 , 34 , 40 , 45 , 46 , 47 , 48 , 49 ], heat wave [ 43 , 47 , 48 ], airspeed and movement around the workplace [ 16 , 43 , 45 , 47 , 48 , 49 ], high levels of heat exposure (WBGT = 37.5–49 ℃) [ 38 , 46 , 47 ], tropical nights [ 48 ], working in sun- exposed conditions [ 16 , 38 , 39 , 47 ], solar radiation [ 26 , 40 , 43 , 46 , 47 , 48 ], high humidity [ 16 , 27 , 31 , 34 , 40 , 43 , 45 , 47 , 48 , 49 ], UV radiation [ 26 , 47 , 48 , 49 ], the moisture content of the outdoor settings or workplaces [ 16 , 39 ], radiant heat [ 16 , 26 , 31 , 36 , 45 , 47 , 48 ], and the air-pollution index [ 30 ].

Occupational-related heat exposure risk factors

However, workers encounter various barriers, such as inadequate cool housing designs for rest [ 38 ], a lack of management and engineering commitment [ 41 , 42 , 47 ], heavy physical workloads for long hours [ 16 , 47 ] or physically demanding jobs [ 44 , 46 ], insufficient awareness and prevention training [ 38 , 40 , 41 , 43 , 47 ], a lack of knowledge regarding adaptive behavior [ 41 , 43 ], the absence of occupational heat stress guidelines and adaptation strategies [ 38 , 41 , 46 , 47 ], a lack of regular training on adaptation measures [ 41 ], limited management commitment [ 41 ], the nature of the physical workload [ 16 , 40 , 41 , 46 , 47 ], the absence of specific thermal stress-related policy regulations [ 41 ], working in proximity to heat sources [ 16 , 44 , 47 ], the type of protective clothing [ 16 , 40 , 47 ], limited access to innovative technology and equipment [ 41 ], the nature of the work [ 40 , 41 , 46 , 47 ], inadequate management commitment, work-break regimes [ 43 , 47 ] and cooling systems [ 26 , 28 , 40 , 41 , 47 , 48 ]. Additionally, workers face challenges such as inadequate knowledge of adaptive behavior [ 41 , 46 ], a lack of regular training on thermal stress risk, adaptation, and safety measures [ 41 , 47 ], a deficiency in specific heat-related policies and regulations [ 41 ], limited management commitment to heat-related health and safety measures [ 41 ], restricted access to innovative equipment and technology [ 41 ], insufficient regular breaks and work-rest time [ 35 , 39 , 41 , 46 , 47 ], limited access to shade [ 38 , 43 , 47 ], inadequate financial resources [ 38 , 41 ], the absence of an acclimatization program [ 41 , 43 , 47 ], suboptimal water management [ 47 ], and insufficient medical attention when implementing adaptation strategies for climate change and occupational heat stress.

Factors that enhance resilience to climate change among outdoor workers

Enhanced resilience to climate change can be achieved through various means, including personal, managerial, and engineering protective factors.

Personal protective factors

Outdoor workers can take several measures to protect themselves. They should consider adjusting their work schedule [ 35 , 47 ], maintaining adequate hydration [ 28 , 33 , 35 , 37 , 38 , 39 , 40 , 47 ], adjusting their clothing [ 31 , 35 , 47 ], drinking more water [ 35 ] or drinking plenty of cool water frequently before feeling thirsty [ 13 , 26 , 41 , 44 , 47 ]. It’s important to take more frequent planned breaks [ 35 , 38 , 44 ], wear broad-brimmed hats [ 35 , 39 , 41 , 47 ] and ventilated helmets [ 28 ], understand how to self-pace [ 13 , 38 , 40 , 44 , 47 ], wear sun-protective gear [ 38 , 49 ], including sunglasses and gloves during hot weather conditions [ 41 ], and take work breaks and rest in cooler or shaded areas [ 13 , 28 , 33 , 35 , 38 , 39 , 40 , 41 , 43 , 44 , 47 ]. Using sunblock [ 38 , 39 , 44 ], and having a higher education level [ 39 , 44 , 47 ], are also beneficial. Workers should consider wearing loose and light-colored clothing [ 28 , 34 , 35 , 38 , 39 , 41 , 44 ] and opting for short-sleeved shirts and shorts when possible [ 13 ]. Using cooling vests [ 27 , 47 ], implementing a ‘Buddy system’ [ 47 ], acclimatization [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ], maintaining normal anthropometric measures [ 29 ], and changing clothing ensembles to more breathable single-layer garments [ 43 ] can further enhance personal protection.

Managerial protective factors

Maintaining good quality working conditions and a suitable climate can significantly improve worker performance, productivity, and company profits [ 37 ]. Workplace management and training programs [ 16 , 35 , 38 , 40 , 41 , 47 , 49 ] are crucial for worker well-being. Developing prevention strategies [ 12 , 13 , 38 , 48 ], improving guidelines for worker safety, health, and productivity, and adhering to occupational health standards [ 12 , 38 , 47 ] are essential. Scheduling heavy routine outdoor work during the early morning [ 47 ] or evening hours or in shaded areas [ 13 , 41 , 44 , 49 ] can help mitigate heat stress. Providing access to cooling systems, such as air conditioning and fans [ 13 , 16 , 26 , 38 , 39 , 40 , 41 , 44 , 47 ], and offering climate change adaptation strategies [ 13 , 48 , 49 ] are beneficial. Adjusting the duration of breaks/rest periods [ 12 , 13 , 16 , 26 , 36 , 43 , 44 , 47 ], ensuring access to shade [ 16 , 47 , 49 ], and providing access to drinking water or implementing programs to improve hydration status [ 13 , 16 , 20 , 25 , 44 , 47 , 49 ] are important managerial measures. Training workers in heat-related illness prevention [ 20 , 38 , 40 ], providing access to medical attention [ 20 ], sharing heavier jobs and rotating job assignments on shift schedules [ 13 , 41 , 47 , 49 ], offering air-conditioned vehicles [ 13 , 38 , 47 ], promoting climate change awareness to support healthy lives and decent jobs [ 39 ], implementing work stoppages if the daily maximum temperature exceeds 40 °C [ 13 , 44 , 47 ], raising worker awareness about heat risks [ 47 ] modifying work habits [ 49 ], considering the TWL [ 30 ], and promoting the understanding of the need for workers to self-pace during hot weather [ 13 , 38 , 47 ] are all valuable managerial protective factors.

Engineering protective factors

Providing and designing regular breaks in shaded areas [ 38 , 47 ], implementing strategies to eliminate or replace thermal stress risks [ 37 , 44 ], installing a central cooling system [ 13 , 44 , 47 ], halting work during periods of high thermal stress and supplying mechanical equipment [ 41 , 47 ], initiating heat-shield projects [ 47 ], and enhancing ventilation [ 38 , 39 , 44 , 47 ].

Our systematic review’s outcomes help us understand strategies for increasing occupational heat stress resilience and assessing the effects of global warming on outdoor workers’ adaptation strategies. This is particularly crucial in numerous warm workplaces, especially in low- and middle-income countries. The implementation of strategies to ensure adequate hydration, including access to drinking water and programs to improve hydration status [ 13 , 16 , 20 , 25 , 44 , 47 , 49 ], is one of the most critical interventions for managing warm workplaces. Hydrated workers [ 28 , 33 , 35 , 37 , 38 , 39 , 40 , 47 ] are more likely to maintain an acceptable work rate and physical activity without health risks in various hot-dry and hot-humid weather conditions [ 25 ]. Employers bear the responsibility of providing a safe work environment, conducting training and awareness programs [ 16 , 35 , 38 , 40 , 41 , 47 , 49 ], supervision [ 50 ], and providing suitable protective equipment to mitigate the negative effects of thermal stress due to global warming on safety and health [ 26 , 49 ]. Cooling the core body temperature through wearable liquid cooling garments (SCG) [ 27 ], evaporative cooling garments (ECGs) [ 15 ], fluid cooling garments (FCGs) [ 51 ], hybrid cooling (HBCGs) [ 52 ], and phase change materials (PCMs) [ 53 ] worn by individuals who require personal protective equipment [ 47 , 54 ], including firefighters and construction workers, significantly reduces occupational heat strain and enhances thermal comfort and performance [ 32 ]. Chan et al. recommend implementing appropriate protective measures, such as work-rest schedules and heat tolerance guidelines, to ensure the safety and health of personnel exposed to hot weather conditions [ 28 ]. Therefore, it’s advisable to conduct further research on work-rest schedule optimization models for workers, particularly in the context of construction workers [ 28 ]. It is recommended that safe work durations should be modified based on expected type of clothing and work intensity [ 55 ]. Our review’s results indicate that personal risk factors such as dehydration [ 20 , 25 , 28 , 32 , 34 , 37 , 40 , 46 , 47 , 48 ], smoking [ 30 ] and alcohol-drinking habits [ 26 , 28 , 30 , 34 , 37 , 40 , 41 , 46 , 47 ], age [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ], BMI [ 29 , 30 , 37 , 40 , 47 , 49 ], and non-acclimatization [ 29 , 32 , 37 , 40 , 41 , 43 , 44 , 47 ]; as well as work-related factors like work-rest cycles [ 35 , 39 , 41 , 46 , 47 ] and environmental risk factors such as air temperature [ 12 , 16 , 26 , 27 , 31 , 34 , 40 , 45 , 46 , 47 , 48 , 49 ], relative humidity (RH) [ 16 , 27 , 31 , 34 , 40 , 43 , 45 , 47 , 48 , 49 ], heat radiant [ 16 , 26 , 31 , 36 , 45 , 47 , 48 ], and Thermal Work Limit (TWL) [ 30 ], are significant predictors for determining the physiological responses to HRI among outdoor workers [ 30 ]. More efforts should be made to educate workers and employers about the effects of occupational heat stress on safety, health and performance, and appropriate screening protocols (pre-employment and periodic examinations) should be included in health and safety legislation [ 56 ].

Educating outdoor workers about physiological and perceptual responses to HRI [ 20 , 38 , 40 ] and heat acclimation under uncompensated thermal stress [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ], as well as emphasizing cooling techniques and fluid intake [ 28 , 33 , 35 , 37 , 38 , 39 , 40 , 47 ], is essential. Furthermore, it’s necessary to investigate the impact of gender (both women and men) [ 16 , 33 , 35 , 38 , 39 , 40 , 41 , 46 , 47 ] and aging on heat tolerance and psychophysiological adaptation during work in hot-dry and hot-humid environmental conditions. This is especially crucial since elderly workers [ 38 , 40 , 43 , 44 , 46 , 47 ] display increased susceptibility to HRI in future studies, even if they haven’t engaged in prolonged or strenuous physical labor [ 31 ]. Pogačar et al.‘s study revealed that the most common symptoms of heat stress include excessive sweating, thirst, and fatigue. Interestingly, there was a significant difference among age groups regarding thirst and excessive sweating [ 35 ]. Gender differences in temperature regulation become more apparent under varying heat loads [ 8 ]. In general, women lose more heat through convection [ 11 ], which is advantageous in hot-humid environments [ 57 ], while men lose more heat through evaporation, which is more pronounced in hot-dry environments [ 58 ]. The resilience of vulnerable worker groups to heat stress can be compromised despite existing standards and knowledge. This vulnerability is particularly relevant when considering outdoor workers exposed to different climate conditions in tropical and subtropical countries [ 12 , 38 , 47 ]. Kjellstrom et al.‘s study underscores that mine workers remain the most significant population in terms of preventing the impact of thermal stress. This also extends to many construction workers, agricultural workers, and individuals laboring in warm workplaces without effective cooling systems [ 20 ]. Lui et al. demonstrated that wildland firefighters experience heat acclimatization across the thermal stress and fire season, leading to significant decreases in physiological and perceptual responses. These adaptations can reduce the risk of HRI [ 32 ]. Implementing acclimatization [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ] and adaptation programms [ 13 , 48 , 49 ] for workers exposed to thermal stress is crucial. Adaptation policies aim to increase climate change resilience and reduce climate vulnerability [ 48 ]. Managers and occupational health professionals should also assess workers’ health status and individual habits, such as sleep deprivation [ 33 , 34 , 40 , 47 ], dehydration, and alcohol consumption before work [ 34 ]. International agencies have proposed various climate change adaptation and prevention strategies, including conducting training and awareness programs, using cooling mechanisms [ 13 , 16 , 26 , 38 , 39 , 40 , 41 , 44 , 47 ], and ensuring the availability of cool drinking water [ 13 , 16 , 20 , 25 , 44 , 47 , 49 ]. The most effective solutions at mitigating occupational heat strain were heat acclimation [ 26 , 29 , 30 , 31 , 32 , 33 , 34 , 36 , 37 , 40 , 47 ], wearing specialized cooling garments [ 27 , 47 ], cold water immersion [ 59 ], improving aerobic fitness [ 15 ], and applying ventilation [ 49 ]. Extending the exposure time to thermal stress leads to an increase in core body temperature and dehydration levels [ 60 ]. Acclimatized workers, with beneficial physiological adaptations like an efficient sweating system, lower heart rate, and core body temperature, can tolerate higher levels of dehydration and lose more water through sweat per shift. This means that the maximum allowable exposure time is greater for acclimatized workers compared to non-acclimatized workers [ 38 , 42 , 47 ]. Venugopal et al. demonstrated a strong correlation between physical workload, thermal stress exposures, Heat Strain Indicators (HSIs), and HRIs, leading to adverse health outcomes among outdoor workers [ 46 ]. There is a pressing need for evidence-based reviews and interventions to prevent occupational heat stress and enhance comprehensive resilience labor policies for outdoor workers in low and middle-income countries as climate change progresses. Increased awareness and consciousness among workers can lead to better adaptability to climate change risks [ 31 ]. Workers often implement conscious and flexible behavioral attitudes to manage their heat stress, especially in extremely hot workplaces, such as outdoor work [ 49 ]. Understanding the relationship between endurance time and WBGT values is crucial for training workers in very hot environments and ensuring their health and safety [ 43 ]. Elevated carbon emissions in the atmosphere contribute to extremely hot environments and climate changes, exacerbating occupational heat strains for outdoor workers [ 61 ]. A high-quality air and work environment can enhance worker safety, health, productivity, and company profitability [ 37 , 49 ]. Sustainable adaptation to warming climatic conditions [ 13 ] and social protection strategies during exposure to occupational heat stress depend on the availability of financial resources and collaborative efforts to overcome adaptation barriers [ 48 ]. The severity of occupational heat stress caused by climate change depends on workers’ sensitivity and vulnerability to different weather conditions. Additionally, the extent of adaptation capacity and resilience planning plays a crucial role [ 33 , 38 ]. Also, establishing a program that can assess how thermal stress due to climate change may increase heat-related effects on outdoor workers and document future heat-related events leading to relevant occupational health and safety regulations, seems essential [ 15 ].

The HEAT-SHIELD project is a customized occupational heat stress-related warning system that provides short- and long-term heat warnings to safeguard workers’ health and productivity. This project represents a useful adaptation strategy aimed at protecting workers, particularly those exposed to the effects of climate change [ 55 , 62 , 63 , 64 , 65 , 66 ].

The findings of this study are valuable for policymakers and professionals in the field of occupational health. They can use this information to develop guidelines and regulations aimed at preventing occupational heat stress and strengthening the resilience of outdoor workers during exposure to heat stress caused by climate change. However, it’s important to note that developing countries face a higher risk of negative occupational health outcomes compared to developed countries due to their lower adaptive capacity [ 46 ], increased poverty, and insufficient technological progress to combat climate change-induced temperature increases [ 6 , 47 ]. Outdoor workers often lack awareness of heat-related risks and HRI due to global warming [ 67 , 68 ]. Therefore, there is a critical need to raise awareness of heat-related hazards, bolster heat stress education, and update existing heat prevention measures. This includes optimizing current heat-related laws and adaptation policies to ensure effective implementation and compliance, especially in hot-dry and hot-humid work environments, particularly in low-middle-income countries [ 44 , 48 ]. Studies of this nature are essential among workers in these countries to provide health professionals and senior managers with the necessary knowledge to inform occupational heat stress adaptation policies, social protection measures, and resilience strategies for sustainable development.

Limitations

One limitation of this systematic review was the limited focus on female workers. Consequently, the results may not accurately represent the perspectives of women working outdoors, which is an important demographic to consider. Another significant limitation of this study is its heavy reliance on cross-sectional and experimental studies. Incorporating clinical aspects into data collection could greatly enhance and advance occupational health interventions. Furthermore, there is an evident scarcity of research exploring the social dimensions and the broader effects of occupational heat stress. Additionally, there is insufficient investigation into the adaptation strategies employed by workers in the context of increasing thermal stress and climate change, particularly in tropical and subtropical countries. These research gaps highlight the need for further studies to provide a more comprehensive understanding of this critical occupational health issue.

Addressing the health risks associated with occupational thermal stress among outdoor workers requires a multi-level approach that includes standard procedures and safety interventions. Currently, there is a lack of formal guidelines for outdoor workers, and most advisory systems do not adequately support this workforce in implementing solutions to mitigate occupational heat stress and enhance climate change resilience. While many workers acknowledge the importance of increased hydration and clothing adjustments during hot-dry and hot-humid climate conditions, a smaller proportion attempt to modify the nature of their work or seek rest in cooler areas. It is crucial to recognize that occupational heat stress remains a prevalent issue among these populations. To address these challenges, we recommend conducting further research to enhance our understanding of strategies aimed at bolstering the resilience of outdoor workers against heat stress resulting from climate change. This research should encompass diverse fields such as medicine, climatology, occupational health, and epidemiology. Additionally, there is a need to improve information dissemination, develop relevant regulations, and implement protective strategies among outdoor workers. These efforts will aid in identifying and preventing heat stress-related policies, including mitigation and adaptation measures.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on request.

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Habibi, P., Razmjouei, J., Moradi, A. et al. Climate change and heat stress resilient outdoor workers: findings from systematic literature review. BMC Public Health 24 , 1711 (2024). https://doi.org/10.1186/s12889-024-19212-3

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