key qualities of a good literature review

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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See an example

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

Scribbr slides are free to use, customize, and distribute for educational purposes.

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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The following are the characteristics of good literature review

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

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

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

What are Literature Reviews?

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

Goals of Literature Reviews

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

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

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

What kinds of sources require a Literature Review?

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

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

Types of Literature Reviews

What kinds of literature reviews are written?

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

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

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

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

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

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

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

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

Literature Reviews in the Health Sciences

• UConn Health subject guide on systematic reviews Explanation of the different review types used in health sciences literature as well as tools to help you find the right review type
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• Next: How to Pick a Topic >>
• Last Updated: Sep 21, 2022 2:16 PM
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Literature Review: The What, Why and How-to Guide: Literature Reviews?

• Literature Reviews?
• Strategies to Finding Sources
• Keeping up with Research!
• Evaluating Sources & Literature Reviews
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• Other Academic Writings

What is a Literature Review?

So, what is a literature review .

"A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available or a set of summaries." - Quote from Taylor, D. (n.d)."The Literature Review: A Few Tips on Conducting it".

• Citation: "The Literature Review: A Few Tips on Conducting it"

What kinds of literature reviews are written?

Each field has a particular way to do reviews for academic research literature. In the social sciences and humanities the most common are:

• Narrative Reviews: The purpose of this type of review is to describe the current state of the research on a specific research topic and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weaknesses, and gaps are identified. The review ends with a conclusion section that summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : A type of literature review typical in History and related fields, e.g., Latin American studies. For example, the Latin American Research Review explains that the purpose of this type of review is to “(1) to familiarize readers with the subject, approach, arguments, and conclusions found in a group of books whose common focus is a historical period; a country or region within Latin America; or a practice, development, or issue of interest to specialists and others; (2) to locate these books within current scholarship, critical methodologies, and approaches; and (3) to probe the relation of these new books to previous work on the subject, especially canonical texts. Unlike individual book reviews, the cluster reviews found in LARR seek to address the state of the field or discipline and not solely the works at issue.” - LARR

What are the Goals of Creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 
• Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what has been written about your research topic and to point out how your own research will shed new light into a body of scholarship.

Where I can find examples of Literature Reviews?

Note:  In the humanities, even if they don't use the term "literature review", they may have a dedicated  chapter that reviewed the "critical bibliography" or they incorporated that review in the introduction or first chapter of the dissertation, book, or article.

• UCSB electronic theses and dissertations In partnership with the Graduate Division, the UC Santa Barbara Library is making available theses and dissertations produced by UCSB students. Currently included in ADRL are theses and dissertations that were originally filed electronically, starting in 2011. In future phases of ADRL, all theses and dissertations created by UCSB students may be digitized and made available.

Where to Find Standalone Literature Reviews

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature review looks at a topic from a historical perspective to see how the understanding of the topic has changed over time. 

• Find e-Journals for Standalone Literature Reviews The best way to get familiar with and to learn how to write literature reviews is by reading them. You can use our Journal Search option to find journals that specialize in publishing literature reviews from major disciplines like anthropology, sociology, etc. Usually these titles are called, "Annual Review of [discipline name] OR [Discipline name] Review. This option works best if you know the title of the publication you are looking for. Below are some examples of these journals! more... less... Journal Search can be found by hovering over the link for Research on the library website.

Social Sciences

• Annual Review of Anthropology
• Annual Review of Political Science
• Annual Review of Sociology
• Ethnic Studies Review

Hard science and health sciences:

• Annual Review of Biomedical Data Science
• Annual Review of Materials Science
• Systematic Review From journal site: "The journal Systematic Reviews encompasses all aspects of the design, conduct, and reporting of systematic reviews" in the health sciences.
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• Last Updated: Mar 5, 2024 11:44 AM
• URL: https://guides.library.ucsb.edu/litreview

A Guide to Literature Reviews

Importance of a good literature review.

• Conducting the Literature Review
• Structure and Writing Style
• Types of Literature Reviews
• Citation Management Software This link opens in a new window
• Acknowledgements

A literature review is not only a summary of key sources, but  has an organizational pattern which combines both summary and synthesis, often within specific conceptual categories . A summary is a recap of the important information of the source, but a synthesis is a re-organization, or a reshuffling, of that information in a way that informs how you are planning to investigate a research problem. The analytical features of a literature review might:

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

The purpose of a literature review is to:

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

Marco pautasso.

1 Centre for Functional and Evolutionary Ecology (CEFE), CNRS, Montpellier, France

2 Centre for Biodiversity Synthesis and Analysis (CESAB), FRB, Aix-en-Provence, France

Literature reviews are in great demand in most scientific fields. Their need stems from the ever-increasing output of scientific publications [1] . For example, compared to 1991, in 2008 three, eight, and forty times more papers were indexed in Web of Science on malaria, obesity, and biodiversity, respectively [2] . Given such mountains of papers, scientists cannot be expected to examine in detail every single new paper relevant to their interests [3] . Thus, it is both advantageous and necessary to rely on regular summaries of the recent literature. Although recognition for scientists mainly comes from primary research, timely literature reviews can lead to new synthetic insights and are often widely read [4] . For such summaries to be useful, however, they need to be compiled in a professional way [5] .

When starting from scratch, reviewing the literature can require a titanic amount of work. That is why researchers who have spent their career working on a certain research issue are in a perfect position to review that literature. Some graduate schools are now offering courses in reviewing the literature, given that most research students start their project by producing an overview of what has already been done on their research issue [6] . However, it is likely that most scientists have not thought in detail about how to approach and carry out a literature review.

Reviewing the literature requires the ability to juggle multiple tasks, from finding and evaluating relevant material to synthesising information from various sources, from critical thinking to paraphrasing, evaluating, and citation skills [7] . In this contribution, I share ten simple rules I learned working on about 25 literature reviews as a PhD and postdoctoral student. Ideas and insights also come from discussions with coauthors and colleagues, as well as feedback from reviewers and editors.

Rule 1: Define a Topic and Audience

How to choose which topic to review? There are so many issues in contemporary science that you could spend a lifetime of attending conferences and reading the literature just pondering what to review. On the one hand, if you take several years to choose, several other people may have had the same idea in the meantime. On the other hand, only a well-considered topic is likely to lead to a brilliant literature review [8] . The topic must at least be:

• interesting to you (ideally, you should have come across a series of recent papers related to your line of work that call for a critical summary),
• an important aspect of the field (so that many readers will be interested in the review and there will be enough material to write it), and
• a well-defined issue (otherwise you could potentially include thousands of publications, which would make the review unhelpful).

Ideas for potential reviews may come from papers providing lists of key research questions to be answered [9] , but also from serendipitous moments during desultory reading and discussions. In addition to choosing your topic, you should also select a target audience. In many cases, the topic (e.g., web services in computational biology) will automatically define an audience (e.g., computational biologists), but that same topic may also be of interest to neighbouring fields (e.g., computer science, biology, etc.).

Rule 2: Search and Re-search the Literature

After having chosen your topic and audience, start by checking the literature and downloading relevant papers. Five pieces of advice here:

• keep track of the search items you use (so that your search can be replicated [10] ),
• keep a list of papers whose pdfs you cannot access immediately (so as to retrieve them later with alternative strategies),
• use a paper management system (e.g., Mendeley, Papers, Qiqqa, Sente),
• define early in the process some criteria for exclusion of irrelevant papers (these criteria can then be described in the review to help define its scope), and
• do not just look for research papers in the area you wish to review, but also seek previous reviews.

The chances are high that someone will already have published a literature review ( Figure 1 ), if not exactly on the issue you are planning to tackle, at least on a related topic. If there are already a few or several reviews of the literature on your issue, my advice is not to give up, but to carry on with your own literature review,

The bottom-right situation (many literature reviews but few research papers) is not just a theoretical situation; it applies, for example, to the study of the impacts of climate change on plant diseases, where there appear to be more literature reviews than research studies [33] .

• discussing in your review the approaches, limitations, and conclusions of past reviews,
• trying to find a new angle that has not been covered adequately in the previous reviews, and
• incorporating new material that has inevitably accumulated since their appearance.

When searching the literature for pertinent papers and reviews, the usual rules apply:

• be thorough,
• use different keywords and database sources (e.g., DBLP, Google Scholar, ISI Proceedings, JSTOR Search, Medline, Scopus, Web of Science), and
• look at who has cited past relevant papers and book chapters.

Rule 3: Take Notes While Reading

If you read the papers first, and only afterwards start writing the review, you will need a very good memory to remember who wrote what, and what your impressions and associations were while reading each single paper. My advice is, while reading, to start writing down interesting pieces of information, insights about how to organize the review, and thoughts on what to write. This way, by the time you have read the literature you selected, you will already have a rough draft of the review.

Of course, this draft will still need much rewriting, restructuring, and rethinking to obtain a text with a coherent argument [11] , but you will have avoided the danger posed by staring at a blank document. Be careful when taking notes to use quotation marks if you are provisionally copying verbatim from the literature. It is advisable then to reformulate such quotes with your own words in the final draft. It is important to be careful in noting the references already at this stage, so as to avoid misattributions. Using referencing software from the very beginning of your endeavour will save you time.

Rule 4: Choose the Type of Review You Wish to Write

After having taken notes while reading the literature, you will have a rough idea of the amount of material available for the review. This is probably a good time to decide whether to go for a mini- or a full review. Some journals are now favouring the publication of rather short reviews focusing on the last few years, with a limit on the number of words and citations. A mini-review is not necessarily a minor review: it may well attract more attention from busy readers, although it will inevitably simplify some issues and leave out some relevant material due to space limitations. A full review will have the advantage of more freedom to cover in detail the complexities of a particular scientific development, but may then be left in the pile of the very important papers “to be read” by readers with little time to spare for major monographs.

There is probably a continuum between mini- and full reviews. The same point applies to the dichotomy of descriptive vs. integrative reviews. While descriptive reviews focus on the methodology, findings, and interpretation of each reviewed study, integrative reviews attempt to find common ideas and concepts from the reviewed material [12] . A similar distinction exists between narrative and systematic reviews: while narrative reviews are qualitative, systematic reviews attempt to test a hypothesis based on the published evidence, which is gathered using a predefined protocol to reduce bias [13] , [14] . When systematic reviews analyse quantitative results in a quantitative way, they become meta-analyses. The choice between different review types will have to be made on a case-by-case basis, depending not just on the nature of the material found and the preferences of the target journal(s), but also on the time available to write the review and the number of coauthors [15] .

Rule 5: Keep the Review Focused, but Make It of Broad Interest

Whether your plan is to write a mini- or a full review, it is good advice to keep it focused 16 , 17 . Including material just for the sake of it can easily lead to reviews that are trying to do too many things at once. The need to keep a review focused can be problematic for interdisciplinary reviews, where the aim is to bridge the gap between fields [18] . If you are writing a review on, for example, how epidemiological approaches are used in modelling the spread of ideas, you may be inclined to include material from both parent fields, epidemiology and the study of cultural diffusion. This may be necessary to some extent, but in this case a focused review would only deal in detail with those studies at the interface between epidemiology and the spread of ideas.

While focus is an important feature of a successful review, this requirement has to be balanced with the need to make the review relevant to a broad audience. This square may be circled by discussing the wider implications of the reviewed topic for other disciplines.

Rule 6: Be Critical and Consistent

Reviewing the literature is not stamp collecting. A good review does not just summarize the literature, but discusses it critically, identifies methodological problems, and points out research gaps [19] . After having read a review of the literature, a reader should have a rough idea of:

• the major achievements in the reviewed field,
• the main areas of debate, and
• the outstanding research questions.

It is challenging to achieve a successful review on all these fronts. A solution can be to involve a set of complementary coauthors: some people are excellent at mapping what has been achieved, some others are very good at identifying dark clouds on the horizon, and some have instead a knack at predicting where solutions are going to come from. If your journal club has exactly this sort of team, then you should definitely write a review of the literature! In addition to critical thinking, a literature review needs consistency, for example in the choice of passive vs. active voice and present vs. past tense.

Rule 7: Find a Logical Structure

Like a well-baked cake, a good review has a number of telling features: it is worth the reader's time, timely, systematic, well written, focused, and critical. It also needs a good structure. With reviews, the usual subdivision of research papers into introduction, methods, results, and discussion does not work or is rarely used. However, a general introduction of the context and, toward the end, a recapitulation of the main points covered and take-home messages make sense also in the case of reviews. For systematic reviews, there is a trend towards including information about how the literature was searched (database, keywords, time limits) [20] .

How can you organize the flow of the main body of the review so that the reader will be drawn into and guided through it? It is generally helpful to draw a conceptual scheme of the review, e.g., with mind-mapping techniques. Such diagrams can help recognize a logical way to order and link the various sections of a review [21] . This is the case not just at the writing stage, but also for readers if the diagram is included in the review as a figure. A careful selection of diagrams and figures relevant to the reviewed topic can be very helpful to structure the text too [22] .

Rule 8: Make Use of Feedback

Reviews of the literature are normally peer-reviewed in the same way as research papers, and rightly so [23] . As a rule, incorporating feedback from reviewers greatly helps improve a review draft. Having read the review with a fresh mind, reviewers may spot inaccuracies, inconsistencies, and ambiguities that had not been noticed by the writers due to rereading the typescript too many times. It is however advisable to reread the draft one more time before submission, as a last-minute correction of typos, leaps, and muddled sentences may enable the reviewers to focus on providing advice on the content rather than the form.

Feedback is vital to writing a good review, and should be sought from a variety of colleagues, so as to obtain a diversity of views on the draft. This may lead in some cases to conflicting views on the merits of the paper, and on how to improve it, but such a situation is better than the absence of feedback. A diversity of feedback perspectives on a literature review can help identify where the consensus view stands in the landscape of the current scientific understanding of an issue [24] .

Rule 9: Include Your Own Relevant Research, but Be Objective

In many cases, reviewers of the literature will have published studies relevant to the review they are writing. This could create a conflict of interest: how can reviewers report objectively on their own work [25] ? Some scientists may be overly enthusiastic about what they have published, and thus risk giving too much importance to their own findings in the review. However, bias could also occur in the other direction: some scientists may be unduly dismissive of their own achievements, so that they will tend to downplay their contribution (if any) to a field when reviewing it.

In general, a review of the literature should neither be a public relations brochure nor an exercise in competitive self-denial. If a reviewer is up to the job of producing a well-organized and methodical review, which flows well and provides a service to the readership, then it should be possible to be objective in reviewing one's own relevant findings. In reviews written by multiple authors, this may be achieved by assigning the review of the results of a coauthor to different coauthors.

Rule 10: Be Up-to-Date, but Do Not Forget Older Studies

Given the progressive acceleration in the publication of scientific papers, today's reviews of the literature need awareness not just of the overall direction and achievements of a field of inquiry, but also of the latest studies, so as not to become out-of-date before they have been published. Ideally, a literature review should not identify as a major research gap an issue that has just been addressed in a series of papers in press (the same applies, of course, to older, overlooked studies (“sleeping beauties” [26] )). This implies that literature reviewers would do well to keep an eye on electronic lists of papers in press, given that it can take months before these appear in scientific databases. Some reviews declare that they have scanned the literature up to a certain point in time, but given that peer review can be a rather lengthy process, a full search for newly appeared literature at the revision stage may be worthwhile. Assessing the contribution of papers that have just appeared is particularly challenging, because there is little perspective with which to gauge their significance and impact on further research and society.

Inevitably, new papers on the reviewed topic (including independently written literature reviews) will appear from all quarters after the review has been published, so that there may soon be the need for an updated review. But this is the nature of science [27] – [32] . I wish everybody good luck with writing a review of the literature.

Acknowledgments

Many thanks to M. Barbosa, K. Dehnen-Schmutz, T. Döring, D. Fontaneto, M. Garbelotto, O. Holdenrieder, M. Jeger, D. Lonsdale, A. MacLeod, P. Mills, M. Moslonka-Lefebvre, G. Stancanelli, P. Weisberg, and X. Xu for insights and discussions, and to P. Bourne, T. Matoni, and D. Smith for helpful comments on a previous draft.

Funding Statement

This work was funded by the French Foundation for Research on Biodiversity (FRB) through its Centre for Synthesis and Analysis of Biodiversity data (CESAB), as part of the NETSEED research project. The funders had no role in the preparation of the manuscript.

University Libraries

Literature review.

• What is a Literature Review?
• What is Its Purpose?
• 1. Select a Topic
• 2. Set the Topic in Context
• 3. Types of Information Sources
• 4. Use Information Sources
• 5. Get the Information
• 6. Organize / Manage the Information
• 7. Position the Literature Review
• 8. Write the Literature Review

A literature review is a comprehensive summary of previous research on a topic. The literature review surveys scholarly articles, books, and other sources relevant to a particular area of research.  The review should enumerate, describe, summarize, objectively evaluate and clarify this previous research.  It should give a theoretical base for the research and help you (the author) determine the nature of your research.  The literature review acknowledges the work of previous researchers, and in so doing, assures the reader that your work has been well conceived.  It is assumed that by mentioning a previous work in the field of study, that the author has read, evaluated, and assimiliated that work into the work at hand.

A literature review creates a "landscape" for the reader, giving her or him a full understanding of the developments in the field.  This landscape informs the reader that the author has indeed assimilated all (or the vast majority of) previous, significant works in the field into her or his research. 

 "In writing the literature review, the purpose is to convey to the reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. The literature review must be defined by a guiding concept (eg. your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries.( http://www.writing.utoronto.ca/advice/specific-types-of-writing/literature-review )

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• Next: What is Its Purpose? >>
• Last Updated: Oct 2, 2023 12:34 PM

Penn State University Libraries

Soc 001: introductory sociology.

• Literature Reviews: Strategies for Writing
• Fake News and Evaluating Sources

Literature Reviews

What is a Literature Review? The literature review is a critical look at the existing research that is significant to the work that you are carrying out. This overview identifies prominent research trends in addition to assessing the overall strengths and weaknesses of the existing research.

Purpose of the Literature Review

• To provide background information about a research topic.
• To establish the importance of a topic.
• To demonstrate familiarity with a topic/problem.
• To “carve out a space” for further work and allow you to position yourself in a scholarly conversation.

Characteristics of an effective literature review In addition to fulfilling the purposes outlined above, an effective literature review provides a critical overview of existing research by

• Outlining important research trends.
• Assessing strengths and weaknesses (of individual studies as well the existing research as a whole).
• Identifying potential gaps in knowledge.
• Establishing a need for current and/or future research projects.

Steps of the Literature Review Process

1) Planning: identify the focus, type, scope and discipline of the review you intend to write. 2) Reading and Research: collect and read current research on your topic. Select only those sources that are most relevant to your project. 3) Analyzing: summarize, synthesize, critique, and compare your sources in order to assess the field of research as a whole. 4) Drafting: develop a thesis or claim to make about the existing research and decide how to organize your material. 5) Revising: revise and finalize the structural, stylistic, and grammatical issues of your paper.

This process is not always a linear process; depending on the size and scope of your literature review, you may find yourself returning to some of these steps repeatedly as you continue to focus your project.

These steps adapted from the full workshop offered by the Graduate Writing Center at Penn State. 

Literature Review Format

 Introduction

• Provide an overview of the topic, theme, or issue.
• Identify your specific area of focus.
• Describe your methodology and rationale. How did you decide which sources to include and which to exclude? Why? How is your review organized?
• Briefly discuss the overall trends in the published scholarship in this area.
•  Establish your reason for writing the review.
•  Find the best organizational method for your review.
•  Summarize sources by providing the most relevant information.
•  Respectfully and objectively critique and evaluate the studies.
•  Use direct quotations sparingly and only if appropriate.

 Conclusion

•  Summarize the major findings of the sources that you reviewed, remembering to keep the focus on your topic.
•  Evaluate the current state of scholarship in this area (ex. flaws or gaps in the research, inconsistencies in findings) 
•  Identify any areas for further research.
•  Conclude by making a connection between your topic and some larger area of study such as the discipline. 
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Types of Literature Review — A Guide for Researchers

Table of Contents

Researchers often face challenges when choosing the appropriate type of literature review for their study. Regardless of the type of research design and the topic of a research problem , they encounter numerous queries, including:

What is the right type of literature review my study demands?

• How do we gather the data?
• How to conduct one?
• How reliable are the review findings?
• How do we employ them in our research? And the list goes on.

If you’re also dealing with such a hefty questionnaire, this article is of help. Read through this piece of guide to get an exhaustive understanding of the different types of literature reviews and their step-by-step methodologies along with a dash of pros and cons discussed.

Heading from scratch!

What is a Literature Review?

A literature review provides a comprehensive overview of existing knowledge on a particular topic, which is quintessential to any research project. Researchers employ various literature reviews based on their research goals and methodologies. The review process involves assembling, critically evaluating, and synthesizing existing scientific publications relevant to the research question at hand. It serves multiple purposes, including identifying gaps in existing literature, providing theoretical background, and supporting the rationale for a research study.

What is the importance of a Literature review in research?

Literature review in research serves several key purposes, including:

• Background of the study: Provides proper context for the research. It helps researchers understand the historical development, theoretical perspectives, and key debates related to their research topic.
• Identification of research gaps: By reviewing existing literature, researchers can identify gaps or inconsistencies in knowledge, paving the way for new research questions and hypotheses relevant to their study.
• Theoretical framework development: Facilitates the development of theoretical frameworks by cultivating diverse perspectives and empirical findings. It helps researchers refine their conceptualizations and theoretical models.
• Methodological guidance: Offers methodological guidance by highlighting the documented research methods and techniques used in previous studies. It assists researchers in selecting appropriate research designs, data collection methods, and analytical tools.
• Quality assurance and upholding academic integrity: Conducting a thorough literature review demonstrates the rigor and scholarly integrity of the research. It ensures that researchers are aware of relevant studies and can accurately attribute ideas and findings to their original sources.

Types of Literature Review

Literature review plays a crucial role in guiding the research process , from providing the background of the study to research dissemination and contributing to the synthesis of the latest theoretical literature review findings in academia.

However, not all types of literature reviews are the same; they vary in terms of methodology, approach, and purpose. Let's have a look at the various types of literature reviews to gain a deeper understanding of their applications.

1. Narrative Literature Review

A narrative literature review, also known as a traditional literature review, involves analyzing and summarizing existing literature without adhering to a structured methodology. It typically provides a descriptive overview of key concepts, theories, and relevant findings of the research topic.

Unlike other types of literature reviews, narrative reviews reinforce a more traditional approach, emphasizing the interpretation and discussion of the research findings rather than strict adherence to methodological review criteria. It helps researchers explore diverse perspectives and insights based on the research topic and acts as preliminary work for further investigation.

Steps to Conduct a Narrative Literature Review

Source:- https://www.researchgate.net/figure/Steps-of-writing-a-narrative-review_fig1_354466408

Define the research question or topic:

The first step in conducting a narrative literature review is to clearly define the research question or topic of interest. Defining the scope and purpose of the review includes — What specific aspect of the topic do you want to explore? What are the main objectives of the research? Refine your research question based on the specific area you want to explore.

Conduct a thorough literature search

Once the research question is defined, you can conduct a comprehensive literature search. Explore and use relevant databases and search engines like SciSpace Discover to identify credible and pertinent, scholarly articles and publications.

Select relevant studies

Before choosing the right set of studies, it’s vital to determine inclusion (studies that should possess the required factors) and exclusion criteria for the literature and then carefully select papers. For example — Which studies or sources will be included based on relevance, quality, and publication date?

*Important (applies to all the reviews): Inclusion criteria are the factors a study must include (For example: Include only peer-reviewed articles published between 2022-2023, etc.). Exclusion criteria are the factors that wouldn’t be required for your search strategy (Example: exclude irrelevant papers, preprints, written in non-English, etc.)

Critically analyze the literature

Once the relevant studies are shortlisted, evaluate the methodology, findings, and limitations of each source and jot down key themes, patterns, and contradictions. You can use efficient AI tools to conduct a thorough literature review and analyze all the required information.

Synthesize and integrate the findings

Now, you can weave together the reviewed studies, underscoring significant findings such that new frameworks, contrasting viewpoints, and identifying knowledge gaps.

Discussion and conclusion

This is an important step before crafting a narrative review — summarize the main findings of the review and discuss their implications in the relevant field. For example — What are the practical implications for practitioners? What are the directions for future research for them?

Write a cohesive narrative review

Organize the review into coherent sections and structure your review logically, guiding the reader through the research landscape and offering valuable insights. Use clear and concise language to convey key points effectively.

Structure of Narrative Literature Review

A well-structured, narrative analysis or literature review typically includes the following components:

• Introduction: Provides an overview of the topic, objectives of the study, and rationale for the review.
• Background: Highlights relevant background information and establish the context for the review.
• Main Body: Indexes the literature into thematic sections or categories, discussing key findings, methodologies, and theoretical frameworks.
• Discussion: Analyze and synthesize the findings of the reviewed studies, stressing similarities, differences, and any gaps in the literature.
• Conclusion: Summarizes the main findings of the review, identifies implications for future research, and offers concluding remarks.

Pros and Cons of Narrative Literature Review

• Flexibility in methodology and doesn’t necessarily rely on structured methodologies
• Follows traditional approach and provides valuable and contextualized insights
• Suitable for exploring complex or interdisciplinary topics. For example — Climate change and human health, Cybersecurity and privacy in the digital age, and more
• Subjectivity in data selection and interpretation
• Potential for bias in the review process
• Lack of rigor compared to systematic reviews

Example of Well-Executed Narrative Literature Reviews

Paper title:  Examining Moral Injury in Clinical Practice: A Narrative Literature Review

Source: SciSpace

While narrative reviews offer flexibility, academic integrity remains paramount. So, ensure proper citation of all sources and maintain a transparent and factual approach throughout your critical narrative review, itself.

2. Systematic Review

A systematic literature review is one of the comprehensive types of literature review that follows a structured approach to assembling, analyzing, and synthesizing existing research relevant to a particular topic or question. It involves clearly defined criteria for exploring and choosing studies, as well as rigorous methods for evaluating the quality of relevant studies.

It plays a prominent role in evidence-based practice and decision-making across various domains, including healthcare, social sciences, education, health sciences, and more. By systematically investigating available literature, researchers can identify gaps in knowledge, evaluate the strength of evidence, and report future research directions.

Steps to Conduct Systematic Reviews

Source:- https://www.researchgate.net/figure/Steps-of-Systematic-Literature-Review_fig1_321422320

Here are the key steps involved in conducting a systematic literature review

Formulate a clear and focused research question

Clearly define the research question or objective of the review. It helps to centralize the literature search strategy and determine inclusion criteria for relevant studies.

Develop a thorough literature search strategy

Design a comprehensive search strategy to identify relevant studies. It involves scrutinizing scientific databases and all relevant articles in journals. Plus, seek suggestions from domain experts and review reference lists of relevant review articles.

Screening and selecting studies

Employ predefined inclusion and exclusion criteria to systematically screen the identified studies. This screening process also typically involves multiple reviewers independently assessing the eligibility of each study.

Data extraction

Extract key information from selected studies using standardized forms or protocols. It includes study characteristics, methods, results, and conclusions.

Critical appraisal

Evaluate the methodological quality and potential biases of included studies. Various tools (BMC medical research methodology) and criteria can be implemented for critical evaluation depending on the study design and research quetions .

Data synthesis

Analyze and synthesize review findings from individual studies to draw encompassing conclusions or identify overarching patterns and explore heterogeneity among studies.

Interpretation and conclusion

Interpret the findings about the research question, considering the strengths and limitations of the research evidence. Draw conclusions and implications for further research.

The final step — Report writing

Craft a detailed report of the systematic literature review adhering to the established guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). This ensures transparency and reproducibility of the review process.

By following these steps, a systematic literature review aims to provide a comprehensive and unbiased summary of existing evidence, help make informed decisions, and advance knowledge in the respective domain or field.

Structure of a systematic literature review

A well-structured systematic literature review typically consists of the following sections:

• Introduction: Provides background information on the research topic, outlines the review objectives, and enunciates the scope of the study.
• Methodology: Describes the literature search strategy, selection criteria, data extraction process, and other methods used for data synthesis, extraction, or other data analysis..
• Results: Presents the review findings, including a summary of the incorporated studies and their key findings.
• Discussion: Interprets the findings in light of the review objectives, discusses their implications, and identifies limitations or promising areas for future research.
• Conclusion: Summarizes the main review findings and provides suggestions based on the evidence presented in depth meta analysis.

*Important (applies to all the reviews): Remember, the specific structure of your literature review may vary depending on your topic, research question, and intended audience. However, adhering to a clear and logical hierarchy ensures your review effectively analyses and synthesizes knowledge and contributes valuable insights for readers.

Pros and Cons of Systematic Literature Review

• Adopts rigorous and transparent methodology
• Minimizes bias and enhances the reliability of the study
• Provides evidence-based insights
• Time and resource-intensive
• High dependency on the quality of available literature (literature research strategy should be accurate)
• Potential for publication bias

Example of Well-Executed Systematic Literature Review

Paper title: Systematic Reviews: Understanding the Best Evidence For Clinical Decision-making in Health Care: Pros and Cons.

Read this detailed article on how to use AI tools to conduct a systematic review for your research!

3. Scoping Literature Review

A scoping literature review is a methodological review type of literature review that adopts an iterative approach to systematically map the existing literature on a particular topic or research area. It involves identifying, selecting, and synthesizing relevant papers to provide an overview of the size and scope of available evidence. Scoping reviews are broader in scope and include a diverse range of study designs and methodologies especially focused on health services research.

The main purpose of a scoping literature review is to examine the extent, range, and nature of existing studies on a topic, thereby identifying gaps in research, inconsistencies, and areas for further investigation. Additionally, scoping reviews can help researchers identify suitable methodologies and formulate clinical recommendations. They also act as the frameworks for future systematic reviews or primary research studies.

Scoping reviews are primarily focused on —

• Emerging or evolving topics — where the research landscape is still growing or budding. Example — Whole Systems Approaches to Diet and Healthy Weight: A Scoping Review of Reviews .
• Broad and complex topics : With a vast amount of existing literature.
• Scenarios where a systematic review is not feasible: Due to limited resources or time constraints.

Steps to Conduct a Scoping Literature Review

While Scoping reviews are not as rigorous as systematic reviews, however, they still follow a structured approach. Here are the steps:

Identify the research question: Define the broad topic you want to explore.

Identify Relevant Studies: Conduct a comprehensive search of relevant literature using appropriate databases, keywords, and search strategies.

Select studies to be included in the review: Based on the inclusion and exclusion criteria, determine the appropriate studies to be included in the review.

Data extraction and charting : Extract relevant information from selected studies, such as year, author, main results, study characteristics, key findings, and methodological approaches.  However, it varies depending on the research question.

Collate, summarize, and report the results: Analyze and summarize the extracted data to identify key themes and trends. Then, present the findings of the scoping review in a clear and structured manner, following established guidelines and frameworks .

Structure of a Scoping Literature Review

A scoping literature review typically follows a structured format similar to a systematic review. It includes the following sections:

• Introduction: Introduce the research topic and objectives of the review, providing the historical context, and rationale for the study.
• Methods : Describe the methods used to conduct the review, including search strategies, study selection criteria, and data extraction procedures.
• Results: Present the findings of the review, including key themes, concepts, and patterns identified in the literature review.
• Discussion: Examine the implications of the findings, including strengths, limitations, and areas for further examination.
• Conclusion: Recapitulate the main findings of the review and their implications for future research, policy, or practice.

Pros and Cons of Scoping Literature Review

• Provides a comprehensive overview of existing literature
• Helps to identify gaps and areas for further research
• Suitable for exploring broad or complex research questions
• Doesn’t provide the depth of analysis offered by systematic reviews
• Subject to researcher bias in study selection and data extraction
• Requires careful consideration of literature search strategies and inclusion criteria to ensure comprehensiveness and validity.

In short, a scoping review helps map the literature on developing or emerging topics and identifying gaps. It might be considered as a step before conducting another type of review, such as a systematic review. Basically, acts as a precursor for other literature reviews.

Example of a Well-Executed Scoping Literature Review

Paper title: Health Chatbots in Africa Literature: A Scoping Review

Check out the key differences between Systematic and Scoping reviews — Evaluating literature review: systematic vs. scoping reviews

4. Integrative Literature Review

Integrative Literature Review (ILR) is a type of literature review that proposes a distinctive way to analyze and synthesize existing literature on a specific topic, providing a thorough understanding of research and identifying potential gaps for future research.

Unlike a systematic review, which emphasizes quantitative studies and follows strict inclusion criteria, an ILR embraces a more pliable approach. It works beyond simply summarizing findings — it critically analyzes, integrates, and interprets research from various methodologies (qualitative, quantitative, mixed methods) to provide a deeper understanding of the research landscape. ILRs provide a holistic and systematic overview of existing research, integrating findings from various methodologies. ILRs are ideal for exploring intricate research issues, examining manifold perspectives, and developing new research questions.

Steps to Conduct an Integrative Literature Review

• Identify the research question: Clearly define the research question or topic of interest as formulating a clear and focused research question is critical to leading the entire review process.
• Literature search strategy: Employ systematic search techniques to locate relevant literature across various databases and sources.
• Evaluate the quality of the included studies : Critically assess the methodology, rigor, and validity of each study by applying inclusion and exclusion criteria to filter and select studies aligned with the research objectives.
• Data Extraction: Extract relevant data from selected studies using a structured approach.
• Synthesize the findings : Thoroughly analyze the selected literature, identify key themes, and synthesize findings to derive noteworthy insights.
• Critical appraisal: Critically evaluate the quality and validity of qualitative research and included studies by using BMC medical research methodology.
• Interpret and present your findings: Discuss the purpose and implications of your analysis, spotlighting key insights and limitations. Organize and present the findings coherently and systematically.

Structure of an Integrative Literature Review

• Introduction : Provide an overview of the research topic and the purpose of the integrative review.
• Methods: Describe the opted literature search strategy, selection criteria, and data extraction process.
• Results: Present the synthesized findings, including key themes, patterns, and contradictions.
• Discussion: Interpret the findings about the research question, emphasizing implications for theory, practice, and prospective research.
• Conclusion: Summarize the main findings, limitations, and contributions of the integrative review.

Pros and Cons of Integrative Literature Review

• Informs evidence-based practice and policy to the relevant stakeholders of the research.
• Contributes to theory development and methodological advancement, especially in the healthcare arena.
• Integrates diverse perspectives and findings
• Time-consuming process due to the extensive literature search and synthesis
• Requires advanced analytical and critical thinking skills
• Potential for bias in study selection and interpretation
• The quality of included studies may vary, affecting the validity of the review

Example of Integrative Literature Reviews

Paper Title: An Integrative Literature Review: The Dual Impact of Technological Tools on Health and Technostress Among Older Workers

5. Rapid Literature Review

A Rapid Literature Review (RLR) is the fastest type of literature review which makes use of a streamlined approach for synthesizing literature summaries, offering a quicker and more focused alternative to traditional systematic reviews. Despite employing identical research methods, it often simplifies or omits specific steps to expedite the process. It allows researchers to gain valuable insights into current research trends and identify key findings within a shorter timeframe, often ranging from a few days to a few weeks — unlike traditional literature reviews, which may take months or even years to complete.

When to Consider a Rapid Literature Review?

• When time impediments demand a swift summary of existing research
• For emerging topics where the latest literature requires quick evaluation
• To report pilot studies or preliminary research before embarking on a comprehensive systematic review

Steps to Conduct a Rapid Literature Review

• Define the research question or topic of interest. A well-defined question guides the search process and helps researchers focus on relevant studies.
• Determine key databases and sources of relevant literature to ensure comprehensive coverage.
• Develop literature search strategies using appropriate keywords and filters to fetch a pool of potential scientific articles.
• Screen search results based on predefined inclusion and exclusion criteria.
• Extract and summarize relevant information from the above-preferred studies.
• Synthesize findings to identify key themes, patterns, or gaps in the literature.
• Prepare a concise report or a summary of the RLR findings.

Structure of a Rapid Literature Review

An effective structure of an RLR typically includes the following sections:

• Introduction: Briefly introduce the research topic and objectives of the RLR.
• Methodology: Describe the search strategy, inclusion and exclusion criteria, and data extraction process.
• Results: Present a summary of the findings, including key themes or patterns identified.
• Discussion: Interpret the findings, discuss implications, and highlight any limitations or areas for further research
• Conclusion: Summarize the key findings and their implications for practice or future research

Pros and Cons of Rapid Literature Review

• RLRs can be completed quickly, authorizing timely decision-making
• RLRs are a cost-effective approach since they require fewer resources compared to traditional literature reviews
• Offers great accessibility as RLRs provide prompt access to synthesized evidence for stakeholders
• RLRs are flexible as they can be easily adapted for various research contexts and objectives
• RLR reports are limited and restricted, not as in-depth as systematic reviews, and do not provide comprehensive coverage of the literature compared to traditional reviews.
• Susceptible to bias because of the expedited nature of RLRs. It would increase the chance of overlooking relevant studies or biases in the selection process.
• Due to time constraints, RLR findings might not be robust enough as compared to systematic reviews.

Example of a Well-Executed Rapid Literature Review

Paper Title: What Is the Impact of ChatGPT on Education? A Rapid Review of the Literature

A Summary of Literature Review Types

Tools and Resources for Conducting Different Types of Literature Reviews

Online scientific databases.

Platforms such as SciSpace , PubMed , Scopus , Elsevier , and Web of Science provide access to a vast array of scholarly literature, facilitating the search and data retrieval process.

Reference management software

Tools like SciSpace Citation Generator , EndNote, Zotero , and Mendeley assist researchers in organizing, annotating, and citing relevant literature, streamlining the review process altogether.

Automate Literature Review with AI tools

Automate the literature review process by using tools like SciSpace literature review which helps you compare and contrast multiple papers all on one screen in an easy-to-read matrix format. You can effortlessly analyze and interpret the review findings tailored to your study. It also supports the review in 75+ languages, making it more manageable even for non-English speakers.

Goes without saying — literature review plays a pivotal role in academic research to identify the current trends and provide insights to pave the way for future research endeavors. Different types of literature review has their own strengths and limitations, making them suitable for different research designs and contexts. Whether conducting a narrative review, systematic review, scoping review, integrative review, or rapid literature review, researchers must cautiously consider the objectives, resources, and the nature of the research topic.

If you’re currently working on a literature review and still adopting a manual and traditional approach, switch to the automated AI literature review workspace and transform your traditional literature review into a rapid one by extracting all the latest and relevant data for your research!

There you go!

Frequently Asked Questions

Narrative reviews give a general overview of a topic based on the author's knowledge. They may lack clear criteria and can be biased. On the other hand, systematic reviews aim to answer specific research questions by following strict methods. They're thorough but time-consuming.

A systematic review collects and analyzes existing research to provide an overview of a topic, while a meta-analysis statistically combines data from multiple studies to draw conclusions about the overall effect of an intervention or relationship between variables.

A systematic review thoroughly analyzes existing research on a specific topic using strict methods. In contrast, a scoping review offers a broader overview of the literature without evaluating individual studies in depth.

A systematic review thoroughly examines existing research using a rigorous process, while a rapid review provides a quicker summary of evidence, often by simplifying some of the systematic review steps to meet shorter timelines.

A systematic review carefully examines many studies on a single topic using specific guidelines. Conversely, an integrative review blends various types of research to provide a more comprehensive understanding of the topic.

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Literature Review

• What is a Literature Review?

What is a good literature review?

• Types of Literature Reviews
• What are the parts of a Literature Review?
• What is the difference between a Systematic Review and a Literature Review?

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

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

The purpose of a literature review is to:

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

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

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Ten elements of a good literature review

• A good literature review is a critical synthesis of the literature on a specific topic e.g. the relationship between class size and student achievement. Too many students engage in “telling” (what X or Y said about the topic) rather than also “synthesizing” (what is said, how well it is said, what is missing etc.)
• A good literature review works with published research literature rather than opinion pieces, advocacy material or professional viewpoints on the topic. This means that the principal resource for information on the topic is journal articles that publish current research.
• A good literature review works mainly with recent research on the topic given the growth in knowledge on any subject. The only exception is where a classic text is referred to or in the case of historical research which of course requires a long-term view of the literature e.g. the history of corporal punishment in South African education.
• A good literature review, having described what is known about the topic, brings in the voice of the researcher in the assessment of that literature. This is difficult for novice researchers but something that should and can be learnt, for example, by reading how others do book reviews or literature reviews in journals that specialize in that particular craft e.g. The Review of Educational Research or The Review of Research in Education.
• A good literature review is able to give a competent account of what is known about the topic as a first step. This means being able to give a cogent and concise account in one paragraph, in your own words, what a body of research says about the topic.
• A good literature review then is able to say what it not well known about the topic as a second step. This means being able to identify silences, gaps or contradictions in the body of literature on the specific topic. This is the critical in a critical synthesis of the literature.
• A good literature review then is able to say how your research addresses the weakness(es) in the literature reviewed as a third step.
• A good literature review is therefore able to acknowledge the research done on the topic (we stand on the shoulders of giants) and then demonstrate how the research proposed on the topic adds value or new knowledge on the topic (we step on the toes of giants).
• A good literature review has a competent grasp of all the major published research on the topic . This means, as a rule of thumb, at least 100 solid research articles on the topic should be reviewed.
• A good literature review is written in a fluent, academic voice from beginning to end, almost like a spy novel, so that reader is captured in the story until it reaches its climax—“and this is how my research hopes to fill the gap/address the silence/resolve the contradiction/add new knowledge on the topic under review. This means that the final copy of the literature review would have undergone MANY revisions and, done well, could be a standalone chapter in the thesis or dissertation.

PS. Always useful to do an annotated bibliography of all your literature references before starting to write the literature review

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Home » Literature Review – Types Writing Guide and Examples

Literature Review – Types Writing Guide and Examples

Table of Contents

Literature Review

Definition:

A literature review is a comprehensive and critical analysis of the existing literature on a particular topic or research question. It involves identifying, evaluating, and synthesizing relevant literature, including scholarly articles, books, and other sources, to provide a summary and critical assessment of what is known about the topic.

Types of Literature Review

Types of Literature Review are as follows:

• Narrative literature review : This type of review involves a comprehensive summary and critical analysis of the available literature on a particular topic or research question. It is often used as an introductory section of a research paper.
• Systematic literature review: This is a rigorous and structured review that follows a pre-defined protocol to identify, evaluate, and synthesize all relevant studies on a specific research question. It is often used in evidence-based practice and systematic reviews.
• Meta-analysis: This is a quantitative review that uses statistical methods to combine data from multiple studies to derive a summary effect size. It provides a more precise estimate of the overall effect than any individual study.
• Scoping review: This is a preliminary review that aims to map the existing literature on a broad topic area to identify research gaps and areas for further investigation.
• Critical literature review : This type of review evaluates the strengths and weaknesses of the existing literature on a particular topic or research question. It aims to provide a critical analysis of the literature and identify areas where further research is needed.
• Conceptual literature review: This review synthesizes and integrates theories and concepts from multiple sources to provide a new perspective on a particular topic. It aims to provide a theoretical framework for understanding a particular research question.
• Rapid literature review: This is a quick review that provides a snapshot of the current state of knowledge on a specific research question or topic. It is often used when time and resources are limited.
• Thematic literature review : This review identifies and analyzes common themes and patterns across a body of literature on a particular topic. It aims to provide a comprehensive overview of the literature and identify key themes and concepts.
• Realist literature review: This review is often used in social science research and aims to identify how and why certain interventions work in certain contexts. It takes into account the context and complexities of real-world situations.
• State-of-the-art literature review : This type of review provides an overview of the current state of knowledge in a particular field, highlighting the most recent and relevant research. It is often used in fields where knowledge is rapidly evolving, such as technology or medicine.
• Integrative literature review: This type of review synthesizes and integrates findings from multiple studies on a particular topic to identify patterns, themes, and gaps in the literature. It aims to provide a comprehensive understanding of the current state of knowledge on a particular topic.
• Umbrella literature review : This review is used to provide a broad overview of a large and diverse body of literature on a particular topic. It aims to identify common themes and patterns across different areas of research.
• Historical literature review: This type of review examines the historical development of research on a particular topic or research question. It aims to provide a historical context for understanding the current state of knowledge on a particular topic.
• Problem-oriented literature review : This review focuses on a specific problem or issue and examines the literature to identify potential solutions or interventions. It aims to provide practical recommendations for addressing a particular problem or issue.
• Mixed-methods literature review : This type of review combines quantitative and qualitative methods to synthesize and analyze the available literature on a particular topic. It aims to provide a more comprehensive understanding of the research question by combining different types of evidence.

Parts of Literature Review

Parts of a literature review are as follows:

Introduction

The introduction of a literature review typically provides background information on the research topic and why it is important. It outlines the objectives of the review, the research question or hypothesis, and the scope of the review.

Literature Search

This section outlines the search strategy and databases used to identify relevant literature. The search terms used, inclusion and exclusion criteria, and any limitations of the search are described.

Literature Analysis

The literature analysis is the main body of the literature review. This section summarizes and synthesizes the literature that is relevant to the research question or hypothesis. The review should be organized thematically, chronologically, or by methodology, depending on the research objectives.

Critical Evaluation

Critical evaluation involves assessing the quality and validity of the literature. This includes evaluating the reliability and validity of the studies reviewed, the methodology used, and the strength of the evidence.

The conclusion of the literature review should summarize the main findings, identify any gaps in the literature, and suggest areas for future research. It should also reiterate the importance of the research question or hypothesis and the contribution of the literature review to the overall research project.

The references list includes all the sources cited in the literature review, and follows a specific referencing style (e.g., APA, MLA, Harvard).

How to write Literature Review

Here are some steps to follow when writing a literature review:

• Define your research question or topic : Before starting your literature review, it is essential to define your research question or topic. This will help you identify relevant literature and determine the scope of your review.
• Conduct a comprehensive search: Use databases and search engines to find relevant literature. Look for peer-reviewed articles, books, and other academic sources that are relevant to your research question or topic.
• Evaluate the sources: Once you have found potential sources, evaluate them critically to determine their relevance, credibility, and quality. Look for recent publications, reputable authors, and reliable sources of data and evidence.
• Organize your sources: Group the sources by theme, method, or research question. This will help you identify similarities and differences among the literature, and provide a structure for your literature review.
• Analyze and synthesize the literature : Analyze each source in depth, identifying the key findings, methodologies, and conclusions. Then, synthesize the information from the sources, identifying patterns and themes in the literature.
• Write the literature review : Start with an introduction that provides an overview of the topic and the purpose of the literature review. Then, organize the literature according to your chosen structure, and analyze and synthesize the sources. Finally, provide a conclusion that summarizes the key findings of the literature review, identifies gaps in knowledge, and suggests areas for future research.
• Edit and proofread: Once you have written your literature review, edit and proofread it carefully to ensure that it is well-organized, clear, and concise.

Examples of Literature Review

Here’s an example of how a literature review can be conducted for a thesis on the topic of “ The Impact of Social Media on Teenagers’ Mental Health”:

• Start by identifying the key terms related to your research topic. In this case, the key terms are “social media,” “teenagers,” and “mental health.”
• Use academic databases like Google Scholar, JSTOR, or PubMed to search for relevant articles, books, and other publications. Use these keywords in your search to narrow down your results.
• Evaluate the sources you find to determine if they are relevant to your research question. You may want to consider the publication date, author’s credentials, and the journal or book publisher.
• Begin reading and taking notes on each source, paying attention to key findings, methodologies used, and any gaps in the research.
• Organize your findings into themes or categories. For example, you might categorize your sources into those that examine the impact of social media on self-esteem, those that explore the effects of cyberbullying, and those that investigate the relationship between social media use and depression.
• Synthesize your findings by summarizing the key themes and highlighting any gaps or inconsistencies in the research. Identify areas where further research is needed.
• Use your literature review to inform your research questions and hypotheses for your thesis.

For example, after conducting a literature review on the impact of social media on teenagers’ mental health, a thesis might look like this:

“Using a mixed-methods approach, this study aims to investigate the relationship between social media use and mental health outcomes in teenagers. Specifically, the study will examine the effects of cyberbullying, social comparison, and excessive social media use on self-esteem, anxiety, and depression. Through an analysis of survey data and qualitative interviews with teenagers, the study will provide insight into the complex relationship between social media use and mental health outcomes, and identify strategies for promoting positive mental health outcomes in young people.”

Reference: Smith, J., Jones, M., & Lee, S. (2019). The effects of social media use on adolescent mental health: A systematic review. Journal of Adolescent Health, 65(2), 154-165. doi:10.1016/j.jadohealth.2019.03.024

Reference Example: Author, A. A., Author, B. B., & Author, C. C. (Year). Title of article. Title of Journal, volume number(issue number), page range. doi:0000000/000000000000 or URL

Applications of Literature Review

some applications of literature review in different fields:

• Social Sciences: In social sciences, literature reviews are used to identify gaps in existing research, to develop research questions, and to provide a theoretical framework for research. Literature reviews are commonly used in fields such as sociology, psychology, anthropology, and political science.
• Natural Sciences: In natural sciences, literature reviews are used to summarize and evaluate the current state of knowledge in a particular field or subfield. Literature reviews can help researchers identify areas where more research is needed and provide insights into the latest developments in a particular field. Fields such as biology, chemistry, and physics commonly use literature reviews.
• Health Sciences: In health sciences, literature reviews are used to evaluate the effectiveness of treatments, identify best practices, and determine areas where more research is needed. Literature reviews are commonly used in fields such as medicine, nursing, and public health.
• Humanities: In humanities, literature reviews are used to identify gaps in existing knowledge, develop new interpretations of texts or cultural artifacts, and provide a theoretical framework for research. Literature reviews are commonly used in fields such as history, literary studies, and philosophy.

Role of Literature Review in Research

Here are some applications of literature review in research:

• Identifying Research Gaps : Literature review helps researchers identify gaps in existing research and literature related to their research question. This allows them to develop new research questions and hypotheses to fill those gaps.
• Developing Theoretical Framework: Literature review helps researchers develop a theoretical framework for their research. By analyzing and synthesizing existing literature, researchers can identify the key concepts, theories, and models that are relevant to their research.
• Selecting Research Methods : Literature review helps researchers select appropriate research methods and techniques based on previous research. It also helps researchers to identify potential biases or limitations of certain methods and techniques.
• Data Collection and Analysis: Literature review helps researchers in data collection and analysis by providing a foundation for the development of data collection instruments and methods. It also helps researchers to identify relevant data sources and identify potential data analysis techniques.
• Communicating Results: Literature review helps researchers to communicate their results effectively by providing a context for their research. It also helps to justify the significance of their findings in relation to existing research and literature.

Purpose of Literature Review

Some of the specific purposes of a literature review are as follows:

• To provide context: A literature review helps to provide context for your research by situating it within the broader body of literature on the topic.
• To identify gaps and inconsistencies: A literature review helps to identify areas where further research is needed or where there are inconsistencies in the existing literature.
• To synthesize information: A literature review helps to synthesize the information from multiple sources and present a coherent and comprehensive picture of the current state of knowledge on the topic.
• To identify key concepts and theories : A literature review helps to identify key concepts and theories that are relevant to your research question and provide a theoretical framework for your study.
• To inform research design: A literature review can inform the design of your research study by identifying appropriate research methods, data sources, and research questions.

Characteristics of Literature Review

Some Characteristics of Literature Review are as follows:

• Identifying gaps in knowledge: A literature review helps to identify gaps in the existing knowledge and research on a specific topic or research question. By analyzing and synthesizing the literature, you can identify areas where further research is needed and where new insights can be gained.
• Establishing the significance of your research: A literature review helps to establish the significance of your own research by placing it in the context of existing research. By demonstrating the relevance of your research to the existing literature, you can establish its importance and value.
• Informing research design and methodology : A literature review helps to inform research design and methodology by identifying the most appropriate research methods, techniques, and instruments. By reviewing the literature, you can identify the strengths and limitations of different research methods and techniques, and select the most appropriate ones for your own research.
• Supporting arguments and claims: A literature review provides evidence to support arguments and claims made in academic writing. By citing and analyzing the literature, you can provide a solid foundation for your own arguments and claims.
• I dentifying potential collaborators and mentors: A literature review can help identify potential collaborators and mentors by identifying researchers and practitioners who are working on related topics or using similar methods. By building relationships with these individuals, you can gain valuable insights and support for your own research and practice.
• Keeping up-to-date with the latest research : A literature review helps to keep you up-to-date with the latest research on a specific topic or research question. By regularly reviewing the literature, you can stay informed about the latest findings and developments in your field.

Advantages of Literature Review

There are several advantages to conducting a literature review as part of a research project, including:

• Establishing the significance of the research : A literature review helps to establish the significance of the research by demonstrating the gap or problem in the existing literature that the study aims to address.
• Identifying key concepts and theories: A literature review can help to identify key concepts and theories that are relevant to the research question, and provide a theoretical framework for the study.
• Supporting the research methodology : A literature review can inform the research methodology by identifying appropriate research methods, data sources, and research questions.
• Providing a comprehensive overview of the literature : A literature review provides a comprehensive overview of the current state of knowledge on a topic, allowing the researcher to identify key themes, debates, and areas of agreement or disagreement.
• Identifying potential research questions: A literature review can help to identify potential research questions and areas for further investigation.
• Avoiding duplication of research: A literature review can help to avoid duplication of research by identifying what has already been done on a topic, and what remains to be done.
• Enhancing the credibility of the research : A literature review helps to enhance the credibility of the research by demonstrating the researcher’s knowledge of the existing literature and their ability to situate their research within a broader context.

Limitations of Literature Review

Limitations of Literature Review are as follows:

• Limited scope : Literature reviews can only cover the existing literature on a particular topic, which may be limited in scope or depth.
• Publication bias : Literature reviews may be influenced by publication bias, which occurs when researchers are more likely to publish positive results than negative ones. This can lead to an incomplete or biased picture of the literature.
• Quality of sources : The quality of the literature reviewed can vary widely, and not all sources may be reliable or valid.
• Time-limited: Literature reviews can become quickly outdated as new research is published, making it difficult to keep up with the latest developments in a field.
• Subjective interpretation : Literature reviews can be subjective, and the interpretation of the findings can vary depending on the researcher’s perspective or bias.
• Lack of original data : Literature reviews do not generate new data, but rather rely on the analysis of existing studies.
• Risk of plagiarism: It is important to ensure that literature reviews do not inadvertently contain plagiarism, which can occur when researchers use the work of others without proper attribution.

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Literature Reviews: 5. Write the Review

• Library Basics
• 1. Choose Your Topic
• How to Find Books
• Types of Clinical Study Designs
• Types of Literature
• 3. Search the Literature
• 4. Read & Analyze the Literature
• 5. Write the Review
• Keeping Track of Information
• Style Guides
• Books, Tutorials & Examples

Qualities of A Good Lit Review

Create an Outline, Then Summarize & Synthesize

Draft an outline for your review.   Read more about developing an outline here at the Purdue OWL site.

Summarize & Synthesize

• Place each work in the context of its contribution to the understanding of the topic.
• Describe the relationship of each work to the others under consideration, noting contradictory studies.
• Identify areas of prior scholarship to prevent duplication of effort.
• Point the way forward for further research.

Choose How to Organize Your Paper

Before writing, you should consider a few different ways of organizing or categorizing the literature you've looked at and consider prioritizing the readings, or grouping them by methodology or theme.

1.  Chronologically – Organizing your sources by the date of publication can show how scholarly perspective on a topic has changed over time.

2.  Thematically – Organizing by theme puts all of the sources with a similar focus together, making it very easy to see where differences in perspective emerge.

3.  Methodologically – Organizing by method, much like organizing by theme, puts similar sources together and illustrates what effect method has on final product.  

At a loss for words?

• Academic Phrasebank Check out this phrasebank of terms and phrases to use in your research papers.

Elements of the Literature Review

There are many different ways to organize your references in a literature review, but most reviews contain certain basic elements.

Objectives - Clearly describe the purpose of the paper and state your objectives in completing the literature review.

Background/Introduction – Give an overview of your research topic and what prompted it.

Methods - Describe step by step how your performed your evaluation of the materials.

Discussion/Body - The body contains the evaluation or synthesis of the materials.  Discuss and compare common themes and gaps in the literature. You may also want to include a section on "questions for further research" and discuss what issues the review has sparked about the topic/field or offer suggestions for future studies that build on your current findings.

Conclusion – A summary of your analysis and evaluation of the reviewed works and how it is related to its parent discipline, scientific endeavor, or profession.

Bibliography - A list of the papers you discussed, aka References.  To learn more about different citation styles, visit the "Manage References and Citations" tab.

Writing Tips

Once you actually begin to write the review, stick to your outline and keep these tips in mind:

• Consider your audience.  Are you engaging with specialists in one discipline? Or generalists in more than one discipline?
• When writing for a more general audience, avoid jargon and strive for "plain English."
• When writing for a very specialized audience, consider using "plain English" anyway.
• Short paragraphs are easier to read than long paragraphs.
• Subheadings and subsections can help to underscore the structure of your review.
• Do more than just summarize the readings.  A lit review is not an annotated bibliography.
• Resist the temptation to refer to *all* the readings you've evaluated.  To begin with, focus on readings you've identified as essential or representative.
• Tell the reader how the literature intersects with your project -- how your project complements the existing literature.
• Be objective.  
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Home » Purdue University » What Makes A Good Literature Review?

What Makes A Good Literature Review?

Table of Contents

A good literature review shows signs of synthesis and understanding of the topic . There should be strong evidence of analytical thinking shown through the connections you make between the literature being reviewed.

What are the 5 characteristics of a good literature review?

Literature Review Format

• Provide an overview of the topic, theme, or issue.
• Identify your specific area of focus.
• Describe your methodology and rationale.
• Briefly discuss the overall trends in the published scholarship in this area.
• Establish your reason for writing the review.

What are the 5 C’s of writing literature review?

Is including the five C’s( Cite, Compare, Contrast, Critique and Connect ) really important in writing a literature review for your research project?

Why makes a good literature review?

A literature review establishes familiarity with and understanding of current research in a particular field before carrying out a new investigation . Conducting a literature review should enable you to find out what research has already been done and identify what is unknown within your topic.

What are the 4 main functions of literature review?

In relation to your own study, the literature review can help in four ways. It can: 1 bring clarity and focus to your research problem; 2 improve your research methodology; 3 broaden your knowledge base in your research area; and 4 contextualise your findings .

What are the 4 stages of literature review?

Literature search—finding materials relevant to the subject being explored. Data evaluation—determining which literature makes a significant contribution to the understanding of the topic. Analysis and interpretation—discussing the findings and conclusions of pertinent literature.

What are some of the most critical components of a good literature review?

The basic components of a literature review include:

• a description of the publication;
• a summary of the publication’s main points;
• a discussion of gaps in research;
• an evaluation of the publication’s contribution to the topic.

How do we write a literature review?

Write a Literature Review

• Narrow your topic and select papers accordingly.
• Search for literature.
• Read the selected articles thoroughly and evaluate them.
• Organize the selected papers by looking for patterns and by developing subtopics.
• Develop a thesis or purpose statement.
• Write the paper.
• Review your work.

How do you write a literature review example?

There are five key steps to writing a literature review:

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

What are the seven qualities of great literature?

The seven literary standards are: artistry, suggestiveness, intellectual value, spiritual value, permanence, universality and style . These are a set of characteristics to determine whether or not a work is literary. The criteria was developed by writer William J.

What makes good literature?

Great literature is based on ideas that are startling, unexpected, unusual, weighty. or new . Great literature makes us see or think things we never did before. The ideas underpinning the work challenge our accustomed categories and ways of thinking, putting minds on edge.

What are three six ways to write literature review?

6 Steps to Writing A Literature Review

• Synthesize.

What are the 6 steps in writing a literature review?

Organized around a proven six-step model and incorporating technology into all of the steps, the book provides examples, strategies, and exercises that take students step by step through the entire process: (1) Selecting a topic; (2) Searching the literature; (3) Developing arguments; (4) Surveying the literature; (5)

What makes a literature review fail?

There are several mistakes that may happen while writing an effective literature review includes no proper lines like dispute statement, absences of appropriate research, indicating the sources incorrectly, the poor formation of paper, plagiarism checking .

What are the 3 parts of literature review?

Just like most academic papers, literature reviews also must contain at least three basic elements: an introduction or background information section; the body of the review containing the discussion of sources; and, finally, a conclusion and/or recommendations section to end the paper .

What are the ten simple rules in writing literature?

Ten Simple Rules for Writing a Literature Review

• Rule 1: Define a Topic and Audience.
• Rule 2: Search and Re-search the Literature.
• Rule 3: Take Notes While Reading.
• Rule 4: Choose the Type of Review You Wish to Write.
• Rule 5: Keep the Review Focused, but Make It of Broad Interest.
• Rule 6: Be Critical and Consistent.

When starting your literature review what is the first step?

1. Define your topic . The first step is defining your task — choosing a topic and noting the questions you have about the topic. This will provide a focus that guides your strategy in step II and will provide potential words to use in searches in step III.

How many words should a literature review be?

In a PhD thesis, the literature review typically comprises one chapter (perhaps 8-10,000 words), for a Masters dissertation it may be around 2-3,000 words, and for an undergraduate dissertation it may be no more than 2,000 words.

How many sources should a literature review have?

The number of sources you will need will depend upon your assignment, professor, and level of study. In general, undergraduate students will usually be required to use somewhere between 5 and 20 sources; graduate students typically will need between 20 and 40 .

How many pages should literature review be?

The length of a literature review varies depending on its purpose and audience. In a thesis or dissertation, the review is usually a full chapter ( at least 20 pages), but for an assignment it may only be a few pages . There are several ways to organize and structure a literature review.

What are the qualities that make a piece of writing be considered literature?

Main Characteristics:

• usually fiction that displays a sense of reality.
• tension or conflict.
• artistic unity (a main idea is conveyed)
• figurative language (similes, metaphors, irony, symbolism, analogy)

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• Volume 8, Issue 2
• Public health leadership in the COVID-19 era: how does it fit? A scoping review
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• Tommaso Osti 1 ,
• Angelica Valz Gris 1 ,
• Valerio Flavio Corona 1 ,
• http://orcid.org/0000-0001-9375-8731 Leonardo Villani 1 ,
• Floriana D’Ambrosio 1 ,
• Marta Lomazzi 2 , 3 ,
• Carlo Favaretti 4 ,
• Fidelia Cascini 1 ,
• http://orcid.org/0000-0001-7357-2892 Maria Rosaria Gualano 4 , 5 ,
• Walter Ricciardi 1 , 4
• 1 Section of Hygiene, University Department of Life Sciences and Public Health , Università Cattolica del Sacro Cuore-Campus di Roma , Rome , Italy
• 2 World Federation of Public Health Association , Geneva , Switzerland
• 3 Institute of Global Health , University of Geneva , Geneva , Switzerland
• 4 Leadership Research Center , Università Cattolica del Sacro Cuore-Campus di Roma , Rome , Italy
• 5 UniCamillus - Saint Camillus International University of Health and Medical Sciences , Rome , Italy
• Correspondence to Professor Maria Rosaria Gualano, UniCamillus, Rome 00131, Italy; mar.guala{at}gmail.com

The COVID-19 pandemic has put a lot of pressure on all the world’s health systems and public health leaders who have often found themselves unprepared to handle an emergency of this magnitude. This study aims to bring together published evidence on the qualities required to leaders to deal with a public health issue like the COVID-19 pandemic. This scoping literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases. A total of 2499 records were screened, and 45 articles were included, from which 93 characteristics of effective leadership were extrapolated and grouped into 6 clusters. The qualities most frequently reported in the articles were human traits and emotional intelligence (46.7%) and communication skills such as transparency and reliability (48.9%). Responsiveness and preparedness (40%), management skills (33.3%) and team working (35.6%) are considered by a significant percentage of the articles as necessary for the construction of rapid and effective measures in response to the emergency. A considerable proportion of articles also highlighted the need for leaders capable of making evidence-based decisions and driving innovation (31.1%). Although identifying leaders who possess all the skills described in this study appears complex, determining the key characteristics of effective public health leadership in a crisis, such as the COVID-19 pandemic, is useful not only in selecting future leaders but also in implementing training and education programmes for the public health workforce.

• public health
• leadership assessment
• medical leadership

Data availability statement

Data sharing not applicable as no datasets generated and/or analysed for this study.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/leader-2022-000653

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Introduction

The COVID-19 pandemic represents a major public health issue with a huge health, social and economic impact worldwide. 1–3 After more than 3 years from the beginning of the pandemic, hundreds of millions confirmed cases and more than 6 million deaths have been reported worldwide. 4

Indeed, the pandemic has undoubtedly generated enormous pressure on health systems, not only in terms of the scientific and logistical challenge of countering a new virus, but also in terms of allocation of resources and frequent disruption of essential services. 5 This situation has created new barriers between the general population and the demand for healthcare, resulting in an intensification of health inequalities. 2 6 Despite the lessons learnt from previous infectious diseases outbreaks, 7 the COVID-19 pandemic demonstrated the lack of preparedness of healthcare systems, with significant implications for population health, economic growth of countries, social cohesion of communities and stability of governments and democracies. 8 Moreover, shortage of investment in sectors such as healthcare, education and research has contributed to miscommunication, growing distrust in institutions and science, challenging public health decision-makers in implementing necessary measures to tackle the pandemic. 9 10 Addressing these challenges requires strong evidence-driven public health leadership to coordinate an integrated policy response that can reduce the impact of the crisis and provide effective responses to increase resilience of health systems. 11 In this context, keeping in mind Roger Gill’s quote ‘There is no one correct definition of leadership, or any one set of personal qualities or competencies that characterize leaders’, 12 leadership is traditionally conceptualised through theoretical models that consider competence, behaviours and values. However, public health issues are complex, involve almost every sector of management and have consequences for every aspect of people’s lives, requiring public health leaders to engage multiple stakeholders in activities that are public and open to broad scrutiny and public debate. 13 Models of health leadership need to consider the complexity of healthcare organisations, the intersectionality of challenges, and the need to involve and empower the population to give sustainability to the actions and the policies adopted. During the COVID-19 emergency, people who had to manage the pandemic both at a macro (political, governmental and institutional) and micro level (eg, in a hospital and local healthcare settings) faced several challenges, such as the limited or constantly changing nature of information, the need for rapid and problem-oriented responses, and fear and mistrust of the population. 14 Therefore, leaders are required to direct, guide and establish the most appropriate strategies to make a difference between success and failure in the management of potentially catastrophic situations at all levels.

In this context, the aim of this review is to summarise evidence on the main leadership’s characteristics reported during the COVID-19 pandemic. Identifying capacities, values and traits of leaders can help institutions and educators to build programmes that ensure a workforce capable of strengthening the resilience and preparedness of healthcare systems and leading public health to address possible future threats. 15

Search strategy

This scoping review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. 16 A search of relevant articles was performed in the PubMed, Scopus and Web of Science databases using a query related to leadership skills and characteristics during the COVID-19 pandemic ( online supplemental figure 1 ). The search was performed from January 2020 to February 2022. The resulting records were entered on the web application Rayyan-Intelligent Systematic Review, 17 to be subsequently screened according to the inclusion/exclusion criteria. After the removal of duplicates, the selection of articles was made by reading titles and abstracts, and then full texts.

Supplemental material

Inclusion/exclusion criteria.

Eligible articles were any type of publication that outlined one or more characteristics of public health leadership during the COVID-19 pandemic, such as communication abilities, soft skills, ethics and values, management skills, training and work experience. We included articles concerning local healthcare settings, specifically hospital directorate and medical and nursing management of wards, or public health management at a national or international level. We considered articles published between the beginning of the healthcare emergency in January 2020 and February 2022. We considered only articles written in English or Italian. We excluded all articles that did not explicitly address the COVID-19 pandemic or with a different setting (eg, veterinarian, schools, enterprise). Moreover, we excluded articles that did not identify any leadership characteristics, intended as communication abilities, soft skills, ethics and values, management skills, training and work experience (wrong outcome).

Selection process and data extraction

Each record was assessed by title and abstract by two independent reviewers (VFC and FD’A). Any disagreement between reviewers, whether necessary, was discussed and solved with a third reviewer (TO).

The full-text assessment was performed in the same manner, thereby identifying the final list of eligible articles. Data extraction was performed by two reviewers (TO and AVG), and every disagreement was resolved by discussion with a third reviewer (LV). The data from the eligible studies were extracted in a predefined Excel sheet, defined by the following columns regarding information extracted from the studies: authors’ name, publication year, study country, study design, type of publication, study setting and main findings. Three reviewers (TO, AVG, LV) analysed and clustered elements that emerged from the analysis by using an iterative process rooted in grounded theory to compare and develop emergent themes. 18 Thus, characteristics emerged as relevant and the number of times each characteristic was discussed was clustered in six macro groups: human traits, behaviour and emotional intelligence; management skills and decision-making; team working, collaboration and empowerment; responsiveness and preparedness; communication skills and stakeholder engagement; evidence-based approach and innovation. Finally, the entire research team discussed the clustering results to identify and resolve any disagreements.

The overall research in the three databases yielded a total of 2449 articles. After duplicates removal, 1471 articles were screened based on the title and abstract. In total, 132 full-text articles were selected. Following the inclusion and exclusion criteria, the screening resulted in the final inclusion of 45 articles. Details about the study selection process are shown in figure 1 . Of these, 7 were literature reviews (15.6%), 16 were research articles (35.6%) and 22 were classified as ‘other’ (48.8%), including editorials, commentaries, opinion pieces and reports.

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Data were recruited from a variety of countries, with the USA being the most represented, although about 30% of the articles are not placed in any specific geographical setting but produce general considerations.

More than 57.8% of the articles (n=26) addressed public health management setting, at national or government level, while 19 (42.2%) hospital setting, involving physicians (11.1%), nurses (11.1%), healthcare directorate and management (20%) ( table 1 ).

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General characteristics of the included studies

Leadership characteristics and clustering

We identified 93 characteristics (a characteristic can be expressed several times in different studies, for a total of 170 citations) that we clustered into six main groups: human traits, behaviour and emotional intelligence; management skills and decision-making; team working, collaboration and empowerment; responsiveness and preparedness; communication skills and stakeholder engagement; evidence-based approach and innovation.

Among the groups, in three cases (management skills and decision-making; team working, collaboration and empowerment; evidence-based approach and innovation), we found both positive and negative aspects related to the leaders’ characteristics. The groups identified are shown in table 2 , while table 3 specifically reports the nomenclature and the frequency of each item found.

Number of articles reporting leadership characteristics by categories

Aspects of leadership mentioned in articles by categories

Characteristics attributable to the first group, ‘human traits, behaviour and emotional intelligence’, were identified in 21 articles (46.7%), 8 of which were research articles, 19–26 11 opinion pieces 27–37 and 2 reviews. 38 39 In particular, empathy and ‘honesty and truthfulness in relationships’ were the two most cited characteristics (six and three times, respectively), followed by compassion, emotional intelligence and psychological safety, attention to psychological well-being, emotional effectiveness, equity and values, sense-making and sense-giving (all cited two times). Other characteristics emerged only once from the analysis ( table 3 ).

In group 2, ‘management skill and decision-making’, we identified 15 articles (33.3%) containing features from this domain: 5 research articles, 19 21 40–42 7 opinion pieces 29 33 35 36 43–45 and 3 reviews. 38 46 47 Elements that have emerged most frequently are decision-making (eight times), organisation and planning (both three times), adherence to rules, influencing policies, prepare (twice each). Moreover, in this group, three characteristics emerged as negatively associated with public health leadership: ‘inconsistent policy position’, ‘management at federal level’ and ‘unpredictable behaviour’. 48 49

Sixteen articles (35.6%) were related to group 3, ‘team working, collaboration and empowerment’, of which eight research articles, 19 20 22 24 26 42 50 51 six opinion pieces 34 36 37 52–54 and two reviews. 38 55 Notable characteristics are collaboration, which emerged predominantly five times, accountability, empowerment and team building (three times each), and shared decision-making/leadership (twice). Lack of coordination was underlined once as a negative aspect, 49 while autocratic leadership was still presented as a deductive factor. 56

Eighteen studies (40%) were included in group 4, ‘responsiveness and ‘preparedness’ (10 research articles, 19–21 24 40–42 50 51 57 5 opinion pieces 32 34 35 44 51 and 3 reviews 38 46 47 ). ‘Adapt according to the situation’ was the most cited characteristic (seven times), followed by resilience (four times), act fast, creating strategies, ‘integrative and systematic thinking skills’ (three times), and pragmatism (twice).

The characteristics of the fifth group, ‘communication skills and stakeholder engagement’, were reported in 7 research articles, 19–22 24 26 42 13 opinion pieces 27 29–31 35–37 43 45 52 58–60 and 2 reviews 38 61 (48.9%). About this topic, elements that emerged with greater frequency are clear communication, (10 times), transparency (6 times), advocacy, risk and crisis communication (2 times each).

Finally, group 6, ‘evidence-based approach and communication’ aspects have been found in 14 articles (31.1%), of which 5 research articles, 19 20 25 62 63 7 opinion pieces 27 32 35 36 44 53 60 and 2 reviews. 46 47 ‘Evidence-based decision-making’ (six times) and technological skills (two times) are the most represented characteristics. Finally, one opinion piece 48 highlighted ‘mistrust of science’ as a negative feature.

Finally, we found a different distribution of the characteristics according to the healthcare setting and type of professionalism ( table 4 ). In particular, characteristics related to communication and team working, human traits and management capabilities were reported in articles dealing with medical professionalism, while no articles focused on the importance of the evidence-based approach. The importance of team working was reported also in articles dealing with nursing professionalism, as well as evidence-based approaches. In the articles dealing with the healthcare directorate, we found many leadership characteristics, such as human traits, preparedness and communicative elements. Finally, in the public health management setting, we mainly found leadership characteristics such as communication, team working and those related to human traits.

Distribution of leadership characteristics according to the healthcare setting and type of professionalism

In this scoping review we summarised the main leadership’s characteristics that emerged during the COVID-19 pandemic, addressing both governmental and international as well as local settings. In detail, we identified six macro groups referring to several aspects of leadership that are reported as fundamental in order to be a good leader, capable of managing a public health emergency. Elements emerged from this analysis outline a varied profile, ranging in different characteristics and capacity areas. Human traits, behaviour and emotional intelligence emerged as really necessary to create and transmit trust and confidence, both at an institutional level (and therefore to citizens) and in the work team. In particular, empathy, compassion, attention to well-being and honesty are reaffirmed as key characteristics for ensuring credibility and trust, 64–66 allowing the implementation of actions and measures, specifically during the pandemic, without causing doubt, perplexity and, in extreme cases, anger from the population. These points are closely linked to communication skills. Our study, in fact, shows that clear communication and transparency are the most cited characteristics in the description of the communication skills of a good leader during the pandemic. Indeed, the ability to communicate information in a clear, empathetic and evidence-based manner is critical to enable people to understand and accept measures being taken. 67 68 The same could be highlighted at a micro level, like for example in hospital setting, where clear and transparent communication within the team and towards patients is fundamental for effective project development and goals’ achievement. 69 70 A clear example of wrong communication and misinformation is about the COVID-19 vaccine campaign, where, based on assumptions and not on data, the administration of the AstraZeneca vaccine was stopped claiming associations between vaccination and increased risk of death. 71 The suspension of this vaccine generated great panic among citizens, increasing doubts, fear and vaccine hesitancy, 72 causing a slowdown of the campaign.

Similarly, the lack of transparency and objective communication of risk by several political leaders all over the world led to underestimation of the risk and made it impossible to control the spread of the infection in many countries, resulting in a high number of cases and deaths. 73–75

Second, the results report as characteristics of a good leader, ‘management skill and decision-making’, closely related to ‘team working, collaboration and empowerment’. Another important theme is related to ‘responsiveness and preparedness’, with reference to the ability to plan and predict events in order to optimise resources available. Extending this vision to an international level, the definition of a clear chain of command and the centralisation of some decisions are a necessary prerogative for the correct management of an emergency. 76 This is consistent with the vision of the dynamics that regulate the events during a pandemic as attributable to a system that we can define as ‘complex adaptive’, 77–79 so it requires not only careful planning 14 but also a considerable adaptability and resilience.

Leaders, by definition, never work alone, so it is essential that he or she is supported by a loyal and responsive working group, creating a constructive synergy. Of course, to achieve this type of relationship, it is important for leaders to provide inputs aimed at conveying a sense of empowerment to the group, promoting team-building dynamics that shift the structure of some decisions on a more shared level. 80

Finally, another important aspect emerged from our study is the focal role of ‘evidence-based decision-making’ acquired during the COVID-19 pandemic. A leader’s activity in public health cannot be done without a robust system of scientific evidence to support decisions. This both to implement decisions that will positively impact the course of events and to fully justify the direction taken in a public health perspective. 81 82

Regarding the distribution of leadership characteristics according to different settings, we noted a homogeneous distribution of qualities in specific settings. Indeed, both of the health directorate in local health authorities and hospitals and the public health management are representations, at macro and meso levels, of organisational and health planning settings, in which the leader is called to deal with multidisciplinary and varied inputs, 83 thus requiring all the different categories highlighted by our study. Therefore, in these specific contexts, the clusters we have identified constitute paramount cross-cutting and key elements in the identification of the figure of a leader. Indeed, these are settings that can be traced to the complex system model, and as such require a systemic and inclusive approach of multiple elements, 84 such as the one proposed in this work. Indeed, leaders operating in these areas should have a profile that reflects the multiplicity of challenges they face. This element suggests the importance of a cross-fertilisation of skills and capabilities between healthcare workers, including clinicians, surgeons, nurses and public health professionals. Thus, creating joint training programmes, taking into account the various characteristics we have identified, would improve professional capabilities and knowledge, fostering collaboration within complex systems at different levels.

Strengths and limitations

As far as we know, this is the first scoping review investigating characteristics of leadership during COVID-19 and succeeds in providing a comprehensive set of all the main qualities of a public health leader described in the literature. However, it is necessary to highlight the structural limits of some of the studies included in the analysis, as they lacked a standardised methodology in the process of identification and evaluation in terms of the characteristics and qualities regarding leadership in public health. Furthermore, in the search for articles, only articles in English and Italian were selected, which may have resulted in the omission of literature from some geographical areas. Given the limited number of studies in the literature aimed at measuring the effectiveness of a leader’s competencies in various contexts and the possible variables of interest, it is advisable to increase research aimed at finding methods to measure how leadership competencies actually influence the impact of public health measures and consequently the well-being of the population.

Conclusions

The pandemic has highlighted the need for leaders highly prepared to manage public health emergency contexts. Of course, identifying a leader who possesses all the qualities we highlighted in our study could appear difficult or even impossible; however, for this reason, it is necessary and more urgent than ever to continue and increase investment in the preparation of those in charge of guiding people across difficult situations like the one we are experiencing with the COVID-19 pandemic. In this context, the training of professionals and leaders is a paramount action to address the challenges of the future in public health. In the area of communication, it would be appropriate to integrate training programmes specifically targeting communication skills into health professionals’ and decision-makers’ curricula at different organisational levels. We cannot assume that a single communication style fits all settings and situations in which a leader operates; however, by taking advantage of the available evidence, 85 it is possible to identify the most appropriate educational tool for the development of effective communication skills. Similarly, the other elements that emerged from our study, such as adherence to an evidence-based approach in decision-making processes, emotional intelligence and team working abilities, should be included in the training programmes, in order to prepare leaders who interface with public health issues.

The development of research in the field of public health leadership can, starting from the characteristics we have identified, make use of quantitative and qualitative methods to investigate with increasing rigour the weight these attributes have in the management of critical public health issues. In this sense, future studies that can analyse more thoroughly the specific role in health crises of elements related to human traits, team working and communication skills are desirable, possibly proposing objective evaluations of how these factors have weighed in the management of the COVID-19 pandemic in different global settings. It would also be useful to investigate further the gaps in the literature referring to the lack of articles highlighting the importance of the evidence-based approach in a physicians' leadership setting and the crucial role of communication in nursing.

Finally, it is necessary to dwell on technological and digital skills, particularly related to the information sector and social media, as those deeply affecting the dynamics underlying the social response to health policies aimed at responding to a pandemic situation. 86 The importance, today, in knowing how to use digital and information technology tools for the benefit of shared health is, in our view, critical in defining the characteristics that compete for a public health leader.

Thus, the value of our research lies in providing a comprehensive view of the attributes to look for in the figures we place at the top of our decision-making systems, promoting the value of leadership research and training to ensure we are prepared for future public health emergencies and emerging challenges affecting public health interventions.

Ethics statements

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Not required.

Ethics approval

Not applicable.

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Supplementary materials

Supplementary data.

This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

• Data supplement 1

Collaborators Public Health Leadership Coalition: Natasha Azzopardi Muscat, WHO Regional Office for Europe, Copenhagen, Denmark; Georges Benjamin, American Public Health Association, Washington, DC, USA; Bettina Borisch, Institute of Global Health, University of Geneva, Geneva, Switzerland, World Federation of Public Health Association, Geneva, Switzerland; Luis Eugenio de Souza, Health Collective Institute, Federal University of Bahia, Salvador, Brazil; Sharon Friel, Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Canberra, Australian Capital Territory, Australia; Alejandro Jadad, Centre for Global eHealth Innovation, University of Toronto, Toronto, Ontario, Canada; Jeff Smith, Australian Centre for Climate and Environmental Law, University of Sydney, Sydney, Australia; K Srinath Reddy, Public Health Foundation of India, New Delhi, India; Rüdiger Krech, Division of Universal Health Coverage and Healthier Populations, Department of Health Promotion, WHO, Geneva, Switzerland; Martin McKee, London School of Hygiene and Tropical Medicine, London, UK; Michael Moore, Public Health Association Australia, Curtin, Australian Capital Territory, Australia; Iveta Nagyova, European Public Health Association (EUPHA)-president, Utrecht, the Netherlands; Jean-Marie Okwo-Bele, Board of Trustees of the International Vaccine Institute; María del Rocío Sáenz Madrigal, School of Public Health, University of Costa Rica, San José, Mercedes, Costa Rica; Stefano Scarpetta, Director for Employment, Labour and Social Affairs at the OECD, Paris, France; Melissa Sweet, Croakey Health Media, Sydney School of Public Health, University of Sydney, Sydney, Australia; Sheila Tlou, Department of Nursing Education, University of Botswana, Gaborone, Botswana; Collin Tukuitonga, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

Contributors All authors, including the collaborating group, contributed to the study conception and design. Material preparation and data collection were performed by TO, AVG, LV, VFC and FD'A. The data extraction was performed by TO and AVG, and every disagreement was resolved by LV. The first draft of the manuscript was written by TO, AVG, FC and ML. MRG and WR commented on the latest version of the manuscript and supervised the study. All authors, including the collaborating group, read and approved the final manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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• Open access
• Published: 26 June 2024

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

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

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

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

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

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

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

Peer Review reports

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

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

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

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

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

Identifying the research question

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

WHO is tendering flexible respite?

WHEN is flexible respite tendered?

HOW is flexible respite tendered?

Identifying relevant documents

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

Study selection

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

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

Conceptual mapping of results: HOW , WHEN , WHO

Charting the data

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

Collating, summarizing, and reporting the results

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

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

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

Consultation

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

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

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

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

Characteristics of selected documents

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

Characteristics of survey participants

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

Characterization of flexible at-home respite

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

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

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

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

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

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

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

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

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

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

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

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

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

Limitations and strengths

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

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

Data availability

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

Abbreviations

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

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Acknowledgements

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

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

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Maude Viens, Alexandra Éthier, Véronique Provencher & Annie Carrier

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MV conducted the review and co-wrote the article with AE. AE co-validated the study selection and co-wrote the article. AC co-validated the study selection, data charting and reviewed the article. VP reviewed the article. All authors read and approved the final manuscript.

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Viens, M., Éthier, A., Provencher, V. et al. WHO, WHEN, HOW: a scoping review on flexible at-home respite for informal caregivers of older adults. BMC Health Serv Res 24 , 767 (2024). https://doi.org/10.1186/s12913-024-11058-0

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• http://orcid.org/0009-0006-9680-7969 Hanna A A Röwer ,
• http://orcid.org/0000-0003-2602-9277 Franziska A Herbst and
• http://orcid.org/0000-0002-3575-3817 Sven Schwabe
• Institute for General Practice and Palliative Care , Hanover Medical School , Hanover , Germany
• Correspondence to Ms Hanna A A Röwer, Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany; roewer.hanna{at}mh-hannover.de

Background Regional hospice and palliative care networks (RHPCNs) are increasingly being established to improve integrative care for patients with life-limiting illnesses. This scoping review aimed at identifying and synthesising international literature on RHPCNs, focusing on structures, outcomes, benefits, success factors and good practices.

Method Following Arksey and O’Malley’s (2005) framework, a search of four electronic databases (CINAHL, Google Scholar, PubMed, Web of Science Core Collection) was conducted on 7 July 2023. Additionally, a manual search of reference lists of the identified articles was performed. Original research, qualification theses and descriptive reports on RHPCNs at a structural level were included.

Findings Two researchers analysed 777 article abstracts, screened 104 full texts and selected 24 articles. The included studies predominantly used qualitative designs. RHPCNs self-identify as local stakeholders, employ coordination offices and steering committees, and actively recruit network partners. Outcomes included improved professional practices, enhanced quality of care, increased patient utilisation of regional care offerings and improved patient transitions between care providers. Success factors included clear coordination, transparent communication, strategic planning and resource-securing strategies.

Conclusions The analysis identified key RHPCN success factors such as effective communication and adaptive leadership. Despite the need for further research, the findings emphasise RHPCNs’ potential to improve palliative care and encourage policymaker support.

Other This scoping review is part of the research project HOPAN, which aims at assessing and analysing RHPCNs in Germany. The project is funded by the German Innovation Fund of the Federal Joint Committee (G-BA) (Grant N° 01VSF22042; funding period: 01/2023–12/2024).

• Hospice care
• Palliative Care
• Case Management
• Supportive care
• Communication

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/ .

https://doi.org/10.1136/spcare-2024-004974

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WHAT IS ALREADY KNOWN ON THIS TOPIC

The existing literature recognises regional hospice and palliative care networks (RHPCNs) as promising structural approaches for optimising end-of-life care. A comprehensive overview of RHPCN structures and benefits is lacking. A scoping review was considered appropriate to synthesise the literature and address research gaps.

WHAT THIS STUDY ADDS

The present review provided an understanding of RHPCNs’ nuanced organisational structures, multifaceted outcomes and benefits (eg, improved professional practices, enhanced client services), and specific success factors (eg, transparent communication, strategic planning, resource securing strategies for sustainability).

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE, OR POLICY

The findings may guide efforts to refine and strengthen RHPCN structures and activities, thereby bolstering the ability of RHPCNs to provide effective and integrated end-of-life care. Policymakers and stakeholders may use the findings to improve the structural frameworks and funding conditions of RHPCNs.

Introduction

Effective palliative care requires collaboration and coordination among various healthcare professionals, organisations and community resources. 1 2 Thus, the emergence of regional hospice and palliative care networks (RHPCNs) shows promise for enhancing the delivery of comprehensive and integrated care for patients with life-limiting illnesses at a structural level.

An RHPCN is a structured collaborative system encompassing a wide array of stakeholders in a specific geographic region. RHPCNs bring together various healthcare providers, organisations and services to address the complex and interconnected healthcare challenges faced by patients and communities. Unlike isolated cases of provider cooperation, RHPCNs collaborate at a structural level, with key stakeholders working together to improve healthcare delivery in palliative and hospice settings in their local region. RHPCNs aim at facilitating the sharing of expertise, resources and good practices, ultimately optimising the delivery of palliative care across different contexts, including hospitals, long-term care facilities and outpatient care settings. 3 4

Given the increasing implementation of RHPCNs, 5–8 a comprehensive understanding of their structures, benefits and success factors is crucial to guide their continued development and refinement. A scoping review may help to achieve this by mapping and synthesising the literature on RHPCNs, exploring the range of evidence available to identify key themes and research gaps.

The present scoping review aimed at generating an overview of the current knowledge and understanding of RHPCNs. Specifically, it addressed the following question: What is known about RHPCNs worldwide, with regard to (a) their structure, (b) their benefits and outcomes, and (c) their success factors and good practices?

Through this systematic scoping review, the study sought to inform both current and prospective RHPCN providers and funders about the state of knowledge on RHPCNs, while also drawing researchers’ attention to gaps in the scientific data. Additionally, the results aimed at guiding the further development of RHPCNS through recommendations and evaluation frameworks to improve network maturity. The work comprised part of the broader HOPAN research project. 9

The research question necessitated a methodology that would offer a comprehensive overview of the existing literature. Scoping reviews are designed to capture a wide range of information, allowing for a broad and diverse collection of knowledge. Consequently, for the present study, a scoping review was preferred to a systematic review, as the research question called for an open, exploratory approach.

The scoping review followed the five-step methodological framework of Arksey and O’Malley 10 : (1) identifying the research question(s), (2) identifying the relevant studies, (3) selecting the studies, (4) charting the data, and (5) collecting, summarising and reporting the results.

Protocol and registration

The present scoping review has not been registered. To enable transparent documentation and to ensure replicability, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist 11 and a review protocol were used to both plan and conduct the review, as well as to guide the reporting of the results.

Eligibility criteria

Articles were assessed and selected on the basis of the study population and setting, as well as the publication language and article type. As RHPCNs are a rather recent phenomenon, the review search period was left open. Publications in both German and English were included in the review. English contributions were accepted in order to capture results from around the world, while German articles were included to generate additional insights into the authors’ local context.

The review considered original research, scientific qualification theses and descriptive reports, as these types of publications typically follow rigorous methodologies, ensuring systematic and thorough investigation. Limiting the review to these types of publications also aimed at ensuring the credibility, validity and relevance of the included literature. Congress abstracts were excluded because these often lack sufficient detail on methodology and results to guarantee scientific quality.

Information sources

A comprehensive search of the electronic databases CINAHL, Google Scholar, PubMed and Web of Science Core Collection was conducted on 7 July 2023. These databases were selected to provide broad coverage of different disciplines. Additional databases were considered redundant or irrelevant. The compilation of full texts relied on the resources of the Hannover Medical School library.

Search strategy

The search strategy was developed by HR, with support from SvS and FH. The initial approach involved compiling a list of key articles deemed essential for answering the research question. 5 12–16 The search strategy was then iteratively adjusted until it included all of the identified key articles. Additional grey literature was sought via Google Scholar. Reference lists of the full texts were hand-searched to identify further relevant studies.

The following search strategy was used in PubMed:

(network[Tiab] OR networks[Tiab] OR networking[Tiab] AND rural[Tiab] OR regional[Tiab] OR local[Tiab] AND ‘palliative care’[MeSH Terms] OR ‘hospice care’[MeSH Terms] OR ‘terminal care’[MeSH Terms] OR palliative[Tiab] OR ‘terminally ill’[Tiab] OR ‘terminal illness’[Tiab] OR ‘terminal illnesses’[Tiab] OR ‘terminal disease’[Tiab] OR ‘terminal diseases’[Tiab] OR hospice[Tiab] OR hospices[Tiab] OR ‘end of life’[Tiab] OR eol[Tiab] OR ‘life’s end’[Tiab] OR ‘advanced care planning’[Tiab] OR ‘advanced illness’[Tiab] OR ‘advanced illnesses’[Tiab] OR ‘end stage disease’[Tiab] OR ‘end stage illness’[Tiab] OR ‘end stage illnesses’[Tiab] OR ‘end stage diseases’[Tiab])

This search strategy was adapted for the other databases according to the individual database standards, and retested to ensure that key articles in the respective databases were identified.

Selection of sources of evidence

To be included in the review, studies were required to focus specifically on RHPCNs comprised of interdisciplinary providers in hospice and palliative care settings, working at a structural level. Additionally, studies were only included if their population was a regional healthcare network promoting collaboration and coordination among different healthcare service providers in a specific geographic region. These networks were required to involve care providers from various health professions and disciplines, such as physicians, nurses, social workers, therapists and other experts from outpatient and/or inpatient facilities. Studies focused solely on specific cases of collaboration between individual providers were excluded, given the research objective to analyse structurally operating networks, rather than isolated instances of collaborative effort. Finally, studies were included only if they related to hospice or palliative care settings (ie, networks addressing the care of individuals with life-limiting illnesses at the end-of-life and their families).

Data charting

All of the retrieved articles were imported into EndNote 20 reference management software (Clarivate, Philadelphia, USA). After screening for duplicates, two researchers (HR and SvS) independently reviewed the titles and abstracts of the remaining studies. Documentation of the main reasons for exclusion was used to reach consensus. Both researchers independently moved excluded studies to separate EndNote groups according to the exclusion criteria: (1) other population, (2) other research setting, (3) other publication type or (4) other language. Researcher decisions were subsequently compared. In the event of disagreement, consensus was sought. Where consensus was not reached, a third researcher (FH) was consulted for clarification. In the next step, two researchers (HR and SvS) independently reviewed the full text of the remaining studies, according to the aforementioned criteria.

All of the included articles provided information on at least one of the three aspects covered by the research question. The analysis of RHPCN structures relied on data regarding their organisation and operational framework. The examination of benefits and outcomes referred to studies describing the effects of RHPCNs on patients and their families, as well as local professionals. Finally, the identification of RHPCN good practices and success factors relied on studies highlighting established and recognised methods and processes leading to optimal RHPCN conditions. Benefits, outcomes, good practices and success factors that were listed in articles as potentially significant but not actually observed were not included.

Critical appraisal of individual sources of evidence

No quality assessment of the reported evidence was conducted, due to the chosen form of review and the immediate need for evidence to support an ongoing research project.

Synthesis of results

Studies were included if they provided information on at least one of the following three topics: (1) structures, (2) benefits and outcomes, and (3) success factors and good practices. Information on these topics was compiled in a table.

The search resulted in 24 articles for the final review, including one article identified through a hand search.

A total of 1089 records were identified from CINAHL (n=248), Google Scholar (n=30), PubMed (n=362) and Web of Science Core Collection (n=449) (see figure 1 ). Prior to the screening process, 313 duplicate records were removed, leaving 776 unique records for further assessment. During the screening phase, the abstracts and titles of each of the 776 records were reviewed for study eligibility. This resulted in the exclusion of 670 records for the following reasons: study population other than structural networks (n=644), study setting other than hospice and palliative care settings (n=23), other publication type (n=2), or published in a language other than English or German (n=2). Following the initial screening, the full texts of 105 potentially relevant articles were sought for retrieval. However, two of these articles could not be retrieved. Hence, a total of 103 full texts were assessed for eligibility. From these articles, further exclusions were made based on the following criteria: study population other than structural networks (n=51), study setting other than hospice and palliative care settings (n=2), other publication type (n=15), or published in a language other than English or German (n=12). A hand search of the reference lists of the chosen full texts resulted in the inclusion of one further paper. Ultimately, 24 studies were included in the systematic review.

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Flow diagram.

Characteristics of sources of evidence

The included 24 studies focused on RHPCNs in different countries, with the majority (n=10) based in Canada. 3 17–25 Five articles provided insights into RHPCNs in different regions of Australia, 16 26–29 five originated from Germany 12–15 30 and two were based in the USA. 31 32 One article explored the formation and evaluation of RHPCNs in the Netherlands. 5 Finally, one article focused on the experiences of community nurses in RHPCNs based in the UK. 8 The earliest study was published in 1980 31 and only a small number of articles (n=6) were published in the last 10 years since the database search. 12–15 24 30 These more recent studies primarily stemmed from Germany. 12–15 Most articles were published in 2001, 8 28 between 2005 and 2007, 3 5 10 21 26 29 between 2009 and 2011, 16–20 22 and in 2017 12 13 (see figure 2 ).

Publications (full texts) by year and country of origin.

Thirteen studies drew on qualitative research in the form of interviews and focus groups. 3 5 8 12–14 19 21 22 26 27 29 30 Document analysis was applied in five studies, 3 5 16 18 19 mainly describing the establishment and structural composition of RHPCNs. While the use of surveys was noted in seven studies, 5 12 14 18 20–22 only one study used a survey as their sole data source. 20 The number of network participants varied across studies, from 1 15 19 23–25 27 30 32 to 13. 20 The number of interviewees in studies reporting this information ranged from 1 17 to 20, 19 with an average of 11. The number of focus group or workshop participants in studies reporting this data ranged from 8 32 to 106, 28 with an average of 42. The number of survey participants in studies reporting this data ranged from 12 26 to 61, 20 with an average of 25. Additionally, two studies 23 30 analysed a total of n=43 012 patient data sets.

Results of individual sources of evidence

In the following tables present the principal data pertaining to the articles and their content in relation to the research questions (see tables 1–6 ).

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Summarised characteristics of the included studies (part 1)

Summarised characteristics of the included studies (part 2)

Summarised characteristics of the included studies (part 3)

Summarised characteristics of the included studies (part 4)

Summarised characteristics of the included studies (part 5)

Summarised characteristics of the included studies (part 6)

The findings of the scoping review are presented in accordance with the three topics covered by the research question.

Seventeen articles 5 8 12 13 15 17–20 22 23 25 28–32 addressed RHPCN structures. Taken together, these articles provided a comprehensive overview of two central RHPCN themes: network role and organisational structure. In more detail, 14 articles 5 8 12 13 15 17 19 23 28–32 addressed network role and 14 articles 5 8 12 13 15 17–20 25 29–32 addressed organisational structure.

Network role

RHPCNs were found to contribute to collaboration and the efficient delivery of patient-centred care. Some studies emphasised the central role played by RHPCNs in sustaining interprofessional collaboration and cooperation. 17 21 30 Two studies described RHPCNs as a central point of information exchange between regional providers, 25 29 while other studies showed that RHPCNs aim at improving the flow of information through centralised information platforms. 19 Some articles positioned RHPCNs as strategic management tools within health systems, describing them as multi-institutional systems for coordination or consolidation, involved in planning and evaluation, rather than policy. 8 31 Several authors further indicated that RHPCNs act as catalysts for sustained collaboration, 20 engage in advocacy through coordination and programme evaluation, 32 and expand to new target groups, fostering diverse partnerships. 12 The included studies varied in their descriptions of the extended functions of RHPCNs, which included establishing new provider facilities (eg, branch offices) or completely new regional offerings, 15 and serving as catalysts for organisational and stakeholder organisation. 23 28 Several authors also indicated that RHPCNs may play a governance role, 19 highlighting diverse functions ranging from coordinating volunteers to exerting political influence, 28 29 while also suggesting the importance of formal structures to facilitate commitment and alignment.

Overall, the included studies showed that RHPCNs facilitate interprofessional collaboration through team-based approaches emphasising ethical awareness. 17 In addition, several authors argued that RHPCNs align with larger healthcare strategies, recognising their evolving nature. 8 12 15

Organisational structure

The included studies identified differing RHPCN organisational models, based on various forms of cooperation. These included cooperation agreements, 13 20 cooperation via coordination offices or steering committees, 13 15 and cooperation with no formal agreement in place but the intention to share costs. 32 This highlights the adaptive nature of these networks. A qualitative study of n=10 network coordinators described partnerships within RHPCNs as expansive, including hospitals, general practitioners, specialised doctors, outpatient care services, inpatient care homes, local authorities, pharmacies and aid suppliers. 12 One study found that some RHPCNs had approximately 100 member organisations. 18 The authors of three other papers described that RHPCNs focus on expanding local educational services, adapting to external policy frameworks and accommodating different palliative care service models. 15 23 28 One publication noted that local stakeholder-driven networks adopt inclusive structures, uniting leaders from numerous organisations. 21

Another study described that RHPCN organisational structures vary in accordance with internal and external factors, such as structural disparities and funding challenges. Variations in interorganisational cooperation may pose further complexities. 19 Two studies described RHPCNs as constantly evolving in response to government guidance. 8 29 These same studies also described how the influence of external policy frameworks on service models 8 29 can challenge structural uniformity. Furthermore, two studies reported structural inequalities within RHPCNs due to inadequate funding, variable palliative care capacity, and a lack of standardised information systems. 5 19

In summary, the investigated studies suggest that RHPCNs are remarkably adaptable to local contexts. Furthermore, they navigate challenges through diverse structures, promote interprofessional collaboration and contribute to strategic health priorities.

Outcomes and benefits

Eighteen articles 3 5 8 13 15 17–23 25–27 30–32 addressed the outcomes and benefits of RHPCNs, underlining two main themes: professional practice benefits and client service benefits. Both of these categories were covered by all of the 18 articles, with consistent themes emerging.

Professional practice benefits

Various studies described that interdisciplinary collaboration and a team-based approach could improve coordination and communication at an interdisciplinary level. 5 8 17 27 31 Some of the publications noted that the integration of comprehensive pain and bereavement management skills through networking could also contribute significantly to holistic patient care. 3 17 26–28 Two studies based in Australia and Canada, respectively, identified that networking improved both ethical awareness and knowledge of legislation, promoting greater compliance with legislation and models of ethical healthcare. 17 27 In addition, some authors argued that networking could facilitate greater collaboration between healthcare professionals and ensure a consistently high quality of patient care. 5 8 19–21 26 Professional practice was also described as being strengthened through the exchange of valuable information and further training within the network. 26 28 32

Studies also identified that improvements in symptom management and the introduction of regional standardised assessment procedures, both associated with RHPCNs, could significantly improve the effectiveness of patient care. 20 22 23 30 31 Four studies described that networking could promote the efficient use of resources, knowledge sharing and interdisciplinary cooperation, enabling the optimal use of healthcare resources. 13 15 23 30 In addition, three studies showed how the culture of collaboration fostered by RHPCNs, as evidenced by their greater transparency and promotion of effective conflict resolution, had a positive impact on primary caregiver satisfaction. 5 19 21

Client service benefits

In addition to the client benefits derived from the improved professional practice associated with RHPCNs, studies also identified a number of concrete benefits to local communities. As an example, six papers described that RHPCNs facilitate better communication and coordination among healthcare professionals, leading to improved access to healthcare services and continuity of care for their respective populations. 5 13 15 19 21 23 In addition, two studies identified a reduction in emergency visits and the introduction of evidence-based practices in RHPCNs as a result of networking. 22 31 Two further articles explained that bereavement support and strong ethical awareness among professionals may significantly contribute to the expansion of holistic end-of-life care offerings. 17 This outcome could also be promoted by more effective pain management skills in RHPCNs. 17 27 Studies also revealed that RHPCNs can increase public awareness and political influence with respect to local end-of-life issues. Increased public awareness of such issues could facilitate access and increase support from current or prospective funders. 18 19 23 32

Success factors and good practices

Twenty-four articles addressed RHPCN success factors and good practices. The articles strongly advocated for interdisciplinary collaboration and team-based approaches to improve patient care and coordination across healthcare providers. 8 13 16–19 21 25 Six studies also highlighted effective leadership and governance structures as crucial to the success of RHPCNs, ensuring clear direction, commitment and the ability to navigate complex dynamics. 8 13 16 17 19 21 Moreover, several authors argued that effective coordination is a crucial success factor for overall healthcare delivery, encompassing streamlined care coordination, standardised practices and centralised capacities. 13 15 20 21 30 Seven studies indicated that the establishment of robust networks and open communication are pivotal in facilitating collaboration, knowledge sharing and overall effectiveness in RHPCNs. 8 13 15 17 22 26 30 Four studies identified transparency and trust as critical factors for fostering effective relationships between stakeholders, healthcare providers and the community, thereby increasing a network’s impact. 15 21 22 30 Flexibility and adaptability were also emphasised, in recognition of the dynamic nature of healthcare environments and the need for RHPCNs to evolve in response to changing circumstances. 8 15 19 21

Seven articles stressed the need for sustainable resource management, including financial considerations and incentives, to ensure long-term viability and effectiveness. 5 8 17 18 22 30 In particular, sustainable healthcare practices, including efficient resource use, were highlighted as essential for the long-term success and impact of RHPCNs. 15 17 22

The provision of bereavement support was noted as an integral aspect of RHPCNs, underlining the importance of addressing the emotional and psychological needs of patients and their family caregivers. 17 22 28 Various articles 3 14 17–20 26 32 emphasised the importance of comprehensive patient care, including thorough pain management and bereavement support. In addition, four studies highlighted the implementation of patient-centred care, prioritising patient needs and preferences and ensuring more personalised and effective healthcare. 8 14 18 25 Continuous quality improvement and rigorous evaluation processes were also advocated to ensure the continued success and effectiveness of RHPCNs in meeting the evolving needs of patients and communities. 8 14 15 17 21 22 30 One study showed that the common language used within RHPCNs may help patients understand the procedures and implications across different settings, enabling them to make more informed decisions. 23

Seven studies identified education and training programmes as essential for healthcare professionals within these networks, promoting continuous learning, skills development, and the integration of innovative approaches, as well as professional confidence. 14 15 17 26 28 29 In this context, collaborative resource utilisation was emphasised as an effective strategy, encouraging the pooling of expertise and resources to optimise service delivery and improve overall healthcare outcomes. 26 28 32 One study showed that agreement over the sharing of medical aids (eg, diffusers, walking aids) across all RHPCN providers could simplify patient transfers between facilities. 23

Six studies recognised community engagement as another RHPCN success factor, emphasising public involvement in, awareness of, and support for healthcare initiatives. 17 18 20 21 29 32 In this vein, community outreach and the promotion of public awareness were highlighted as key strategies for fostering community involvement and understanding, while promoting the central role played by RHPCNs. 29 31 32 One paper identified political support and advocacy as influential for shaping favourable policies and creating environments conducive to the effective operation of healthcare networks. 17

Summary of the evidence

The results of the scoping review highlight the crucial role played by RHPCNs in fostering collaboration, enhancing patient care and contributing to the sustainability of the healthcare system. The identified success factors and good practices provide a roadmap for optimising the effectiveness and impact of RHPCNs in delivering quality, accessible and sustainable palliative care services to patients and communities in need. The geographical diversity of the studies—encompassing full texts from six countries across three continents, plus abstracts from seven other countries (including one from a fourth continent)—and nearly 40-year range of publication (ie, from 1980 to 2019), reflect the global importance and ongoing development of RHPCNs.

The findings can be compared with those of previous systematic reviews and meta-analyses on healthcare networks, particularly in terms of good practices and success factors. In line with the present review, these studies have underlined that healthcare networks are most effective when they have structural features that promote connection and communication, and when they are well managed with effective leadership. 33–36 One scoping review identified success factors such as clearly defined responsibilities and tasks, alongside a coordinating position where possible. Although effective leadership emerged as key to network performance in the present scoping review and other studies of health networks, 33–36 some studies have also shown that tensions can arise in healthcare networks between the moderating mechanisms of collaboration and control, due to the confluence of different structures, ways of working, and objectives. 37 38 The simultaneous use and development of new structures, behaviours and goals has been suggested as a way to manage these tensions. 37 This approach may also be relevant to RHPCNs, though it was not explicitly identified in the present review.

The ability to connect with other stakeholders based on commonly agreed standards is essential for the collaborative delivery of patient-centred and cost-effective services in healthcare networks. 39 Findings from qualitative studies of healthcare networks 33 suggest that networks with access to adequate funding and effective leadership and governance, combined with effective communication strategies and trust-based collaborative relationships, exhibit greater quality of care and patient outcomes. This is consistent with the results of the present scoping review, which identified intersections between good practices and success factors for healthcare networks in general, as well as those focused on end-of-life care.

Two systematic reviews on this topic have revealed some evidence that clinical networks can improve quality of care, network efficiency and patient outcomes, 33 40 based on a small number of studies. The present scoping review aligned with these previous works, as most of the studies, it investigated on the benefits and outcomes of networks emphasised improved patient outcomes and greater network effectiveness. However, the subjective experiences of professionals and patients have rarely been considered in studies of general networks 33 or RHPCNs, more specifically (as shown by the present results).

Strengths and limitations

The present scoping review used a robust methodological framework based on Arksey and O’Malley, 10 conducting a thorough search of multiple electronic databases (CINAHL, Google Scholar, PubMed, Web of Science) to ensure comprehensive coverage of the relevant literature. Clear inclusion criteria were established, focused on studies of networks in hospice and palliative care settings, including original research and reports of projects and initiatives. This ensured the relevance and applicability of the included studies. To minimise bias, two researchers independently reviewed abstracts and full texts to identify relevant articles. This transparent process helped to ensure the reliability of the review findings.

Overall, these strengths contribute to the credibility and reliability of the scoping review, making it a valuable resource for understanding the current landscape of RHPCNs and identifying areas for future research and practice.

At the same time, it is important to acknowledge certain limitations due to the inclusion criteria related to language. Some articles may have been excluded from the analysis because they were not available in the language(s) specified for the review. This language limitation may have led to the omission of valuable research and insights published in other languages. As a result, the findings and conclusions of this review may not fully represent the global landscape of RHPCNs.

It is also important to note the challenges involved in distinguishing between care and case networks, as many care structures work collaboratively or interprofessionally (eg, those funded by health insurance funds in Germany), without being active at a structural level. The types of networks included in the reviewed studies were not always clear. Thus, when the relevance of the network type was in doubt, the relevant article was excluded from the analysis. This may have influenced the final selection of studies. Furthermore, it was not always clear how the different conceptualizations of networks—which included varying degrees of formalisation—could be compared between studies. Consequently, it was not possible to establish a relationship between benefits/outcomes and degree of network organisation.

Conclusions

The present scoping review explored the structures, outcomes, benefits, success factors and good practices of healthcare networks in hospice and palliative care contexts. The investigated studies applied different research methods without time limitations, providing a broad overview of the research field.

Nevertheless, certain research gaps emerged from the review. While numerous qualitative studies have identified success factors, the lack of quantitative studies precludes any analysis of the relative importance and strength of these factors in facilitating effective networking. The RHPCN structures reported in this scoping review varied from loose collaboration to contractual relationships headed by a fully funded coordinating office. However, it is unclear which of these structures best supports good networking. It would also be useful to determine whether the financial participation of network members contributes to determining their commitment to network collaboration. Overall, there are no established quality criteria or reference points for determining RHPCN quality. Studies aimed at filling these gaps through comprehensive research and a balanced representation of perspectives would contribute significantly to our understanding of the functioning and impact of RHPCNs.

Furthermore, the present scoping review suggests potential implications not only for RHPNs but also for policymakers, encouraging them to support and invest in these networks to ensure long-term sustainability and facilitate moderation and coordination.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Acknowledgments.

The authors thank Nilab Kamandi, the student assistant involved in the research project HOPAN, for their support in testing the search strategy and obtaining the full texts. The authors also acknowledge Valerie Appleby’s professional copyediting of the manuscript.

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FAH and SS are joint senior authors.

Contributors HAAR and SvS conceived of the scoping review. HAAR, SvS and FAH designed and coordinated the review study. HAAR conducted the database search. HAAR and SvS screened the search results and extracted the data. FAH supervised the data screening process. HAAR wrote the first draft of the manuscript. SvS and FAH revised the manuscript critically for important intellectual content and contributed to the draft. All authors approved the final version of the manuscript. All contributors are responsible for the overall content, as guarantors.

Funding The present scoping review comprised part of the research project HOPAN, which aims at assessing and analyzing RHPCNs in Germany. The project is funded by the German Innovation Fund of the Federal Joint Committee (G-BA) (Grant N° 01VSF22042; funding period: 01/2023–12/2024). The funding body was not involved in the study design, the preparation of this paper, or the decision to submit the paper for publication.

Competing interests Non competing interests.

Provenance and peer review Not commissioned; internally peer reviewed.

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