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What is the Purpose of a Literature Review?

What is the Purpose of a Literature Review?

4-minute read

  • 23rd October 2023

If you’re writing a research paper or dissertation , then you’ll most likely need to include a comprehensive literature review . In this post, we’ll review the purpose of literature reviews, why they are so significant, and the specific elements to include in one. Literature reviews can:

1. Provide a foundation for current research.

2. Define key concepts and theories.

3. Demonstrate critical evaluation.

4. Show how research and methodologies have evolved.

5. Identify gaps in existing research.

6. Support your argument.

Keep reading to enter the exciting world of literature reviews!

What is a Literature Review?

A literature review is a critical summary and evaluation of the existing research (e.g., academic journal articles and books) on a specific topic. It is typically included as a separate section or chapter of a research paper or dissertation, serving as a contextual framework for a study. Literature reviews can vary in length depending on the subject and nature of the study, with most being about equal length to other sections or chapters included in the paper. Essentially, the literature review highlights previous studies in the context of your research and summarizes your insights in a structured, organized format. Next, let’s look at the overall purpose of a literature review.

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Literature reviews are considered an integral part of research across most academic subjects and fields. The primary purpose of a literature review in your study is to:

Provide a Foundation for Current Research

Since the literature review provides a comprehensive evaluation of the existing research, it serves as a solid foundation for your current study. It’s a way to contextualize your work and show how your research fits into the broader landscape of your specific area of study.  

Define Key Concepts and Theories

The literature review highlights the central theories and concepts that have arisen from previous research on your chosen topic. It gives your readers a more thorough understanding of the background of your study and why your research is particularly significant .

Demonstrate Critical Evaluation 

A comprehensive literature review shows your ability to critically analyze and evaluate a broad range of source material. And since you’re considering and acknowledging the contribution of key scholars alongside your own, it establishes your own credibility and knowledge.

Show How Research and Methodologies Have Evolved

Another purpose of literature reviews is to provide a historical perspective and demonstrate how research and methodologies have changed over time, especially as data collection methods and technology have advanced. And studying past methodologies allows you, as the researcher, to understand what did and did not work and apply that knowledge to your own research.  

Identify Gaps in Existing Research

Besides discussing current research and methodologies, the literature review should also address areas that are lacking in the existing literature. This helps further demonstrate the relevance of your own research by explaining why your study is necessary to fill the gaps.

Support Your Argument

A good literature review should provide evidence that supports your research questions and hypothesis. For example, your study may show that your research supports existing theories or builds on them in some way. Referencing previous related studies shows your work is grounded in established research and will ultimately be a contribution to the field.  

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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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Conducting a literature review: why do a literature review, why do a literature review.

  • How To Find "The Literature"
  • Found it -- Now What?

Besides the obvious reason for students -- because it is assigned! -- a literature review helps you explore the research that has come before you, to see how your research question has (or has not) already been addressed.

You identify:

  • core research in the field
  • experts in the subject area
  • methodology you may want to use (or avoid)
  • gaps in knowledge -- or where your research would fit in

It Also Helps You:

  • Publish and share your findings
  • Justify requests for grants and other funding
  • Identify best practices to inform practice
  • Set wider context for a program evaluation
  • Compile information to support community organizing

Great brief overview, from NCSU

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Literature reviews, what is a literature review, learning more about how to do a literature review.

  • Planning the Review
  • The Research Question
  • Choosing Where to Search
  • Organizing the Review
  • Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

  • Sage Research Methods Core Collection This link opens in a new window SAGE Research Methods supports research at all levels by providing material to guide users through every step of the research process. SAGE Research Methods is the ultimate methods library with more than 1000 books, reference works, journal articles, and instructional videos by world-leading academics from across the social sciences, including the largest collection of qualitative methods books available online from any scholarly publisher. – Publisher

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Why is it important to do a literature review in research?

Why is it important to do a literature review in research?

Scientific Communication in Healthcare industry

The importance of scientific communication in the healthcare industry

importance and role of biostatistics in clinical research, biostatistics in public health, biostatistics in pharmacy, biostatistics in nursing,biostatistics in clinical trials,clinical biostatistics

The Importance and Role of Biostatistics in Clinical Research

 “A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research”. Boote and Baile 2005

Authors of manuscripts treat writing a literature review as a routine work or a mere formality. But a seasoned one knows the purpose and importance of a well-written literature review.  Since it is one of the basic needs for researches at any level, they have to be done vigilantly. Only then the reader will know that the basics of research have not been neglected.

Importance of Literature Review In Research

The aim of any literature review is to summarize and synthesize the arguments and ideas of existing knowledge in a particular field without adding any new contributions.   Being built on existing knowledge they help the researcher to even turn the wheels of the topic of research.  It is possible only with profound knowledge of what is wrong in the existing findings in detail to overpower them.  For other researches, the literature review gives the direction to be headed for its success. 

The common perception of literature review and reality:

As per the common belief, literature reviews are only a summary of the sources related to the research. And many authors of scientific manuscripts believe that they are only surveys of what are the researches are done on the chosen topic.  But on the contrary, it uses published information from pertinent and relevant sources like

  • Scholarly books
  • Scientific papers
  • Latest studies in the field
  • Established school of thoughts
  • Relevant articles from renowned scientific journals

and many more for a field of study or theory or a particular problem to do the following:

  • Summarize into a brief account of all information
  • Synthesize the information by restructuring and reorganizing
  • Critical evaluation of a concept or a school of thought or ideas
  • Familiarize the authors to the extent of knowledge in the particular field
  • Encapsulate
  • Compare & contrast

By doing the above on the relevant information, it provides the reader of the scientific manuscript with the following for a better understanding of it:

  • It establishes the authors’  in-depth understanding and knowledge of their field subject
  • It gives the background of the research
  • Portrays the scientific manuscript plan of examining the research result
  • Illuminates on how the knowledge has changed within the field
  • Highlights what has already been done in a particular field
  • Information of the generally accepted facts, emerging and current state of the topic of research
  • Identifies the research gap that is still unexplored or under-researched fields
  • Demonstrates how the research fits within a larger field of study
  • Provides an overview of the sources explored during the research of a particular topic

Importance of literature review in research:

The importance of literature review in scientific manuscripts can be condensed into an analytical feature to enable the multifold reach of its significance.  It adds value to the legitimacy of the research in many ways:

  • Provides the interpretation of existing literature in light of updated developments in the field to help in establishing the consistency in knowledge and relevancy of existing materials
  • It helps in calculating the impact of the latest information in the field by mapping their progress of knowledge.
  • It brings out the dialects of contradictions between various thoughts within the field to establish facts
  • The research gaps scrutinized initially are further explored to establish the latest facts of theories to add value to the field
  • Indicates the current research place in the schema of a particular field
  • Provides information for relevancy and coherency to check the research
  • Apart from elucidating the continuance of knowledge, it also points out areas that require further investigation and thus aid as a starting point of any future research
  • Justifies the research and sets up the research question
  • Sets up a theoretical framework comprising the concepts and theories of the research upon which its success can be judged
  • Helps to adopt a more appropriate methodology for the research by examining the strengths and weaknesses of existing research in the same field
  • Increases the significance of the results by comparing it with the existing literature
  • Provides a point of reference by writing the findings in the scientific manuscript
  • Helps to get the due credit from the audience for having done the fact-finding and fact-checking mission in the scientific manuscripts
  • The more the reference of relevant sources of it could increase more of its trustworthiness with the readers
  • Helps to prevent plagiarism by tailoring and uniquely tweaking the scientific manuscript not to repeat other’s original idea
  • By preventing plagiarism , it saves the scientific manuscript from rejection and thus also saves a lot of time and money
  • Helps to evaluate, condense and synthesize gist in the author’s own words to sharpen the research focus
  • Helps to compare and contrast to  show the originality and uniqueness of the research than that of the existing other researches
  • Rationalizes the need for conducting the particular research in a specified field
  • Helps to collect data accurately for allowing any new methodology of research than the existing ones
  • Enables the readers of the manuscript to answer the following questions of its readers for its better chances for publication
  • What do the researchers know?
  • What do they not know?
  • Is the scientific manuscript reliable and trustworthy?
  • What are the knowledge gaps of the researcher?

22. It helps the readers to identify the following for further reading of the scientific manuscript:

  • What has been already established, discredited and accepted in the particular field of research
  • Areas of controversy and conflicts among different schools of thought
  • Unsolved problems and issues in the connected field of research
  • The emerging trends and approaches
  • How the research extends, builds upon and leaves behind from the previous research

A profound literature review with many relevant sources of reference will enhance the chances of the scientific manuscript publication in renowned and reputed scientific journals .

References:

http://www.math.montana.edu/jobo/phdprep/phd6.pdf

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Literature Reviews

  • First Online: 07 June 2024

Cite this chapter

importance of literature review in a research

  • George P. Moschis 2  

A literature review is a critical component of a scientific study and holds significant importance, as literature reviews serve several important functions within the research process:

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Zhao, S. (1991). Metatheory, metamethod, meta-data-analysis: What, why and how? Sociological Perspectives, 34 , 377–390.

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Moschis, G.P. (2024). Literature Reviews. In: Academic Research in Business and the Social Sciences. Springer, Cham. https://doi.org/10.1007/978-3-031-56548-9_8

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

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

  • Getting Started
  • How to Pick a Topic
  • Strategies to Find Sources
  • Evaluating Sources & Lit. Reviews
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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

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What is a Literature Review?

A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important past and current research and practices. It provides background and context, and shows how your research will contribute to the field. 

A literature review should: 

  • Provide a comprehensive and updated review of the literature;
  • Explain why this review has taken place;
  • Articulate a position or hypothesis;
  • Acknowledge and account for conflicting and corroborating points of view

From  S age Research Methods

Purpose of a Literature Review

A literature review can be written as an introduction to a study to:

  • Demonstrate how a study fills a gap in research
  • Compare a study with other research that's been done

Or it can be a separate work (a research article on its own) which:

  • Organizes or describes a topic
  • Describes variables within a particular issue/problem

Limitations of a Literature Review

Some of the limitations of a literature review are:

  • It's a snapshot in time. Unlike other reviews, this one has beginning, a middle and an end. There may be future developments that could make your work less relevant.
  • It may be too focused. Some niche studies may miss the bigger picture.
  • It can be difficult to be comprehensive. There is no way to make sure all the literature on a topic was considered.
  • It is easy to be biased if you stick to top tier journals. There may be other places where people are publishing exemplary research. Look to open access publications and conferences to reflect a more inclusive collection. Also, make sure to include opposing views (and not just supporting evidence).

Source: Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal, vol. 26, no. 2, June 2009, pp. 91–108. Wiley Online Library, doi:10.1111/j.1471-1842.2009.00848.x.

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What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

  • Review the abstracts carefully.  
  • Keep careful notes so that you may track your thought processes during the research process.
  • Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

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Research Methods

  • Getting Started
  • Literature Review Research
  • Research Design
  • Research Design By Discipline
  • SAGE Research Methods
  • Teaching with SAGE Research Methods

Literature Review

  • What is a Literature Review?
  • What is NOT a Literature Review?
  • Purposes of a Literature Review
  • Types of Literature Reviews
  • Literature Reviews vs. Systematic Reviews
  • Systematic vs. Meta-Analysis

Literature Review  is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.

Also, we can define a literature review as the collected body of scholarly works related to a topic:

  • Summarizes and analyzes previous research relevant to a topic
  • Includes scholarly books and articles published in academic journals
  • Can be an specific scholarly paper or a section in a research paper

The objective of a Literature Review is to find previous published scholarly works relevant to an specific topic

  • Help gather ideas or information
  • Keep up to date in current trends and findings
  • Help develop new questions

A literature review is important because it:

  • Explains the background of research on a topic.
  • Demonstrates why a topic is significant to a subject area.
  • Helps focus your own research questions or problems
  • Discovers relationships between research studies/ideas.
  • Suggests unexplored ideas or populations
  • Identifies major themes, concepts, and researchers on a topic.
  • Tests assumptions; may help counter preconceived ideas and remove unconscious bias.
  • Identifies critical gaps, points of disagreement, or potentially flawed methodology or theoretical approaches.
  • Indicates potential directions for future research.

All content in this section is from Literature Review Research from Old Dominion University 

Keep in mind the following, a literature review is NOT:

Not an essay 

Not an annotated bibliography  in which you summarize each article that you have reviewed.  A literature review goes beyond basic summarizing to focus on the critical analysis of the reviewed works and their relationship to your research question.

Not a research paper   where you select resources to support one side of an issue versus another.  A lit review should explain and consider all sides of an argument in order to avoid bias, and areas of agreement and disagreement should be highlighted.

A literature review serves several purposes. For example, it

  • provides thorough knowledge of previous studies; introduces seminal works.
  • helps focus one’s own research topic.
  • identifies a conceptual framework for one’s own research questions or problems; indicates potential directions for future research.
  • suggests previously unused or underused methodologies, designs, quantitative and qualitative strategies.
  • identifies gaps in previous studies; identifies flawed methodologies and/or theoretical approaches; avoids replication of mistakes.
  • helps the researcher avoid repetition of earlier research.
  • suggests unexplored populations.
  • determines whether past studies agree or disagree; identifies controversy in the literature.
  • tests assumptions; may help counter preconceived ideas and remove unconscious bias.

As Kennedy (2007) notes*, it is important to think of knowledge in a given field as consisting of three layers. First, there are the primary studies that researchers conduct and publish. Second are the reviews of those studies that summarize and offer new interpretations built from and often extending beyond the original studies. Third, there are the perceptions, conclusions, opinion, and interpretations that are shared informally that become part of the lore of field. In composing a literature review, it is important to note that it is often this third layer of knowledge that is cited as "true" even though it often has only a loose relationship to the primary studies and secondary literature reviews.

Given this, while literature reviews are designed to provide an overview and synthesis of pertinent sources you have explored, there are several approaches to how they can be done, depending upon the type of analysis underpinning your study. Listed below are definitions of types of literature reviews:

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

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

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

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

Systematic Review      This form consists of an overview of existing evidence pertinent to a clearly formulated research question, which uses pre-specified and standardized methods to identify and critically appraise relevant research, and to collect, report, and analyse data from the studies that are included in the review. Typically it focuses on a very specific empirical question, often posed in a cause-and-effect form, such as "To what extent does A contribute to B?"

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

* Kennedy, Mary M. "Defining a Literature."  Educational Researcher  36 (April 2007): 139-147.

All content in this section is from The Literature Review created by Dr. Robert Larabee USC

Robinson, P. and Lowe, J. (2015),  Literature reviews vs systematic reviews.  Australian and New Zealand Journal of Public Health, 39: 103-103. doi: 10.1111/1753-6405.12393

importance of literature review in a research

What's in the name? The difference between a Systematic Review and a Literature Review, and why it matters . By Lynn Kysh from University of Southern California

importance of literature review in a research

Systematic review or meta-analysis?

A  systematic review  answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria.

A  meta-analysis  is the use of statistical methods to summarize the results of these studies.

Systematic reviews, just like other research articles, can be of varying quality. They are a significant piece of work (the Centre for Reviews and Dissemination at York estimates that a team will take 9-24 months), and to be useful to other researchers and practitioners they should have:

  • clearly stated objectives with pre-defined eligibility criteria for studies
  • explicit, reproducible methodology
  • a systematic search that attempts to identify all studies
  • assessment of the validity of the findings of the included studies (e.g. risk of bias)
  • systematic presentation, and synthesis, of the characteristics and findings of the included studies

Not all systematic reviews contain meta-analysis. 

Meta-analysis is the use of statistical methods to summarize the results of independent studies. By combining information from all relevant studies, meta-analysis can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review.  More information on meta-analyses can be found in  Cochrane Handbook, Chapter 9 .

A meta-analysis goes beyond critique and integration and conducts secondary statistical analysis on the outcomes of similar studies.  It is a systematic review that uses quantitative methods to synthesize and summarize the results.

An advantage of a meta-analysis is the ability to be completely objective in evaluating research findings.  Not all topics, however, have sufficient research evidence to allow a meta-analysis to be conducted.  In that case, an integrative review is an appropriate strategy. 

Some of the content in this section is from Systematic reviews and meta-analyses: step by step guide created by Kate McAllister.

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Conducting a Literature Review

Benefits of conducting a literature review.

  • Steps in Conducting a Literature Review
  • Summary of the Process
  • Additional Resources
  • Literature Review Tutorial by American University Library
  • The Literature Review: A Few Tips On Conducting It by University of Toronto
  • Write a Literature Review by UC Santa Cruz University Library

While there might be many reasons for conducting a literature review, following are four key outcomes of doing the review.

Assessment of the current state of research on a topic . This is probably the most obvious value of the literature review. Once a researcher has determined an area to work with for a research project, a search of relevant information sources will help determine what is already known about the topic and how extensively the topic has already been researched.

Identification of the experts on a particular topic . One of the additional benefits derived from doing the literature review is that it will quickly reveal which researchers have written the most on a particular topic and are, therefore, probably the experts on the topic. Someone who has written twenty articles on a topic or on related topics is more than likely more knowledgeable than someone who has written a single article. This same writer will likely turn up as a reference in most of the other articles written on the same topic. From the number of articles written by the author and the number of times the writer has been cited by other authors, a researcher will be able to assume that the particular author is an expert in the area and, thus, a key resource for consultation in the current research to be undertaken.

Identification of key questions about a topic that need further research . In many cases a researcher may discover new angles that need further exploration by reviewing what has already been written on a topic. For example, research may suggest that listening to music while studying might lead to better retention of ideas, but the research might not have assessed whether a particular style of music is more beneficial than another. A researcher who is interested in pursuing this topic would then do well to follow up existing studies with a new study, based on previous research, that tries to identify which styles of music are most beneficial to retention.

Determination of methodologies used in past studies of the same or similar topics.  It is often useful to review the types of studies that previous researchers have launched as a means of determining what approaches might be of most benefit in further developing a topic. By the same token, a review of previously conducted studies might lend itself to researchers determining a new angle for approaching research.

Upon completion of the literature review, a researcher should have a solid foundation of knowledge in the area and a good feel for the direction any new research should take. Should any additional questions arise during the course of the research, the researcher will know which experts to consult in order to quickly clear up those questions.

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Frequently asked questions

What is the purpose of a literature review.

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.

Frequently asked questions: Academic writing

A rhetorical tautology is the repetition of an idea of concept using different words.

Rhetorical tautologies occur when additional words are used to convey a meaning that has already been expressed or implied. For example, the phrase “armed gunman” is a tautology because a “gunman” is by definition “armed.”

A logical tautology is a statement that is always true because it includes all logical possibilities.

Logical tautologies often take the form of “either/or” statements (e.g., “It will rain, or it will not rain”) or employ circular reasoning (e.g., “she is untrustworthy because she can’t be trusted”).

You may have seen both “appendices” or “appendixes” as pluralizations of “ appendix .” Either spelling can be used, but “appendices” is more common (including in APA Style ). Consistency is key here: make sure you use the same spelling throughout your paper.

The purpose of a lab report is to demonstrate your understanding of the scientific method with a hands-on lab experiment. Course instructors will often provide you with an experimental design and procedure. Your task is to write up how you actually performed the experiment and evaluate the outcome.

In contrast, a research paper requires you to independently develop an original argument. It involves more in-depth research and interpretation of sources and data.

A lab report is usually shorter than a research paper.

The sections of a lab report can vary between scientific fields and course requirements, but it usually contains the following:

  • Title: expresses the topic of your study
  • Abstract: summarizes your research aims, methods, results, and conclusions
  • Introduction: establishes the context needed to understand the topic
  • Method: describes the materials and procedures used in the experiment
  • Results: reports all descriptive and inferential statistical analyses
  • Discussion: interprets and evaluates results and identifies limitations
  • Conclusion: sums up the main findings of your experiment
  • References: list of all sources cited using a specific style (e.g. APA)
  • Appendices: contains lengthy materials, procedures, tables or figures

A lab report conveys the aim, methods, results, and conclusions of a scientific experiment . Lab reports are commonly assigned in science, technology, engineering, and mathematics (STEM) fields.

The abstract is the very last thing you write. You should only write it after your research is complete, so that you can accurately summarize the entirety of your thesis , dissertation or research paper .

If you’ve gone over the word limit set for your assignment, shorten your sentences and cut repetition and redundancy during the editing process. If you use a lot of long quotes , consider shortening them to just the essentials.

If you need to remove a lot of words, you may have to cut certain passages. Remember that everything in the text should be there to support your argument; look for any information that’s not essential to your point and remove it.

To make this process easier and faster, you can use a paraphrasing tool . With this tool, you can rewrite your text to make it simpler and shorter. If that’s not enough, you can copy-paste your paraphrased text into the summarizer . This tool will distill your text to its core message.

Revising, proofreading, and editing are different stages of the writing process .

  • Revising is making structural and logical changes to your text—reformulating arguments and reordering information.
  • Editing refers to making more local changes to things like sentence structure and phrasing to make sure your meaning is conveyed clearly and concisely.
  • Proofreading involves looking at the text closely, line by line, to spot any typos and issues with consistency and correct them.

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 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.

Avoid citing sources in your abstract . There are two reasons for this:

  • The abstract should focus on your original research, not on the work of others.
  • The abstract should be self-contained and fully understandable without reference to other sources.

There are some circumstances where you might need to mention other sources in an abstract: for example, if your research responds directly to another study or focuses on the work of a single theorist. In general, though, don’t include citations unless absolutely necessary.

An abstract is a concise summary of an academic text (such as a journal article or dissertation ). It serves two main purposes:

  • To help potential readers determine the relevance of your paper for their own research.
  • To communicate your key findings to those who don’t have time to read the whole paper.

Abstracts are often indexed along with keywords on academic databases, so they make your work more easily findable. Since the abstract is the first thing any reader sees, it’s important that it clearly and accurately summarizes the contents of your paper.

In a scientific paper, the methodology always comes after the introduction and before the results , discussion and conclusion . The same basic structure also applies to a thesis, dissertation , or research proposal .

Depending on the length and type of document, you might also include a literature review or theoretical framework before the methodology.

Whether you’re publishing a blog, submitting a research paper , or even just writing an important email, there are a few techniques you can use to make sure it’s error-free:

  • Take a break : Set your work aside for at least a few hours so that you can look at it with fresh eyes.
  • Proofread a printout : Staring at a screen for too long can cause fatigue – sit down with a pen and paper to check the final version.
  • Use digital shortcuts : Take note of any recurring mistakes (for example, misspelling a particular word, switching between US and UK English , or inconsistently capitalizing a term), and use Find and Replace to fix it throughout the document.

If you want to be confident that an important text is error-free, it might be worth choosing a professional proofreading service instead.

Editing and proofreading are different steps in the process of revising a text.

Editing comes first, and can involve major changes to content, structure and language. The first stages of editing are often done by authors themselves, while a professional editor makes the final improvements to grammar and style (for example, by improving sentence structure and word choice ).

Proofreading is the final stage of checking a text before it is published or shared. It focuses on correcting minor errors and inconsistencies (for example, in punctuation and capitalization ). Proofreaders often also check for formatting issues, especially in print publishing.

The cost of proofreading depends on the type and length of text, the turnaround time, and the level of services required. Most proofreading companies charge per word or page, while freelancers sometimes charge an hourly rate.

For proofreading alone, which involves only basic corrections of typos and formatting mistakes, you might pay as little as $0.01 per word, but in many cases, your text will also require some level of editing , which costs slightly more.

It’s often possible to purchase combined proofreading and editing services and calculate the price in advance based on your requirements.

There are many different routes to becoming a professional proofreader or editor. The necessary qualifications depend on the field – to be an academic or scientific proofreader, for example, you will need at least a university degree in a relevant subject.

For most proofreading jobs, experience and demonstrated skills are more important than specific qualifications. Often your skills will be tested as part of the application process.

To learn practical proofreading skills, you can choose to take a course with a professional organization such as the Society for Editors and Proofreaders . Alternatively, you can apply to companies that offer specialized on-the-job training programmes, such as the Scribbr Academy .

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Writing an effective literature review

Lorelei lingard.

Schulich School of Medicine & Dentistry, Health Sciences Addition, Western University, London, Ontario Canada

In the Writer’s Craft section we offer simple tips to improve your writing in one of three areas: Energy, Clarity and Persuasiveness. Each entry focuses on a key writing feature or strategy, illustrates how it commonly goes wrong, teaches the grammatical underpinnings necessary to understand it and offers suggestions to wield it effectively. We encourage readers to share comments on or suggestions for this section on Twitter, using the hashtag: #how’syourwriting?

This Writer’s Craft instalment is the first in a two-part series that offers strategies for effectively presenting the literature review section of a research manuscript. This piece alerts writers to the importance of not only summarizing what is known but also identifying precisely what is not, in order to explicitly signal the relevance of their research. In this instalment, I will introduce readers to the mapping the gap metaphor, the knowledge claims heuristic, and the need to characterize the gap.

Mapping the gap

The purpose of the literature review section of a manuscript is not to report what is known about your topic. The purpose is to identify what remains unknown— what academic writing scholar Janet Giltrow has called the ‘knowledge deficit’ — thus establishing the need for your research study [ 1 ]. In an earlier Writer’s Craft instalment, the Problem-Gap-Hook heuristic was introduced as a way of opening your paper with a clear statement of the problem that your work grapples with, the gap in our current knowledge about that problem, and the reason the gap matters [ 2 ]. This article explains how to use the literature review section of your paper to build and characterize the Gap claim in your Problem-Gap-Hook. The metaphor of ‘mapping the gap’ is a way of thinking about how to select and arrange your review of the existing literature so that readers can recognize why your research needed to be done, and why its results constitute a meaningful advance on what was already known about the topic.

Many writers have learned that the literature review should describe what is known. The trouble with this approach is that it can produce a laundry list of facts-in-the-world that does not persuade the reader that the current study is a necessary next step. Instead, think of your literature review as painting in a map of your research domain: as you review existing knowledge, you are painting in sections of the map, but your goal is not to end with the whole map fully painted. That would mean there is nothing more we need to know about the topic, and that leaves no room for your research. What you want to end up with is a map in which painted sections surround and emphasize a white space, a gap in what is known that matters. Conceptualizing your literature review this way helps to ensure that it achieves its dual goal: of presenting what is known and pointing out what is not—the latter of these goals is necessary for your literature review to establish the necessity and importance of the research you are about to describe in the methods section which will immediately follow the literature review.

To a novice researcher or graduate student, this may seem counterintuitive. Hopefully you have invested significant time in reading the existing literature, and you are understandably keen to demonstrate that you’ve read everything ever published about your topic! Be careful, though, not to use the literature review section to regurgitate all of your reading in manuscript form. For one thing, it creates a laundry list of facts that makes for horrible reading. But there are three other reasons for avoiding this approach. First, you don’t have the space. In published medical education research papers, the literature review is quite short, ranging from a few paragraphs to a few pages, so you can’t summarize everything you’ve read. Second, you’re preaching to the converted. If you approach your paper as a contribution to an ongoing scholarly conversation,[ 2 ] then your literature review should summarize just the aspects of that conversation that are required to situate your conversational turn as informed and relevant. Third, the key to relevance is to point to a gap in what is known. To do so, you summarize what is known for the express purpose of identifying what is not known . Seen this way, the literature review should exert a gravitational pull on the reader, leading them inexorably to the white space on the map of knowledge you’ve painted for them. That white space is the space that your research fills.

Knowledge claims

To help writers move beyond the laundry list, the notion of ‘knowledge claims’ can be useful. A knowledge claim is a way of presenting the growing understanding of the community of researchers who have been exploring your topic. These are not disembodied facts, but rather incremental insights that some in the field may agree with and some may not, depending on their different methodological and disciplinary approaches to the topic. Treating the literature review as a story of the knowledge claims being made by researchers in the field can help writers with one of the most sophisticated aspects of a literature review—locating the knowledge being reviewed. Where does it come from? What is debated? How do different methodologies influence the knowledge being accumulated? And so on.

Consider this example of the knowledge claims (KC), Gap and Hook for the literature review section of a research paper on distributed healthcare teamwork:

KC: We know that poor team communication can cause errors. KC: And we know that team training can be effective in improving team communication. KC: This knowledge has prompted a push to incorporate teamwork training principles into health professions education curricula. KC: However, most of what we know about team training research has come from research with co-located teams—i. e., teams whose members work together in time and space. Gap: Little is known about how teamwork training principles would apply in distributed teams, whose members work asynchronously and are spread across different locations. Hook: Given that much healthcare teamwork is distributed rather than co-located, our curricula will be severely lacking until we create refined teamwork training principles that reflect distributed as well as co-located work contexts.

The ‘We know that …’ structure illustrated in this example is a template for helping you draft and organize. In your final version, your knowledge claims will be expressed with more sophistication. For instance, ‘We know that poor team communication can cause errors’ will become something like ‘Over a decade of patient safety research has demonstrated that poor team communication is the dominant cause of medical errors.’ This simple template of knowledge claims, though, provides an outline for the paragraphs in your literature review, each of which will provide detailed evidence to illustrate a knowledge claim. Using this approach, the order of the paragraphs in the literature review is strategic and persuasive, leading the reader to the gap claim that positions the relevance of the current study. To expand your vocabulary for creating such knowledge claims, linking them logically and positioning yourself amid them, I highly recommend Graff and Birkenstein’s little handbook of ‘templates’ [ 3 ].

As you organize your knowledge claims, you will also want to consider whether you are trying to map the gap in a well-studied field, or a relatively understudied one. The rhetorical challenge is different in each case. In a well-studied field, like professionalism in medical education, you must make a strong, explicit case for the existence of a gap. Readers may come to your paper tired of hearing about this topic and tempted to think we can’t possibly need more knowledge about it. Listing the knowledge claims can help you organize them most effectively and determine which pieces of knowledge may be unnecessary to map the white space your research attempts to fill. This does not mean that you leave out relevant information: your literature review must still be accurate. But, since you will not be able to include everything, selecting carefully among the possible knowledge claims is essential to producing a coherent, well-argued literature review.

Characterizing the gap

Once you’ve identified the gap, your literature review must characterize it. What kind of gap have you found? There are many ways to characterize a gap, but some of the more common include:

  • a pure knowledge deficit—‘no one has looked at the relationship between longitudinal integrated clerkships and medical student abuse’
  • a shortcoming in the scholarship, often due to philosophical or methodological tendencies and oversights—‘scholars have interpreted x from a cognitivist perspective, but ignored the humanist perspective’ or ‘to date, we have surveyed the frequency of medical errors committed by residents, but we have not explored their subjective experience of such errors’
  • a controversy—‘scholars disagree on the definition of professionalism in medicine …’
  • a pervasive and unproven assumption—‘the theme of technological heroism—technology will solve what ails teamwork—is ubiquitous in the literature, but what is that belief based on?’

To characterize the kind of gap, you need to know the literature thoroughly. That means more than understanding each paper individually; you also need to be placing each paper in relation to others. This may require changing your note-taking technique while you’re reading; take notes on what each paper contributes to knowledge, but also on how it relates to other papers you’ve read, and what it suggests about the kind of gap that is emerging.

In summary, think of your literature review as mapping the gap rather than simply summarizing the known. And pay attention to characterizing the kind of gap you’ve mapped. This strategy can help to make your literature review into a compelling argument rather than a list of facts. It can remind you of the danger of describing so fully what is known that the reader is left with the sense that there is no pressing need to know more. And it can help you to establish a coherence between the kind of gap you’ve identified and the study methodology you will use to fill it.

Acknowledgements

Thanks to Mark Goldszmidt for his feedback on an early version of this manuscript.

PhD, is director of the Centre for Education Research & Innovation at Schulich School of Medicine & Dentistry, and professor for the Department of Medicine at Western University in London, Ontario, Canada.

  • Social Sciences

The Importance of Literature Review in Research Writing

  • Author: Yoon Sik Kim

A literature review is a must before writing a research paper.

A literature review is a must before writing a research paper.

By NASA Terry Leibold (Great Images in NASA Description) [Public domain], via Wikimedia Commons

Why Literature Reviews?

Doing a careful and thorough literature review is essential when you write about research at any level. It is basic homework that is assumed to have been done vigilantly and a given fact in all research papers. By providing one, usually offered in your introduction, before you reach your thesis statement, you are telling your reader that you have not neglected the basics of research.

It not only surveys what research has been done in the past on your topic, but it also appraises, encapsulates, compares, contrasts, and correlates various scholarly books, research articles, and other relevant sources that are directly related to your current research. Given the fundamental nature of providing one, your research paper will not be considered seriously if it lacks one at the beginning of the paper.

1. It Creates a Rapport With Your Audience

A literature review helps you create a sense of rapport with your audience or readers so they can trust that you have done your homework. As a result, they can give you credit for your due diligence: you have done your fact-finding and fact-checking mission, one of the initial steps of any research writing.

As a student, you may not be an expert in a given field; however, by listing a thorough review in your research paper, you are telling the audience, in essence, that you know what you are talking about. As a result, the more books, articles, and other sources you can list in the literature review, the more trustworthy your scholarship and expertise will be.

Depending on the nature of your research paper, each entry can be long or short. For example, if you are writing a doctoral dissertation or master’s thesis, the entries can be longer than the ones in a term paper. The key is to stick to the gist of the sources as you synthesize the source in the review: its thesis, research methods, findings, issues, and further discussions mentioned in the source.

You need to familiarize yourself with the scholars who came before you.

You need to familiarize yourself with the scholars who came before you.

By photographer unknown [Public domain], via Wikimedia Commons

2. It Helps You Avoid Incidental Plagiarism

Imagine this scenario. You have written a research paper, an original paper in your area of specialization, without a literature review. When you are about to publish the paper, you soon learn that someone has already published a paper on a topic very similar to yours. Of course, you have not plagiarized anything from that publication; however, if and when you publish your work, people will be suspicious of your authenticity. They will ask further about the significance of repeating similar research.

In short, you could have utilized the time, money, and other resources you have wasted on your research on something else. Had you prepared a literature review at the onset of your research, you could have easily avoided such mishaps. During the compilation of your review, you could have noticed how someone else has done similar research on your topic. By knowing this fact, you can tailor or tweak your own research in such a way that it is not a mere rehashing of someone else’s original or old idea.

3. It Sharpens Your Research Focus

As you assemble outside sources, you will condense, evaluate, synthesize, and paraphrase the gist of outside sources in your own words. Through this process of winnowing, you will be able to place the relevance of your research in the larger context of what other researchers have already done on your topic in the past (See Reference 1).

The literature review will help you compare and contrast what you are doing in the historical context of the research as well as how your research is different or original from what others have done, helping you rationalize why you need to do this particular research (See Reference 2).

Perhaps you are using a new or different research method that has not been available before, allowing you to collect the data more accurately or conduct an experiment that is more precise and exact thanks to many innovations of modern technology. Thus, it is essential in helping you shape and guide your research in the direction you may not have thought of by offering insights and different perspectives on the research topic.

Many Different Types

Depending on your area of specialization, a literature review can take various forms: argumentative review, integrative review, historical review, methodological review, systematic review, and theoretical review (See Reference 1).

  • An argumentative review is written to present an opposing view to a given position. This will be valuable to persuade others to join you in supporting your thesis.
  • An integrative review is composed of examinations and critical analysis on a given topic to introduce a need for new research. For example, you can use it on the spreading of a pandemic plague, arguing how the old methods of gathering and analyzing the data were inadequate and how modern technology, such as DNA analysis, will help make the same research more accurate.
  • Similarly, a historical review will assess all the historical records of scholarship chronologically while a methodological review examines the research methods alone—a collection of data, their critical analysis, interpretation, and research results, for example.

A literature review in any field is essential as it offers a comprehensive overview and recapitulation of the given scholarship from past to present, giving the reader a sense of focus as to which direction your new research is headed (See Reference 3).

  • Wesleyan University: Library [http://www.wesleyan.edu/libr/guides/litrev/whatsalitreview.html]
  • The University of Southern California: USC Libraries [ http://libguides.usc.edu/content.php?pid=83009&sid=615851 ]
  • The University of North Carolina: The Writing Center [ http://writingcenter.unc.edu/handouts/literature-reviews/ ]

Recommended

wellington-house-britains-ww1-propaganda-bureau

Wellington House: Britain's WW1 Propaganda Bureau

How can you face an audience without the confidence of being well-read on your subject matter?

How can you face an audience without the confidence of being well-read on your subject matter?

By U.S. Navy photo by Mass Communication Specialist 1st Class Davis Anderson [Public domain], via Wikimedia Commons

Related Articles

  • 10 Steps to Writing an Academic Research Proposal This article explores and explains some of the common elements in an academic research proposal. In this article you will find helpful hints of how to write a research proposal that will catch the eye of your professor, thesis, and dissertation chair
  • 7 Reasons Why Research Is Important Learn the true importance of research in daily life. Research is an invaluable skill that's necessary to master if you want to fully experience life.
  • Concept Mapping to Write a Literature Review This article will explain how to use concept mapping to write an in-depth, thought-provoking literature review or essay.

Questions & Answers

Question: How can we use marketing research to make money?

Answer: Without marketing, you can never know what type of business is needed in an area where you want to set up one. Marketing research is designed to give you the necessary data:who, what, when, where, why, and how.

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Chapter 1: Introduction

Learning objectives.

At the conclusion of this chapter, you will be able to:

  • Identify the purpose of the literature review in  the research process
  • Distinguish between different types of literature reviews

1.1 What is a Literature Review?

Pick up nearly any book on research methods and you will find a description of a literature review.  At a basic level, the term implies a survey of factual or nonfiction books, articles, and other documents published on a particular subject.  Definitions may be similar across the disciplines, with new types and definitions continuing to emerge.  Generally speaking, a literature review is a:

  • “comprehensive background of the literature within the interested topic area…” ( O’Gorman & MacIntosh, 2015, p. 31 ).
  • “critical component of the research process that provides an in-depth analysis of recently published research findings in specifically identified areas of interest.” ( House, 2018, p. 109 ).
  • “written document that presents a logically argued case founded on a comprehensive understanding of the current state of knowledge about a topic of study” ( Machi & McEvoy,  2012, p. 4 ).

As a foundation for knowledge advancement in every discipline, it is an important element of any research project.  At the graduate or doctoral level, the literature review is an essential feature of thesis and dissertation, as well as grant proposal writing.  That is to say, “A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research…A researcher cannot perform significant research without first understanding the literature in the field.” ( Boote & Beile, 2005, p. 3 ).  It is by this means, that a researcher demonstrates familiarity with a body of knowledge and thereby establishes credibility with a reader.  An advanced-level literature review shows how prior research is linked to a new project, summarizing and synthesizing what is known while identifying gaps in the knowledge base, facilitating theory development, closing areas where enough research already exists, and uncovering areas where more research is needed. ( Webster & Watson, 2002, p. xiii )

A graduate-level literature review is a compilation of the most significant previously published research on your topic. Unlike an annotated bibliography or a research paper you may have written as an undergraduate, your literature review will outline, evaluate and synthesize relevant research and relate those sources to your own thesis or research question. It is much more than a summary of all the related literature.

It is a type of writing that demonstrate the importance of your research by defining the main ideas and the relationship between them. A good literature review lays the foundation for the importance of your stated problem and research question.

Literature reviews:

  • define a concept
  • map the research terrain or scope
  • systemize relationships between concepts
  • identify gaps in the literature ( Rocco & Plathotnik, 2009, p. 128 )

The purpose of a literature review is to demonstrate that your research question  is meaningful. Additionally, you may review the literature of different disciplines to find deeper meaning and understanding of your topic. It is especially important to consider other disciplines when you do not find much on your topic in one discipline. You will need to search the cognate literature before claiming there is “little previous research” on your topic.

Well developed literature reviews involve numerous steps and activities. The literature review is an iterative process because you will do at least two of them: a preliminary search to learn what has been published in your area and whether there is sufficient support in the literature for moving ahead with your subject. After this first exploration, you will conduct a deeper dive into the literature to learn everything you can about the topic and its related issues.

Literature Review Tutorial

A video titled "Literature Reviews: An overview for graduate students." Video here: https://www.lib.ncsu.edu/tutorials/litreview/. Transcript available here: https://siskel.lib.ncsu.edu/RIS/instruction/litreview/litreview.txt

1.2 Literature Review Basics

An effective literature review must:

  • Methodologically analyze and synthesize quality literature on a topic
  • Provide a firm foundation to a topic or research area
  • Provide a firm foundation for the selection of a research methodology
  • Demonstrate that the proposed research contributes something new to the overall body of knowledge of advances the research field’s knowledge base. ( Levy & Ellis, 2006 ).

All literature reviews, whether they are qualitative, quantitative or both, will at some point:

  • Introduce the topic and define its key terms
  • Establish the importance of the topic
  • Provide an overview of the amount of available literature and its types (for example: theoretical, statistical, speculative)
  • Identify gaps in the literature
  • Point out consistent finding across studies
  • Arrive at a synthesis that organizes what is known about a topic
  • Discusses possible implications and directions for future research

1.3 Types of Literature Reviews

There are many different types of literature reviews, however there are some shared characteristics or features.  Remember a comprehensive literature review is, at its most fundamental level, an original work based on an extensive critical examination and synthesis of the relevant literature on a topic. As a study of the research on a particular topic, it is arranged by key themes or findings, which may lead up to or link to the  research question.  In some cases, the research question will drive the type of literature review that is undertaken.

The following section includes brief descriptions of the terms used to describe different literature review types with examples of each.   The included citations are open access, Creative Commons licensed or copyright-restricted.

1.3.1 Types of Review

1.3.1.1 conceptual.

Guided by an understanding of basic issues rather than a research methodology. You are looking for key factors, concepts or variables and the presumed relationship between them. The goal of the conceptual literature review is to categorize and describe concepts relevant to your study or topic and outline a relationship between them. You will include relevant theory and empirical research.

Examples of a Conceptual Review:

  • Education : The formality of learning science in everyday life: A conceptual literature review. ( Dohn, 2010 ).
  • Education : Are we asking the right questions? A conceptual review of the educational development literature in higher education. ( Amundsen & Wilson, 2012 ).

Figure 1.1 shows a diagram of possible topics and subtopics related to the use of information systems in education. In this example, constructivist theory is a concept that might influence the use of information systems in education. A related but separate concept the researcher might want to explore are the different perspectives of students and teachers regarding the use of information systems in education.

1.3.1.2 Empirical

An empirical literature review collects, creates, arranges, and analyzes numeric data reflecting the frequency of themes, topics, authors and/or methods found in existing literature. Empirical literature reviews present their summaries in quantifiable terms using descriptive and inferential statistics.

Examples of an Empirical Review:

  • Nursing : False-positive findings in Cochrane meta-analyses with and without application of trial sequential analysis: An empirical review. ( Imberger, Thorlund, Gluud, & Wettersley, 2016 ).
  • Education : Impediments of e-learning adoption in higher learning institutions of Tanzania: An empirical review ( Mwakyusa & Mwalyagile, 2016 ).

1.3.1.3 Exploratory

Unlike a synoptic literature review, the purpose here is to provide a broad approach to the topic area. The aim is breadth rather than depth and to get a general feel for the size of the topic area. A graduate student might do an exploratory review of the literature before beginning a synoptic, or more comprehensive one.

Examples of an Exploratory Review:

  • Education : University research management: An exploratory literature review. ( Schuetzenmeister, 2010 ).
  • Education : An exploratory review of design principles in constructivist gaming learning environments. ( Rosario & Widmeyer, 2009 ).

importance of literature review in a research

1.3.1.4 Focused

A type of literature review limited to a single aspect of previous research, such as methodology. A focused literature review generally will describe the implications of choosing a particular element of past research, such as methodology in terms of data collection, analysis and interpretation.

Examples of a Focused Review:

  • Nursing : Clinical inertia in the management of type 2 diabetes mellitus: A focused literature review. ( Khunti, Davies, & Khunti, 2015 ).
  • Education : Language awareness: Genre awareness-a focused review of the literature. ( Stainton, 1992 ).

1.3.1.5 Integrative

Critiques past research and draws overall conclusions from the body of literature at a specified point in time. Reviews, critiques, and synthesizes representative literature on a topic in an integrated way. Most integrative reviews are intended to address mature topics or  emerging topics. May require the author to adopt a guiding theory, a set of competing models, or a point of view about a topic.  For more description of integrative reviews, see Whittemore & Knafl (2005).

Examples of an Integrative Review:

  • Nursing : Interprofessional teamwork and collaboration between community health workers and healthcare teams: An integrative review. ( Franklin,  Bernhardt, Lopez, Long-Middleton, & Davis, 2015 ).
  • Education : Exploring the gap between teacher certification and permanent employment in Ontario: An integrative literature review. ( Brock & Ryan, 2016 ).

1.3.1.6 Meta-analysis

A subset of a  systematic review, that takes findings from several studies on the same subject and analyzes them using standardized statistical procedures to pool together data. Integrates findings from a large body of quantitative findings to enhance understanding, draw conclusions, and detect patterns and relationships. Gather data from many different, independent studies that look at the same research question and assess similar outcome measures. Data is combined and re-analyzed, providing a greater statistical power than any single study alone. It’s important to note that not every systematic review includes a meta-analysis but a meta-analysis can’t exist without a systematic review of the literature.

Examples of a Meta-Analysis:

  • Education : Efficacy of the cooperative learning method on mathematics achievement and attitude: A meta-analysis research. ( Capar & Tarim, 2015 ).
  • Nursing : A meta-analysis of the effects of non-traditional teaching methods on the critical thinking abilities of nursing students. ( Lee, Lee, Gong, Bae, & Choi, 2016 ).
  • Education : Gender differences in student attitudes toward science: A meta-analysis of the literature from 1970 to 1991. ( Weinburgh, 1995 ).

1.3.1.7 Narrative/Traditional

An overview of research on a particular topic that critiques and summarizes a body of literature. Typically broad in focus. Relevant past research is selected and synthesized into a coherent discussion. Methodologies, findings and limits of the existing body of knowledge are discussed in narrative form. Sometimes also referred to as a traditional literature review. Requires a sufficiently focused research question. The process may be subject to bias that supports the researcher’s own work.

Examples of a Narrative/Traditional Review:

  • Nursing : Family carers providing support to a person dying in the home setting: A narrative literature review. ( Morris, King, Turner, & Payne, 2015 ).
  • Education : Adventure education and Outward Bound: Out-of-class experiences that make a lasting difference. ( Hattie, Marsh, Neill, & Richards, 1997 ).
  • Education : Good quality discussion is necessary but not sufficient in asynchronous tuition: A brief narrative review of the literature. ( Fear & Erikson-Brown, 2014 ).
  • Nursing : Outcomes of physician job satisfaction: A narrative review, implications, and directions for future research. ( Williams & Skinner, 2003 ).

1.3.1.8 Realist

Aspecific type of literature review that is theory-driven and interpretative and is intended to explain the outcomes of a complex intervention program(s).

Examples of a Realist Review:

  • Nursing : Lean thinking in healthcare: A realist review of the literature. ( Mazzacato, Savage, Brommels, 2010 ).
  • Education : Unravelling quality culture in higher education: A realist review. ( Bendermacher, Egbrink, Wolfhagen, & Dolmans, 2017 ).

1.3.1.9 Scoping

Tend to be non-systematic and focus on breadth of coverage conducted on a topic rather than depth. Utilize a wide range of materials; may not evaluate the quality of the studies as much as count the number. One means of understanding existing literature. Aims to identify nature and extent of research; preliminary assessment of size and scope of available research on topic. May include research in progress.

Examples of a Scoping Review:

  • Nursing : Organizational interventions improving access to community-based primary health care for vulnerable populations: A scoping review. ( Khanassov, Pluye, Descoteaux, Haggerty,  Russell, Gunn, & Levesque, 2016 ).
  • Education : Interdisciplinary doctoral research supervision: A scoping review. ( Vanstone, Hibbert, Kinsella, McKenzie, Pitman, & Lingard, 2013 ).
  • Nursing : A scoping review of the literature on the abolition of user fees in health care services in Africa. ( Ridde, & Morestin, 2011 ).

1.3.1.10 Synoptic

Unlike an exploratory review, the purpose is to provide a concise but accurate overview of all material that appears to be relevant to a chosen topic. Both content and methodological material is included. The review should aim to be both descriptive and evaluative. Summarizes previous studies while also showing how the body of literature could be extended and improved in terms of content and method by identifying gaps.

Examples of a Synoptic Review:

  • Education : Theoretical framework for educational assessment: A synoptic review. ( Ghaicha, 2016 ).
  • Education : School effects research: A synoptic review of past efforts and some suggestions for the future. ( Cuttance, 1981 ).

1.3.1.11 Systematic Review

A rigorous review that follows a strict methodology designed with a presupposed selection of literature reviewed.  Undertaken to clarify the state of existing research, the evidence, and possible implications that can be drawn from that.  Using comprehensive and exhaustive searching of the published and unpublished literature, searching various databases, reports, and grey literature.  Transparent and reproducible in reporting details of time frame, search and methods to minimize bias.  Must include a team of at least 2-3 and includes the critical appraisal of the literature.  For more description of systematic reviews, including links to protocols, checklists, workflow processes, and structure see “ A Young Researcher’s Guide to a Systematic Review “.

Examples of a Systematic Review:

  • Education : The potentials of using cloud computing in schools: A systematic literature review ( Hartmann, Braae, Pedersen, & Khalid, 2017 )
  • Nursing : Is butter back? A systematic review and meta-analysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality. ( Pimpin, Wu, Haskelberg, Del Gobbo, & Mozaffarian, 2016 ).
  • Education : The use of research to improve professional practice: a systematic review of the literature. ( Hemsley-Brown & Sharp, 2003 ).
  • Nursing : Using computers to self-manage type 2 diabetes. ( Pal, Eastwood, Michie, Farmer, Barnard, Peacock, Wood, Inniss, & Murray, 2013 ).

1.3.1.12 Umbrella/Overview of Reviews

Compiles evidence from multiple systematic reviews into one document. Focuses on broad condition or problem for which there are competing interventions and highlights reviews that address those interventions and their effects. Often used in recommendations for practice.

Examples of an Umbrella/Overview Review:

  • Education : Reflective practice in healthcare education: An umbrella review. ( Fragknos, 2016 ).
  • Nursing : Systematic reviews of psychosocial interventions for autism: an umbrella review. ( Seida, Ospina, Karkhaneh, Hartling, Smith, & Clark, 2009 ).

For a brief discussion see “ Not all literature reviews are the same ” (Thomson, 2013).

1.4 Why do a Literature Review?

The purpose of the literature review is the same regardless of the topic or research method. It tests your own research question against what is already known about the subject.

1.4.1 First – It’s part of the whole. Omission of a literature review chapter or section in a graduate-level project represents a serious void or absence of critical element in the research process.

The outcome of your review is expected to demonstrate that you:

  • can systematically explore the research in your topic area
  • can read and critically analyze the literature in your discipline and then use it appropriately to advance your own work
  • have sufficient knowledge in the topic to undertake further investigation

1.4.2 Second – It’s good for you!

  • You improve your skills as a researcher
  • You become familiar with the discourse of your discipline and learn how to be a scholar in your field
  • You learn through writing your ideas and finding your voice in your subject area
  • You define, redefine and clarify your research question for yourself in the process

1.4.3 Third – It’s good for your reader. Your reader expects you to have done the hard work of gathering, evaluating and synthesizes the literature.  When you do a literature review you:

  • Set the context for the topic and present its significance
  • Identify what’s important to know about your topic – including individual material, prior research, publications, organizations and authors.
  • Demonstrate relationships among prior research
  • Establish limitations of existing knowledge
  • Analyze trends in the topic’s treatment and gaps in the literature

1.4.4 Why do a literature review?

  • To locate gaps in the literature of your discipline
  • To avoid reinventing the wheel
  • To carry on where others have already been
  • To identify other people working in the same field
  • To increase your breadth of knowledge in your subject area
  • To find the seminal works in your field
  • To provide intellectual context for your own work
  • To acknowledge opposing viewpoints
  • To put your work in perspective
  • To demonstrate you can discover and retrieve previous work in the area

1.5 Common Literature Review Errors

Graduate-level literature reviews are more than a summary of the publications you find on a topic.  As you have seen in this brief introduction, literature reviews are a very specific type of research, analysis, and writing.  We will explore these topics more in the next chapters.  Some things to keep in mind as you begin your own research and writing are ways to avoid the most common errors seen in the first attempt at a literature review.  For a quick review of some of the pitfalls and challenges a new researcher faces when he/she begins work, see “ Get Ready: Academic Writing, General Pitfalls and (oh yes) Getting Started! ”.

As you begin your own graduate-level literature review, try to avoid these common mistakes:

  • Accepts another researcher’s finding as valid without evaluating methodology and data
  • Contrary findings and alternative interpretations are not considered or mentioned
  • Findings are not clearly related to one’s own study, or findings are too general
  • Insufficient time allowed to define best search strategies and writing
  • Isolated statistical results are simply reported rather than synthesizing the results
  • Problems with selecting and using most relevant keywords, subject headings and descriptors
  • Relies too heavily on secondary sources
  • Search methods are not recorded or reported for transparency
  • Summarizes rather than synthesizes articles

In conclusion, the purpose of a literature review is three-fold:

  • to survey the current state of knowledge or evidence in the area of inquiry,
  • to identify key authors, articles, theories, and findings in that area, and
  • to identify gaps in knowledge in that research area.

A literature review is commonly done today using computerized keyword searches in online databases, often working with a trained librarian or information expert. Keywords can be combined using the Boolean operators, “and”, “or” and sometimes “not”  to narrow down or expand the search results. Once a list of articles is generated from the keyword and subject heading search, the researcher must then manually browse through each title and abstract, to determine the suitability of that article before a full-text article is obtained for the research question.

Literature reviews should be reasonably complete, and not restricted to a few journals, a few years, or a specific methodology or research design. Reviewed articles may be summarized in the form of tables, and can be further structured using organizing frameworks such as a concept matrix.

A well-conducted literature review should indicate whether the initial research questions have already been addressed in the literature, whether there are newer or more interesting research questions available, and whether the original research questions should be modified or changed in light of findings of the literature review.

The review can also provide some intuitions or potential answers to the questions of interest and/or help identify theories that have previously been used to address similar questions and may provide evidence to inform policy or decision-making. ( Bhattacherjee, 2012 ).

importance of literature review in a research

Read Abstract 1.  Refer to Types of Literature Reviews.  What type of literature review do you think this study is and why?  See the Answer Key for the correct response.

Nursing : To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing.

An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care.

Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents.

General information available on patient safety should be incorporated in paediatric nursing care. ( Wegner, Silva, Peres, Bandeira, Frantz, Botene, & Predebon, 2017 ).

Read Abstract 2.  Refer to Types of Literature Reviews.  What type of lit review do you think this study is and why?  See the Answer Key for the correct response.

Education : The focus of this paper centers around timing associated with early childhood education programs and interventions using meta-analytic methods. At any given assessment age, a child’s current age equals starting age, plus duration of program, plus years since program ended. Variability in assessment ages across the studies should enable everyone to identify the separate effects of all three time-related components. The project is a meta-analysis of evaluation studies of early childhood education programs conducted in the United States and its territories between 1960 and 2007. The population of interest is children enrolled in early childhood education programs between the ages of 0 and 5 and their control-group counterparts. Since the data come from a meta-analysis, the population for this study is drawn from many different studies with diverse samples. Given the preliminary nature of their analysis, the authors cannot offer conclusions at this point. ( Duncan, Leak, Li, Magnuson, Schindler, & Yoshikawa, 2011 ).

Test Yourself

See Answer Key for the correct responses.

The purpose of a graduate-level literature review is to summarize in as many words as possible everything that is known about my topic.

A literature review is significant because in the process of doing one, the researcher learns to read and critically assess the literature of a discipline and then uses it appropriately to advance his/her own research.

Read the following abstract and choose the correct type of literature review it represents.

Nursing: E-cigarette use has become increasingly popular, especially among the young. Its long-term influence upon health is unknown. Aim of this review has been to present the current state of knowledge about the impact of e-cigarette use on health, with an emphasis on Central and Eastern Europe. During the preparation of this narrative review, the literature on e-cigarettes available within the network PubMed was retrieved and examined. In the final review, 64 research papers were included. We specifically assessed the construction and operation of the e-cigarette as well as the chemical composition of the e-liquid; the impact that vapor arising from the use of e-cigarette explored in experimental models in vitro; and short-term effects of use of e-cigarettes on users’ health. Among the substances inhaled by the e-smoker, there are several harmful products, such as: formaldehyde, acetaldehyde, acroleine, propanal, nicotine, acetone, o-methyl-benzaldehyde, carcinogenic nitrosamines. Results from experimental animal studies indicate the negative impact of e-cigarette exposure on test models, such as ascytotoxicity, oxidative stress, inflammation, airway hyper reactivity, airway remodeling, mucin production, apoptosis, and emphysematous changes. The short-term impact of e-cigarettes on human health has been studied mostly in experimental setting. Available evidence shows that the use of e-cigarettes may result in acute lung function responses (e.g., increase in impedance, peripheral airway flow resistance) and induce oxidative stress. Based on the current available evidence, e-cigarette use is associated with harmful biologic responses, although it may be less harmful than traditional cigarettes. (J ankowski, Brożek, Lawson, Skoczyński, & Zejda, 2017 ).

  • Meta-analysis
  • Exploratory

Education: In this review, Mary Vorsino writes that she is interested in keeping the potential influences of women pragmatists of Dewey’s day in mind while presenting modern feminist re readings of Dewey. She wishes to construct a narrowly-focused and succinct literature review of thinkers who have donned a feminist lens to analyze Dewey’s approaches to education, learning, and democracy and to employ Dewey’s works in theorizing on gender and education and on gender in society. This article first explores Dewey as both an ally and a problematic figure in feminist literature and then investigates the broader sphere of feminist pragmatism and two central themes within it: (1) valuing diversity, and diverse experiences; and (2) problematizing fixed truths. ( Vorsino, 2015 ).

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Literature Reviews for Education and Nursing Graduate Students Copyright © by Linda Frederiksen is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Importance and Issues of Literature Review in Research

  • November 2020
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  • Systematic Review
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  • Published: 30 May 2024

Patient experiences: a qualitative systematic review of chemotherapy adherence

  • Amineh Rashidi 1 ,
  • Susma Thapa 1 ,
  • Wasana Sandamali Kahawaththa Palliya Guruge 1 &
  • Shubhpreet Kaur 1  

BMC Cancer volume  24 , Article number:  658 ( 2024 ) Cite this article

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Adherence to chemotherapy treatment is recognized as a crucial health concern, especially in managing cancer patients. Chemotherapy presents challenges for patients, as it can lead to potential side effects that may adversely affect their mobility and overall function. Patients may sometimes neglect to communicate these side effects to health professionals, which can impact treatment management and leave their unresolved needs unaddressed. However, there is limited understanding of how patients’ experiences contribute to improving adherence to chemotherapy treatment and the provision of appropriate support. Therefore, gaining insights into patients’ experiences is crucial for enhancing the accompaniment and support provided during chemotherapy.

This review synthesizes qualitative literature on chemotherapy adherence within the context of patients’ experiences. Data were collected from Medline, Web of Science, CINAHL, PsychINFO, Embase, Scopus, and the Cochrane Library, systematically searched from 2006 to 2023. Keywords and MeSH terms were utilized to identify relevant research published in English. Thirteen articles were included in this review. Five key themes were synthesized from the findings, including positive outlook, receiving support, side effects, concerns about efficacy, and unmet information needs. The review underscores the importance for healthcare providers, particularly nurses, to focus on providing comprehensive information about chemotherapy treatment to patients. Adopting recommended strategies may assist patients in clinical practice settings in enhancing adherence to chemotherapy treatment and improving health outcomes for individuals living with cancer.

Peer Review reports

Introduction

Cancer can affect anyone and is recognized as a chronic disease characterized by abnormal cell multiplication in the body [ 1 ]. While cancer is prevalent worldwide, approximately 70% of cancer-related deaths occur in low- to middle-income nations [ 1 ]. Disparities in cancer outcomes are primarily attributed to variations in the accessibility of comprehensive diagnosis and treatment among countries [ 1 , 2 ]. Cancer treatment comes in various forms; however, chemotherapy is the most widely used approach [ 3 ]. Patients undergoing chemotherapy experience both disease-related and treatment-related adverse effects, significantly impacting their quality of life [ 4 ]. Despite these challenges, many cancer patients adhere to treatment in the hope of survival [ 5 ]. However, some studies have shown that concerns about treatment efficacy may hinder treatment adherence [ 6 ]. Adherence is defined as “the extent to which a person’s behaviour aligns with the recommendations of healthcare providers“ [ 7 ]. Additionally, treatment adherence is influenced by the information provided by healthcare professionals following a cancer diagnosis [ 8 ]. Patient experiences suggest that the decision to adhere to treatment is often influenced by personal factors, with family support playing a crucial role [ 8 ]. Furthermore, providing adequate information about chemotherapy, including its benefits and consequences, can help individuals living with cancer gain a better understanding of the advantages associated with adhering to chemotherapy treatment [ 9 ].

Recognizing the importance of adhering to chemotherapy treatment and understanding the impact of individual experiences of chemotherapy adherence would aid in identifying determinants of adherence and non-adherence that are modifiable through effective interventions [ 10 ]. Recently, systematic reviews have focused on experiences and adherence in breast cancer [ 11 ], self-management of chemotherapy in cancer patients [ 12 ], and the influence of medication side effects on adherence [ 13 ]. However, these reviews were narrow in scope, and to date, no review has integrated the findings of qualitative studies designed to explore both positive and negative experiences regarding chemotherapy treatment adherence. This review aims to synthesize the qualitative literature on chemotherapy adherence within the context of patients’ experiences.

This review was conducted in accordance with the Joanna Briggs Institute [ 14 ] guidelines for systemic review involving meta-aggregation. This review was registered in PROSPERO (CRD42021270459).

Search methods

The searches for peer reviewed publications in English from January 2006-September 2023 were conducted by using keywords, medical subject headings (MeSH) terms and Boolean operators ‘AND’ and ‘OR’, which are presented in the table in Appendix 1 . The searches were performed in a systematic manner in core databases such including Embase, Medline, PsycINFO, CINAHL, Web of Science, Cochrane Library, Scopus and the Joanna Briggs Institute (JBI). The search strategy was developed from keywords and medical subject headings (MeSH) terms. Librarian’s support and advice were sought in forming of the search strategies.

Study selection and inclusion criteria

The systematic search was conducted on each database and all articles were exported to Endnote and duplicates records were removed. Then, title and abstract of the full text was screened by two independent reviewers against the inclusion criteria. For this review, populations were patients aged 18 and over with cancer, the phenomenon of interest was experiences on chemotherapy adherence and context was considered as hospitals, communities, rehabilitation centres, outpatient clinics, and residential aged care. All peer-reviewed qualitative study design were also considered for inclusion. Studies included in this review were classified as primary research, published in English since 2006, some intervention implemented to improve adherence to treatment. This review excluded any studies that related to with cancer and mental health condition, animal studies and grey literature.

Quality appraisal and data extraction

The JBI Qualitative Assessment and Review Instrument for qualitative studies was used to assess the methodological quality of the included studies, which was conducted by the primary and second reviewers independently. There was no disagreement between the reviews. The qualitative data on objectives, study population, context, study methods, and the phenomena of interest and findings form the included studies were extracted.

Data synthesis

The meta-aggregation approach was used to combine the results with similar meaning. The primary and secondary reviewers created categories based on the meanings and concept. These categories were supported by direct quotations from participants. The findings were assess based on three levels of evidence, including unequivocal, credible, and unsupported [ 15 , 16 ]. Findings with no quotation were not considered for synthesis in this review. The categories and findings were also discussed by the third and fourth reviewers until a consensus was reached. The review was approved by the Edith Cowan University Human Research Ethics Committee (2021–02896).

Study inclusion

A total of 4145 records were identified through a systematic search. Duplicates ( n  = 647) were excluded. Two independent reviewers conducted screening process. The remaining articles ( n  = 3498) were examined for title and abstract screening. Then, the full text screening conducted, yielded 13 articles to be included in the final synthesis see Appendix 2 .

Methodological quality of included studies

All included qualitative studies scored between 7 and 9, which is displayed in Appendix 3 . The congruity between the research methodology and the research question or objectives, followed by applying appropriate data collection and data analysis were observed in all included studies. Only one study [ 17 ] indicated the researcher’s statement regarding cultural or theoretical perspectives. Three studies [ 18 , 19 , 20 ] identified the influence of the researcher on the research and vice-versa.

Characteristics of included studies

Most of studies conducted semi-structured and in-depth interviews, one study used narrative stories [ 19 ], one study used focus group discussion [ 21 ], and one study combined focus group and interview [ 22 ] to collect data. All studies conducted outpatient’s clinic, community, or hospital settings [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. The study characteristics presented in Appendix 4 .

Review findings

Eighteen findings were extracted and synthesised into five categories: positive outlook, support, side effects, concern about efficacy and unmet information needs.

Positive outlook

Five studies discussed the link between positivity and hope and chemotherapy adherence [ 19 , 20 , 23 , 27 , 28 ]. Five studies commented that feeling positive and avoid the negativity and worry could encourage people to adhere in their mindset chemotherapy: “ I think the main thing for me was just keeping a positive attitude and not worrying, not letting myself worry about it ” [ 20 ]. Participants also considered the positive thoughts as a coping mechanism, that would help them to adhere and complete chemotherapy: “ I’m just real positive on how everything is going. I’m confident in the chemo, and I’m hoping to get out of her soon ” [ 23 ]. Viewing chemotherapy as part of their treatment regimen and having awareness of negative consequences of non-adherence to chemotherapy encouraged them to adhere chemotherapy: “ If I do not take medicine, I do not think I will be able to live ” [ 28 ]. Adhering chemotherapy was described as a survivor tool which helped people to control cancer-related symptoms: “ it is what is going to restore me. If it wasn’t this treatment, maybe I wasn’t here talking to you. So, I have to focus in what he is going to give me, life !” [ 27 ]. Similarly, people accepted the medical facts and prevent their life from worsening; “ without the treatment, it goes the wrong way. It is hard, but I have accepted it from the beginning, yes. This is how it is. I cannot do anything about it. Just have to accept it ” [ 19 ].

Finding from six studies contributed to this category [ 20 , 21 , 23 , 24 , 25 , 29 ]. Providing support from families and friends most important to the people. Receiving support from family members enhanced a sense responsibility towards their families, as they believed to survive for their family even if suffered: “ yes, I just thought that if something comes back again and I say no, then I have to look my family and friends in the eye and say I could have prevented it, perhaps. Now, if something comes back again, I can say I did everything I could. Cancer is bad enough without someone saying: It’s your own fault!!” [ 29 ]. Also, emotional support from family was described as important in helping and meeting their needs, and through facilitation helped people to adhere chemotherapy: “ people who genuinely mean the support that they’re giving […] just the pure joy on my daughter’s face for helping me. she was there day and night for me if I needed it, and that I think is the main thing not to have someone begrudgingly looking after you ” [ 20 ]. Another study discussed the role family, friends and social media as the best source of support during their treatment to adhere and continue “ I have tons of friends on Facebook, believe it or not, and it’s amazing how many people are supportive in that way, you know, just sending get-well wishes. I can’t imagine going through this like 10 years ago whenever stuff like that wasn’t around ” [ 23 ]. Receiving support from social workers was particularly helpful during chemotherapy in encouraging adherence to the chemotherapy: “ the social worker told me that love is courage. That was a huge encouragement, and I began to encourage myself ” [ 25 ].

Side effects

Findings from five studies informed this category [ 17 , 21 , 22 , 25 , 26 ]. Physical side effects were described by some as the most unpleasure experience: “ the side effects were very uncomfortable. I felt pain, fatigue, nausea, and dizziness that limited my daily activities. Sometimes, I was thinking about not keeping to my chemotherapy schedule due to those side effect ” [ 17 ]. The impact of side effects affected peoples’ ability to maintain their independence and self-care: “ I couldn’t walk because I didn’t have the energy, but I wouldn’t have dared to go out because the diarrhoea was so bad. Sometimes I couldn’t even get to the toilet; that’s very embarrassing because you feel like you’re a baby ” [ 26 ]. Some perceived that this resulted in being unable to perform independently: “ I was incredibly weak and then you still have to do things and you can’t manage it ” [ 22 ]. These side effect also decreased their quality of life “ I felt nauseated whenever I smelled food. I simply had no appetite when food was placed in front of me. I lost my sense of taste. Food had no taste anymore ” [ 25 ]. Although, the side effects impacted on patients´ leisure and free-time activities, they continued to undertake treatment: “ I had to give up doing the things I liked the most, such as going for walks or going to the beach. Routines, daily life in general were affected ” [ 21 ].

Concern about efficacy

Findings form four studies informed this category [ 17 , 18 , 24 , 28 ]. Although being concerned about the efficacy of the chemotherapy and whether or not chemotherapy treatment would be successful, one participant who undertook treatment described: “the efficacy is not so great. It is said to expect about 10% improvement, but I assume that it declines over time ” [ 28 ]. People were worried that such treatment could not cure their cancer and that their body suffered more due to the disease: “ I was really worried about my treatment effectiveness, and I will die shortly ” [ 17 ]. There were doubts expressed about remaining the cancer in the body after chemotherapy: “ there’s always sort of hidden worries in there that whilst they’re not actually taking the tumour away, then you’re wondering whether it’s getting bigger or what’s happening to it, whether it’s spreading or whatever, you know ” [ 24 ]. Uncertainty around the outcome of such treatment, or whether recovering from cancer or not was described as: “it makes you feel confused. You don’t know whether you are going to get better or else whether the illness is going to drag along further” [ 18 ].

Unmet information needs

Five studies contributed to this category [ 17 , 21 , 22 , 23 , 26 ]. The need for adequate information to assimilate information and provide more clarity when discussing complex information were described. Providing information from clinicians was described as minimal: “they explain everything to you and show you the statistics, then you’re supposed to take it all on-board. You could probably go a little bit slower with the different kinds of chemo and grappling with these statistics” [ 26 ]. People also used the internet search to gain information about their cancer or treatments, “I’ve done it (consult google), but I stopped right away because there’s so much information and you don’t know whether it’s true or not ” [ 21 ]. The need to receive from their clinicians to obtain clearer information was described as” I look a lot of stuff up online because it is not explained to me by the team here at the hospital ” [ 23 ]. Feeling overwhelmed with the volume of information could inhibit people to gain a better understanding of chemotherapy treatment and its relevant information: “ you don’t absorb everything that’s being said and an awful lot of information is given to you ” [ 22 ]. People stated that the need to know more information about their cancer, as they were never dared to ask from their clinicians: “ I am a low educated person and come from a rural area; I just follow the doctor’s advice for my health, and I do not dare to ask anything” [ 17 ].

The purpose of this review was to explore patient’s experiences about the chemotherapy adherence. After finalizing the searches, thirteen papers were included in this review that met the inclusion criteria.

The findings of the present review suggest that social support is a crucial element in people’s positive experiences of adhering to chemotherapy. Such support can lead to positive outcomes by providing consistent and timely assistance from family members or healthcare professionals, who play vital roles in maintaining chemotherapy adherence [ 30 ]. Consistent with our study, previous research has highlighted the significant role of family members in offering emotional and physical support, which helps individuals cope better with chemotherapy treatment [ 31 , 32 ]. However, while receiving support from family members reinforces individuals’ sense of responsibility in managing their treatment and their family, it also instils a desire to survive cancer and undergo chemotherapy. One study found that assuming self-responsibility empowers patients undergoing chemotherapy, as they feel a sense of control over their therapy and are less dependent on family members or healthcare professionals [ 33 ]. A qualitative systematic review reported that support from family members enables patients to become more proactive and effective in adhering to their treatment plan [ 34 ]. This review highlights the importance of maintaining a positive outlook and rational beliefs as essential components of chemotherapy adherence. Positive thinking helps individuals recognize their role in chemotherapy treatment and cope more effectively with their illness by accepting it as part of their treatment regimen and viewing it as a tool for survival. This finding is supported by previous studies indicating that positivity and positive affirmations play critical roles in helping individuals adapt to their reality and construct attitudes conducive to chemotherapy adherence [ 35 , 36 ]. Similarly, maintaining a positive mindset can foster more favourable thoughts regarding chemotherapy adherence, ultimately enhancing adherence and overall well-being [ 37 ].

This review identified side effects as a significant negative aspect of the chemotherapy experience, with individuals expressing concerns about how these side effects affected their ability to perform personal self-care tasks and maintain independent living in their daily lives. Previous studies have shown that participants with a history of chemotherapy drug side effects were less likely to adhere to their treatment regimen due to worsening symptoms, which increased the burden of medication side effects [ 38 , 39 ]. For instance, cancer patients who experienced minimal side effects from chemotherapy were at least 3.5 times more likely to adhere to their treatment plan compared to those who experienced side effects [ 40 ]. Despite experiencing side effects, patients were generally willing to accept and adhere to their treatment program, although one study in this review indicated that side effects made some patients unable to maintain treatment adherence. Side effects also decreased quality of life and imposed restrictions on lifestyle, as seen in another study where adverse effects limited individuals in fulfilling daily commitments and returning to normal levels of functioning [ 41 ]. Additionally, unmet needs regarding information on patients’ needs and expectations were common. Healthcare professionals were considered the most important source of information, followed by consultation with the internet. Providing information from healthcare professionals, particularly nurses, can support patients effectively and reinforce treatment adherence [ 42 , 43 ]. Chemotherapy patients often preferred to base their decisions on the recommendations of their care providers and required adequate information retention. Related studies have highlighted that unmet needs among cancer patients are known factors associated with chemotherapy adherence, emphasizing the importance of providing precise information and delivering it by healthcare professionals to improve adherence [ 44 , 45 ]. Doubts about the efficacy of chemotherapy treatment, as the disease may remain latent, were considered negative experiences. Despite these doubts, patients continued their treatment, echoing findings from a study where doubts regarding efficacy were identified as a main concern for chemotherapy adherence. Further research is needed to understand how doubts about treatment efficacy can still encourage patients to adhere to chemotherapy treatment.

Strengths and limitation

The strength of this review lies in its comprehensive search strategy across databases to select appropriate articles. Additionally, the use of JBI guidelines provided a comprehensive and rigorous methodological approach in conducting this review. However, the exclusion of non-English studies, quantitative studies, and studies involving adolescents and children may limit the generalizability of the findings. Furthermore, this review focuses solely on chemotherapy treatment and does not encompass other types of cancer treatment.

Conclusion and practical implications

Based on the discussion of the findings, it is evident that maintaining a positive mentality and receiving social support can enhance chemotherapy adherence. Conversely, experiencing treatment side effects, concerns about efficacy, and unmet information needs may lead to lower adherence. These findings present an opportunity for healthcare professionals, particularly nurses, to develop standardized approaches aimed at facilitating chemotherapy treatment adherence, with a focus on providing comprehensive information. By assessing patients’ needs, healthcare professionals can tailor approaches to promote chemotherapy adherence and improve the survival rates of people living with cancer. Raising awareness and providing education about cancer and chemotherapy treatment can enhance patients’ understanding of the disease and its treatment options. Utilizing videos and reading materials in outpatient clinics and pharmacy settings can broaden the reach of educational efforts. Policy makers and healthcare providers can collaborate to develop sustainable patient education models to optimize patient outcomes in the context of cancer care. A deeper understanding of individual processes related to chemotherapy adherence is necessary to plan the implementation of interventions effectively. Further research examining the experiences of both adherent and non-adherent patients is essential to gain a comprehensive understanding of this topic.

Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. on our submission system as well.

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First author (AR) and second author (ST) conceived the review and the second author oversight for all stages of the review provided by the second author. All authors (AR), (ST), (WG) and (SK) undertook the literature search. Data extraction, screening the included papers and quality appraisal were undertaken by all authors (AR), (ST), (WG) and (SK). First and second authors (AR) and (ST) analysed the data and wrote the first draft of the manuscript and revised the manuscript and all authors (AR), (ST), (WG) and (SK) approved the final version of the manuscript.

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Rashidi, A., Thapa, S., Kahawaththa Palliya Guruge, W. et al. Patient experiences: a qualitative systematic review of chemotherapy adherence. BMC Cancer 24 , 658 (2024). https://doi.org/10.1186/s12885-024-12353-z

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Determinants of prescribing decisions for off-patent biological medicines in Belgium: a qualitative study

  • Yannick Vandenplas 1 ,
  • Steven Simoens 1 ,
  • Philippe Van Wilder 2 ,
  • Arnold G. Vulto 1 , 3 ,
  • Florian Turk 4 &
  • Isabelle Huys 1  

BMC Health Services Research volume  22 , Article number:  1211 ( 2022 ) Cite this article

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A competitive market for off-patent biologicals leads to more affordable and high-quality healthcare. In recent years, Belgium has been characterized by its low use of biosimilars and by its shifts from off-patent biologicals toward new alternative therapies. Yet, the prescribing decisions involved in these observations are poorly understood. This study aims to better understand prescribing choices among Belgian physicians in the ambulatory care setting.

This study consisted of two phases. First, a scoping literature review to identify determinants of prescribing choices was conducted. Scientific databases (Embase and PubMed) were searched until 4 November 2021. Second, the nominal group technique (NGT) was employed during focus group discussions with Belgian physicians to consider and validate these determinants for off-patent biologicals in the Belgian context. The qualitative data resulting from the literature review and focus group discussions were analyzed using the thematic framework method.

Fifty-three scientific articles that discussed elements that determine prescribing choices were identified. Out of these, 17 determinants of prescribing choices were found. These were divided into five categories: (1) product-related, (2) physicians’ personal, (3) healthcare system-related, (4) patient-related, and (5) determinants related to the pharmaceutical company or brand. Nineteen Belgian physicians from different therapeutic areas that regularly prescribe biologicals then participated in focus group discussions. Using the NGT, the group discussions revealed that prescribing choices for off-patent biologicals are determined by a complex set of elements. Clinical data, geographical region, working environment, pharmaceutical marketing, patient profile, clinical guidelines, and preference of key opinion leaders (KOL) were considered most influential. Physicians indicated that the importance of these determinants differs depending on product classes or therapeutic domain.

Conclusions

Multiple elements determine the choice of an off-patent biological or biosimilar product. The importance of each of these determinants varies depending on the context in which the prescribing choice is made. To increase the prescription of best-value biologicals in the Belgian ambulatory care, a set of synergistic measures is required including information for healthcare providers (HCP) and patients, prescribing feedback, prescribing targets, tangible incentives, KOL involvement, guidelines regarding pharmaceutical promotion, and regular revision of reimbursement modalities.

Peer Review reports

Governments have increasingly experienced difficulties in keeping their healthcare budgets under control over the past few decades. This problem has become even more pressing as there is a growing number of challenges faced by healthcare systems worldwide, such as ageing populations, the emergence of expensive innovative therapies like precision medicine, and the recent COVID-19 pandemic [ 1 ]. Belgium is no exception and faces these challenges as well. Belgian healthcare spending has increased annually and is now among the highest in the European Union [ 2 ]. A significant portion of healthcare spending is on pharmaceuticals [ 3 ]. The most recent data show that pharmaceuticals represent 18% of the total Belgian healthcare budget, with an overall pharmaceutical budget of approximately 5 billion euros in 2021 [ 4 , 5 , 6 ]. Moreover, the pharmaceutical budget in Belgium has risen rapidly in recent years, with a growth of 10.7% in 2021. This situation is no longer sustainable given the limited resources available in a country where healthcare is mainly publicly funded. The national health insurer (the National Institute of Health and Disability Insurance or NIHDI) also identified this problem during their recent budget discussions [ 4 , 7 ].

Therefore, there is a clear need to develop strategies to maintain the financial sustainability of the Belgian healthcare system. One of these strategies should focus on the rational and cost-effective use of medicines, more specifically of biological medicines. Biological medicines or biologicals are medicines produced by living organisms, such as bacteria or animal cells [ 8 ]. They have been successful in treating several life-threatening or chronic disorders such as cancer, diabetes, and immune mediated inflammatory disorders. Because of a costly development and manufacturing process, biological medicines are generally more expensive compared to traditional chemical molecules [ 9 ]. Together with their widespread use, this results in biologicals representing a high cost to national healthcare systems. To date, biologicals represent about 30% of all pharmaceutical spending across Europe [ 5 ]. The expected advent of a large number of new biological therapies in the coming years will probably result in a further increase of this share [ 1 ]. After the expiry of market exclusivities of biologicals and the market entry of similar versions of authorized biologicals (i.e., biosimilars), off-patent biologicals obtain a more favorable cost-effectiveness profile [ 10 ]. Yet, in order to benefit from these more cost-effective medicines, a sustainable off-patent biologicals market is required. A sustainable market refers to a situation in which both off-patent biological and biosimilar products can coexist. It therefore not only strives towards a competitive market, but also towards economic viability for pharmaceutical industry [ 11 ]. However, it has become clear that the Belgian market is not sustainable [ 12 , 13 ]. Significant shifts from off-patent biologicals towards new therapeutic classes (such as interleukin (IL) inhibitors, Janus Kinase (JAK) inhibitors, etc.) and the dominant market position of originator biologicals that lost their market exclusivities (and thus a low use of biosimilars) are the main elements supporting this observation [ 12 , 13 , 14 ]. Biosimilars (including etanercept, adalimumab, and insulin glargine) have been part of Belgium’s ambulatory care since 2016. Yet, their market shares have only increased slowly over the past few years and remain very limited [ 12 , 13 ]. This is especially so in the ambulatory segment of the market where the choice for a particular biological is made by the prescribing physician and is not subject to tender decisions [ 12 , 13 ].

Due to substantial mandatory price reductions for both biosimilars and reference biological products, price differences are limited and both generate savings for the Belgian healthcare system. Therefore, the concept of best-value biologicals was introduced, which recognizes that both originator biologicals and biosimilars can contribute to a more sustainable healthcare system [ 13 , 15 ]. The Belgian government supports the concept of best-value biologicals and introduced several initiatives to encourage the use of cost-effective biologicals in the past years [ 12 ]. In addition, given the very low biosimilar market shares in Belgium’s ambulatory care, the Belgian government has aimed to specifically increase the use of biosimilars as well [ 4 , 12 , 16 , 17 ]. However, these initiatives have not been successful to date, underlining a poor understanding of what drives prescribing decisions within the off-patent biologicals market [ 12 , 13 ]. As a result, it is of particular interest to better understand what elements determine the choice between different molecules, as well as between a reference biological and its biosimilar(s). In order to design policy interventions to stimulate physicians to prescribe cost-effective medicines in the future, the underlying drivers behind prescribing decisions have to be clearly understood [ 18 , 19 ].

This study aimed to identify elements that determine the prescription choice for off-patent biologicals in the Belgian ambulatory setting. In doing so, we must not lose sight of the current reality and set the goal of looking beyond the choice between reference products and their biosimilar(s). As described earlier, when choosing a biological product, new molecules or follow-on products are also considered. Ultimately, a better understanding of prescribing choices can be used to inform Belgian policymakers when they are designing interventions to stimulate the prescription of best-value biological medicines or biosimilars.

Since there currently is no published evidence on the kinds of elements that determine the prescription of off-patent biological medicines, a two-step qualitative approach was used to identify these determinants. During the first step, an overview was made of elements that generally determine prescribing behavior based on a scoping literature review of scientific databases. This served to inform the next step where these identified elements were discussed in focus groups with Belgian physicians. An overview of the consecutive steps of the used methodological approach is provided in Fig.  1 .

figure 1

Overview of the methodological approach of this study

Scoping literature review

A scoping review of the literature in Embase and PubMed (MEDLINE) was conducted using a predefined search strategy. Scoping literature reviews aim to identify and map the existing evidence related to a certain topic of interest in a systematic way [ 20 , 21 ]. Full-text, peer-reviewed, English articles that were published between 2008 and 2021 were eligible for inclusion. Both original research articles and literature reviews were considered. Only articles that described determinants of prescribing decisions were included. Search terms were therefore related to ‘prescribing’, ‘behavior’, and ‘physician’. These search terms were adjusted according to the respective scientific database. Initially, the literature was searched up to March 2021 but was subsequently updated to 4 November 2021. The full literature search protocol can be found in the Supplementary Material .

All identified articles were imported into Mendeley software and duplicates were removed. The remaining articles were then screened by one reviewer (YV) based on title and abstract using Rayyan software [ 22 ]. Subsequent screening based on the full text of the selected articles was conducted by the same researcher (YV), and the remaining articles were included in the qualitative analysis. Peer-reviewed articles describing determinants that influence prescribing choices were analyzed qualitatively using the thematic framework method described by Gale et al. [ 23 ]. This process included mostly inductive coding as the researchers did not know in advance which determinants were involved in prescribing decisions. During the analysis of the first articles by two researchers (YV and IH), similar codes were identified as determinants of prescribing behavior and were grouped together to form a coding tree (i.e., thematic framework). The codes of the developed framework were agreed upon by the two researchers who coded the first articles. Subsequently, the remaining articles were analyzed by placing relevant passages under the developed thematic framework. In case new themes or codes were found, these were added to the existing framework. In the last phase, the results were summarized in a framework matrix and interpreted by the researchers.

Focus group discussions using the nominal group technique (NGT)

After general determinants of prescribing decisions were identified from the scoping literature review, the purpose of this study was to further examine these determinants in relation to off-patent biological medicines in the Belgian context. The results of the scoping literature review were therefore used as a starting point. Each of the identified determinants were discussed separately during focus group discussions and were scored quantitatively by the participants according to their relative importance. The nominal group technique (NGT) was used to achieve the latter. The NGT is a method to establish structured group discussions or interactions, which encourages all participants to provide their insights and to react to these insights [ 24 ]. It was chosen since the NGT allows for structured group discussions with the purpose to achieve an agreement related to a particular topic of interest. The NGT was considered appropriate for this research question as the technique also allows for ranking of priorities and the generation of new ideas [ 24 ].

The NGT consists of four distinct parts as defined by Delbecq and Van de Ven: (i) silent generation, (ii) round robin (i.e., the moderator asks each participant to share a single idea with the group), (iii) clarification, and (iv) ranking [ 24 , 25 ]. However, the NGT is a highly adaptable method depending on the specific research question and desired outcomes [ 24 ]. This allows researchers to replace or skip certain steps. For example, in this study, silent generation was omitted and replaced by a comprehensive literature review. Based on the ideas identified (in this case, determinants of prescribing behavior), the participants performed an initial ranking step prior to the group discussions. During the ranking exercise, each participant was asked to score the importance of each of the identified determinants on a five-point Likert scale in the following way: 1 = very low impact, 2 = low impact, 3 = some impact, 4 = high impact, 5 = very high impact. Average ranking values were calculated per determinant. In addition, participants were asked if there were other determinants influencing prescribing decisions regarding off-patent biologicals or if certain elements were irrelevant in this regard. After the initial ranking step, the traditional steps of the NGT were followed. As a result, the NGT consisted of the following steps:

First grading step prior to the group discussion, based on the list of determinants of prescribing decisions resulting from the scoping literature review

Presentation of the aggregated results of the first grading step to the participants (i.e., average ranking values per determinant)

Group discussion where each participant was asked to comment on the identified determinants of prescribing decisions and the results of the first grading step

Second grading step where participants were asked to rank the identified determinants again

Concluding step where each participant could share any final thoughts or remarks.

Usually, group discussions take place face-to-face, but the COVID-19 pandemic situation did not allow for physical interactions at the time when the study was conducted. Therefore, all the group discussions took place remotely via Microsoft Teams. The focus group discussions were anticipated to last between 90 and 120 minutes. All focus groups were moderated by the same researchers (YV and IH), who have experience with conducting qualitative research.

Participant selection and recruitment

Participants were Belgian specialist physicians working in therapeutic domains where off-patent biologicals and biosimilars are being prescribed in the ambulatory care setting. These products are listed in the Supplementary Material and mainly include tumor necrosis factor (TNF)-alpha inhibitors and insulin analogues. Therefore, eligible participating physicians were endocrinologists, dermatologists, gastroenterologists, and rheumatologists. The physicians were required to have a good knowledge of biologics and experience with prescribing both originator biologicals and biosimilars. The physicians were selected based on purposeful sampling, that is the identification and selection of individuals or groups who are especially knowledgeable about the topic of interest [ 26 ]. Participants were contacted via e-mail. Their contact details were obtained via publicly available information or through the network of the research unit where this study was conducted.

NGT group discussions usually involve two to fourteen participants, with an ideal number of seven participants [ 24 ]. To ensure a good balance between input coming from a variety of participants and giving each participant sufficient time to speak, the researchers aimed to have a minimum of four and a maximum of ten participants per group. The researchers ensured that a variety of backgrounds (i.e., region, working environment, therapeutic area) were present in each of the focus groups. Differences in language (i.e., Dutch or French) were also considered. Therefore, participants were asked to speak English during the focus groups. However, if necessary, participants could express themselves in their native language and the moderators acted as translators. Eligible participants were invited via e-mail and provided with all relevant study information and the informed consent form (Cfr. Supplementary Material ). All participants were required to provide written informed consent prior via e-mail to the start of the study. The study was approved by the Ethics Committee Research of UZ/KU Leuven (S65328).

Data analysis

The group discussions were audio recorded and transcribed verbatim manually. The transcripts were analyzed according to the thematic framework with NVivo software (Release 1.3), using a combination of inductive and deductive coding [ 23 ]. The deductive coding was based on the findings of the first step of this study (i.e., the scoping literature review). The transcripts were analyzed by categorizing the relevant transcript sections to the thematic framework that was developed during the first step of this study. Additional codes that arose during the group discussions were added inductively to the coding tree. The group discussions also served to detect subcodes under the existing themes that were identified through the scoping literature review. Next, the results of the coding process were charted into a framework matrix and interpreted by the researchers. Ultimately, the results were narratively described, and illustrative quotes supporting the findings were extracted.

To guarantee the confidentiality of all participants, the recordings and transcripts were pseudonymized by removing all names and references towards the identifiable person (Cfr. Supplementary Material ). These were replaced by a code randomly assigned to each participant per focus group, of which only the researchers have the code key to identify each participant.

The NGT also generates a small amount of quantitative data in addition to qualitative data. These are the result of the first and second ranking step (i.e., the five-point Likert scale) and are reported as an average score per determinant. The results of the first ranking step were presented to the participants, while the average scores per determinant of the second ranking were reported as the final result of this study (Cfr. Table  3 ). Prior to the study, a mean cutoff ranking score of 3.5 was defined by the researchers to identify the predominant determinants. The cutoff score was based on previous similar research, as well as on the perceptions of the NGT participants [ 27 ]. Finally, all average scores per determinant were ranked from high to low (Table 3 ).

As discussed above, a scoping literature review was conducted prior to the focus group discussions in order to identify elements that drive prescribing decisions in general. These identified determinants were used as a starting point for the focus group discussions with Belgian physicians.

The predefined search strategy identified a total of 2587 records. After the removal of duplicates and screening of the title and abstract, 48 articles remained. Further screening of the full-text articles led to 10 articles being excluded. The literature search was updated at the time the researchers finalized the analysis, by again using the same search strategy to look for newly published articles. This resulted in an additional 15 records that were included in the qualitative analysis. Therefore, 53 articles were included in the final qualitative analysis. An overview of the literature search process, including the flow chart of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 28 ], is included in the Supplementary Material .

Five main categories of determinants that drive prescribing choices were identified: (1) product-related, (2) physicians’ personal, (3) healthcare system-related, (4) patient-related, and (5) determinants related to the pharmaceutical company or brand. Each of these main categories was subdivided into specific determinants. An overview of all elements determining prescribing decisions with a brief explanation is provided in Table  1 . A detailed overview of the different determinants of prescribing choices identified in each article can be found in the Supplementary Material , along with a summary of the key characteristics of each study (i.e., title, author, year, location, study objectives, design, and sample size).

Demographics of participants

Nineteen physicians participated in the focus group discussions. Most participants were working in Flanders ( n  = 11), while the rest worked either in Wallonia ( n  = 6) or Brussels ( n  = 2). They included rheumatologists ( n  = 7), gastroenterologists ( n  = 6), dermatologists ( n  = 3), and endocrinologists ( n  = 3). All age groups were represented in this study, except for the youngest group of 18 to 29-year-olds. This was expected given the age at which physician specialists graduate in Belgium. Most of the physicians were working in an academic hospital setting ( n  = 10). A summary of the demographic characteristics of all participants can be found in Table  2 .

The results of the focus group discussions are presented below for each of the 17 determinants identified from the scoping literature review. An overview of all these elements, along with their average ranking after the second round, is summarized in Table 3 .

Product-related

Clinical data.

Physicians stated that the need for clinical data regarding biosimilars has evolved over the years. In the past, Belgian physicians had insufficient knowledge about the clinical development of biosimilars, which influenced their prescription practices. Until recently, uncertainty existed among Belgian physicians about the clinical differences when transitioning from an original biological to a biosimilar. These doubts are less prevalent nowadays due to an increase of positive experiences with biosimilars. It was agreed that when choosing between a biosimilar and its originator biological, doubts regarding reduced efficacy or safety are becoming less of an issue in Belgium. According to the participating physicians, the concept of extrapolation of indication does not pose an issue anymore for most Belgian physicians.

However, the situation differs when choosing between products with different mechanisms of action (MOA). In this case, the clinical data were considered important. For example, among the dermatologists, IL-17/23 inhibitors are considered clinically superior to existing off-patent alternatives (i.e., TNF-alpha inhibitors). This is one of the main reasons why existing off-patent biologicals are rarely prescribed for the treatment of new patients with psoriasis. This importance was also reflected in the average ranking score of 3.6 (Cfr. Table 3 ).

Physicians agreed that cost should be an important determinant, given the rising pharmaceutical expenditure in Belgium over the last few years. However, despite the important price differences between off-patent and competing patented products, it was believed that this only mattered for a small number of physicians when choosing a particular biological. The main reason for this would be that Belgian physicians are not sufficiently aware of the cost of medicines. Participants mentioned that there is a general lack of awareness about increasing pharmaceutical costs and the importance of a financially sustainable healthcare system. Moreover, the other determinants discussed in this article were believed to outweigh the impact of price considerations, according to the participating physicians.

According to the participants, cost considerations become an almost irrelevant determinant when choosing between an originator biological and its biosimilar(s) because of the limited price differences in the ambulatory care.

Overall, it was concluded that the cost of biological products has a limited influence on prescribing decisions in Belgium.

Administration

Physicians agreed that the administration modalities play a role for certain therapeutic areas. However, the influence of this depends greatly on the product or on whether different administration routes, devices, or frequencies are available. Off-patent biologicals in the ambulatory setting are always subcutaneously (SC) administered. Hence, the route of administration was considered to be unimportant. However, for certain therapeutic groups, oral (non-biological) alternatives are also available (e.g., JAK inhibitors). The oral administration route was thought to be one of the reasons for the current increase of JAK inhibitors being prescribed in Belgium, especially for patients with rheumatoid arthritis.

For most off-patent SC products, there are products available with different injection devices, frequencies of administration, and injection comfort. Physicians agreed that these differences, if present, play a role in the choice of a particular off-patent biological, although they are mostly related to patient comfort and patient preferences (see patient-related). Physicians concluded that administration modalities are certainly taken into consideration but should not be overestimated when looking at the overall picture.

Notwithstanding the success of certain new alternatives (such as IL-17/23 inhibitors, patented TNF-alpha inhibitors, JAK inhibitors, etc.) compared to off-patent biologicals, the mere fact that these are new products was believed to only play a small part in prescribing choices. The other elements discussed in this study are more likely to be causing the observed shift in prescribing behavior.

Physicians’ personal

Working environment.

Regarding the working environment of prescribers, the main point raised during the focus group discussions was that Belgian physicians working in hospitals or private practices differ in their access to information and certain support services. In academic hospitals, physicians would often have more access to information and are visited more frequently by pharmaceutical representatives. In addition, physicians in academic hospitals often already have experience with new MOA products through research studies, which would lead to a faster prescription uptake of these products. Differences in support services between individual hospitals, however, was considered to be even more influential by the participating physicians. Also, participants expressed that academic hospitals often have access to a larger nursing staff or more hospital beds. As a result, when pharmaceutical companies offer value-added services as a tool to promote their products to prescribers, this would influence their prescribing decisions to a lesser extent than for physicians working in general hospitals. Participants indicated that services provided by the pharmaceutical industry will have a lower impact on physicians working in private practices, which is particularly common among Belgian dermatologists and rheumatologists.

In general, physicians noted the importance of the prescriber’s working environment, but this difference was mostly linked to other determinants, such as pharmaceutical promotion, prescribing habits, and the influence of KOLs.

Several physicians pointed out some demonstrable differences between Belgian regions. For example, in rheumatology the transition from existing off-patent TNF inhibitors to JAK inhibitors is more prominent in Wallonia. However, the participants could not provide a particular reason for this. In addition, it was also indicated that there is a difference in the use of SC-administered biosimilars between Flanders and Wallonia, with higher SC biosimilar prescription rates in Flanders. It was argued that such differences may be due to different pharmaceutical marketing approaches and prescribing habits in both regions.

Prescribing habits

Prescribing habits were described by physicians as one of the most important determinants of prescribing choices. It was confirmed across all specialties that physicians tend to stick with products they have experience with. As a result, originator biologicals are often preferred over biosimilars in Belgium as prescribers have had limited experiences with biosimilars in the ambulatory care to date. An associated fear of loss of clinical efficacy was believed to be the main underlying reason for this therapeutic inertia when making prescribing choices. However, participants mentioned that prescribing habits tend to be more influencial when choosing between reference products and biosimilars compared to when new MOA products are being considered. For the latter, physicians had the impression that the abovementioned therapeutic inertia plays less of a role as moves to new MOAs are common practice in the Belgian ambulatory care.

Participating physicians agreed that the age of the prescribing physician plays little or no role in their prescribing choices. However, it was mentioned several times that older physicians, who have also known a time without the abundance of therapeutic options, are probably more inclined to prescribe the products that have been on the market for a longer period (i.e., off-patent products). Moreover, it was argued that younger physicians will have accumulated less experience with the more mature biologicals and are more likely to transition to new MOAs for this reason.

Healthcare system-related

Preference of key opinion leaders (kol).

The preference of KOLs was regarded as a major determining element when making prescribing choices for off-patent biological medicines. Physicians indicated that when KOLs express a particular preference regarding biological medicines, this generally has an impact on the prescribing choices of their peers. However, the preferences of KOLs were said to be mostly shown for specific MOAs, and not for reference biologicals and their biosimilars. According to the participants, this might have resulted in the shift that has been seen from off-patent biologicals towards new MOA products. KOLs have been less outspoken about their preferences towards biosimilars. Physicians indicated that it is precisely because KOLs give little attention to biosimilars, fewer biosimilars are being prescribed.

Clinical guidelines

Regarding the impact of clinical guidelines as a determinant for choosing a biological, all physicians emphasized that there is a substantial difference between choosing a particular molecule versus an originator biological or biosimilar. Belgian guidelines are generally scarce, and so European guidelines are seen as impactful. Clinical guidelines were thought to be a substantial determinant when choosing between different MOAs and thus between different off-patent (or patented) biologicals. However, it was indicated that clinical guidelines usually do not influence the decision when choosing between an originator biological and its biosimilar. The main reason for this is that both at the Belgian and the European level, this choice is often not explicitly incorporated in the clinical guidelines.

Time pressure

There was agreement among the participating physicians that it takes time to sufficiently explain to patients a transition from an original biological to a biosimilar. It was indicated that the limited length of a consultation does not allow for enough time to provide an explanation of a possible switch to a biosimilar. However, it was emphasized that time constraints are a commonly used excuse not to prescribe biosimilars. Physicians from the various therapeutic areas admitted that time pressure only plays a minor role when choosing between an originator biological or biosimilar medicine. In reality, there are other more predominant elements that determine this choice.

Across the different therapeutic areas, there was an agreement that transitioning between different molecules was regarded as common practice without the concerns of time constraints. Hence, there is no reason to assume that this should be much different when transitioning to a biosimilar. Therefore, even if more explanation is required when transitioning to a biosimilar, this should not be a valid reason to avoid prescribing biosimilars.

Financial incentives

During the group discussions, it emerged that financial incentives can be an important determinant of prescribing choices for off-patent biologicals. It was pointed out that the right incentives to increase the use of biosimilars may have an important impact, although these are currently absent in Belgium. The financial incentive introduced in 2019 to promote biosimilar prescription was cited as an example of the negligible impact of individual financial incentives. An incentive that supports the quality of care could have a much larger impact according to the participants.

Moreover, the impact of an incentive to promote biosimilar prescription would differ between hospitals. As indicated earlier, the amount of support varies from hospital to hospital. Therefore, the potential impact of supporting incentives from the government is partly dependent on this. Physicians working in private practices indicated that financial incentives, whether on an individual basis or at the hospital level, have a minor impact on their prescribing choices.

Patient-related

Patient profile.

Participating physicians agreed that the patient profile plays little or no role in the choice of an originator biological versus its biosimilar. When it comes to choosing between different molecules or MOAs, the patient profile does play a role. Comorbidities, age, lifestyle, socio-professional context, and comedication were mentioned as relevant examples in this context. Physicians indicated that these determinants, together with the administration modality, can largely determine medication adherence. For example, a less frequent administration would be more appropriate for an active or young patient. Participants also indicated that these aspects are often mentioned in clinical guidelines. Therefore, the importance patient profile is also linked to the availability of clinical guidelines.

Patient preference

Physicians indicated that the choice of a biological is only marginally influenced by the patient as most patients have limited preferences. If patients do have a preference, which is mostly for a particular injection device or administration route, it was mentioned that this obviously has a significant impact on the prescribing choice. Physicians confirmed that apart from a small group of patients, most patients generally have no preference regarding a biosimilar or originator biological.

Knowledge or perception of patients

Patient knowledge or perception about a particular type of medicine only has a minor effect on prescribing choices, as patients typically have a limited knowledge about biologicals. Physicians agreed that it may play a role with a small number of patients who have a rather negative perception towards biosimilar medicines. Nonetheless, if strong negative preconceptions about a particular medicine exists, this could have a significant impact on prescribing choices since these negative preconceptions may induce nocebo effects (i.e., the induction or exacerbation of symptoms through negative expectations about the therapy). Endocrinologists indicated that a resistance to taking insulin therapy can be an important barrier for patients with type 2 diabetes, as there is often an underlying perception of failure and shame when being treated with insulin.

Related to the pharmaceutical company or brand

Pharmaceutical marketing and promotion.

The impact of promotion and marketing activities from the pharmaceutical industry was considered by all participating physicians to be very large. It was striking that the focus group participants mentioned that although its impact is undoubtably significant, physicians often deny this impact. The influence of everything related to pharmaceutical marketing was rated as especially high when it comes to prescribing an originator biological or its biosimilar(s). It was postulated that this is because physicians usually know that the originator biological and its biosimilar(s) are clinically equivalent products. Therefore, physicians acknowledged that marketing and promotion become more important determinants in this context, compared to when choosing between different molecules or MOAs where clinical differences might come into play.

Based on the suggestions provided during the focus group discussions, this category was divided into three subcategories: (a) value-added services, (b) visits by pharmaceutical companies, and (c) sponsorship or grants.

Value-added services

When choosing between an original biological or a biosimilar, the services that a company offers to physicians or hospitals were considered the most important determinant within the category of marketing and promotion. Examples cited by participating physicians included patient support programs, therapeutic drug monitoring (TDM), and nursing support. Companies offering such services are preferred when choosing between an original biological and its biosimilar(s). Usually, companies that market the originator biological offer these services already before biosimilars become available. Physicians, therefore, questioned why they would transition to a biosimilar if prescribers and patients would lose this important support. However, it was also indicated that physicians generally do not find this a transparent and correct system, and therefore, government incentives to support biosimilar prescribing remain important. As elaborated earlier, it became clear during the group discussions that the impact of these services also depends in part on the support already in place in the hospital where the prescriber works.

Visits by pharmaceutical companies

Physicians agreed that one should not underestimate the impact of representatives from the pharmaceutical industry. Consciously or unconsciously, prescribers will be influenced by this when choosing an off-patent biological. A good personal contact with the prescriber would certainly have an impact. Physicians pointed out that this was a reason why prescribers do not transition to a biosimilar, but also why they do transition more quickly to another MOA. After all, the alternative MOA products are often marketed by the same company as the originator biological, and thus, by the same pharmaceutical representative. The information provided by representatives during visits was also considered to have a great effect. The physicians indicated that they usually have little time to inform themselves about the latest products, and as a result, they are sometimes limited to the information provided to them by industry representatives.

Sponsorships or grants

Many pharmaceutical companies provide additional sponsorships to prescribers to conduct research with their pharmaceutical product. This was also mentioned as a common practice for biological medicines, both with innovator and off-patent biologicals. Physicians indicated that such sponsorships certainly increase the likelihood of prescribing these products. This may occur because the prescriber would like to give something back to the company. Also, the fact that the physician has already some experience with the product increases the likelihood of future prescriptions.

Reputation of the pharmaceutical company or brand

Participating physicians mentioned that the reputation and trust in the pharmaceutical company is an element that matters when choosing a medicine, but is certainly of less importance than promotional activities. When deciding between an original biological and a biosimilar, certain companies have a less favorable reputation among Belgian physicians than others. Participating physicians appear to prefer companies that also invest in drug research and development, rather than companies that purely produce or market biosimilars. Participants also indicated that prescribers are more likely to prefer biologicals produced by companies that have experience with producing biological products. Both elements were viewed by participants as reasons why biosimilars are less often considered in prescribing decisions. In general, it was assumed that reputation has an impact on prescribing behavior especially when choosing between products with the same MOA, such as between an originator biological and it biosimilar(s).

Key study findings

This study identified five main categories of elements that may determine prescribing choices for off-patent biologicals in Belgium. These five categories were the result of a scoping literature review that looked for determinants of prescribing choices in general: (1) product-related, (2) physicians’ personal, (3) healthcare system-related, (4) patient-related, and (5) determinants related to the pharmaceutical company or brand. Each of these was subdivided into several subcategories, leading to a total of seventeen determinants. In the second phase of this study, focus group discussions using the NGT with Belgian physicians were conducted to validate these determinants for prescribing off-patent biologicals in Belgium. From this, seven elements emerged as predominant in this setting: clinical data, region, working environment, marketing and promotion, patient profile, clinical guidelines, and preference of KOLs.

One of the most discussed topics was the influence of pharmaceutical promotion. Physicians generally agreed during the group discussions that the influence of pharmaceutical promotion is substantial. Several reviews on the influence of pharmaceutical promotion have concluded as well that its impact on prescribing decisions is considerable [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. This study confirms these findings also for off-patent biological medicines.

The other much debated element was the impact of the medication cost. Although not strongly reflected in the ranking scores, participating physicians appeared to agree that too little attention is paid to medication cost among Belgian prescribers. This was also demonstrated in a previous study of Belgian prescribing practices where shifts towards more expensive molecules rather than off-patent biologicals were observed [ 13 ].

It is clear that prescription choices are complex and determined by a wide range of elements [ 36 ]. This was illustrated by the considerable number of determinants that were identified from the literature, and the fact that almost all were considered important to some degree by the Belgian participants in the context of off-patent biological prescribing.

Avenues for further research

This study, in addition to the existing knowledge [ 12 , 13 , 14 ], made an important step towards informing Belgian policymakers to create tailored measures for a more sustainable market for off-patent biologicals and biosimilars in Belgium. Nonetheless, in the future, a more thorough and quantitative examination of the determinants of prescribing behavior would be interesting. A quantitative approach with a behavioral model is therefore advisable. This qualitative study could serve as a base for creating such a behavioral model and for thoroughly investigating prescribing behavior in the future.

Opportunities for policymakers

Investments should be made to continuously increase the awareness of physicians about the importance of cost-effective prescribing. In this regard, several opportunities for policymakers were listed in Table  4 based on the identified determinants of prescribing decisions for off-patent biologicals in Belgium.

Benefit-sharing incentives appear to have an influence on prescribing choices, although they will need to be introduced in the form of healthcare support within hospital departments and not as individual financial incentives at the level of the prescriber [ 37 ]. This study made clear that these needs differ between types of hospitals, regions, and therapeutic areas. Therefore, a certain amount of freedom on how hospital departments choose to deploy these incentives within their working environment is appropriate. More restrictive measures such as prescription targets (on biosimilars or on best-value biologicals) are helpful but should not be used as a standalone measure [ 27 , 38 , 39 ]. Invariably, prescribing targets should be accompanied by information, benefit-sharing initiatives, and other measures to empower physicians in their prescribing choices [ 40 ].

In an ideal world, resources are infinite and governments can provide all patients with access to the medicine with the best clinical outcomes or therapeutic value. However, in reality, budgets are limited and therefore the use of cost-effective therapies is essential [ 41 ]. In this way, clinical outcomes are maximized and as many patients as possible can be treated with the limited financial resources available [ 42 , 43 ]. For this reason, clinical guidelines increasingly focus on the importance of cost-effectiveness in medicine selection [ 44 , 45 , 46 , 47 ]. The Belgian reimbursement committee usually adopts these clinical guidelines in their reimbursement modalities. However, in the specific case of JAK inhibitors versus TNF-alpha inhibitors in rheumatology, these have not yet been included in the reimbursement modalities. As a result, physicians are free to choose the various second-line products that are in competition with off-patent biologicals, regardless of the significant differences in treatment costs that have emerged after biosimilar market entry. The Belgian reimbursement committee should, therefore, periodically revise reimbursement modalities for off-patent biologicals as soon as they lose their market exclusivity or when biosimilars enter the market [ 10 , 13 ]. This may result in bringing more cost-effective products into the treatment line sooner or at an earlier disease stage [ 48 ].

As mentioned above, pharmaceutical promotion may be an important determinant of prescribing decisions. Despite the existing regulations (i.e., Article 10 of the Belgian Law on Pharmaceutical products of March 1964 and Directive 2001/83/EC on Medicines for human use) and code of ethics (i.e., Mdeon) at the Belgian and European level [ 49 , 50 , 51 , 52 ], more guidelines on transparency and authorized promotion are desirable. Belgian physicians indicated that there is a need for more detailed transparency regarding what support physicians receive from pharmaceutical companies. This was also previously proposed by Medaxes, the umbrella association for the Belgian generic and biosimilar industry [ 53 ]. Moreover, in particular for value-added services and patient support programs, guidelines are advised on which services are allowed (and which are prohibited).

Given the rapidly evolving off-patent biologics landscape with new biological medicines losing their market exclusivities, new second-generation products, and new therapeutic classes coming to the market, it is important that policymakers act proactively. Policy measures should therefore be tailored to the product-specific context and implemented prior to the changing market environment when biosimilars enter the market.

Study strengths and limitations

There have been no peer-reviewed research articles published that have examined prescribing choices for off-patent biologicals to date. Therefore, as far as the authors know, this study is the first to do so in an academic setting. By starting from elements found in the existing scientific literature and evaluating these further in the context of biological medicines with various Belgian physicians during focus group discussions, a comprehensive picture was obtained. The NGT was appropriate for this purpose as qualitative insights from the group discussions could be combined with a quantitative aspect to estimate the relative impact of each determinant in prescribing decisions.

This study sought to identify which aspects influence prescribing choices through a combination of a literature review and focus group discussions. The scoping literature review aimed to identify general determinants of prescribing choices from the scientific literature. Because of the broad search strategy and the fact that only one independent investigator performed the screening, relevant articles may have been missed (i.e., selection bias). However, the purpose of this scoping review was not to provide a complete overview of all articles describing determinants of prescribing behavior. Instead, the researchers aimed to give an overall picture of the existing literature on this topic, in order to allow for further exploration in a second step during focus group discussions.

A significant part of human decisions happens unconsciously, and people do not consciously make specific trade-offs all the time. This aspect is challenging to map through focus group discussions. In addition, we should also consider possible bias in the results because physicians may be more likely to name elements that should drive prescribing choices rather than those that actually drive their choices. However, this was avoided as much as possible by clearly informing the participating physicians about the research aims.

A disadvantage of the chosen qualitative method is that it is more difficult to draw conclusions about the entire population due to the relatively small sample. This selection bias is inherent to the purposeful sampling method [ 54 ]. Also, the majority of participants were active in academic hospitals. Considering the differences between academic hospitals and private practices or general hospitals, this may also have led to a certain bias in the results. Lastly, a generalization of the obtained conclusions to a wider geographical scope other than Belgium would not be appropriate.

As is inherent in qualitative research, personal biases and opinions may influence the interpretation of the research findings [ 55 ]. However, through close consultation with the researchers involved and a standardized protocol for each step of this study, the probabilities of this were kept to a minimum. In this way, reflexivity was embedded in the research process.

Prescribing is inextricably linked to human choices and behavior, and thus should be understood in this context. Product-, patient-, healthcare system-, personal-, and pharmaceutical marketing-related elements play a role in prescribing decisions, underlining the complexity of prescribing choices. To increase the prescribing of best-value biologicals in the future, policy measures should be tailored to the product-specific context and implemented prior to the changing market environment when biosimilars enter the market.

Availability of data and materials

The data generated or analyzed related to the literature review of this study are included in this published article and its supplementary information files. The datasets generated and/or analyzed during the focus group discussions are not publicly available due to privacy constraints but are available from the corresponding author on reasonable request.

Abbreviations

Nominal Group Technique

Key Opinion Leader

National Institute for Health and Disability Insurance

Interleukin

Janus Kinase

Tumor Necrosis Factor

Mechanism of Action

Subcutaneous

Therapeutic Drug Monitoring

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Acknowledgements

The authors would like to express their appreciation to the Pharmaceutical Policy Department of NIHDI for their financial support in this research project. In addition, the authors would like to thank all participating physicians who shared their expertise during the focus group discussions.

This manuscript is supported and funded by KU Leuven and the Belgian National Institute for Health and Disability Insurance (NIHDI).

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Yannick Vandenplas, Steven Simoens, Arnold G. Vulto & Isabelle Huys

Ecole de Santé Publique, Université Libre de Bruxelles (ULB), Brussels, Belgium, Germany

Philippe Van Wilder

Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, the Netherlands

Arnold G. Vulto

Unversity of Paderborn, Paderborn, Germany

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Contributions

IH, FT, AGV, SS, and YV developed the idea for the study and were involved in its design. YV conducted the data collection and drafted the initial version of the manuscript. IH, FT, AGV, SS, and PVW critically reviewed the manuscript. All authors have read and approved the final manuscript.

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YV works as a PhD researcher in the Department of Clinical Pharmacology and Pharmacotherapy at KU Leuven (Belgium) and is involved in a research project entitled ‘Policy for best-value biological medicines in Belgium’. This research project is supported by the Belgian national health insurer, RIZIV-INAMI.

SS is a professor in Health Economics in the Department of Clinical Pharmacology and Pharmacotherapy at KU Leuven (Belgium).

PVW is a professor in Health Economics at the Ecole de Santé Publique of ULB (Belgium).

AGV is a professor of Hospital Pharmacy & Practical Therapeutics at the department of Clinical Pharmacology and Pharmacotherapy at KU Leuven (Belgium) and Erasmus MC in Rotterdam (the Netherlands).

FT is a professor at the University of Paderborn (Germany), with profound expertise in behavioral sciences and biosimilar policymaking.

IH is a professor in Regulatory Sciences in the Department of Clinical Pharmacology and Pharmacotherapy at KU Leuven (Belgium).

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The authors confirm that all experiments were performed in accordance with relevant guidelines and regulations (including the Declaration of Helsinki). This study was approved by the Ethics Committee Research of UZ/KU Leuven (S65328). Written informed consent was obtained from all participants prior to the study.

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This research project is funded by the Belgian National Institute for Health and Disability Insurance (NIHDI). NIHDI was not involved in the design of the study and collection, analysis, interpretation of data, nor in writing the manuscript.

SS, IH and AGV founded the KU Leuven Fund for Market Analysis of Biologics and Biosimilars following Loss of Exclusivity (MABEL). SS was involved in a stakeholder roundtable on biologics and biosimilars sponsored by Amgen, Pfizer, and MSD; he has participated in advisory board meetings for Pfizer, Sandoz, and Amgen; he has contributed to studies on biologics and biosimilars for Hospira (together with AGV and IH), Celltrion, Mundipharma, and Pfizer; and he has had speaking engagements for Amgen, Celltrion, and Sandoz. AGV is involved in consulting, advisory work, and speaking engagements for several companies, including AbbVie, Accord, Amgen, Biogen, EGA, Effik Benelux, Pfizer/Hospira, Mundipharma, Roche, and Sandoz. PVW acted as a healthcare consultant to public and private organizations, including pharmaceutical companies and their professional associations. FT acts as an advisor to, and is a consultant for, several pharmaceutical organizations and has represented pharmaceutical organizations in professional associations.

All other authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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Vandenplas, Y., Simoens, S., Van Wilder, P. et al. Determinants of prescribing decisions for off-patent biological medicines in Belgium: a qualitative study. BMC Health Serv Res 22 , 1211 (2022). https://doi.org/10.1186/s12913-022-08591-1

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Gender and Media Representations: A Review of the Literature on Gender Stereotypes, Objectification and Sexualization

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  • 1 Department of Psychology, University of Turin, Via Verdi 10, 10124 Turin, Italy.
  • PMID: 37239498
  • PMCID: PMC10218532
  • DOI: 10.3390/ijerph20105770

Media representations play an important role in producing sociocultural pressures. Despite social and legal progress in civil rights, restrictive gender-based representations appear to be still very pervasive in some contexts. The article explores scientific research on the relationship between media representations and gender stereotypes, objectification and sexualization, focusing on their presence in the cultural context. Results show how stereotyping, objectifying and sexualizing representations appear to be still very common across a number of contexts. Exposure to stereotyping representations appears to strengthen beliefs in gender stereotypes and endorsement of gender role norms, as well as fostering sexism, harassment and violence in men and stifling career-related ambitions in women. Exposure to objectifying and sexualizing representations appears to be associated with the internalization of cultural ideals of appearance, endorsement of sexist attitudes and tolerance of abuse and body shame. In turn, factors associated with exposure to these representations have been linked to detrimental effects on physical and psychological well-being, such as eating disorder symptomatology, increased body surveillance and poorer body image quality of life. However, specificities in the pathways from exposure to detrimental effects on well-being are involved for certain populations that warrant further research.

Keywords: gender; media; objectification; representation; sexualization; stereotypes.

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The four building blocks of change

Large-scale organizational change has always been difficult, and there’s no shortage of research showing that a majority of transformations continue to fail. Today’s dynamic environment adds an extra level of urgency and complexity. Companies must increasingly react to sudden shifts in the marketplace, to other external shocks, and to the imperatives of new business models. The stakes are higher than ever.

So what’s to be done? In both research and practice, we find that transformations stand the best chance of success when they focus on four key actions to change mind-sets and behavior: fostering understanding and conviction, reinforcing changes through formal mechanisms, developing talent and skills, and role modeling. Collectively labeled the “influence model,” these ideas were introduced more than a dozen years ago in a McKinsey Quarterly article, “ The psychology of change management .” They were based on academic research and practical experience—what we saw worked and what didn’t.

Digital technologies and the changing nature of the workforce have created new opportunities and challenges for the influence model (for more on the relationship between those trends and the model, see this article’s companion, “ Winning hearts and minds in the 21st century ”). But it still works overall, a decade and a half later (exhibit). In a recent McKinsey Global Survey, we examined successful transformations and found that they were nearly eight times more likely to use all four actions as opposed to just one. 1 1. See “ The science of organizational transformations ,” September 2015. Building both on classic and new academic research, the present article supplies a primer on the model and its four building blocks: what they are, how they work, and why they matter.

Fostering understanding and conviction

We know from research that human beings strive for congruence between their beliefs and their actions and experience dissonance when these are misaligned. Believing in the “why” behind a change can therefore inspire people to change their behavior. In practice, however, we find that many transformation leaders falsely assume that the “why” is clear to the broader organization and consequently fail to spend enough time communicating the rationale behind change efforts.

This common pitfall is predictable. Research shows that people frequently overestimate the extent to which others share their own attitudes, beliefs, and opinions—a tendency known as the false-consensus effect. Studies also highlight another contributing phenomenon, the “curse of knowledge”: people find it difficult to imagine that others don’t know something that they themselves do know. To illustrate this tendency, a Stanford study asked participants to tap out the rhythms of well-known songs and predict the likelihood that others would guess what they were. The tappers predicted that the listeners would identify half of the songs correctly; in reality, they did so less than 5 percent of the time. 2 2. Chip Heath and Dan Heath, “The curse of knowledge,” Harvard Business Review , December 2006, Volume 8, Number 6, hbr.org.

Therefore, in times of transformation, we recommend that leaders develop a change story that helps all stakeholders understand where the company is headed, why it is changing, and why this change is important. Building in a feedback loop to sense how the story is being received is also useful. These change stories not only help get out the message but also, recent research finds, serve as an effective influencing tool. Stories are particularly effective in selling brands. 3 3. Harrison Monarth, “The irresistible power of storytelling as a strategic business tool,” Harvard Business Review , March 11, 2014, hbr.org.

Even 15 years ago, at the time of the original article, digital advances were starting to make employees feel involved in transformations, allowing them to participate in shaping the direction of their companies. In 2006, for example, IBM used its intranet to conduct two 72-hour “jam sessions” to engage employees, clients, and other stakeholders in an online debate about business opportunities. No fewer than 150,000 visitors attended from 104 countries and 67 different companies, and there were 46,000 posts. 4 4. Icons of Progress , “A global innovation jam,” ibm.com. As we explain in “Winning hearts and minds in the 21st century,” social and mobile technologies have since created a wide range of new opportunities to build the commitment of employees to change.

Reinforcing with formal mechanisms

Psychologists have long known that behavior often stems from direct association and reinforcement. Back in the 1920s, Ivan Pavlov’s classical conditioning research showed how the repeated association between two stimuli—the sound of a bell and the delivery of food—eventually led dogs to salivate upon hearing the bell alone. Researchers later extended this work on conditioning to humans, demonstrating how children could learn to fear a rat when it was associated with a loud noise. 5 5. John B. Watson and Rosalie Rayner, “Conditioned emotional reactions,” Journal of Experimental Psychology , 1920, Volume 3, Number 1, pp. 1–14. Of course, this conditioning isn’t limited to negative associations or to animals. The perfume industry recognizes how the mere scent of someone you love can induce feelings of love and longing.

Reinforcement can also be conscious, shaped by the expected rewards and punishments associated with specific forms of behavior. B. F. Skinner’s work on operant conditioning showed how pairing positive reinforcements such as food with desired behavior could be used, for example, to teach pigeons to play Ping-Pong. This concept, which isn’t hard to grasp, is deeply embedded in organizations. Many people who have had commissions-based sales jobs will understand the point—being paid more for working harder can sometimes be a strong incentive.

Despite the importance of reinforcement, organizations often fail to use it correctly. In a seminal paper “On the folly of rewarding A, while hoping for B,” management scholar Steven Kerr described numerous examples of organizational-reward systems that are misaligned with the desired behavior, which is therefore neglected. 6 6. Steven Kerr, “On the folly of rewarding A, while hoping for B,” Academy of Management Journal , 1975, Volume 18, Number 4, pp. 769–83. Some of the paper’s examples—such as the way university professors are rewarded for their research publications, while society expects them to be good teachers—are still relevant today. We ourselves have witnessed this phenomenon in a global refining organization facing market pressure. By squeezing maintenance expenditures and rewarding employees who cut them, the company in effect treated that part of the budget as a “super KPI.” Yet at the same time, its stated objective was reliable maintenance.

Even when organizations use money as a reinforcement correctly, they often delude themselves into thinking that it alone will suffice. Research examining the relationship between money and experienced happiness—moods and general well-being—suggests a law of diminishing returns. The relationship may disappear altogether after around $75,000, a much lower ceiling than most executives assume. 7 7. Belinda Luscombe, “Do we need $75,000 a year to be happy?” Time , September 6, 2010, time.com.

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Money isn’t the only motivator, of course. Victor Vroom’s classic research on expectancy theory explained how the tendency to behave in certain ways depends on the expectation that the effort will result in the desired kind of performance, that this performance will be rewarded, and that the reward will be desirable. 8 8. Victor Vroom, Work and motivation , New York: John Wiley, 1964. When a Middle Eastern telecommunications company recently examined performance drivers, it found that collaboration and purpose were more important than compensation (see “Ahead of the curve: The future of performance management,” forthcoming on McKinsey.com). The company therefore moved from awarding minor individual bonuses for performance to celebrating how specific teams made a real difference in the lives of their customers. This move increased motivation while also saving the organization millions.

How these reinforcements are delivered also matters. It has long been clear that predictability makes them less effective; intermittent reinforcement provides a more powerful hook, as slot-machine operators have learned to their advantage. Further, people react negatively if they feel that reinforcements aren’t distributed fairly. Research on equity theory describes how employees compare their job inputs and outcomes with reference-comparison targets, such as coworkers who have been promoted ahead of them or their own experiences at past jobs. 9 9. J. S. Adams, “Inequity in social exchanges,” Advances in Experimental Social Psychology , 1965, Volume 2, pp. 267–300. We therefore recommend that organizations neutralize compensation as a source of anxiety and instead focus on what really drives performance—such as collaboration and purpose, in the case of the Middle Eastern telecom company previously mentioned.

Developing talent and skills

Thankfully, you can teach an old dog new tricks. Human brains are not fixed; neuroscience research shows that they remain plastic well into adulthood. Illustrating this concept, scientific investigation has found that the brains of London taxi drivers, who spend years memorizing thousands of streets and local attractions, showed unique gray-matter volume differences in the hippocampus compared with the brains of other people. Research linked these differences to the taxi drivers’ extraordinary special knowledge. 10 10. Eleanor Maguire, Katherine Woollett, and Hugo Spires, “London taxi drivers and bus drivers: A structural MRI and neuropsychological analysis,” Hippocampus , 2006, Volume 16, pp. 1091–1101.

Despite an amazing ability to learn new things, human beings all too often lack insight into what they need to know but don’t. Biases, for example, can lead people to overlook their limitations and be overconfident of their abilities. Highlighting this point, studies have found that over 90 percent of US drivers rate themselves above average, nearly 70 percent of professors consider themselves in the top 25 percent for teaching ability, and 84 percent of Frenchmen believe they are above-average lovers. 11 11. The art of thinking clearly, “The overconfidence effect: Why you systematically overestimate your knowledge and abilities,” blog entry by Rolf Dobelli, June 11, 2013, psychologytoday.com. This self-serving bias can lead to blind spots, making people too confident about some of their abilities and unaware of what they need to learn. In the workplace, the “mum effect”—a proclivity to keep quiet about unpleasant, unfavorable messages—often compounds these self-serving tendencies. 12 12. Eliezer Yariv, “‘Mum effect’: Principals’ reluctance to submit negative feedback,” Journal of Managerial Psychology , 2006, Volume 21, Number 6, pp. 533–46.

Even when people overcome such biases and actually want to improve, they can handicap themselves by doubting their ability to change. Classic psychological research by Martin Seligman and his colleagues explained how animals and people can fall into a state of learned helplessness—passive acceptance and resignation that develops as a result of repeated exposure to negative events perceived as unavoidable. The researchers found that dogs exposed to unavoidable shocks gave up trying to escape and, when later given an opportunity to do so, stayed put and accepted the shocks as inevitable. 13 13. Martin Seligman and Steven Maier, “Failure to escape traumatic shock,” Journal of Experimental Psychology , 1967, Volume 74, Number 1, pp. 1–9. Like animals, people who believe that developing new skills won’t change a situation are more likely to be passive. You see this all around the economy—from employees who stop offering new ideas after earlier ones have been challenged to unemployed job seekers who give up looking for work after multiple rejections.

Instilling a sense of control and competence can promote an active effort to improve. As expectancy theory holds, people are more motivated to achieve their goals when they believe that greater individual effort will increase performance. 14 14. Victor Vroom, Work and motivation , New York: John Wiley, 1964. Fortunately, new technologies now give organizations more creative opportunities than ever to showcase examples of how that can actually happen.

Role modeling

Research tells us that role modeling occurs both unconsciously and consciously. Unconsciously, people often find themselves mimicking the emotions, behavior, speech patterns, expressions, and moods of others without even realizing that they are doing so. They also consciously align their own thinking and behavior with those of other people—to learn, to determine what’s right, and sometimes just to fit in.

While role modeling is commonly associated with high-power leaders such as Abraham Lincoln and Bill Gates, it isn’t limited to people in formal positions of authority. Smart organizations seeking to win their employees’ support for major transformation efforts recognize that key opinion leaders may exert more influence than CEOs. Nor is role modeling limited to individuals. Everyone has the power to model roles, and groups of people may exert the most powerful influence of all. Robert Cialdini, a well-respected professor of psychology and marketing, examined the power of “social proof”—a mental shortcut people use to judge what is correct by determining what others think is correct. No wonder TV shows have been using canned laughter for decades; believing that other people find a show funny makes us more likely to find it funny too.

Today’s increasingly connected digital world provides more opportunities than ever to share information about how others think and behave. Ever found yourself swayed by the number of positive reviews on Yelp? Or perceiving a Twitter user with a million followers as more reputable than one with only a dozen? You’re not imagining this. Users can now “buy followers” to help those users or their brands seem popular or even start trending.

The endurance of the influence model shouldn’t be surprising: powerful forces of human nature underlie it. More surprising, perhaps, is how often leaders still embark on large-scale change efforts without seriously focusing on building conviction or reinforcing it through formal mechanisms, the development of skills, and role modeling. While these priorities sound like common sense, it’s easy to miss one or more of them amid the maelstrom of activity that often accompanies significant changes in organizational direction. Leaders should address these building blocks systematically because, as research and experience demonstrate, all four together make a bigger impact.

Tessa Basford is a consultant in McKinsey’s Washington, DC, office; Bill Schaninger is a director in the Philadelphia office.

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  1. Literature review as a research methodology: An overview and guidelines

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    A literature review is a critical summary and evaluation of the existing research (e.g., academic journal articles and books) on a specific topic. It is typically included as a separate section or chapter of a research paper or dissertation, serving as a contextual framework for a study.

  7. Importance of a Good Literature Review

    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.

  8. Conducting a Literature Review: Why Do A Literature Review?

    Besides the obvious reason for students -- because it is assigned! -- a literature review helps you explore the research that has come before you, to see how your research question has (or has not) already been addressed. You identify: core research in the field. experts in the subject area. methodology you may want to use (or avoid)

  9. Reviewing literature for research: Doing it the right way

    Review of research literature can be summarized into a seven step process: (i) Selecting research questions/purpose of the literature review (ii) ... An important tool that must be used while searching for research work is screening. Screening helps to improve the accuracy of search results. It is of two types: (1) Practical: To identify a ...

  10. Research Guides: Literature Reviews: What is a Literature Review?

    A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the ...

  11. Why is it important to do a literature review in research?

    "A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research". Boote and Baile 2005 . Authors of manuscripts treat writing a literature review as a routine work or a mere formality. But a seasoned one knows the purpose and importance of a well-written literature review.

  12. Literature Reviews

    A literature review is a critical component of a scientific study and holds significant importance, as literature reviews serve several important functions within the research process: ... Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333-339. Article Google Scholar

  13. Literature Review: The What, Why and How-to Guide

    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 ...

  14. What is a literature review?

    A literature or narrative review is a comprehensive review and analysis of the published literature on a specific topic or research question. The literature that is reviewed contains: books, articles, academic articles, conference proceedings, association papers, and dissertations. It contains the most pertinent studies and points to important ...

  15. How to Undertake an Impactful Literature Review: Understanding Review

    The systematic literature review (SLR) is one of the important review methodologies which is increasingly becoming popular to synthesize literature in any discipline in general and management in particular. ... Snyder H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333-339 ...

  16. Steps in Conducting a Literature Review

    A literature review is important because it: Explains the background of research on a topic. ... Your literature review should be guided by your central research question. The literature represents background and research developments related to a specific research question, interpreted and analyzed by you in a synthesized way. ...

  17. 5. The 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 ...

  18. Literature Review Research

    The objective of a Literature Review is to find previous published scholarly works relevant to an specific topic. A literature review is important because it: Explains the background of research on a topic. Demonstrates why a topic is significant to a subject area. Discovers relationships between research studies/ideas.

  19. Conducting a Literature Review

    Upon completion of the literature review, a researcher should have a solid foundation of knowledge in the area and a good feel for the direction any new research should take. Should any additional questions arise during the course of the research, the researcher will know which experts to consult in order to quickly clear up those questions.

  20. What is the purpose of a literature review?

    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.

  21. Writing an effective literature review

    Mapping the gap. The purpose of the literature review section of a manuscript is not to report what is known about your topic. The purpose is to identify what remains unknown—what academic writing scholar Janet Giltrow has called the 'knowledge deficit'—thus establishing the need for your research study [].In an earlier Writer's Craft instalment, the Problem-Gap-Hook heuristic was ...

  22. The Importance of Literature Review in Research Writing

    7 Reasons Why Research Is Important Learn the true importance of research in daily life. Research is an invaluable skill that's necessary to master if you want to fully experience life. Concept Mapping to Write a Literature Review This article will explain how to use concept mapping to write an in-depth, thought-provoking literature review or ...

  23. Chapter 1: Introduction

    An advanced-level literature review shows how prior research is linked to a new project, summarizing and synthesizing what is known while identifying gaps in the knowledge base, facilitating theory development, closing areas where enough research already exists, and uncovering areas where more research is needed. (Webster & Watson, 2002, p. xiii)

  24. Importance and Issues of Literature Review in Research

    Abstract. The process of literature review in research is explained in detail with llustrations. Content may be subject to copyright. 1. A literature review may be an end in itself to. 2. It can ...

  25. Smartphone use and academic performance: A literature review

    A third shortcoming in the scientific literature so far is the lack of research investigating the empirical validity of the reviewed theoretical mechanisms for a potential impact of smartphone use on academic performance. However, uncovering the mechanisms at work is of great importance for policy making. ... so that a literature review ...

  26. Patient experiences: a qualitative systematic review of chemotherapy

    Studies included in this review were classified as primary research, published in English since 2006, some intervention implemented to improve adherence to treatment. This review excluded any studies that related to with cancer and mental health condition, animal studies and grey literature. Quality appraisal and data extraction

  27. Determinants of prescribing decisions for off-patent biological

    Scoping literature review. A scoping review of the literature in Embase and PubMed (MEDLINE) was conducted using a predefined search strategy. Scoping literature reviews aim to identify and map the existing evidence related to a certain topic of interest in a systematic way [20, 21].Full-text, peer-reviewed, English articles that were published between 2008 and 2021 were eligible for inclusion.

  28. Gender and Media Representations: A Review of the Literature ...

    Media representations play an important role in producing sociocultural pressures. Despite social and legal progress in civil rights, restrictive gender-based representations appear to be still very pervasive in some contexts. The article explores scientific research on the relationship between medi …

  29. Reference examples

    More than 100 reference examples and their corresponding in-text citations are presented in the seventh edition Publication Manual.Examples of the most common works that writers cite are provided on this page; additional examples are available in the Publication Manual.. To find the reference example you need, first select a category (e.g., periodicals) and then choose the appropriate type of ...

  30. A model for effective change management

    In both research and practice, we find that transformations stand the best chance of success when they focus on four key actions to change mind-sets and behavior: fostering understanding and conviction, reinforcing changes through formal mechanisms, developing talent and skills, and role modeling. Collectively labeled the "influence model ...