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

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

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

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

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

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

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

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

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

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

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

You can use boolean operators to help narrow down your search:

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

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

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

For each publication, ask yourself:

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

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

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

It is often written as part of a dissertation , thesis, research paper , or proposal .

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

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

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

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

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Literature Reviews

• Getting started

What is a literature review?

Why conduct a literature review, stages of a literature review, lit reviews: an overview (video), check out these books.

• Types of reviews
• 1. Define your research question
• 2. Plan your search
• 3. Search the literature
• 4. Organize your results
• 5. Synthesize your findings
• 6. Write the review
• Artificial intelligence (AI) tools
• Thompson Writing Studio This link opens in a new window
• Need to write a systematic review? This link opens in a new window

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Definition: A literature review is a systematic examination and synthesis of existing scholarly research on a specific topic or subject.

Purpose: It serves to provide a comprehensive overview of the current state of knowledge within a particular field.

Analysis: Involves critically evaluating and summarizing key findings, methodologies, and debates found in academic literature.

Identifying Gaps: Aims to pinpoint areas where there is a lack of research or unresolved questions, highlighting opportunities for further investigation.

Contextualization: Enables researchers to understand how their work fits into the broader academic conversation and contributes to the existing body of knowledge.

tl;dr  A literature review critically examines and synthesizes existing scholarly research and publications on a specific topic to provide a comprehensive understanding of the current state of knowledge in the field.

What is a literature review NOT?

❌ An annotated bibliography

❌ Original research

❌ A summary

❌ Something to be conducted at the end of your research

❌ An opinion piece

❌ A chronological compilation of studies

The reason for conducting a literature review is to:

Literature Reviews: An Overview for Graduate Students

While this 9-minute video from NCSU is geared toward graduate students, it is useful for anyone conducting a literature review.

Writing the literature review: A practical guide

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Writing literature reviews: A guide for students of the social and behavioral sciences

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So, you have to write a literature review: A guided workbook for engineers

Telling a research story: Writing a literature review

The literature review: Six steps to success

Systematic approaches to a successful literature review

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

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

Table of Contents

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

How to write a good literature review 

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

What is a literature review?

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

What is the purpose of literature review?

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

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

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

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

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

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

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

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

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

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

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

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

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

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

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

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

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How to write a literature review faster with Paperpal?

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

Here’s how to use the Research feature:  

• Ask a question: Get started with a new document on paperpal.com. Click on the “Research” feature and type your question in plain English. Paperpal will scour over 250 million research articles, including conference papers and preprints, to provide you with accurate insights and citations. 
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• Cite with Confidence: Paperpal makes it easy to incorporate relevant citations and references into your writing, ensuring your arguments are well-supported by credible sources. This translates to a polished, well-researched literature review. 

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

Frequently asked questions

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

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

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

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

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

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

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

References 

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

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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

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SWRK 330 - Social Work Research Methods

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What is a Literature Review?

Empirical research.

• Annotated Bibliographies

A literature review  summarizes and discusses previous publications  on a topic.

It should also:

explore past research and its strengths and weaknesses.

be used to validate the target and methods you have chosen for your proposed research.

consist of books and scholarly journals that provide research examples of populations or settings similar to your own, as well as community resources to document the need for your proposed research.

The literature review does not present new  primary  scholarship. 

be completed in the correct citation format requested by your professor  (see the  C itations Tab)

Access Purdue  OWL's Social Work Literature Review Guidelines here .  

Empirical Research  is  research  that is based on experimentation or observation, i.e. Evidence. Such  research  is often conducted to answer a specific question or to test a hypothesis (educated guess).

How do you know if a study is empirical? Read the subheadings within the article, book, or report and look for a description of the research "methodology."  Ask yourself: Could I recreate this study and test these results?

These are some key features to look for when identifying empirical research.

NOTE:  Not all of these features will be in every empirical research article, some may be excluded, use this only as a guide.

• Statement of methodology
• Research questions are clear and measurable
• Individuals, group, subjects which are being studied are identified/defined
• Data is presented regarding the findings
• Controls or instruments such as surveys or tests were conducted
• There is a literature review
• There is discussion of the results included
• Citations/references are included

See also Empirical Research Guide

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Module 2 Chapter 3: What is Empirical Literature & Where can it be Found?

In Module 1, you read about the problem of pseudoscience. Here, we revisit the issue in addressing how to locate and assess scientific or empirical literature . In this chapter you will read about:

• distinguishing between what IS and IS NOT empirical literature
• how and where to locate empirical literature for understanding diverse populations, social work problems, and social phenomena.

Probably the most important take-home lesson from this chapter is that one source is not sufficient to being well-informed on a topic. It is important to locate multiple sources of information and to critically appraise the points of convergence and divergence in the information acquired from different sources. This is especially true in emerging and poorly understood topics, as well as in answering complex questions.

What Is Empirical Literature

Social workers often need to locate valid, reliable information concerning the dimensions of a population group or subgroup, a social work problem, or social phenomenon. They might also seek information about the way specific problems or resources are distributed among the populations encountered in professional practice. Or, social workers might be interested in finding out about the way that certain people experience an event or phenomenon. Empirical literature resources may provide answers to many of these types of social work questions. In addition, resources containing data regarding social indicators may also prove helpful. Social indicators are the “facts and figures” statistics that describe the social, economic, and psychological factors that have an impact on the well-being of a community or other population group.The United Nations (UN) and the World Health Organization (WHO) are examples of organizations that monitor social indicators at a global level: dimensions of population trends (size, composition, growth/loss), health status (physical, mental, behavioral, life expectancy, maternal and infant mortality, fertility/child-bearing, and diseases like HIV/AIDS), housing and quality of sanitation (water supply, waste disposal), education and literacy, and work/income/unemployment/economics, for example.

Three characteristics stand out in empirical literature compared to other types of information available on a topic of interest: systematic observation and methodology, objectivity, and transparency/replicability/reproducibility. Let’s look a little more closely at these three features.

Systematic Observation and Methodology. The hallmark of empiricism is “repeated or reinforced observation of the facts or phenomena” (Holosko, 2006, p. 6). In empirical literature, established research methodologies and procedures are systematically applied to answer the questions of interest.

Objectivity. Gathering “facts,” whatever they may be, drives the search for empirical evidence (Holosko, 2006). Authors of empirical literature are expected to report the facts as observed, whether or not these facts support the investigators’ original hypotheses. Research integrity demands that the information be provided in an objective manner, reducing sources of investigator bias to the greatest possible extent.

Transparency and Replicability/Reproducibility.   Empirical literature is reported in such a manner that other investigators understand precisely what was done and what was found in a particular research study—to the extent that they could replicate the study to determine whether the findings are reproduced when repeated. The outcomes of an original and replication study may differ, but a reader could easily interpret the methods and procedures leading to each study’s findings.

What is NOT Empirical Literature

By now, it is probably obvious to you that literature based on “evidence” that is not developed in a systematic, objective, transparent manner is not empirical literature. On one hand, non-empirical types of professional literature may have great significance to social workers. For example, social work scholars may produce articles that are clearly identified as describing a new intervention or program without evaluative evidence, critiquing a policy or practice, or offering a tentative, untested theory about a phenomenon. These resources are useful in educating ourselves about possible issues or concerns. But, even if they are informed by evidence, they are not empirical literature. Here is a list of several sources of information that do not meet the standard of being called empirical literature:

• your course instructor’s lectures
• political statements
• advertisements
• newspapers & magazines (journalism)
• television news reports & analyses (journalism)
• many websites, Facebook postings, Twitter tweets, and blog postings
• the introductory literature review in an empirical article

You may be surprised to see the last two included in this list. Like the other sources of information listed, these sources also might lead you to look for evidence. But, they are not themselves sources of evidence. They may summarize existing evidence, but in the process of summarizing (like your instructor’s lectures), information is transformed, modified, reduced, condensed, and otherwise manipulated in such a manner that you may not see the entire, objective story. These are called secondary sources, as opposed to the original, primary source of evidence. In relying solely on secondary sources, you sacrifice your own critical appraisal and thinking about the original work—you are “buying” someone else’s interpretation and opinion about the original work, rather than developing your own interpretation and opinion. What if they got it wrong? How would you know if you did not examine the primary source for yourself? Consider the following as an example of “getting it wrong” being perpetuated.

Example: Bullying and School Shootings . One result of the heavily publicized April 1999 school shooting incident at Columbine High School (Colorado), was a heavy emphasis placed on bullying as a causal factor in these incidents (Mears, Moon, & Thielo, 2017), “creating a powerful master narrative about school shootings” (Raitanen, Sandberg, & Oksanen, 2017, p. 3). Naturally, with an identified cause, a great deal of effort was devoted to anti-bullying campaigns and interventions for enhancing resilience among youth who experience bullying.  However important these strategies might be for promoting positive mental health, preventing poor mental health, and possibly preventing suicide among school-aged children and youth, it is a mistaken belief that this can prevent school shootings (Mears, Moon, & Thielo, 2017). Many times the accounts of the perpetrators having been bullied come from potentially inaccurate third-party accounts, rather than the perpetrators themselves; bullying was not involved in all instances of school shooting; a perpetrator’s perception of being bullied/persecuted are not necessarily accurate; many who experience severe bullying do not perpetrate these incidents; bullies are the least targeted shooting victims; perpetrators of the shooting incidents were often bullying others; and, bullying is only one of many important factors associated with perpetrating such an incident (Ioannou, Hammond, & Simpson, 2015; Mears, Moon, & Thielo, 2017; Newman &Fox, 2009; Raitanen, Sandberg, & Oksanen, 2017). While mass media reports deliver bullying as a means of explaining the inexplicable, the reality is not so simple: “The connection between bullying and school shootings is elusive” (Langman, 2014), and “the relationship between bullying and school shooting is, at best, tenuous” (Mears, Moon, & Thielo, 2017, p. 940). The point is, when a narrative becomes this publicly accepted, it is difficult to sort out truth and reality without going back to original sources of information and evidence.

What May or May Not Be Empirical Literature: Literature Reviews

Investigators typically engage in a review of existing literature as they develop their own research studies. The review informs them about where knowledge gaps exist, methods previously employed by other scholars, limitations of prior work, and previous scholars’ recommendations for directing future research. These reviews may appear as a published article, without new study data being reported (see Fields, Anderson, & Dabelko-Schoeny, 2014 for example). Or, the literature review may appear in the introduction to their own empirical study report. These literature reviews are not considered to be empirical evidence sources themselves, although they may be based on empirical evidence sources. One reason is that the authors of a literature review may or may not have engaged in a systematic search process, identifying a full, rich, multi-sided pool of evidence reports.

There is, however, a type of review that applies systematic methods and is, therefore, considered to be more strongly rooted in evidence: the systematic review .

Systematic review of literature. A systematic reviewis a type of literature report where established methods have been systematically applied, objectively, in locating and synthesizing a body of literature. The systematic review report is characterized by a great deal of transparency about the methods used and the decisions made in the review process, and are replicable. Thus, it meets the criteria for empirical literature: systematic observation and methodology, objectivity, and transparency/reproducibility. We will work a great deal more with systematic reviews in the second course, SWK 3402, since they are important tools for understanding interventions. They are somewhat less common, but not unheard of, in helping us understand diverse populations, social work problems, and social phenomena.

Locating Empirical Evidence

Social workers have available a wide array of tools and resources for locating empirical evidence in the literature. These can be organized into four general categories.

Journal Articles. A number of professional journals publish articles where investigators report on the results of their empirical studies. However, it is important to know how to distinguish between empirical and non-empirical manuscripts in these journals. A key indicator, though not the only one, involves a peer review process . Many professional journals require that manuscripts undergo a process of peer review before they are accepted for publication. This means that the authors’ work is shared with scholars who provide feedback to the journal editor as to the quality of the submitted manuscript. The editor then makes a decision based on the reviewers’ feedback:

• Accept as is
• Accept with minor revisions
• Request that a revision be resubmitted (no assurance of acceptance)

When a “revise and resubmit” decision is made, the piece will go back through the review process to determine if it is now acceptable for publication and that all of the reviewers’ concerns have been adequately addressed. Editors may also reject a manuscript because it is a poor fit for the journal, based on its mission and audience, rather than sending it for review consideration.

Indicators of journal relevance. Various journals are not equally relevant to every type of question being asked of the literature. Journals may overlap to a great extent in terms of the topics they might cover; in other words, a topic might appear in multiple different journals, depending on how the topic was being addressed. For example, articles that might help answer a question about the relationship between community poverty and violence exposure might appear in several different journals, some with a focus on poverty, others with a focus on violence, and still others on community development or public health. Journal titles are sometimes a good starting point but may not give a broad enough picture of what they cover in their contents.

In focusing a literature search, it also helps to review a journal’s mission and target audience. For example, at least four different journals focus specifically on poverty:

• Journal of Children & Poverty
• Journal of Poverty
• Journal of Poverty and Social Justice
• Poverty & Public Policy

Let’s look at an example using the Journal of Poverty and Social Justice . Information about this journal is located on the journal’s webpage: http://policy.bristoluniversitypress.co.uk/journals/journal-of-poverty-and-social-justice . In the section headed “About the Journal” you can see that it is an internationally focused research journal, and that it addresses social justice issues in addition to poverty alone. The research articles are peer-reviewed (there appear to be non-empirical discussions published, as well). These descriptions about a journal are almost always available, sometimes listed as “scope” or “mission.” These descriptions also indicate the sponsorship of the journal—sponsorship may be institutional (a particular university or agency, such as Smith College Studies in Social Work ), a professional organization, such as the Council on Social Work Education (CSWE) or the National Association of Social Work (NASW), or a publishing company (e.g., Taylor & Frances, Wiley, or Sage).

Indicators of journal caliber.  Despite engaging in a peer review process, not all journals are equally rigorous. Some journals have very high rejection rates, meaning that many submitted manuscripts are rejected; others have fairly high acceptance rates, meaning that relatively few manuscripts are rejected. This is not necessarily the best indicator of quality, however, since newer journals may not be sufficiently familiar to authors with high quality manuscripts and some journals are very specific in terms of what they publish. Another index that is sometimes used is the journal’s impact factor . Impact factor is a quantitative number indicative of how often articles published in the journal are cited in the reference list of other journal articles—the statistic is calculated as the number of times on average each article published in a particular year were cited divided by the number of articles published (the number that could be cited). For example, the impact factor for the Journal of Poverty and Social Justice in our list above was 0.70 in 2017, and for the Journal of Poverty was 0.30. These are relatively low figures compared to a journal like the New England Journal of Medicine with an impact factor of 59.56! This means that articles published in that journal were, on average, cited more than 59 times in the next year or two.

Impact factors are not necessarily the best indicator of caliber, however, since many strong journals are geared toward practitioners rather than scholars, so they are less likely to be cited by other scholars but may have a large impact on a large readership. This may be the case for a journal like the one titled Social Work, the official journal of the National Association of Social Workers. It is distributed free to all members: over 120,000 practitioners, educators, and students of social work world-wide. The journal has a recent impact factor of.790. The journals with social work relevant content have impact factors in the range of 1.0 to 3.0 according to Scimago Journal & Country Rank (SJR), particularly when they are interdisciplinary journals (for example, Child Development , Journal of Marriage and Family , Child Abuse and Neglect , Child Maltreatmen t, Social Service Review , and British Journal of Social Work ). Once upon a time, a reader could locate different indexes comparing the “quality” of social work-related journals. However, the concept of “quality” is difficult to systematically define. These indexes have mostly been replaced by impact ratings, which are not necessarily the best, most robust indicators on which to rely in assessing journal quality. For example, new journals addressing cutting edge topics have not been around long enough to have been evaluated using this particular tool, and it takes a few years for articles to begin to be cited in other, later publications.

Beware of pseudo-, illegitimate, misleading, deceptive, and suspicious journals . Another side effect of living in the Age of Information is that almost anyone can circulate almost anything and call it whatever they wish. This goes for “journal” publications, as well. With the advent of open-access publishing in recent years (electronic resources available without subscription), we have seen an explosion of what are called predatory or junk journals . These are publications calling themselves journals, often with titles very similar to legitimate publications and often with fake editorial boards. These “publications” lack the integrity of legitimate journals. This caution is reminiscent of the discussions earlier in the course about pseudoscience and “snake oil” sales. The predatory nature of many apparent information dissemination outlets has to do with how scientists and scholars may be fooled into submitting their work, often paying to have their work peer-reviewed and published. There exists a “thriving black-market economy of publishing scams,” and at least two “journal blacklists” exist to help identify and avoid these scam journals (Anderson, 2017).

This issue is important to information consumers, because it creates a challenge in terms of identifying legitimate sources and publications. The challenge is particularly important to address when information from on-line, open-access journals is being considered. Open-access is not necessarily a poor choice—legitimate scientists may pay sizeable fees to legitimate publishers to make their work freely available and accessible as open-access resources. On-line access is also not necessarily a poor choice—legitimate publishers often make articles available on-line to provide timely access to the content, especially when publishing the article in hard copy will be delayed by months or even a year or more. On the other hand, stating that a journal engages in a peer-review process is no guarantee of quality—this claim may or may not be truthful. Pseudo- and junk journals may engage in some quality control practices, but may lack attention to important quality control processes, such as managing conflict of interest, reviewing content for objectivity or quality of the research conducted, or otherwise failing to adhere to industry standards (Laine & Winker, 2017).

One resource designed to assist with the process of deciphering legitimacy is the Directory of Open Access Journals (DOAJ). The DOAJ is not a comprehensive listing of all possible legitimate open-access journals, and does not guarantee quality, but it does help identify legitimate sources of information that are openly accessible and meet basic legitimacy criteria. It also is about open-access journals, not the many journals published in hard copy.

An additional caution: Search for article corrections. Despite all of the careful manuscript review and editing, sometimes an error appears in a published article. Most journals have a practice of publishing corrections in future issues. When you locate an article, it is helpful to also search for updates. Here is an example where data presented in an article’s original tables were erroneous, and a correction appeared in a later issue.

• Marchant, A., Hawton, K., Stewart A., Montgomery, P., Singaravelu, V., Lloyd, K., Purdy, N., Daine, K., & John, A. (2017). A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS One, 12(8): e0181722. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558917/
• Marchant, A., Hawton, K., Stewart A., Montgomery, P., Singaravelu, V., Lloyd, K., Purdy, N., Daine, K., & John, A. (2018).Correction—A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown. PLoS One, 13(3): e0193937.  http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193937

Search Tools. In this age of information, it is all too easy to find items—the problem lies in sifting, sorting, and managing the vast numbers of items that can be found. For example, a simple Google® search for the topic “community poverty and violence” resulted in about 15,600,000 results! As a means of simplifying the process of searching for journal articles on a specific topic, a variety of helpful tools have emerged. One type of search tool has previously applied a filtering process for you: abstracting and indexing databases . These resources provide the user with the results of a search to which records have already passed through one or more filters. For example, PsycINFO is managed by the American Psychological Association and is devoted to peer-reviewed literature in behavioral science. It contains almost 4.5 million records and is growing every month. However, it may not be available to users who are not affiliated with a university library. Conducting a basic search for our topic of “community poverty and violence” in PsychINFO returned 1,119 articles. Still a large number, but far more manageable. Additional filters can be applied, such as limiting the range in publication dates, selecting only peer reviewed items, limiting the language of the published piece (English only, for example), and specified types of documents (either chapters, dissertations, or journal articles only, for example). Adding the filters for English, peer-reviewed journal articles published between 2010 and 2017 resulted in 346 documents being identified.

Just as was the case with journals, not all abstracting and indexing databases are equivalent. There may be overlap between them, but none is guaranteed to identify all relevant pieces of literature. Here are some examples to consider, depending on the nature of the questions asked of the literature:

• Academic Search Complete—multidisciplinary index of 9,300 peer-reviewed journals
• AgeLine—multidisciplinary index of aging-related content for over 600 journals
• Campbell Collaboration—systematic reviews in education, crime and justice, social welfare, international development
• Google Scholar—broad search tool for scholarly literature across many disciplines
• MEDLINE/ PubMed—National Library of medicine, access to over 15 million citations
• Oxford Bibliographies—annotated bibliographies, each is discipline specific (e.g., psychology, childhood studies, criminology, social work, sociology)
• PsycINFO/PsycLIT—international literature on material relevant to psychology and related disciplines
• SocINDEX—publications in sociology
• Social Sciences Abstracts—multiple disciplines
• Social Work Abstracts—many areas of social work are covered
• Web of Science—a “meta” search tool that searches other search tools, multiple disciplines

Placing our search for information about “community violence and poverty” into the Social Work Abstracts tool with no additional filters resulted in a manageable 54-item list. Finally, abstracting and indexing databases are another way to determine journal legitimacy: if a journal is indexed in a one of these systems, it is likely a legitimate journal. However, the converse is not necessarily true: if a journal is not indexed does not mean it is an illegitimate or pseudo-journal.

Government Sources. A great deal of information is gathered, analyzed, and disseminated by various governmental branches at the international, national, state, regional, county, and city level. Searching websites that end in.gov is one way to identify this type of information, often presented in articles, news briefs, and statistical reports. These government sources gather information in two ways: they fund external investigations through grants and contracts and they conduct research internally, through their own investigators. Here are some examples to consider, depending on the nature of the topic for which information is sought:

• Agency for Healthcare Research and Quality (AHRQ) at https://www.ahrq.gov/
• Bureau of Justice Statistics (BJS) at https://www.bjs.gov/
• Census Bureau at https://www.census.gov
• Morbidity and Mortality Weekly Report of the CDC (MMWR-CDC) at https://www.cdc.gov/mmwr/index.html
• Child Welfare Information Gateway at https://www.childwelfare.gov
• Children’s Bureau/Administration for Children & Families at https://www.acf.hhs.gov
• Forum on Child and Family Statistics at https://www.childstats.gov
• National Institutes of Health (NIH) at https://www.nih.gov , including (not limited to):
• National Institute on Aging (NIA at https://www.nia.nih.gov
• National Institute on Alcohol Abuse and Alcoholism (NIAAA) at https://www.niaaa.nih.gov
• National Institute of Child Health and Human Development (NICHD) at https://www.nichd.nih.gov
• National Institute on Drug Abuse (NIDA) at https://www.nida.nih.gov
• National Institute of Environmental Health Sciences at https://www.niehs.nih.gov
• National Institute of Mental Health (NIMH) at https://www.nimh.nih.gov
• National Institute on Minority Health and Health Disparities at https://www.nimhd.nih.gov
• National Institute of Justice (NIJ) at https://www.nij.gov
• Substance Abuse and Mental Health Services Administration (SAMHSA) at https://www.samhsa.gov/
• United States Agency for International Development at https://usaid.gov

Each state and many counties or cities have similar data sources and analysis reports available, such as Ohio Department of Health at https://www.odh.ohio.gov/healthstats/dataandstats.aspx and Franklin County at https://statisticalatlas.com/county/Ohio/Franklin-County/Overview . Data are available from international/global resources (e.g., United Nations and World Health Organization), as well.

Other Sources. The Health and Medicine Division (HMD) of the National Academies—previously the Institute of Medicine (IOM)—is a nonprofit institution that aims to provide government and private sector policy and other decision makers with objective analysis and advice for making informed health decisions. For example, in 2018 they produced reports on topics in substance use and mental health concerning the intersection of opioid use disorder and infectious disease,  the legal implications of emerging neurotechnologies, and a global agenda concerning the identification and prevention of violence (see http://www.nationalacademies.org/hmd/Global/Topics/Substance-Abuse-Mental-Health.aspx ). The exciting aspect of this resource is that it addresses many topics that are current concerns because they are hoping to help inform emerging policy. The caution to consider with this resource is the evidence is often still emerging, as well.

Numerous “think tank” organizations exist, each with a specific mission. For example, the Rand Corporation is a nonprofit organization offering research and analysis to address global issues since 1948. The institution’s mission is to help improve policy and decision making “to help individuals, families, and communities throughout the world be safer and more secure, healthier and more prosperous,” addressing issues of energy, education, health care, justice, the environment, international affairs, and national security (https://www.rand.org/about/history.html). And, for example, the Robert Woods Johnson Foundation is a philanthropic organization supporting research and research dissemination concerning health issues facing the United States. The foundation works to build a culture of health across systems of care (not only medical care) and communities (https://www.rwjf.org).

While many of these have a great deal of helpful evidence to share, they also may have a strong political bias. Objectivity is often lacking in what information these organizations provide: they provide evidence to support certain points of view. That is their purpose—to provide ideas on specific problems, many of which have a political component. Think tanks “are constantly researching solutions to a variety of the world’s problems, and arguing, advocating, and lobbying for policy changes at local, state, and federal levels” (quoted from https://thebestschools.org/features/most-influential-think-tanks/ ). Helpful information about what this one source identified as the 50 most influential U.S. think tanks includes identifying each think tank’s political orientation. For example, The Heritage Foundation is identified as conservative, whereas Human Rights Watch is identified as liberal.

While not the same as think tanks, many mission-driven organizations also sponsor or report on research, as well. For example, the National Association for Children of Alcoholics (NACOA) in the United States is a registered nonprofit organization. Its mission, along with other partnering organizations, private-sector groups, and federal agencies, is to promote policy and program development in research, prevention and treatment to provide information to, for, and about children of alcoholics (of all ages). Based on this mission, the organization supports knowledge development and information gathering on the topic and disseminates information that serves the needs of this population. While this is a worthwhile mission, there is no guarantee that the information meets the criteria for evidence with which we have been working. Evidence reported by think tank and mission-driven sources must be utilized with a great deal of caution and critical analysis!

In many instances an empirical report has not appeared in the published literature, but in the form of a technical or final report to the agency or program providing the funding for the research that was conducted. One such example is presented by a team of investigators funded by the National Institute of Justice to evaluate a program for training professionals to collect strong forensic evidence in instances of sexual assault (Patterson, Resko, Pierce-Weeks, & Campbell, 2014): https://www.ncjrs.gov/pdffiles1/nij/grants/247081.pdf . Investigators may serve in the capacity of consultant to agencies, programs, or institutions, and provide empirical evidence to inform activities and planning. One such example is presented by Maguire-Jack (2014) as a report to a state’s child maltreatment prevention board: https://preventionboard.wi.gov/Documents/InvestmentInPreventionPrograming_Final.pdf .

When Direct Answers to Questions Cannot Be Found. Sometimes social workers are interested in finding answers to complex questions or questions related to an emerging, not-yet-understood topic. This does not mean giving up on empirical literature. Instead, it requires a bit of creativity in approaching the literature. A Venn diagram might help explain this process. Consider a scenario where a social worker wishes to locate literature to answer a question concerning issues of intersectionality. Intersectionality is a social justice term applied to situations where multiple categorizations or classifications come together to create overlapping, interconnected, or multiplied disadvantage. For example, women with a substance use disorder and who have been incarcerated face a triple threat in terms of successful treatment for a substance use disorder: intersectionality exists between being a woman, having a substance use disorder, and having been in jail or prison. After searching the literature, little or no empirical evidence might have been located on this specific triple-threat topic. Instead, the social worker will need to seek literature on each of the threats individually, and possibly will find literature on pairs of topics (see Figure 3-1). There exists some literature about women’s outcomes for treatment of a substance use disorder (a), some literature about women during and following incarceration (b), and some literature about substance use disorders and incarceration (c). Despite not having a direct line on the center of the intersecting spheres of literature (d), the social worker can develop at least a partial picture based on the overlapping literatures.

Figure 3-1. Venn diagram of intersecting literature sets.

Take a moment to complete the following activity. For each statement about empirical literature, decide if it is true or false.

Social Work 3401 Coursebook Copyright © by Dr. Audrey Begun is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License , except where otherwise noted.

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This definition of the Literature Review is excerpted from your textbook ( bolding added):

"Once the researcher identifies a topic that can and should be studied, the search can begin for related literature on the topic. The literature review accomplishes several purposes. It shares with the reader the results of other studies that are closely related to the one being undertaken. It relates a study to the larger, ongoing dialogue in the literature, filling in gaps and extending prior studies (Cooper, 2010; Marshall & Rossman, 2011). It provides a framework for establishing the importance of the study as well as a benchmark for comparing the results with other findings. All or some of these reasons may be the foundation for writing the scholarly literature into a study (see Boote & Beile, 2005, for a more extensive discussion of purposes for compiling a literature review in research). Studies need to add to the body of literature on a topic, and literature sections in proposals are generally shaped from the larger problem to the narrower issue that leads directly into the methods of a study."

Writing a Literature Review

Here are links to several websites and videos that provide useful information on writing a Literature Review.

• Learn How to Write a Review of Literature From the University of Wisconsin-Madison
• Literature Reviews From the Writing Center at the University of North Carolina Chapel Hill
• Literature Reviews: An Overview for Graduate Students Video from North Carolina State University Libraries  
• Writing a Literature Review Paper Video from San Jose State University Libraries
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Unemployment Scarring Effects: An Overview and Meta-analysis of Empirical Studies

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This article reviews the empirical literature on the scarring effects of unemployment, by first presenting an overview of empirical evidence relating to the impact of unemployment spells on subsequent labor market outcomes and then exploiting meta-regression techniques. Empirical evidence is homogeneous in highlighting significant and often persistent wage losses and strong unemployment state dependence. This is confirmed by a meta-regression analysis under the assumption of a common true effect. Heterogeneous findings emerge in the literature, related to the magnitude of these detrimental effects, which are particularly penalizing in terms of labor earnings in case of unemployment periods experienced by laid-off workers. We shed light on further sources of heterogeneity and find that unemployment is particularly scarring for men and when studies’ identification strategy is based on selection on observables.

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Data availability.

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

Moreover, further outcomes discussed by the literature on scarring are family formation, crime and negative psychological implications in terms of well-being, life satisfaction and mental health (see e.g. Helbling and Sacchi 2014 ; Strandh et al. 2014 ; Mousteri et al. 2018 ; Clark and Lepinteur 2019 ).

A further strand of the recent literature focuses on the effect of adverse labor market conditions at graduation, for example focusing on the effect of local unemployment rate or graduating during a recession (see e.g. Raaum and Roed, 2006 ; Kahn 2010 ; Oreopoulos et al. 2012 ; Kawaguchi and Murao 2014 ; Altonji et al. 2016 ). The consequences of economic downturns on wages, labor supply and social outcomes for young labor market entrants have been recently surveyed by Cockx ( 2016 ), Von Wachter (2020) and Rodriguez et al. ( 2020 ).

The stigma effect means that individuals who have been unemployed face lower chances of being hired because employers may use their past history of unemployment as a negative signal.

Thus, papers using traditional multivariate descriptive analysis, duration models, or OLS regressions with a reduced number of controls which do not properly address endogeneity issues and are unlikely to have a causal interpretation (endogeneity issues are discussed in SubSect.  3.2 ).

For intergenerational scars we mean that studies focused on the effect of parents’ unemployment experiences on the children’ future employment status (see e.g. Karhula et al. 2017 ). For macroeconomic conditions at graduation we mean that we excluded that literature focused on the local unemployment rate at graduation or other local labor market conditions, rather than on individual unemployment experience and state dependence (see e.g. Oreopoulos et al. 2012 ; Raaem and Roed, 2006 ).

When we could not directly retrieve the t -statistics because not reported among the study results, we computed them as the ratio between the estimated unemployment effects ( \({\beta }_{i}\) ) and their standard errors. If studies only displayed the estimated effects and their 95% confidence intervals, the standard error can be calculated by SE  = ( ub − lb )/(2 × 1.96), where ub and lb are the upper bound and the lower bound, respectively.

We removed from the meta-regression analysis 8 articles because they did not contain sufficient information to compute the t -statistic of the estimated scarring effect. They are reported in italics in Tables 5 and 6 .

For employment outcomes we mean the likelihood of experiencing future unemployment, the probability to have a job later (employability), the fraction of days spent at work or the hours worked during the following years (labor market participation), the call-backs from employers in case of field experiment. Earning outcomes include hourly wages, labor earnings, income, etc.

Since many studies did not provide precise information on the number of covariates, we approximated \({dk}_{i}\) with the number of observations minus 2. Indeed, given that in microeconometric applications the sample sizes are very often much larger than the number of the parameters, the calculation of the partial correlation coefficient is quite robust to errors in deriving \({dk}_{i}\) (Picchio 2022 ).

The publication bias is the bias arising from the tendency of editors to publish more easily findings consistent with a conventional view or with statistically significant results, whereas studies that find small or no significant effects tend to remain unpublished (Card and Krueger 1995 ).

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Acknowledgements

The author acknowledges financial support from the Cariverona Foundation Ph.D. research scholarship. He is particularly grateful to Matteo Picchio and Claudia Pigini for their comments and suggestions on a preliminary version of this paper. He also thanks the Associate Editor Massimiliano Bratti and two anonymous reviewers, whose comments were very useful for an important improvement of the paper.

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Published on 23.5.2024 in Vol 12 (2024)

Digital Phenotyping for Stress, Anxiety, and Mild Depression: Systematic Literature Review

Authors of this article:

• Adrien Choi, BAdvSci(Hons)   ; 
• Aysel Ooi, BSocSci, MInfoTech   ; 
• Danielle Lottridge, PhD  

School of Computer Science, Faculty of Science, University of Auckland, Auckland, New Zealand

Corresponding Author:

Danielle Lottridge, PhD

School of Computer Science

Faculty of Science

University of Auckland

38 Princes Street

Auckland, 1010

New Zealand

Phone: 64 9 373 7599 ext 82930

Email: [email protected]

Background: Unaddressed early-stage mental health issues, including stress, anxiety, and mild depression, can become a burden for individuals in the long term. Digital phenotyping involves capturing continuous behavioral data via digital smartphone devices to monitor human behavior and can potentially identify milder symptoms before they become serious.

Objective: This systematic literature review aimed to answer the following questions: (1) what is the evidence of the effectiveness of digital phenotyping using smartphones in identifying behavioral patterns related to stress, anxiety, and mild depression? and (2) in particular, which smartphone sensors are found to be effective, and what are the associated challenges?

Methods: We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) process to identify 36 papers (reporting on 40 studies) to assess the key smartphone sensors related to stress, anxiety, and mild depression. We excluded studies conducted with nonadult participants (eg, teenagers and children) and clinical populations, as well as personality measurement and phobia studies. As we focused on the effectiveness of digital phenotyping using smartphones, results related to wearable devices were excluded.

Results: We categorized the studies into 3 major groups based on the recruited participants: studies with students enrolled in universities, studies with adults who were unaffiliated to any particular organization, and studies with employees employed in an organization. The study length varied from 10 days to 3 years. A range of passive sensors were used in the studies, including GPS, Bluetooth, accelerometer, microphone, illuminance, gyroscope, and Wi-Fi. These were used to assess locations visited; mobility; speech patterns; phone use, such as screen checking; time spent in bed; physical activity; sleep; and aspects of social interactions, such as the number of interactions and response time. Of the 40 included studies, 31 (78%) used machine learning models for prediction; most others (n=8, 20%) used descriptive statistics. Students and adults who experienced stress, anxiety, or depression visited fewer locations, were more sedentary, had irregular sleep, and accrued increased phone use. In contrast to students and adults, less mobility was seen as positive for employees because less mobility in workplaces was associated with higher performance. Overall, travel, physical activity, sleep, social interaction, and phone use were related to stress, anxiety, and mild depression.

Conclusions: This study focused on understanding whether smartphone sensors can be effectively used to detect behavioral patterns associated with stress, anxiety, and mild depression in nonclinical participants. The reviewed studies provided evidence that smartphone sensors are effective in identifying behavioral patterns associated with stress, anxiety, and mild depression.

Introduction

Digital phenotyping is “the moment-by-moment quantification of the individual level human phenotype in situ using data from personal digital devices” [ 1 ]. Digital phenotyping applies the concept of phenotypes, in other words, the observable characteristics resulting from the genotype and environment, to conceptualize observable patterns in individuals’ digital data. In the last decade, digital phenotyping studies have been able to compare typical and atypical patterns in daily activities to correlate atypical behavior with negative emotions [ 2 , 3 ]. Behavioral patterns include variations in mobility, frequency of being in various locations, and sleep patterns. In smartphones, user data can be stored, managed, interpreted, and captured in enormous amounts [ 1 , 4 , 5 ]. This can be done actively or passively. Active data collection requires the user to self-report and complete surveys, whereas passive sensing collects data automatically without user input [ 5 ]. Most studies combine active and passive sensing to more accurately detect and predict behavioral abnormalities. Modern smartphone analytics can be used for the discovery of commonalities and abnormalities in user behavior. The ease of using passive sensing makes it an ideal data gathering method for mental health studies [ 6 - 8 ] and an ideal technique for assessing mental health [ 9 ].

Digital phenotyping has been successful in the early detection and prediction of behaviors related to neuropharmacology [ 10 ]; cardiovascular diseases [ 11 ]; diabetes [ 12 ]; and major severe injuries, such as spinal cord injury [ 13 ], motivating further adoption. Digital phenotyping has also proven useful for the detection of severe mental health issues, such as schizophrenia [ 14 , 15 ], bipolar disorder [ 16 ], and suicidal thoughts [ 17 ]. Digital phenotyping has been so successful for specialized, clinical populations that it is increasingly considered for mass market use with nonclinical populations. Digital phenotyping applications and software tools have been used to capture employee information, such as their screen time and clicking patterns [ 18 ]. However, there are not many digital phenotyping studies that have specifically examined the detection or prediction of stress, anxiety, and mild depression.

Individuals with stress, anxiety, and mild depression can develop chronic mental health symptoms that impact their mobility, satisfaction with life, and social interaction [ 19 , 20 ]. When these symptoms are not detected early, they worsen, and the impact is more significant [ 21 - 23 ], increasing the need for medication and hospitalization. This makes mild mental health symptoms a valid target for digital phenotyping, as its goal is to enable early detection and, subsequently, early treatment. Smartphones are increasingly ubiquitous [ 24 ], which makes them an optimal platform for digital phenotyping. We constrained our systematic literature search to the more challenging problem of the detection of mild mental health symptoms using only smartphone sensors and excluded studies that used additional wearable sensors. In general, we believe that additional wearables might increase the effectiveness of digital phenotyping in detecting stress, anxiety, and mild depression. Given the ubiquity of smartphones, we aimed to answer the following question: what is the effectiveness of digital phenotyping using smartphone sensors in detecting stress, anxiety, and mild depression?

The objective of this systematic literature review was to better understand the current uses of digital phenotyping and results of using digital phenotyping for the detection and prediction of mild behavioral patterns related to stress, anxiety, and mild depression. The 2 research questions this review sought to answer were as follows:

• What is the evidence of the effectiveness of digital phenotyping using smartphones in identifying behavioral patterns related to stress, anxiety, and mild depression?
• In particular, which smartphone sensors are found to be effective, and what are the associated challenges?

For these research questions, we considered statistically significant associations between sensor patterns and behavioral patterns as evidence of effectiveness.

Type of Studies

This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines [ 25 ] ( Multimedia Appendix 1 ). Figure 1 shows the reviewing process and search results. In the first round of screening studies, 1 author excluded studies that were not relevant to the research questions. Another author reran the queries for confirmation. Studies were included in this review if they were conducted to measure and detect stress, anxiety, or mild depression, even if they included other variables, such as job performance, promotion, or discrimination. We included studies in which data were collected through smartphones with an iOS (Apple Inc) or Android (Google LLC) operating system. Data collected through wearable devices were excluded. We included studies in which the participants were adults aged ≥18 years and were from a nonclinical population. Studies conducted with nonadult participants (eg, teenagers and children) were excluded. Given our research questions, if the studies’ participants had or had had any severe mental health disorder, such as schizophrenia, bipolar disorder, or psychosis, they were not included. We also excluded personality and character measurement and phobia studies. The primary research language was English. The studies included were conducted from September 2010 to September 2023. Peer-reviewed conference articles and journal articles were included. The data we wished to extract were the study aim, data collected, operating system in the smartphone used for data collection, behavioral patterns identified, surveys used for verification, and sample size. A total of 3 authors reviewed the studies independently to extract data and confirm the extracted data. After the first round of data extraction, 1 author re-examined the studies to extract the predictive modeling used. These data are presented in the Results section. We noticed that participants in the included studies fell into 1 of 3 major groups (ie, students, adults, and employees). We refer to the participants of the studies that recruited adults enrolled in universities as “students,” participants of the studies that recruited adults unaffiliated to any particular organization as “adults,” and participants of the studies that recruited adults employed at a particular organization as “employees.”

Search Strategy

A total of 3 databases were queried: Web of Science, ACM, and PubMed. PubMed is a medicine-based database, ACM is a technology-based database, and Web of Science is a cross-domain database. The search query was the same for the 3 platforms: “digital phenotyping” OR “passive sensing” AND (stress OR anxiety OR ((mild OR moderate) AND depression)).

The study length varied from 10 days [ 26 ] to 3 years [ 27 ]. One study [ 28 ] conducted in-depth interviews with students lasting an average of 4.5 hours per person, and another study was a controlled laboratory study [ 29 ]. These 2 studies are not presented in Table 1 . In the studies conducted with students, a semester or spring or winter term was a common duration. The studies with general nonclinical adult populations were typically longer than those with students.

Number of Participants

The number of participants ranged from a minimum of 7 adults [ 26 ] to a maximum of 18,000 adults [ 27 ]. Apart from the 3-year longitudinal study with 18,000 participants [ 27 ], the average number of participants was 129.4 (SD 184.01). We observed a pattern of attrition, where the number of participants who completed the study was lower than the number of the participants recruited. The number of participants reported in this review is the final sample size. For example, one of the studies [ 52 ] recruited 112 participants, of whom 84 (75%) completed the study. In the study by Pratap et al [ 55 ], there was a drastic drop in participants, with only 359 (30.42%) of the 1180 enrolled participants completing the study. Another significant drop was seen in the study by Nepal et al [ 40 ], where 750 participants were interested in the research, whereas only 141 (18.8%) of them completed the study. Some studies were less affected; for example, 86 participants started the study by Rhim et al [ 49 ], and 78 (91%) completed it.

Publication Years of the Studies

Although the query started with the year 2010, the earliest publication was from 2014 [ 26 ], extending to articles published as of April 2023 [ 35 ]. Over the years, the interest in detecting and predicting stress, anxiety, and mild depression in the nonclinical population has increased ( Table 2 ).

Studies With the iOS and Android Operating Systems

The Android operating system was more common than iOS. Among the 40 included studies, only 2 (5%) were compatible with only iOS [ 29 , 51 ]. A total of 27 (68%) studies were available for both iOS and Android [ 26 , 28 , 30 , 34 , 35 , 37 - 42 , 45 - 47 , 50 , 53 - 61 ]. A total of 11 (28%) studies were for only Android users [ 27 , 31 - 33 , 36 , 42 - 44 , 48 , 49 , 52 ]. The reasons identified for the use of the Android operating system were that it has more freedom to capture more modalities, such as keyboard typing and use of apps, and that Android devices enable apps to run more easily in the background [ 49 ].

Studies With Students

Table 3 presents the data extracted from the studies that were conducted with student populations. The average length of the studies with students was 158.6 (SD 176.4) days. The average number of participants was 137.3 (SD 152.1). There were significantly more studies with students than studies with employees or general adults. The sample sizes of the studies with students were similar to those of the studies with adults but smaller than those of the studies with employees. In the studies with students, various passive sensors were used, and some were found to be effective for detection, prediction, or both.

Of the 28 studies with students, 23 (82%) used machine learning models for prediction. A total of 12 studies (43%) [ 30 , 31 , 33 , 37 , 38 , 44 , 46 , 47 , 54 ] used decision tree–based methods, and 9 studies (32%) [ 37 , 39 , 42 , 49 - 51 , 57 , 58 ] used regression-based methods. A total of 3 (11%) studies conducted in recent years [ 43 , 60 , 61 ] used deep neural networks because of their enhanced ability to discern underlying patterns in large unstructured data sets. Tree-based models have the best performance when trained with structured data, and the reported studies mostly used tree-based models and structured data. Among the 28 studies, 2 studies [ 57 , 60 ] conducted in 2023 addressed the generalizability of their proposed detection method and verified its applicability across students from various years, classes, and institutions. Two (7%) studies [ 42 , 43 ] in Table 3 used the StudentLife data set [ 62 ]. Each study contributed substantial original analyses including different behavioral patterns and was considered a “study” in this systematic review. Entries with “N/A” in the predictive modeling column indicate that the study did not involve any attempts to predict future occurrences. However, these studies may still contain statistical analyses as part of their research approach. Overall, students who experienced depression, anxiety, and stress visited fewer locations [ 39 , 44 , 50 , 58 - 60 ] and were more sedentary [ 47 , 50 , 58 - 60 ]. Depression was also associated with shorter or irregular sleep [ 35 , 46 , 47 , 50 , 52 , 59 , 60 ] and accrued phone use [ 46 , 47 , 50 , 51 , 58 - 60 ].

a PHQ: Patient Health Questionnaire.

b N/A: not applicable.

c DASS: Depression Anxiety Stress Scales.

d SIAS: Social Interaction Anxiety Scale.

e GAD-7: Generalized Anxiety Disorder Scale-7.

f PQ: Prodromal Questionnaire.

g PSS: Perceived Stress Scale.

h PSQI: Pittsburgh Sleep Quality Index.

i BASIS: Behavior and Symptom Identification Scale.

j SF: Short Form Health Survey.

k SFS: Social Functioning Schedule Scale.

l CGI: Clinical Global Impressions Scale.

m HDRS: Hamilton Depression Rating Scale.

n CAS: Coronavirus Anxiety Scale.

o HAI: Health Anxiety Inventory.

p UCLA: University of California, Los Angeles.

q XGBoost: extreme gradient boosting.

r LOOCV: leave-one-out cross validation.

s PANAS: Positive and Negative Affect Schedule.

t MPSM: Mobile Photographic Stress Meter.

u LSTM: long short-term memory.

v CNN: convolutional neural network.

w WEMWBS: Warwick-Edinburgh Mental Well-Being Scale.

x BDI: Beck Depression Inventory.

y EMA: ecological momentary assessment.

z PAM: Patient Activation Measure.

aa BFI: Big Five Inventory.

ab LASSO: least absolute shrinkage and selection operator.

ac COMOSWB: Concise Measure of Subjective Well-Being.

ad SAS: Sport Anxiety Scale.

ae PPC: Perceived Personal Control.

af SSS: Social Support Scale.

ag MAAS: Mindful Attention Awareness Scale.

ah ERQ: Emotion Regulation Questionnaire.

ai BRS: Brief Resilience Scale.

aj CES-D: Center for Epidemiological Studies-Depression.

ak STAI: State Trait Anxiety Inventory.

al LOSOCV: leave-one-subject-out cross validation.

am AdaBoost: adaptive boosting.

an LightGBM: light gradient boosting machine.

ao MERF: mixed-effects random forest.

ap TIPI: Ten-Item Personality inventory.

aq ESS: Epworth Sleepiness Scale.

ar MCTQ: Munich Chronotype Questionnaire.

as PROMIS: Patient-Reported Outcomes Measurement Information System.

at BHM: Behavioral Health Measure.

au CD-RISC: Connor-Davidson Resilience Scale.

av 1D-CNN: 1-dimensional convolutional neural network.

aw MCDCNN: multi-channel deep convolutional neural network.

ax ResNet: residual network.

ay TWIESN: time warping invariant echo state network.

az FCNN: fully convolutional neural network.

ba AUROC: area under the receiver operating characteristic curve.

bb DWAI: Digital Working Alliance Inventory.

Studies With Adults

Table 4 presents the data extracted from the studies conducted with the general adult population. The average study duration was 201.6 (SD 367) days. Apart from a 3-year longitudinal study with 18,000 participants, the average number of participants was 123.4 (SD 139.8). Of the 8 studies with adults, 2 (25%) [ 32 , 52 ] were conducted with the same set of participants. A total of 3 (38%) studies used predictive modeling, with regression-based models being the most common [ 34 , 36 , 52 ], and 1 (12%) study identified gender differences in behavioral patterns [ 27 ]. Overall, the research with adults showed that GPS, accelerometer, ambient audio, and illuminance data related to individuals’ emotional state. Adults with depression were less likely to leave home and were less physically active, whereas adults who were socially anxious were more active and left their home more often but avoided going to places where they needed to socially interact.

a N/A: not applicable.

b LSAS: Liebowitz Social Anxiety Scale.

c GAD-7: Generalized Anxiety Disorder Assessment-7.

d PHQ: Patient Health Questionnaire.

e SDS: Sheehan Disability Scale.

f LASSO: least absolute shrinkage and selection operator.

g BIS: Barratt Impulsiveness Scale.

h UPPS: Impulsive Behavior Scale.

i PAM: Patient Activation Measure.

j XGBoost: extreme gradient boosting.

k STAI: State Trait Anxiety Inventory.

l PANAS: Positive and Negative Affect Schedule.

m PSS: Perceived Stress Scale.

n MAAS: Mindful Attention Awareness Scale.

o SPIN: Social Phobia Inventory.

p RBM: Restricted Boltzmann Machine.

Studies With Employees

Table 5 presents the data extracted from the studies that were conducted with employees. Among the 4 studies with employees, 1 (25%) study recruited its own participants [ 56 ], and the other 3 (75%) studies [ 40 - 42 ] used the Tesserae data set [ 63 ]. Compared with students and adults, the employee population was the least studied, with the fewest articles. However, the studies with employees had the largest number of participants, with a mean of 427.3 (SD 280.3). All 4 studies used regression-based predictive modeling, and 2 (50%) of them [ 40 , 56 ] evaluated a variety of models, with logistic regression, support vector machine, and random forest being the most common methods. Detecting and predicting employees’ stress in workplaces were examined in tandem with employees’ work performance. The research goal for these studies was to understand the underlining reasons for lowered work-related productivity. In contrast to the other 2 populations (ie, students and adults), less mobility was seen as positive for employees because less mobility in workplaces was associated with more positivity and higher performance.

a XGBoost: extreme gradient boosting.

b ITP: Psychological Type Indicator.

c IRB: in-role behavior.

d OCB: organizational citizenship behavior.

e CWB: counterproductive work behavior.

f ROCKET: random convolutional kernel transform.

g EMA: ecological momentary assessment.

h PAM: Patient Activation Measure.

i PANAS: Positive and Negative Affect Schedule.

Passive Sensors

Table 6 provides an overview of the range of sensors used to detect patterns related to mild mental health symptoms and summarizes the evidence of the effectiveness of the various sensors. The first column lists the sensor, and the second column presents how the data from that sensor are interpreted; in other words, it presents the behavior-related information that the sensor data are intended to represent. The third column indicates which articles found significant associations between the specific sensor and stress, anxiety, or mild depression. The fourth column indicates which articles found no significant associations between the specific sensor and mental health outcomes (ie, explicitly stated so in the articles). In the subsequent sections, we discuss the types of activities detected by the sensors.

Social Interaction: Call and Text Logs, Audio, Microphone, and Bluetooth

The social interaction of an individual is reflective of their current mood and mental state [ 44 , 64 , 65 , 66 ]. Individuals with depression and stress may be expected to decrease their social interactions. This is measured through the frequency of receiving texts and calls, how fast individuals respond, and the frequency of being around others. Among the 40 included studies, 18 (45%) [ 27 , 28 , 30 , 31 , 33 - 35 , 37 , 44 - 48 , 51 , 53 , 55 , 60 ] examined call logs to understand social interaction patterns, mainly through the number of incoming and outgoing calls, the number of missed calls, and the duration of calls. Individuals who experience depression and stress may engage in longer outgoing calls [ 51 ]. Evening communications were predictive of depression [ 47 ], anxiety, and loneliness [ 54 ]. Students who experienced discriminations [ 53 ] and anxious participants had more evening communications [ 54 ]. Metadata on SMS text messages were examined in 10 (25%) [ 27 , 28 , 30 , 31 , 33 , 37 , 44 , 45 , 48 , 55 ] of the 40 studies, including the frequency of receiving SMS text messages and the average time of responses. People who are socially anxious were found to take different amounts of time to respond to SMS text messages and calls [ 33 ]. Increases in the number of calls were associated with increased social anxiety [ 48 ]. Those who experienced social anxiety were less likely to call or text in public [ 44 ]. For students, fewer conversations were associated with more stress [ 39 ] and more mood instability [ 42 ]. One of the studies found that more emotionally unstable individuals tended to text more than emotionally stable individuals [ 27 ].

Location: GPS, Bluetooth, and Wi-Fi

Location data can provide insights into individuals’ mental health state in terms of the normal or abnormal variety and frequency of locations visited [ 67 ]. As presented in Table 6 , GPS has been one of the most commonly used passive sensors for stress, anxiety, and mild depression research. The findings regarding location consistently demonstrate that students and adults who experienced depression, anxiety, or stress tended to visit fewer places [ 39 , 44 , 50 , 58 - 60 ]. One of the studies [ 48 ] found that location data are highly inversely correlated with mild depression severity. The main way in which this is measured is through the frequency of exiting the house, the variety of locations visited, and mobility. The frequency of exiting the house is less for individuals who are depressed, and there is less variety in the visited locations for individuals who are socially anxious. Individuals who are feeling depressed often experience being less energetic [ 68 , 69 ]. Overall, negative emotions were associated with time spent at specific locations, but this is also affected by personal routines and preferences [ 30 ]. For students, stress and lower subjective well-being were associated with more time spent on campus [ 39 , 49 ] and less time spent at campus food locations [ 39 ]. Students who experienced depression spent more time at home [ 60 ], whereas individuals at higher risk of psychosis spent less time at home [ 51 ]. Time spent at exercise locations was positively correlated with changes in depressive symptoms [ 48 ]. Another study [ 38 ] distinguished between students experiencing severe stress and those with normal stress levels, revealing that students with severe stress spent significantly less time on campus and were less involved in work-related activities compared with their counterparts with normal stress levels. As for employees, higher performers were found to visit fewer locations on weekday evenings but more locations during weekends [ 56 ].

Voice Recognition: Audio

The microphone is used to measure audio data of speech and ambient noises. One of the studies [ 26 ] examined how people with stress speak by analyzing their voice, including the speed of speech, how energetic their vocality is, and the pitch. One caveat is that the study by Adams et al [ 26 ] used audio captured within laboratory environments and found that stress could be recognized from the absence of speech. In variable environments, it will be harder to recognize the changing voice patterns. One study found that generalized anxiety and depression related to reward-related words in ambient speech, and social anxiety related to vision-related words [ 32 ]. Another study [ 52 ] identified that people with depression tend to speak less and use more death-related words.

Sleep: Accelerometer, Audio, and Illuminance

Sleep is highly correlated with individuals’ mental state [ 26 , 35 , 36 , 42 , 45 - 47 , 59 , 60 ]. Among the 40 included studies, 5 (13%) [ 35 , 46 , 52 , 60 ] found that more disturbed sleep correlated with more depressive symptoms. However, occasional sleep disturbance is not necessarily predictive. For example, for those with social anxiety, sleep disturbance might be positive because it suggests night-time activity and social interactions. Metadata on the time spent in darkness can be indicative of sleep patterns. The study by Fukazawa et al [ 36 ] stated that anxiety levels increase when the time spent in darkness increases. The study by Di Matteo et al [ 52 ] found that individuals with symptoms related to social anxiety and depression spent less time in darker environments. Another study [ 39 ] stated that stress changed students’ sleep patterns, where they became less likely to move around between 6 PM and midnight. Of the 40 studies, 6 (15%) found that shorter sleep duration was correlated with more mood instability [ 42 ], more depressive symptoms [ 59 , 60 ], and more stress [ 36 , 44 ]. One of the studies [ 45 ] also found that the student population, in general, tended to sleep less during examination periods and slept more during breaks, and they felt more stressed during both breaks and examination periods.

Phone Use: On and Off Screen, Lock and Unlock, and App Use

Today, smartphones are used for self-regulated “distractions,” such as the use of social media [ 38 ]. This type of self-regulated distraction can temporarily reduce stress. The study by Chikersal et al [ 47 ] showed that depression can impact concentration levels, so if distraction by phone can be measured, this could be a potential predictive marker. Several studies found that increasing phone use was correlated with more depressive symptoms [ 46 , 47 , 50 , 52 , 58 - 60 ], anxiety [ 52 , 59 ], impulsivity [ 34 ] and lower subjective-wellbeing [ 49 ]. The study by Morshed et al [ 42 ] outlined that for postsemester depression, phone use at night is not predictive, whereas another study [ 47 ] summarized that phone use during the day is predictive of depression. More frequent phone locks or unlocks correlated with higher levels of depressive symptoms [ 60 ] and impulsivity [ 34 ]. Higher performing employees tended to unlock their phones less frequently in the evenings [ 56 ]. Additionally, individuals who were promoted spent more time on their phones during early mornings and late evenings, with more unlocks occurring during nighttime compared with their nonpromoted counterparts [ 40 ].

Physical Activity and Mobility: Accelerometer

According to Table 6 , along with GPS, accelerometer is one of the most widely used passive sensors in digital phenotyping research to monitor participant’s mobility, activity, and sedentary periods. Increased sedentary time was correlated with increased depressive symptoms [ 47 , 48 , 50 , 58 - 60 ], increased mood instability [ 27 , 42 ], increased stress [ 36 ] and decreased subjective well-being [ 49 ]. Exercise duration was positively correlated with changes in anxiety [ 36 ] and depressive symptoms [ 48 ]. The study by Mirjafari et al [ 56 ] found that the amount of movement and physical activity was related to employee’s stress level and highlighted that if the activity is regular, it should reduce stress. Different occupations require different levels of physical activity, social interactions, and mobility. For instance, developers spend most of their time at their desks, and their tasks might require less social interaction and mobility at work, but this does not mean they are more stressed. Project managers have more mobility during the day, and this may be because they need to move around to meet with the stakeholders [ 56 ]. Several studies have observed variations in mobility and gait consistency. The study by Boukhechba et al [ 44 ] reported that individuals with high social anxiety exhibited a narrower range of activities, whereas the study by Xu et al [ 60 ] revealed that students experiencing depression demonstrated more consistent mobility patterns. Additionally, accelerometer data indicated that individuals with low social anxiety maintained a steady walking pace, whereas those with high social anxiety tended to walk more rapidly and with greater irregularity [ 33 ].

Muscle Activity: Keyboard

Stress can cause muscle tension [ 70 , 71 ]. One of the studies [ 29 ] collected the data of users with stress via a keyboard in a laboratory environment and found that typing pressure significantly increased under stressful conditions.

Digital phenotyping for mild mental health symptoms in nonclinical participants can present ethical challenges, limitations to the research, and technical challenges. We review the challenges that were stated in the literature.

Ethical Challenges

Among the 40 included studies, 7 (18%) specifically mentioned privacy-related ethical concerns [ 28 , 31 , 35 , 36 , 40 , 41 , 43 ]. A major concern for participants across several studies was whether authorities, such as employers or teachers, will have access to their data. One of the studies [ 28 ] conducted in-depth interviews with 15 students to understand their perspectives on digital phenotyping through app prototypes. They found that the students’ core concerns were whether the acquainted university staff had access to the data. They also found that students’ acceptability of such apps depends on the perceived relevancy of the data collected and the effects on students’ devices. The study by Nepal et al [ 40 ] with employees reported a similar privacy concern of whether the employees’ data would be leaked to their boss; if the boss is aware of a potential mental health issue, it may impact their work performance ratings.

The methods of collecting and storing passive sensing data also present privacy concerns [ 28 , 70 , 72 ], particularly when the tracked data involve sensitive topics, such as mental health [ 72 ]. Sensors that infer individuals’ social interactions provide insights into their mental health status [ 26 , 36 , 53 ]. However, these types of data were less likely to be shared by participants because of privacy concerns. In the study by Rooksby et al [ 28 ], students identified camera, microphone, call log, and keyboard data as highly unacceptable types of data to capture.

Location data were associated with privacy and security concerns. In the study by Wen et al [ 34 ], participants felt uncomfortable with location tracking because it might breach their privacy and were hesitant to log their location when they moved from one place to another. Some studies excluded specific sensors to protect the participant’s privacy. Location data were not recorded owing to security concerns, even though they could provide valuable insights into the mental state [ 36 , 38 ]. In the study by Adams et al [ 26 ], the microphone was disabled to capture calls and conversations while individuals were talking to their family members. Another ethical concern was regarding the misuse of data. The main focus in studies of digital phenotyping using smartphones was on tracking participants’ usual behavioral patterns and identifying whether they behaved unusually. There were concerns regarding secondary uses. For example, participants’ leaked data can be used for advertising purposes or to create content [ 34 , 41 ].

Limitations to the Research

Coping mechanisms related to stress and anxiety vary among individuals [ 22 ]. Individual differences can make it challenging to label individuals as stressed, anxious, or depressed, particularly nonclinical participants. Certain behavioral patterns can be generally expected; however, not all individuals will follow the same pattern. To make generalizable and powerful analyses and understand behavioral patterns associated with mild mental health concerns, it is recommended to study diverse groups for longer than a 2-week period. Of the 40 included studies, 2 (5%) [ 33 , 39 ] focused on a particular demographic subset, namely, undergraduate students. Therefore, the generalizability of the studies is limited. In the studies by Rooksby et al [ 28 ], Exposito et al [ 29 ], and Wang et al [ 50 ], limited variation in representation was seen as a major limitation. The studies by Rhim et al [ 49 ], DaSilva et al [ 39 ], and Fukazawa et al [ 36 ] stressed the importance of selecting a wider age group, as younger people use their smartphones proactively, whereas older people’s behavioral patterns might show differences when they are experiencing mild mental health symptoms. The study by Nepal et al [ 40 ] suggested that diverse population testing is required for more reliable results, considering interindividual differences. Furthermore, the accuracy and effectiveness of machine learning models are highly affected by data set quality. We noticed that over the last 4 years [ 38 , 46 , 57 , 60 ], there has been increased focus on the generalizability of machine learning models, with the goal of assessing generalizability across students from various years, classes, and institutions.

Technical Challenges

Digital phenotyping studies on mild symptoms related to mental health with nonclinical participants presented technical challenges. A main concern was the accuracy of the sensor data collected from smartphones. The study by Fukazawa et al [ 36 ] sought to understand the time spent in darkness and its effects on the relationship between stress and anxiety patterns and sleep. However, when individuals carried their smartphone in their pockets or bags, the smartphone could not detect the darkness of the environment. This presented a challenge because illuminance data were captured even when the phone was not used actively. Similar concerns were raised in the study by Di Matteo et al [ 52 ]. The time spent in darkness feature did not distinguish whether the device was in a dark room or a dark location (ie, in the pocket). The study by Melcher et al [ 35 ] stated that the captured accelerometer data may not accurately represent daily activity, as not all participants constantly carried their phones throughout the day. In the study by Di Matteo et al [ 32 ], environmental audio did not produce clear transcripts in louder environments. This study mentioned that transcripts were produced based on dictionaries, so language analysis of complex speech, such as metaphors and sarcasm, was ignored. Therefore, the entire content of the conversation might not be correctly interpreted. In the study by Di Matteo et al [ 52 ], similar challenges were identified, as the speech data produced from smartphones were not clear. The recorded voices of the participants were masked by those of the people around them or even sound from other sources such as television or radio. Moreover, it was not possible to identify whether the death-related words came from the participants or from the people they interacted with.

Another technical challenge identified was battery life [ 47 ]. As expected, moment-by-moment data collection requires high power use, which might shorten the battery life. Participants had to charge their phones more often, which was inconvenient, and altered their usual behavior because they could not carry their phones as usual when the phones were charging. The study by Chikersal et al [ 47 ] mentioned another technical limitation: the transfer rate was affected if the app stopped working randomly. During these times, data were not transferred or collected. With the increase in the use of 5G technology, Wi-Fi data for indoor locations may cease to be relevant. In the study by Zakaria et al [ 38 ], some users were on their 5G indoors rather than their Wi-Fi, and this may point to a future trend of the use of 5G. We now turn to the discussion.

Principal Findings

This literature review examined digital phenotyping studies that detected and predicted stress, anxiety, and depression in their mild states in nonclinical populations using data collected from smartphones. The primary objective of digital phenotyping in the context of mild mental health was similar among the 3 participant cohorts: students, adults, and employees. However, notable distinctions emerged among these groups. Among university students, the geographical proximity and relevance of the university campus were discerned as influential factors. Moreover, academic pursuits, particularly coursework and study-related activities, assumed significance within this demographic. Conversely, among employees, work aspects held salience, accompanied by the workplace environment. The remaining studies encompassed a general population cohort, delineated by undisclosed characteristics. Overall, we found that identifying behavioral abnormalities related to stress and anxiety was possible but raised certain challenges. Generalized stress and anxiety symptoms vary largely among individuals, whereas serious diagnoses, such as bipolar disorder or schizophrenia, have well-documented behavioral changes. Sleep was a strong predictor variable, yet some individuals tended to sleep more while they were stressed, whereas others lacked sleep under stress. This may be one of the reasons why there are fewer studies and reviews completed on stress and anxiety compared with studies on serious conditions such as bipolar disorder, severe depression, and schizophrenia. Another reason is that clinical psychologists and psychiatrists who are familiar with clinical populations are leading the digital phenotyping research.

Studies tended to use self-report to categorize nonclinical populations as stressed, depressed, or anxious. It was not always clear whether the identified patterns of the passive sensor data would effectively discriminate among groups. Most studies used prestudy and poststudy surveys to identify participants’ mental state. There were concerns raised regarding the accuracy of the categorization of self-report surveys. For instance, the study by Sefidgar et al [ 53 ] stated that students with stress may not report themselves as very stressed. Melcher et al [ 70 ] conducted a review and found that students were concerned regarding their professors learning about their data [ 71 ]. Thus, the accuracy of self-report remains an issue for passive sensing studies that use self-report labels, especially when there are privacy concerns. This may be related to the high dropout rates in the studies.

Many types of data sensors were used in the reviewed studies. Few articles related sensor patterns to specific symptoms validated by relevant psychological evidence. One of the studies [ 46 ] extracted interpretable rules (such as intermittent sleep episodes or number of bouts of being asleep or number of outgoing calls during weekends) through association rule mining to distinguish the behavioral patterns between students who were depressed and students who were not. However, although the behavioral patterns were identified, they were not validated to be exclusive to the addressed mental health issue; for example, high mobility and physical activity do not necessarily mean that the person is not stressed. In the study by Tseng et al [ 45 ], students were more mobile during the examination week, despite being under high pressure and stress. In the same study, some students were less mobile when studying for their examinations, which we cannot necessarily be interpreted as being under stress. Of the 40 included studies, 4 (10%) [ 35 , 58 , 59 , 61 ] explored the effects of the COVID-19 pandemic on behavioral and mental health. Additional recent investigations, which independently gathered their own data sets during the COVID-19 pandemic, have shown that quarantine measures have influenced individual behavioral patterns. For the purpose of making precise predictions in digital phenotyping, it is imperative to consider contextual and environmental factors.

Privacy and secondary data uses were the main concerns identified for digital phenotyping. Individuals using digital phenotyping systems have the right to provide informed consent. This means that they should be made aware of how all their data will be used, who will have access to their data, where their data will be stored, and for how long their data will be stored, and they have the right to decline to participate. We urge researchers and medical practitioners to carefully consider the system design and requirements because data transferred to the cloud and other services may fall under various service agreements. To empower end users and improve the quality of digital phenotyping systems, we recommend that transparent algorithms and explainable artificial intelligence be combined with user-accessible and understandable displays so that adults can engage in the process of identifying and categorizing patterns related to mild mental health symptoms.

The digital phenotyping research focused on in this review may enable the design of tailored intervention programs for nonclinical participants who are showing symptoms of stress, anxiety, and mild depression. Most of the studies included in this review were conducted within a restricted timeline and limited scope of detection and prediction. Only 4 (10%) of the 40 studies mentioned potential intervention programs upon predicting stress, anxiety, and mild depression [ 31 , 38 , 47 , 53 ].

Our review has some limitations. We excluded studies conducted with teenagers, children, and adults who were clinically diagnosed. Thus, we missed studies that focused on the detection and prediction of stress, anxiety, and mild depression in these populations. These populations are likely to show different patterns than those in adults who are not clinically diagnosed. Further, we excluded studies conducted using technologies other than smartphones. We chose this more limited subset of technologies to scope findings related to widely available technologies. The availability of technologies is changing rapidly, and wearables such as smartwatches are becoming more common. As wearable technologies become ubiquitous, we recommend including them in future systematic reviews.

This literature review is unique in that it examines studies focused on the behavioral patterns of nonclinical populations, namely students, employees, and adults who are stressed, anxious, or mildly depressed. We examined each type of sensor and indicated when it was significantly associated with mild mental health symptoms. We identified commonalities in the studies in terms of ethical challenges, limitations to the research, and technical challenges.

Conclusions

This systematic literature review found that digital phenotyping can be an effective way of identifying certain behavioral patterns related to stress, anxiety, and mild depression. A range of passive sensors was used in the studies, such as GPS, Bluetooth, ambient audio, light sensors, accelerometers, microphones, illuminance, and Wi-Fi. We found that location, physical activity, and social interaction data were highly related to participants’ mental health and well-being. The surveyed literature discussed the ethical and technical challenges that limit the accuracy and generalizability of results. One of the greatest challenges was privacy concerns, and these were primarily related to camera, location, SMS text message, and call log data. Another challenge was the significant variation among individuals and their unique behaviors related to mental health. Finally, technical limitations have not been fully resolved, with issues such as the sensor for illuminance still capturing data while not in use reducing the accuracy of the collected data. It is hoped that this overview of digital phenotyping and mental health studies conducted in the last decade, including the common privacy and technical concerns, can help move this area of research forward, ultimately improving the quality of passive sensing, and provide benefits in terms of the early detection of relevant mild mental health phenomena.

Acknowledgments

The authors would like to thank the School of Computer Science at the University of Auckland for their financial support.

Conflicts of Interest

None declared.

The PRISMA 2020 checklist.

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Abbreviations

Edited by L Buis; submitted 01.07.22; peer-reviewed by J Rooksby, KS Sahu, A Joseph; comments to author 09.08.22; revised version received 03.10.22; accepted 27.09.23; published 23.05.24.

©Adrien Choi, Aysel Ooi, Danielle Lottridge. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 23.05.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mHealth and uHealth, is properly cited. The complete bibliographic information, a link to the original publication on https://mhealth.jmir.org/, as well as this copyright and license information must be included.

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• Published: 14 May 2024

Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review

• Agani Afaya 1 , 2 ,
• Emmanuel Anongeba Anaba 3 ,
• Victoria Bam 4 ,
• Richard Adongo Afaya 5 ,
• Ahmed-Rufai Yahaya 6 ,
• Abdul-Aziz Seidu 7 &
• Bright Opoku Ahinkorah 8  

BMC Women's Health volume  24 , Article number:  288 ( 2024 ) Cite this article

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Breast cancer is currently the most commonly diagnosed cancer in Ghana and the leading cause of cancer mortality among women. Few published empirical evidence exist on cultural beliefs and perceptions about breast cancer diagnosis and treatment in Ghana. This systematic review sought to map evidence on the socio-cultural beliefs and perceptions influencing the diagnosis and treatment of breast cancer among Ghanaian women.

This review was conducted following the methodological guideline of Joanna Briggs Institute and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The literature search was conducted in PubMed, CINAHL via EBSCO host , PsycINFO, Web of Science, and Embase. Studies that were conducted on cultural, religious, and spiritual beliefs were included. The included studies were screened by title, abstract, and full text by three reviewers. Data were charted and results were presented in a narrative synthesis form.

After the title, abstract, and full-text screening, 15 studies were included. Three categories were identified after the synthesis of the charted data. The categories included: cultural, religious and spiritual beliefs and misconceptions about breast cancer. The cultural beliefs included ancestral punishment and curses from the gods for wrongdoing leading to breast cancer. Spiritual beliefs about breast cancer were attributed to spiritual or supernatural forces. People had the religious belief that breast cancer is a test from God and they resorted to prayers for healing. Some women perceived that breast cancer is caused by spider bites, heredity, extreme stress, trauma, infections, diet, or lifestyle.

This study adduces evidence of the socio-cultural beliefs that impact on the diagnosis and treatment of breast cancer among women in Ghana. Taking into consideration the diverse cultural and traditional beliefs about breast cancer diagnosis and treatment, there is a compelling need to intensify nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. We recommend the need to incorporate socio-cultural factors influencing breast cancer diagnosis and treatment into breast cancer awareness programs, education, and interventions in Ghana.

Peer Review reports

Introduction

Breast cancer is a global public health concern due to its increasing incidence coupled with the high mortality rate among women in low- and high-income countries [ 1 ]. In 2020, it was estimated that 2.3 million breast cancer cases were newly diagnosed with approximately 685,000 deaths globally [ 1 ]. In Ghana, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women [ 2 ]. In 2020, breast cancer accounted for approximately 31.8% of all cancer cases in Ghana [ 3 ].

Evidence shows that cultural factors such as conceptualizations of health, illness, beliefs, and values influence breast cancer screening among women in certain populations [ 4 , 5 , 6 ]. Breast cancer screening is reported to be relatively low among women living in Ghana. A nationwide study revealed that only 4.5% of Ghanaian women aged 50 years and older had undergone mammography screening [ 7 ]. The low levels of breast cancer screening lead to undetected breast cancer symptoms, contributing to the late-stage diagnosis of breast cancer and subsequent poorer outcomes and mortality [ 8 ]. There have been low levels of awareness and knowledge about breast cancer among women in Ghana [ 9 ]. Also, there is a lack of understanding of the perceptions and beliefs toward breast cancer diagnosis and treatment in Ghana.

Culture is considered a multidimensional set of shared beliefs and socially transmitted ideologies about the world, which are passed on from generation to generation [ 10 , 11 ]. Cultural beliefs within certain communities across the globe are considered a determinant of health risk perceptions and behaviors in promoting or seeking health care in diverse populations [ 12 ]. In traditional Ghanaian communities, good health is recognized as a suitable relationship between the living and the dead and being in harmony with the individuals’ environment. Thus, disease is conceptualized as a malfunctioning of the body system which is probably due to a lack of harmony with supernatural/ancestral forces [ 13 ]. This belief influences how diseases are treated and the steps taken to manage the disease and ultimately how the disease is experienced [ 13 , 14 ]. Cultural beliefs connected to breast cancer are among the key determinants in women’s decision-making regarding breast cancer screening practices in traditional societies [ 14 , 15 ]. In most Ghanaian communities, breast cancer is believed to be associated with supernatural powers, hence, women seek alternative treatments (healing/prayer camps) first and only report to health facilities in advanced stages of breast cancer [ 16 ].

It is therefore important to consider how socio-cultural factors impact breast cancer diagnosis and treatment because these factors influence cancer care in resource-limited settings. To the best of our knowledge, no review has been conducted in Ghana specifically to address the cultural, religious, and spiritual beliefs influencing timely diagnosis and treatment of breast cancer among women. To fill this gap, this systematic review sought to map evidence on the cultural beliefs and perceptions that influence the timely diagnosis and treatment of breast cancer among women.

This systematic review was conducted following the updated methodological guideline of Joanna Briggs Institute (JBI) [ 17 , 18 ] and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The updated JBI methodological guidance regarding conducting a mixed methods systematic review recommends that reviewers use a convergent approach to synthesize and integrate both qualitative and quantitative studies [ 18 ]. Therefore, using a mixed methods systematic review involving both quantitative and qualitative studies was deemed the most appropriate study design because this is the first evidence synthesis on the cultural, religious, and spiritual beliefs that influence breast cancer diagnosis and treatment in Ghana.

Inclusion and exclusion criteria

Studies conducted among women and explored the cultural beliefs and perceptions about breast cancer were included.

Studies that were only limited to Ghanaian communities were included.

Empirical studies published in peer-review journals.

Observational studies, using qualitative and/or quantitative methods were also included.

The exclusion criteria involved review studies, conference papers, editorials and abstracts.

Studies published before 2012 were also excluded.

Search strategy

This review adopted the triple-step search strategy proposed by the JBI for all types of reviews [ 19 ]. The first step involved an initial limited search in PubMed for already existing published research articles on sociocultural beliefs and perceptions about breast cancer in Ghana. The initial limited search ensured the identification of relevant keywords used in developing the preliminary search terms. Step two involved a formal search after finalizing and combining the following keywords (‘breast cancer’, ‘cultural beliefs’, ‘religious beliefs’, ‘traditional beliefs’, ‘perception’, and ‘Ghana’) using Boolean operators. A comprehensive search was conducted in PubMed, CINAHL via EBSCO host , PsycINFO, Web of Science, and Embase from 2012–2022. The final step involved manual tracing of the reference list of studies for additional studies. This was done up to the point of saturation where no new information emanated from the subsequent manual search of articles.

Study selection

Following the searches, the identified records were exported into EndNote 2020 reference manager for duplicate removal. After the duplicate removal, the reviewers ensured consistency in screening through the following process: (1) joint screening by two reviewers was conducted until they felt confident to start independent screening, (2) independent blinded screening of titles/abstracts followed by a meeting and discussion of discrepancies and (3) repetition of step 2 until an acceptable agreement was met. Following the screening of the titles/abstracts, full-text review was conducted following a two-step process. The first step involved two reviewers who screened all the articles identified after the title/abstract screening. Thereafter, two independent reviewers assessed the full-text articles for inclusion or exclusion. In the course of the full-text screening, any disagreements that emerged were discussed for consensus. Throughout the screening of the abstracts, full-texts, and data extraction, the reviewers regularly met to discuss and solve emerging issues.

Data extraction

A data extraction form was developed in line with the aim of this review. Two authors independently extracted the relevant information from the included articles. The following information was extracted from the articles: first author’s name, year of publication, study location, study type, aim, study population, and key findings. Disagreements during the data extraction process were resolved by a discussion and where a resolution was not reachable, the last author resolved it through further adjudication. Study selection and data extraction were conducted manually.

Data analysis

A convergent integrated approach [ 20 ] was employed to transform the data into narrative form because the extracted information was from quantitative and qualitative studies. The analysis followed JBI recommendation where we qualitized quantitative data for data transformation because this is less prone to error when codified than when qualitative data is given numerical values. Qualitizing entails taking data from quantitative studies, translating or converting it into textual descriptions so that it can be integrated with qualitative data, and providing a narrative interpretation of the quantitative results [ 18 ]. Following the convergent synthesis of the transformed data, the reviewers undertook repeated, detailed examination of the assembled data to identify categories on the basis of similarity in meaning [ 18 ]. Out of these, three categories were derived from the analysis.

Assessment of methodological quality

Using the Mixed Methods Appraisal Tool (MMAT)  version 2018, two researchers (AA and RAA) evaluated each included study’s quality separately [ 21 ]. After discussing disagreements between the two reviewers (AA and RAA), BOA helped to forge a consensus. Methodological quality standards for evaluating research using mixed methodologies, quantitative, and qualitative approaches are included in the MMAT. The MMAT assesses the suitability of the research objective, study design, technique, participant recruitment, data collection, data analysis, results presentation, author comments, and conclusions. Hong et al. [ 21 ] discourages the overall quality scoring of the included studies, therefore, the methodological quality of the studies was evaluated using the recommended guidelines.

Flow Chart of evidence selection

Literature search

Our search yielded a total of 176 records from the electronic databases. After duplicates were automatically removed through the EndNote ( n  = 76), 100 records were reviewed independently by two authors based on the title and abstract. Records that did not meet the inclusion ( n  = 75) were removed after holding discussions to identify discrepancies in the review process. Thereafter, full texts of the remaining 25 articles were assessed for eligibility. Hand-search of the included study references yielded no results. In total, we included 15 studies [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The article selection process is shown in the PRISMA flow diagram (Fig.  1 ).

Characteristics of the included studies and quality

The majority of the studies [ 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] were conducted in the southern part of Ghana where there are better health infrastructures compared to the northern part of Ghana. Eight of the included studies were qualitative while the rest employed quantitative study designs. The summary of the characteristics of the 15 studies is shown in Table  1 . The appraisal of the included studies was assessed using the MMAT. All the studies were included, and none were excluded due to poor methodological quality. All 15 studies met the screening criteria and provided clear research questions. The studies included clearly stated and described research design, and target population, and used appropriate measurements.

Cultural beliefs

Breast cancer is believed by some sections of Ghanaians to be a curse or a punishment from the lesser gods for sins committed by the individual [ 22 ]. Some women believed that an extra-marital immoral lifestyle provokes God’s retribution for breast cancer development [ 29 ]. Some people believed that it is an ancestral punishment for the woman’s refusal to give birth in order to continue the ancestral lineage [ 23 ] and because of this, they are given spiritual babies to suckle the breast which then causes cancer [ 23 ]. It is also believed some women have been pronounced cursed due to some wrongdoings [ 25 ]. Due to the cultural belief, some women prayed to their ancestors so that traditional medicine will heal them of the breast cancer [ 26 ].

“…when it started, my uncles came to my aid, they took me to the village to see a “Tim Lana” (referring to a traditional healer). He was very good. He told me everything about my problem. So, there was no need for visiting the hospital…” [ 36 ].

Spiritual and religious beliefs

Some studies in Greater Accra, Tamale, and Kumasi indicated that breast cancer was a spiritual attack from humans or family members that sought to kill them while some believe it emanated from evil forces [ 29 , 31 , 36 ]. Participants in some studies indicated that breast cancer is attributed to some spiritual or supernatural forces [ 32 , 33 , 36 ] and can only be cured through spiritual means [ 33 ]. Due to the spiritual beliefs, some women went to traditional healers for treatment [ 26 , 36 ]. A study in the northern part of Ghana revealed that women who suffer from breast cancer are witches and have used their breasts for ritual purposes [ 25 ] while in the southern part of Ghana some participants believed that breast cancer is caused by witches [ 22 ]. For example, a narration from a participant stated:

“I believe my condition is spiritual and I realized it is coming from my mother’s side” [ 31 ].

“The problem is that my disease is a spiritual attack, so it has to be treated spiritually; the hospital drugs cannot get this out of me…” [ 36 ].

Some studies in the southern and northern part of Ghana stated that participants had a religious belief that the disease was a test from God and resulted in prayers for healing [ 31 , 36 ] and also believed that God had the supernatural powers to miraculously melt the breast lump [ 29 , 32 ] and completely cure them [ 32 ]. Some women also believed that it was their fate to get breast cancer [ 36 ]. Due to these religious beliefs some women had to resort to prayer camps for healing which leads to delay in diagnosis and treatment of breast cancer [ 26 ].

Misconceptions about breast cancer

Some women perceived that breast cancer is caused by spider bites [ 24 ], heredity, extreme stress [ 22 , 32 ], trauma, infections [ 22 ], diet, or lifestyle [ 22 , 35 ]. Some perceived risk factors of breast cancer as stated by some women included non-breastfeeding women, obesity, or overweight [ 25 , 30 , 33 ], and contraceptive use [ 30 ]. Some women had the perception that male health practitioners would not be allowed to examine or see their breasts while some preferred male doctors to examine their breasts [ 27 ]. A study in Accra conducted among female nonmedical students revealed that suckling the breast by a male caused breast cancer [ 28 ]. It is also perceived that putting money in the brassieres could be a possible cause of breast cancer among females [ 23 , 35 ]. A study by Iddrisu et al. [ 31 ] and Agbokey [ 23 ] revealed that breast cancer is a disgraceful disease, dangerous, and a fast killer. Some people also believed that breast cancer can be cured [ 27 , 32 ] by herbal treatment or medicine [ 25 ] while some believed that it is not curable [ 27 ]. Some people also believed that breast cancer was contagious and transmissible and avoided sharing equipment with breast cancer survivors [ 31 ]. A breast cancer survivor narrated:

“…my mum believes the disease can be transmitted so she does not allow me to eat with my son. I have separate bowls, spoons, and cups from that of the family…” [ 31 ].

This study reviews the existing literature on socio-cultural beliefs influencing the timely diagnosis and treatment of breast cancer among women, and this revealed diverse cultural, spiritual, and religious beliefs across the regions of Ghana. The current findings emphasize critical issues that lead to misguidance and share ignorance about breast cancer and its treatment among a section of Ghanaian communities which is rooted in their personal beliefs. Cultural beliefs are key in the decision-making process for the treatment of ailments depending on their knowledge level about the condition. This could probably lead to making the right decision or the wrong treatment decision. The diverse cultural, spiritual, and religious beliefs about breast cancer could affect the health seeking behavior of women diagnosed with breast cancer within the Ghanaian communities.

Consistent with a systematic review findings [ 13 ] it is believed that breast cancer emanates as a result of supernatural forces, curses, and punishment from lesser gods/ancestors for wrongdoings. Though not all Africans hold this traditional belief in ancestral spirits, some believe that health and illness are in the hands of a higher power such as God or Allah [ 13 ]. Hence, in most African communities it is common practice to seek traditional medicine for the treatment of diseases which is in line with their beliefs [ 37 ]. Due to the cultural/traditional belief systems and practices, most women report to health facilities with advanced stages of breast cancer which adversely impacts the breast cancer diagnosis and treatment [ 36 ]. Most women resort to traditional or spiritual healing because this method of treatment combines body, soul, and spirit. In some African settings, traditional healers are trusted to treat diseases including cancer because women believe they look for both scientific and metaphysical causes of the disease. It is possible that breast cancer patients who combine both traditional and modern methods of treatment may experience treatment interference. This dual approach can impact treatment effectiveness and lead to adverse effects or complications. The provision of culturally sensitive care by recognizing unique cultural, religious, and social beliefs and practices is of paramount importance for early detection and treatment of breast cancer among women [ 38 , 39 , 40 ]. Globally, women’s cultural beliefs and perceptions towards breast cancer should be examined to optimize timely breast cancer diagnosis and treatment.

Religious fanaticism coupled with lack of knowledge about the disease condition could impede the utilization of medical treatment, especially when religious beliefs impact negatively on people’s health-seeking behaviors [ 36 ]. A study in Nigeria revealed that religious beliefs about breast cancer were observed to be a barrier to breast cancer screening among women [ 41 ]. This review found that some women in the southern part of Ghana believed that breast cancer was a test from God and resorted to prayers because they believed that God had supernatural powers to heal them from the disease. Though religious beliefs are considered to be a source of spiritual strength and help people to cope with the disease, the religious misconceptions, and mistaken beliefs are thought to contribute to delayed heath-seeking attitudes and lack of breast cancer screening among women [ 42 ]. In the current review, it was reported that some women stayed in prayer camps for almost one year seeking healing and later reported to health facilities with advanced breast cancer which has dire consequences on the survival rate of women. Efforts to sensitize women and religious leaders about the early presentation of breast disease to health facilities for diagnosis and treatment would be key to reduce the number of breast cancer cases detained in religious camps. It is also imperative for religious bodies to discuss health related issues including breast cancer to create much awareness about the condition.

This review identified varied perceptions of breast cancer where breast cancer has been attributed to spider bites and putting money in the brassieres among others. Some believed that breast cancer was a contagious and transmissible disease. These findings show poor knowledge level among women concerning breast cancer. Even though in this review most women had heard or were aware of breast cancer, the varied perceptions about breast cancer suggests low knowledge level of breast cancer. The low knowledge level of breast cancer among women have been associated with late presentation of breast cancer to health facilities [ 40 ]. Women presenting to health facilities with advanced stage breast cancer have been associated with low survival rate in the African region as compared to high income countries [ 43 ]. A study conducted in Ghana revealed that the breast cancer survival rate among women was below 50% which was probably due to late presentation and lack of breast cancer screening [ 44 ]. We recommend intensification of public health education campaigns on breast cancer in order to improve women’s knowledge of the disease which will subsequently enhance early presentation, diagnosis, and treatment.

Implication for policy and practice

Metaphors such as spider bites, supernatural forces, witchcraft, and many other beliefs are associated with breast cancer in Ghana which impact the understanding of the disease and whether or not to seek medical treatment. Therefore, culturally sensitive intervention programs targeted at improving breast cancer awareness among women, religious and traditional leaders are imperative. These intervention programs could entail community engagement, workshops, or educational materials tailored to address specific cultural beliefs and misconceptions.

Taking into consideration the diverse cultural beliefs about breast cancer, there is a compelling need for nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. The education program should be culturally tailored to address the myths and misconceptions. It is important that considerations are given to these issues, not only focusing on how these issues affect women’s lives post-treatment but also on how these issues can be resolved to improve diagnosis and treatment of the disease. We recommend that socio-cultural factors influencing breast cancer diagnosis and treatment should be incorporated into breast cancer awareness programs, education, and intervention programs in Ghana. We believe these would help inform women and encourage them to report to health facilities early with breast cancer symptoms to initiate timely diagnosis and treatment to improve the outcomes of the disease in Ghana.

Further research is required to explore appropriate and effective multidimensional culturally sensitive intervention research that integrates cultural beliefs and breast cancer treatment especially, in different Ghanaian communities.

Strengths and limitations of the study

This study has several strengths, one major strength is the extensive and comprehensive search in various electronic databases following the methodological guideline of JBI and reported in accordance with the PRISMA guidelines. Also, the inclusion of both qualitative and quantitative studies, allowed for a more comprehensive understanding of the socio-cultural beliefs influencing breast cancer diagnosis and treatment in Ghana.

The review considered only published studies and possibly may have overlooked unpublished or gray literature that could contribute to a more comprehensive understanding of the subject matter. Most of the studies were concentrated in the southern part of Ghana and therefore the results might not represent all the regions in Ghana.

This study adduces evidence on the socio-cultural beliefs that impact diagnosis and treatment of breast cancer among women in Ghana. As policy makers, clinicians and other stakeholders strive to improve breast cancer diagnosis and treatment, there is a need to address the socio-cultural beliefs to improve breast cancer outcomes in Ghana and potentially reduce breast cancer-related mortality.

Data availability

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

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AA, and EAA conceived the study, analyzed and wrote the methods section. AA, VB and RAA conducted the literature search and wrote the background. AA, RAA, and RY screened the included articles and extracted the data. AA, AS and BOA conducted literature search and discussed the results. All the authors reviewed and provided intellectual content and modification. All the authors reviewed and approved the final draft of the manuscript.

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Afaya, A., Anaba, E.A., Bam, V. et al. Socio-cultural beliefs and perceptions influencing diagnosis and treatment of breast cancer among women in Ghana: a systematic review. BMC Women's Health 24 , 288 (2024). https://doi.org/10.1186/s12905-024-03106-y

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Received : 02 March 2023

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DOI : https://doi.org/10.1186/s12905-024-03106-y

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