a systematic literature review example

Systematic Reviews

• Introduction
• Guidelines and procedures
• Management tools
• Define the question
• Check the topic
• Determine inclusion/exclusion criteria
• Develop a protocol
• Identify keywords
• Databases and search strategies
• Grey literature
• Manage and organise
• Screen & Select
• Locate full text
• Extract data

Example reviews

• Examples of systematic reviews
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For more information about how to conduct and write reviews, please see the Guidelines section of this guide.

• Health & Medicine
• Social sciences
• Vibration and bubbles: a systematic review of the effects of helicopter retrieval on injured divers. (2018).
• Nicotine effects on exercise performance and physiological responses in nicotine‐naïve individuals: a systematic review. (2018).
• Association of total white cell count with mortality and major adverse events in patients with peripheral arterial disease: A systematic review. (2014).
• Do MOOCs contribute to student equity and social inclusion? A systematic review 2014–18. (2020).
• Interventions in Foster Family Care: A Systematic Review. (2020).
• Determinants of happiness among healthcare professionals between 2009 and 2019: a systematic review. (2020).
• Systematic review of the outcomes and trade-offs of ten types of decarbonization policy instruments. (2021).
• A systematic review on Asian's farmers' adaptation practices towards climate change. (2018).
• Are concentrations of pollutants in sharks, rays and skates (Elasmobranchii) a cause for concern? A systematic review. (2020).
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• Systematic Review | Definition, Examples & Guide

Systematic Review | Definition, Examples & Guide

Published on 15 June 2022 by Shaun Turney . Revised on 17 October 2022.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesise all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question ‘What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?’

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

Table of contents

What is a systematic review, systematic review vs meta-analysis, systematic review vs literature review, systematic review vs scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce research bias . The methods are repeatable , and the approach is formal and systematic:

• Formulate a research question
• Develop a protocol
• Search for all relevant studies
• Apply the selection criteria
• Extract the data
• Synthesise the data
• Write and publish a report

Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesising all available evidence and evaluating the quality of the evidence. Synthesising means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

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Systematic reviews often quantitatively synthesise the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesise results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarise and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimise bias by using transparent and repeatable methods.

However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

• A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
• If you’re doing a systematic review on your own (e.g., for a research paper or thesis), you should take appropriate measures to ensure the validity and reliability of your research.
• Access to databases and journal archives. Often, your educational institution provides you with access.
• Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
• Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

• They minimise research b ias by considering all available evidence and evaluating each study for bias.
• Their methods are transparent , so they can be scrutinised by others.
• They’re thorough : they summarise all available evidence.
• They can be replicated and updated by others.

Systematic reviews also have a few cons .

• They’re time-consuming .
• They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

• Allow you to more effectively communicate your research to other researchers and practitioners
• Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

• Population(s) or problem(s)
• Intervention(s)
• Comparison(s)

You can rearrange these four components to write your research question:

• What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fourth component, the type of study design . In this case, the acronym is PICOT .

• Type of study design(s)
• The population of patients with eczema
• The intervention of probiotics
• In comparison to no treatment, placebo , or non-probiotic treatment
• The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
• Randomised control trials, a type of study design

Their research question was:

• What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

• Background information : Provide the context of the research question, including why it’s important.
• Research objective(s) : Rephrase your research question as an objective.
• Selection criteria: State how you’ll decide which studies to include or exclude from your review.
• Search strategy: Discuss your plan for finding studies.
• Analysis: Explain what information you’ll collect from the studies and how you’ll synthesise the data.

If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:

• Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
• Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
• Grey literature: Grey literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of grey literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of grey literature.
• Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

• Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
• Handsearch: Conference proceedings and reference lists of articles
• Grey literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
• Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.

You should apply the selection criteria in two phases:

• Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
• Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarise what you did using a PRISMA flow diagram .

Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

• Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
• Your judgement of the quality of the evidence, including risk of bias .

You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomised into the control and treatment groups.

Step 6: Synthesise the data

Synthesising the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesising the data:

• Narrative ( qualitative ): Summarise the information in words. You’ll need to discuss the studies and assess their overall quality.
• Quantitative : Use statistical methods to summarise and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analysed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

• Abstract : A summary of the review
• Introduction : Including the rationale and objectives
• Methods : Including the selection criteria, search method, data extraction method, and synthesis method
• Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
• Discussion : Including interpretation of the results and limitations of the review
• Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

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

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

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

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

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

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How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses

Affiliations.

• 1 Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling FK9 4LA, United Kingdom; email: [email protected].
• 2 Department of Psychological and Behavioural Science, London School of Economics and Political Science, London WC2A 2AE, United Kingdom.
• 3 Department of Statistics, Northwestern University, Evanston, Illinois 60208, USA; email: [email protected].
• PMID: 30089228
• DOI: 10.1146/annurev-psych-010418-102803

Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.

Keywords: evidence; guide; meta-analysis; meta-synthesis; narrative; systematic review; theory.

• Guidelines as Topic
• Meta-Analysis as Topic*
• Publication Bias
• Review Literature as Topic
• Systematic Reviews as Topic*

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How to write a systematic literature review [9 steps]

What is a systematic literature review?

Where are systematic literature reviews used, what types of systematic literature reviews are there, how to write a systematic literature review, 1. decide on your team, 2. formulate your question, 3. plan your research protocol, 4. search for the literature, 5. screen the literature, 6. assess the quality of the studies, 7. extract the data, 8. analyze the results, 9. interpret and present the results, registering your systematic literature review, frequently asked questions about writing a systematic literature review, related articles.

A systematic literature review is a summary, analysis, and evaluation of all the existing research on a well-formulated and specific question.

Put simply, a systematic review is a study of studies that is popular in medical and healthcare research. In this guide, we will cover:

• the definition of a systematic literature review
• the purpose of a systematic literature review
• the different types of systematic reviews
• how to write a systematic literature review

➡️ Visit our guide to the best research databases for medicine and health to find resources for your systematic review.

Systematic literature reviews can be utilized in various contexts, but they’re often relied on in clinical or healthcare settings.

Medical professionals read systematic literature reviews to stay up-to-date in their field, and granting agencies sometimes need them to make sure there’s justification for further research in an area. They can even be used as the starting point for developing clinical practice guidelines.

A classic systematic literature review can take different approaches:

• Effectiveness reviews assess the extent to which a medical intervention or therapy achieves its intended effect. They’re the most common type of systematic literature review.
• Diagnostic test accuracy reviews produce a summary of diagnostic test performance so that their accuracy can be determined before use by healthcare professionals.
• Experiential (qualitative) reviews analyze human experiences in a cultural or social context. They can be used to assess the effectiveness of an intervention from a person-centric perspective.
• Costs/economics evaluation reviews look at the cost implications of an intervention or procedure, to assess the resources needed to implement it.
• Etiology/risk reviews usually try to determine to what degree a relationship exists between an exposure and a health outcome. This can be used to better inform healthcare planning and resource allocation.
• Psychometric reviews assess the quality of health measurement tools so that the best instrument can be selected for use.
• Prevalence/incidence reviews measure both the proportion of a population who have a disease, and how often the disease occurs.
• Prognostic reviews examine the course of a disease and its potential outcomes.
• Expert opinion/policy reviews are based around expert narrative or policy. They’re often used to complement, or in the absence of, quantitative data.
• Methodology systematic reviews can be carried out to analyze any methodological issues in the design, conduct, or review of research studies.

Writing a systematic literature review can feel like an overwhelming undertaking. After all, they can often take 6 to 18 months to complete. Below we’ve prepared a step-by-step guide on how to write a systematic literature review.

• Decide on your team.
• Formulate your question.
• Plan your research protocol.
• Search for the literature.
• Screen the literature.
• Assess the quality of the studies.
• Extract the data.
• Analyze the results.
• Interpret and present the results.

When carrying out a systematic literature review, you should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

You may also need to team up with a librarian to help with the search, literature screeners, a statistician to analyze the data, and the relevant subject experts.

Define your answerable question. Then ask yourself, “has someone written a systematic literature review on my question already?” If so, yours may not be needed. A librarian can help you answer this.

You should formulate a “well-built clinical question.” This is the process of generating a good search question. To do this, run through PICO:

• Patient or Population or Problem/Disease : who or what is the question about? Are there factors about them (e.g. age, race) that could be relevant to the question you’re trying to answer?
• Intervention : which main intervention or treatment are you considering for assessment?
• Comparison(s) or Control : is there an alternative intervention or treatment you’re considering? Your systematic literature review doesn’t have to contain a comparison, but you’ll want to stipulate at this stage, either way.
• Outcome(s) : what are you trying to measure or achieve? What’s the wider goal for the work you’ll be doing?

Now you need a detailed strategy for how you’re going to search for and evaluate the studies relating to your question.

The protocol for your systematic literature review should include:

• the objectives of your project
• the specific methods and processes that you’ll use
• the eligibility criteria of the individual studies
• how you plan to extract data from individual studies
• which analyses you’re going to carry out

For a full guide on how to systematically develop your protocol, take a look at the PRISMA checklist . PRISMA has been designed primarily to improve the reporting of systematic literature reviews and meta-analyses.

When writing a systematic literature review, your goal is to find all of the relevant studies relating to your question, so you need to search thoroughly .

This is where your librarian will come in handy again. They should be able to help you formulate a detailed search strategy, and point you to all of the best databases for your topic.

➡️ Read more on on how to efficiently search research databases .

The places to consider in your search are electronic scientific databases (the most popular are PubMed , MEDLINE , and Embase ), controlled clinical trial registers, non-English literature, raw data from published trials, references listed in primary sources, and unpublished sources known to experts in the field.

➡️ Take a look at our list of the top academic research databases .

Tip: Don’t miss out on “gray literature.” You’ll improve the reliability of your findings by including it.

Don’t miss out on “gray literature” sources: those sources outside of the usual academic publishing environment. They include:

• non-peer-reviewed journals
• pharmaceutical industry files
• conference proceedings
• pharmaceutical company websites
• internal reports

Gray literature sources are more likely to contain negative conclusions, so you’ll improve the reliability of your findings by including it. You should document details such as:

• The databases you search and which years they cover
• The dates you first run the searches, and when they’re updated
• Which strategies you use, including search terms
• The numbers of results obtained

➡️ Read more about gray literature .

This should be performed by your two reviewers, using the criteria documented in your research protocol. The screening is done in two phases:

• Pre-screening of all titles and abstracts, and selecting those appropriate
• Screening of the full-text articles of the selected studies

Make sure reviewers keep a log of which studies they exclude, with reasons why.

➡️ Visit our guide on what is an abstract?

Your reviewers should evaluate the methodological quality of your chosen full-text articles. Make an assessment checklist that closely aligns with your research protocol, including a consistent scoring system, calculations of the quality of each study, and sensitivity analysis.

The kinds of questions you'll come up with are:

• Were the participants really randomly allocated to their groups?
• Were the groups similar in terms of prognostic factors?
• Could the conclusions of the study have been influenced by bias?

Every step of the data extraction must be documented for transparency and replicability. Create a data extraction form and set your reviewers to work extracting data from the qualified studies.

Here’s a free detailed template for recording data extraction, from Dalhousie University. It should be adapted to your specific question.

Establish a standard measure of outcome which can be applied to each study on the basis of its effect size.

Measures of outcome for studies with:

• Binary outcomes (e.g. cured/not cured) are odds ratio and risk ratio
• Continuous outcomes (e.g. blood pressure) are means, difference in means, and standardized difference in means
• Survival or time-to-event data are hazard ratios

Design a table and populate it with your data results. Draw this out into a forest plot , which provides a simple visual representation of variation between the studies.

Then analyze the data for issues. These can include heterogeneity, which is when studies’ lines within the forest plot don’t overlap with any other studies. Again, record any excluded studies here for reference.

Consider different factors when interpreting your results. These include limitations, strength of evidence, biases, applicability, economic effects, and implications for future practice or research.

Apply appropriate grading of your evidence and consider the strength of your recommendations.

It’s best to formulate a detailed plan for how you’ll present your systematic review results. Take a look at these guidelines for interpreting results from the Cochrane Institute.

Before writing your systematic literature review, you can register it with OSF for additional guidance along the way. You could also register your completed work with PROSPERO .

Systematic literature reviews are often found in clinical or healthcare settings. Medical professionals read systematic literature reviews to stay up-to-date in their field and granting agencies sometimes need them to make sure there’s justification for further research in an area.

The first stage in carrying out a systematic literature review is to put together your team. You should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

Your systematic review should include the following details:

A literature review simply provides a summary of the literature available on a topic. A systematic review, on the other hand, is more than just a summary. It also includes an analysis and evaluation of existing research. Put simply, it's a study of studies.

The final stage of conducting a systematic literature review is interpreting and presenting the results. It’s best to formulate a detailed plan for how you’ll present your systematic review results, guidelines can be found for example from the Cochrane institute .

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Writing a Systematic Literature Review

Investigating concepts associated with psychology requires an indefinite amount of reading. Hence, good literature reviews are an inevitably needed part of providing the modern scientists with a broad spectrum of knowledge. In order to help, this blog post will introduce you to the basics of literature reviews and explain a specific methodological approach towards writing one, known as the systematic literature review.

Literature review is a term associated with the process of collecting, checking and (re)analysing data from the existing literature with a particular search question in mind. The latter could be for example:

• What are the effects of yoga associated with individual’s subjective well-being?
• Does brief psychotherapy produce beneficial outcomes for individuals diagnosed with agoraphobia?
• What personality traits are most commonly associated with homelessness in the modern literature?

A literature review (a) defines a specific issue, concept, theory, phenomena; (b) compiles published literature on a topic; (c) summarises critical points of current knowledge about the problem and (d) suggests next steps in addressing it.

Literature reviews can be based on all sorts of information found in scientific journals, books, academic dissertations, electronic bibliographic databases and the rest of the Internet.  Electronic databases such as PsycINFO , PubMed , Web of Science could be a good starting point. Some of them, like EBSCOhost , ScienceDirect , SciELO , and ProQuest , provide full-text information, while others provide the users mostly with the abstracts of the material. Besides scientific literature, literature reviews often include the so called gray literature . This refers to the material that is either unpublished or published in non-commercial form (e.g., theses, dissertations, government reports, fact sheets, pre-prints of articles). Excluding it completely from a literature review is inappropriate because the search should be always as complete as possible in order to reduce the risk of publication bias. However, when reviewing the material on for example Google Scholar , Science.gov , Social Science Research Network , or PsycEXTRA it should be kept in mind that such search engines also display the material without peer-review and have therefore less credibility regarding the information they are disclosing.

When performing literature reviews, the use of appropriately selected terminology is essential, since it allows the researchers much clearer communication. In psychology, without some commonly agreed lists of terms, we would all get lost in the variety of concepts and vocabularies that could be applied. A typical recommendation for where to look for such index terms would be ‘ Thesaurus of Psychological Index Terms (2007) ’, which includes nearly 9,000 most commonly cross-referenced terms in psychology. In addition, electronic databases mentioned before sometimes prompt the use of the so-called Boolean operators , simple words such as AND, OR, NOT, or AND NOT. These are used for combining and/or excluding specific terms in your search and sometimes allow to obtain more focused and productive results in the search. Other tools to make search strategy more comprehensive and focused are also truncations – a tool for searching terminologies that have same initial roots (e.g., anxiety and anxious) and wildcards for words with spelling deviations (e.g., man and men). It is worth noting that the databases slightly differ in how they label the index terms and utilize specific search tools in their systems.

Among authors, there is not much coherence about different types of literature reviews but in general, most recognize at least two: traditional and systematic. The main difference between them is situated in the process of collecting and selecting data and the material for the review. Systematic literature review, as the name implies, is the more structured of the two and is thought to be more credible. On the other hand, traditional is thought to heavily depend on the researcher’s decisions regarding the data selection and, consequently, evaluation and results. Systematic protocol of the systematic literature review can be therefore understood as an optional solution for controlling the incomplete and possibly biased reports of traditional reviews.

THE SYSTEMATIC LITERATURE REVIEW

The systematic literature review is a method/process/protocol in which a body of literature is aggregated, reviewed and assessed while utilizing pre-specified and standardized techniques. In other words, to reduce bias, the rationale, the hypothesis, and the methods of data collection are prepared before the review and are used as a guide for performing the process. Just like it is for the traditional literature reviews, the goal is to identify, critically appraise, and summarize the existing evidence concerning a clearly defined problem.

Systematic literature reviews allow us to examine conflicting and/or coincident findings, as well as to identify themes that require further investigation. Furthermore, they include the possibility of evaluating consistency and generalization of the evidence regarding specific scientific questions and are, therefore, also of great practical value within the psychological field. The method is particularly useful to integrate the information of a group of studies investigating the same phenomena and it typically focuses on a very specific empirical question, such as ‘Does the Rational Emotive Therapy intervention benefit the well-being of the patients diagnosed with depression?’.

Systematic literature reviews include all (or most) of the following characteristics:

• Objectives clearly defined a priori;
• Explicit pre-defined criteria for inclusion/exclusion of the literature;
• Predetermined search strategy in the collection of the information and systematic following of the process;
• Predefined characteristic criteria applied to all the sources utilized and clearly presented in the review;
• Systematic evaluation of the quality of the studies included in the review;
• Identification of the excluded sources of literature and justification for excluding them;
• Analysis/synthesis of the information (i.e., comparison of the results, qualitative synthesis of the results, meta-analysis);
• References to the incoherences and the errors found in the selected material.

The process of performing a systematic literature review consists of several stages and can be reported in a form of an original research article with the same name (i.e., systematic literature review):

1: Start by clearly defining the objective of the review or form a structured research question.

Place in the research article: Title, Abstract, Introduction.

Example of the objective: The objective of this literature revision is to systematically review and analyse the current research on the effects of music on the anxiety levels of children in hospital settings.

Example of a structured research question: What are the most important factors associated with the development of PTSD in soldiers?

Tip: In the title, identify that the report is a systematic literature review.

2: Clearly specify the methodology of the review and define eligibility criteria (i.e., study selection criteria that the published material must meet in order to be included or excluded from the study). The search should be extensive.

Place in the research article: Methods.

Examples of inclusion criteria: Publication was an academic and peer-reviewed study. Publication was a study that examined the effects of regular physical exercise intervention on depression and included a control group.

Examples of exclusion criteria: Publication was involving male adults. Studies that also examined non-physical activities as interventions. Studies that were only published in a language other than English.

Tips: The eligibility criteria sometimes fit to be presented in tables.

3: Retrieve eligible literature and thoroughly report your search strategy throughout the process. (Ideally, the selection process is performed by at least two independent investigators.)

Example: The EBSCOhost and PsychInfo electronic databases from 2010 to 2017 were searched. These were chosen because of the psychological focus that encompasses psychosocial effects of emotional abuse in childhood. Search terms were ‘emotional abuse’, ‘childhood’, ‘psychosocial effects’, and ‘psychosocial consequences’.  The EBSCOhost produced 200 results from the search criteria, while PsychInfo produced 467, for a total of 667 articles. […] Articles were rejected if it was determined from the title and the abstract that the study failed to meet the inclusion criteria. Any ambiguities regarding the application of the selection criteria were resolved through discussions between all the researchers involved.

Tip: Sometimes it is nice to represent the selection process in a graphical representation; in the form of a decision tree or a flow diagram (check PRISMA ).

4: Assess the methodological quality of the selected literature whenever possible and exclude the articles with low methodological quality. Keep in mind that the quality of the systematic review depends on the validity and the quality of the studies included in the review.

Examples of the instruments available for evaluating the quality of the studies: PEDro, Jadad scale, the lists of Delphi, OTseeker, Maastricht criteria.

Tip: Present the excluded articles as a part of the selection process mentioned in step 3.

5: Proceed with the so-called characterization of the studies. Decide which data to look for in all the selected studies and present it in a summarized way. If the information is missing in some specific paper, always register it in your reports. (Ideally, the characterization of the studies is performed by at least two independent investigators.)

Place in the research article: Results.

Examples of the information that should and/or could be collected for characterization of the literature: authors, year, sample size, study design, aims and objectives, findings/results, limitations.

Tip: Sometimes results can be presented nicely in a form of a table depicting the main characteristics.

6: Write a synthesis of the results – integrate the results of different studies and  interpret them in a narrative form.

Place in the research article: Interpretation, Conclusions.

Patterns discovered as results should be summarized in a qualitative, narrative form. Modulate one (or more) general arguments for organizing the review. Some trick to help you do this is to choose two or three main information sources (e.g., articles, books, other literature reviews) to explain the results of other studies through a similar way of organization. Connect the information reported by different sources and do not just summarize the results. Find patterns in the results of different studies, identify them, address the theoretical and/or methodological conflicts and try to interpret them. Summarize the principal conclusions and evaluate the current state on the subject by pointing out possible further directions.

CONCLUSIONS

The results emerging from the data that were included in such retrospective studies can lead to a certain level of credibility regarding their conclusions. Actually, systematic literature reviews are thought to be one of our best methods to summarize and synthesize evidence about some specific research question and are often used as the main ‘practice making guidelines’ in many health care disciplines. Therefore, it is no wonder why systematic reviews are gaining popularity among researchers and why journals are moving in this direction as well. This also shows in the development of more and more specific guidelines and checklists for writing systematic literature reviews (see for example PRISMA or Cochrane Handbook for Systematic Reviews of Interventions ). To find examples of systematic literature review articles you can check Cochrane Database of Systematic Reviews , BioMed Central’s Systematic Reviews Journal , and PROSPERO . If you are aware of the concept of ‘registered reports’, it is worth mentioning that submitting with PROSPERO provides you with the option of publishing the latter as well. I suggest that you go through the list of useful resources provided below and hopefully, you can get enough information about anything related that remained unanswered. Now, I encourage you to try to be a little more to be systematic whenever researching some topic, to try to write a systematic literature review yourself and to maybe even consider submitting it to JEPS .

USEFUL RESOURCES

• Cochrane Database of Systematic Reviews : http://www.cochranelibrary.com/cochrane-database-of-systematic-reviews/

EBSCOhost : https://search.ebscohost.com/

Google Scholar : https://scholar.google.com/

PRISMA : http://www.prisma-statement.org/

PROSPERO : https://www.crd.york.ac.uk/prospero/

ProQuest : http://www.proquest.com/

PsycEXTRA : http://www.apa.org/pubs/databases/psycextra/index.aspx :

PsycINFO : http://www.apa.org/pubs/databases/psycinfo/index.aspx

PubMed : https://www.ncbi.nlm.nih.gov/pubmed/

SciELO : http://www.scielo.org/php/index.php?lang=en

Science.gov : https://www.science.gov/

ScienceDirect : http://www.sciencedirect.com/

Scorpus : http://www.scopus.com/freelookup/form/author.uri

Social Science Research Network : https://www.ssrn.com/en/

Systematic Reviews Journal (BIOMED) : https://systematicreviewsjournal.biomedcentral.com/

Web of Science : https://webofknowledge.com/

Other sources

• Sampaio, R. F., & Mancini, M. C. (2007). Systematic review studies: A guide for a careful synthesis of scientific evidence. Brasilian Journal of Physical Therapy, 11 (1), 77-82. doi:http://dx.doi.org/10.1590/S1413-35552
• Tuleya, L. G. (2007). Thesaurus of psychological index terms . Washington, DC: American Psychological Association.

Eva Štrukelj

Eva Štrukelj is currently studying Clinical and Health Psychology at the University of Algarve in Portugal. Her main areas of interest are social psychology and health psychology. Regarding research, she is particularly curious about stigma and with it related topics.

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Data visualisation in scoping reviews and evidence maps on health topics: a cross-sectional analysis

• Emily South   ORCID: orcid.org/0000-0003-2187-4762 1 &
• Mark Rodgers 1  

Systematic Reviews volume  12 , Article number:  142 ( 2023 ) Cite this article

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Scoping reviews and evidence maps are forms of evidence synthesis that aim to map the available literature on a topic and are well-suited to visual presentation of results. A range of data visualisation methods and interactive data visualisation tools exist that may make scoping reviews more useful to knowledge users. The aim of this study was to explore the use of data visualisation in a sample of recent scoping reviews and evidence maps on health topics, with a particular focus on interactive data visualisation.

Ovid MEDLINE ALL was searched for recent scoping reviews and evidence maps (June 2020-May 2021), and a sample of 300 papers that met basic selection criteria was taken. Data were extracted on the aim of each review and the use of data visualisation, including types of data visualisation used, variables presented and the use of interactivity. Descriptive data analysis was undertaken of the 238 reviews that aimed to map evidence.

Of the 238 scoping reviews or evidence maps in our analysis, around one-third (37.8%) included some form of data visualisation. Thirty-five different types of data visualisation were used across this sample, although most data visualisations identified were simple bar charts (standard, stacked or multi-set), pie charts or cross-tabulations (60.8%). Most data visualisations presented a single variable (64.4%) or two variables (26.1%). Almost a third of the reviews that used data visualisation did not use any colour (28.9%). Only two reviews presented interactive data visualisation, and few reported the software used to create visualisations.

Conclusions

Data visualisation is currently underused by scoping review authors. In particular, there is potential for much greater use of more innovative forms of data visualisation and interactive data visualisation. Where more innovative data visualisation is used, scoping reviews have made use of a wide range of different methods. Increased use of these more engaging visualisations may make scoping reviews more useful for a range of stakeholders.

Peer Review reports

Scoping reviews are “a type of evidence synthesis that aims to systematically identify and map the breadth of evidence available on a particular topic, field, concept, or issue” ([ 1 ], p. 950). While they include some of the same steps as a systematic review, such as systematic searches and the use of predetermined eligibility criteria, scoping reviews often address broader research questions and do not typically involve the quality appraisal of studies or synthesis of data [ 2 ]. Reasons for conducting a scoping review include the following: to map types of evidence available, to explore research design and conduct, to clarify concepts or definitions and to map characteristics or factors related to a concept [ 3 ]. Scoping reviews can also be undertaken to inform a future systematic review (e.g. to assure authors there will be adequate studies) or to identify knowledge gaps [ 3 ]. Other evidence synthesis approaches with similar aims have been described as evidence maps, mapping reviews or systematic maps [ 4 ]. While this terminology is used inconsistently, evidence maps can be used to identify evidence gaps and present them in a user-friendly (and often visual) way [ 5 ].

Scoping reviews are often targeted to an audience of healthcare professionals or policy-makers [ 6 ], suggesting that it is important to present results in a user-friendly and informative way. Until recently, there was little guidance on how to present the findings of scoping reviews. In recent literature, there has been some discussion of the importance of clearly presenting data for the intended audience of a scoping review, with creative and innovative use of visual methods if appropriate [ 7 , 8 , 9 ]. Lockwood et al. suggest that innovative visual presentation should be considered over dense sections of text or long tables in many cases [ 8 ]. Khalil et al. suggest that inspiration could be drawn from the field of data visualisation [ 7 ]. JBI guidance on scoping reviews recommends that reviewers carefully consider the best format for presenting data at the protocol development stage and provides a number of examples of possible methods [ 10 ].

Interactive resources are another option for presentation in scoping reviews [ 9 ]. Researchers without the relevant programming skills can now use several online platforms (such as Tableau [ 11 ] and Flourish [ 12 ]) to create interactive data visualisations. The benefits of using interactive visualisation in research include the ability to easily present more than two variables [ 13 ] and increased engagement of users [ 14 ]. Unlike static graphs, interactive visualisations can allow users to view hierarchical data at different levels, exploring both the “big picture” and looking in more detail ([ 15 ], p. 291). Interactive visualizations are often targeted at practitioners and decision-makers [ 13 ], and there is some evidence from qualitative research that they are valued by policy-makers [ 16 , 17 , 18 ].

Given their focus on mapping evidence, we believe that scoping reviews are particularly well-suited to visually presenting data and the use of interactive data visualisation tools. However, it is unknown how many recent scoping reviews visually map data or which types of data visualisation are used. The aim of this study was to explore the use of data visualisation methods in a large sample of recent scoping reviews and evidence maps on health topics. In particular, we were interested in the extent to which these forms of synthesis use any form of interactive data visualisation.

This study was a cross-sectional analysis of studies labelled as scoping reviews or evidence maps (or synonyms of these terms) in the title or abstract.

The search strategy was developed with help from an information specialist. Ovid MEDLINE® ALL was searched in June 2021 for studies added to the database in the previous 12 months. The search was limited to English language studies only.

The search strategy was as follows:

Ovid MEDLINE(R) ALL

(scoping review or evidence map or systematic map or mapping review or scoping study or scoping project or scoping exercise or literature mapping or evidence mapping or systematic mapping or literature scoping or evidence gap map).ab,ti.

limit 1 to english language

(202006* or 202007* or 202008* or 202009* or 202010* or 202011* or 202012* or 202101* or 202102* or 202103* or 202104* or 202105*).dt.

The search returned 3686 records. Records were de-duplicated in EndNote 20 software, leaving 3627 unique records.

A sample of these reviews was taken by screening the search results against basic selection criteria (Table 1 ). These criteria were piloted and refined after discussion between the two researchers. A single researcher (E.S.) screened the records in EPPI-Reviewer Web software using the machine-learning priority screening function. Where a second opinion was needed, decisions were checked by a second researcher (M.R.).

Our initial plan for sampling, informed by pilot searching, was to screen and data extract records in batches of 50 included reviews at a time. We planned to stop screening when a batch of 50 reviews had been extracted that included no new types of data visualisation or after screening time had reached 2 days. However, once data extraction was underway, we found the sample to be richer in terms of data visualisation than anticipated. After the inclusion of 300 reviews, we took the decision to end screening in order to ensure the study was manageable.

Data extraction

A data extraction form was developed in EPPI-Reviewer Web, piloted on 50 reviews and refined. Data were extracted by one researcher (E. S. or M. R.), with a second researcher (M. R. or E. S.) providing a second opinion when needed. The data items extracted were as follows: type of review (term used by authors), aim of review (mapping evidence vs. answering specific question vs. borderline), number of visualisations (if any), types of data visualisation used, variables/domains presented by each visualisation type, interactivity, use of colour and any software requirements.

When categorising review aims, we considered “mapping evidence” to incorporate all of the six purposes for conducting a scoping review proposed by Munn et al. [ 3 ]. Reviews were categorised as “answering a specific question” if they aimed to synthesise study findings to answer a particular question, for example on effectiveness of an intervention. We were inclusive with our definition of “mapping evidence” and included reviews with mixed aims in this category. However, some reviews were difficult to categorise (for example where aims were unclear or the stated aims did not match the actual focus of the paper) and were considered to be “borderline”. It became clear that a proportion of identified records that described themselves as “scoping” or “mapping” reviews were in fact pseudo-systematic reviews that failed to undertake key systematic review processes. Such reviews attempted to integrate the findings of included studies rather than map the evidence, and so reviews categorised as “answering a specific question” were excluded from the main analysis. Data visualisation methods for meta-analyses have been explored previously [ 19 ]. Figure  1 shows the flow of records from search results to final analysis sample.

Flow diagram of the sampling process

Data visualisation was defined as any graph or diagram that presented results data, including tables with a visual mapping element, such as cross-tabulations and heat maps. However, tables which displayed data at a study level (e.g. tables summarising key characteristics of each included study) were not included, even if they used symbols, shading or colour. Flow diagrams showing the study selection process were also excluded. Data visualisations in appendices or supplementary information were included, as well as any in publicly available dissemination products (e.g. visualisations hosted online) if mentioned in papers.

The typology used to categorise data visualisation methods was based on an existing online catalogue [ 20 ]. Specific types of data visualisation were categorised in five broad categories: graphs, diagrams, tables, maps/geographical and other. If a data visualisation appeared in our sample that did not feature in the original catalogue, we checked a second online catalogue [ 21 ] for an appropriate term, followed by wider Internet searches. These additional visualisation methods were added to the appropriate section of the typology. The final typology can be found in Additional file 1 .

We conducted descriptive data analysis in Microsoft Excel 2019 and present frequencies and percentages. Where appropriate, data are presented using graphs or other data visualisations created using Flourish. We also link to interactive versions of some of these visualisations.

Almost all of the 300 reviews in the total sample were labelled by review authors as “scoping reviews” ( n  = 293, 97.7%). There were also four “mapping reviews”, one “scoping study”, one “evidence mapping” and one that was described as a “scoping review and evidence map”. Included reviews were all published in 2020 or 2021, with the exception of one review published in 2018. Just over one-third of these reviews ( n  = 105, 35.0%) included some form of data visualisation. However, we excluded 62 reviews that did not focus on mapping evidence from the following analysis (see “ Methods ” section). Of the 238 remaining reviews (that either clearly aimed to map evidence or were judged to be “borderline”), 90 reviews (37.8%) included at least one data visualisation. The references for these reviews can be found in Additional file 2 .

Number of visualisations

Thirty-six (40.0%) of these 90 reviews included just one example of data visualisation (Fig.  2 ). Less than a third ( n  = 28, 31.1%) included three or more visualisations. The greatest number of data visualisations in one review was 17 (all bar or pie charts). In total, 222 individual data visualisations were identified across the sample of 238 reviews.

Number of data visualisations per review

Categories of data visualisation

Graphs were the most frequently used category of data visualisation in the sample. Over half of the reviews with data visualisation included at least one graph ( n  = 59, 65.6%). The least frequently used category was maps, with 15.6% ( n  = 14) of these reviews including a map.

Of the total number of 222 individual data visualisations, 102 were graphs (45.9%), 34 were tables (15.3%), 23 were diagrams (10.4%), 15 were maps (6.8%) and 48 were classified as “other” in the typology (21.6%).

Types of data visualisation

All of the types of data visualisation identified in our sample are reported in Table 2 . In total, 35 different types were used across the sample of reviews.

The most frequently used data visualisation type was a bar chart. Of 222 total data visualisations, 78 (35.1%) were a variation on a bar chart (either standard bar chart, stacked bar chart or multi-set bar chart). There were also 33 pie charts (14.9% of data visualisations) and 24 cross-tabulations (10.8% of data visualisations). In total, these five types of data visualisation accounted for 60.8% ( n  = 135) of all data visualisations. Figure  3 shows the frequency of each data visualisation category and type; an interactive online version of this treemap is also available ( https://public.flourish.studio/visualisation/9396133/ ). Figure  4 shows how users can further explore the data using the interactive treemap.

Data visualisation categories and types. An interactive version of this treemap is available online: https://public.flourish.studio/visualisation/9396133/ . Through the interactive version, users can further explore the data (see Fig.  4 ). The unit of this treemap is the individual data visualisation, so multiple data visualisations within the same scoping review are represented in this map. Created with flourish.studio ( https://flourish.studio )

Screenshots showing how users of the interactive treemap can explore the data further. Users can explore each level of the hierarchical treemap ( A Visualisation category >  B Visualisation subcategory >  C Variables presented in visualisation >  D Individual references reporting this category/subcategory/variable permutation). Created with flourish.studio ( https://flourish.studio )

Data presented

Around two-thirds of data visualisations in the sample presented a single variable ( n  = 143, 64.4%). The most frequently presented single variables were themes ( n  = 22, 9.9% of data visualisations), population ( n  = 21, 9.5%), country or region ( n  = 21, 9.5%) and year ( n  = 20, 9.0%). There were 58 visualisations (26.1%) that presented two different variables. The remaining 21 data visualisations (9.5%) presented three or more variables. Figure  5 shows the variables presented by each different type of data visualisation (an interactive version of this figure is available online).

Variables presented by each data visualisation type. Darker cells indicate a larger number of reviews. An interactive version of this heat map is available online: https://public.flourish.studio/visualisation/10632665/ . Users can hover over each cell to see the number of data visualisations for that combination of data visualisation type and variable. The unit of this heat map is the individual data visualisation, so multiple data visualisations within a single scoping review are represented in this map. Created with flourish.studio ( https://flourish.studio )

Most reviews presented at least one data visualisation in colour ( n  = 64, 71.1%). However, almost a third ( n  = 26, 28.9%) used only black and white or greyscale.

Interactivity

Only two of the reviews included data visualisations with any level of interactivity. One scoping review on music and serious mental illness [ 22 ] linked to an interactive bubble chart hosted online on Tableau. Functionality included the ability to filter the studies displayed by various attributes.

The other review was an example of evidence mapping from the environmental health field [ 23 ]. All four of the data visualisations included in the paper were available in an interactive format hosted either by the review management software or on Tableau. The interactive versions linked to the relevant references so users could directly explore the evidence base. This was the only review that provided this feature.

Software requirements

Nine reviews clearly reported the software used to create data visualisations. Three reviews used Tableau (one of them also used review management software as discussed above) [ 22 , 23 , 24 ]. Two reviews generated maps using ArcGIS [ 25 ] or ArcMap [ 26 ]. One review used Leximancer for a lexical analysis [ 27 ]. One review undertook a bibliometric analysis using VOSviewer [ 28 ], and another explored citation patterns using CitNetExplorer [ 29 ]. Other reviews used Excel [ 30 ] or R [ 26 ].

To our knowledge, this is the first systematic and in-depth exploration of the use of data visualisation techniques in scoping reviews. Our findings suggest that the majority of scoping reviews do not use any data visualisation at all, and, in particular, more innovative examples of data visualisation are rare. Around 60% of data visualisations in our sample were simple bar charts, pie charts or cross-tabulations. There appears to be very limited use of interactive online visualisation, despite the potential this has for communicating results to a range of stakeholders. While it is not always appropriate to use data visualisation (or a simple bar chart may be the most user-friendly way of presenting the data), these findings suggest that data visualisation is being underused in scoping reviews. In a large minority of reviews, visualisations were not published in colour, potentially limiting how user-friendly and attractive papers are to decision-makers and other stakeholders. Also, very few reviews clearly reported the software used to create data visualisations. However, 35 different types of data visualisation were used across the sample, highlighting the wide range of methods that are potentially available to scoping review authors.

Our results build on the limited research that has previously been undertaken in this area. Two previous publications also found limited use of graphs in scoping reviews. Results were “mapped graphically” in 29% of scoping reviews in any field in one 2014 publication [ 31 ] and 17% of healthcare scoping reviews in a 2016 article [ 6 ]. Our results suggest that the use of data visualisation has increased somewhat since these reviews were conducted. Scoping review methods have also evolved in the last 10 years; formal guidance on scoping review conduct was published in 2014 [ 32 ], and an extension of the PRISMA checklist for scoping reviews was published in 2018 [ 33 ]. It is possible that an overall increase in use of data visualisation reflects increased quality of published scoping reviews. There is also some literature supporting our findings on the wide range of data visualisation methods that are used in evidence synthesis. An investigation of methods to identify, prioritise or display health research gaps (25/139 included studies were scoping reviews; 6/139 were evidence maps) identified 14 different methods used to display gaps or priorities, with half being “more advanced” (e.g. treemaps, radial bar plots) ([ 34 ], p. 107). A review of data visualisation methods used in papers reporting meta-analyses found over 200 different ways of displaying data [ 19 ].

Only two reviews in our sample used interactive data visualisation, and one of these was an example of systematic evidence mapping from the environmental health field rather than a scoping review (in environmental health, systematic evidence mapping explicitly involves producing a searchable database [ 35 ]). A scoping review of papers on the use of interactive data visualisation in population health or health services research found a range of examples but still limited use overall [ 13 ]. For example, the authors noted the currently underdeveloped potential for using interactive visualisation in research on health inequalities. It is possible that the use of interactive data visualisation in academic papers is restricted by academic publishing requirements; for example, it is currently difficult to incorporate an interactive figure into a journal article without linking to an external host or platform. However, we believe that there is a lot of potential to add value to future scoping reviews by using interactive data visualisation software. Few reviews in our sample presented three or more variables in a single visualisation, something which can easily be achieved using interactive data visualisation tools. We have previously used EPPI-Mapper [ 36 ] to present results of a scoping review of systematic reviews on behaviour change in disadvantaged groups, with links to the maps provided in the paper [ 37 ]. These interactive maps allowed policy-makers to explore the evidence on different behaviours and disadvantaged groups and access full publications of the included studies directly from the map.

We acknowledge there are barriers to use for some of the data visualisation software available. EPPI-Mapper and some of the software used by reviews in our sample incur a cost. Some software requires a certain level of knowledge and skill in its use. However numerous online free data visualisation tools and resources exist. We have used Flourish to present data for this review, a basic version of which is currently freely available and easy to use. Previous health research has been found to have used a range of different interactive data visualisation software, much of which does not required advanced knowledge or skills to use [ 13 ].

There are likely to be other barriers to the use of data visualisation in scoping reviews. Journal guidelines and policies may present barriers for using innovative data visualisation. For example, some journals charge a fee for publication of figures in colour. As previously mentioned, there are limited options for incorporating interactive data visualisation into journal articles. Authors may also be unaware of the data visualisation methods and tools that are available. Producing data visualisations can be time-consuming, particularly if authors lack experience and skills in this. It is possible that many authors prioritise speed of publication over spending time producing innovative data visualisations, particularly in a context where there is pressure to achieve publications.

Limitations

A limitation of this study was that we did not assess how appropriate the use of data visualisation was in our sample as this would have been highly subjective. Simple descriptive or tabular presentation of results may be the most appropriate approach for some scoping review objectives [ 7 , 8 , 10 ], and the scoping review literature cautions against “over-using” different visual presentation methods [ 7 , 8 ]. It cannot be assumed that all of the reviews that did not include data visualisation should have done so. Likewise, we do not know how many reviews used methods of data visualisation that were not well suited to their data.

We initially relied on authors’ own use of the term “scoping review” (or equivalent) to sample reviews but identified a relatively large number of papers labelled as scoping reviews that did not meet the basic definition, despite the availability of guidance and reporting guidelines [ 10 , 33 ]. It has previously been noted that scoping reviews may be undertaken inappropriately because they are seen as “easier” to conduct than a systematic review ([ 3 ], p.6), and that reviews are often labelled as “scoping reviews” while not appearing to follow any established framework or guidance [ 2 ]. We therefore took the decision to remove these reviews from our main analysis. However, decisions on how to classify review aims were subjective, and we did include some reviews that were of borderline relevance.

A further limitation is that this was a sample of published reviews, rather than a comprehensive systematic scoping review as have previously been undertaken [ 6 , 31 ]. The number of scoping reviews that are published has increased rapidly, and this would now be difficult to undertake. As this was a sample, not all relevant scoping reviews or evidence maps that would have met our criteria were included. We used machine learning to screen our search results for pragmatic reasons (to reduce screening time), but we do not see any reason that our sample would not be broadly reflective of the wider literature.

Data visualisation, and in particular more innovative examples of it, is currently underused in published scoping reviews on health topics. The examples that we have found highlight the wide range of methods that scoping review authors could draw upon to present their data in an engaging way. In particular, we believe that interactive data visualisation has significant potential for mapping the available literature on a topic. Appropriate use of data visualisation may increase the usefulness, and thus uptake, of scoping reviews as a way of identifying existing evidence or research gaps by decision-makers, researchers and commissioners of research. We recommend that scoping review authors explore the extensive free resources and online tools available for data visualisation. However, we also think that it would be useful for publishers to explore allowing easier integration of interactive tools into academic publishing, given the fact that papers are now predominantly accessed online. Future research may be helpful to explore which methods are particularly useful to scoping review users.

Availability of data and materials

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

Abbreviations

Organisation formerly known as Joanna Briggs Institute

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Munn Z, Pollock D, Khalil H, Alexander L, McLnerney P, Godfrey CM, Peters M, Tricco AC. What are scoping reviews? Providing a formal definition of scoping reviews as a type of evidence synthesis. JBI Evid Synth. 2022;20:950–952.

Peters MDJ, Marnie C, Colquhoun H, Garritty CM, Hempel S, Horsley T, Langlois EV, Lillie E, O’Brien KK, Tunçalp Ӧ, et al. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev. 2021;10:263.

Article   PubMed   PubMed Central   Google Scholar  

Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18:143.

Sutton A, Clowes M, Preston L, Booth A. Meeting the review family: exploring review types and associated information retrieval requirements. Health Info Libr J. 2019;36:202–22.

Article   PubMed   Google Scholar  

Miake-Lye IM, Hempel S, Shanman R, Shekelle PG. What is an evidence map? A systematic review of published evidence maps and their definitions, methods, and products. Syst Rev. 2016;5:28.

Tricco AC, Lillie E, Zarin W, O’Brien K, Colquhoun H, Kastner M, Levac D, Ng C, Sharpe JP, Wilson K, et al. A scoping review on the conduct and reporting of scoping reviews. BMC Med Res Methodol. 2016;16:15.

Khalil H, Peters MDJ, Tricco AC, Pollock D, Alexander L, McInerney P, Godfrey CM, Munn Z. Conducting high quality scoping reviews-challenges and solutions. J Clin Epidemiol. 2021;130:156–60.

Lockwood C, dos Santos KB, Pap R. Practical guidance for knowledge synthesis: scoping review methods. Asian Nurs Res. 2019;13:287–94.

Article   Google Scholar  

Pollock D, Peters MDJ, Khalil H, McInerney P, Alexander L, Tricco AC, Evans C, de Moraes ÉB, Godfrey CM, Pieper D, et al. Recommendations for the extraction, analysis, and presentation of results in scoping reviews. JBI Evidence Synthesis. 2022;10:11124.

Google Scholar  

Peters MDJ GC, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping reviews (2020 version). In: Aromataris E MZ, editor. JBI Manual for Evidence Synthesis. JBI; 2020. Available from https://synthesismanual.jbi.global . Accessed 1 Feb 2023.

Tableau Public. https://www.tableau.com/en-gb/products/public . Accessed 24 January 2023.

flourish.studio. https://flourish.studio/ . Accessed 24 January 2023.

Chishtie J, Bielska IA, Barrera A, Marchand J-S, Imran M, Tirmizi SFA, Turcotte LA, Munce S, Shepherd J, Senthinathan A, et al. Interactive visualization applications in population health and health services research: systematic scoping review. J Med Internet Res. 2022;24: e27534.

Isett KR, Hicks DM. Providing public servants what they need: revealing the “unseen” through data visualization. Public Adm Rev. 2018;78:479–85.

Carroll LN, Au AP, Detwiler LT, Fu T-c, Painter IS, Abernethy NF. Visualization and analytics tools for infectious disease epidemiology: a systematic review. J Biomed Inform. 2014;51:287–298.

Lundkvist A, El-Khatib Z, Kalra N, Pantoja T, Leach-Kemon K, Gapp C, Kuchenmüller T. Policy-makers’ views on translating burden of disease estimates in health policies: bridging the gap through data visualization. Arch Public Health. 2021;79:17.

Zakkar M, Sedig K. Interactive visualization of public health indicators to support policymaking: an exploratory study. Online J Public Health Inform. 2017;9:e190–e190.

Park S, Bekemeier B, Flaxman AD. Understanding data use and preference of data visualization for public health professionals: a qualitative study. Public Health Nurs. 2021;38:531–41.

Kossmeier M, Tran US, Voracek M. Charting the landscape of graphical displays for meta-analysis and systematic reviews: a comprehensive review, taxonomy, and feature analysis. BMC Med Res Methodol. 2020;20:26.

Ribecca, S. The Data Visualisation Catalogue. https://datavizcatalogue.com/index.html . Accessed 23 November 2021.

Ferdio. Data Viz Project. https://datavizproject.com/ . Accessed 23 November 2021.

Golden TL, Springs S, Kimmel HJ, Gupta S, Tiedemann A, Sandu CC, Magsamen S. The use of music in the treatment and management of serious mental illness: a global scoping review of the literature. Front Psychol. 2021;12: 649840.

Keshava C, Davis JA, Stanek J, Thayer KA, Galizia A, Keshava N, Gift J, Vulimiri SV, Woodall G, Gigot C, et al. Application of systematic evidence mapping to assess the impact of new research when updating health reference values: a case example using acrolein. Environ Int. 2020;143: 105956.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Jayakumar P, Lin E, Galea V, Mathew AJ, Panda N, Vetter I, Haynes AB. Digital phenotyping and patient-generated health data for outcome measurement in surgical care: a scoping review. J Pers Med. 2020;10:282.

Qu LG, Perera M, Lawrentschuk N, Umbas R, Klotz L. Scoping review: hotspots for COVID-19 urological research: what is being published and from where? World J Urol. 2021;39:3151–60.

Article   CAS   PubMed   Google Scholar  

Rossa-Roccor V, Acheson ES, Andrade-Rivas F, Coombe M, Ogura S, Super L, Hong A. Scoping review and bibliometric analysis of the term “planetary health” in the peer-reviewed literature. Front Public Health. 2020;8:343.

Hewitt L, Dahlen HG, Hartz DL, Dadich A. Leadership and management in midwifery-led continuity of care models: a thematic and lexical analysis of a scoping review. Midwifery. 2021;98: 102986.

Xia H, Tan S, Huang S, Gan P, Zhong C, Lu M, Peng Y, Zhou X, Tang X. Scoping review and bibliometric analysis of the most influential publications in achalasia research from 1995 to 2020. Biomed Res Int. 2021;2021:8836395.

Vigliotti V, Taggart T, Walker M, Kusmastuti S, Ransome Y. Religion, faith, and spirituality influences on HIV prevention activities: a scoping review. PLoS ONE. 2020;15: e0234720.

van Heemskerken P, Broekhuizen H, Gajewski J, Brugha R, Bijlmakers L. Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa-a scoping review. Hum Resour Health. 2020;18:51.

Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014;5:371–85.

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H. Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth. 2020;18:2119–26.

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–73.

Nyanchoka L, Tudur-Smith C, Thu VN, Iversen V, Tricco AC, Porcher R. A scoping review describes methods used to identify, prioritize and display gaps in health research. J Clin Epidemiol. 2019;109:99–110.

Wolffe TAM, Whaley P, Halsall C, Rooney AA, Walker VR. Systematic evidence maps as a novel tool to support evidence-based decision-making in chemicals policy and risk management. Environ Int. 2019;130:104871.

Digital Solution Foundry and EPPI-Centre. EPPI-Mapper, Version 2.0.1. EPPI-Centre, UCL Social Research Institute, University College London. 2020. https://eppi.ioe.ac.uk/cms/Default.aspx?tabid=3790 .

South E, Rodgers M, Wright K, Whitehead M, Sowden A. Reducing lifestyle risk behaviours in disadvantaged groups in high-income countries: a scoping review of systematic reviews. Prev Med. 2022;154: 106916.

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Domestic violence against women during the COVID19 pandemic in Jordan: a systematic review

• Maissa N. Alrawashdeh 1 ,
• Rula Odeh Alsawalqa   ORCID: orcid.org/0000-0002-5605-5444 2 ,
• Rami Aljbour 3 ,
• Ann Alnajdawi 4 &
• Fawzi Khalid AlTwahya 5  

Humanities and Social Sciences Communications volume  11 , Article number:  598 ( 2024 ) Cite this article

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This study aimed to explore the forms and causes of domestic violence against women in Jordan during the COVID-19 pandemic through a systematic literature review. The review yielded eight articles published between April 2020 and November 2022 in the final sample, all of which met the inclusion criteria. The results revealed 11 forms of domestic violence against women in Jordan during and after the full and partial lockdowns due to the pandemic. Physical violence was the most prevalent form of domestic violence, followed by economic, psychological, emotional, verbal, and sexual forms, as well as control and humiliation, bullying, online abuse, harassment and neglect-related violence. The causes were a combination of economic, socio-cultural, and psychological factors emerging because of the pandemic and lockdowns (e.g., poverty, job loss, low wages, gender discrimination, double burden on women [monotonous roles, paid work], male dominance, reduced income, high cost of living). Additionally, effects of the pandemic included psychological, mental, and emotional negative consequences (e.g., anxiety, fear, stress, depression, loneliness, failure, status frustration). Individuals in Jordanian societies employed the norms, ideas, and values of the patriarchal culture to negatively adapt to the economic and psychological effects of the pandemic, which contributed to more domestic violence cases.

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Introduction.

Domestic violence (DV) is a significant global and social problem. United Nations ( 2022 ) defined DV as a pattern of behavior in any relationship that is used to gain or maintain power and control over an intimate partner, including physical, sexual, psychological, emotional, and financial acts or threats of action that influence another person. DV is also called “domestic abuse,” “family violence” or “intimate partner violence (IPV)” (Xue et al. 2020 ; Alsawalqa 2021a ). “DV is reaching across national boundaries as well as socio-economic, cultural, racial and class distinctions… its incidence is also extensive, making it a typical and accepted behavior… Its continued existence is morally indefensible…” (Kaur & Garg, 2008 : p. 73). DV is the most common form of violence against women (Xue et al. 2020 ). According to UN Women ( 2021 : p. 4), the experiences of violence against women can be classified into several categories: physical abuse (i.e., been slapped, hit, kicked, had things thrown at them, or other physical harm); verbal abuse (i.e., being yelled at, called names, humiliated); denied basic needs (i.e., health care, money, food, water, shelter); denied communication (i.e., with other people, including being forced to stay alone for long periods of time); and sexual harassment (i.e., being subjected to inappropriate jokes, suggestive comments, leering or unwelcome touch/kisses). UN Women used this definition for the purpose of the measuring the impact of COVID-19 on violence against women.

DV as a “shadow pandemic” grew and intensified during the COVID-19 pandemic, particularly against women and girls (Women UN 2021 ). UN women ( 2021 ) confirmed there was an increase in calls to DV helplines in many countries since the outbreak of COVID-19. Xue et al. ( 2020 ) indicated that during the COVID-19 lockdown, homes became an unsafe environment for victims of DV; women and children were disproportionately affected and made vulnerable during the crisis, which prevented them from seeking help, thus increasing their vulnerability and suffering. The lockdown measures due to the pandemic imposed social distancing, leading to increased family isolation and limited access to legal and social services (Xue et al. 2020 ; Leslie and Wilson 2020 ). These socio-economic stressors led to negative emotional, behavioral, and psychological consequences including depression, anxiety, panic, obsessive-compulsive behaviors, and paranoia (Pedrosa et al. 2020 ), and thus facilitated DV, child abuse, and elder abuse (Al-Tammemi 2020 ; Xue et al. 2020 ).

Since the first registered case of COVID-19 on March 2, 2020, the Jordanian government took several protective measures to prevent the rapid spread of the virus by implementing the National Defense Law on March 14. Under this law, the roads, schools, universities, air and land border crossings, all private businesses, and non-essential public services were closed. Additionally, this law suspended air traffic, and public gatherings as well as religious practices were banned. These rigorous measures had negative multidimensional effects on the economic and social conditions of Jordanian citizens, including human rights violations, such as labor rights, freedom of expression (Alsawalqa et al. 2022a ), loss of human resources, decreased income levels because of declining economic growth, drop in productivity, dismissal of employees from their work, and the inability of some organizations to pay employees’ salaries (Abufaraj et al. 2021 ; Al-Tammemi 2020 ). These poor conditions contributed to an increase in DV cases, in particular against women and children. Jordanian Juvenile and Family Protection Department ( 2020 ) stated that the number of reports of DV increased from 41,221 in 2018, to 54,743 in 2020; of these cases, 58.7% were physical violence, and 34% sexual violence, and most of the victims were female (Higher Population Council, 2021 ; National Council for Family Affairs 2022 ; 2013 ). According to the United Nations Population Fund, approximately 69% of Jordanian women were victims of some type of gender-based DV during the COVID-19 pandemic (Anderson 2020 ).

Jordanian women suffering multiple socio-economic constraints was directly related to the economic, social, and health impacts of the COVID-19 pandemic, which imposed new obligations on women, consumed more of their time and effort, and increased their stress and responsibility owing to the long period for which they had to stay at home. Homes became increasingly crowded with all members of the family present, thus increasing the household chores and caregiving burden faced by women and also the burden in meeting family needs in terms of food and supervising their children’s online education and recreation activities. Moreover, women also had to ensure that health and safety precautions to protect their family were performed diligently. Additionally, they experienced increasing financial obligations, declining income, and accumulated debt owing to the pandemic (AbuTayeh 2021 ). Similarly, Sisterhood is Global Institute-Jordan (SIGI) ( 2021a , 2021b ) mentioned that the most important effects of the COVID-19 pandemic on women included the burden of unpaid family care; the high risk of women and children being exposed to DV, and the decline in protection, prevention and response services provided to them; the exacerbation of a lack of women’s economic participation, the increase in the requirement of women in the healthcare sector, and the weak representation of women in leadership positions and response teams.

The Jordanian government implemented several measures to address cases of DV and violence against women and girls. These included the establishment of the Family Protection Department in 1997, which was merged with the Juvenile Department in 2021 to become the Juveniles and Family Protection Department (Public Security Directorate 2022 ). For the first time in Jordan, the principle of promoting gender equality was adopted as an organizing factor in the economic and social development plan (1999–2003), by integrating a gender perspective (The Jordanian National Commission for Women 1998 ). In addition, the National Council for Family Affairs was established in 2001 as a civil society organization to contribute to formulating and analyzing legislation for senior citizens, family counseling, and for early childhood and family protection against violence; it included the national team for family protection against violence to address the gaps in the protection system for family members and stop incidents of DV. The government also approved the Protection from Domestic Violence Law No. 15 in 2017, in comparison with the Protection from Domestic Violence Law No. 6 of 2008 that can be regarded as a protective law without mention of gender-based violence, Law No. 15 states the importance of adapting legal texts to address the needs of Jordanian families, and to expand the umbrella of family preservation by introducing alternative measures to punishment that could reform the family and enable it to overcome the obstacles it might face (EuroMed Rights, 2018 ; National Council for Family Affairs 2022 ; 2013 ). According to the Secretary-General of the National Council for Family Affairs, this new law gave a broader concept of the place where family members usually reside and expanded the concept of family by adding relatives up to the fourth degree and in-laws from the third and fourth degrees to the list of those covered by the protection law (Protection from domestic violence law, 2017; Al-Nimri 2019 ). Within the women’s protection system in Jordan, there are five main care homes affiliated with the Ministry of Social Development regarding family harmony for women whose lives are at risk: Dar Al-Wefaq Amman, Dar Al-Wefaq Irbid, Dar Al-Karama, Rusaifa Girls’ Care Home, and Amna. These care homes welcome women whose lives are threatened by honor killings; they wish to end “preventive detention,” in which women whose lives are at risk are referred to prisons in order to preserve their lives (Ministry of Social Development 2022 ). Regarding government priorities in combating violence against women in light of the COVID-19 pandemic, in March 2020, the Council of Ministers approved the national strategy for women’s empowerment (2020–2025) for a society free from discrimination and gender-based violence, where women and girls can enjoy full human rights and equal opportunities to achieve comprehensive and sustainable development (The Jordanian National Commission For Women 2020 ).

In spite of the official Jordanian statements about the increase in the number of DV cases against women and girls during the COVID-19 lockdown, the growing momentum of Jordanian media reports on issues of DV against women, and the publication of individual stories of women and girls who have been subjected to physical and psychological violence, murders, or underage marriage of girls (Darwish 2020 ; Ziyadat 2021 ; Zoud 2021 ), the data on DV during the COVID-19 pandemic still remains scarce in Jordan. The reliance on the press and media reports to understand the reasons for this has increased. Therefore, this review aimed to explore the link between the economic, social, and health-related effects of the pandemic and the high number of DV cases against women in Jordan. For this purpose, we explored the forms and causes of DV against women in Jordan, during and after the full and partial lockdowns imposed due to the pandemic, as discussed in the relevant literature.

Sample selection process and search criteria

All studies that revealed the forms and causes of DV against women in Jordan during the COVID-19 pandemic, that were published between April 2020 and November 2022, were searched using the University of Jordan Library, PubMed, Google Scholar, and SCOPUS database. We used the following six sets of terms: “gender-based violence” + “Jordan” + “COVID-19,” “partner violence” + “Jordan” + “COVID-19,” “domestic violence” + “Jordan” + “COVID-19,” “domestic abuse” + “Jordan” + “COVID-19,” “women abuse” + “Jordan” + “COVID-19,” and “wife abuse” + “Jordan” + “COVID-19.” The search comprised studies published in Arabic and English in academic journals, which used quantitative, qualitative, and mixed methods research designs. Primary search results yielded 231 studies. Of these studies, 66 studies were excluded as they did not meet the inclusion criteria. The systematic review was developed according to the PRISMA (see the flowchart [Fig. 1 ]).

PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analyses. A PRISMA flow diagram visually summarises the screening process. It records the total number of articles found from the initial searches, and then makes the selection process transparent by reporting on inclusion or exclusion decisions made at various stages of the systematic review (Celegence, 2022 ; Macquarie University Library, 2023 ).

Data inclusion and exclusion criteria

The primary inclusion criteria for the papers include (a) the presence of DV against women construct, (b) Jordanian society, (c) use of Arabic and English language, (d) published scientific research, and (e) the time range during and after the COVID-19 pandemic between April 2020 and November 2022. This period was identified because it witnessed an increased momentum in scientific research regarding the consequences of the pandemic globally. Papers on DV, especially those about DV in Jordan, experienced stagnation toward the end of 2022. It was observed by the researchers that scientific journals, especially local Jordanian journals, no longer include the repercussions of the pandemic on DV among their priorities and interests in publishing. This was also confirmed through communication with other researchers and publishers.

We also included both qualitative and quantitative articles focusing on constructs connected to DV against women, such as women abuse, wife abuse, partner violence, gender-based violence, domestic abuse, family abuse, and family violence. Studies that examine DV against women in Jordan before the COVID-19 pandemic, and DV against the elderly before the COVID-19 pandemic, or children before or during and after the COVID-19 pandemic were excluded. Additionally, unpublished studies, national and international reports, duplicate articles, master’s and Ph.D. theses, conference abstracts, and studies that included refugee DV against women (e.g. families or Syrian women) in Jordan were also excluded.

After assessing the quality of the primary studies and refining the included studies in the final sample, all eight remaining studies that met the inclusion criteria were exported to EndNote. The data were extracted and sorted through a structured table that contained seven variables: (a) author and publication year, (b) aim, (c) study design, (d) sample details, (e) occurred sample location, (f) definition of DV, (g) forms of DV, (h) causes of DV, (i) abuser, and (j) study limitations (see Table 1 ).

Quality assessment

The search in the literature via a comprehensive search of bibliographic databases, manual searches, and exploration of grey literature searches contribute to reducing bias. Moreover, the inclusion of studies has been thoroughly reviewed and their eligibility was independently assessed by two sociology professors, A.A and K.B with expertise in the fields of violence and abuse within the Jordanian context. They screened all study titles and abstracts to ensure that the study objectives were adhered to, in collaboration with both researchers M.A and R.A. They then examined the texts of the studies following the systematic review protocol as a guide (PRISMA 2020 ); R.A and A.A and reviewed the data, and the whole team discussed and agreed on the results of the data. Quantitative studies were assessed using the Quality Assessment Tool for quantitative studies, which includes eight categories: selection bias, study design, confounders, blinding, data collection method, withdrawals and dropouts, intervention integrity, and analysis appropriate to questions. Each examined practice receives a mark ranging between “strong,” “moderate,” and “weak” (Thomas 2003 ). For qualitative studies, the Critical Appraisal Skills Program (CASP Qualitative Studies Checklist) was used, which includes ten questions, answerable with three options (“yes”, “no” or “can’t tell”), to evaluate the study aims, validity of methodology, data analysis and results, research design validity and novelty. The CASP is divided into three sections — Section A: Are the results of the study valid? Section B: What are the results? Section C: Will the results help locally? (CASP website 2022 ).

Sample description

The eight articles included in the final sample were published between April 2020 and November 2022 in eight separate English-language journals on interpersonal violence, clinical practice, humanities and social sciences, and psychology. Of these super specialty journals and their scope in issues related to violence, only one journal specialized in violence—the Journal of Interpersonal Violence . Most of these studies had a quantitative descriptive design via online survey, and included cross-sectional (four articles), descriptive statistical (two articles), and descriptive comparative (one article) studies. The remaining study adopted qualitative exploratory descriptive analysis through a semi-structured interview guide (one article). Most of the participants in these studies were married women, between 18 and 55 years of age, who had experienced violence from their husbands; a few of them had experienced it from their father, brother, mother, or work colleagues. Only one study addressed DV among pregnant women (Abujilban et al. 2022 ). Two articles included samples of men: one of them included only married men and explored the causes and forms of DV against their wives from the perspective of the husbands. Most of these studies considered the rural and urban classification in selecting the population samples from the north, central, and southern regions of Jordan (five articles), while three articles selected samples from Amman, the capital of Jordan. No article defined or presented a clear concept of DV, except three articles, one of which was based on the World Health Organization’s definition (Abujilban et al. 2022 ). The other articles defined DV as any abusive or violent behavior that occurred between spouses. Two articles used the term “intimate partner” to refer to the husband, and some used IPV, “spousal violence,” “women abuse,” and “male violence against women” synonymously with DV (Table 1 ).

Limitations of the study

The present study is one of the first studies to address DV against women during and after the COVID-19 pandemic in Jordan, that is, within an Arab Muslim social- cultural context. The strengths of this review are the focus on the concept of DV used in studies as well as the identity of the abuser. in Jordan (rural, urban/ North, Central, South), with differently ages (18-60 years) and their educational, professional, and marital status, as well as their health status (e.g. pregnant women).

This study enriches the field of family sociology studies and women’s studies in Jordan, considering that the data on DV Against Women during the COVID-19 pandemic are still scarce in Jordan and the reliance on the press and media reports to understand the reasons for this has increased. Nevertheless, the present study also had some limitations. First, it excludes women of other nationalities, such as those who hold Syrian and Iraqi nationality and lived for a period in Jordan and were involved in its cultural context and experienced the same economic conditions, especially during and after the pandemic. Without this exclusion, the study sample could have enhanced the results and presented clearer details on women’s DV experiences in Jordan in general. Second, this review was limited to publications in English and Arabic, and in international and local academic journals only, which means that studies that may have been published in other languages were not considered, and scientific studies conducted by organizations and educational institutions that could have added to causes or forms of violence were not considered. Finally, this study does not consider studies on DV consequences and intervention strategies, which may hinder a complete understanding of this complex phenomenon.

The findings of our review were divided according to the main research goals: exploring forms and causes of DV against Jordanian women during and after the full and partial lockdowns imposed due to the pandemic.

Forms of DV against women during and after the COVID-19 pandemic

The results of our systematic review revealed 11 forms of DV experienced by women and girls in Jordan during and after the full and partial lockdowns due to the pandemic: physical (Abujilban et al. 2022 ; Abuhammad, 2021 ; Alsawalqa, 2021a ; Alsawalqa, 2021b ; Alsawalqa et al. 2021 ; Kataybeh 2021 ; Qudsieh et al. 2022 ), economic (Alsawalqa 2021a ; Alsawalqa, 2021b ; Qudsieh et al. 2022 ), psychological (Abujilban et al. 2022 ; Abuhammad, 2021 ; Alsawalqa 2021a ; Alsawalqa 2021b ; Kataybeh 2021 ), emotional (Alsawalqa, 2021a ; Alsawalqa 2021b ) verbal (Kataybeh 2021 ; Qudsieh et al. 2022 ; Alsawalqa et al. 2021 ), sexual (Abujilban et al. 2022 ; Kataybeh 2021 ), control and humiliation (Abujilban et al. 2022 ), bullying (Alsawalqa et al. 2021 ), online abuse (Alsawalqa et al. 2021 ), harassment (Alsawalqa 2021b ), and neglect (Alsawalqa 2021a ). Physical violence was the most prevalent among the samples of these studies. Notably, some of these articles dealt with psychological and emotional abuse as belonging to the same category, or as a separate concept [e.g., Qudsieh et al. 2022 ; Kataybeh 2021 ]. By contrast, some researchers defined the concepts of verbal, psychological, and emotional abuse, and dealt with them separately [e.g., Alsawalqa 2021b ; Kataybeh 2021 ]. One article addressed DV in general without clarifying its types and measurement; its results simply indicated that “20.5% of the participants suffered from increased domestic abuse during the COVID-19 pandemic” (Aolymat, 2020 : 520).

Causes of DV against women during and after the COVID-19 pandemic

We found that the causes of DV Against Women during the pandemic were the result of a combination of the economic, socio-cultural, and psychological effects of the COVID-19 pandemic and curfew. Six articles confirmed that the economic factors included poverty; job loss; low, insufficient, or reduced income; and high cost of living and healthcare facilities, which led to the spread and rise of DV (Abuhammad, 2021 ; Qudsieh et al. 2022 ; Alsawalqa, 2021a ; Alsawalqa 2021b ; Aolymat 2020 ; Kataybeh 2021 ). Moreover, the lockdown increased the time spent with partners and family members and caused negative psychological responses, such as stress and tension (Abuhammad, 2021 ). Five articles emphasized that the main socio-cultural factor that encouraged violence against women was the hegemonic masculinity and patriarchy that normalized violence, making women accept, tolerate, and even justify it (Abuhammad, 2021 ; Alsawalqa 2021a ; Alsawalqa 2021b ; Alsawalqa et al. 2021 ; Kataybeh 2021 ). Furthermore, the studies showed that the wives’ families often interfered in their marital life (Alsawalqa 2021a ; Kataybeh 2021 ; Alsawalqa et al. 2021 ). The results of the study Alsawalqa ( 2021a ) also confirmed that the wives’ long preoccupation with social media, and neglect of the house, children, and their personal hygiene, in addition to the husband’s unfulfilled sexual needs, were among the main reasons why they were violent to their wives, before and during the pandemic. All studies indicated that these economic, social, and cultural factors and their negative effects on the psychological, emotional, and social well-being of individuals had long-term effects which continued after the end of the lockdown.

Despite the abundance of publications on DV in Jordan, particularly during the COVID-19 pandemic, there was no clear or explicit definition of the concept of DV or an accurate distinction of its forms (Alsawalqa et al. 2022b ). Our study attempted to shed light on published scientific research that addressed DV in Jordan during and after the COVID-19 pandemic, to gain knowledge and enhance our understanding of the link between the pandemic’s ramifications and high rates of DV in Jordan.

Globally, before the COVID-19 pandemic began, one in every three women experienced physical or sexual violence mostly by an intimate partner; 245 million women and girls aged 15 years or over have been subjected to sexual or physical violence. The violence against women and girls has intensified since the outbreak of COVID-19 (Women UN 2021 ).

According to World Health Organization ( 2020 : p1) the Eastern Mediterranean Region has the second highest prevalence of violence against women (37%) worldwide. This is due to structural systems that maintain gender inequalities at different levels of society, compounded by political crises and socioeconomic instability in the region. Based on a Women UN ( 2021 ) study, in collaboration with Ipsos, and with support from national statistical offices, national women’s machineries and a technical advisory group of experts, the pooled data from 13 countries covering more than 16,000 women respondents, found that 1 in 4 women say that household conflicts have become more frequent, and they feel more unsafe in their home, and (58%) women have experienced or know a woman who has experienced violence since COVID-19. The most common form is verbal abuse (50%), followed by sexual harassment (40%), physical abuse (36%), denial of basic needs (35%) and denial of means of communication (30%). Additionally, (56%) women felt less safe at home since the COVID-19 pandemic. (44%) women living in rural areas, were more likely to report feeling more unsafe while walking alone at night since the pandemic, compared to women living in urban areas (39%). (62%) were also more likely to think that sexual harassment in public spaces has worsened, compared to (55%) of women living in urban areas. Moreover, younger women aged 18–49 years were the more vulnerable group, with nearly 1 in 2 of them affected, and more than 3 in 10 women (34%) aged 60+ and more than 4 in 10 women aged 50–59 years (42%) reported having experienced violence or knowing someone who has since the pandemic began. Women living with children were more likely to report having experienced violence or to know someone who has experienced it since the pandemic, whether they were partnered (47%) or not (48%). Conversely, nearly 4 in 10 women living without children, partnered (37%) or not (41%), reported such experiences. Women who were not employed during the pandemic were also particularly affected, with an estimated (52%) reporting such experiences, compared to (43%) of employed women. Additionally, exposure was highest among women in Kenya (80%), Morocco (69%), Jordan (49%) and Nigeria (48%). Those in Paraguay were the least likely to report such experiences, at (25%) (p. 5-6, 8).

In Jordan, the spread of the COVID-19 pandemic and the strict lockdown measures to prevent its spread had negative economic, social, and psychological effects on the citizens. Regarding economic repercussions, according to Raouf et al. ( 2020 ), the Jordanian gross domestic product decreased by (23%) during the lockdown. The service sector was the hardest hit, seeing an estimated drop in output of approximately (30%), and food systems experienced a reduction in output of approximately (40%). Moreover, employment losses during the lockdown were estimated at over (20%), mainly driven by job losses in the service and agriculture sectors. Household incomes decreased on average by approximately one-fifth owing to the lockdown, mainly driven by contraction in the service sector, slowdown in manufacturing, and lower remittances from abroad. As a result of this lockdown and company exploitation of the National Defense Law’s decisions imposed in emergency situations to ensure protect public safety, many workers were dismissed, several others did not receive their salaries, and some workers’ incomes decreased by (30–50%). Additionally, some companies and organizations deducted the period of lockdown imposed by the government from workers’ salaries (Jordan Labor Watch 2020 ; Jordan Economic Forum 2020 ).

The unemployment rate during the fourth quarter of 2019 reached (19%), an increase of (0.3%) from the fourth quarter of 2018. Unemployment rates reached (24.7%) in 2020 and (25%) during the first quarter of 2021, reflecting an increase of (5.7%) from the first quarter of 2020. The rate in the fourth quarter of 2021 reached (23.3%), an increase of (0.1%) from the third quarter of the same year, and a decrease of (1.4%) from the fourth quarter of 2020 (Department of Statistics 2021 ; 2020 ). Additionally, self-isolation measures and lockdown policies led to a lack of access to adequate healthcare services (Alijla 2021 ), particularly restricting women’s access to healthcare (Jordanian Economic and Social Council 2020a , 2020b ). There were also increases in food prices and people getting into debt (UNDP 2020 ).

According to the latest survey on household income and expenditures conducted by the Department of Statistics (2017-2018) (Department of Statistics, Jordan [DOS], 2018 ), poverty in Jordan was relatively high. It reached (15.7%), representing 1.069 million Jordanians, while the rate of (extreme) hunger poverty in Jordan reached (0.12%), which is equivalent to 7993 Jordanian individuals. Poverty in Jordan increased significantly during the COVID-19 pandemic; the estimates of the World Bank showed that the potential increase in the short-term poverty rates in Jordan may increase by an additional (11%) over the official rate declared before the COVID-19 pandemic (15.7%), to approximately (27%) (Baybars 2021 ). A UNICEF study ( 2020 ), which covered both Jordanian and Syrian families, also found that the number of households with a monthly income of less than 100 JD (140 USD) had doubled since before the COVID-19 pandemic, and only (28%) of households had adequate finances to sustain themselves for a two-week period. Four out of ten families were unable to purchase the hygiene products they need; children went to bed hungry in (28%) of the homes during lockdown, decreasing to (15%) post-lockdown. As a result of the pandemic, employment was disrupted in (68%) of households. Furthermore, (17%) of the children under five years did not receive basic vaccinations, (23%) of children who were sick during the pandemic did not receive medical attention (largely owing to fear of the virus and lack of funds), eight out of 10 households adopted negative coping strategies, and (89%) of young women performed household duties (including caring) compared to (49%) of young men.

Notably, The Jordan Economic Monitor report issued by the World Bank showed that economic growth in Jordan in 2021 was strong at (2.2%), owing to the significant expansions in the service, industry, and travel and tourism sectors. However, some sectors, such as the service sector that deals directly with the public (through restaurants, hotels, and so on) were still experiencing low levels of economic growth before the COVID-19 pandemic in 2020 (Refaqat et al. 2022 ). The termination of worker services in affected organizations and businesses had a significant impact on the economic circumstances of many families, particularly women-led households, causing health and psychological harm due to the inability to ensure general well-being and access to effective healthcare. Additionally, women working in low-wage, informal, temporary, or short-term sectors, such as seasonal jobs or small-scale businesses, were disproportionately affected by the pandemic. Furthermore, (35.4%) of Jordanian women who worked in the education sector had to switch to remote teaching because of the pandemic, which added to their domestic work. By contrast, (13.4%) of women in Jordan who worked in the health and social services sectors continued to provide their services along with the burdens of social responsibilities imposed on them (Jordanian Economic and Social Council 2020a , 2020b ).

Regarding social and psychological repercussions, the negative economic conditions, in addition to the lockdowns, social distancing behaviors, and the lack of in-person social interaction, created enormous pressures that led to high levels of anxiety, stress, and depression among the Jordanian people, particularly among those aged 18–39 years. The stress was greater in men than in women, and anxiety and depression levels were higher in women than in men (Abuhammad et al. 2022 ). People with poor social support, who were younger and female, were more likely to experience lockdown-related anxiety (Massad et al. 2022 ). Moreover, the COVID-19 pandemic had a notable effect on the mental health of the Jordanians who had low monthly income (<500 JD) or were unemployed, as well as diabetes patients (Suleiman et al. 2022 ), who felt neglected or lonely. Married couples with higher income were less likely to feel lonely than others (Jordanian Economic and Social Council, 2020a , 2020b ). Gresham et al. ( 2021 ) found that COVID-19-related stressors (financial anxiety, social disconnection, health anxiety, COVID-19-specific stress, and so on) were associated with greater IPV during the pandemic. Additionally, IPV was associated with movement outside of the home (leaving the residence); greater movement outside the home may act as a way for victims to physically distance themselves from their partners, thereby reducing stress and avoiding further abuse.

These negative socio-economic effects caused by the COVID-19 pandemic led to exacerbating DV among Jordanian families. During the mandatory curfew, (35%) of Jordanians were subjected to at least one form of domestic abuse (10% total increase), (58%) of which were victims of abuse by a male family member (25% father, 16.5% husband, and 16.5% brother), (33%) by a female family member (25% mother, 8% sister), and (9%) by others. The most prevalent forms of DV reported during the lockdown were verbal violence (48%), psychological violence (26%), neglect (17%), and physical abuse (9%). These violent acts (between March 21st to April 26th, 2020) occurred 1–3 times among (75%) of the COVID-19 domestic abuse victims, 4–6 among (19%), and (7+) times among (7%) (Center for Strategic Studies-Jordan 2020 ). Additionally, since the beginning of 2021 until November 23, 2021, 15 family murders were reported (Sisterhood is Global Institute-Jordan 2021b ).

Jordanian husbands confirmed that poverty, insufficient salary, wives’ money spending habits and not considering the negative economic effects of COVID-19 on their work led to their abusive behavior and violent response (Alsawalqa 2021a ). The patriarchal structure in the Jordanian society requires men to adhere to masculine standards and ideals of “true manhood,” which require men to be strong, independent, emotionally restrained, tough, and assume responsibility for leadership, family care, and financial support, given that they occupy a higher rank than women. Masculinity has social advantages and entitlements, the most prominent of which are male control, ownership, and dominance. If men are unable to achieve these standards, society can confront them with humiliation, marginalization, stigmatization, and blame (particularly from their wives). This can make them feel shame, disgrace, sadness, depression, failure, status frustration, anxiety, fear of the future, and low self-esteem. Couples express these negative feelings through aggressive and violent behaviors (Alsawalqa et al. 2021 ; Alsawalqa and Alrawashdeh 2022 ).

Additionally, some wives (working and non-working) were unable to repay their loans, especially their loans from microfinance institutions. These financial institutions provide loans and financial facilities to specific economic sectors (such as agriculture) and groups of the population (such as women, the poor, and artisans). These institutions have been excessive in lending to women for consumption purposes at the expense of productive projects and have been unable to lift women out of poverty and empower them economically. Owing to the existence of a major defect in the legislative system, lending conditions, and the economic repercussions of the COVID-19 pandemic, women borrowers (known as “female debtors,” or Algharimat in Arabic) were subjected to legal accountability and imprisonment if they failed to pay back the debt (Jordanian Economic and Social Council 2020b ). Notably, some husbands or fathers forced their wives to borrow because of poverty by dominating or exercising coercive control over the women; some women borrowed voluntarily with the aim of improving the family income. If women refuse to contribute to the household income or borrow money, they can face physical, verbal, psychological, and economic abuse.

Moreover, if women borrow money (which subjects them to legal accountability) without the knowledge of her husband or male guardian, it can expose them to more violence, because men can consider this act as a violation of their control which can cause a scandal or encourage stigma (Sa’deh, 2022 ). Jordanian working women who are married and live in rural and urban areas have encountered spousal economic abuse through control of their economic resources, management of their financial decisions, and exploitation of their economic resources. Moreover, they have endured emotional, psychological, and physical abuse, and harassment as tactics by husbands to reinforce their economic abuse and maintain control over them (Alsawalqa 2021b ). Peterman et al. ( 2020 ) indicated that the increased violence against women and children during the pandemic was associated with economic insecurity and poverty-related stress, lockdowns, social isolation, exploitative relationships, and reduced health and domestic support options.

The Information and Research Center - King Hussein Foundation (IRCKHF) and Hivos report ( 2020 : p. 4, 14) on the double burden of women in Jordan during COVID-19, showed that in times of disease outbreaks, most women take up greater responsibilities and are often overburdened with paid and unpaid work, which impacts their overall well-being. Unpaid work within the home, sometimes referred to as reproductive work, includes a variety of tasks such as childbearing and caring, preparing meals, cleaning, doing laundry, maintaining the house, and taking care of older adults or disabled family members, among others. Although paid work is tied to a monetary value, unpaid work is usually not recognized as “real work”. Moreover, the new e-learning systems resulted in parents, especially mothers, spending a lot of time ensuring that their children were learning and following up on their schoolwork. Some parents worried about the future of their children’s education; the closure of schools and nurseries created an additional burden for working parents who had to find childcare solutions while they went to work. These additional burdens created new psychological pressures and increased the problem of violence among family members. Married Jordanian women, particularly those who work and are educated, often face conflicts in the economic, political, and socio-cultural aspects (Alsawalqa 2016 ). Moreover, they experience Marriage and emotional burnout that worsens with the increase in the number of children, which negatively affects their health and leads to headaches, eating disorders, irregular heart rate, stomach pain, and so on (Alsawalqa, 2019 ; Alsawalqa, 2017 ). These problems contribute to a higher marriage burnout rate among spouses, particularly among those who work full-time jobs, have been married for ≥ 10 years, and have children. Marriage burnout is a painful state of emotional exhaustion, with physical and emotional depletion experienced by spouses. This state results from emotional exhaustion, work exhaustion, and failure to fulfill the requirements (particularly emotional requirements) of the marriage (Alsawalqa 2019 ).

Conclusions

The COVID-19 pandemic did not create new motives for DV in Jordan but contributed to its negative economic and psychological repercussions in exacerbating and confirming the pre-existing motives. The patriarchal structure and gender stereotypes in Jordanian society that establish the relationships between men and women based on coercive control produced prejudices that led to social injustice and gender inequality and made both sexes victims of DV. Individuals in Jordanian societies employed the norms, ideas, and values of the patriarchal culture to negatively adapt to the adverse economic and psychological effects of the pandemic, leading to more cases of DV.

The COVID-19 pandemic revealed the weak economic and social structures in place before the crisis and their negative impact during the pandemic, such as women’s poor economic participation, the gender gap in the labor market, high income tax, high cost of living, administrative and financial corruption, a weak labor market and infrastructure, and high rates of unemployment and poverty. This study highlighted the need for serious participatory work from the government and civil society organizations based on scientific research and approaches to change the cultural and social norms that reinforce patriarchal domination and stereotypes that perpetuate the gender gap. One way of achieving this is through the educational curricula in schools and universities; educating individuals on how to deal with life pressures; choosing a life partner; understanding the motives for marriage and the foundations for successful and healthy relationships, and raising children; and positive social self-development. We recommend supporting the efforts of the Jordanian government to continue the process of development and diligently follow up on the implementation of the directives and vision of His Majesty Abdullah II bin Al-Hussein, King of Jordan, on economic, political, and administrative reform, activating the role of youth and empowering women. We realize that social and cultural change, and the reforming of sectors is not an easy task and requires tremendous efforts over a long period.

Implications of the study

Considering the current study results, a follow-up study to highlight the lack of conceptual clarity on DV Against Women and its various forms is recommended. Future research must carefully study the behaviors involved in each form of DV and identify the abuser of women as this will help in developing effective policies and practices to reduce or end DV against women. In addition, it would contribute to directing researchers via a correct scientific methodology as they study women’s resistance to violence, and educating women to understand forms of violence and seek the most appropriate resistance strategies to reduce or end it, and avoid involvement in the cycle of violence. Moreover, we recommend paying attention to conducting more studies on DV against males by their wives, mothers, or intimate partners, and DV against the elderly, which will contribute to understanding the factors and forms of domestic violence in more detail. We believe that these aforementioned suggestions will aid in formulating the best intervention strategies.

To reduce DV in Jordan, it is necessary to implementing courses and workshops for women, girls, and males, especially in rural areas, aiming to increase their awareness about the motives for marriage and the foundations of choosing a suitable partner, how to manage emotions, and resist and reduce violence. Additionally, promoting anti-gender discrimination thinking in educational curricula in universities and schools. Moreover, remove obstacles in implementing the Law on Protection from DV, and not to waive personal rights in crimes of DV. In addition, rehabilitation for victims and perpetrators of violence.

Data availability

All data relevant to the study are included in the article.

AbuTayeh AM (2021) Socio-economic constraints Jordanian women had encountered as a result of COVID-19 pandemic, and coping mechanisms. Asian Soc Sci 17:63–76. https://doi.org/10.5539/ass.v17n10p63

Article   Google Scholar  

Abufaraj M, Eyadat Z, Al-Sabbagh MQ, Nimer A, Moonesar IA, Yang L et al. (2021) Gender-based disparities on health indices during COVID-19 crisis: A nationwide cross-sectional study in Jordan. Int J Equity Health 20:91. https://doi.org/10.1186/s12939-021-01435-0

Article   PubMed   PubMed Central   Google Scholar  

Abuhammad S (2021) Violence against Jordanian women during COVID-19 outbreak. Int J Clin Pract 75:e13824. https://doi.org/10.1111/ijcp.13824

Article   CAS   PubMed   Google Scholar  

Abuhammad S, Khabour OF, Alomari MA, Alzoubi KH (2022) Depression, stress, anxiety among Jordanian people during COVID-19 pandemic: A survey-based study. Inf Med Unlocked 30:100936. https://doi.org/10.1016/j.imu.2022.100936

Abujilban S, Mrayan L, Hamaideh S, Obeisat S, Damra J (2022) Intimate partner violence against pregnant Jordanian women at the time of COVID-19 pandemic’s quarantine. J Interpers Violence 37:NP2442–64. https://doi.org/10.1177/0886260520984259

Alijla A (2021) Possibilities and challenges: Social protection and COVID-19 crisis in Jordan. Civ, 1. https://doi.org/10.28943/CSKC.002.90003

Al-Nimri N (2019). Adoption of national legislation to strengthen the family and child protection system: The amended Domestic Violence Protection Law is among the most prominent national social achievements. Al Ghad. [Accessed 10 February 2022]. https://alghad.com/

Alsawalqa RO (2021a) A qualitative study to investigate male victims’ experiences of female-perpetrated domestic abuse in Jordan Curr Psychol 1–16. https://doi.org/10.1007/s12144-021-01905-2

Alsawalqa RO, Al Qaralleh AS, Al-Asasfeh AM (2022a) The Threat of the COVID-19 Pandemic to Human Rights: Jordan as a Model. J Hum Rights Soc Work 7:265–276. https://doi.org/10.1007/s41134-021-00203-y

Alsawalqa RO (2021b) Women’s abuse experiences in Jordan: A comparative study using rural and urban classifications. Humanit Soc Sci Commun 8:186. https://doi.org/10.1057/s41599-021-00853-3

Alsawalqa RO, Alrawashdeh MN, Sa’deh YAR, Abuanzeh A (2022b) Exploring Jordanian women’s resistance strategies to domestic violence: A scoping review. Front Socio. 7:1026408. https://doi.org/10.3389/fsoc.2022.1026408

Alsawalqa RO, Alrawashdeh MN, Hasan S (2021) Understanding the Man Box: The link between gender socialization and domestic violence in Jordan. Heliyon 7:e08264. https://doi.org/10.1016/j.heliyon.2021.e08264

Alsawalqa RO, Alrawashdeh MN (2022) The role of patriarchal structure and gender stereotypes in cyber dating abuse: A qualitative examination of male perpetrators experiences. Br J Socio 73:587–606. https://doi.org/10.1111/1468-4446.12946

Alsawalqa R (2016) Social change and conflict of values among educated women in Jordanian society: A comparative study. Dirasat Hum Soc Sci 43:2067–93

Alsawalqa RO (2017) Emotional burnout among working wives: Dimensions and effect. Can Soc Sci 13:58–69

Google Scholar  

Alsawalqa RO(2019) Marriage burnout: When the emotions exhausted quietly quantitative research Iran J Psychiatry Behav Sci 13:e68833. https://doi.org/10.5812/ijpbs.68833

Anderson K (2020) Daring to Ask, Listen, and Act: A Snapshot of the Impacts of COVID-19 on Women and Girls’ Rights and Sexual and Reproductive Health [Report]. United Nations Fund for Population Activities, Geneva, https://reliefweb.int/sites/reliefweb.int/files/resources/20200511_Daring%20to%20ask%20Rapid%20Assessment%20Report_FINAL.pdf

Aolymat I (2020) A cross-sectional study of the impact of COVID-19 on domestic violence, menstruation, genital tract health, and contraception use among women in Jordan. Am J Trop Med Hyg 104:519–25. https://doi.org/10.4269/ajtmh.20-1269

Article   CAS   PubMed   PubMed Central   Google Scholar  

Al-Tammemi AB (2020) The battle against COVID-19 in Jordan: An early overview of the Jordanian experience. Front Public Health 8:188. https://doi.org/10.3389/fpubh.2020.00188

Baybars S (2021) The World Bank: Corona’s Repercussions Have Raised the Poverty Rate in Jordan. https://alghad.com . [Accessed 10 February 2022]

Celegence (2022) PRISMA flow diagram – CAPTIS™ features. https://www.celegence.com/prisma-flow-diagram/ . Accessed May 2022

Center for Strategic Studies-Jordan (2020). Coronavirus lockdown exacerbating domestic violence in Jordan. Jordan’s barometer: The pulse of the Jordanian street– (20). Hivos [Study]. https://www.cawtarclearinghouse.org/

Darwish R (2020) 2020 Was Not a Perfect Year for Jordanian Women. https://www.bbc.com/arabic/middleeast-55468564 . [Accessed 10 February 2022]

Department of Statistics, Jordan [DOS] (2018) Jordan population and family and health survey 2017–18: key indicators. DOS and ICF, Amman, Jordan, and Rockville, MD, USA, http://www.dos.gov.jo/dos_home_a/main/linked-html/DHS2017_en.pdf

Department of Statistics (DoS) (2020) Unemployment Rate During the First Quarter of 2020 – Official Report. http://dosweb.dos.gov.jo/unemp_q12020

Department of Statistics (DoS). (2021). Unemployment Rate During the First Quarter of 2021 –official Report. http://dos.gov.jo/dos_home_a/main/archive/unemp/2021/Emp_Q12021.pdf

EuroMed Rights (2018) Situation Report on Violence against Women: Legislative Framework. Report Online, Retrievedِ April 2020. https://euromedrights.org

CASP website (2022).CASP Checklist: 10 questions to help you make sense of a Qualitative research. Retrieved May 2022. https://casp-uk.net/casp-tools-checklists/

Gresham AM, Peters BJ, Karantzas G, Cameron LD, Simpson JA (2021) Examining associations between COVID-19 stressors, intimate partner violence, health, and health behaviors. J Soc Personal Relat 38:2291–307. https://doi.org/10.1177/02654075211012098

Higher Population Council (HPC) (2021) Jordan joins the world in commemorating the International Day of Non-Violence. https://www.hpc.org.jo/en/content/jordan-joins-world-commemorating-international-day-non-violence . [Accessed 10 February 2022]

IRCKHF and Hivos (2020) COVID-19 and the Double Burden on Women in Jordan. Ministry of Foreign Affairs of the Netherlands [Report], Hivos, https://irckhf.org/projects/covid-19-and-the-double-burden-on-women-in-jordan/

Jordan Economic Forum (2020) Unemployment in Jordan: Reality, expectations and proposals. https://soundcloud.com/jordaneconomicforum-jef/5xedpqmblc51

Jordan Labor Watch J (2020) Unprecedented Challenges for Workers in Jordan: A Report on the Occasion of International Labor Day. http://phenixcenter.net/

Jordanian Economic & Social Council (2020a) Impact of COVID-19 on Gender Roles and Violence Against Women -Results from Jordan [Study]. Amman, Hashemite Kingdom of Jordan. https://jordan.un.org/

Jordanian Economic & Social Council (2020b). Gender-related impacts of Coronavirus pandemic in the areas of health, domestic violence and the economy in Jordan. Hashemite Kingdom of Jordan: Amman. https://jordan.unwomen.org/

Jordanian Juvenile and Family Protection Department (2020). Digital statistics. https://www.psd.gov.jo/en-us/content/digital-statistics/ . [Accessed 10 February 2022]

Kataybeh Y (2021) Male Violence Against Women: An Exploratory Study of Its Manifestations, Causes, and Discrepancies over Jordanian Women under Corona Pandemic. Preprints 1. https://pesquisa.bvsalud.org/global-literature-on-novel-coronavirus-2019-ncov/resource/pt/ppzbmed-10.20944.preprints202104.0695.v1?lang=en

Kaur R, Garg S (2008) Addressing domestic violence against women: an unfinished agenda. Indian J Community Med: official publication of Indian Association of Preventive & Social Medicine 33(2):73–76. https://doi.org/10.4103/0970-0218.40871

Leslie E, Wilson R (2020) Sheltering in place and domestic violence: Evidence from calls for service during COVID-19. J Public Econ (2020) 189:104241. https://doi.org/10.1016/j.jpubeco.2020.104241

Macquarie University Library (2023) Systematic reviews: PRISMA flow diagram & diagram generator tool. https://libguides.mq.edu.au/systematic_reviews/prisma_screen . Accessed May 2024

Massad I, Al-Taher R, Massad F, Al-Sabbagh MQ, Haddad M, Abufaraj M (2022) The impact of the COVID-19 pandemic on mental health: Early quarantine-related anxiety and its correlates among Jordanians. East Mediterr Health J 26:1165–72. https://doi.org/10.26719/emhj.20.115

Ministry of Social Development (2022) Care homes for family harmony for women whose lives are at risk. http://mosd.gov.jo

National Council for Family Affairs (2013). Socioeconomic characteristics of domestic violence cases [Study]. [Accessed 10 February 2022]. https://ncfa.org.jo/uploads/2020/07/ab0d5083-3d7e-5f1feb76ebd1.pdf

National Council for Family Affairs. (2022). Domestic violence in Jordan: Knowledge, reality. Trends. [Accessed 10 February 2022]. https://ncfa.org.jo/uploads/2020/07/38ceffed-d7a4-5f1ffdb3f907.pdf

Pedrosa AL, Bitencourt L, Fróes ACF, Cazumbá MLB, Campos RGB, de Brito SBCS et al. (2020) Emotional, behavioral, and psychological impact of the COVID-19 pandemic. Front Psychol 11:566212. https://doi.org/10.3389/fpsyg.2020.566212

Peterman A, Potts A, O’Donnell M, Thompson K, Shah N, OerteltPrigione S, et al. (2020). Pandemics and violence against women and children. Center for Global Development Working Paper 528. http://iawmh.org/wp-content/uploads/2020/04/pandemics-and-vawg-april2.pdf . [Accessed 24 September, 2022]

PRISMA (2020) The NEW Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) website. https://www.prisma-statement.org . Retrievedِ february 2021

Public Security Directorate (2022) Juvenile and Family Protection Department. https://www.psd.gov.jo/en-us/psd-department-s/family-and-juvenile-protection-department/ . Accessed 10 February 2022

Qudsieh S, Mahfouz IA, Qudsieh H, Barbarawi LA, Asali F, Al-Zubi M et al. (2022) The impact of the coronavirus pandemic curfew on the psychosocial lives of pregnant women in Jordan. Midwifery 109:103317. https://doi.org/10.1016/j.midw.2022.103317

Raouf M, Elsabbagh D, Wiebelt M (2020) Impact of COVID-19 on the Jordanian Economy: Economic Sectors, Food Systems, and Households (Projest Paper). The International Food Policy Research Institute. https://doi.org/10.2499/p15738coll2.134132

Refaqat S, Janzer-Araji A, Mahmood A, Kim J (2022) Jordan economic Monitor. Spring. DC: World Bank Group. (2022): Global Turbulence Dampens Recovery and Job Creation (English).Jordan Economic Monitor, Washington, http://documents.worldbank.org/curated/en/099410007122222740/IDU05823c2b70646004a400b9fa0477cea7736a4

Sa’deh Y (2022) Economic abuse from a gender perspective: A qualitative study on female debtors “Algharimat” in Jordan [unpublished Master’s thesis]. Department of Sociology and Anthropology, Doha Institute for Graduate Studies, Qatar

Sisterhood is global institute-Jordan (SIGI) (2021a). What do the Numbers tell us about Injuries and Deaths: An Analytical Reading from a Gender Perspective (Facts Paper). [Accessed 12 March 2022]. https://www.sigi-jordan.org/?p=10613

Sisterhood is global institute-Jordan (SIGI). (2021b). 47% of Women in Jordan Have Their Voices Unheard and Their Sufferings Unseen with Regard to Domestic Violence [Report] https://www.unicef.org/jordan/media/3041/file/Socio%20Economic%20Assessment.pdf

Suleiman YA, Abdel-Qader DH, Suleiman BA, Suleiman AH, Hamadi S, Al Meslamani AZ (2022) Evaluating the impact of COVID-19 on mental health of the public in Jordan: A cross-sectional study. J Pharm Pharmacogn Res 10:196–205. https://doi.org/10.56499/jppres21.1191_10.2.196

Article   CAS   Google Scholar  

The Jordanian National Commission for Women (2020). National strategy for women in Jordan (2020–2025). https://digitallibrary.un.org/record/1309642?ln=en

The Jordanian National Commission for Women, (1998). A preliminary report on the implementation of the Beijing Approach. https://digitallibrary.un.org/record/1309642?ln=en

Thomas, H (2003). Quality assessment tool for quantitative studies. Effective public health practice project. Hamilton, ON, Canada: McMaster University. https://www.ephpp.ca/PDF/Quality%20Assessment%20Tool_2010_2.pdf

UNDP (2020). COVID-19 Impact on Households in Jordan: A rapid assessment. https://www.undp.org/sites/g/files/zskgke326/files/migration/arabstates/UNDP-Impact-of-COVID-19-on-Households-General-21-FINAL-21-May.pdf . [Accessed 10 February 2022]

UNICEF (2020). Socio-Economic Assessment of Children and Youth in the time of COVID-19. Jordan Publishing [Study]. https://www.unicef.org/jordan/media/3041/file/Socio%20Economic%20Assessment.pdf

United Nations. (2022). What is domestic abuse? https://www.un.org/en/coronavirus/what-is-domestic-abuse [Accessed 12 March 2022]

Women UN (2021). Measuring the Shadow Pandemic: Violence Against Women During COVID-19 [Report]. https://data.unwomen.org/sites/default/files/documents/Publications/Measuring-shadow-pandemic.pdf . [Accessed 12 March 2022]

World Health Organization (2020) COVID-19 and violence against women in the Eastern Mediterranean Region. Report Online, Retrieved February 2022. https://pmnch.who.int/docs/librariesprovider9/meeting-reports/covid-19-and-violence-against-women-in-emro.pdf?sfvrsn=970ca82e_3

Xue J, Chen J, Chen C, Hu R, Zhu T (2020) The hidden pandemic of family violence during COVID-19: Unsupervised learning of tweets. J. Med Internet Res 22:e24361. https://doi.org/10.2196/24361

Ziyadat A (2021) Domestic violence: Murders rise in Jordan during Corona. The New Press, Arab, https://www.alaraby.co.uk/society/

Zoud B (2021). How did Corona raise the rate of Child marriage in Jordan? Ammannet. https://tinyurl.com/yz5549an . [Accessed 12 March 2022]

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Department of Sociology, School of Arts, The University of Jordan, Amman, Hashemite Kingdom of Jordan

Maissa N. Alrawashdeh

Department of Sociology, The University of Jordan, Amman, Hashemite Kingdom of Jordan

Rula Odeh Alsawalqa

Al- Balqa’ Applied University, Amman, Jordan

Rami Aljbour

Department of Social Work, School of Arts, The University of Jordan, Amman, Hashemite Kingdom of Jordan

Ann Alnajdawi

School of Arts, The University of Jordan, Amman, Hashemite Kingdom of Jordan

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Alrawashdeh, M.N., Alsawalqa, R.O., Aljbour, R. et al. Domestic violence against women during the COVID19 pandemic in Jordan: a systematic review. Humanit Soc Sci Commun 11 , 598 (2024). https://doi.org/10.1057/s41599-024-03117-y

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• Published: 11 May 2024

Effectiveness of simulation-based interventions on empathy enhancement among nursing students: a systematic literature review and meta-analysis

• Mi-Kyoung Cho 1 &
• Mi Young Kim 2  

BMC Nursing volume  23 , Article number:  319 ( 2024 ) Cite this article

Metrics details

This study aimed to secure and analyze evidence regarding the enhancement of nursing students’ empathy through simulation-based interventions. It comprehensively analyzed self-reported emotions and reactions as primary outcomes, along with the results reported by nursing students who experienced simulation-based interventions, including empathy.

This systematic literature review and meta-analysis investigated the effects of simulation-based interventions on enhancing empathy among nursing students. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for the systematic review and meta-analysis. The following details were considered: population, nursing students; intervention, simulation-based interventions targeting empathy enhancement; comparators, control groups without intervention or those undergoing general non-simulation-based classes; and outcomes, self-reported empathy.

In the systematic review of 28 studies, it was found that the use of simulation-based interventions among nursing students led to an increase in empathy, albeit with a small effect size. This was demonstrated through a pooled, random-effects meta-analysis, yielding an effect size (Hedge’s g) of 0.35 (95% CI: 0.14, 0.57, p  = 0.001). The results of meta-regression and subgroup analysis significantly increased in empathy for studies published after 2019 (Hedge’s g = 0.52, 95% CI: 0.31 to 0.73, p  < 0.001), quasi-experimental research design (Hedge’s g = 0.51, 95% CI: 0.27 to 0.74, p  < 0.001), more than 60 participants (Hedge’s g = 0.31, 95% CI: 0.02 to 0.59, p  = 0.034), and simulation-based interventions in nursing education (Hedge’s g = 0.43, 95% CI: 0.22 to 0.65, p  < 0.001).

Conclusions

Considering factors such as variations in sample size, research approaches, and the effects of independent studies on empathy, this systematic literature review and meta-analysis suggests that simulation-based education can significantly improve nursing students’ overall empathy skills.

Peer Review reports

In modern society, concerns are growing regarding empathy deficits, which lead to issues such as indifference and apathy in workplace relationships—aggravating even in common social situations [ 1 ]. Empathy is a complex concept comprising an affective component of feeling and recognizing emotions from others’ perspectives and a cognitive component of understanding others’ emotions [ 2 ]. Highly empathetic professionals in health-related fields foster a high level of communication with patients, leading to positive outcomes in patient care, such as better self-care, higher patient satisfaction, and faster recovery times [ 3 , 4 ]. Although empathy is essential for healthcare workers, studies have demonstrated that it is not taught sufficiently during training in numerous fields, including medicine, nursing, dentistry, and pharmacy [ 5 , 6 ].

Empathy plays a crucial role in healthcare, as evidenced by its strong correlation with the quality of care provided to patients. When patients perceive that nurses empathize with them, they tend to feel they are receiving care tailored to their needs [ 7 ]. Therefore, improving empathy is necessary for enhancing the quality of nursing care. Efforts have been made to develop programs that foster empathy through education and training [ 8 ]. Adequate levels of empathy are essential for nursing students as they are future nurses. However, research has indicated that nursing students have lower levels of empathy than other healthcare workers do [ 9 , 10 ].

Empathy is defined as the ability to place oneself in the same position as another person and to understand and accept their position and perspective [ 11 ]. Training that enhances empathy includes simulation-based learning that recreates realistic clinical situations [ 12 ]. Additionally, healthcare can be simulated in various ways, including virtual patients, manikins, role-playing, gaming, and simulating hypothetical or disease situations [ 13 ]. Simulations in healthcare most often allow students to function in the role for which they are training, though there is evidence students’ empathy increases when they function in the role of patients because they are encouraged to understand patients’ perspectives, emotions, and experiences [ 14 ]. Whether students function in professional or patient roles during simulation, post-simulation debriefing helps students translate their simulation experiences. Post-simulation debriefing sessions have been shown to help students learn how to translate their simulation experiences into appropriate empathetic behaviors and attitudes toward patients in the real world [ 14 ]. Previous systematic reviews have included studies focusing on specific simulation methods, such as role-play or virtually simulated patients, dementia-specific virtual reality scenarios, clinical simulations with dramatization, and simulation equipment for older-adult-specific scenarios [ 15 ]. Since its emergence, improving empathy in healthcare has been the subject of several studies and meta-analyses [ 16 ]. Through a meta-analysis and effectiveness evaluation study on various simulation-based programs aimed at nursing students, both future and current medical professionals, we investigated the elements of simulation that contribute to empathy enhancement. Our study identified key elements crucial for designing effective simulation education programs, which can be reflected upon in practice. By analyzing the components of simulation-based education that impact empathy enhancement, we can identify crucial elements to enhance empathy when implementing this approach.

Simulation is becoming more prevalent as an educational approach for instilling empathy in pre-service health professional students [ 17 ]. As these various forms of simulation are applied to improve empathy, a systematic review and analysis of nursing students are needed to determine their effectiveness and the factors that should be considered. Systematic reviews and meta-analyses can consider differences in sample sizes, variations in research approaches, and the effects of interventions in independent studies while integrating the results of the included studies. Therefore, a systematic review and meta-analysis will enable an assessment of the overall effectiveness of simulation-based education in improving empathy among nursing students. This study aims to provide a foundation for simulation-based interventions by conducting a systematic literature review and meta-analysis to examine their effectiveness in improving empathy among nursing students.

Study design

This systematic literature review and meta-analysis followed the Population, Intervention, Comparison, Outcome, and Study Design (PICO-SD) framework to determine the effectiveness of simulation-based interventions in improving empathy among nursing students.

Eligibility criteria and outcome variables

This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 18 ]. This was prepared by referring to the PRISMA 2020 checklist ( https://prisma-statement.org/PRISMAStatement/Checklist.aspx , accessed May 16, 2023). In line with this study’s purpose, a systematic literature search was conducted. The inclusion criteria were as follows: the study population (P) included nursing students who received simulation training; the intervention (I) included nursing education using simulation to promote empathy; the control I group comprised those who did not receive the simulation intervention as a comparison group; and for outcomes (O), the primary outcome was empathy, while the secondary outcomes wereempathic communication, interpersonal relationships, and competency. The first post-intervention value was used to calculate the effect size. The study design (SD) involved randomized controlled trials (RCTs) and quasi-experimental studies that included manuscripts published in English or Korean from May 1971 to April 2023. Only studies that reported means, standard deviations, and concrete sample sizes were included to merge the effect sizes for the primary and secondary outcomes. The exclusion criteria were as follows: studies that included students other than nursing students, interventions that were not simulations, measured variables that were not graphically represented such that effect sizes could not be merged, studies that only presented p-values or the number of participants in each group, studies with mean and standard deviation not available, and duplicate studies. Quasi-experimental studies with a single-group pretest-posttest design were excluded.

Search strategies

Data were retrieved from eight electronic databases or e-journals, specifically PubMed, Cochrane, EMBASE, CINAHL, World of Science, SCOPUS, PQDT, and Research Information Sharing Service (RISS), for articles published in English and Korean from May 1971 to April 2023. The search protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews (registration no. CRD42023423747, available at https://www.crd.york.ac.uk/prospero ) on May 16, 2023. The search formula used was Medical Subject Headings (MeSH) and text words from titles and abstracts, and the search was conducted from April 24, 2023, to June 3, 2023. The terms used in the search were (“Simulation Training”[MeSH Terms] OR “simulate*”[All Fields]) OR (“psychodrama”[MeSH Terms] OR “psychodrama*”[All Fields] OR “role-play*”[All Fields]) for interventions, and (“Empathy”[MeSH Terms] OR “empath*”[All Fields] OR “Emotional Intelligence”[MeSH Terms] OR “Emotional Intelligence”[All Fields]) for results. The data collection process for the articles included in the analysis was based on a systematic review. A literature search was conducted by two authors (MYK and MKC) with the guidance of a meta-analysis expert.

Quality assessment

The quality of the selected articles was independently assessed by two authors (MYK and MKC) using the Joanna Briggs Institute (JBI) checklist (Checklist for Randomized Controlled Trials, Checklist for Quasi-Experimental Studies [ 19 , 20 , 21 ]. In the initial quality assessment, no discrepancies were observed across most items. However, divergence arose regarding the clarity of blinding of outcome assessors to study participants. Upon thorough discussion, we agreed that a score would be assigned only if the methodology section of a study explicitly stated that outcome assessors were blinded to treatment assignment. The JBI RCT Checklist comprises the following 13 items: randomization, allocation concealment, pre-homogeneity verification, blinding (participants, interventors, and assessors), identical conditions other than experimental treatment, description of dropouts, analysis based on randomization, equivalence of outcome measures, appropriateness of outcome variable measures and statistical analysis methods, and appropriateness of the study design [ 19 ]. The JBI Quasi-Experimental Studies Checklist comprises the following nine items: certainty of cause and effect, pre-homogeneity verification, exposure to the same environment outside of the intervention, presence or absence of a control group, pre- and post-intervention effect measures, description of dropouts, equivalence of outcome measures, appropriateness of outcome variable measures, and statistical analysis methods [ 20 ]. The checklist scored “yes” as 1 and “unclear,” “no,” and “not applicable” as 0 for each item. Discrepancies in the quality assessment of the studies were resolved through consultation with a meta-analysis expert and discussions between the two authors (MYK and MKC) (Table  1 ).

Selection process

The two authors (MYK and MKC) shared the search formula, searched for data independently, and shared the bibliographic information of the articles retrieved from domestic and foreign core electronic databases and journals in an Excel file. Duplicate articles were removed by sorting by title and author using the Microsoft Excel filtering function. Based on this search strategy, relevant articles were identified through titles and abstracts, after which the full texts of the selected articles were reviewed.

Data analysis and statistical methods

The article characteristics were presented as frequencies, means, and standard deviations, and statistical analyses of effect size pooling methods were performed Z-test and p-value using MIX 2.0 Pro Ver. 2.0.1.6 (BiostatXL, Mountain View, CA, USA). As the effect sizes were continuous variables, and the number of participants in each study was small, Hedge’s g, 95% confidence intervals (CI), and the weight of each effect size were obtained using the inverse of variance [ 22 ]. The overall effect (Hedges’ g) was calculated using a pooled, random-effects model to account for between-participant variations in individual studies and heterogeneity among studies. The effect sizes indicated by Hedge’s g values of 0.15, 0.40, and 0.75 were classified as small, medium, and large effects, respectively [ 23 ]. The studies’ heterogeneity was assessed by calculating Higgin’s I 2 value, which represented the true variance or variance ratio across studies to the total observed variance. It was interpreted as heterogeneous if I 2 was greater than 50%. Subgroup and meta-regression analyses were performed to identify the sources of heterogeneity. Publication bias in the selected studies was tested using funnel plots, Begg’s test, Egger’s regression test, and the trim-and-fill method with a correction for Hedge’s g [ 24 ].

Study selection

This study followed the PRISMA guidelines during the study selection process, as illustrated in Fig.  1 . A total of 1,265 articles were retrieved from each database in Step 1. Furthermore, 578 articles were extracted by excluding duplicate studies (686) and one retracted article in Step 2, and 81 articles were extracted by excluding studies that did not fulfill the inclusion and exclusion criteria in Step 3. Finally, after a thorough review and full-text reading, 25 articles meeting our search criteria were identified for inclusion. Notably, Layton’s (1979) study was distinguished by its comparison of experimental and control groups across four distinct simulation interventions. Given the unique structure of this study, each simulation intervention was treated as a separate unit of analysis, thereby extending the total number of analyzed studies to 28. In this study, the participants of the studies included in the meta-analysis were undergraduate nursing students, and a total of 2,598 participated. The data extraction form was compiled by extracting the author, year of publication, presence or absence of IRB, number of participants, research design, experimental group’s intervention type, intervention session, session time, control group’s intervention, post-test measurement time, delayed measurement, and outcome variables. The primary variable, empathy score, and the secondary variables, empathic communication, interpersonal relationships, and competency were coded as the mean, standard deviation, and number of samples of the first post-test or the difference value of the post-pretest for both the experimental and control groups after the intervention.

PRISMA flow diagram

Study characteristics

The analysis included 28 studies, with 15 published in 2019 or later, 23 with IRB reviews before the study. The research design for simulation-based interventions included 14 RCTs: 13 with 60 or more participants, 13 simulated-based learning, 15 role-plays, and 21 studies with usual or no interventions for the control group. Simulation-based learning encompasses a variety of structured activities designed to mirror real or potential scenarios in educational settings, facilitating practice and skill development. These activities enable participants to augment their understanding, expertise, and mindset, while also providing opportunities to analyze and address realistic situations within a simulated environment [ 25 ]. Role-playing entails the enactment of specific roles within defined contexts. For instance, it may encompass a situated teaching program where patients portray themselves and articulate their experiences within a psychiatric nursing practice setting, or a role-playing training regimen conducted within an operating room situation. The intervention time or session was more than 1 h, the outcome was measured immediately after the intervention, the outcome was followed up, pre-briefing was conducted, and debriefing was conducted in study ID: 24, 11, 12, 26, 10, 6, and 14 studies. The majority of the control group adheres to a Traditional curriculum. This curriculum typically includes conventional empathic skill training through lectures, seminars, individual presentations at meetings, discussions, and similar formats. In contrast, for the experimental group, simulation involves a sequence of processes (such as orientation, pre-briefing, SP simulation performance, debriefing, and feedback). Typically, this process occurs once rather than being repeated. The impact is evaluated following the completion of this singular series of processes. The predominant empathy scale utilized was The Jefferson Scale of Empathy-Health Profession-Student (JSE-HP-S), with various other assessment tools also employed to measure empathy.

The primary outcome was empathy, which was assessed in all 28 studies. Empathic communication, interpersonal relationships, and competency were measured in study ID: 5, 6, and 9 studies, respectively (Appendix 1 ). When the sample size is small, Cohen’s d may exaggerate the effect size of an individual study. Therefore, the adjusted effect size, referred to as Hedge’s g [ 25 ], was provided along with 95% Confidence Intervals. Hedge’s g was calculated by entering the mean, standard deviation, and number of samples of each study’s experimental and control groups into the Mix Pro 2.0 program.

Risk of bias in studies

The average quality assessment score for RCTs was 8.18 (SD 0.75, range: 7–9), and the average quality assessment score for quasi-experimental studies was 8.00 (SD 1.11, range: 6–9). Among the internal validity assessment items for the RCT studies, “Q2. Was the allocation to treatment groups concealed?” for bias related to selection and allocation, and “Q5. Were those delivering the treatment blinded to the treatment assignment?” for bias related to administration of intervention or exposure, and “Were outcome assessors blind to treatment assignment?” for bias related to the assessment, detection, and measurement of the outcome were not reported in any study. Furthermore, “Q4. Were participants blinded to the treatment assignments?” was reported in only one study, and “Q12. Was an appropriate statistical analysis used?” was used to measure the validity of the statistical conclusions in three studies. Most items (Q1-5, Q7-9) that assess the quality of quasi-experimental studies have been reported. “Q6. Was the follow-up complete, and if not, were the differences between groups in terms of their follow-up adequately described and analyzed?” were reported in only seven studies (Table  1 ).

Effect of simulation-based intervention on empathy

Layton’s (1979) study was distinguished by its comparison of experimental and control groups across four distinct simulation interventions. Each simulation intervention was treated as a separate unit of analysis, thereby extending the total number of analyzed studies to 28. The effect sizes were pooled using a random-effects model and presented as Hedge’s g, 95% CI, weight, and a synthesis forest plot (Fig.  2 ). Using a simulation-based intervention among nursing students significantly increased empathy, with a total effect size of Hedge’s g = 0.35, which was a small effect based on Brydges’ criteria for interpreting effect sizes. The effect sizes indicated by Hedge’s g values of 0.15, 0.40, and 0.75 were classified as small, medium, and large effects, respectively [ 26 ]. The heterogeneity test revealed a Higgins I 2 value of 84.8%, indicating a high degree of heterogeneity among merged studies. Therefore, subgroup and meta-regression analyses were conducted for exploratory and descriptive heterogeneity analyses.

The effect of simulation-based intervention on empathy. Notes. ES: Effect size; CI: Confidence interval. Superscripts a, b, c, and d were Layton’s (1979) study divided by intervention

In the subgroup analyses, a significant increase in empathy was reported in the studies published after 2019 (Hedge’s g = 0.52, 95% CI:0.31, 0.73), IRB-approved studies (Hedge’s g = 0.39, 95% CI:0.15, 0.62), quasi-experimental studies (Hedge’s g = 0.51, 95% CI:0.27, 0.74), simulation-based interventions (Hedge’s g = 0.43, 95% CI:0.22, 0.65), and studies with no control group intervention or with usual interventions (Hedge’s g = 0.30, 95% CI:0.08, 0.53). The same was reported in studies with the intervention time per session not reported or less than 1 h (Hedge’s g = 0.42, 95% CI:0.20, 0.63), studies measuring the outcome right after the intervention (Hedge’s g = 0.38, 95% CI:0.16, 0.60), studies adopting no follow-up measurements for verifying the intervention’s long-term effects (Hedge’s g = 0.45, 95% CI:0.22, 0.68), and studies performing debriefing after simulation (Hedge’s g = 0.48, 95% CI:0.18, 0.78), compared to the studies that did not. Additionally, the effect sizes for the number of participants, pre-briefing, and quality assessment score were statistically significant (Table  2 ).

Univariate meta-regression analysis was performed to determine the potential impact of study heterogeneity on effect size, which revealed that the following variables had statistically significant effects—specifically, year of publication, IRB-approved studies, the number of participants, study design, intervention type, control group intervention, and intervention time per session (Table  3 ). The exclusion sensitivity test excluded one study from each of the 28 studies and compared the merged effect size to the original effect size to determine the impact of the estimated effect size [ 24 ]. Examining the magnitude and statistical significance of the combined effect sizes of the simulation-based interventions indicated that Hedge’s g was small, ranging from 0.31 to 42, the 95% CI (0.10 to 0.23, 0.52 to 0.61) did not include zero, and all were statistically significant. The effect size was not significantly different from that of Hedge’s g (0.35), including all 28 studies, and all studies were statistically significant. Therefore, the meta-analysis was considered robust (Table  4 ).

Effect of an intervention program on secondary outcomes

Secondary outcomes were empathic communication, interpersonal relationships, and competency, all of which were statistically significant. After the program, empathic communication with Hedge’s g = 1.35 (95% CI:0.25, 2.45), interpersonal relationship with Hedge’s g = 0.52 (95% CI:0.21, 0.84), and competency with Hedge’s g = 0.75 (95% CI:0.24, 1.26), indicating medium to large effect sizes (Table  5 ).

Publication bias

Funnel plot analysis was conducted to assess publication bias, which revealed that the individual effect sizes (blue circles) of the 28 included studies were skewed to the right, indicating some degree of publication bias (Fig.  3 ). For further analysis of publication bias, using the trim-and-fill method, the number of articles that should be added to the study was identified as nine [ 27 ]. The corrected effect size of the 37 articles was 0.04 (95%CI: -0.19, 0.26). The effect size of empathy was smaller after correction than before, but the difference was not statistically significant after correction. Moreover, the results of different methods used to detect publication bias differed. Nonetheless, the results obtained using the trim-and-fill method, which is particularly effective in illustrating publication bias in continuous variables, indicated publication bias in this study (Appendix 2 ).

Funnel plot of simulation-based interventions for empathy. Notes. Precision = 1/standard error, 0.05; limit line = 95% confidence limit

A random-effects on the results of 28 studies was performed to quantify the influence of simulation on empathy among undergraduate nursing students. The impact of the simulation-based program on empathy showed a small effect size, specifically with an effect size of 0.35. Despite variance within studies and heterogeneity in effects between studies, it was observed that the vast majority of nursing students agree that simulation increases empathy and that empathy is greater after simulation than before. The high I2 indicates significant heterogeneity, which consequently reduces the precision of summary estimates.

This aligns with previous primary research, indicating that to empathize with others beyond oneself, it’s essential to understand the other person’s perspective or position. Moreover, research suggests that such empathy can be cultivated through education [ 28 ]. This finding is also consistent with a previous study reporting that learning could improve empathy and a meta-analysis finding that empathy training improved empathy [ 17 , 29 , 30 ]. This study corroborates earlier primary research findings suggesting that empathy training ought to incorporate real-life experiences via imagination and simulations, with a focus on understanding the unobservable mental processes of others [ 31 ].

Based on a meta-regression analysis evaluating empathy [ 17 ], the factors influencing improvements in empathy are discussed below. Initially, upon scrutinizing the content of recent simulations (since 2019), they delineate as follows: Publication years after 2019 had a more significant impact on empathy than publication years before 2019. The COVID-19 pandemic has significantly influenced prelicensure nursing education, resulting in extensive disruptions that potentially affect the learning and engagement outcomes of nursing students [ 31 ]. These results reflect the diversification and sophistication of simulation education. This is because, reportedly, nursing schools in Korea have been educating and evaluating core nursing skills designated by the Korean Accreditation Board of Nursing Education as curricular and extracurricular programs to improve the clinical performance of nursing students, with an increasing number of simulation classes based on clinical scenarios similar to the clinical environment since the 2000s [ 32 ]. Since 2019, simulations have been conducted systematically and actively. Thus, the impact on empathy was significantly greater after 2019.

The causes of heterogeneity in characteristics are as follows: The effect on empathy was notably stronger with IRB approval, implying that undergoing an IRB review may signal a scientifically and ethically robust study design. Ensuring scientifically sound design and impact evaluation is crucial, even with the same program. Concerning study design, empathy’s impact was more pronounced in quasi-experimental studies compared to randomized controlled trials (RCTs). Rigorous designs, as seen in certain RCTs with multiple controls, might lead to conservative estimates of simulation effects on empathy due to tight control. Conversely, quasi-experimental studies conducted in natural learning environments suggest empathy impacts may stem from factors beyond simulation. However, further validation through research is needed. Moreover, empathy’s impact was significantly higher with 60 or more participants, likely due to increased effect power. Hence, repeated studies with sufficient participant numbers are essential for evaluating empathy improvements.

By program type, scenario-based simulations had a more significant impact on empathy than role-playing, which is in line with a previous study suggesting that role-play is usually based on a simple situation [ 33 ]. By contrast, the simulation was based on a structured scenario that allowed participants to indirectly experience the care recipient’s condition, thereby matching another person’s mind with their mental state. Moreover, role-playing has been found to contribute to empathy, as reported in a previous study in which nursing students’ critical thinking and emotional intelligence increased significantly after learning digital storytelling problem-based learning through role-playing, and a case study containing the care recipient’s disease experience and overall clinical situation [ 34 ]. More elaborate settings, assumptions, and preparations for the situation are needed to enable students to experience what being in the situation feels like rather than merely playing a role, which is expected to allow students to be more immersed cognitively and emotionally engaged with the target situation.

The intervention duration was significantly longer for four weeks or more than four weeks than for non-reported or less than four weeks, suggesting that the intervention should be at least four weeks in line with the idea that empathy is formed through continuous and steady learning [ 1 ]. This finding indicates that empathy cannot be improved through a short period of experience or training. Instead, empathy, as a process of integrating experiences and existing perceptions, is formed over time.

Other variables whose effects on empathy were not statistically significant were as follows: There were no significant differences in the time per intervention session, whether the outcome measurement time was immediate or delayed, outcome follow-up, prebriefing, debriefing, or quality score. In typical simulation training, prebriefing and debriefing are considered essential and reflective. Nevertheless, this study found no significant effect of pre-or debriefing on empathy, suggesting that the simulation context in which empathy is provided is essential, considering the nature of empathy. However, further studies on this topic are required. Furthermore, in this study, empathy was assessed using a variety of measurement tools. We also recommend that future analyses take into account the specific measurement tools employed.

The findings of this study affirm that simulation-based education, when employed across diverse clinical contexts such as women’s health, operating room scenarios, psychiatric nursing, and geriatric nursing, constitutes a fundamental approach for fostering empathy among nursing students. Among the myriad approaches aimed at enhancing empathy among medical students, the implementation of “patient simulation”—involving students in a curriculum that mirrors real patient encounters—has been noted as effective [ 35 ]. Furthermore, previous studies examining the relationship between proficiency and person-centered care competence have consistently demonstrated a positive correlation between empathy and competence in delivering person-centered care [ 36 , 37 ].

In this study, we conducted a meta-analysis of research exploring the impact of simulation-based education on empathy. Our findings indicate that simulation-based training across diverse scenarios can indeed enhance empathy levels. Specifically, focusing on immersive simulations conducted for a minimum duration of four weeks, spanning a range of authentic clinical contexts, proved to be particularly effective. Moreover, our study underscores the holistic nature of empathy, revealing its interconnectedness with other nursing competencies. As such, further research in this domain is warranted to deepen our understanding and refine instructional methodologies.

Data availability

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

Abbreviations

Population, Intervention, Comparison, Outcome, and Study Design

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Study Design

Randomized Controlled Trials

Research Information Sharing Service

Prospective Register of Systematic Reviews

Medical Subject Headings

Joanna Briggs Institute

Jefferson Scale of Empathy-Health Profession-Student

Shin HJ, Cho MO. Influence of critical thinking disposition and empathy ability on self- leadership of nursing students. J Korean Assn Learn Cent Curric Instr. 2023;23(2):115–27. https://doi.org/10.22251/jlcci.2023.23.2.115 .

Article   Google Scholar  

Hatfield E, Rapson R. Emotional contagion and empathy. In: The Corsini Encyclopedia of Psychology and Behavioral Science. 2009. https://doi.org/10.7551/mitpress/9780262012973.003.0003 .

Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med. 2011;86(3):359–64. https://doi.org/10.1097/acm.0b013e3182086fe1 .

Article   PubMed   Google Scholar  

Menendez ME, Chen NC, Mudgal CS, Jupiter JB, Ring D. Physician empathy as a driver of hand surgery patient satisfaction. J Hand Surg Am (Am Ed). 2015;40(9):1860–e51862. https://doi.org/10.1016/j.jhsa.2015.06.105 .

Nunes P, Williams S, Sa B, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Int J Med Educ. 2011;2:12–7. https://doi.org/10.5116/ijme.4d47.ddb0 .

Ferri P, Guerra E, Marcheselli L, Cunico L, Di Lorenzo R. Empathy and burnout: an analytic cross-sectional study among nurses and nursing students. Acta Biomed. 2015;86(Supplemento 2):104–15.

PubMed   Google Scholar  

Ryu HR, Bang KS. A validation study of the Korean version of the Jefferson empathy scale for health professionals for Korean nurses. J Korean Acad Nurs. 2016;46(2):207–14. https://doi.org/10.4040/jkan.2016.46.2.207 .

Ozcan CT, Oflaz F, Sutcu Cicek H. Empathy: the effects of undergraduate nursing education in Turkey. Int Nurs Rev. 2010;57(4):493–9. https://doi.org/10.1111/j.1466-7657.2010.00832.x .

Article   CAS   PubMed   Google Scholar  

Williams B, Brown T, Boyle M, McKenna L, Palermo C, Etherington J, Williams B, Brown T, Boyle M, McKenna L, Palermo C, Etherington J. Levels of empathy in undergraduate emergency health, nursing, and midwifery students: a longitudinal study. Adv Medical Educ Pract. 2014;5:299–306. https://doi.org/10.2147/AMEP.S66681 .

Williams B, Brown T, McKenna L, Boyle MJ, Palermo C, Nestel D, Brightwell R, McCall L, Russo V. Empathy levels among health professional students: a cross-sectional study at two universities in Australia. Adv Med Educ Pract. 2014;5:107–13. https://doi.org/10.2147/AMEP.S5756 .

Article   PubMed   PubMed Central   Google Scholar  

Roger D, Hudson C. The role of emotion control and emotional rumination in stress management training. Int J Stress Manag. 1995;2:119–32. https://doi.org/10.1007/BF01740298 .

Bas-Sarmiento P, Fernández-Gutiérrez M, Baena-Baños M, Correro-Bermejo A, Soler-Martins PS, de la Torre-Moyano S. Empathy training in health sciences: a systematic review. Nurse Educ Pract. 2020;44:102739. https://doi.org/10.1016/j.nepr.2020.102739 . Article Unsp 102739.

Harris KB, McCarty D, Wilson JA, Nealy KL, Waghel R, Coleman M, Battise D, Boland C. The use of a disease state simulation assignment increased students’ empathy and comfort with diabetes nutrition counseling. Curr Pharm Teach Learn. 2018;10(9):1272–9. https://doi.org/10.1016/j.cptl.2018.06.017 .

Bearman M, Palermo C, Allen LM, Williams B. Learning empathy through simulation: a systematic literature review. Simul Healthc. 2015;10(5):308–19. https://doi.org/10.1097/sih.0000000000000113 .

Eost-Telling C, Kingston P, Taylor L, Emmerson L. Ageing simulation in health and social care education: a mixed methods systematic review. J Adv Nurs. 2021;77(1):23–46. https://doi.org/10.1111/jan.14577 .

Brunero S, Cowan D, Chaniang S, Lamont S. Empathy education in post-graduate nurses: an integrative review. Nurse Educ Today. 2022;112:105338. https://doi.org/10.1016/j.nedt.2022.105338 .

Bearman M, et al. Learning empathy through simulation: a systematic literature review. Simul Healthc. 2015;105:308–19. https://doi.org/10.1097/SIH.0000000000000113 .

Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA group preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Br Med J. 2009;339:b2535. https://doi.org/10.1136/bmj.b2535 .

JBI. 2020 ( https://jbi.global/critical-appraisal-tools accessed on 16 May 2023).

Barker TH, Stone JC, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J, Aromataris E, Munn Z. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evid Synth. 2023;21(3):494506. https://doi.org/10.11124/JBIES-22-00430 .

Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Chapter 3: Systematic reviews of effectiveness. In: Aromataris E, Munn Z, editors. JBI Manual for Evidence Synthesis. JBI, 2020. https://synthesismanual.jbi.global ( https://jbi.global/critical-appraisal-tools accessed on 16 May 2023).

Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to meta-analysis. West Sussex, UK: Wiley; 2009.

Book   Google Scholar  

Sterne JA, Egger M, Moher D. Addressing Reporting Biases. In Cochrane Handbook for Systematic Reviews of Interventions: 2nd ed. Higgins JP, Green S. Eds.; Version 5.1.0 (Updated March 2011); The Cochrane Collaboration: London, UK. 2011.

Pilcher J, et al. Simulation-based learning: it’s not just for NRP. Neonatal Netw. 2012;31(5):281–8. https://doi.org/10.1891/0730-0832.31.5.281 .

Brydges CR. Effect size guidelines, sample size calculations, and statistical power in gerontology. Innov Aging. 2019;3(4):igz036.

Bown MJ, Sutton AJ. Quality control in systematic reviews and meta-analyses. Eur J Vasc Endovasc Surg. 2010;40(5):669–77. https://doi.org/10.1016/j.ejvs.2010.07.011 .

Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics. 2000;56:455–63. https://doi.org/10.1111/j.0006-341X.2000.00455.x .

Jeong JO, Kim S. The effect of an empathy education program on nursing students’ empathy ability, interpersonal ability, and caring. J Korean Acad Soc Nurs Educ. 2019;25(3):344–56. https://doi.org/10.5977/jkasne.2019.25.3.344 .

Levett-Jones T, Cant R, Lapkin S. A systematic review of the effectiveness of empathy education for undergraduate nursing students. Nurse Educ Today. 2019;75:80–94. https://doi.org/10.1016/j.nedt.2019.01.006 .

Patel S, Pelletier-Bui A, Smith S, Roberts MB, Kilgannon H, Trzeciak S, Roberts BW. Curricula for empathy and compassion training in medical education: a systematic review. PLoS ONE. 2019;14:e0221412. https://doi.org/10.1371/journal.pone.0221412 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Yeo H. Predictors of empathy for nursing students. J Korea Acad-Indust coop Soc. 2017;18(1):177–84. https://doi.org/10.5762/KAIS.2017.18.1.177 .

Martin B, Kaminski-Ozturk N, O’Hara C, Smiley R. Examining the impact of the COVID-19 pandemic on burnout and stress among U.S. nurses. J Nurs Regul. 2023;14(1):4–12. https://doi.org/10.1016/S2155-8256(23)00063-7 .

Kim SY. The effect of subjective happiness, ethical sensitivity, Empathy ability on personality in nursing students. J Digit Converg. 2022;4737–45. https://doi.org/10.14400/JDC.2022.20.4.737 .

Kim KM. Effects of grit, empathy, and awareness of the nursing profession on clinical performance of nursing students. J Korean Assn Learn Cent Curric. 2022;22(16):47–58. https://doi.org/10.22251/jlcci.2022.22.16.47 .

Chang HK, Do YJ. Problem-based learning using digital storytelling: examining intelligence, critical thinking disposition, clinical competence, and metacognition. J Korean Assn Learn Cent Curric. 2021;21(8):853–66. https://doi.org/10.22251/jlcci.2021.21.8.853 .

Chen JT, LaLopa J, Dang DK. Impact of patient empathy modeling on pharmacy students caring for the underserved. Am J Pharm Educ. 2008;72(2):40. https://doi.org/10.5688/aj720240 .

Park E, Choi J. Attributes associated with person-centered care competence among undergraduate nursing students. Res Nurs Health. 2020;43(5):511–9. https://doi.org/10.1002/nur.22062 .

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This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean Government (MSIT) (No. 2022R1F1A1076248).

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Cho, MK., Kim, M.Y. Effectiveness of simulation-based interventions on empathy enhancement among nursing students: a systematic literature review and meta-analysis. BMC Nurs 23 , 319 (2024). https://doi.org/10.1186/s12912-024-01944-7

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Child sexual abuse, adolescent/adult sexual violence, and sexual functioning among college women: a systematic review

• Prachi H. Bhuptani 1 , 2 ,
• Elizabeth Mayer 2 ,
• Georgia Chan 3 &
• Lindsay M. Orchowski 1 , 2  

BMC Global and Public Health volume  2 , Article number:  29 ( 2024 ) Cite this article

Metrics details

Sexual violence, including childhood sexual abuse and adolescent/adult sexual assault, is a major public health concern, especially for college women. Sexual violence is associated with numerous negative consequences, including difficulties relating to sexual functioning. The current systematic review aimed to synthesize the existing research literature examining the association between sexual violence on sexual functioning among college women.

Only peer-reviewed articles reporting original data and written in English, which assessed for sexual functioning and sexual violence among a sample of college women, were included in the review. Articles were included if the research study assessed sexual violence occurring in childhood, adolescence, or adulthood.

A total of 21 articles met these inclusion criteria and were included in the synthesis of the literature. In studies of college women, sexual violence occurring in adulthood was associated with worse sexual functioning outcomes among college women in 7 of the 21 studies. Findings were mixed regarding the association between childhood sexual abuse and sexual functioning among college women. Further, in three studies, psychological symptoms (e.g., depression, anxiety) mediated the association between sexual violence in adulthood and worse sexual functioning among college women. Studies varied in what domains of sexual functioning were assessed, and as a result, a limited number of studies included assessments of the same domain of sexual functioning. Further, some studies did not assess sexual violence at multiple points in development (i.e., childhood, adolescence, adulthood).

Conclusions

Future studies with longitudinal designs and a wider range of sexual functioning outcomes are needed, including studies focused on women attending 2-year and technical colleges.

Peer Review reports

Sexual violence is a major social and public health problem [ 1 ]. Sexual violence is any nonconsensual sexual act including sexual contact, sexual coercion, facilitated sexual assault, attempted rape, and completed rape that can occur in childhood and/or adulthood [ 2 ]. Sexual violence is especially prevalent among college women in the United States [ 3 ]. For example, a recent systematic review suggested that as many as 25% of female college students in the United States may have experienced some form of sexual violence at some point in their lives [ 4 ]. Further, over half of the women in the United States experience some unwanted sexual contact in their lives, while one in four women experiences lifetime attempted or completed rape [ 2 ]. Lastly, one in four women experiences child sexual abuse (CSA) before the age of 18 [ 2 ]. Researchers suggest, however, that estimates of the prevalence of sexual violence among college women are likely to under-represent the scope of the problem [ 5 ]. Sexual violence is associated with numerous negative psychological, physical, and relational consequences [ 6 , 7 , 8 , 9 ]. Given the intimate nature of sexual violence, many survivors also struggle with sexual functioning following an assault [ 10 ].

When examining sexual functioning among survivors of sexual violence, comprehensive indicators of sexual functioning need to be included. Although there is no uniform definition of sexual functioning, the World Health Organization (WHO) refers to sexual functioning as sexual health and defines it as encompassing sexuality-related physical, emotional, mental, and social well-being [ 11 ]. The Diagnostic Statistical Manual for Mental Disorder , 5th edition ([DSM-5, [ 12 ]] refers to sexual functioning as sexual dysfunction and refers to a wide-ranging set of problems associated with an impaired ability to “respond sexually or to experience sexual pleasure.” Specific areas of sexual dysfunction described by the DSM-5 include physiological aspects such as desire, arousal, pain, orgasm, and lubrication along with psychological aspects such as satisfaction. The empirical literature has also examined sexual satisfaction as an important form of sexual function involving global sexual satisfaction and a range of specific sources such as sexual competence, sexual communication, and sexual compatibility [ 13 ]. Apart from the areas outlined by DSM-5, individuals who experience sexual violence may also experience a wider range of psychological difficulties associated with sex, such as sexual aversion [ 10 ] and negative sexual self-esteem [ 14 , 15 ]. Thus, when investigating sexual functioning correlates among survivors of sexual violence, it is important to examine correlates beyond those identified by the DSM-5 such as sexual self-esteem [ 14 , 15 , 16 ], sexual schema [ 17 ], erotophilia [ 17 ], sex-related guilt [ 18 ], sex-related dissociation [ 19 ], sexual avoidance/aversion [ 10 ], and assertiveness [ 10 ].

Sexual functioning difficulties are widely prevalent among individuals who experience sexual violence [ 20 ]. Whereas 40–45% of women experience difficulties with sexual functioning regardless of a prior history of assault [ 21 ], approximately 60% of women who have experienced sexual abuse or assault experience some form of difficulties with sexual functioning [ 22 , 23 ]. The ways in which sexual violence impacts sexual functioning is complex. For example, some studies suggest that adolescent/adult sexual assault (ASA) is associated with difficulties in some domains of sexual functioning, including lower sexual satisfaction [ 24 ] and diminished sexual desire [ 25 ], whereas CSA is related to higher levels of negative sexual self-esteem [ 14 , 15 ] and lower response to sex therapy [ 26 ]. However, other studies fail to document an association between experiencing CSA or ASA and other domains of sexual functioning including sexual aversion [ 10 ], levels of sexual arousal [ 27 ], and difficulty with orgasm [ 27 ]. Given the varied impact of sexual violence on sexual functioning, it is important to synthesize prior literature on this topic.

Prior reviews have been conducted on the impact of childhood sexual abuse (CSA) on sexual functioning [ 20 , 28 , 29 , 30 ] as well as the impact of military sexual trauma (MST) on sexual functioning [ 31 ]. Each of these reviews suggests that CSA and MST are associated with greater risk of difficulties in sexual functioning in adulthood. To date, research addressing the potential link between violence in other developmental time periods other than CSA (including violence in adolescence or adulthood) and sexual functioning has yet to be synthesized. Investigating the impact of CSA as well as sexual violence in other development time periods on sexual functioning is important given that some studies report that ASA, but not CSA, impacts overall sexual functioning [ 10 , 27 , 32 ], difficulties with lubrication [ 27 ], and difficulties with sexual distress [ 27 ]. For these reasons, synthesizing the literature examining the impact of CSA as well as violence at other points in the lifespan — such as adolescence or adulthood — is important when attempting to understand the impact of sexual violence on sexual functioning among college women.

The current systematic review aimed to synthesize the existing research literature examining the association between sexual violence on sexual functioning among college women. We chose to focus on both childhood and adulthood sexual violence. Several factors drove our decision to focus specifically on studies among college women. Firstly, college years are a critical period during which women explore sexual behaviors and begin to define their sexual identity [ 33 ]. Secondly, college age women report higher levels of personal distress associated with sexual problems and more concerns related to sexual functioning compared to older women [ 34 , 35 ]. For example, in a study of 309 women from a Midwestern University in United States, 65.8% of college women reported a sexual dysfunction problem [ 25 ]. In reviewing the literature, we attempted to answer the following questions: (1) What is the prevalence of sexual dysfunction among college women with history of sexual violence? (2) What are the sexual functioning correlates of violence at various points in the lifespan (i.e., childhood, adolescence) among college women?

This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 36 ] (see Additional file 1 for PRISMA checklist). A Boolean search strategy was used to find studies in six electronic databases (EBSCO, ScienceDirect, PsycINFO, PubMed, Scopus, Web of Science). Variations of the following search terms were used for each electronic database: women, sexual trauma, sexual violence, intimate partner violence, sexual dysfunction, sexual function, and sexual well-being (see Additional file 2 for full search terms). Covidence systematic review software was used to retrieve and organize articles [ 37 ]. Researchers also performed manual searches of review articles and references. The initial search was completed in July of 2022. There was no date range for the review, and thus, all studies published before July of 2022 were included in the review.

Inclusion criteria, abstraction, and synthesis

Studies were included in the systematic review if they met the following inclusion criteria: (a) were a peer-reviewed article; (b) reported original data — subsamples were accepted; (c) the article was written in English; (d) the study assessed for sexual violence at some point in the lifespan; (e) the study assessed for at least one domain of sexual functioning; and (f) the study included a sample of college women. The first, second, and third authors independently screened abstracts and full-text articles. Each abstract and article was screened by at least two authors. The first and last authors performed data charting. The initial literature search resulted in 11,411 articles, 157 of which were identified as duplicates and removed. Researchers screened the title and abstract of these articles for eligibility. After initial screening, 10,972 articles were deemed ineligible for either not reporting findings on sexual violence or sexual functioning. A total of 281 articles were considered relevant for full-text screening. Of those, 262 articles were excluded for not reporting empirical data, not reporting findings on sexual functioning, or not explicitly sampling a defined cohort of college women. Dissertations were also excluded. The final 21 articles were then independently reviewed by members of the research team to assess the findings related to the impact of sexual violence on sexual functioning among college women. A PRISMA diagram illustrating the study selection process can be found in Fig.  1 .

PRISMA flow diagram. Systematic identification of studies that evaluated sexual functioning in college women who experienced sexual violence. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Authors used a structured and systematic data abstraction process to record data on study elements. All authors developed the abstraction form collaboratively, pilot tested the form on five articles, and deemed that no changes to the form were necessary. The process of article abstraction and comparison of data was conducted by all authors, and any discrepancies were discussed until consensus was reached. The abstraction form included inclusion and exclusion criteria, study design, sample, independent and dependent variables, assessment measures, and results. The abstraction process included results relevant to college women samples only.

Information collected on study design, measured outcomes, and evidence on the relationship between sexual violence and sexual functioning can be found in Table  1 .

Study designs

Findings yielded 21 studies that have examined the impact of sexual violence experiences on sexual functioning among college women [ 10 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 24 , 25 , 27 , 32 , 33 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ]. All studies except one [ 19 ] were cross-sectional in nature, using self-report survey-based designs. The study by Bird and colleagues [ 19 ] was experimental in nature.

Sample characteristics

Five of the 21 studies [ 10 , 14 , 17 , 27 , 41 ] examined the impact of sexual violence on sexual functioning among different subsets of the same sample of college women. Thus, the association between sexual violence and sexual functioning among female college survivors has been examined in 16 unique samples. Additionally, 2 of the 21 studies utilized samples that were recruited from college but involved both college women and community-residing women [ 19 , 40 ], and did not distinguish between which women in the sample were college women or community residing women. Notably, all but one [ 16 ] studies focused on a typical 4-year university. Lemieux and Byers [ 16 ] focused on both community college and 4-year university women without examining differences between the two. No study has focused solely on community college women survivors. The earliest study was published in 1983 [ 43 ], and the latest studies were published in 2020 [ 10 , 45 ]. Across studies, samples were primarly white and heterosexual (see Table  1 ).

Measurement of sexual violence experiences

Seven studies focused on survivors of CSA only [ 13 , 15 , 19 , 38 , 40 , 42 , 44 ]. There was also variability in the definitions used to distinguish between childhood and adolescent sexual violence. For example, four studies utilized Finkelhor’s [ 46 ] definition to classify CSA, which involves experiencing sexual noncontact or contact by a perpetrator who is at least 5 years older than the survivors, was a caretaker or an authority figure, or used some form of coercion or force was used to secure the survivors’ participation [ 13 , 15 , 38 , 40 ]. Varied age cut-off criteria were used to define CSA across these four studies. For example, two studies used 18 years and below as the age cutoff [ 13 , 40 ], one used 16 years and below [ 15 ], one used 12 years and below [ 44 ], and one did not specify any age cutoff [ 38 ]. Bird and colleagues [ 19 ] used the Childhood Trauma Questionnaire-sexual abuse subscale [ 47 ] to assess CSA, without specifying any age cutoff. Kinzl and colleagues [ 42 ] used a self-designed CSA checklist, again without specifying any age cut off. Lastly, Rellini and Meston [ 44 ] used an adapted measure of CSA and defined it as activities involving genital touch, oral sex, anal penetration, or vaginal penetration before the age of 12.

Four studies focused on survivors of ASA only [ 17 , 24 , 25 , 43 ]. Whereas three of the studies [ 17 , 24 , 43 ] defined ASA as unwanted sexual experiences occurring after the age of 14 and used varied versions of the Sexual Experiences Scale to measure ASA [ 48 , 49 ], Turchik and Hassija [ 25 ] used Sexual Coercion Tactics Scale [ 50 ] which as the age cut-off criteria of 16 and above.

Eight studies assessed for experiences of both CSA and ASA within the study sample [ 10 , 14 , 16 , 18 , 27 , 32 , 41 , 45 ]. All but one [ 16 ] used Finkelhor’s [ 46 ] definition to classify CSA. Lemieux and Byers [ 16 ] restricted measurement of CSA to contact behaviors (e.g., touching, fondling, intercourse) before the age of 13. Of the remaining studies, all except one [ 32 ] used the age cutoff of 14 and below. Bartoi and Kinder [ 32 ] used 16 years and below as the age cutoff for CSA. Further, all but one [ 32 ] of the studies used varied versions of the Sexual Experiences Scale to measure ASA [ 48 , 49 ] with the age cutoff of 14 and above. Bartoi and Kinder [ 32 ] used the age cutoff of 16 and above to classify ASA. Lastly, two studies assessed for lifetime history of sexual violence [ 33 , 39 ] and thus did not provide age cutoff.

Indicators of sexual functioning

Across 21 studies, there was variability in the indicators of sexual functioning measured. Eleven studies examined overall sexual functioning [ 16 , 17 , 18 , 25 , 27 , 33 , 38 , 39 , 40 , 41 , 44 ], seven studies examined sexual satisfaction [ 13 , 24 , 32 , 38 , 43 , 44 , 45 ], and three studies evaluated sexual self-esteem among survivors [ 14 , 15 , 16 ]. One study examined sexual schema which evaluated women’s view of themselves as sexual persons from a negative (i.e., embarrassment/conservatism) to positive (i.e., romantic, open) dimension along with erotophilia (i.e., participant’s affective response to certain sexual behaviors or stimuli) [ 17 ]. One study evaluated sex-related guilt [ 18 ]. One study measured levels of sexual arousal after watching an erotic video along with sex-related dissociation [ 19 ], whereas one study assessed sexual avoidance/aversion and assertiveness [ 10 ].

Prevalence rates of sexual dysfunction

Only three studies provided prevalence rates of sexual dysfunction [ 33 , 40 , 42 ] with two using the DSM-III criteria [ 40 , 42 ] and one using the DSM-IV diagnostic criteria [ 33 ]. Among women with history of CSA, 65% of survivors met DSM-III criteria for one or more sexual dysfunctions. Specifically, 50% reported inhibited sexual desire, 45% inhibited orgasm, 35% inhibited sexual excitement, 25% dyspareunia, and 10% vaginismus [ 40 ]. Another study evaluated prevalence rates of sexual dysfunction based on whether women experienced a single incident of CSA or multiple [ 42 ]. The authors found that among college women who had experienced single incident CSA, 11.1% met criteria for sexual pain disorders, 11.1% met criteria for sexual desire/arousal disorder, and 27.8% met criteria for orgasm disorder. The prevalence rates across domains increase exponentially when examining women with multiple incident CSA. Among these women, 15.4% met criteria for sexual pain disorder, 30.8% met criteria for sexual desire/arousal disorder, and 42.3% met criteria for orgasm disorder. The last study found among college women history of lifetime sexual violence, 83% ( n  = 167) experienced problems with sexual dysfunction, whereas around 44% ( n  = 167) of participants with at least one sexual dysfunction problem reported a history of lifetime sexual violence [ 33 ].

Impact of CSA on sexual functioning

Seven studies examined the impact of CSA on sexual functioning [ 13 , 15 , 19 , 38 , 40 , 42 , 44 ] among adult college women and demonstrated mixed findings for psychological aspects of sexual functioning. Two studies found that women with and without history of CSA do not differ on sexual satisfaction [ 13 , 38 ]. Specifically, Meston and colleagues reported that women with and without history of CSA did not differ on global sexual satisfaction and as well as specific domains such as sexual contentment, sexual competence, sexual communication, and sexual compatibility. However, two studies found women with history of CSA reported less satisfaction (overall and specific components such as decreased frequency of intercourse, poorer quality of communication, and poorer quality of orgasm) [ 40 ] and less sexual distress [ 44 ]. One study found that CSA severity was not associated with sex-related dissociation [ 19 ]. Three studies noted compared to women without history of CSA, and women with history of CSA do not differ on sexual functioning [ 38 , 44 ], sexual information [ 40 ] attitudes [ 40 ] experience [ 40 ], or fantasies [ 40 ]. Along this vein, another study found that history of CSA was not associated with sexual adjustment and self-esteem [ 15 ]. In contrast, one study found that history of CSA was associated with increased variety of sexual fantasies and experiences, increased unrestricted sexual behaviors, attitudes, and fantasies [ 13 ]. Similarly, whereas one study found that women with history of CSA demonstrated poorer body image [ 40 ], another study found that history of CSA was not associated with body image [ 13 ]. Lastly, one study found that specific abuse characteristics (i.e., vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse) were associated with sexual satisfaction but not with sexual function [ 44 ].

Studies also find mixed evidence for physical aspects of sexual functioning. Specifically, two studies noted compared to women without history of CSA, and women with history of CSA do not differ on sexual drive [ 40 ]. Similarly, one study found that history of CSA was not associated with avoidance of sexual activity, sexual desire, orgasmic capacity, having an orgasm, or anorgasmia [ 15 ]. In contrast, one study found that history of CSA was associated with lower sexual drive and increased masturbation [ 13 ]. One study found the survivors of repeated incidents of CSA significantly demonstrated more sexual dysfunction, as qualified by DSM-III, than those who experienced one incident of CSA or did not experience it all [ 42 ]. The authors also reported that individuals who did not experience CSA and those who experienced one incident of CSA did not differ on sexual functioning.

Impact of ASA on sexual functioning

Four studies have examined the impact of ASA on sexual functioning and found consistent associations between ASA and psychological (sexual satisfaction, sexual compatibility, and sexual concerns) and physical (desire and ability to achieve orgasm) functioning [ 17 , 24 , 25 , 43 ]. One study found that ASA severity was associated with sexual satisfaction such that women who experience sexual contact or rape reported less sexual satisfaction compared to those who experience pressure and/or coercion. One study found that women history of ASA reported less sexual compatibility with their sexual partners and higher levels of sexual concerns (but not global sexual contentment and sexual communication satisfaction) compared to women without history of SA [ 24 ]. Two studies found that ASA severity was associated with sexual functioning [ 25 , 43 ]. Specifically, women who reported experiencing sexual contact, sexual coercion, or rape were more likely to report a lack of sexual desire compared with those who reported no violence [ 25 ]. In addition, women who reported experiencing rape were more likely to report difficulty achieving orgasm compared with those who reported no violence [ 25 ].

Impact of ASA-related labeling

Two studies found that labeling of ASA also had an impact on both psychological and physical aspects of sexual functioning [ 17 , 24 ]. Specifically, one study found that labeling of ASA as assault was indirectly associated with greater levels of sexual lubrication difficulties and sexual dissatisfaction (but not sexual desire, arousal, orgasm, and pain) via anxious coping (but not avoidance and cognitive coping) [ 17 ]. Similarly, another study found that survivors who label their ASA experiences as sexual assault demonstrated significantly more sexual concerns than those without history of sexual assault [ 24 ]. However, the authors found that survivors who did not label their ASA experiences as assault were not significantly different from those labeled on sexual functioning.

Impact of ASA-related psychological symptoms

Four studies examined how psychological symptoms impacted physical and psychological aspects sexual functioning among ASA survivors [ 10 , 24 , 27 , 41 ]. ASA-related intrusive symptoms were associated with orgasm difficulties and sexual distress [ 27 ]. Another study found that increased anxiety and greater post-traumatic symptoms mediated the relationship between ASA and fewer sexual difficulties, but only post-traumatic symptoms mediated the relation between ASA and greater orgasm difficulties and ASA and greater sexual pain [ 41 ]. Further, increased depression symptoms also mediated the relation between ASA and greater sexual pain. The third study found that depression accounted for the majority of sexual concerns between individuals with and without history of ASA, suggesting that depressive affectivity may explain differences in sexual concerns between these two groups [ 24 ]. The fourth study reported that ASA-related post-traumatic stress symptoms did not mediate the relationship between ASA and sexual aversion [ 10 ].

Impact of joint experiences of CSA and ASA on sexual functioning

Eight studies assessed for both CSA and ASA within the study sample [ 10 , 14 , 16 , 18 , 27 , 32 , 41 , 45 ].

Differential impact of CSA and ASA

Five studies examined the differential impact of both CSA and ASA [ 14 , 16 , 18 , 27 , 32 ]. One found that a history of CSA was uniquely related to lower control sexual self-esteem, whereas history of ASA was uniquely related to greater erotophilia and more positive romantic/passionate sexual self-schema yet lower control, attractiveness, and moral/judgment sexual self-esteem [ 14 ]. Further, one study found that women who experienced penetration during CSA reported lower sexual self-esteem than those who experienced fondling during CSA or did not experience CSA [ 16 ]. Two studies found that that ASA, and not CSA, had a detrimental impact on sexual satisfaction [ 16 , 32 ]. One reported that women with history of ASA reported more sexual dissatisfaction and higher levels of nonsensuality compared to women with history of CSA and women without a history of sexual violence [ 32 ]. Further, the authors reported that women who were sexually abused in childhood did not differ on indicators of sexual functioning from women who were not victimized. Lastly, another study found that ASA severity (but not CSA severity) was associated with lubrication difficulties and sexual distress [ 27 ].

In contrast, five studies [ 10 , 18 , 27 , 32 , 41 ] find that neither ASA nor CSA were related to certain physical and psychological indicators of sexual functioning. For example, studies report that neither ASA nor CSA were related to sexual aversion [ 10 ], sexual arousal [ 27 ], orgasm difficulties [ 27 ], sexual functioning [ 41 ], anorgasmia [ 32 ], sexual avoidance [ 32 ], sexual noncommunication [ 32 ], vaginismus [ 32 ], fantasies [ 18 ], sex drive [ 18 ], sexual satisfaction [ 18 ], and sex guilt [ 18 ].

Additive impact of CSA and ASA

Two studies have examined additive impact of both CSA and ASA [ 14 , 16 ]. The authors found experiencing both CSA and ASA was not significantly related to any sexual functioning indicators, including pain, lubrication, orgasm, desire, arousal, and overall satisfaction [ 14 ], compared to survivors who experienced only CSA or ASA. Another study found contrasting results and indicated that compared to revictimized women, the women who had experienced CSA only had fewer sexual problems and lower sexual self-esteem [ 16 ].

Impact of lifetime history of sexual violence

Four studies assessed lifetime history of sexual violence [ 32 , 33 , 39 , 45 ] and largely found that lifetime history of sexual violence was related to adverse sexual functioning outcomes. One found that maladaptive sex motives (reduce their negative affect, improve their self-esteem, and obtain approval or avoid censure from their peers and sexual partners) mediated the relation between lifetime rape history and sexual satisfaction [ 45 ]. Another study reported that participants with a lifetime history of sexual violence were also about two times more likely to have difficulties with sexual functioning [ 39 ]. Another study found that women with history of lifetime sexual violence were 0.4 times likely to experience with female sexual interest/arousal problems and 0.7 times likely to experience female orgasmic problems [ 33 ]. In contrast to these three studies, one study found that women with lifetime history of sexual violence did not differ from those without a history of violence on interpersonal communication with sexual partner [ 32 ].

The purpose of the current review is to synthesize what is known about the relation between sexual functioning and sexual violence among college women. Specifically, the review aimed at identifying the prevalence of sexual dysfunction among college women with history of sexual violence. Additionally, results were synthesized to determine the sexual functioning correlates of both CSA and ASA among college women. Findings suggest that CSA is not uniformly related to varied indicators of sexual functioning among college women. For example, whereas two studies found that women with and without history of CSA do not differ on sexual satisfaction [ 13 , 38 ], one study found women with history of CSA reported less sexual satisfaction [ 40 ]. Similarly, whereas one study found a history of CSA was associated with poorer body image [ 40 ], another study found that history of CSA was not associated with body image [ 13 ]. One study also report that CSA severity [ 27 ] is not associated with sexual functioning outcomes. Findings are in contrast with prior reviews on sexual functioning and CSA which note a positive association between CSA and poorer sexual functioning [ 20 , 28 , 29 ].

Our findings may contradict prior reviews [ 20 , 28 , 29 ] for several reasons. Firstly, this is the first systematic review on this question, and previous reviews were all narrative. Thus, studies that may show nonsignificant findings between CSA and sexual functioning may not be included in the prior reviews. Secondly, the review conducted by Pulverman and colleagues [ 20 ] notes that associations between CSA and sexual functioning are examined in predominantly clinical and community samples. For example, only 2 of the 12 studies exmained in this review included college sample. Thus, findings of current review in conjuction with prior review suggests that CSA may not be relevant for all indicators of sexual functioning among nonclinical college samples.

Thirdly, there is considerable variability in how sexual functioning indicators were mesaured across the studies. For example, one study examined sexual satisfaction [ 38 ], and two studies also examined body image as an indicator of sexual functioning [ 13 , 40 ]. Jackson and colleagues measured global sexual satisfaction as well as satisfaction within specific such as decreased frequency of intercourse, poorer quality of communication, and poorer quality of orgasm [ 40 ]. However, Meston and colleagues [ 13 ] defined sexual satisfactions as including global sexual satisfaction and a range of specific sources of sexual dissatisfaction, including sexual contentment, sexual competence, sexual communication, and sexual compatibility [ 13 ]. Both studies found contrasting results indicating that CSA may be relevant for certain aspects of sexual satisfaction (e.g., poorer quality of orgasm) as opposed to others (e.g., sexual competence) [ 13 , 40 ]. Additionally, Alexander and Lupfer [ 38 ] did not define sexual satisfaction or provide a measure description with citation which may also contribute to variability in results. Lastly, abuse characteristics (rather than the presence versus absence of CSA) may be associated with sexual functioning. For example, one study found that experiencing multiple incidents of CSA rather than one incident may lead to poorer sexual functioning [ 42 ]. Another study found that vaginal penetration, fear at the time of the abuse, familial relationship with the perpetrator, and chronic frequency of the abuse were associated with sexual satisfaction [ 44 ]. Thus, future studies investigating link between CSA and sexual functioning must examine in the role of abuse characteristics [ 51 ].

In contrast to the link between CSA and sexual functioning among college women, findings from current review suggest that both history of ASA and severity is consistently linked to varied psychological aspects of sexual functioning indicators such as less sexual compatibility with their sexual partners [ 24 ], higher levels of sexual concerns [ 24 ], and less sexual satisfaction [ 43 ]. Additionally, history of ASA is associated with physiological aspects of sexual functioning as well such as a lack of sexual desire [ 25 ] and difficulty achieving orgasm [ 25 ]. Results are in line with prior systematic review on MST, a specific and unique form of ASA, and sexual functioning [ 31 ] that found a consistent relation between MST and sexual functioning among women veteran samples. The differential impact of ASA and CSA on sexual functioning among college women is reported by two studies [ 27 , 32 ]. The two studies found that ASA severity (but not CSA severity) was associated lubrication difficulties and sexual distress [ 27 ], and history of ASA (but not CSA) was associated with greater reported sexual dissatisfaction and higher levels of nonsensuality [ 32 ]. Thus, findings suggest that experiences of ASA must be attended to especially when working with college women with problems related to sexual functioning. Additionally, different mechanisms and thus different interventions may be salient in the association between ASA and physical aspects sexual functioning as well as ASA and psychological aspects of sexual functioning, a topic of future inquiry.

Review findings also suggest that the relation between ASA and sexual functioning is complex and nuanced. As a matter of fact, anxious coping [ 17 ], ASA-related intrusive symptoms [ 27 ], anxiety [ 41 ], and depressive affectivity [ 24 , 41 ] mediate the relation between ASA and sexual functioning indicators. In addition to being common post-assault experiences [ 8 ], depression and anxiety share a bidirectional relation with sexual functioning such that increased depression/anxiety is associated with poorer sexual functioning and vice versa [ 52 , 53 ]. Findings suggest that ASA experiences on their own may not contribute to poorer sexual functioning but rather psychological distress following an experience of ASA may contribute to poorer sexual functioning. Findings have specific implications for research and practice. Firstly, empirical investigation of sexual functioning and sexual violence must also investigate the impact of psychological distress on sexual functioning. Secondly, clinicians who work with clients who have a history of sexual violence and psychological distress must attend to challenges with sexual functioning. Lastly, although not investigated in the studies included in the review, gender norms may also play a salient role in the relation between sexual violence and sexual functioning. For example, within the US context, heterosexual sexual scripts largely guide sexual activity and assume that women will conform to feminine gender norms (e.g., passivity) and men will conform to masculine gender norms (e.g., assertiveness), and great gender conformity is associated with lower sexual satisfaction for women [ 54 , 55 ]. The very act of sexual violence may reinforce these gender scripts leading to lower sexual functioning. Thus, future studies should examine the role of gender norms in the relation between sexual violence and sexual functioning.

Only three studies have provided prevalence of female sexual dysfunction reported by college women with history of sexual violence [ 33 , 40 , 42 ]. Two studies found that among college women with history of CSA, 11–65% of survivors met DSM-III criteria for one or more sexual dysfunctions [ 40 , 42 ], whereas another study among college women with lifetime history of sexual violence found that 83% of survivors experienced problems with sexual dysfunction [ 33 ]. The prevalence rate of sexual dysfunction is higher than prevalence of female sexual dysfunction reported by college women in general (35–42%) [ 56 , 57 ] and community women (12–50%) [ 58 , 59 , 60 ]. Thus, findings highlight the detrimental impact of sexual violence on sexual functioning. However, additional future research is required to determine the prevalence of sexual dysfunction among college women survivors. Additionally, future studies should consider using diagnostic clinical interviews for female sexual dysfunction disorders and include all relevant diagnostic criteria to improve the accuracy and specificity of prevalence of sexual dysfunction in this overlooked population.

Findings also suggest the importance of examining varied indicators of sexual functioning, beyond those defined by the DSM-5 as results highlight that experiences of sexual violence may be associated with certain sexual functioning indicators that are not captured by the DSM-5 criteria for sexual dysfunction [e.g., sexual compatibility [ 24 ] or sex-related dissociation [ 19 ]]. Additionally, there is need for uniformity in measurement of similar domains of sexual functioning. Specifically, there is difference in conceptualization of similar domains of sexual functioning within studies evaluating similar outcomes such as sexual functioning [ 17 , 18 , 25 , 27 , 33 , 38 , 39 , 40 , 41 ] or sexual satisfaction [ 13 , 24 , 32 , 38 , 43 , 45 ], However, varied conceptualization may contribute to inconsistent findings noted in the review. Developing uniformity in measurement is recommended to improve understanding of the link between sexual functioning and sexual functioning.

All studies evaluated in this review are using the typical 4-year university samples, which overlooks community college women. Sexual violence is a pervasive concern among community college women as well with research estimating that 25% of women experience sexual violence prior to entering community college [ 61 ] and 12.7% of women experience sexual violence while enrolled in community college [ 62 ]. Further, compared to students enrolled at 4-year colleges, women at community colleges display particularly higher rates of sexual risk behaviors and greater physical and mental health concerns [ 63 , 64 , 65 ]. Thus, it is imperative that the outcomes of sexual violence, particularly sexual functioning, must be evaluated among college community samples as well. It should also be noted that two of the studies included in the review [ 19 , 40 ] include both college women and women residing in the community, but did not distinguish between these two groups in the study sample. Future research should take care to ensure that groups are clearly delineated, so that outcomes that might be utilized to inform practice, intervention and prevention activities in college health centers can be readily delineated from the research.

Relatedly, samples in studies identified in the review were predominantly White and heterosexual which limits investigation into how race and sexual orientation may impact relation between sexual violence and sexual functioning. Racial and sexual minority women experience sexual violence at disproportionately higher rates compared to White and heterosexual women [ 66 ]. Racial and sexual minority individuals also rate higher or lower on varied aspects of sexual functioning. For example, African-American women reported greater levels of sexual satisfaction compared to White women [ 67 ]. Another study found that Black women tend experience lower desire and decreased pleasure compared to White women, whereas White women report experiencing more sexual pain compared to Black women [ 60 ]. Similarly, women report differently on sexual functioning based on their sexual identity [ 68 ]. For example, a meta-analysis demonstrated that lesbian women experience more orgasms than heterosexual women [ 69 ]. Given these important racial and sexual differences in prevalence of sexual violence and sexual functioning, future studies that oversample for racial and sexual minority are needed to investigate how race or sexual identity may impact the relation between sexual violence and sexual functioning.

Notably, none of the studies examining ASA and sexual functioning distinguished between assault experienced before college and during college [ 17 , 24 , 25 , 43 ]. Studies used the cut-off age of 14 [ 10 , 17 , 24 , 27 , 41 , 43 , 45 ] and 16 years old to classify ASA [ 25 , 32 ] and thus did not examine the impact of assaults experienced while in college. This is an important limitation as 1.8–34% of college women expereince sexual assault while they are in college [ 3 ]. Additionally, college women are at an important development stage for sexual development as a majority of college students are engaging in sexual activity [ 70 ]. Thus, it is important to investigate the impact of college sexual assault on sexual functioning of college women.

Additionally, the current review highlighted that all studies investigating the link between sexual violence and sexual functioning among college women are cross-sectional in nature. Further, the relation between sexual violence and sexual functioning has been examined only in 14 unique samples. Thus, there is need for more research with rigorous study designs, including longitudinal designs and experimental designs, in order to increase confidence in findings. Longitudinal research on the relationship between sexual violence and sexual functioning in college women before, during, and after college could begin to explore potential causal relationships among these variables. Meta-analyses that examine for publication bias would help in improving clarity of the results. Further, use of randomized controlled trials of treatments to address sexual functioning following sexual violence could also help to explicate the mechanisms through which sexual violence and poorer sexual functioning are associated. Burgeoning evidence from RCT shows that such cognitive behavioral therapy [ 71 ] and psychoeducational training [ 72 ] are effective in improving sexual dysfunction and need to adapted and evaluated among survivors of sexual violence. Further, evidence suggests that it is not enough to treat post-trauma distress to improve sexual functioning. For example, a meta-analytic review that included four RCTs found that PTSD treatment did not improve sexual functioning in women with histories of sexual violence [ 73 ]. The authors concluded that psychological treatment for PTSD has no effect on sexual problems. One of the limitations noted by the meta-analysis was that most interventions did not actively target sexual problems. Thus, future research focused on designing and evaluating sexual functioning intervention for sexual violence survivors is required. Along this vein, the burden of improving sexual functioning should not only be on survivors. Trauma-informed couple-based sexual functioning interventions [ 74 ] should be developed and evaluated. Apart from designing interventions focused on sexual functioning, sexual assault prevention programs provided by college student health and education personnel should address potential sexual functioning outcomes following sexual violence. For example, the Enhanced Assess, Acknowledge, Act (EAAA) program utilizes a positive sexuality framework [ 75 ]. The program empowers women, including survivors, with skills focused on enhancing positive sexual experiences such as increased awareness of women’s own sexual desire and confidence in asserting in sexual situations.

Limitations

Findings of the review should be interpreted in the context of limitations. Firstly, one of the inclusion criteria for the systematic review was to include peer-reviewed articles in order to maintain the quality of studies included in the review. Given that there can be publication biases with research, future systematic review should include dissertations as well as non-published studies that may report nonsignificant effects. Secondly, studies on sexual functioning may inadvertently exclude survivors who may choose to abstain from sex. Specifically, measures of sexual function [e.g., Female Sexual Function Index [ 76 ]] were developed for women who are sexually active and may fail to take into account the sexual function of survivors histories who abstain from sexual activity. Different profiles of characteristics (e.g., mental health symptoms, assault history) may emerge for survivors who abstain from sexual activity. Thus, future reviews should focus on expanding the definition of sexual functioning to include survivors who are not engaging in sexual activity.

The current systematic review highlighted the positive link between sexual violence and worsened sexual functioning outcomes among college women. Review demonstrated that the relation between sexual violence and sexual functioning has been examined in only 14 unique samples. Findings suggest a lack of uniformity in definition and measurement of sexual functioning. Results also highlighted the need to examine the association between sexual violence and sexual functioning using longitudinal studies. Post-assault distress such as anxiety and depression contributes to sexual dysfunction among college women survivors. Future studies on community college women, longitudinal studies, and RCTs evaluating interventions for sexual functioning are required.

Availability of data and materials

All data on diagnostic yield analyzed during the current study are available in the main text or supplementary material.

García-Moreno C, Pallitto C, Devries K, Stöckl H, Watts C, Abrahams N. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization; 2013.  https://www.who.int/reproductivehealth/publications/violence/9789241564625/en/ .

Basile KC, Smith SG, Breiding M, Black MC, Mahendra RR. Sexual violence surveillance: uniform definitions and recommended data elements. Version 2.0. 2014.

Google Scholar  

Fedina L, Holmes JL, Backes BL. Campus sexual assault: a systematic review of prevalence research from 2000 to 2015. Trauma Violence Abuse. 2018;19(1):76–93.

Article   PubMed   Google Scholar  

Rosenberg M, Townes A, Taylor S, Luetke M, Herbenick D. Quantifying the magnitude and potential influence of missing data in campus sexual assault surveys: a systematic review of surveys, 2010–2016. J Am Coll Health. 2019;67(1):42–50.

Caron SL, Mitchell D. “I’ve Never Told Anyone”: a qualitative analysis of interviews with college women who experienced sexual assault and remained silent. Violence against women. 2022;28(9):1987–2009.

Tjaden PG, Thoennes N. Extent, nature, and consequences of rape victimization: findings from the National Violence Against Women Survey. 2006.

Edwards KM, Dardis CM, Gidycz CA. The role of adolescent victimization in women’s aggression. 2011.

Dworkin ER. Risk for mental disorders associated with sexual assault: a meta-analysis. Trauma Violence Abuse. 2020;21(5):1011–28.

Molstad TD, Weinhardt JM, Jones R. Sexual assault as a contributor to academic outcomes in university: a systematic review. Trauma Violence Abuse. 2023;24(1):218–30.

Kelley EL, Gidycz CA. Mediators of the relationship between sexual assault and sexual behaviors in college women. J Interpers Violence. 2020;35(21–22):4863–86.

Organization WH. Sexual health and its linkages to reproductive health: an operational approach. 2017. Report No.: 9241512881.

Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington DC: American Psychiatric Association; 2015.

Meston CM, Heiman JR, Trapnell PD. The relation between early abuse and adult sexuality. J Sex Res. 1999;36(4):385–95.

Article   Google Scholar  

Kelley EL, Gidycz CA. Differential relationships between childhood and adolescent sexual victimization and cognitive–affective sexual appraisals. Psychol Violence. 2015;5(2):144.

Fromuth ME. The relationship of childhood sexual abuse with later psychological and sexual adjustment in a sample of college women. Child Abuse Negl. 1986;10(1):5–15.

Article   CAS   PubMed   Google Scholar  

Lemieux SR, Byers ES. The sexual well-being of women who have experienced child sexual abuse. Psychol Women Q. 2008;32(2):126–44.

Kelley EL, Gidycz CA. Labeling of sexual assault and its relationship with sexual functioning: the mediating role of coping. J Interpers Violence. 2015;30(2):348–66.

Pihlgren EM, Gidycz CA, Lynn SJ. Impact of adulthood and adolescent rape experiences on subsequent sexual fantasies. Imagin Cogn Pers. 1993;12(4):321–39.

Bird ER, Gilmore AK, Stappenbeck CA, Heiman JR, Davis KC, Norris J, et al. Women’s sex-related dissociation: the effects of alcohol intoxication, attentional control instructions, and history of childhood sexual abuse. J Sex Marital Ther. 2017;43(2):121–31.

Pulverman CS, Kilimnik CD, Meston CM. The impact of childhood sexual abuse on women’s sexual health: a comprehensive review. Sexual Medicine Reviews. 2018;6(2):188–200.

Lewis RW, Fugl-Meyer KS, Corona G, Hayes RD, Laumann EO, Moreira ED Jr, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7(4_Part_2):1598–607.

Becker JV, Skinner LJ, Abel GG, Cichon J. Level of postassault sexual functioning in rape and incest victims. Arch Sex Behav. 1986;15(1):37–49.

Öberg K, Fugl-Meyer A, Fugl-Meyer KS. On categorization and quantification of women’s sexual dysfunctions: an epidemiological approach. Int J Impot Res. 2004;16(3):261–9.

Kilimnik CD, Trapnell PD, Humphreys TP. Negative affectivity in females’ identification of their nonconsensual sexual experiences and sexual dissatisfaction. Can J Hum Sex. 2016;25(3):177–85.

Turchik JA, Hassija CM. Female sexual victimization among college students: assault severity, health risk behaviors, and sexual functioning. J Interpers Violence. 2014;29(13):2439–57.

Van Der Made F, Bloemers J, Van Ham D, Yassem WE, Kleiverda G, Everaerd W, et al. Childhood sexual abuse, selective attention for sexual cues and the effects of testosterone with or without vardenafil on physiological sexual arousal in women with sexual dysfunction: a pilot study. J Sex Med. 2009;6(2):429–39.

Kelley EL, Gidycz CA. Posttraumatic stress and sexual functioning difficulties in college women with a history of sexual assault victimization. Psychol Violence. 2019;9(1):98.

Leonard LM, Follette VM. Sexual functioning in women reporting a history of child sexual abuse: review of the empirical literature and clinical implications. Annu Rev Sex Res. 2002;13(1):346–88.

PubMed   Google Scholar  

Loeb TB, Rivkin I, Williams JK, Wyatt GE, Carmona JV, Chin D. Child sexual abuse: associations with the sexual functioning of adolescents and adults. Annu Rev Sex Res. 2002;13(1):307–45.

Bigras N, Vaillancourt-Morel M-P, Nolin M-C, Bergeron S. Associations between childhood sexual abuse and sexual well-being in adulthood: a systematic literature review. J Child Sex Abus. 2021;30(3):332–52.

Pulverman CS, Creech SK. The impact of sexual trauma on the sexual health of women veterans: a comprehensive review. Trauma Violence Abuse. 2021;22(4):656–71.

Bartoi MG, Kinder BN. Effects of child and adult sexual abuse on adult sexuality. J Sex Marital Ther. 1998;24(2):75–90.

Garneau-Fournier J, McBain S, Torres T, Turchik J. Sexual dysfunction problems in female college students: sexual victimization, substance use, and personality factors. J Sex Marital Ther. 2017;43(1):24–39.

DeRogatis LR, Burnett AL. The epidemiology of sexual dysfunctions. J Sex Med. 2008;5(2):289–300.

Stephenson KR, Meston CM. Differentiating components of sexual well-being in women: are sexual satisfaction and sexual distress independent constructs? J Sex Med. 2010;7(7):2458–68.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9 w64.

Babineau J. Product review: Covidence (systematic review software). J Can Health Lib Assoc /Journal de l’Association des bibliothèques de la santé du Canada. 2014;35(2):68–71.

Alexander PC, Lupfer SL. Family characteristics and long-term consequences associated with sexual abuse. Arch Sex Behav. 1987;16:235–45.

Halle-Ekane GE, Timti LF, Tanue EA, Ekukole CM, Yenshu EV. Prevalence and associated factors of female sexual dysfunction among sexually active students of the University of Buea. Sexual Medicine. 2021;9(5):100402.

Article   PubMed   PubMed Central   Google Scholar  

Jackson JL, Calhoun KS, Amick AE, Maddever HM, Habif VL. Young adult women who report childhood intrafamilial sexual abuse: subsequent adjustment. Arch Sex Behav. 1990;19:211–21.

Kelley EL, Gidycz CA. Mediators of the relationship between sexual assault and sexual functioning difficulties among college women. Psychol Violence. 2017;7(4):574.

Kinzl JF, Traweger C, Biebl W. Sexual dysfunctions: relationship to childhood sexual abuse and early family experiences in a nonclinical sample. Child Abuse Negl. 1995;19(7):785–92.

Orlando JA, Koss MP. The effects of sexual victimization on sexual satisfaction: a study of the negative-association hypothesis. J Abnorm Psychol. 1983;92(1):104.

Rellini A, Meston C. Sexual function and satisfaction in adults based on the definition of child sexual abuse. J Sex Med. 2007;4(5):1312–21.

Layh M, Rudolph K, Littleton H. Sexual risk behavior and sexual satisfaction among rape victims: examination of sexual motives as a mediator. J Trauma Dissociation. 2020;21(1):73–86. https://doi.org/10.1080/15299732.2019.1675112 .

Finkelhor D. Sexually victimized children. New York: Simon and Schuster; 2010.

Bernstein DP, Fink L, Handelsman L, Foote J. Childhood trauma questionnaire. In: Assessment of family violence: a handbook for researchers and practitioners. 1998.

Koss MP, Abbey A, Campbell R, Cook S, Norris J, Testa M, et al. Revising the SES: a collaborative process to improve assessment of sexual aggression and victimization. Psychol Women Q. 2007;31(4):357–70.

Koss MP, Gidycz CA. Sexual experiences survey: reliability and validity. J Consult Clin Psychol. 1985;53(3):422.

Struckman-Johnson C, Struckman-Johnson D, Anderson PB. Tactics of sexual coercion: when men and women won’t take no for an answer. J Sex Res. 2003;40(1):76–86.

Kilimnik CD, Pulverman CS, Meston CM. Methodologic considerations for the study of childhood sexual abuse in sexual health outcome research: a comprehensive review. Sex Med Rev. 2018;6(2):176–87.

Norton GR, Jehu D. The role of anxiety in sexual dysfunctions: a review. Arch Sex Behav. 1984;13(2):165–83.

Atlantis E, Sullivan T. Bidirectional association between depression and sexual dysfunction: a systematic review and meta-analysis. J Sex Med. 2012;9(6):1497–507.

Sanchez DT, Crocker J, Boike KR. Doing gender in the bedroom: investing in gender norms and the sexual experience. Pers Soc Psychol Bull. 2005;31(10):1445–55.

Sanchez DT, Kiefer AK, Ybarra O. Sexual submissiveness in women: costs for sexual autonomy and arousal. Pers Soc Psychol Bull. 2006;32(4):512–24.

Marques Cerentini T, La Rosa VL, Goulart CDL, Latorre GFS, Caruso S, Sudbrack AC. Female sexual dysfunctions: prevalence and related factors in a sample of young university women – a cross-sectional study. Sex Relatsh Ther. 2023;38(1):106–17.

Chapa HO, Fish JT, Hagar C, Wilson T. Prevalence of female sexual dysfunction among women attending college presenting for gynecological care at a university student health center. J Am Coll Health. 2020;68(1):52–60.

Nappi PRE, Cucinella L, Martella S, Rossi M, Tiranini L, Martini E. Female sexual dysfunction (FSD): prevalence and impact on quality of life (QoL). Maturitas. 2016;94:87–91.

Shifren JL, Monz BU, Russo PA, Segreti A, Johannes CB. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol. 2008;112(5):970–8.

Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.

Voth Schrag RJ, Edmond TE. Intimate partner violence, trauma, and mental health need among female community college students. J Am Coll Health. 2018;66(7):702–11.

Howard RM, Potter SJ, Guedj CE, Moynihan MM. Sexual violence victimization among community college students. J Am Coll Health. 2019;67(7):674–87.

Simons-Morton B, Haynie D, O’Brien F, Lipsky L, Bible J, Liu D. Variability in measures of health and health behavior among emerging adults 1 year after high school according to college status. J Am Coll Health. 2017;65(1):58–66.

Trieu SL, Marshak HH, Bratton SI. Sexual and reproductive health behaviors of Asian Pacific Islander community college students. Commun Coll J Res Pract. 2013;37(6):467–77.

Trieu SL, Bratton S, Hopp MH. Sexual and reproductive health behaviors of California community college students. J Am Coll Health. 2011;59(8):744–50.

Coulter RW, Mair C, Miller E, Blosnich JR, Matthews DD, McCauley HL. Prevalence of past-year sexual assault victimization among undergraduate students: exploring differences by and intersections of gender identity, sexual identity, and race/ethnicity. Prev Sci. 2017;18:726–36.

Addis IB, Van Den Eeden SK, Wassel-Fyr CL, Vittinghoff E, Brown JS, Thom DH. Sexual activity and function in middle-aged and older women. Obstet Gynecol. 2006;107(4):755–64.

Holt LL, Chung YB, Janssen E, Peterson ZD. Female sexual satisfaction and sexual identity. J Sex Res. 2021;58(2):195–205.

Macedo A, Capela E, Peixoto M. Sexual satisfaction among Lesbian and heterosexual cisgender women: a systematic review and meta-analysis. Healthcare. 2023;11(12):1680.

Stupiansky NW, Reece M, Middlestadt SE, Finn P, Sherwood-Laughlin C. The role of sexual compulsivity in casual sexual partnerships among college women. Sex Addict Compuls. 2009;16(3):241–52.

Nezamnia M, Iravani M, Bargard MS, Latify M. Effectiveness of cognitive-behavioral therapy on sexual function and sexual self-efficacy in pregnant women: an RCT. Int J Reprod Biomed. 2020;18(8):625–36.

PubMed   PubMed Central   Google Scholar  

Chow KM, Chan JC, Choi KK, Chan CW. A review of psychoeducational interventions to improve sexual functioning, quality of life, and psychological outcomes in gynecological cancer patients. Cancer Nurs. 2016;39(1):20–31.

O’Driscoll C, Flanagan E. Sexual problems and post-traumatic stress disorder following sexual trauma: a meta-analytic review. Psychol Psychother Theory Res Pract. 2016;89(3):351–67.

Reese JB, Zimmaro LA, Lepore SJ, Sorice KA, Handorf E, Daly MB, et al. Evaluating a couple-based intervention addressing sexual concerns for breast cancer survivors: study protocol for a randomized controlled trial. Trials. 2020;21(1):1–13.

Senn CY, Eliasziw M, Hobden KL, Barata PC, Radtke HL, Thurston WE, et al. Testing a model of how a sexual assault resistance education program for women reduces sexual assaults. Psychol Women Q. 2021;45(1):20–36.

Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D’Agostino R. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.

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Prachi H. Bhuptani & Lindsay M. Orchowski

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Bhuptani, P.H., Mayer, E., Chan, G. et al. Child sexual abuse, adolescent/adult sexual violence, and sexual functioning among college women: a systematic review. BMC Global Public Health 2 , 29 (2024). https://doi.org/10.1186/s44263-024-00060-7

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Received : 09 October 2023

Accepted : 19 April 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s44263-024-00060-7

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• Sexual assault
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