peer reviewed literature meaning

Peer Reviewed Literature

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review, terminology, peer review what does that mean, what types of articles are peer-reviewed, what information is not peer-reviewed, what about google scholar.

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

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This Guide was created by Carolyn Swidrak (retired).

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

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

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

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

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

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  For example, the Harvard Business Review is an academic journal but it is editorially reviewed, not peer-reviewed.

Peer-reviewed and refereed are identical terms.

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

Peer reviewed articles can include:

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

There is much excellent, credible information in existence that is NOT peer-reviewed.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

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

Government Agencies

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

Conference Proceedings

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

Dissertations

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

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

• Peer reviewed journal articles (although they are not identified as peer-reviewed)
• Unpublished scholarly articles (not peer-reviewed)
• Masters theses, doctoral dissertations and other degree publications (not peer-reviewed)
• Book citations and links to some books (not necessarily peer-reviewed)
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What are Peer-Reviewed Journals?

• A Definition of Peer-Reviewed
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• What are Peer-reviewed Articles and How Do I Find Them? From Capella University Libraries

Introduction

Peer-reviewed journals (also called scholarly or refereed journals) are a key information source for your college papers and projects. They are written by scholars for scholars and are an reliable source for information on a topic or discipline. These journals can be found either in the library's online databases, or in the library's local holdings. This guide will help you identify whether a journal is peer-reviewed and show you tips on finding them.

What is Peer-Review?

Peer-review is a process where an article is verified by a group of scholars before it is published.

When an author submits an article to a peer-reviewed journal, the editor passes out the article to a group of scholars in the related field (the author's peers). They review the article, making sure that its sources are reliable, the information it presents is consistent with the research, etc. Only after they give the article their "okay" is it published.

The peer-review process makes sure that only quality research is published: research that will further the scholarly work in the field.

When you use articles from peer-reviewed journals, someone has already reviewed the article and said that it is reliable, so you don't have to take the steps to evaluate the author or his/her sources. The hard work is already done for you!

Identifying Peer-Review Journals

If you have the physical journal, you can look for the following features to identify if it is peer-reviewed.

Masthead (The first few pages) : includes information on the submission process, the editorial board, and maybe even a phrase stating that the journal is "peer-reviewed."

Publisher: Peer-reviewed journals are typically published by professional organizations or associations (like the American Chemical Society). They also may be affiliated with colleges/universities.

Graphics:  Typically there either won't be any images at all, or the few charts/graphs are only there to supplement the text information. They are usually in black and white.

Authors: The authors are listed at the beginning of the article, usually with information on their affiliated institutions, or contact information like email addresses.

Abstracts: At the beginning of the article the authors provide an extensive abstract detailing their research and any conclusions they were able to draw.

Terminology:  Since the articles are written by scholars for scholars, they use uncommon terminology specific to their field and typically do not define the words used.

Citations: At the end of each article is a list of citations/reference. These are provided for scholars to either double check their work, or to help scholars who are researching in the same general area.

Advertisements: Peer-reviewed journals rarely have advertisements. If they do the ads are for professional organizations or conferences, not for national products.

Identifying Articles from Databases

When you are looking at an article in an online database, identifying that it comes from a peer-reviewed journal can be more difficult. You do not have access to the physical journal to check areas like the masthead or advertisements, but you can use some of the same basic principles.

Points you may want to keep in mind when you are evaluating an article from a database:

• A lot of databases provide you with the option to limit your results to only those from peer-reviewed or refereed journals. Choosing this option means all of your results will be from those types of sources.  
• When possible, choose the PDF version of the article's full text. Since this is exactly as if you photocopied from the journal, you can get a better idea of its layout, graphics, advertisements, etc.  
• Even in an online database you still should be able to check for author information, abstracts, terminology, and citations.
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What is peer review?

From a publisher’s perspective, peer review functions as a filter for content, directing better quality articles to better quality journals and so creating journal brands.

Running articles through the process of peer review adds value to them. For this reason publishers need to make sure that peer review is robust.

Editor Feedback

"Pointing out the specifics about flaws in the paper’s structure is paramount. Are methods valid, is data clearly presented, and are conclusions supported by data?” (Editor feedback)

“If an editor can read your comments and understand clearly the basis for your recommendation, then you have written a helpful review.” (Editor feedback)

Peer Review at Its Best

What peer review does best is improve the quality of published papers by motivating authors to submit good quality work – and helping to improve that work through the peer review process. 

In fact, 90% of researchers feel that peer review improves the quality of their published paper (University of Tennessee and CIBER Research Ltd, 2013).

What the Critics Say

The peer review system is not without criticism. Studies show that even after peer review, some articles still contain inaccuracies and demonstrate that most rejected papers will go on to be published somewhere else.

However, these criticisms should be understood within the context of peer review as a human activity. The occasional errors of peer review are not reasons for abandoning the process altogether – the mistakes would be worse without it.

Improving Effectiveness

Some of the ways in which Wiley is seeking to improve the efficiency of the process, include:

• Reducing the amount of repeat reviewing by innovating around transferable peer review
• Providing training and best practice guidance to peer reviewers
• Improving recognition of the contribution made by reviewers

Visit our Peer Review Process and Types of Peer Review pages for additional detailed information on peer review.

Transparency in Peer Review

Wiley is committed to increasing transparency in peer review, increasing accountability for the peer review process and giving recognition to the work of peer reviewers and editors. We are also actively exploring other peer review models to give researchers the options that suit them and their communities.

Special Issues

Special Issues are subject to extensive review, during which journal Editors or Editorial Board input is solicited for each proposal. Our approval process includes an assessment of the rationale and scope of the proposed topic(s), and the expertise of Guest Editors, if any are involved. Special Issue articles must follow the same policies as described in the journal's Author Guidelines.

Editor/Editorial Board papers

Papers authored by Editors or Editorial Board members of the title are sent to Editors that are unaffiliated with the author or institution and monitored carefully to ensure there is no peer review bias.

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Peer Review and Primary Literature: An Introduction: Peer Review: What is it?

• Scholarly Journal vs. Magazine
• Peer Review: What is it?
• Finding Peer-Reviewed Articles
• Primary Journal Literature
• Is it Primary Research? How Do I Know?

What is Peer Review?

What Does "Peer Reviewed" Mean? When a journal is peer-reviewed (also called " Refereed "), it means that all articles submitted for publication have gone through a rigorous evaluation.  To ensure that each article meets the highest standards of scholarship, it is evaluated by the editor(s) of the journal.  This is sometimes called " internal review ." In some cases multiple in-house research editors will evaluate the scholarly strength of the article before even considering it for further peer-review.

The editor(s) then enlists the services of other scholars in the same field as the manuscript's author--in other words, that author's peers. This peer-review process is sometimes called " external review ."  These peer scholars offer their view on the quality of the article and its research.  How appropriate and exacting was the research method?  Were the results presented in the best way possible?  Was the literature review thorough?  Does the article make a significant contribution to the scholarship of that field?  Does it meet the scope of this particular journal? There are many criteria for judgement!

The exact peer-review process will vary between publishers.  Additionally, the whole value of peer review, as it now exists, is often hotly debated. Some believe that the Open Access (OA) movement of publishing research on the web and inviting scrutiny and comment will eventually eliminate the need for publisher driven peer-review.

However, as of now, peer-reviewed journal literature is still considered the highest form of scholarship.  Also, your professors will likely say that they want you to use peer-reviewed articles in your paper--sometimes exclusively.

Links to Additional Pages That Discuss the Peer Review Process

Here are a few additional web links for discussions of specific processes and the current controversies:

• View a PowerPoint presentation on the process at the BMJ (British Medical Journal) Group.
• One major publisher of scholarly journals is Elsevier (the publisher behind ScienceDirect).  Here is a page on their peer review policies.  They link to other related articles, blog entries and the like on the bottom half of that page.
• Even to receive a grant to conduct field research, scientists often must go through a peer review.  Here is an example of that process from the National Institutes of Health.

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Understanding peer review

The peer review process.

Peer review is a formal quality control process completed before an  academic work  is published. Not all academic literature is peer reviewed, but many academic journal articles and books will be. Peer-reviewed literature is sometimes also called “refereed literature”.

“Peer assessment”, where peers and colleagues give general feedback on your work, is sometimes also called peer review. However, “peer review” in published research refers specifically to the process described below.

Researchers who are experts in the same field review the submitted work to see if the research and arguments are sound, original, and of high enough quality to be published. Peer reviewers will provide feedback for the author to incorporate before the article is published, or they may advise that the work is not published at all. 

If the peer review process is conducted to a high standard by relevant, respected experts, it can improve the quality of published academic literature and encourage original, high-quality research. However, peer review takes time, which affects how quickly an article can be published. The quality of peer review processes can also vary across publishers and reviewers.           

Find peer-reviewed literature

In most cases, you can identify whether an academic work is peer reviewed by looking at the publisher’s website or using a “peer reviewed” filter when searching a database. 

Academic journals

Some journals require all research articles to be peer reviewed. You can look up the journal’s website to find out their peer review process. Be aware that other content in these journals, like reviews and editorial pieces, may not be peer reviewed. 

Another way to check if a journal has a peer review process is to look it up in a journal directory.

• Search a journal’s International Standard Serial Number (ISSN) or title ( not the article title) and see if it is listed with this black ”refereed” icon.  
• Click the journal title for more details and a link to the journal website.

Directory of Open Access Journals (DOAJ)

• Search for open access journals. Click the journal title in the search results to check for links to their peer review process.

Some academic journal databases will include an option to only search peer-reviewed journals. This option will appear either in their “advanced search” function or as a filter for their results page once you’ve searched. The  Library catalogue also has a “peer-reviewed journals” filter on its search results page.

Academic books 

Check the book publisher’s website for their review processes. University presses are highly likely to publish peer-reviewed academic books.

If the book is open access, check to see if it’s listed in the Directory of Open Access Books (DOAB) , which only includes scholarly, peer-reviewed books. 

Academic books are less likely than academic journals to be clearly identified as peer reviewed in databases. Searching an ebook collection that focuses on research will increase your chances of finding peer-reviewed books.

You can also search for a book’s title in the Library catalogue or an academic journal database to see if other researchers have reviewed it and commented on the book’s peer review process. 

Related information

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Frequently asked questions

What is the definition of peer review.

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

Frequently asked questions: Citing sources

A scientific citation style is a system of source citation that is used in scientific disciplines. Some commonly used scientific citation styles are:

• Chicago author-date , CSE , and Harvard , used across various sciences
• ACS , used in chemistry
• AMA , NLM , and Vancouver , used in medicine and related disciplines
• AAA , APA , and ASA , commonly used in the social sciences

There are many different citation styles used across different academic disciplines, but they fall into three basic approaches to citation:

• Parenthetical citations : Including identifying details of the source in parentheses —usually the author’s last name and the publication date, plus a page number if available ( author-date ). The publication date is occasionally omitted ( author-page ).
• Numerical citations: Including a number in brackets or superscript, corresponding to an entry in your numbered reference list.
• Note citations: Including a full citation in a footnote or endnote , which is indicated in the text with a superscript number or symbol.

A source annotation in an annotated bibliography fulfills a similar purpose to an abstract : they’re both intended to summarize the approach and key points of a source.

However, an annotation may also evaluate the source , discussing the validity and effectiveness of its arguments. Even if your annotation is purely descriptive , you may have a different perspective on the source from the author and highlight different key points.

You should never just copy text from the abstract for your annotation, as doing so constitutes plagiarism .

Most academics agree that you shouldn’t cite Wikipedia as a source in your academic writing , and universities often have rules against doing so.

This is partly because of concerns about its reliability, and partly because it’s a tertiary source. Tertiary sources are things like encyclopedias and databases that collect information from other sources rather than presenting their own evidence or analysis. Usually, only primary and secondary sources are cited in academic papers.

A Wikipedia citation usually includes the title of the article, “Wikipedia” and/or “Wikimedia Foundation,” the date the article was last updated, and the URL.

In APA Style , you’ll give the URL of the current revision of the article so that you’re sure the reader accesses the same version as you.

There’s some disagreement about whether Wikipedia can be considered a reliable source . Because it can be edited by anyone, many people argue that it’s easy for misleading information to be added to an article without the reader knowing.

Others argue that because Wikipedia articles cite their sources , and because they are worked on by so many editors, misinformation is generally removed quickly.

However, most universities state that you shouldn’t cite Wikipedia in your writing.

Hanging indents are used in reference lists in various citation styles to allow the reader to easily distinguish between entries.

You should apply a hanging indent to your reference entries in APA , MLA , and Chicago style.

A hanging indent is used to indent all lines of a paragraph except the first.

When you create a hanging indent, the first line of the paragraph starts at the border. Each subsequent line is indented 0.5 inches (1.27 cm).

APA and MLA style both use parenthetical in-text citations to cite sources and include a full list of references at the end, but they differ in other ways:

• APA in-text citations include the author name, date, and page number (Taylor, 2018, p. 23), while MLA in-text citations include only the author name and page number (Taylor 23).
• The APA reference list is titled “References,” while MLA’s version is called “ Works Cited .”
• The reference entries differ in terms of formatting and order of information.
• APA requires a title page , while MLA requires a header instead.

A parenthetical citation in Chicago author-date style includes the author’s last name, the publication date, and, if applicable, the relevant page number or page range in parentheses . Include a comma after the year, but not after the author’s name.

For example: (Swan 2003, 6)

To automatically generate accurate Chicago references, you can use Scribbr’s free Chicago reference generator .

APA Style distinguishes between parenthetical and narrative citations.

In parenthetical citations , you include all relevant source information in parentheses at the end of the sentence or clause: “Parts of the human body reflect the principles of tensegrity (Levin, 2002).”

In narrative citations , you include the author’s name in the text itself, followed by the publication date in parentheses: “Levin (2002) argues that parts of the human body reflect the principles of tensegrity.”

In a parenthetical citation in MLA style , include the author’s last name and the relevant page number or range in parentheses .

For example: (Eliot 21)

A parenthetical citation gives credit in parentheses to a source that you’re quoting or paraphrasing . It provides relevant information such as the author’s name, the publication date, and the page number(s) cited.

How you use parenthetical citations will depend on your chosen citation style . It will also depend on the type of source you are citing and the number of authors.

APA does not permit the use of ibid. This is because APA in-text citations are parenthetical and there’s no need to shorten them further.

Ibid. may be used in Chicago footnotes or endnotes .

Write “Ibid.” alone when you are citing the same page number and source as the previous citation.

When you are citing the same source, but a different page number, use ibid. followed by a comma and the relevant page number(s). For example:

• Ibid., 40–42.

Only use ibid . if you are directing the reader to a previous full citation of a source .

Ibid. only refers to the previous citation. Therefore, you should only use ibid. directly after a citation that you want to repeat.

Ibid. is an abbreviation of the Latin “ibidem,” meaning “in the same place.” Ibid. is used in citations to direct the reader to the previous source.

Signal phrases can be used in various ways and can be placed at the beginning, middle, or end of a sentence.

To use signal phrases effectively, include:

• The name of the scholar(s) or study you’re referencing
• An attributive tag such as “according to” or “argues that”
• The quote or idea you want to include

Different citation styles require you to use specific verb tenses when using signal phrases.

• APA Style requires you to use the past or present perfect tense when using signal phrases.
• MLA and Chicago requires you to use the present tense when using signal phrases.

Signal phrases allow you to give credit for an idea or quote to its author or originator. This helps you to:

• Establish the credentials of your sources
• Display your depth of reading and understanding of the field
• Position your own work in relation to other scholars
• Avoid plagiarism

A signal phrase is a group of words that ascribes a quote or idea to an outside source.

Signal phrases distinguish the cited idea or argument from your own writing and introduce important information including the source of the material that you are quoting , paraphrasing , or summarizing . For example:

“ Cognitive psychologist Steven Pinker (1994) insists that humans possess an innate faculty for comprehending grammar.”

If you’re quoting from a text that paraphrases or summarizes other sources and cites them in parentheses , APA and Chicago both recommend retaining the citations as part of the quote. However, MLA recommends omitting citations within a quote:

• APA: Smith states that “the literature on this topic (Jones, 2015; Sill, 2019; Paulson, 2020) shows no clear consensus” (Smith, 2019, p. 4).
• MLA: Smith states that “the literature on this topic shows no clear consensus” (Smith, 2019, p. 4).

Footnote or endnote numbers that appear within quoted text should be omitted in all styles.

If you want to cite an indirect source (one you’ve only seen quoted in another source), either locate the original source or use the phrase “as cited in” in your citation.

In scientific subjects, the information itself is more important than how it was expressed, so quoting should generally be kept to a minimum. In the arts and humanities, however, well-chosen quotes are often essential to a good paper.

In social sciences, it varies. If your research is mainly quantitative , you won’t include many quotes, but if it’s more qualitative , you may need to quote from the data you collected .

As a general guideline, quotes should take up no more than 5–10% of your paper. If in doubt, check with your instructor or supervisor how much quoting is appropriate in your field.

To present information from other sources in academic writing , it’s best to paraphrase in most cases. This shows that you’ve understood the ideas you’re discussing and incorporates them into your text smoothly.

It’s appropriate to quote when:

• Changing the phrasing would distort the meaning of the original text
• You want to discuss the author’s language choices (e.g., in literary analysis )
• You’re presenting a precise definition
• You’re looking in depth at a specific claim

To paraphrase effectively, don’t just take the original sentence and swap out some of the words for synonyms. Instead, try:

• Reformulating the sentence (e.g., change active to passive , or start from a different point)
• Combining information from multiple sentences into one
• Leaving out information from the original that isn’t relevant to your point
• Using synonyms where they don’t distort the meaning

The main point is to ensure you don’t just copy the structure of the original text, but instead reformulate the idea in your own words.

“ Et al. ” is an abbreviation of the Latin term “et alia,” which means “and others.” It’s used in source citations to save space when there are too many authors to name them all.

Guidelines for using “et al.” differ depending on the citation style you’re following:

To insert endnotes in Microsoft Word, follow the steps below:

• Click on the spot in the text where you want the endnote to show up.
• In the “References” tab at the top, select “Insert Endnote.”
• Type whatever text you want into the endnote.

If you need to change the type of notes used in a Word document from footnotes to endnotes , or the other way around, follow these steps:

• Open the “References” tab, and click the arrow in the bottom-right corner of the “Footnotes” section.
• In the pop-up window, click on “Convert…”
• Choose the option you need, and click “OK.”

To insert a footnote automatically in a Word document:

• Click on the point in the text where the footnote should appear
• Select the “References” tab at the top and then click on “Insert Footnote”
• Type the text you want into the footnote that appears at the bottom of the page

Footnotes are notes indicated in your text with numbers and placed at the bottom of the page. They’re used to provide:

• Citations (e.g., in Chicago notes and bibliography )
• Additional information that would disrupt the flow of the main text

Be sparing in your use of footnotes (other than citation footnotes), and consider whether the information you’re adding is relevant for the reader.

Footnotes appear at the bottom of the page they refer to. This is convenient for the reader but may cause your text to look cluttered if there are a lot of footnotes.

Endnotes appear all together at the end of the whole text. This may be less convenient for the reader but reduces clutter.

Both footnotes and endnotes are used in the same way: to cite sources or add extra information. You should usually choose one or the other to use in your text, not both.

An in-text citation is an acknowledgement you include in your text whenever you quote or paraphrase a source. It usually gives the author’s last name, the year of publication, and the page number of the relevant text. In-text citations allow the reader to look up the full source information in your reference list and see your sources for themselves.

If you are reusing content or data you used in a previous assignment, make sure to cite yourself. You can cite yourself just as you would cite any other source: simply follow the directions for that source type in the citation style you are using.

Keep in mind that reusing your previous work can be considered self-plagiarism , so make sure you ask your professor or consult your university’s handbook before doing so.

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

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

Academic dishonesty can be intentional or unintentional, ranging from something as simple as claiming to have read something you didn’t to copying your neighbor’s answers on an exam.

You can commit academic dishonesty with the best of intentions, such as helping a friend cheat on a paper. Severe academic dishonesty can include buying a pre-written essay or the answers to a multiple-choice test, or falsifying a medical emergency to avoid taking a final exam.

Academic dishonesty refers to deceitful or misleading behavior in an academic setting. Academic dishonesty can occur intentionally or unintentionally, and varies in severity.

It can encompass paying for a pre-written essay, cheating on an exam, or committing plagiarism . It can also include helping others cheat, copying a friend’s homework answers, or even pretending to be sick to miss an exam.

Academic dishonesty doesn’t just occur in a classroom setting, but also in research and other academic-adjacent fields.

To apply a hanging indent to your reference list or Works Cited list in Word or Google Docs, follow the steps below.

Microsoft Word:

• Highlight the whole list and right click to open the Paragraph options.
• Under Indentation > Special , choose Hanging from the dropdown menu.
• Set the indent to 0.5 inches or 1.27cm.

Google Docs:

• Highlight the whole list and click on Format >  Align and indent >  Indentation options .
• Under  Special indent , choose Hanging from the dropdown menu.

When the hanging indent is applied, for each reference, every line except the first is indented. This helps the reader see where one entry ends and the next begins.

For a published interview (whether in video , audio, or print form ), you should always include a citation , just as you would for any other source.

For an interview you conducted yourself , formally or informally, you often don’t need a citation and can just refer to it in the text or in a footnote , since the reader won’t be able to look them up anyway. MLA , however, still recommends including citations for your own interviews.

The main elements included in a newspaper interview citation across APA , MLA , and Chicago style are the names of the interviewer and interviewee, the interview title, the publication date, the name of the newspaper, and a URL (for online sources).

The information is presented differently in different citation styles. One key difference is that APA advises listing the interviewer in the author position, while MLA and Chicago advise listing the interviewee first.

The elements included in a newspaper article citation across APA , MLA , and Chicago style are the author name, the article title, the publication date, the newspaper name, and the URL if the article was accessed online .

In APA and MLA, the page numbers of the article appear in place of the URL if the article was accessed in print. No page numbers are used in Chicago newspaper citations.

Untitled sources (e.g. some images ) are usually cited using a short descriptive text in place of the title. In APA Style , this description appears in brackets: [Chair of stained oak]. In MLA and Chicago styles, no brackets are used: Chair of stained oak.

For social media posts, which are usually untitled, quote the initial words of the post in place of the title: the first 160 characters in Chicago , or the first 20 words in APA . E.g. Biden, J. [@JoeBiden]. “The American Rescue Plan means a $7,000 check for a single mom of four. It means more support to safely.”

MLA recommends quoting the full post for something short like a tweet, and just describing the post if it’s longer.

The main elements included in image citations across APA , MLA , and Chicago style are the name of the image’s creator, the image title, the year (or more precise date) of publication, and details of the container in which the image was found (e.g. a museum, book , website ).

In APA and Chicago style, it’s standard to also include a description of the image’s format (e.g. “Photograph” or “Oil on canvas”). This sort of information may be included in MLA too, but is not mandatory.

The main elements included in a lecture citation across APA , MLA , and Chicago style are the name of the speaker, the lecture title, the date it took place, the course or event it was part of, and the institution it took place at.

For transcripts or recordings of lectures/speeches, other details like the URL, the name of the book or website , and the length of the recording may be included instead of information about the event and institution.

The main elements included in a YouTube video citation across APA , MLA , and Chicago style are the name of the author/uploader, the title of the video, the publication date, and the URL.

The format in which this information appears is different for each style.

All styles also recommend using timestamps as a locator in the in-text citation or Chicago footnote .

Each annotation in an annotated bibliography is usually between 50 and 200 words long. Longer annotations may be divided into paragraphs .

The content of the annotation varies according to your assignment. An annotation can be descriptive, meaning it just describes the source objectively; evaluative, meaning it assesses its usefulness; or reflective, meaning it explains how the source will be used in your own research .

Any credible sources on your topic can be included in an annotated bibliography . The exact sources you cover will vary depending on the assignment, but you should usually focus on collecting journal articles and scholarly books . When in doubt, utilize the CRAAP test !

An annotated bibliography is an assignment where you collect sources on a specific topic and write an annotation for each source. An annotation is a short text that describes and sometimes evaluates the source.

The elements included in journal article citations across APA , MLA , and Chicago style are the name(s) of the author(s), the title of the article, the year of publication, the name of the journal, the volume and issue numbers, the page range of the article, and, when accessed online, the DOI or URL.

In MLA and Chicago style, you also include the specific month or season of publication alongside the year, when this information is available.

In APA , MLA , and Chicago style citations for sources that don’t list a specific author (e.g. many websites ), you can usually list the organization responsible for the source as the author.

If the organization is the same as the website or publisher, you shouldn’t repeat it twice in your reference:

• In APA and Chicago, omit the website or publisher name later in the reference.
• In MLA, omit the author element at the start of the reference, and cite the source title instead.

If there’s no appropriate organization to list as author, you will usually have to begin the citation and reference entry with the title of the source instead.

The main elements included in website citations across APA , MLA , and Chicago style are the author, the date of publication, the page title, the website name, and the URL. The information is presented differently in each style.

When you want to cite a specific passage in a source without page numbers (e.g. an e-book or website ), all the main citation styles recommend using an alternate locator in your in-text citation . You might use a heading or chapter number, e.g. (Smith, 2016, ch. 1)

In APA Style , you can count the paragraph numbers in a text to identify a location by paragraph number. MLA and Chicago recommend that you only use paragraph numbers if they’re explicitly marked in the text.

For audiovisual sources (e.g. videos ), all styles recommend using a timestamp to show a specific point in the video when relevant.

The abbreviation “ et al. ” (Latin for “and others”) is used to shorten citations of sources with multiple authors.

“Et al.” is used in APA in-text citations of sources with 3+ authors, e.g. (Smith et al., 2019). It is not used in APA reference entries .

Use “et al.” for 3+ authors in MLA in-text citations and Works Cited entries.

Use “et al.” for 4+ authors in a Chicago in-text citation , and for 10+ authors in a Chicago bibliography entry.

Check if your university or course guidelines specify which citation style to use. If the choice is left up to you, consider which style is most commonly used in your field.

• APA Style is the most popular citation style, widely used in the social and behavioral sciences.
• MLA style is the second most popular, used mainly in the humanities.
• Chicago notes and bibliography style is also popular in the humanities, especially history.
• Chicago author-date style tends to be used in the sciences.

Other more specialized styles exist for certain fields, such as Bluebook and OSCOLA for law.

The most important thing is to choose one style and use it consistently throughout your text.

The main elements included in all book citations across APA , MLA , and Chicago style are the author, the title, the year of publication, and the name of the publisher. A page number is also included in in-text citations to highlight the specific passage cited.

In Chicago style and in the 6th edition of APA Style , the location of the publisher is also included, e.g. London: Penguin.

A block quote is a long quote formatted as a separate “block” of text. Instead of using quotation marks , you place the quote on a new line, and indent the entire quote to mark it apart from your own words.

The rules for when to apply block quote formatting depend on the citation style:

• APA block quotes are 40 words or longer.
• MLA block quotes are more than 4 lines of prose or 3 lines of poetry.
• Chicago block quotes are longer than 100 words.

In academic writing , there are three main situations where quoting is the best choice:

• To analyze the author’s language (e.g., in a literary analysis essay )
• To give evidence from primary sources
• To accurately present a precise definition or argument

Don’t overuse quotes; your own voice should be dominant. If you just want to provide information from a source, it’s usually better to paraphrase or summarize .

Every time you quote a source , you must include a correctly formatted in-text citation . This looks slightly different depending on the citation style .

For example, a direct quote in APA is cited like this: “This is a quote” (Streefkerk, 2020, p. 5).

Every in-text citation should also correspond to a full reference at the end of your paper.

A quote is an exact copy of someone else’s words, usually enclosed in quotation marks and credited to the original author or speaker.

The DOI is usually clearly visible when you open a journal article on an academic database. It is often listed near the publication date, and includes “doi.org” or “DOI:”. If the database has a “cite this article” button, this should also produce a citation with the DOI included.

If you can’t find the DOI, you can search on Crossref using information like the author, the article title, and the journal name.

A DOI is a unique identifier for a digital document. DOIs are important in academic citation because they are more permanent than URLs, ensuring that your reader can reliably locate the source.

Journal articles and ebooks can often be found on multiple different websites and databases. The URL of the page where an article is hosted can be changed or removed over time, but a DOI is linked to the specific document and never changes.

When a book’s chapters are written by different authors, you should cite the specific chapter you are referring to.

When all the chapters are written by the same author (or group of authors), you should usually cite the entire book, but some styles include exceptions to this.

• In APA Style , single-author books should always be cited as a whole, even if you only quote or paraphrase from one chapter.
• In MLA Style , if a single-author book is a collection of stand-alone works (e.g. short stories ), you should cite the individual work.
• In Chicago Style , you may choose to cite a single chapter of a single-author book if you feel it is more appropriate than citing the whole book.

Articles in newspapers and magazines can be primary or secondary depending on the focus of your research.

In historical studies, old articles are used as primary sources that give direct evidence about the time period. In social and communication studies, articles are used as primary sources to analyze language and social relations (for example, by conducting content analysis or discourse analysis ).

If you are not analyzing the article itself, but only using it for background information or facts about your topic, then the article is a secondary source.

A fictional movie is usually a primary source. A documentary can be either primary or secondary depending on the context.

If you are directly analyzing some aspect of the movie itself – for example, the cinematography, narrative techniques, or social context – the movie is a primary source.

If you use the movie for background information or analysis about your topic – for example, to learn about a historical event or a scientific discovery – the movie is a secondary source.

Whether it’s primary or secondary, always properly cite the movie in the citation style you are using. Learn how to create an MLA movie citation or an APA movie citation .

To determine if a source is primary or secondary, ask yourself:

• Was the source created by someone directly involved in the events you’re studying (primary), or by another researcher (secondary)?
• Does the source provide original information (primary), or does it summarize information from other sources (secondary)?
• Are you directly analyzing the source itself (primary), or only using it for background information (secondary)?

Some types of source are nearly always primary: works of art and literature, raw statistical data, official documents and records, and personal communications (e.g. letters, interviews ). If you use one of these in your research, it is probably a primary source.

Primary sources are often considered the most credible in terms of providing evidence for your argument, as they give you direct evidence of what you are researching. However, it’s up to you to ensure the information they provide is reliable and accurate.

Always make sure to properly cite your sources to avoid plagiarism .

Common examples of secondary sources include academic books, journal articles , reviews, essays , and textbooks.

Anything that summarizes, evaluates or interprets primary sources can be a secondary source. If a source gives you an overview of background information or presents another researcher’s ideas on your topic, it is probably a secondary source.

Common examples of primary sources include interview transcripts , photographs, novels, paintings, films, historical documents, and official statistics.

Anything you directly analyze or use as first-hand evidence can be a primary source, including qualitative or quantitative data that you collected yourself.

The Scribbr Citation Generator is developed using the open-source Citation Style Language (CSL) project and Frank Bennett’s citeproc-js . It’s the same technology used by dozens of other popular citation tools, including Mendeley and Zotero.

You can find all the citation styles and locales used in the Scribbr Citation Generator in our publicly accessible repository on Github .

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Peer-reviewed journal articles

What is peer review, why use peer-reviewed articles, peer reviewed articles video.

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Peer review (also known as refereeing) is a process where other scholars in the same field (peers) evaluate the quality of a research paper before it's published. The aim is to ensure that the work is rigorous and coherent, is based on sound research, and adds to what we already know. 

The purpose of peer review is to maintain the integrity of research and to ensure that only valid and quality research is published.

To learn more about the peer review process, visit:

• What is peer review? Comprehensive overview of the peer review process and different types of peer review from Elsevier

Your lecturers will often require you to use information from academic journal articles that are peer reviewed (also known as refereed).

Peer-reviewed articles are credible sources of information. The articles have been written and reviewed by trusted experts in the field, and represent the best scholarship and research currently available.

Explanation of peer reviewed articles and journals (YouTube, 1m51s)

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What is peer review? What is a peer-reviewed journal?

Peer-reviewed (or refereed) journals.

Peer-reviewed or refereed journals have an editorial board of subject experts who review and evaluate submitted articles before accepting them for publication. A journal may be a scholarly journal but not a peer-reviewed journal.

Peer review (or referee) process

• An editorial board asks subject experts to review and evaluate submitted articles before accepting them for publication in a scholarly journal.
• Submissions are evaluated using criteria including the excellence, novelty and significance of the research or ideas.
• Scholarly journals use this process to protect and maintain the quality of material they publish.
• Members of the editorial board are listed near the beginning of each journal issue.

How to tell if a journal is peer-reviewed

• If you are searching for scholarly or peer-reviewed articles in a  database , you may be able to limit your results to peer-reviewed articles. 
• If you're looking at the journal itself, search for references to their peer-review process, such as in an editorial statement, or a section with instructions to authors. 
• You can also check the entry for a journal in the Library Catalogue . Many journal records will have a note in the Description section, e.g. to say "Refereed / Peer-reviewed."

For an overview of the different types of journals, see What is a scholarly (or peer-reviewed) journal?

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• Reumatologia
• v.59(1); 2021

Peer review guidance: a primer for researchers

Olena zimba.

1 Department of Internal Medicine No. 2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine

Armen Yuri Gasparyan

2 Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, West Midlands, UK

The peer review process is essential for quality checks and validation of journal submissions. Although it has some limitations, including manipulations and biased and unfair evaluations, there is no other alternative to the system. Several peer review models are now practised, with public review being the most appropriate in view of the open science movement. Constructive reviewer comments are increasingly recognised as scholarly contributions which should meet certain ethics and reporting standards. The Publons platform, which is now part of the Web of Science Group (Clarivate Analytics), credits validated reviewer accomplishments and serves as an instrument for selecting and promoting the best reviewers. All authors with relevant profiles may act as reviewers. Adherence to research reporting standards and access to bibliographic databases are recommended to help reviewers draft evidence-based and detailed comments.

Introduction

The peer review process is essential for evaluating the quality of scholarly works, suggesting corrections, and learning from other authors’ mistakes. The principles of peer review are largely based on professionalism, eloquence, and collegiate attitude. As such, reviewing journal submissions is a privilege and responsibility for ‘elite’ research fellows who contribute to their professional societies and add value by voluntarily sharing their knowledge and experience.

Since the launch of the first academic periodicals back in 1665, the peer review has been mandatory for validating scientific facts, selecting influential works, and minimizing chances of publishing erroneous research reports [ 1 ]. Over the past centuries, peer review models have evolved from single-handed editorial evaluations to collegial discussions, with numerous strengths and inevitable limitations of each practised model [ 2 , 3 ]. With multiplication of periodicals and editorial management platforms, the reviewer pool has expanded and internationalized. Various sets of rules have been proposed to select skilled reviewers and employ globally acceptable tools and language styles [ 4 , 5 ].

In the era of digitization, the ethical dimension of the peer review has emerged, necessitating involvement of peers with full understanding of research and publication ethics to exclude unethical articles from the pool of evidence-based research and reviews [ 6 ]. In the time of the COVID-19 pandemic, some, if not most, journals face the unavailability of skilled reviewers, resulting in an unprecedented increase of articles without a history of peer review or those with surprisingly short evaluation timelines [ 7 ].

Editorial recommendations and the best reviewers

Guidance on peer review and selection of reviewers is currently available in the recommendations of global editorial associations which can be consulted by journal editors for updating their ethics statements and by research managers for crediting the evaluators. The International Committee on Medical Journal Editors (ICMJE) qualifies peer review as a continuation of the scientific process that should involve experts who are able to timely respond to reviewer invitations, submitting unbiased and constructive comments, and keeping confidentiality [ 8 ].

The reviewer roles and responsibilities are listed in the updated recommendations of the Council of Science Editors (CSE) [ 9 ] where ethical conduct is viewed as a premise of the quality evaluations. The Committee on Publication Ethics (COPE) further emphasizes editorial strategies that ensure transparent and unbiased reviewer evaluations by trained professionals [ 10 ]. Finally, the World Association of Medical Editors (WAME) prioritizes selecting the best reviewers with validated profiles to avoid substandard or fraudulent reviewer comments [ 11 ]. Accordingly, the Sarajevo Declaration on Integrity and Visibility of Scholarly Publications encourages reviewers to register with the Open Researcher and Contributor ID (ORCID) platform to validate and publicize their scholarly activities [ 12 ].

Although the best reviewer criteria are not listed in the editorial recommendations, it is apparent that the manuscript evaluators should be active researchers with extensive experience in the subject matter and an impressive list of relevant and recent publications [ 13 ]. All authors embarking on an academic career and publishing articles with active contact details can be involved in the evaluation of others’ scholarly works [ 14 ]. Ideally, the reviewers should be peers of the manuscript authors with equal scholarly ranks and credentials.

However, journal editors may employ schemes that engage junior research fellows as co-reviewers along with their mentors and senior fellows [ 15 ]. Such a scheme is successfully practised within the framework of the Emerging EULAR (European League Against Rheumatism) Network (EMEUNET) where seasoned authors (mentors) train ongoing researchers (mentees) how to evaluate submissions to the top rheumatology journals and select the best evaluators for regular contributors to these journals [ 16 ].

The awareness of the EQUATOR Network reporting standards may help the reviewers to evaluate methodology and suggest related revisions. Statistical skills help the reviewers to detect basic mistakes and suggest additional analyses. For example, scanning data presentation and revealing mistakes in the presentation of means and standard deviations often prompt re-analyses of distributions and replacement of parametric tests with non-parametric ones [ 17 , 18 ].

Constructive reviewer comments

The main goal of the peer review is to support authors in their attempt to publish ethically sound and professionally validated works that may attract readers’ attention and positively influence healthcare research and practice. As such, an optimal reviewer comment has to comprehensively examine all parts of the research and review work ( Table I ). The best reviewers are viewed as contributors who guide authors on how to correct mistakes, discuss study limitations, and highlight its strengths [ 19 ].

Structure of a reviewer comment to be forwarded to authors

Some of the currently practised review models are well positioned to help authors reveal and correct their mistakes at pre- or post-publication stages ( Table II ). The global move toward open science is particularly instrumental for increasing the quality and transparency of reviewer contributions.

Advantages and disadvantages of common manuscript evaluation models

Since there are no universally acceptable criteria for selecting reviewers and structuring their comments, instructions of all peer-reviewed journal should specify priorities, models, and expected review outcomes [ 20 ]. Monitoring and reporting average peer review timelines is also required to encourage timely evaluations and avoid delays. Depending on journal policies and article types, the first round of peer review may last from a few days to a few weeks. The fast-track review (up to 3 days) is practised by some top journals which process clinical trial reports and other priority items.

In exceptional cases, reviewer contributions may result in substantive changes, appreciated by authors in the official acknowledgments. In most cases, however, reviewers should avoid engaging in the authors’ research and writing. They should refrain from instructing the authors on additional tests and data collection as these may delay publication of original submissions with conclusive results.

Established publishers often employ advanced editorial management systems that support reviewers by providing instantaneous access to the review instructions, online structured forms, and some bibliographic databases. Such support enables drafting of evidence-based comments that examine the novelty, ethical soundness, and implications of the reviewed manuscripts [ 21 ].

Encouraging reviewers to submit their recommendations on manuscript acceptance/rejection and related editorial tasks is now a common practice. Skilled reviewers may prompt the editors to reject or transfer manuscripts which fall outside the journal scope, perform additional ethics checks, and minimize chances of publishing erroneous and unethical articles. They may also raise concerns over the editorial strategies in their comments to the editors.

Since reviewer and editor roles are distinct, reviewer recommendations are aimed at helping editors, but not at replacing their decision-making functions. The final decisions rest with handling editors. Handling editors weigh not only reviewer comments, but also priorities related to article types and geographic origins, space limitations in certain periods, and envisaged influence in terms of social media attention and citations. This is why rejections of even flawless manuscripts are likely at early rounds of internal and external evaluations across most peer-reviewed journals.

Reviewers are often requested to comment on language correctness and overall readability of the evaluated manuscripts. Given the wide availability of in-house and external editing services, reviewer comments on language mistakes and typos are categorized as minor. At the same time, non-Anglophone experts’ poor language skills often exclude them from contributing to the peer review in most influential journals [ 22 ]. Comments should be properly edited to convey messages in positive or neutral tones, express ideas of varying degrees of certainty, and present logical order of words, sentences, and paragraphs [ 23 , 24 ]. Consulting linguists on communication culture, passing advanced language courses, and honing commenting skills may increase the overall quality and appeal of the reviewer accomplishments [ 5 , 25 ].

Peer reviewer credits

Various crediting mechanisms have been proposed to motivate reviewers and maintain the integrity of science communication [ 26 ]. Annual reviewer acknowledgments are widely practised for naming manuscript evaluators and appreciating their scholarly contributions. Given the need to weigh reviewer contributions, some journal editors distinguish ‘elite’ reviewers with numerous evaluations and award those with timely and outstanding accomplishments [ 27 ]. Such targeted recognition ensures ethical soundness of the peer review and facilitates promotion of the best candidates for grant funding and academic job appointments [ 28 ].

Also, large publishers and learned societies issue certificates of excellence in reviewing which may include Continuing Professional Development (CPD) points [ 29 ]. Finally, an entirely new crediting mechanism is proposed to award bonus points to active reviewers who may collect, transfer, and use these points to discount gold open-access charges within the publisher consortia [ 30 ].

With the launch of Publons ( http://publons.com/ ) and its integration with Web of Science Group (Clarivate Analytics), reviewer recognition has become a matter of scientific prestige. Reviewers can now freely open their Publons accounts and record their contributions to online journals with Digital Object Identifiers (DOI). Journal editors, in turn, may generate official reviewer acknowledgments and encourage reviewers to forward them to Publons for building up individual reviewer and journal profiles. All published articles maintain e-links to their review records and post-publication promotion on social media, allowing the reviewers to continuously track expert evaluations and comments. A paid-up partnership is also available to journals and publishers for automatically transferring peer-review records to Publons upon mutually acceptable arrangements.

Listing reviewer accomplishments on an individual Publons profile showcases scholarly contributions of the account holder. The reviewer accomplishments placed next to the account holders’ own articles and editorial accomplishments point to the diversity of scholarly contributions. Researchers may establish links between their Publons and ORCID accounts to further benefit from complementary services of both platforms. Publons Academy ( https://publons.com/community/academy/ ) additionally offers an online training course to novice researchers who may improve their reviewing skills under the guidance of experienced mentors and journal editors. Finally, journal editors may conduct searches through the Publons platform to select the best reviewers across academic disciplines.

Peer review ethics

Prior to accepting reviewer invitations, scholars need to weigh a number of factors which may compromise their evaluations. First of all, they are required to accept the reviewer invitations if they are capable of timely submitting their comments. Peer review timelines depend on article type and vary widely across journals. The rules of transparent publishing necessitate recording manuscript submission and acceptance dates in article footnotes to inform readers of the evaluation speed and to help investigators in the event of multiple unethical submissions. Timely reviewer accomplishments often enable fast publication of valuable works with positive implications for healthcare. Unjustifiably long peer review, on the contrary, delays dissemination of influential reports and results in ethical misconduct, such as plagiarism of a manuscript under evaluation [ 31 ].

In the times of proliferation of open-access journals relying on article processing charges, unjustifiably short review may point to the absence of quality evaluation and apparently ‘predatory’ publishing practice [ 32 , 33 ]. Authors when choosing their target journals should take into account the peer review strategy and associated timelines to avoid substandard periodicals.

Reviewer primary interests (unbiased evaluation of manuscripts) may come into conflict with secondary interests (promotion of their own scholarly works), necessitating disclosures by filling in related parts in the online reviewer window or uploading the ICMJE conflict of interest forms. Biomedical reviewers, who are directly or indirectly supported by the pharmaceutical industry, may encounter conflicts while evaluating drug research. Such instances require explicit disclosures of conflicts and/or rejections of reviewer invitations.

Journal editors are obliged to employ mechanisms for disclosing reviewer financial and non-financial conflicts of interest to avoid processing of biased comments [ 34 ]. They should also cautiously process negative comments that oppose dissenting, but still valid, scientific ideas [ 35 ]. Reviewer conflicts that stem from academic activities in a competitive environment may introduce biases, resulting in unfair rejections of manuscripts with opposing concepts, results, and interpretations. The same academic conflicts may lead to coercive reviewer self-citations, forcing authors to incorporate suggested reviewer references or face negative feedback and an unjustified rejection [ 36 ]. Notably, several publisher investigations have demonstrated a global scale of such misconduct, involving some highly cited researchers and top scientific journals [ 37 ].

Fake peer review, an extreme example of conflict of interest, is another form of misconduct that has surfaced in the time of mass proliferation of gold open-access journals and publication of articles without quality checks [ 38 ]. Fake reviews are generated by manipulating authors and commercial editing agencies with full access to their own manuscripts and peer review evaluations in the journal editorial management systems. The sole aim of these reviews is to break the manuscript evaluation process and to pave the way for publication of pseudoscientific articles. Authors of these articles are often supported by funds intended for the growth of science in non-Anglophone countries [ 39 ]. Iranian and Chinese authors are often caught submitting fake reviews, resulting in mass retractions by large publishers [ 38 ]. Several suggestions have been made to overcome this issue, with assigning independent reviewers and requesting their ORCID IDs viewed as the most practical options [ 40 ].

Conclusions

The peer review process is regulated by publishers and editors, enforcing updated global editorial recommendations. Selecting the best reviewers and providing authors with constructive comments may improve the quality of published articles. Reviewers are selected in view of their professional backgrounds and skills in research reporting, statistics, ethics, and language. Quality reviewer comments attract superior submissions and add to the journal’s scientific prestige [ 41 ].

In the era of digitization and open science, various online tools and platforms are available to upgrade the peer review and credit experts for their scholarly contributions. With its links to the ORCID platform and social media channels, Publons now offers the optimal model for crediting and keeping track of the best and most active reviewers. Publons Academy additionally offers online training for novice researchers who may benefit from the experience of their mentoring editors. Overall, reviewer training in how to evaluate journal submissions and avoid related misconduct is an important process, which some indexed journals are experimenting with [ 42 ].

The timelines and rigour of the peer review may change during the current pandemic. However, journal editors should mobilize their resources to avoid publication of unchecked and misleading reports. Additional efforts are required to monitor published contents and encourage readers to post their comments on publishers’ online platforms (blogs) and other social media channels [ 43 , 44 ].

The authors declare no conflict of interest.

• Richard G. Trefry Library

Q. What does "peer reviewed" mean?

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Answered By: Priscilla Coulter Last Updated: Jul 29, 2022     Views: 285649

Essentially, peer review is an academic term for quality control .  Each article published in a peer-reviewed journal was closely examined by a panel of reviewers who are experts on the article's topic (that is, the author’s professional peers…hence the term peer review).   The reviewers assess the author’s proper use of research methods, the significance of the paper’s contribution to the existing literature, and check on the authors’ works on the topic in any discussions or mentions in citations.  Papers published in these journals are expert-approved…and the most authoritative sources of information for college-level research papers. 

Articles from popula r publications, on the other hand (like magazines, newspapers,  or many sites on the Internet), are published with minimal editing (for spelling and grammar, perhaps; but, typically not for factual accuracy or intellectual integrity).  While interesting to read, these articles aren’t sufficient to support research at an academic level. 

But, with so many articles out there, how do you know which are peer-reviewed?

• Searching the library’s databases can save you a lot of time …allowing you to limit your search to scholarly or peer-reviewed articles only . Most internet search engines (like Google and Yahoo) can’t do this for you, leaving you to determine for yourself which of those thousands of articles are peer-reviewed.   
• If you’ve already found an article that you’d like to use in a research paper, but you’re not sure if it’s popular or scholarly, there are ways to tell.  The table below lists some of the most obvious clues (but your librarians will be happy to help you figure it out as well). 

See also:   What does "scholarly" mean?  Is it the same as "peer-reviewed?"

Need a visual?  Watch this quick video from the North Carolina State University Libraries:

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How to Recognize Peer-Reviewed (Refereed) Journals

Find all the information you need on recognizing and citing sources for your research papers. 

In many cases, professors will require that students utilize articles from “peer-reviewed” journals. Sometimes the phrases “refereed journals” or “scholarly journals” are used to describe the same type of journals. But what are peer-reviewed (or refereed or scholarly) journal articles, and why do faculty require their use?

Popular, Trade and Scholarly Information

• “Popular” newspapers and magazines containing news - Articles are written by reporters who may or may not be experts in the field of the article. Consequently, articles may contain incorrect information.
• Journals containing articles written by professionals and/or academics - Some trade or academic journals have articles that are written by a single person with little review. Although the articles are written by “experts,” any particular “expert” may have some ideas that are really “out there!”
• Peer-reviewed (refereed or scholarly) journals - Articles are written by experts and are reviewed by several other experts in the field before the article is published in the journal in order to ensure the article’s quality. (The article is more likely to be scientifically valid, reach reasonable conclusions, etc.) In most cases, the reviewers do not know who the author of the article is, so the article succeeds or fails on its own merit, not the reputation of the expert.

Helpful hint!

Not all information in a peer-reviewed journal is actually refereed or reviewed. For example, editorials, letters to the editor, book reviews and other types of information don’t count as articles, and may not be accepted by your professor.

How do you determine whether an article qualifies as a peer-reviewed journal article?

First, you need to be able to identify which journals are peer-reviewed. There are generally four methods for doing this

• Limiting a database search to peer-reviewed journals only. Some databases allow you to limit searches for articles to peer-reviewed journals only. For example, Academic Search Complete has this feature on the initial search screen - click on the pertinent box to limit the search. In some databases, you may have to go to an “advanced” or “expert” search screen to do this. Remember, many databases do not allow you to limit your search in this way.

• Locate the journal in the Library or online, then identify the most current entire year’s issues.
• Locate the masthead of the publication. This oftentimes consists of a box towards either the front or the end of the periodical and contains publication information such as the editors of the journal, the publisher, the place of publication, the subscription cost and similar information.
• Does the journal say that it is peer-reviewed? If so, you’re done! If not, move on to step d.
• Check in and around the masthead to locate the method for submitting articles to the publication.  If you find information similar to “to submit articles, send three copies…”, the journal is probably peer-reviewed. In this case, you are inferring that the publication is then going to send multiple copies of the article to the journal’s reviewers. This may not always be the case, so relying upon this criterion alone may prove inaccurate.
• If you do not see this type of statement in the first issue of the journal that you look at, examine the remaining journals to see if this information is included. Sometimes publications will include this information in only a single issue a year.
• Is it scholarly, using technical terminology? Does the article format approximate the following - abstract, literature review, methodology, results, conclusion, and references? Are the articles written by scholarly researchers in the field that the periodical pertains to? Is advertising non-existent, or kept to a minimum? Are there references listed in footnotes or bibliographies? If you answered yes to all these questions, the journal may very well be peer-reviewed. This determination would be strengthened by having met the previous criterion of a multiple-copies submission requirement. If you answered these questions no , the journal is probably not peer-reviewed.
• Find the official website on the internet, and check to see if it states that the journal is peer-reviewed. Be careful to use the official site (often located at the journal publisher’s website), and, even then, information could potentially be inaccurate. Unfortunately, there are online journals that claim to be peer-reviewed that aren’t. These are often created by publishers that are described by librarians as “predatory publishers.” To a great extent, you can avoid using articles from predatory publishers by finding them in database that are supplied by your library.

If you have used the previous four methods in trying to determine if an article is from a peer-reviewed journal and are still unsure, speak to your instructor.

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• TCOM 101 Critical Media Literacy -- Moore

TCOM 101 Critical Media Literacy -- Moore: What does peer-reviewed mean?

Peer-reviewed articles.

A peer-reviewed (or refereed) article has been read, evaluated, and approved for publication by scholars with expertise and knowledge related to the article’s contents.   Peer-reviewing helps insure that articles provide accurate, verifiable, and valuable contributions to a field of study.

• The peer-review process is anonymous, to prevent personal biases and favoritism from affecting the outcomes.   Reviewers read manuscripts that omit the names of the author(s).   When the reviewers’ feedback is given to the author(s), the reviewers’ names are omitted.
• Editors of journals select reviewers who are experts in the subjects addressed in the article.   Reviewers consider the clarity and validity of the research and whether it offers original and important knowledge to a particular field of study.

How do I know if an article is peer reviewed?

• Most scholarly journal articles also have symbols next to their record in the library catalog. 
• Search the journal title in Ulrichsweb Global Serials Directory.

• In general, book reviews, opinion pieces/editorials, and brief news articles are not peer-reviewed. 
• Published peer-reviewed articles name their author(s) and provide details about how to verify the contents of the articles (such as footnotes and/or a list of “literature cited” or “references”).   If the article does not name its author(s), it is not peer-reviewed.
• Some articles provide specific information about the peer-review process, such as dates of review and approval for publication.  
• Some journals list peer-reviewed articles as “research” or “articles” in the table of contents to distinguish them from other materials like “news” or “book reviews”.

What is a scholarly peer reviewed journal article?

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Q. What's the difference between peer-reviewed literature and material like white papers and policy briefs?

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Answered By: James Adams Last Updated: Mar 14, 2024     Views: 3604

Articles in a peer-reviewed or "refereed" journal are reviewed prior to publication by experts (usually faculty members) with credentials in the article's field of study. Many Harvard article databases allow you to limit your search results to only include peer-reviewed journals.

Other material like white papers and policy briefs that are not peer-reviewed can still be valuable for your research. Relevant preprints that will eventually be peer-reviewed or gray literature unlikely to be published in a journal could be included as long as they pass the C.R.A.A.P. test, evaluating Currency , Relevancy , Authority , Accuracy , and Purpose . 

A good strategy for finding gray literature is to conduct a search in the HKS Library Customized Google Think Tank search , which includes over 700 think tank sites from across the world. If you are uncertain about whether to include grey literature in your research project, check with your class instructor.

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What does it mean when a publication is peer reviewed?

A peer-reviewed publication is also sometimes referred to as a scholarly publication. The peer-review process subjects an author's scholarly work, research, or ideas to the scrutiny of others who are experts in the same field (peers) and is considered necessary to ensure academic scientific quality. 

Learn more:  Fundamental Science Practices: Peer Review

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How can I find publications of the USGS?

The USGS Publications Warehouse is an online catalog for searching all USGS publications and downloading free digital versions. USGS Libraries contain sets of all USGS publications plus many state geological survey publications. The public go in person to any USGS library to do research, but USGS library materials can only be borrowed by placing a request with your local library for Interlibrary...

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When/Why does the USGS publish research results in outside journals that require a fee to access rather than in the USGS publication series?

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peer review

Definition of peer review

Examples of peer review in a sentence.

These examples are programmatically compiled from various online sources to illustrate current usage of the word 'peer review.' Any opinions expressed in the examples do not represent those of Merriam-Webster or its editors. Send us feedback about these examples.

Word History

1969, in the meaning defined above

Dictionary Entries Near peer review

peer pressure

Cite this Entry

“Peer review.” Merriam-Webster.com Dictionary , Merriam-Webster, https://www.merriam-webster.com/dictionary/peer%20review. Accessed 5 Jul. 2024.

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3. Health Data Sources

Peer-reviewed journal articles have gone through an evaluation process in which journal editors and other expert scholars critically assess the quality and scientific merit of the article and its research. Articles that pass this process are published in the peer-reviewed literature. Peer-reviewed journals may include the research of scholars who have collected their own data using an experimental study design, survey, or various other study methodologies. They also present the work of researchers who have performed novel analyses of existing data sources, such as the ones described in this section.

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There are several benefits of using peer-reviewed literature, including: the process ensures that the quality of the research and validity of the findings are high, information is available on highly-detailed subject matter and complex analyses, and it is easy to search through millions of articles with online databases.

There are limitations to using peer-reviewed literature, however, including: highly-detailed and complex analyses may be irrelevant for users who are simply searching for descriptive statistics and basic measures of public health; may require a subscription to journals or databases to access articles (which can be costly for individuals, although many universities and other organizations provide access to students and faculty); and may be prone to publication bias due to the fact that studies that report significant statistical results are published in favor of those that yield negative or null results.

Peer-reviewed literature is accessible via academic databases that enable users to execute searches across multiple journals. Here are a few examples:

• PubMed® (including MEDLINE®)
• Cumulative Index to Nursing & Allied Health Literature (CINAHL) Database (EBSCOHost)
• ScienceDirect
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• American Psychological Association PSYCInfo
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Frequently Asked Questions

What is the difference between peer-reviewed (scholarly) articles and everything else.

Peer-reviewed articles, also known as scholarly articles, are published based on the approval of a board of professional experts in the discipline relating to the article topic.

For instance, a paper discussing the psychological effects of homeschooling a child would need to be reviewed by a board of psychology scholars and professional psychologists in order to be approved for publication in a psychology journal.

Scholarly/peer-reviewed articles differ from other easily available print sources because the review process gives them more authority than, for example, a newspaper or magazine article.

Newspaper or popular magazine articles are written by journalists (not specialists in any field except journalism).

They are reviewed only by the magazine/newspaper editors (also not specialists in any field except editing).

For more information, see:  https://wrtg150.lib.byu.edu/finding-sources .

• Research and Writing

Updated 2024-03-07 14:35:37 • LibAnswers page

• Open access
• Published: 26 June 2024

WHO, WHEN, HOW: a scoping review on flexible at-home respite for informal caregivers of older adults

• Maude Viens 1 , 2 ,
• Alexandra Éthier 1 , 2 ,
• Véronique Provencher 1 , 2 &
• Annie Carrier 1 , 2  

BMC Health Services Research volume  24 , Article number:  767 ( 2024 ) Cite this article

146 Accesses

Metrics details

As the world population is aging, considerable efforts need to be put towards developing and maintaining evidenced-based care for older adults. Respite services are part of the selection of homecare offered to informal caregivers. Although current best practices around respite are rooted in person centeredness, there is no integrated synthesis of its flexible components. Such a synthesis could offer a better understanding of key characteristics of flexible respite and, as such, support its implementation and use.

To map the literature around the characteristics of flexible at-home respite for informal caregivers of older adults, a scoping study was conducted. Qualitative data from the review was analyzed using content analysis. The characterization of flexible at-home respite was built on three dimensions: WHO , WHEN and HOW . To triangulate the scoping results, an online questionnaire was distributed to homecare providers and informal caregivers of older adults.

A total of 42 documents were included in the review. The questionnaire was completed by 105 participants. The results summarize the characteristics of flexible at-home respite found in the literature. Flexibility in respite can be understood through three dimensions: (1) WHO is tendering it, (2) WHEN it is tendered and (3) HOW it is tendered. Firstly, human resources ( WHO ) must be compatible with the homecare sector as well as being trained and qualified to offer respite to informal caregivers of older adults. Secondly, flexible respite includes considerations of time, duration, frequency, and predictability ( WHEN ). Lastly, flexible at-home respite exhibits approachability, appropriateness, affordability, availability, and acceptability ( HOW ). Overall, flexible at-home respite adjusts to the needs of the informal caregiver and care recipient in terms of WHO , WHEN , and HOW .

This review is a step towards a more precise definition of flexible at-home respite. Flexibility of homecare, in particular respite, must be considered when designing, implementing and evaluating services.

Peer Review reports

It is an undeniable fact that the world population is aging [ 1 ]. The World Health Organization [ 1 ] estimates that from 2015 to 2050, the percentage of people over 60 years of age will nearly double (from 12 to 22%). Governments must therefore put in place policies, laws and funding infrastructures to provide evidence-based social services and healthcare that are in line with best practices to allow people to age in place [ 2 ]. Aging in place refers to “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level” [ 3 ]. Relevant literature indicates that people do not want to age or end their lives in institutionalized care; most wish to receive care in their home and remain in their community with their informal caregivers [ 4 ].

There is then a need to adequately support informal caregivers (caregiver) in the crucial role that they have in allowing older adults to age in their own home. A caregiver is “a person who provides some type of unpaid, ongoing assistance with activities of daily living or instrumental activities of daily living” [ 5 ]. In their duties, caregivers of older adults are responsible for a considerable amount of homecare [ 6 ]: Transportation, management of appointments and bills, domestic chores, etc. Private and public organizations offer a plethora of services to support caregivers of older adults (e.g., support groups, housekeeping, etc.), including respite. Respite is a service for caregivers consisting in “the temporary provision of care for a person, at home or in an institution, by people other than the primary caregiver” [ 7 ]. Maayan and collaborators [ 7 ] characterize all respite services according to three dimensions: (1) WHERE : The place; in a private home, a daycare centre or a residential setting, (2) WHEN : The duration and planning; ranging from a couple of hours to a number of weeks, planned or unplanned, and finally, (3) WHO : The person providing the service; this may be trained or untrained individuals, paid staff or volunteers. Respite is widely recognized as necessary to support caregivers of older adults [ 8 , 9 ]. Indeed, a large number of studies identify the need and use for respite [ 9 , 10 , 11 , 12 ]. For example, Dal Santo and colleagues (2007) found that caregivers of older adults ( n  = 1643) used respite to manage stressful caregiving situations, but also to have a “time away”, without having to worry about their caregiving role [ 13 ]. At-home respite seems to be favoured over other forms of respite, even with the perceived drawbacks, such as the privacy breach of having a care worker in one’s home [ 14 , 15 ].

Studies suggest that caregivers of older adults seek flexibility as a main component of respite [ 16 , 17 , 18 ]. Flexibility, in line with person-centered care, allows respite that addresses their needs, rather than being services that are prescribed according to other criteria [ 16 , 17 ]. Thus, flexibility, both in accessing and in the respite itself, is essential [ 19 , 20 , 21 , 22 , 23 ]. Although there seems to be a consensus around the broader definition of respite, there is no literature reviewing the characteristics of flexible at-home respite. Some studies and reports from organizations and governments document the flexible characteristics of their models, but there are few literature reviews that address them, specifically [ 18 , 22 , 24 ]. Both reviews by Shaw et al. [ 18 ] and Neville et al. [ 19 ] concede that an operational definition of respite ( WHEN , WHERE , WHO ) is not clear. Neville et al. [ 19 ] conclude that “respite has the potential to be delivered in flexible and positive ways”, without addressing these ways. The absence of a unified definition for flexible at-home respite contributes to the challenges of implementing and evaluating services, as well as measuring their effect. Although respite services are deemed necessary, they are seldom used [ 19 , 25 , 26 , 27 ]; as little as 6% of all caregivers receiving any kind support services in Canada actually use them. In scientific literature, the under-usage of respite services is a shared reality around the world [ 28 ]. One of the main reasons for this under-usage is the overall lack of flexibility in both obtaining and using respite [ 29 , 30 ]. Synthesizing the characteristics of flexible at-home respite services is the first steppingstone to a common operational definition. This could contribute to increasing respite use through the implementation or enrichment of programs in ways that answer the dyad’s (caregiver and older adult) needs.

Consequently, to support the implementation and evaluation of homecare programs, the objective of this study was to synthesize the knowledge on the characteristics of flexible at-home respite services offered to caregivers of older adults.

A scoping review [ 32 , 33 , 34 ] was conducted, as part of a larger multi-method participatory research known as the AMORA project [ 31 ] to characterize flexible at-home respite. Scoping reviews allow to map the extent of literature on a specific topic [ 32 , 34 ]. The six steps proposed by Levac et al. [ 32 ] were followed: [ 1 ] Identifying the research question; [ 2 ] searching and [ 3 ] selecting pertinent documents; [ 4 ] extracting ( or charting ) relevant data; [ 5 ] collating, summarizing and reporting findings; [ 6 ] consultation with stakeholders. The sixth step is optional.

Identifying the research question

The research question was: “What are the characteristics of flexible at-home respite services offered to caregivers of older adults?” As the research was conducted, this question was divided into three sub-questions:

WHO is tendering flexible respite?

WHEN is flexible respite tendered?

HOW is flexible respite tendered?

Identifying relevant documents

The search strategy consisted of two methods. First, the key words (1) respite (2) informal caregivers (3) older adults in the title or abstract allowed to identify relevant documents (Table  1 ). Initially included, the term “ flexib *” was removed from the search, given the low number generated (60 versus 1,179 documents without). The first author and a librarian specialized in health sciences research documentation conducted the literature research in July of 2021 and updated it in December of 2022 in 6 databases ( Ageline , Cochrane , CINAHL , Medline , PsychInfo , and Abstracts in Social Gerontology ). The expanded research strategy then consisted of the identification of relevant documents from the selected bibliography and one article that was found by searching for unavailable references (alternative article).

Study selection

To review the most recent literature on flexible at-home respite service characteristics, the research team focused on writings within a 20-year span, as have other reviews (e.g., [ 35 , 36 ]); documents thus had to be published between 2001 and 2022. The research team selected documents written in French or English, only. Included documents had to come from either (1) scientific literature (i.e., articles in an academic journal presenting an empirical study or reviews) or (2) reports and briefs from government, homecare organizations or research centres. All study designs were included. The research team convened that at-home respite is an (1) individual (i.e., not in a group) service (although, theoretically, two persons living in the same household could receive it) from (2) a professional or a volunteer that occurs (3) in the home and that (4) it requires no transport for the dyad. To select documents related to flexible at-home respite, the research team identified those in which the respite displayed an ability to adapt to the dyad’s needs on at least one characteristic of the service, as presented by Maayan and collaborators ( WHERE [Not relevant to this review, as it focuses on at-home respite] , WHO , WHEN ). The team concluded that these three dimensions lacked the precision to globally characterize the service. Indeed, they did not describe access to or activities occurring during respite, or, as the team called it, the HOW (Fig.  1 ). Excluded documents were those covering several services at once, preventing the differentiation of elements that were specific to at-home respite services. As this is a scoping review, the research team did not include a critical appraisal of individual sources of evidence [ 32 , 34 ].

Following the step-by-step Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines [ 37 ], the research team met to define the selection strategy. First, they screened the documents by their titles and abstracts, before determining their eligibility, based on their full text. Considering the limited human and financial resources, at each step of the PRISMAScR, a second team member assessed 10% of the documents independently to co-validate the selection; the goal was to reach 80% of agreement between both team members regarding document inclusion or exclusion. If an agreement was not reached, they would meet to obtain a consensus. The research team used Zotero reference management software to store documents as well as a cloud-based website to collaborate on the selection.

Conceptual mapping of results: HOW , WHEN , WHO

Charting the data

The first author charted (or extracted) both quantitative and qualitative data. To quantitatively characterize documents, contextual data (country of origin, year of publication, type of documents, etc.) was extracted in a Microsoft Excel table. For the qualitative data, the research team created an extraction table in Microsoft Word that included the three dimensions of respite ( WHO , WHEN and HOW) and one “ other ” dimension, as to not force any excerpts under the three dimensions. To co-validate the data charting, the second and third authors replicated 10% of the process. Expressly, the first author extracted elements related to a flexible characteristic of the at-home respite ( WHO , WHEN , HOW or other ). Considering limited resources, the third and second authors both co-validated the extraction of 10% of the documents. Authors met to reach a consensus where a disagreement arose.

Collating, summarizing, and reporting the results

The research team used content analysis to “attain a condensed and broad description of the phenomenon” [ 38 ]. To do so, data was prepared (familiarization with the data and extraction of pertinent excerpts) and organized (classification of excerpts) to build a characterization of flexible at-home respite. In this scoping review, a deductive content analysis began with three main categories ( WHO , WHEN , HOW ), with the addition of the temporary “ other ” category. Content analysis aimed to divide these categories into several generic categories, which subdivided into sub-categories (Fig.  2 ), inductively. This allowed to define the three main categories. While the WHO and the WHEN categories describe the service itself (time, duration, qualified staff, etc.), the HOW category is specific to the interface between the organization offering respite and the dyad (assessing the needs of the dyad, coordinating care, etc.). An interface is a situation where two “subjects” interact and affect each other [ 39 ]. In the context of homecare services, Levesque, Harris and Russell (2013) have defined that interface as access [ 40 ]. Therefore, to define the generic categories of the HOW , the team used the five dimensions of their access to care framework: Approachability, appropriateness, affordability, availability and acceptability [ 40 ]. Approachability relates to users recognizing the existence and accessibility of a service [ 40 ]. Appropriateness encompasses the alignment between services and users’ needs, considering timeliness and assessment of needs [ 40 ]. Affordability pertains to users’ economic capacity to allocate resources for accessing suitable services [ 40 ]. Availability signifies that services can be reached, both physically and in a timely manner [ 40 ]. Acceptability involves cultural and social factors influencing users’ willingness to accept services [ 40 ]. In other words, the HOW category focuses on the organizational or professional aspects of the service and how they can be adapted to the dyad.

To co-validate the classification, the research team met until they were all satisfied with the categorization. The first author then completed the classification. After classifying 20% of the documents, the second author would comment the classification. When the authors reached an agreement, the first author would move on to the classification of another 20%. First and second authors would meet when disagreements about classification and categories arose, to confer and adjust. Finally, all categories were discussed with the third author, until a consensus was reached. Once categorization was achieved, the team prepared a synthesis report. In this report, the team defined the main categories ( WHO , WHEN, HOW , other ) and their generic and sub-categories (Fig.  2 ) with pertinent excerpts from the reviewed literature. In summary, the results of the scoping review characterize flexible at-home respite under three attributes: WHO , WHEN and HOW .

Content analysis: Types of categories according to Elo and Kyngäs (2007) ( with examples from results )

Consultation

Rather than conducting a focus group as suggested by Levac and collaborators [ 32 ], the team chose to triangulate the results with those from a survey as a consultation strategy. Specifically, the research team took advantage of a survey being conducted with relevant stakeholders in the larger study (AMORA project), as it allowed to respect the scoping review’s allocated resources. The survey aimed to define flexible at-home respite and the factors affecting its implementation and delivery. A committee including a researcher, a doctoral student and a representative of an organization funding homecare services in Québec (Canada), developed the survey following the three stages proposed by Corbière and Fraccaroli [ 41 ]. It originally included a total of 21 items: Thirteen [ 13 ] close-ended and 8 open-ended questions. Of these 8, 2 addressed the characteristics of an ideal at-home service and suggestions regarding respite and were used here for triangulation purposes. The questionnaire was published online, in French, on the Microsoft Forms ® platform in the summer of 2020. Recruitment of participants (caregivers and people from the homecare sector) was done via email, by contacting regional organizations (Eastern Townships, Québec, Canada). In addition, the 18 senior consultation tables spread throughout the territory of the province of Québec were solicited; working in collaboration with governmental instances in charge of services to older adults and caregivers, these tables bring together representatives for associations, groups or organizations concerned with their living conditions.

The goal was to triangulate the scoping review’s results, i.e., to identify what was common between the literature and real-world experiences, and, as such, to bring contextual value to the results. Accordingly, the team analyzed data using mixed categorization [ 42 ]. The categories from the scoping review served as a starting point (closed categorization), leaving room to create new categories, as the analysis progressed (open categorization). Once all the data (scoping and survey) was categorized, the team identified the characteristics according to sources. To do so, the team tabulated the reoccurrence of each category in the survey, in the scoping review, or in both. They then integrated the results to provide one unified categorization of flexible at-home respite. The AMORA project was approved by the research ethics committee of the Integrated University Health and Social Services Centre (CIUSSS) of the Eastern Townships (project number: 2021–3703).

Of the 1,301 papers retrieved through the database searches, 1,146 were not eligible based on title and abstract, while 116 were excluded after reading their full texts, resulting in 39 included documents (Fig.  3 ). Documents were mainly excluded because they did not provide details about the respite service and its flexibility. The expanded search yielded three additional documents, resulting in a total of 42 documents, included in this scoping review. This section details (1) the characteristics of the selected documents and (2) the characterization of flexible at-home respite.

Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) flow chart of the scoping review process [ 37 ]

Characteristics of selected documents

The majority (86%) of the documents in the review (Table  2 ) are from after 2005, with only 14% of the documents published before 2005, and are from 9 countries; United States ( n  = 18; 42%), United Kingdom ( n  = 11; 26%), Australia ( n  = 4; 10%), Canada ( n  = 2; 5%), Ireland ( n  = 2; 5%), France ( n  = 2; 5%), Belgium ( n  = 2; 5%), Germany ( n  = 1; 2%), New Zealand ( n  = 1). The types of documents were diverse: 68% ( n  = 28) were empirical studies, 31% ( n  = 13) theoretical papers and 1% ( n  = 2) government briefs. Most ( n  = 23; 56%) of the documents did not specify their research approach, while 10 and 9 took, respectively, a qualitative (23%) or quantitative approach (21%). Most documents address respite in the context of caregiving for someone living with Alzheimer’s disease or other neurocognitive disorders ( n  = 25; 60%), while some targeted older adults in general ( n  = 14; 34%), people in palliative care ( n  = 4; 9%) or other older adult populations (for example, veterans) ( n  = 3; 1%). Respite was usually tendered by community organizations specialized in homecare ( n  = 32; 78%). Although the majority of the documents ( n  = 31; 75%) did not address the type of region (rural, urban, or mixed) surrounding the caregivers, those who did ( n  = 11; 26%) mainly reported being in a mixed environment ( n  = 9; 21%).

Characteristics of survey participants

Although all 100 participants completed the questionnaire, 71 participants answered at least 1 of the 2 open-ended questions: Each question had 66 and 41 answers. Of those 71 participants, most of them were women ( n  = 60; 85%). All participants were aged on average 55 years old (SD = 15). They were mostly from the Eastern Townships area ( n  = 56; 79%). Most participants were either caregivers ( n  = 24; 34%) or homecare workers ( n  = 28; 39%), while some were service administrators ( n  = 11; 15%), and some reported being both caregivers as well as working in the formal caregiving sector ( n  = 7; 10%). Only one person reported themselves as an older adult having a caregiver.

Characterization of flexible at-home respite

The characterization of flexible at-home respite will be presented below in three main categories which are WHO , WHEN , and HOW . Of note, 10 (24%) of the included documents had three categories of flexible components, 16 (38%) had 2 categories and 1 category. Almost all documents discussed the HOW of flexible at-home respite ( n  = 40, 95%). Out of the 33 categories constructed with the scoping review, only 6 (18%) were not reported in the questionnaire: (1) planned respite ( WHEN ), (2) screening of dyads ( HOW ), (3) determining frequency of respite ( HOW ), (4) coordination of care ( HOW ), (5) voucher approach ( HOW ) and (6) acceptability to low-income households ( HOW ). Moreover, the questionnaire added three characteristics that were not present in the scoping review: (1) respite needs to be approachable, (2) the organization must be prompt** and adhocratic** and (3) able to deliver respite regardless of the season** (availability). Generic or sub-categories present only in the scoping review are identified with 1 asterisk (*), while those present only in the questionnaire have 2 (**).

In the selected documents, the WHO dimension of flexible at-home respite services can be broken down into three qualifiers: (1) Compatible , (2) qualified and (3) trained (Table  3 ). This dimension includes all human resources contributing to homecare (administrative staff, governing bodies, paid and volunteer care workers). First, the workforce behind flexible respite is compatible , meaning it has personal characteristics and profiles relevant to homecare for caregivers of older adults [ 17 , 53 , 62 , 63 , 68 ]. Gendron and Adam explain this by describing how the role of the care worker in Baluchon Alzheimer™ goes beyond training: “The nature of their work with [Baluchon Alzheimer™] requires particular human and professional qualities that are quite as important as academic credentials” [ 53 ]. Personal characteristics such as flexibility [ 53 , 62 , 63 , 68 ], empathy and patience [ 17 , 53 , 62 ] are deemed essential attributes. Secondly, the workforce is qualified : It has the necessary skills, abilities and knowledge from past professional [ 14 , 45 , 62 , 70 ] and personal experience [ 62 ] to work, or volunteer, with caregivers of older adults. For a program like Baluchon Alzheimer™, “the backgrounds of the baluchonneuses vary […]; all have experience in gerontology” [ 53 ]. Other areas of qualification in the included documents are a nursing background [ 18 , 45 ] or knowledge related to dementia [ 69 ]. Finally, flexible at-home respite requires a trained workforce engaged in the process of acquiring knowledge and learning the skills to provide respite services to caregivers of older adults. For example, homecare organizations can offer specific training on various topics, depending on their target clientele: Dementia [ 44 ], palliative care [ 59 ], or homecare in general [ 44 ].

The WHEN dimension of flexible at-home respite contains 4 temporal features: (1) Time , (2) duration , (3) frequency and (4) predictability (Table  4 ). First, flexible respite is available on a wide range of possible time slots. For example, the service is “available 24 hours, but typically from 9 am to 10 pm” [ 64 ]. Secondly, flexible respite is accessible on a wide range of possible durations . The Community Dementia Support Service (CDSS) is an example of flexibility in duration by “[being] totally flexible, being available from 2 to 15 hours per week” [ 69 ]. Thirdly, the service is offered in different frequencies : It can be either recurrent or occasional, or a combination of both [ 18 , 64 , 66 ]. The last feature of the WHEN dimension is flexibility in predictability ; the respite service can be planned* or not. A study on respite services in South Australia found that most providers (93%) planned the respite care with the dyad, but that emergency or crisis services were still offered by 35% of them [ 50 ].

At-home respite is flexible when it demonstrates approachability : Caregivers can identify that some form of respite exists and can be reached (Table  5 ). For the respite service to be approachable, the organization needs to be reaching out to dyads; it proactively makes sure that caregivers of older adults have information on services, know of their existence and that they can be used. For example, the El Portal program put in place “advisory groups that included the local clergy, representatives from businesses, caregivers, and service providers who were used for outreach work” [ 66 ]. The organization also screens* dyads to assess their eligibility for respite, as well as for other services from the same program or organization. For example, the North Carolina (U.S.A.) Project C.A.R.E. has an initial assessment that considers the range of homecare services available, rather than just assessing for eligibility for a program [ 57 ]. In addition, flexible respite requires the organization to set attainable and inclusive requirements for eligibility, as to not discourage use [ 24 , 57 , 61 , 66 ]. Finally, the organization communicates consistently with the dyad. As Shanley explains in their literature review, “there are clear and open ways for carers to express concerns about the service, and an open mechanism is available for dealing with these concerns constructively” [ 17 ]. In addition, the survey participants discussed two other characteristics. First, for respite to be approachable, the organization is prompt**, respecting a reasonable delay between the request and the beginning of the service (wait list). Second, it is adhocratic**, meaning the organization does not depend on complex systems of rules and procedures to operate i.e., bureaucracy.

The second access dimension of flexible at-home respite is appropriateness (Table  6 ): The fit between respite services and the dyad’s needs, its timeliness, the amount of care spent in assessing their needs and determining the correct respite service. For the respite service to be appropriate, the organization assesses needs by collecting details about the dyad’s needs; this can include, but is not limited to, clinical, psychological, or social evaluation. The organization then proposes respite services from a wide range of options or packages: A multi-respite package, as presented by Arksey et al., can simply be the combination of at least two different respite services [ 44 ]. For the service to be appropriate, the organization also paces the respite. Apprehension towards service appropriateness can be mitigated by a gradual introduction to homecare, for example when the respite is presented as a trial [ 68 ]. The organization determines the service with the dyad and defines its different characteristics ( WHEN * , WHO ) so interventions correspond to their needs. The organization then determines the appropriate activities to do with the dyad during the respite. For example, the caregiver of older adults can be encouraged to use respite time for leisure (sleep, physical activity, etc.) [ 45 ], while the care worker supports the beneficiary in engaging in an activity such as a walk or a board game [ 14 ]. Furthermore, the organization coordinates* the services for the dyad and acts as a “respite broker” to arrange all aspects of care; this is especially relevant for programs that include a “care budget” that can be used at the caregivers’ discretion [ 58 ]. Finally, for the respite to be appropriate, the organization assures that it is in continuity with other health services, by connecting the dyads to pertinent resources. As described by Shaw, respite should be “embedded in a context that includes assessment, carer education, case management and counselling” [ 18 ].

The third access dimension of flexible at-home respite is affordability , referring to the economic capacity of the dyad to spend resources to use appropriate respite services (Table  7 ). The included documents only explored the direct cost of respite: The amount of money a dyad must pay to receive services. For the respite to be affordable, its direct cost is either (1) adapted, where the cost is modulated according to the dyad’s financial resources, for example on a sliding scale, based on income or (2) nonexistent [ 44 ].

Next, flexible at-home respite must demonstrate availability (Table  8 ): Services can be reached both physically and in a timely manner. Firstly, the organization offers respite in the dyads’ geographic area. Shanley described an at-home mobile respite program designed to reach rural and remote areas, where two care workers visit different locations for set periods of time [ 17 ]. Moreover, one sub-characteristic identified exclusively by the survey participants was seasonality. Indeed, the dyad has access to respite, regardless of the season**. Thus, the geography category is broken down between the access to service (1) in rural or remote areas and (2) notwithstanding the season. Flexibility in availability also requires that the dyads have access to unlimited respite time; the organization does not assign a finite bank of hours. Finally, the organization proposes diverse payment methods to the dyads. The consumer-directed approach is a way that homecare organizations offer flexibility. A care budget is allocated to the caregiver to purchase hours from homecare agencies or to hire their own respite workers. This includes payments to family members or friends to provide respite care [ 79 ]. An example of a type of consumer-directed approach is the use of vouchers*: Credit notes or coupons to purchase service hours from homecare agencies [ 44 ].

Finally, access to flexible at-home respite also relates to acceptability (Table  9 ): The cultural and social factors determining the possibility for the dyad to accept respite and the perception of the appropriateness of seeking services. For the respite to be acceptable, the organization targets and caters to the cultural diversity represented in their local population. The organization is also able to identify and to accommodate underserved groups. In the included documents, underserved groups lacked access to respite for two reasons: (1) Geographic isolation or (2) the requirements to be eligible to “traditional homecare” does not apply to them, for example, for younger people with dementia and people with HIV/AIDS [ 17 ]. The organization can target and cater to low-income households*. Rosenthal Gelman and his collaborators detail a program where, after realizing that low-income caregivers have greater unmet needs, special funds were set aside for respite care vouchers to be distributed [ 70 ].

This scoping review conducted with Levac and colleagues’ method [ 32 ] synthesized the knowledge on the characteristics of flexible at-home respite services offered to caregivers of older adults, from 42 documents. The results provide a synthesis of the characteristics of flexible at-home respite discussed in the literature. The three dimensions of flexibility in respite relate to (1) WHO is tendering it, (2) WHEN it is tendered and (3) HOW it is tendered. First, human resources ( WHO ) must be compatible with the homecare sector as well as being trained and qualified to offer respite to caregivers of older adults. The second feature of flexible respite is temporality ( WHEN ): The time, duration, frequency, and predictability of the service. The last dimension, access ( HOW ), refers to the interface between the respite and the users. Flexible at-home respite exhibits approachability, appropriateness, affordability, availability, and acceptability. In the light of what we learned, flexible at-home respite could be characterized as a service that has the ability to adjust to the needs of the dyad on all three dimensions ( W HO , WHEN , HOW ). However, this seems to be more of an ideal than a reflection of reality.

The survey provided complementary results to the review; the concordance between the two is strong (27/33 = 82%). Six [ 6 ] characteristics were missing from the survey results, including planned respite and the voucher approach ( HOW ). Moreover, the survey added three elements to the review results: The organization’s adhocracy ( HOW ) and promptness ( HOW ) as well as its ability to offer services, regardless of the season ( HOW ). These mismatches might reflect the Québec (and possibly Canadian) landscape of homecare. For example, in the Québec homecare system, respite is mostly planned, it is therefore not surprising that people only mention that unplanned respite is lacking. The “voucher system” was not mentioned in the survey, probably in part because it does not exist in the province of Québec. Additionally, navigating the healthcare system to have free or affordable homecare can be treacherous [ 80 ]. In short, older adults have to go through (1) evaluation(s) by a social worker from a hospital or another public healthcare organization and (2) various administrative tasks ( adhocratic ) [ 2 ], before possibly being put on a waiting list ( prompt ) [ 81 ]. In addition, Canada can experience harsh winters ( seasonality ) that can make transport, which is an integral part of homecare, particularly laborious. Although those categories could reflect the particularity of homecare in Canada, a promising follow up on this review would be to compare the characteristics of flexible respite from one territory to another. It would contribute to providing a more operational definition of flexible at-home respite.

The remainder of this discussion will focus on two main points before touching on the limitations and strengths of this review. First, flexibility in at-home respite seems exceptional. Second, respite care workers are as skilled as they are underappreciated.

This review, in coherence with the literature, highlights the fact that respite services generally lack flexibility: This is the conclusion of several studies on respite [ 7 , 64 , 82 ]. A pattern seems to emerge in the countries represented in the review: Community organizations specialized in homecare (public and/or privately funded) offer respite on predetermined time slots, usually prescribed between traditional office hours (9 AM to 6 PM) [ 50 ]. This lack of flexibility could be explained in part by the rigidity of the structure of homecare services and the fact that its funding does not allow for customizable and punctual services [ 17 , 62 , 73 ]. Nevertheless, there were some examples of flexible respite models, such as Baluchon Alzheimer™ and consumer-directed approaches. Baluchon Alzheimer™ offers long-term at-home respite (4 to 14 days) by qualified and trained baluchonneuses . Prior to the relay of the caregivers, the baluchonneuse takes the time to learn about the dyad, including their environment and routine [ 53 , 62 ]. Caregivers report feeling refreshed upon their return and appreciate the diaries (or logbooks) that the baluchonneuse meticulously fills out [ 53 ]. Another example would be consumer-directed approaches, where caregivers are attributed a budget to hire their own care worker. Allowing caregivers to choose their care worker (either from a self-employed carer or family and friends) can increase the quality of care and satisfaction, while providing relatively affordable care, especially in a situation of labour shortage [ 51 , 79 ]. Even though these two models are a demonstration of how respite can be adapted to the caregiver-senior dyad, for the most part, flexibility is lacking on all three dimensions of respite ( WHO , WHEN , HOW ).

Secondly, the results from the scoping review highlight how homecare as a profession is often overlooked. Indeed, the reviewed documents state the necessary set of skills to offer respite; the level described is one of highly specialized care professionals with important liability. These skills must also transcend advanced knowledge and qualifications, to include interpersonal capabilities [ 17 , 53 , 62 , 63 , 68 ]. Furthermore, care workers must also be flexible to offer a wide range of service time and duration, in addition to being ready to provide “on-the-go” respite [ 53 , 68 ]. Yet, the occupation of homecare worker is an underappreciated and underpaid position [ 83 ]. Community care, like respite, is generally not a priority for social and healthcare funding [ 24 ]. This can be explained in part by the neoliberal approach to care in which the target is to minimize spending and maximize (measurable) outcomes [ 84 ]. Homecare outcomes are often overlooked in favour of service delivery evaluation, in part because they are difficult to measure [ 44 ]. This approach can also lead to prioritizing third party contracting instead of including respite in the range of public services, as to save on expenses related to employment (insurance and other benefits) [ 85 ]. Another contributor is that funding is used for service administration and not to adequately provide services or remunerate care workers [ 86 ]. Finally, care workers are mostly women, known for doing the invisible work that is at the heart of respite care (emotional support, etc.) [ 87 ]. A telling example from the reviewed documents is that Baluchon Alzheimer™ refers to their care workers as baluchonneuses (feminine form) and not baluchoneurs (masculine form) [ 53 ]. Consequently, the homecare sector is faced with recruitment and retention challenges [ 44 , 64 , 88 ]. Authors of the documents included in the review addressed the fact that flexibility in service meant that service providers had to function with excess capacity; for example, by building an “employee bank” to cover all the hours of the day and emergency calls [ 44 ]. Ultimately, staff turnover and shortage caused in part by the work being underappreciated could create a vicious cycle, leading to inflexibility in respite. In short, overlooking and underestimating the crucial and specialized work of homecare workers can contribute to staff turnover, which in turn could result in a lack of flexibility of at-home respite.

Limitations and strengths

The review’s methodological approach has some limitations and strengths. First, according to Levac, Colquhoun and O’Brien [ 32 ], research teams could conduct a sixth step in their scoping study, consisting in consulting experts through a focus group or workshop. This last phase aims at providing further insight into the review’s results and to begin the knowledge translation process. The team did not conduct a traditional consultation phase. Instead, they triangulated the review’s results through a questionnaire. This method was of interest, because of the natural concordance between the results and the considerable number of participants ( n  = 100). The survey still allowed to refine the characterization of respite, but further knowledge transfer to homecare actors and caregivers is necessary. Although innovative, there is a need to further investigate the validity of this approach as a consultation phase. Secondly, the theme of flexible at-home respite may have narrowed the search and identification of relevant documentation, and therefore caused the team to overlook some of the literature. Empirical studies and reviews on respite seldom include a detailed description of services [ 89 , 90 , 91 ]. This made it challenging to understand what services are like, operationally, for the dyad and to judge their flexibility. In addition, it complexified the extraction of relevant data, as descriptions were sparse and scattered throughout the documents. The team worked to mitigate these limitations in the documentation research and data charting phase. To begin, they sorted through all the literature on at-home respite for caregivers of older adults. In other words, the team not only searched for, but also included any explicit mention of flexibility. After selection, the extraction tables allowed enough versatility to include all the flexible characteristics of service, regardless of their placement in the text (introduction, methodology or discussion) or length. Another limitation is that, due to resource constraints, only 10% of the document selection and extraction was assessed by two reviewers, although a minimum of 80% of agreement was met and discussions were used to reach consensus where a disagreement arose. To conclude, strengths of this review include the extensiveness and diversity of the documents and its rigorous methodology, co-validated by a peer and an experienced researcher, with assistance from a specialized librarian.

This review has both scientific and practical implications. From a scientific point of view, the results contribute to the body of knowledge on flexible respite service models for caregivers of seniors, an under-documented topic. To our knowledge, this is the first review that aims to characterize flexible at-home respite. Our results suggest the relevance of further documenting the factors influencing the implementation and delivery of flexible respite services, as well as the consequences of the lack of flexibility in respite services, which may lead to service underuse. Moreover, researchers could focus on documenting respite programs in countries that are not represented in this review. There were notably no documents from the continents of Asia and Africa. Unfortunately, good practices can go unreported in peer-reviewed publications; therefore, a review focusing on government reports and publications aimed at professionals could shed some light on promising respite models. From a practical point of view, this review serves as a starting point for the implementation of flexible home respite that is tailored to the caregivers’ and older adults’ needs. Our characterization of flexible at-home respite can be used to guide the improvement of existing respite services and to design new resources that reflect best practices in homecare, ultimately contributing to successful aging in place for older adults.

Data availability

The data supporting this study’s findings are available from the corresponding author, upon reasonable request.

Abbreviations

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

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Acknowledgements

The team thanks the Université de Sherbrooke’s library and archives service for their support. The team also want to thank everyone who participated in the survey.

This article describes a part of a larger study on flexible respite funded by the Fonds de la recherche du Québec (#309508) – Santé and the Conseil de recherches en sciences humaines du Canada (#892-2019-3075). Annie Carrier and Véronique Provencher are Fonds de recherche du Québec – Santé Junior 1 and Junior 2 researchers (#296437 and #297008, respectively). Alexandra Éthier is a Canadian Institutes of Health Research - Research Graduate Scholarships – Doctoral Program recipient (#476590 − 71729).

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Defining re-implementation

• Rachel Moyal-Smith   ORCID: orcid.org/0000-0002-3911-7957 1 ,
• James C. Etheridge 1 , 2 ,
• Ami Karlage 1 ,
• Yves Sonnay 1 ,
• Christina T. Yuan 3 ,
• Joaquim M. Havens 1 , 2 ,
• Mary E. Brindle 1 , 4 , 5 &
• William Berry 1  

Implementation Science Communications volume  4 , Article number:  60 ( 2023 ) Cite this article

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The first attempt to implement a new tool or practice does not always lead to the desired outcome. Re-implementation, which we define as the systematic process of reintroducing an intervention in the same environment, often with some degree of modification, offers another chance at implementation with the opportunity to address failures, modify, and ultimately achieve the desired outcomes. This article proposes a definition and taxonomy for re-implementation informed by case examples in the literature.

We conducted a scoping review of the literature for cases that describe re-implementation in concept or practice. We used an iterative process to identify our search terms, pilot testing synonyms or phrases related to re-implementation. We searched PubMed and CINAHL, including articles that described implementing an intervention in the same environment where it had already been implemented. We excluded articles that were policy-focused or described incremental changes as part of a rapid learning cycle, efforts to spread, or a stalled implementation. We assessed for commonalities among cases and conducted a thematic analysis on the circumstance in which re-implementation occurred. A total of 15 articles representing 11 distinct cases met our inclusion criteria. We identified three types of circumstances where re-implementation occurs: (1) failed implementation, where the intervention is appropriate, but the implementation process is ineffective, failing to result in the intended changes; (2) flawed intervention, where modifications to the intervention itself are required either because the tool or process is ineffective or requires tailoring to the needs and/or context of the setting where it is used; and (3) unsustained intervention, where the initially successful implementation of an intervention fails to be sustained. These three circumstances often co-exist; however, there are unique considerations and strategies for each type that can be applied to re-implementation.

Conclusions

Re-implementation occurs in implementation practice but has not been consistently labeled or described in the literature. Defining and describing re-implementation offers a framework for implementation practitioners embarking on a re-implementation effort and a starting point for further research to bridge the gap between practice and science into this unexplored part of implementation.

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Contributions to the literature

This article proposes a definition and taxonomy for re-implementation based on case examples in the literature.

Defining and describing re-implementation provides a unifying terminology and a foundation for future research.

This article describes the practical implications of re-implementation identified in the literature to guide others in developing their re-implementation strategy.

The field of implementation science has grown exponentially over the last decade. There has been a proliferation of frameworks, theories, and strategies to support the implementation of evidence-based practices. Even when implementation practitioners appropriately use these in practice, the intended change may not occur, there may be poor adherence, or sites may not be able to sustain changes. Implementation, or the initial process of integrating an intervention within a setting [ 1 ], requires an intentional approach with active support and dedicated resources to be effective [ 2 , 3 ]. Once the change becomes routine and active support and resources end, the sustainability phase begins [ 3 , 4 ]. However, this is not always the end of the story; implementation may require multiple attempts to obtain the desired outcome.

There are several established process models in implementation science that outline the phases of implementation, with a growing recognition that the implementation process is often non-linear and dynamic, with ongoing adaptations occurring throughout [ 1 , 5 , 6 , 7 , 8 ]. These adaptations are often described as rapid learning cycles or using iterative cycles to test changes on a smaller scale [ 1 , 9 ], which corresponds to the Plan-Do-Study-Act (PDSA) cycles used in continuous quality improvement [ 10 ]. However, there is little detail on the magnitude of change that constitutes a rapid learning cycle, and the dynamism that is described in theory has not yet been translated into clear empirical implications for implementation practice.

There is a need for greater specification of why, when, and how practitioners move between implementation phases over time (e.g., moving from the sustainability phase back to an active implementation phase). Lewin’s three-step model of unfreezing, moving, and refreezing, which describes the process of cycling from sustainment to change, offers insight from the change management literature [ 11 ]. The first step, unfreezing, disrupts the current equilibrium of a process or behavior, opening the possibility of changing the current state. Movement involves frontline staff and leaders working together to adapt and implement the change. Finally, refreezing the system and making the change part of daily work promotes sustainment and prevents regression to old behaviors. Although a cyclical process of implementation has been described in concept in the implementation science literature [ 1 , 8 ], it lacks the practical details of moving from sustainability to a more active state found in Lewin’s model.

In addition to moving between the implementation phases, there needs to be more conceptual clarity and empirical descriptions of the magnitude of change and the impact of the degree of change on selecting implementation strategies. In the management literature, the magnitude of change is often described as incremental (i.e., small changes to existing practices) or transformational (i.e., fundamental, qualitative changes) [ 12 ]. For example, the punctuated equilibrium model describes long periods of stability (equilibrium) punctuated by bursts of fundamental change (revolution) [ 13 ]. During the equilibrium period, there are incremental changes to adapt to changing contexts or address targeted issues [ 13 ]. Incremental change is a more common cost-effective approach, requiring little resources while maintaining the stability of the current system [ 14 ]. In contrast, the revolutionary period is characterized by changes to a core component, with some form of discontinuity from the initial system. These transformational changes take more time and energy, partly due to overcoming greater resistance to changing a system or process that is already routine [ 14 ]. Despite these challenges, transformational change may be necessary after a significant event or when incremental changes reach diminishing returns [ 14 ].

The implementation science literature to date has largely focused on describing incremental changes that occur during the adaptation process [ 10 , 15 , 16 ]. In contrast, there has been relatively little attention paid to transformational changes, in which there is a clear break from the status quo, which in turn triggers the need for a greater level of active support. This level of change requires a re-implementation of the intervention, moving from sustainment to implementation, with a similar level of resources as the initial implementation effort. Our years of collective implementation practice have found that sometimes, re-implementation with fundamental changes to the implementation process or intervention is necessary to achieve success. Similarly, unsustained interventions can not simply be turned back on like a light switch but require active support and modifications to adjust to the current context and prevent slippage in the future.

Re-implementation remains largely unexplored. In this article, we propose a definition and taxonomy for re-implementation based on the literature. We describe three distinct types of circumstances in which re-implementation occurs with case examples that provide insights on how understanding each circumstance can inform the implementers’ approach. This debate article aims to define re-implementation and describe its unique considerations for implementation practitioners to adapt their re-implementation strategy and to serve as a foundation for future research in implementation science.

We conducted a scoping review to identify cases of re-implementation described in the literature. We chose a scoping review because it aligned with our objective to identify incidences of re-implementation and to clarify or define a concept [ 17 ]. Our review followed the five-stage process outlined by Arksey and O’Malley: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data, and (5) collating, summarizing, and reporting the results [ 18 ].

Identifying the research question

Our study team began by generating a list of questions related to re-implementation, drawing on our experience in practice. Ultimately, we decided we first needed to define the concept. We sought to understand more about re-implementation outside our own experience while focusing on health-related contexts. We identified the following question for our search: 

How has re-implementation been described in concept or practice in the literature?

Identifying relevant studies

The research team generated a list of potential search terms that were synonyms (re-implement, relaunch, readopt, revive, rebrand, reboot) and phrases that describe re-implementation, such as “implement again” and “repeat implementation.” We then searched for related MESH terms using our list and other root words related to implementation. Next, we pilot-tested these terms using the Google search engine, to determine their prevalence, ways in which they were used, and to identify additional terms. Then, we tested these terms in PubMed and CINAHL, further refining our keywords using an iterative approach, balancing inclusivity with the feasibility of sorting through the results. Our final search terms included the root words re-implement, relaunch, and readopt and excluded specific keywords related to biology and genetics, which use re-implementation to describe genetic sequencing and synthetic biology (Additional file 1 ). We entered our final search terms into the PubMed and CINAHL databases, which we chose because of our desire to focus on re-implementation in health-related contexts.

Study selection

We imported the citations from our search into Covidence, a review management tool, for abstract and full-text screening [ 19 ]. The study team developed inclusion and exclusion criteria (Table 1 ) based on implementation practice experience and a preliminary literature review focused on the phases of implementation, including sustainment and de-implementation. Two authors conducted the initial screening of abstracts, reviewing articles for applicability to the study question and the inclusion and exclusion criteria. Due to the lack of evidence base for re-implementation, the two reviewers had a low threshold to discuss articles they were unsure about. Then, one author completed the full-text review, bringing all articles to the study team to discuss their inclusion. Finally, we reviewed the references from the included articles to identify related articles. The PRISMA flow diagram [ 20 ] in Fig.  1 details the final number of articles we included and excluded in our review.

PRISMA flow diagram

Charting the data

We developed a table on a shared spreadsheet for data extraction. The table included general information about the article, the intervention that was re-implemented, setting, key findings, and the reason or circumstances that prompted re-implementation. We also included the Expert Recommendations for Implementing Change (ERIC) strategies described in the article, to identify potential commonalities among the cases of re-implementation, and then streamlined these using the ERIC study clusters [ 23 , 24 ]. The ERIC strategies are a compilation of 73 implementation strategy terms and definitions agreed upon by experts in implementation science.

Collating, summarizing, and reporting the results

We used inductive thematic analysis to assess commonalities across the selected articles. Although no themes emerged related to the intervention or setting, three themes were identified for the circumstance in which re-implementation occurred. The study team reviewed these themes and cases and if an article fit under more than one theme, the group discussed the dominant circumstances around re-implementation until a consensus was reached.

We ultimately found 15 relevant articles that represented 11 distinct cases of re-implementation (Additional file 2 ). Although several cases identified in the literature described or explicitly mentioned re-implementation, we found no formal definition. Based on our review, we propose that re-implementation be defined as the systematic process of reintroducing an intervention in the same environment, often with some degree of modification to either the intervention itself or the implementation strategies used to promote uptake. In these cases, re-implementation began with a comprehensive evaluation after the initial implementation, followed by an intentional strategy to re-launch the intervention. The implementation strategies described varied; however, two ERIC strategy clusters were used in every case: the use of evaluative and iterative strategies and the adaptation and tailoring to context.

A proposed typology of re-implementation

We identified three distinct circumstances in which re-implementation occurs: (1) failure of the initial implementation process, (2) initial implementation of a flawed intervention, and (3) failure to sustain the intervention (Fig.  2 ). Multiple types of failure may contribute to the need for re-implementation; for example, a flawed intervention may contribute to a sustainment failure. However, in each case, we were able to identify a dominant failure underlying the need for re-implementation.

Visual representations of the three types of re-implementation

Type 1: Re-implementation following failed implementation

We identified four examples in the literature in which re-implementation was primarily necessitated by deficiencies in the initial implementation process [ 25 , 26 , 27 , 28 , 29 ]. We termed this subset as re-implementation after failed implementation. Failed implementation is when the initial implementation process fails to result in the intended changes and the adoption of the intervention is low or entirely absent.

The first two cases describe the re-implementation of a surfactant administration protocol and imaging guidelines after discovering low adoption and adherence [ 25 , 26 ]. In both cases, an evaluation found the main cause of implementation failure was a lack of staff awareness and difficulty accessing the protocol and guidelines. Both cases used the information from the evaluation to inform the re-implementation strategy. They improved awareness through educational meetings and training sessions and moved the guidelines and protocol to a location that increased accessibility. This dual approach was effective in both case examples and improved adoption and adherence [ 25 , 30 ].

A weak implementation climate and culture can result in a failed implementation, which was the case in the implementation of a barcode medication administration (BCMA) system in the intensive care unit (ICU) [ 29 ]. The system had poor adoption by ICU nurses and stopped being used completely eight months after implementation. An evaluation found that nurses were reluctant to use the system due to a policy that tracked medication errors. They rescinded the policy, and their re-implementation process included co-design, training sessions, local champions, and proactive feedback solicitation through BCMA rounds in the ICU. Ultimately, they were unsuccessful in strengthening the implementation climate. They continued to meet significant resistance, with the nurses continuing dual documentation until the ICU converted to an electronic administration system.

The final case example used a multimodal approach through increasing awareness and strengthening the implementation climate with incentives and an enhanced user experience. The Dossier Médical Partagé (DMP), France’s national health information exchange, was initially implemented in 2006 but was stopped 6 months later due to security concerns with the electronic platform [ 28 , 31 ]. It was re-implemented in 2010 but had very poor adoption, with only 1.5% of the population registered for the DMP 5 years later. One of the primary reasons for low adoption was cultural, with no established culture of sharing medical information among healthcare professionals or with patients [ 31 ]. In addition, there was a lack of political support and education for patients. It was re-implemented again in 2016 as part of the French Health Act, with a name change, public awareness campaign, the ability to self-enroll, and a mobile application for patients. In addition, the government offered substantial financial incentives to providers and practices for enrolling their patients in the DMP. These changes to the implementation process were successful, with a significant increase in patients enrolled in the DMP 18 months after re-implementation [ 27 ].

Type 2: Re-implementation due to a flawed intervention

We identified two examples in the literature where the implementation process was successful, but the intervention failed to achieve the desired outcomes [ 32 , 33 ]. Both of these cases recognized the need to make major modifications to the intervention before re-implementation. We termed this subset as re-implementation due to a flawed intervention. As previously mentioned, this does not include incremental changes made as part of an improvement cycle. When the intervention undergoes significant modifications, re-implementation is needed to properly engage, train, and launch the intervention to encourage the desired behavior change. The re-implementation process is an ideal time to engage stakeholders and reinvigorate an intervention that is not reaching its full potential.

The intervention for the two cases identified was a chest injury protocol for the emergency department and a comprehensive health assessment in a subacute rehabilitation hospital [ 32 , 33 ]. The cases had several similarities. They both began with an evaluation and found that the staff was not using the intervention as intended. The re-implementation centered around engaging clinicians to identify challenges and provide input on modifications. In the case of the chest injury protocol, the staff found that it was too complex. The re-implementation included simplifying the protocol and creating new workflows with training sessions to empower nurses and junior staff.

Similarly, in the other case example, the staff found the comprehensive health assessment burdensome and not fully integrated into the clinical team’s practice. Although they could not modify the assessment fields, they did make significant changes to workflows and the electronic platform used to complete the assessment, which was accompanied by a training course for all staff. The changes to the intervention and subsequent re-implementation were effective in both of these examples, with improvements in uptake and meaningful use.

Type 3: Re-implementation of an unsustained intervention

We identified five cases in the literature where the initial implementation was successful, but sites did not sustain the changes [ 34 , 35 , 36 , 37 , 38 , 39 ]. We termed this subset as re-implementation due to an unsustained intervention. Sustainment is a recognized challenge in implementation, with capacity issues, including workforce, funding, and other resources, as a common reason for failure [ 3 ]. It is recognized that the sustainment phase should be dynamic, adapting to the changing environment using rapid learning cycles [ 1 ]. However, when the environment has undergone dramatic changes or the intervention was discontinued, these incremental changes may not be sufficient, and transformational changes and re-implementation are necessary.

Slippage, or gradual decline resulting from multiple levels of influence, can occur after the initial success of an intervention [ 40 ]. Two case examples identified slippage as the catalyst for re-implementation. The first case example is an evidence-based care bundle for patients undergoing an exploratory laparotomy [ 34 ], and the second is implementing a BCMA system in Argentina [ 35 ]. In both cases, there was an initial success with a decline over time, with less engagement from the staff and leadership. The re-implementation in both examples relied on engaging closely with clinicians to identify areas for improvement and redesign the intervention. They prioritized sustainment and creating a culture of improvement through training sessions on quality improvement, sharing data, and developing channels for communication with the implementation team. Re-implementation was effective in both cases, and strong leadership engagement was cited as critical to their success.

We identified three cases of programs that abruptly ended due to a resource or funding disruption, which is not an uncommon experience in low and middle-income countries [ 36 ]. The first case is a diabetes screening program in Africa that suffered from supply chain disruptions [ 36 ]. The second case is a community health worker program in Mozambique, which experienced several challenges in funding related to a lengthy war [ 37 ]. The final case is ParticipACTION, a Canadian program promoting physical activity that underwent funding cuts after operating successfully for 30 years [ 38 , 39 ].

Each case found strong support for re-implementation based on individuals witnessing the intervention’s benefits and previous success. However, some were concerned about future disruptions [ 36 , 37 ] and how it would fit with other systems that were created to fill gaps when the program ended [ 37 , 39 ]. In the diabetes screening program, interviews found that the disruption had a cascading effect, hindering team learning and decreasing their self-efficacy to deliver the screening [ 36 ]. Their re-implementation strategy included educational programs on handling future supply disruptions and refresher training for teams to increase their self-efficacy when the supplies are available. Although none of the authors commented on the effectiveness of their re-implementation, they all described taking a slow and steady approach while focusing on engaging stakeholders and securing the long-term availability of resources and funding.

Our literature review demonstrates that re-implementation is described and explicitly mentioned in the literature but, to date, has not yet been defined or explored as a key concept in implementation science. We propose that re-implementation offers a more nuanced understanding of the implementation process and occurs when (a) the magnitude of the change is transformational and (b) the intervention had previously been implemented in the same setting. We found it described in various circumstances, with three overarching types identified that relate to the underlying impetus: failed implementation, flawed intervention, and unsustained intervention. Although there are common strategies for re-implementation across all three types, each type also has unique considerations. Defining and understanding the types of re-implementation provide critical information on contextual influences for implementation practitioners to develop their re-implementation strategy and opens up a new area of research in implementation science.

The prevalence of adapting and tailoring to the context in the cases we identified reinforces the influence of context on implementation [ 41 , 42 ]. However, context may have an even stronger influence in re-implementation because it adds another dimension of factors related to the initial implementation that need to be considered. For example, in addition to standard stakeholder engagement activities, implementation practitioners may need to devote additional time to investigate specific areas. After an implementation failure, seeking input from stakeholders on the challenges encountered during the previous implementation effort is crucial to avoid the causes of failure during re-implementation. If the intervention is flawed, in-depth engagement of stakeholders in the modification process will be essential to create buy-in and incorporate human-centered design principles [ 43 ] while considering current practices. Finally, for an unsustained intervention, the focus should be on engaging staff to identify barriers to sustainability and workarounds or other processes created to replace the intervention and accounting for these in the re-implementation strategy.

Through the lens of change management, it becomes apparent how re-implementation may present significant differences from the initial implementation or rapid learning cycles. For example, transformational changes to processes that have already been implemented can be a considerable challenge, with individuals even more resistant when pressured for time, which is common in healthcare settings [ 14 , 44 ]. This challenge is heightened in the setting of a flawed intervention when re-implementation requires a simultaneous de-implementation of a familiar tool or process. This process of unlearning and relearning creates a tension between prior knowledge and established mental models with the willingness to change [ 45 ]. We encountered these challenges during our recent effort re-implementing a flawed intervention and adapted our strategies using re-implementation as a framework, ultimately contributing to our success (Table 2 ).

In each case reviewed, an evaluation of implementation outcomes triggered re-implementation. There is a benefit to periodically evaluating outcomes during implementation to assess adoption and fidelity and in the sustain phase to detect slippage. There is a decision point following the evaluation: sustainment with incremental changes, re-implement with transformational changes, or de-implement. If the decision is to re-implement, implementation practitioners can first identify the reason for re-implementation, and if it is related to a failure in the implementation process, a flawed intervention, or an unsustained intervention. Recognizing the circumstances for re-implementation provides an area of focus to prevent previous failures from recurring. Reviewing deficits in implementation outcomes can help clarify the circumstances for re-implementation. In the cases we reviewed, there were commonalities in implementation outcomes for each type of re-implementation (Fig.  3 ). The next step is evaluating the contextual determinants, focusing on areas that are more salient depending on the type of re-implementation. Finally, implementation practitioners can use this information to adapt the intervention and implementation strategy to fit the local environment.

The re-implementation process

This is the first attempt to systematically describe and define the concept of re-implementation, although it occurs in practice and is explicitly named in the peer-reviewed literature. This article strives to bridge this gap between implementation practice and science. Failing to recognize re-implementation as a concept or classifying transformational changes and intensive re-implementation efforts as continuous implementation impedes further insights, such as differences in resource allocation, training, or messaging during re-implementation planning. We hope our findings spark further conversation about re-implementation and other related topics, such as resilience after implementation failure; the impact of the magnitude of change on implementation; and the integration of management and organization theory into implementation science.

Limitations

This article has many limitations, the definition and taxonomy may be expanded or refined as re-implementation is further explored as an entity with characteristics and considerations that are unique and distinct from those of initial implementation. We were limited by other areas that have not been clearly defined in implementation science, such as further quantifying the different stages of implementation [ 3 ], and the different levels of change in adaptations made during sustainment. Future studies can review and define these concepts, which may overlap and impact our proposed definition of re-implementation.

Our scoping review was carried out with limited resources. It could have been more rigorous, with a full-text review by multiple reviewers and a search that included more databases. Also, we were limited to the depth and breadth of the descriptions of re-implementation found in the literature. There are varying levels of detail in the case examples, so there may have been other strategies or lessons that were part of the re-implementation that the authors did not describe. In addition, there may have been other articles that we did not find in our search. Although we expanded our search to include terms related to re-implementation, others may have described the phenomenon using different terminology. There is also more to learn about others’ re-implementation efforts that have not been published. These limitations emphasize the importance of defining re-implementation, so it can be accurately described and studied. We limited our review to non-policy-related re-implementation because there are significant differences between policy implementation research and implementation science [ 51 ]. Our focus was exploring the re-implementation of interventions in health-related contexts, which goes beyond the implementation of a policy or mandate and includes its own unique set of considerations. Future work can consider exploring policy re-implementation and parallels with our findings.

Defining re-implementation provides a unifying terminology to a phenomenon that occurs in implementation practice but, until now, has not been clearly conceptualized in the literature. By highlighting its existence, we aim to unpack its critical influence on the re-implementation process. Defining and describing re-implementation offer a path forward for unsuccessful or unsustained implementation efforts and a foundation for others as they embark on their re-implementation efforts.

Availability of data and materials

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Abbreviations

Barcode medication administration

Consolidated Framework for Implementation Research

Dossier Médical Partagé

Expert Recommendations for Implementing Change

Intensive care unit

Plan-Do-Study-Act

InterRAI Resident Assessment Instrument–Minimum Data Set

Singapore General Hospital

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Acknowledgements

The authors acknowledge Johnson and Johnson Medical Devices for funding this work and their commitment to patient safety. We would also like to acknowledge Jill Marsteller for her valuable feedback and insights on this topic and Hiang Khoon Tan, Tze Tein Yong, and Shu Rong Lim for their support and dedication to this work.

This work was part of a larger study on device safety funded by Johnson and Johnson Medical Devices.

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James C. Etheridge & Joaquim M. Havens

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Christina T. Yuan

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RMS and JCE conducted the literature review. RMS organized the cases identified into themes with input from JCE and WB. RMS led the creation of the definition and taxonomy for re-implementation. The figures were created by RMS and YS. RMS drafted the manuscript. All authors (JCE, WB, YS, AK, CTY, JMH, MEB) contributed to the conception and design of this work, provided substantial revisions, and have given final approval of the version submitted for review.

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Supplementary Information

Additional file 1..

Search strategy. Table that includes databases and search terms.

Additional file 2.

Re-implementation Cases Identified in the Literature and their Implementation Strategies. Table that includes cases found in the literature with a brief description and corresponding ERIC strategy.

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Moyal-Smith, R., Etheridge, J.C., Karlage, A. et al. Defining re-implementation. Implement Sci Commun 4 , 60 (2023). https://doi.org/10.1186/s43058-023-00440-4

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Received : 15 December 2022

Accepted : 19 May 2023

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DOI : https://doi.org/10.1186/s43058-023-00440-4

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