literature review of action research

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Action research: literature review .

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Exploring the literature review 

Literature review model: 6 steps.

Adapted from The Literature Review , Machi & McEvoy (2009, p. 13).

Your Literature Review

Step 2: search, boolean search strategies, search limiters, ★ ebsco & google drive.

1. Select a Topic

"All research begins with curiosity" (Machi & McEvoy, 2009, p. 14)

Selection of a topic, and fully defined research interest and question, is supervised (and approved) by your professor. Tips for crafting your topic include:

• Be specific. Take time to define your interest.
• Topic Focus. Fully describe and sufficiently narrow the focus for research.
• Academic Discipline. Learn more about your area of research & refine the scope.
• Avoid Bias. Be aware of bias that you (as a researcher) may have.
• Document your research. Use Google Docs to track your research process.
• Research apps. Consider using Evernote or Zotero to track your research.

Consider Purpose

What will your topic and research address?

In The Literature Review: A Step-by-Step Guide for Students , Ridley presents that literature reviews serve several purposes (2008, p. 16-17).  Included are the following points:

• Historical background for the research;
• Overview of current field provided by "contemporary debates, issues, and questions;"
• Theories and concepts related to your research;
• Introduce "relevant terminology" - or academic language - being used it the field;
• Connect to existing research - does your work "extend or challenge [this] or address a gap;" 
• Provide "supporting evidence for a practical problem or issue" that your research addresses.

★ Schedule a research appointment

At this point in your literature review, take time to meet with a librarian. Why? Understanding the subject terminology used in databases can be challenging. Archer Librarians can help you structure a search, preparing you for step two. How? Contact a librarian directly or use the online form to schedule an appointment. Details are provided in the adjacent Schedule an Appointment box.

2. Search the Literature

Collect & Select Data: Preview, select, and organize

AU Library is your go-to resource for this step in your literature review process. The literature search will include books and ebooks, scholarly and practitioner journals, theses and dissertations, and indexes. You may also choose to include web sites, blogs, open access resources, and newspapers. This library guide provides access to resources needed to complete a literature review.

Books & eBooks: Archer Library & OhioLINK

Databases: scholarly & practitioner journals.

Review the Library Databases tab on this library guide, it provides links to recommended databases for Education & Psychology, Business, and General & Social Sciences.

Expand your journal search; a complete listing of available AU Library and OhioLINK databases is available on the Databases  A to Z list . Search the database by subject, type, name, or do use the search box for a general title search. The A to Z list also includes open access resources and select internet sites.

Databases: Theses & Dissertations

Review the Library Databases tab on this guide, it includes Theses & Dissertation resources. AU library also has AU student authored theses and dissertations available in print, search the library catalog for these titles.

Did you know? If you are looking for particular chapters within a dissertation that is not fully available online, it is possible to submit an ILL article request . Do this instead of requesting the entire dissertation.

Newspapers:  Databases & Internet

Consider current literature in your academic field. AU Library's database collection includes The Chronicle of Higher Education and The Wall Street Journal .  The Internet Resources tab in this guide provides links to newspapers and online journals such as Inside Higher Ed , COABE Journal , and Education Week .

Search Strategies & Boolean Operators

There are three basic boolean operators:  AND, OR, and NOT.

Used with your search terms, boolean operators will either expand or limit results. What purpose do they serve? They help to define the relationship between your search terms. For example, using the operator AND will combine the terms expanding the search. When searching some databases, and Google, the operator AND may be implied.

Overview of boolean terms

About the example: Boolean searches were conducted on November 4, 2019; result numbers may vary at a later date. No additional database limiters were set to further narrow search returns.

Database Search Limiters

Database strategies for targeted search results.

Most databases include limiters, or additional parameters, you may use to strategically focus search results.  EBSCO databases, such as Education Research Complete & Academic Search Complete provide options to:

• Limit results to full text;
• Limit results to scholarly journals, and reference available;
• Select results source type to journals, magazines, conference papers, reviews, and newspapers
• Publication date

Keep in mind that these tools are defined as limiters for a reason; adding them to a search will limit the number of results returned.  This can be a double-edged sword.  How? 

• If limiting results to full-text only, you may miss an important piece of research that could change the direction of your research. Interlibrary loan is available to students, free of charge. Request articles that are not available in full-text; they will be sent to you via email.
• If narrowing publication date, you may eliminate significant historical - or recent - research conducted on your topic.
• Limiting resource type to a specific type of material may cause bias in the research results.

Use limiters with care. When starting a search, consider opting out of limiters until the initial literature screening is complete. The second or third time through your research may be the ideal time to focus on specific time periods or material (scholarly vs newspaper).

★ Truncating Search Terms

Expanding your search term at the root.

Truncating is often referred to as 'wildcard' searching. Databases may have their own specific wildcard elements however, the most commonly used are the asterisk (*) or question mark (?).  When used within your search. they will expand returned results.

Asterisk (*) Wildcard

Using the asterisk wildcard will return varied spellings of the truncated word. In the following example, the search term education was truncated after the letter "t."

Explore these database help pages for additional information on crafting search terms.

• EBSCO Connect: Searching with Wildcards and Truncation Symbols
• EBSCO Connect: Searching with Boolean Operators
• EBSCO Connect: EBSCOhost Search Tips
• EBSCO Connect: Basic Searching with EBSCO
• ProQuest Help: Search Tips
• ERIC: How does ERIC search work?

★ EBSCO Databases & Google Drive

Tips for saving research directly to Google drive.

Researching in an EBSCO database?

It is possible to save articles (PDF and HTML) and abstracts in EBSCOhost databases directly to Google drive. Select the Google Drive icon, authenticate using a Google account, and an EBSCO folder will be created in your account. This is a great option for managing your research. If documenting your research in a Google Doc, consider linking the information to actual articles saved in drive.

EBSCO Databases & Google Drive

EBSCOHost Databases & Google Drive: Managing your Research

This video features an overview of how to use Google Drive with EBSCO databases to help manage your research. It presents information for connecting an active Google account to EBSCO and steps needed to provide permission for EBSCO to manage a folder in Drive.

About the Video:  Closed captioning is available, select CC from the video menu.  If you need to review a specific area on the video, view on YouTube and expand the video description for access to topic time stamps.  A video transcript is provided below.

• EBSCOhost Databases & Google Scholar

Defining Literature Review

What is a literature review.

A definition from the Online Dictionary for Library and Information Sciences .

A 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" (Reitz, 2014). 

A systemic review is "a literature review focused on a specific research question, which uses explicit methods to minimize bias in the identification, appraisal, selection, and synthesis of all the high-quality evidence pertinent to the question" (Reitz, 2014).

Recommended Reading

About this page

EBSCO Connect [Discovery and Search]. (2022). Searching with boolean operators. Retrieved May, 3, 2022 from https://connect.ebsco.com/s/?language=en_US

EBSCO Connect [Discover and Search]. (2022). Searching with wildcards and truncation symbols. Retrieved May 3, 2022; https://connect.ebsco.com/s/?language=en_US

Machi, L.A. & McEvoy, B.T. (2009). The literature review . Thousand Oaks, CA: Corwin Press: 

Reitz, J.M. (2014). Online dictionary for library and information science. ABC-CLIO, Libraries Unlimited . Retrieved from https://www.abc-clio.com/ODLIS/odlis_A.aspx

Ridley, D. (2008). The literature review: A step-by-step guide for students . Thousand Oaks, CA: Sage Publications, Inc.

Archer Librarians

Schedule an appointment.

Contact a librarian directly (email), or submit a request form. If you have worked with someone before, you can request them on the form.

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Step 3b: Conducting a Literature Review

Module 2: Action Research Question & Literature Review

Tips for Conducting a Review of the Literature

Luke Duesbery and Todd Twyman (2020) offer some advice for doing an efficient literature review.

Reading a Research Article

• Keyword search
• Skim articles
• Read abstracts
• Read articles
• Check reference lists
• Obtain references (as needed)

After conducting a keyword search and finding literature,

• Start by skimming the articles to identify those most relevant to your research topic or question. Skimming involves quickly reading to assess the potential usefulness of each article.
• Pay special attention to the abstracts, as they summarize the study’s main questions and findings.
• If an abstract suggests the article is highly relevant to your research, read the article in detail to decide if it should be included in your research sources.
• Also, check the reference lists of these articles for additional relevant titles.
• If you find promising sources in these lists, obtain and read them to evaluate their relevance and usefulness for your research.

Structure of a Research Article

Most research articles have a similar structure. Being familiar with the structure of research articles will help you know where to look for what in the article.

• Abstract: Summary of the aims/method/results
• Introduction: General introduction into the topic
• Literature Review: Summary of previous relevant research and identification of research gaps
• Method: Description of how the research was conducted (participants/procedure/data analysis)
• Results: Summary of the significant findings (often includes tables/figures/statistics etc.)
• Discussion: Interpretation of main findings concerning data and the literature
• Conclusion: Summary of main findings/implications/limitations References: Research cited

For each study you review, encapsulate it into a brief summary that reflects any aspect of the study that has relevance to your topic.

This may include

• the variable studied,
• the methodology employed,
• the participants studied, and
• the conclusions obtained.

Note: Remember, however, to emphasize the research findings – that is what will influence your study most.

Identify Themes and Gaps in Literature The following video will help you as you review the literature relevant to your research topic.

Source: Scribbr . YouTube, 23 Apr 2020.

Evaluating the Literature

Once sources are chosen they must be further evaluated to determine how the reviewed information can be used to guide your action research project (Hendricks, 2013).

Questions to ask in evaluating the literature include the following:

Does the source provide information that can help inform my action research study?

Does the source seem credible? If the source is not a research study, are the claims and/or suggestions made by the author based on his or her extensive experience?

Is the information in the source based on the study of a setting that is similar to mine?

Synthesizing the Relevant Literature

Once sources have been chosen based on their relevance, credibility, and similarity to the action research study the next step is to synthesize information. Synthesizing involves connecting information into a coherent, integrated whole. This is done when all the relevant sources have been thoroughly read.

Reflective Activity

Using the documentation tool below, write both your proposed action research topic and the keywords in your action research question.

Proposed Action Research Question: “ How can online polling increase student engagement during lectures ? ” Keywords in Action Research Question: Online Polling , Engagement , Lectures

Action Research Handbook Copyright © by Dr. Zabedia Nazim and Dr. Sowmya Venkat-Kishore is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Best Practices and Lessons Learned for Action Research in eHealth Design and Implementation: Literature Review

Kira oberschmidt.

1 eHealth Cluster, Roessingh Research and Development, Enschede, Netherlands

2 Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands

Christiane Grünloh

Femke nijboer, lex van velsen, associated data.

Full overview of all categories and description of settings for each category.

Full list of categories per setting variable.

Action research (AR) is an established research framework to introduce change in a community following a cyclical approach and involving stakeholders as coresearchers in the process. In recent years, it has also been used for eHealth development. However, little is known about the best practices and lessons learned from using AR for eHealth development.

This literature review aims to provide more knowledge on the best practices and lessons learned from eHealth AR studies. Additionally, an overview of the context in which AR eHealth studies take place is given.

A semisystematic review of 44 papers reporting on 40 different AR projects was conducted to identify the best practices and lessons learned in the research studies while accounting for the particular contextual setting and used AR approach.

Recommendations include paying attention to the training of stakeholders’ academic skills, as well as the various roles and tasks of action researchers. The studies also highlight the need for constant reflection and accessible dissemination suiting the target group.

Conclusions

This literature review identified room for improvements regarding communicating and specifying the particular AR definition and applied approach.

Introduction

The way health care is organized and executed is of great societal concern, as it affects our quality of life. Hence, health care systems and eHealth technologies used to support health care should be designed in a way that meets the needs and expectations of their stakeholders. One way of doing this is through action research (AR). According to Bradbury and Lifvergren [ 1 ], AR in health care “seeks to (1) improve patient experiences and the health of populations, (2) reduce the per capita cost, (3) improve the work life of those who deliver care, and (4) bring health care providers into circumstances that allow for continuous learning together with patients.” AR has been used as a research framework in nursing and health care, for example, to improve the quality of patient care and investigate changes in action [ 2 ]. AR is a collaborative approach, where people affected by the change envisioned in AR become active members of the research team. AR is often used in the design of eHealth systems. However, existing literature reviews of AR in eHealth predominantly focus on the development of new frameworks [ 3 - 5 ] but not on how eHealth AR is currently carried out. Therefore, this literature review outlines the state of the art of AR in eHealth design.

eHealth projects cover a wide variety of topics and technologies and can therefore greatly benefit patients, professionals, and many other health care stakeholders. However, to gain the most from eHealth systems and technologies, it is crucial that they match with what is needed in practice [ 6 ]. To ensure such a match, Van Gemert-Pijnen and colleagues [ 6 ] suggest, among other things, working together with relevant stakeholders in all stages of the project, implementing the study results in practice, and continuously evaluating the process. Similarly, co-design has been mentioned as a useful technique for creating eHealth systems that suit the needs of the end users [ 3 ]. These ideas fit well with the principles of AR, which will be outlined below.

Definitions of AR have changed over the years. AR originated with Kurt Lewin [ 7 ], who described it as several consecutive circles of planning, action, and reflection. These cycles are shown in Figure 1 , developed by Williamson and colleagues [ 2 ]. In later definitions, the cyclical nature of AR remains one of its key features. Reason and Bradbury [ 8 ], who build on Lewin’s work, define AR as research that (1) involves stakeholders not only as participants but also as members of the research team, (2) consists of (at least) 1 cycle of planning, action, and reflection, (3) establishes direct changes, and (4) then evaluates those changes in and with the community. Their work [ 8 ] includes many interesting examples of AR from various fields. Furthermore, Bradbury and colleagues defined 7 “choice points for quality in action research” [ 9 ], criteria that can be used to plan, conduct, report, and assess AR projects .

Action research cycles (adapted from Kurt Lewin [ 7 ] by Williamson and colleagues [ 2 ]).

Within AR, different variations exist, such as action design research (ADR) or participatory action research (PAR). Usually, there is agreement on the main principles of AR explained earlier, but some authors or groups emphasize some aspects over others. For example, as the name suggests, ADR incorporates elements of design research into AR [ 10 ], whereas PAR highlights the involvement of the community [ 11 ]. For a more detailed overview of the similarities and differences between some of these approaches, see Williamson et al [ 2 ] or Coghlan and Brannick [ 11 ].

In general, AR and AR approaches such as ADR are similar to participatory design (PD) approaches that are used in human computer interaction (HCI) research. However, AR emphasizes reflection on and learning from the process that was carried out, whereas the main aim of PD is to create a solution [ 12 ]. AR, as opposed to PD, does not start with a clear goal of what needs to be developed but defines this throughout the process together with stakeholders. Additionally, AR is more immersive and calls for stakeholder involvement for a longer period of time due to its iterative cycles [ 13 ]. Nevertheless, in some cases, studies that are described as PD-related ones also meet Reason and Bradbury’s criteria [ 8 ] for AR [ 14 ]. Hayes [ 12 ] argues that AR and HCI research can supplement each other, as both often provide solutions on a local scale. As Hughes [ 15 ] describes, there is no standard way of implementing AR in health care due to the broadness of the field. Instead, there is a variety regarding the why, how, and with whom AR in health care is carried out [ 15 , 16 ]. For example, levels of stakeholder engagement and the context in which AR takes place can vary [ 16 ]. Other differences among AR studies include the topic, country, project duration, main target group, and methods used. Therefore, these aspects are considered in this review. The purpose of this review is to give an overview of the current literature on eHealth AR and summarize the best practices and points of improvement for future eHealth AR projects. Special attention is paid to the contextual variables of the research (eg, setting, duration, number of stakeholders), as this is expected to influence the outcomes, best practices, and points of improvement of a study. To provide an overview of AR in eHealth, this literature review addresses the following subquestions:

• What is the context of AR eHealth projects?
• How do eHealth AR studies define and operationalize AR?
• What are the best practices for conducting AR in concrete eHealth studies?
• What are the lessons learned from conducting AR in concrete eHealth studies?

Study Selection and Screening

The search was carried out in June 2020. PubMed, Scopus, and Google Scholar were searched using combinations of the search terms “action research” or “participatory design” and “eHealth,” “health technology,” “digital health,” or “telemedicine.” PubMed was chosen for its extensive medical database, and Scopus and Google Scholar were chosen as large scientific databases. Searching for “action research” turns up articles that include similar and related keywords like “participatory action research,” “action design research,” or “action-based research.” “Participatory design” was included as a search term because PD has significant overlap with AR, and both are sometimes used to supplement each other. The list of synonyms for “eHealth,” although not exhaustive, is expected to cover the various facets of the field. The initial search yielded 739 results. Articles were included if they (1) used and explicitly mentioned AR and (2) were about eHealth or health technology. Papers were excluded if they (1) were not written in English, (2) only included a study protocol but did not report results, or (3) only included a review of other articles. Full-text screening of the same 15 articles was performed by 2 authors (KO and CG); the authors discussed whether to include the studies until an agreement was reached. Next, the first author screened the full texts of the remaining articles, with some exceptions where a second opinion was necessary. These were again discussed between the first and second authors until an agreement was reached. Ultimately, 44 articles were included, reporting on 40 different projects. Figure 2 shows the flowchart of the inclusion process.

Inclusion flowchart of the literature search and screening process.

Data Extraction

For each study, the definition of AR that was provided by the authors, and the related AR approaches that they cited (if any) were extracted. Additionally, information about contextual variables of the study was derived. Specifically, we identified the topic, country, organizational context, project duration, types of stakeholders involved, the main target group of the research, and methods used. The types of involved stakeholders were grouped according to the framework described by Schiller et al [ 17 ], in which they define the main stakeholder categories as the public, policy makers, and governments, the research community, practitioners and professionals, health and social service providers, civil society organizations, and private businesses. Finally, the best practices and lessons learned were derived. The best practices and lessons learned were activities that could move forward and benefit the AR project, without necessarily being recognized as standard components of AR. The difference between what was seen as a best practice and as a lesson learned was based on the timing and reporting of these actions. An activity was labeled as a best practice if researchers already planned their project with this in mind (eg, mentioning it in the description of the methods). On the other hand, lessons learned were those points that researchers came to know during their project, which were reported mainly in the discussion section. From the first 5 articles, the best practices and lessons learned were extracted by 2 authors (KO and CG), and they compared their results. The remaining data were extracted by 1 author (KO) in consultation with the second author where a second opinion was necessary. Furthermore, 5 authors published not 1 but 2 papers about their project. For these papers, the same study context was described whereas the definition of and approach to AR and the best practices and lessons learned were reported separately, as these sometimes differed between the articles. A reflection on 2 projects was included in 1 article. In this case, each project context was reported separately whereas only 1 AR definition and approach as well as one set of best practices and lessons learned were outlined.

A general overview of all the included studies describing the AR approach, AR definition, and contextual variables was obtained. The contextual variables (topic, location, target group, stakeholders, duration, and methods used) were categorized. Furthermore, the studies were mapped in a matrix based on the study duration and the types and number of different stakeholders that participated in the study. The contextual data were coded and categorized inductively. To identify which AR approach was the most used, the citation frequency of each approach in the included studies was recorded. Furthermore, the cited AR approaches that were available were accessed and checked for cross-referencing. All cited AR definitions were mapped to show the relationship between them. The AR definitions used, best practices, and lessons learned were coded by 1 author (KO). The best practices and lessons learned were coded individually first and then combined for both categories.

The setting of the included studies was described based on 6 categories (topic, location, duration, involved stakeholders, target group, and methods). Multimedia Appendix 1 presents all the categories and the description of the setting for each study. The most common aspects of each category will be discussed below.

We identified 9 broader categories of the research topics in the 44 included studies (see Table 2.1 in Multimedia Appendix 2 for the full list). The most common were home care and telemonitoring, and health promotion and education (both n=8), followed by electronic medical records and health information systems (n=7), and mental health services (n=5).

The studies were set in 21 different countries, Australia being the most common (n=5) followed by the United States (n=4) and Canada, Sweden, and the United Kingdom (all n=3). Some studies from nonwestern countries, like Tanzania or Colombia were included, but no country was represented more than once or twice. Within the different countries, studies took place in various contexts, the most prevalent of which were rural areas (n=6) and hospitals (n=5). All contexts and countries can be found in Tables 2.2 and 2.3 of Multimedia Appendix 2 .

Target Groups

Among the 44 studies, 2 studies explicitly focused on 2 different target groups at the same time, whereas all other studies had 1 main target group. In most cases, the target groups were patients (n=11). Of these, the most common group was patients with cancer (n=3). There were 6 studies each focusing on clinicians as well as children and young adults, and 5 studies targeted older adults (see Table 2.4 in Multimedia Appendix 2 for the full list of target groups).

Stakeholders

In many cases, several stakeholders were included in the study, up to 6 different types of stakeholders included in some cases. In summary, 20 different types of stakeholders were involved (see Table 2.5 in Multimedia Appendix 2 for the full list). Health care workers (n=18) and patients and their representatives (n=12) were involved the most, followed by governmental bodies (n=9) and general nonmedical staff members (n=8). When clustering these stakeholder types according to the framework defined by Schiller and colleagues [ 17 ], the largest group consisted of practitioners and professionals (n=48), followed by members of the public (n=38). Policy makers and government bodies (n=13), the research community (n=10), private businesses (n=6), and civil society organizations (n=3) were represented less often. The only group that was not represented at all included health and social service providers.

Not all of the 44 studies reported the duration of the project (n=7). Studies that did report the duration (n=33) lasted from a few months (n=5) to more than 10 years (n=2). The majority (n=13) of these studies reported a project duration between 2 and 3 years, and the average project duration was 2.7 years. Figure 3 shows the distribution of the 10 most frequently involved types of stakeholders for the different project durations in the 33 projects that reported the project duration. Stakeholder types are shown in the order of how many times they were involved in total; however, because some studies did not report project durations, the numbers in this graph differ from those described above. The 2 biggest stakeholder groups, health care workers and patients, were rarely, or in the case of patients even not at all, involved in long-term studies.

Heat map showing the most commonly involved types of stakeholders against the project duration.

In Figure 4 , the study duration is mapped against the number of different stakeholders that were involved in each of the 33 projects that reported a project duration. Studies that did not report the overall project duration are not included in the figure. Most of the included studies lasted for up to 2 years, including 2 or 3 stakeholder groups. There are some longer studies including more stakeholder groups.

Heat map showing the number of stakeholders involved against the project duration.

Research Methods Used

As mentioned earlier, AR is a framework that does not advise the use of a single methodology, and studies can therefore include a variety of different research methods. Most of the 44 included studies indeed used several methods, with some studies employing up to 6 different methods . Interviews were used most frequently (n=24), followed by focus groups (n=22), workshops (n=14), and surveys (n=13). On average, studies used nearly 3 different methods (average 2.8). All methods can be found in Table 2.6 of Multimedia Appendix 2 .

AR Definitions

The articles contained 44 definitions of AR. They could be grouped according to 4 different aspects that they emphasized. First, 21 studies emphasized that in AR projects, practitioners and other stakeholders become (co)researchers (n=21). Second, AR is a cyclical process that includes different stages (n=19). Third, 14 studies described how AR focuses on solving a practical issue and aims to extend research knowledge. The fourth aspect was that AR takes place in a community setting (n=10). Further, 2 studies included 3 of these aspects in their definitions, and only 2 other studies mentioned all 4 aspects. Most studies included either 1 (n=16) or 2 (n=17) of the aspects, whereas 7 studies included none of these points in their definition or did not at define AR in detail. Table 1 provides an overview of the number of mentions per aspect and the studies mentioning these aspects.

Number of mentions and studies mentioning the aspects of the AR definition.

AR Approaches

Table 2 gives an overview of the AR approaches that were cited at least twice in the included articles. The AR approach was not cited in 4 studies. In some cases, different papers from the same authors were cited; however, as these eventually described the same approach, the citation count was added up. The most commonly cited approach was that proposed by Reason and Bradbury [ 8 ]. As described earlier, the key elements of this approach are that AR (1) involves stakeholders as coresearchers, (2) consists of plan, act, and reflect cycles, (3) makes a change in practice, and (4) evaluates the said changes in and with the community. Overall, most definitions share these main aspects but differ in terms of the aspects that are particularly emphasized. For example, Baskerville and colleagues [ 55 ] highlight the duality of practical work and scientific knowledge, whereas Baum and colleagues [ 56 ] underline the need for reflective practice that includes all stakeholders. Figures 5 and ​ and6 6 depict the cited approaches in more detail. There are 3 independent researchers or groups that are mentioned as being the origin of AR, namely Lewin [ 7 ], Trist and colleagues [ 57 ], and Freire [ 58 ]. Wherever the origin of AR was mentioned, some cases have named 2 of these, as observed in Figure 5 . The cited AR approaches also frequently refer to each other and sometimes authors collaborate with each other, for example on books about AR (see Figure 6 ). There are no very distinct groups conducting their own AR, but the different AR groups are often connected and build upon each other’s work.

Overview of the most cited action research approaches in the included articles per author or research group, including the number of citations.

Overview of the action research approaches referred to in the included articles, indicating those papers that are mentioned as “the origin” of action research. Studies that either name an approach as being the origin of action research, or are being named as such, are highlighted in blue for better readability.

Overview of action research approaches referred to in the included articles. Arrows indicate citations between the action research approach papers. The number of times that the articles included in this review cited each approach is indicated in the box. We have used different arrow thicknesses for better readability. Blue boxes indicate those papers that were available and checked for citations.

Best Practices and Lessons Learned

As previously described, an activity was identified as a “best practice” if researchers already planned their project with this in mind (eg, mentioning it in the description of methods). Lessons learned were those points that researchers came to know during their project. These were mostly reported in the discussion section. In total, 85 best practices and 66 lessons learned were identified, which were clustered into 22 categories of best practices and 16 categories of lessons learned. Among the 44 papers, 3 papers did not indicate any best practices that they followed, whereas 12 papers did not include any identifiable lessons learned. There were 8 overlapping categories, identified as best practices in some articles and as lessons learned in others. These will be discussed in more detail below.

Best Practices

The identified best practices in the 44 studies were most often related to the use of a specific method (n=9), namely personas (n=2), world café, journey mapping, role play, scenarios, case studies, design cards, and mixing different types of data collection methods (all n=1). Other best practices were a continuous evaluation of the project and a reflection on the process by the research team (n=8). The importance of establishing active contact between researchers and stakeholders and raising the confidence and skills of stakeholders was emphasized by 7 studies. The improvement of stakeholder skills mainly referred to research and analytical skills, allowing stakeholders to set up their own studies or continue the work after the project was finished. There were several specific suggestions to improve the regular project team meetings, for example, to always use the same agenda or to share a common area (office space) to make contact easier. Some other best practices concern the reporting and presentation of outcomes (n=6). The complete list of best practice categories can be found in Table 3 .

Overview of all best practice categories and number of mentions per category (N=44).

Lessons Learned

Apart from the best practices, the lessons learned from each study were identified. The most common lessons learned were increasing stakeholder knowledge and skills (n=8) and continuous evaluation of the project and reflection on the process (n=6). Both of these had been identified as best practices in other articles (more on this overlap below). Recommendations for the use of specific methods were also common (n=5). Lessons learned regarding reporting, adapting the project to fit the needs of stakeholders, fostering a welcoming environment, and the questionable replicability of the research were each mentioned 4 times. All lessons learned are shown in Table 4 .

Overview of all lessons learned categories and number of mentions per category (N=44).

Overlapping Best Practices and Lessons Learned

As stated earlier, some aspects were identified as best practices in some articles and as lessons learned in others. In total, we identified 7 such overlapping aspects. Overall, the most mentioned aspect was the importance of raising stakeholder skills and confidence (n=15, where best practices= 7 and lessons learned=8). Many articles reported the need for stakeholders to learn new skills, for example related to academic research, or the need to be convinced about their ability to perform these tasks. Almost all the studies that reported this as a best practice or lesson learned involved health care professionals as stakeholders. Other commonly mentioned points were recommendations for specific methods, even though the suggested methods differed (n=14, where best practices=9 and lessons learned=5) and there was continuous reframing and evaluation of the project (n=14, where best practices=8 and lessons learned=6). Continuous reframing often referred to the iterations of planning, action, and evaluation in AR projects. Studies that described this mostly did not include this cyclical nature of AR in their definition of it. In total, there were 10 recommendations regarding the reporting and presentation of results (best practices=6 and lessons learned=4), for example calling for open and accessible publishing of outcomes. The best practices and lessons learned included recommendations about meeting regularly (n=9, where best practices=7 and lessons learned=2), adapting to the needs of stakeholders (n=8, where best practices=3 and lessons learned=5), and investing in the relationship between partners (n=6, where best practices=3 and lessons learned=3).

Chronology of Overlapping Best Practices and Lessons Learned

When observing the publication timeline, most of the overlapping aspects appeared as a lesson learned in earlier publications, and then as a best practice in papers published at a later point in time. This was the case regarding stakeholder skills, appearing as a lesson learned in 1999 [ 33 ] and as a best practice in 2016 [ 25 ]; continuous reframing of the project was a lesson learned in 2003 [ 19 ] and best practice in 2009 [ 42 ]; further, having regular meetings was a lesson learned in 2006 [ 72 ] and a best practice in 2018 [ 27 ], and adapting the research to stakeholder needs was a lesson learned in 2007 [ 32 ] and a best practice in 2016 [ 77 ]. Such a clear timeline could not be seen for accessible reporting, appearing as a lesson learned in 2017 [ 78 ] and a best practice in 2007 [ 45 ], and the relationship between partners appearing as a lesson learned in 2017 [ 36 ] and as a best practice in 2008 [ 38 ].

Principal Results

To identify recommendations on how to conduct AR in eHealth studies, this literature review analyzed the setting, AR description, and best practices and lessons learned in 44 studies. The most important recommendations from this review, which will be discussed in more detail below, are as follows: actively raising stakeholder skills and confidence; fulfilling multiple roles and tasks as a researcher; fostering constant reflection and evaluation; ensuring open and accessible dissemination; reporting in a more structured and comprehensive way.

These recommendations are not exclusively related to eHealth, despite them being derived from a review of eHealth AR studies. Hence, it is possible that the recommendations are also relevant for AR in various other fields. Therefore, where possible, examples from different disciplines are discussed below to explain or supplement a recommendation.

Stakeholder Skills and Confidence

Being involved in a project as coresearcher can potentially increase stakeholders’ confidence, besides teaching them new skills [ 79 ]. However, this does not happen automatically. Similar to our findings, the narrative review conducted by Harrison and colleagues [ 80 ] also identified educating the research team as the most important task when stakeholders are involved in health care research. Nevertheless, there is limited research on how skill training for stakeholders could look like, and this can vary greatly between studies. Stakeholders in some eHealth studies might need to learn content-related information [ 81 ], whereas other studies require methodological or statistical skills [ 54 ]. Researchers should provide adequate training and material for their project and encourage stakeholders to make use of it. The studies included in this review that recommended stakeholder skill training almost exclusively worked with health care professionals. The relationship between recommending skill training and working mainly with health care professionals remains unclear. A possible explanation could be that other stakeholder groups in other studies already had the necessary skills and thus did not require any additional training. Another possibility is that other stakeholders were not given the same roles that health care professionals held, and therefore, they did not need skill training. Finally, as we will discuss later, reporting of AR activities was not always very extensive. Thus, stakeholders outside the health care sector were possibly trained, and these studies did not report on this aspect. Generally, not all participants prefer the same level of engagement in a project, and researchers should respect these preferences [ 82 ].

Tasks and Roles of the Researcher

Different aspects of the role and tasks of the researcher in an AR project are discussed. Brydon-Miller and Aragón describe the many different tasks that action researchers need to fulfil as their “500 hats” [ 83 ]. These are not specific to eHealth studies, but they can occur in any AR study. As researchers and stakeholders have many varied duties, their roles are not fixed and might change over the course of the project [ 19 ]. One main task of the researchers that continues throughout the project is the need to foster a welcoming environment for all stakeholders [ 42 ]. Researchers should also be present and actively involve themselves at a higher level than that needed in non-AR projects [ 38 ]. Additional AR-specific tasks for the researchers include investing in partner relationships [ 35 ] or breaking down power structures [ 28 ]. Generally, AR studies demand more self-reflection and awareness from the researchers than other projects and researchers should keep this in mind when entering an AR project.

Constant Reflection

The importance of continuous reframing and evaluation of the project was emphasized in several studies. Although evaluation is 1 of the AR cycles, studies providing recommendations on this topic rarely included this in their definition of AR. Owing to the lack of reports on AR cycles, which will be discussed below, it is unclear if these studies still followed the AR cycles without reporting on them. However, sometimes, it seems that periodic planned evaluation is not enough. Instead, the participants need to regularly reflect on the current status of the project and their role in it. Therefore, new AR projects should create suitable spaces for evaluation and reflection in ways that fit the projects and stakeholders. This is especially important because reflection can become difficult once a person is in the middle of the project [ 49 ]. Holeman and Kane [ 53 ] emphasize that reflection should not only take place within the project, but it should also be explicitly reported to help other researchers. If action researchers take reflection seriously and include honest evaluations in their publishing, the AR community members can learn from each other. Additionally, researchers and other stakeholders within the project learn and benefit from constant reflection [ 9 ].

Accessible Dissemination

Another important aspect concerns paying attention to open and understandable dissemination of results within the community and among researchers. Action researchers need to communicate findings to the academic world while also finding ways to inform the target group about the project in ways that suit the target users’ needs. An example of open and accessible dissemination can be found in Canto-Farachala and Larrea [ 83 ]. They present the results of their AR project regarding territorial development on an interactive website, allowing others to learn from their work. However, it seems that accessible reporting is still not the norm in AR, as Avison and colleagues [ 62 ] describe that many AR studies are generally “published in books rather than as articles. Action researchers have large and complicated stories to tell.” Future AR projects should attempt to narrate their stories in such a way that others can learn from them.

Comprehensive Reporting

The different way of describing AR studies also leads to another issue, incomplete and elusive reporting. Although most studies did provide at least a short description of what they saw as AR, 7 studies provided no definition at all. Additionally, there were only 4 studies that included 3 or all of the 4 aspects of the AR definition in their description. Even the most mentioned aspects appeared in less than half of the included papers. Even though most papers did cite an AR approach of definition, some did not. In combination with the often-limited descriptions of AR, this makes it difficult to obtain a clear picture of how AR is perceived and performed in a particular study. This resonates with what Bradbury and colleagues [ 9 ] describe as 1 of the quality points of AR, namely “action research process and related methods (should be) clearly articulated and illustrated.” The best practices and lessons learned that were extracted from the included studies were seldom mentioned explicitly. Best practices were often hidden in the description of the project, without much reasoning. Similarly, lessons learned were often described as adaptations made during the project or as plans for the future. Although we observed that some lessons learned turned into best practices over time, we think that researchers could benefit more from each other’s work by providing concrete recommendations. This review is a step in that direction. Both aspects show that the reporting of AR studies in eHealth can be improved to show more clearly what eHealth AR projects can look like and help others in setting up such projects with specific recommendations.

Limitations

Approximately a third of the included papers (14 out of 44) were published more than 10 years ago. This also means that some of the technologies that are described in the older papers are now relatively old. However, this literature review focuses mainly on the AR methodology and lessons learned about doing action research. Therefore, there was no exclusion criterium regarding the publication date of the papers.

The search yielded several PD-related papers. These papers could have been included, given that some definitions of PD are very similar to AR. However, as our aim was to provide an overview of how AR is done, these were excluded as the researchers of these studies themselves did not identify their studies as being related to AR (ie, not referring to, mentioning, or describing AR). Although this offers a clearer picture of how researchers conduct AR, it also creates a potential limitation in that best practices and lessons learned could be enriched from PD literature.

This overview of AR approaches focuses mostly on the interconnectedness among the approaches, without a comprehensive comparison of the content. Comparing the approaches with regard to the specific aspects of AR that they describe would be a review in and of itself, going beyond the scope of this current review. Therefore, we decided to focus on the definitions that the authors themselves provided even when they also cited AR approaches, as these are most likely to reflect their own vision of AR.

This review illustrates how AR is conducted in eHealth studies. Studies that fulfilled the inclusion criteria mainly took place in western countries and lasted for 2 to 3 years. Different stakeholders were involved, but the most commonly involved groups were health care professionals and patients. As for the methods used, most studies opted for focus groups and interviews. Even though many studies cited the AR approach proposed by Reason and Bradbury [ 8 ], their own definitions of AR were often not explicit in terms of how they implemented AR. Future projects should report their AR definition as well as the best practices and lessons learned more clearly. Other recommendations include paying attention toward developing the skill and confidence of the stakeholders, being aware of the changing role of the researcher, frequently evaluating the project, and disseminating results in an understandable manner.

Abbreviations

Multimedia appendix 1, multimedia appendix 2.

Authors' Contributions: KO performed the literature search and analysis and was a major contributor in designing the study and writing the manuscript. CG contributed to the design of the study, assisted with the search and analysis, and made major contributions to the manuscript. FN and LvV contributed to the design of the study and substantially revised the manuscript. All authors read and approved the final manuscript. This project has received funding from the European Union’s Horizon 2020 research and innovation program (grant 857188).

Conflicts of Interest: None declared.

Improvement of Instruction Through Action Research (61-682/683)

Structure of a research article, how to write a literature review, why and how.

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• Education: Portraits of Middle School Students Constructing Evidence-Based Arguments During Problem-Based Learning
• Mass Media: Corrupt Politicians? Media Priming Effects on Overtly Expressed Stereotypes toward Politicians
• Natural Sciences: Historical Abundance and Spatial Distribution of the Atlantic Bottlenose Dolphin (Tursiops truncatus) Along the Southeast Coast of the United States
• Physical Education: The Acute Effects of Various Types of Stretching
• Psychology: What is the Best Way to Analyze Less Frequent Forms of Violence? The Case of Sexual Aggression

17 - what is a literature review from Joshua Vossler on Vimeo .

"The purpose of a literature review is to help you explain how the question to be investigated fits into the larger picture and why you have approached the topic the way you have. This section of a scholarly report allows the reader to be brought up to date regarding the state of research in the field and familiarizes him or her to any contrasting perspectives and viewpoints on the topic."

"Summarize and explain what research has been done on the topic, citing the sources as you mention them. Point out the different ways researchers have treated the topic. Point out any connections between the sources especially where one source built upon prior study. Explain how this past work fits together to make your research question significant. Your literature review should present your synthesis of previous research and lay the foundation for understanding your research and appreciating its value."

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Methodology

• What Is Action Research? | Definition & Examples

What Is Action Research? | Definition & Examples

Published on January 27, 2023 by Tegan George . Revised on January 12, 2024.

Table of contents

Types of action research, action research models, examples of action research, action research vs. traditional research, advantages and disadvantages of action research, other interesting articles, frequently asked questions about action research.

There are 2 common types of action research: participatory action research and practical action research.

• Participatory action research emphasizes that participants should be members of the community being studied, empowering those directly affected by outcomes of said research. In this method, participants are effectively co-researchers, with their lived experiences considered formative to the research process.
• Practical action research focuses more on how research is conducted and is designed to address and solve specific issues.

Both types of action research are more focused on increasing the capacity and ability of future practitioners than contributing to a theoretical body of knowledge.

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Action research is often reflected in 3 action research models: operational (sometimes called technical), collaboration, and critical reflection.

• Operational (or technical) action research is usually visualized like a spiral following a series of steps, such as “planning → acting → observing → reflecting.”
• Collaboration action research is more community-based, focused on building a network of similar individuals (e.g., college professors in a given geographic area) and compiling learnings from iterated feedback cycles.
• Critical reflection action research serves to contextualize systemic processes that are already ongoing (e.g., working retroactively to analyze existing school systems by questioning why certain practices were put into place and developed the way they did).

Action research is often used in fields like education because of its iterative and flexible style.

After the information was collected, the students were asked where they thought ramps or other accessibility measures would be best utilized, and the suggestions were sent to school administrators. Example: Practical action research Science teachers at your city’s high school have been witnessing a year-over-year decline in standardized test scores in chemistry. In seeking the source of this issue, they studied how concepts are taught in depth, focusing on the methods, tools, and approaches used by each teacher.

Action research differs sharply from other types of research in that it seeks to produce actionable processes over the course of the research rather than contributing to existing knowledge or drawing conclusions from datasets. In this way, action research is formative , not summative , and is conducted in an ongoing, iterative way.

As such, action research is different in purpose, context, and significance and is a good fit for those seeking to implement systemic change.

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Action research comes with advantages and disadvantages.

• Action research is highly adaptable , allowing researchers to mold their analysis to their individual needs and implement practical individual-level changes.
• Action research provides an immediate and actionable path forward for solving entrenched issues, rather than suggesting complicated, longer-term solutions rooted in complex data.
• Done correctly, action research can be very empowering , informing social change and allowing participants to effect that change in ways meaningful to their communities.

Disadvantages

• Due to their flexibility, action research studies are plagued by very limited generalizability  and are very difficult to replicate . They are often not considered theoretically rigorous due to the power the researcher holds in drawing conclusions.
• Action research can be complicated to structure in an ethical manner . Participants may feel pressured to participate or to participate in a certain way.
• Action research is at high risk for research biases such as selection bias , social desirability bias , or other types of cognitive biases .

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

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Inclusion and exclusion criteria

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

Action research is conducted in order to solve a particular issue immediately, while case studies are often conducted over a longer period of time and focus more on observing and analyzing a particular ongoing phenomenon.

Action research is focused on solving a problem or informing individual and community-based knowledge in a way that impacts teaching, learning, and other related processes. It is less focused on contributing theoretical input, instead producing actionable input.

Action research is particularly popular with educators as a form of systematic inquiry because it prioritizes reflection and bridges the gap between theory and practice. Educators are able to simultaneously investigate an issue as they solve it, and the method is very iterative and flexible.

A cycle of inquiry is another name for action research . It is usually visualized in a spiral shape following a series of steps, such as “planning → acting → observing → reflecting.”

Sources in this article

We strongly encourage students to use sources in their work. You can cite our article (APA Style) or take a deep dive into the articles below.

George, T. (2024, January 12). What Is Action Research? | Definition & Examples. Scribbr. Retrieved April 11, 2024, from https://www.scribbr.com/methodology/action-research/

Cohen, L., Manion, L., & Morrison, K. (2017). Research methods in education (8th edition). Routledge.

Naughton, G. M. (2001).  Action research (1st edition). Routledge.

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3 Planning Your Research: Reviewing the Literature and Developing Questions

ESSENTIAL QUESTIONS

• What is relevant literature? What are the best ways to find it?
• What are the best ways to organize your relevant literature?
• What are the intended outcomes of reviewing your relevant literature?

Nearly all research begins with a review of literature that is relevant to the topic of research, even if it is only a casual review. Reviewing the available literature on your topic is a vital step in the research process. The literature review process provides an anchor for your inquiry. O’Leary (2004, p. 66) states, the “production of new knowledge is fundamentally dependent on past knowledge” because “it is virtually impossible for researchers to add to a body of literature if they are not conversant with it.” By reviewing the literature in the initial stages of the inquiry process, researchers are better able to:

• Understand their topic;
• Develop and focus a topic;
• Provide a clear rationale for, or better situate, their topic;
• Fine-tune their research questions.

In terms of thinking about methodology and the actual research process, reviewing the literature can help researchers:

• Identify well-vetted data collection and analysis methods on their topic;
• Determine whether to replicate a previous study, or develop a completely new study;
• Add rigor and validity to the research by validating the topic, methods, and significance.

Lastly, reviewing the literature also helps the researcher make sense of their findings, in both their field of study and in their educational context, by:

• Assessing whether the findings correlate with findings from another study;
• Determining which of the findings are different than previous studies;
• Determining which of the findings are unique to the researcher’s educational context. [1]

As you may see, the literature review is the backbone, anchor, or foundation of your research study. Overall the review of literature helps you answer three important questions that are the result of the bullet points outlined above. The literature review helps you answer the following:

• What do we know about your topic?
• What do we not know about your topic?
• How does your research address the gap between what we know and what we don’t about your topic?

After reviewing the literature, if you are able to answer those three questions, you will have a very clear and well-rationalized justification for your inquiry. If you cannot answer those questions, then you should probably keep reviewing the literature by looking for related topics or synonyms of major concepts.

While an extensive review of the literature about your topic of study is expected, you should also be realistic as to what you are able to manage. For topics that have a lot of research literature available, make sure you establish parameters for your research, such as:

• Temporal (e.g., only articles in the last 5 or 10 years)
• Content Area (e.g., only in science and math classrooms)
• Age or grade (e.g., only middle school classrooms)
• Research Subject (e.g., girls only, teachers, struggling readers)

These categories provide only a few examples, but parameters like these can make your review of literature much more manageable and your study much more focused.

What Types of Literature Should You Consider in Your Review?

It is helpful to consider the characteristics, purposes, and outcomes of different types of literature. Below are four broad categories I identify within educational research literature. I want to emphasize that my categories are in no way definitive, and only represent my own understanding.

Policy-Based Literature

Policy-based literature includes official documents that outline education policy with which the practitioner needs to be familiar. For example, the Common Core Standards or Content Standards are often refenced in articles to situate the need for research in relation to the standards; if my topic was on place-based education with middle school social studies students, I might have to look at national social studies standards. There also may be initiatives launched by organizations or researchers that become accepted practice. The documents that launch these initiatives (e.g., reports, articles, speeches) would also be useful to review. An example would be the Report of the National Reading Panel: Teaching Children to Read report from the National Reading Panel. These documents may provide rationale, based on the theories and concepts they utilize, and they may provide new ways of thinking about your topic. Similarly, if your topic is based on the local context, recent newspaper articles could also provide policy-type insights. All of these policy-based insights will be useful in providing the landscape or background for your work.

Theoretical Literature

Once you have identified your theoretical perspective, it is also important to locate your research within the appropriate theoretical literature. Many of you may be engaged in highly practice-based or small-scale research and wonder if you need a theoretical basis in your literature review. Regardless of the extent of your project, theoretical literature will help with the rigor and validity of your study and will help identify any theoretical views that underlie your topic. For example, if your study focuses on the place-based education in enhancing social studies students’ learning, it is highly probable that you would cite Kolb’s (1984/2014) work on Experiential Learning. By using Kolb’s work, you situate your research theoretically in the area of experiential learning.

Applicable Literature

Applicable literature will account for the bulk of your literature review. The previous two types of literature provide indication as to where your research is rationalized professionally and situated theoretically. Applicable literature will mainly come from journals related to your specific field of study. If I was doing a study in a social studies classroom, I would look at the journals The Social Studies, Social Education, and Social Studies Research and Practice . Use Google Scholar or your university library databases to examine literature in your specific area. When using these search engines and databases, start as specific as possible with your topic and related concepts. Using the example of place-based learning from above, I would search for “place-based learning” and “social studies” and “middle school” and “historic sites”. If I did not find many articles with this first search, then I would remove “historic sites” and search again. Books or handbooks on research may also have some useful studies to support your literature review section.

Methodological Literature

When sharing or reporting your work, you will want to review and cite research methodology literature to justify the methods you chose. When reading other research articles, pay attention to the research methods used by researchers. It is especially important to find articles that use and cite action research methodology. This type of literature will provide further support of your data gathering and analysis methods. Again, your methods should fit within your theoretical and epistemological stances. In addition, you’ll want to review data collection methods and potentially borrow or adapt rubrics or surveys from other studies.

Sources of Relevant Literature

When searching for these four types of literature, there are two ways to think about possible sources:

• primary sources include government publications, policy documents, research papers, dissertations, conference presentations and institutional occasional papers with accounts of research;
• secondary sources use primary sources as references, such as papers written for professional conferences and journals, books written for practicing professionals and book reviews. This is often called “reference mining” as you look through the reference lists of other studies and then return to the primary source that was cited.

Secondary sources are often just as valuable as primary sources, or potentially more valuable. When beginning your search, secondary sources can provide links to a wealth of primary sources that the secondary source author has already vetted for you, and likely with similar intentions. This is especially true of research handbooks. You will come across both types of literature wherever you search, and they both provide a landscape for your topic and add value to your literature review.

Regardless of being a primary or secondary source, you want to make sure the literature you review is peer-reviewed. Peer-reviewed simply means that the article was reviewed by two to three scholars in the field before it was published. Books, or edited books, would have also gone through a peer-review process. We often recommend teachers to look at professional books from reputable publishing companies and professional organizations, such as ASCD, NCTE, NCTM, or NCSS. This is a way for scholars to objectively review each other’s work to maintain a high level of quality and ethics in the publication of research. Most databases have mostly peer-reviewed journals, and often provide a filter to sort out the non-peer-reviewed journals.

Using the Internet

The internet is a valuable research tool and is becoming increasingly efficient and reliable in providing peer-reviewed literature. Sites like Google Scholar are especially useful. Often, and depending on the topic, the downside of internet-based searches is that it will generate thousands or millions of sources. This can be overwhelming, especially for new researchers, and you will have to develop ways to narrow down the results.

Professional organization websites will also have resources or links to sources that have typically been vetted. With all internet sources, you should evaluate the information for credibility and authority.

Evaluating sources from the Internet

Evaluating internet sources is a whole field of study and research within itself, and an in-depth discussion would take away from the focus of this book. However, O’ Dochartaigh (2007) provides a chapter to help guide the internet source evaluation process. Here is a brief summary, based on O’ Dochartaigh’s book, to give you a general idea of the task of evaluating sources:

• Examine if the material belongs to an advocacy group. Many times, these sources are fine, however, they require extra examination for bias or funding interests.
• As mentioned above, many academic papers are published in refereed journals which are subject to peer-review. Papers found on academic or university websites are typically refereed in some manner; however, some papers are posted by academics on their personal sites and have not been reviewed by other academics. Papers published solely by academics or other experts require further scrutiny before citing.
• When you are reviewing newspaper and magazine articles from the internet be weary of potential conflicts of interest based on the political stance of that periodical.

Therefore, it is wise to consider the objectivity of any source you find on the internet before you accept the literature.

We always recommend that students consider a few questions in their evaluation of sources, which are similar to the formal questions outlined by O’ Dochartaigh (2007):

• Is it clear who is responsible for the document?
• Is there any information about the person or organization responsible for the page?
• Is there a copyright statement?
• Does it have other publications that reinforce its authority?
• Are the sources clearly listed so they can be verified?
• Is there an editorial involvement?
• Are the spelling and grammar correct?
• Are biases and affiliations clearly stated?
• Are there dates for when the document was last updated or revised?

Organizing your Literature

When you begin, here are some things to think about as your read the literature. Again, these are not definitive, but merely provided for guidance. These questions are especially focused on other action research literature:

Questions to Think about as You Examine the Literature

• What was the context of their research?
• Who was involved? Was it a collaborative project?
• Was the choice of using action research as a method justified? Are any models discussed?
• What ‘actions’ actually took place?
• How was data gathered?
• How was data analyzed?
• Were ethical considerations addressed? How?
• What were the conclusions? Were they justified using appropriate evidence?
• Was the report accessible? Useful?
• Is it possible to replicate the study?

Regardless of the amount of literature you review, your challenge will be to organize the literature in way that is manageable and easy to reference. It is important to keep a record of what you read and how it relates conceptually to your topic. Some researchers even use the questions above to organize their literature. It is easy to read and think about the content of an article by making brief notes, however, this is often not enough to initially begin to develop your study or write about your findings. I will state the obvious here: organizing your literature search efficiently from the start is vital!

No matter how you choose to record or document the articles you read (e.g., paper, computer, photo), I would suggest thinking about the format in terms of index cards. Index cards are a very practical and simple model because the space limits you to be precise in recording vital information about each article. I typically create a document on my computer, allow each article the space of an index card, and focus on recording the following information:

• Journal/Book Chapter Title
• Main Arguments/Key findings
• Pertinent Quote(s)
• Implications
• Connective Points (how does it relate to my work and/or other articles)

I find that these aspects provide the information I need to be refreshed on the article and to be able to use it upon review.

There are also a lot of computer applications that are very useful and efficient in managing your literature. For example, Mendeley © provides comprehensive support for reviewing literature, even allowing you to store the article itself and make comments or highlights in text. There are also many citation apps that are helpful if you continue this research agenda and use roughly the same literature for each project.

Using the Literature

Think ahead to when you have collected and read a good amount of literature on your topic. You are now ready to use the literature to think about your topic, your research question, and the methods you plan to use. It might be helpful to peek ahead to Chapter 7 where I discuss writing the literature review for a report to give you an idea of the end goal. The primary purpose of engaging in a literature review is to provide knowledge to construct a framework for understanding the landscape of your topic. I often suggest for students to think of it as constructing an argument for your research decisions, or as if you are telling a story of how we got to this point in researching your topic. Either way you are situating your research in what we know and don’t know about your topic.

Naturally we tend to think about, and potentially write about, the literature in relation to the article’s author (e.g. Clark and Porath (2016) found that…). However, more commonly today in educational research you will find that literature reviews are organized by themes. It can be a little more organic to think about literature in terms of themes because they emerge or become more defined as you read. Also thinking thematically allows the articles to naturally connect and build on each other, whereas thinking in terms of authors can fragment thinking about the topic. In terms of thinking thematically, here are some guidelines:

• Identify the significant themes that have emerged organically from the literature review. These themes would be concepts or ideas that you typed or wrote down in your note-taking or management system.
• Introduce the common concepts or ideas by themes, instead of by authors’ disjointed viewpoints. Paragraphs in a thematic literature review begin like: The research on teacher self-efficacy has identified several key factors that contribute to strong self-efficacy… .
• Lastly, once you have introduced each theme and explained it, then present evidence from your readings to demonstrate the parameters of the knowledge on the theme, including areas of agreement and disagreement among researchers. Using the evidence, explain what the evidence for the theme means to your topic and any of your own relational or critical commentary.

Another way to think about structuring a literature review is a funnel model. A funnel model goes from broad topic, to sub-topics, to link to the study being undertaken. You can think of a literature review as a broad argument using mini-arguments. To use the funnel model, list your topic and the related subtopics, then design questions to answer with the literature. For example if our topic was discussion-based online learning, we might ask the following questions before reading the literature:

• Why is discussion important in learning?
• How does discussion support the development of social, cognitive, and teacher presence in an online course?
• What does research say about the use of traditional discussion boards ?
• What does the research say about asynchronous, video-based discussion ?
• How have other researchers compared written and video responses?
• How does this literature review link to my study?

O’Leary (2004) provides an interesting representation and model of the purpose for the literature review in the research process, in Figure 3.1. We will leave this for you to think about before moving on to Chapter 4.

• We will talk about this aspect of literature reviews further in Chapters 6 and 7. ↵

Action Research Copyright © by J. Spencer Clark; Suzanne Porath; Julie Thiele; and Morgan Jobe is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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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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• Published: 09 April 2024

The potential for artificial intelligence to transform healthcare: perspectives from international health leaders

• Christina Silcox 1 ,
• Eyal Zimlichmann 2 , 3 ,
• Katie Huber   ORCID: orcid.org/0000-0003-2519-8714 1 ,
• Neil Rowen 1 ,
• Robert Saunders 1 ,
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• Charles N. Kahn III 3 , 4 ,
• Claudia A. Salzberg 3 &
• David W. Bates   ORCID: orcid.org/0000-0001-6268-1540 5 , 6 , 7  

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Artificial intelligence (AI) has the potential to transform care delivery by improving health outcomes, patient safety, and the affordability and accessibility of high-quality care. AI will be critical to building an infrastructure capable of caring for an increasingly aging population, utilizing an ever-increasing knowledge of disease and options for precision treatments, and combatting workforce shortages and burnout of medical professionals. However, we are not currently on track to create this future. This is in part because the health data needed to train, test, use, and surveil these tools are generally neither standardized nor accessible. There is also universal concern about the ability to monitor health AI tools for changes in performance as they are implemented in new places, used with diverse populations, and over time as health data may change. The Future of Health (FOH), an international community of senior health care leaders, collaborated with the Duke-Margolis Institute for Health Policy to conduct a literature review, expert convening, and consensus-building exercise around this topic. This commentary summarizes the four priority action areas and recommendations for health care organizations and policymakers across the globe that FOH members identified as important for fully realizing AI’s potential in health care: improving data quality to power AI, building infrastructure to encourage efficient and trustworthy development and evaluations, sharing data for better AI, and providing incentives to accelerate the progress and impact of AI.

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Introduction

Artificial intelligence (AI), supported by timely and accurate data and evidence, has the potential to transform health care delivery by improving health outcomes, patient safety, and the affordability and accessibility of high-quality care 1 , 2 . AI integration is critical to building an infrastructure capable of caring for an increasingly aging population, utilizing an ever-increasing knowledge of disease and options for precision treatments, and combatting workforce shortages and burnout of medical professionals. However, we are not currently on track to create this future. This is in part because the health data needed to train, test, use, and surveil these tools are generally neither standardized nor accessible. This is true across the international community, although there is variable progress within individual countries. There is also universal concern about monitoring health AI tools for changes in performance as they are implemented in new places, used with diverse populations, and over time as health data may change.

The Future of Health (FOH) is an international community of senior health care leaders representing health systems, health policy, health care technology, venture funding, insurance, and risk management. FOH collaborated with the Duke-Margolis Institute for Health Policy to conduct a literature review, expert convening, and consensus-building exercise. In total, 46 senior health care leaders were engaged in this work, from eleven countries in Europe, North America, Africa, Asia, and Australia. This commentary summarizes the four priority action areas and recommendations for health care organizations and policymakers that FOH members identified as important for fully realizing AI’s potential in health care: improving data quality to power AI, building infrastructure to encourage efficient and trustworthy development and evaluations, sharing data for better AI, and providing incentives to accelerate the progress and impact of AI.

Powering AI through high-quality data

“Going forward, data are going to be the most valuable commodity in health care. Organizations need robust plans about how to mobilize and use their data.”

AI algorithms will only perform as well as the accuracy and completeness of key underlying data, and data quality is dependent on actions and workflows that encourage trust.

To begin to improve data quality, FOH members agreed that an initial priority is identifying and assuring reliable availability of high-priority data elements for promising AI applications: those with the most predictive value, those of the highest value to patients, and those most important for analyses of performance, including subgroup analyses to detect bias.

Leaders should also advocate for aligned policy incentives to improve the availability and reliability of these priority data elements. There are several examples of efforts across the world to identify and standardize high-priority data elements for AI applications and beyond, such as the multinational project STANDING Together, which is developing standards to improve the quality and representativeness of data used to build and test AI tools 3 .

Policy incentives that would further encourage high-quality data collection include (1) aligned payment incentives for measures of health care quality and safety, and ensuring the reliability of the underlying data, and (2) quality measures and performance standards focused on the reliability, completeness, and timeliness of collection and sharing of high-priority data itself.

Trust and verify

“Your AI algorithms are only going to be as good as the data and the real-world evidence used to validate them, and the data are only going to be as good as the trust and privacy and supporting policies.”

FOH members stressed the importance of showing that AI tools are both effective and safe within their specific patient populations.

This is a particular challenge with AI tools, whose performance can differ dramatically across sites and over time, as health data patterns and population characteristics vary. For example, several studies of the Epic Sepsis Model found both location-based differences in performance and degradation in performance over time due to data drift 4 , 5 . However, real-world evaluations are often much more difficult for algorithms that are used for longer-term predictions, or to avert long-term complications from occurring, particularly in the absence of connected, longitudinal data infrastructure. As such, health systems must prioritize implementing data standards and data infrastructure that can facilitate the retraining or tuning of algorithms, test for local performance and bias, and ensure scalability across the organization and longer-term applications 6 .

There are efforts to help leaders and health systems develop consensus-based evaluation techniques and infrastructure for AI tools, including HealthAI: The Global Agency for Responsible AI in Health, which aims to build and certify validation mechanisms for nations and regions to adopt; and the Coalition for Health AI (CHAI), which recently announced plans to build a US-wide health AI assurance labs network 7 , 8 . These efforts, if successful, will assist manufacturers and health systems in complying with new laws, rules, and regulations being proposed and released that seek to ensure AI tools are trustworthy, such as the EU AI Act and the 2023 US Executive Order on AI.

Sharing data for better AI

“Underlying these challenges is the investment required to standardize business processes so that you actually get data that’s usable between institutions and even within an institution.”

While high-quality internal data may enable some types of AI-tool development and testing, this is insufficient to power and evaluate all AI applications. To build truly effective AI-enabled predictive software for clinical care and predictive supports, data often need to be interoperable across health systems to build a diverse picture of patients’ health across geographies, and reliably shared.

FOH members recommended that health care leaders work with researchers and policymakers to connect detailed encounter data with longitudinal outcomes, and pilot opportunities across diverse populations and systems to help assure valid outcome evaluations as well as address potential confounding and population subgroup differences—the ability to aggregate data is a clear rate-limiting step. The South African National Digital Health Strategy outlined interventions to improve the adoption of digital technologies while complying with the 2013 Protection of Personal Information Act 9 . Although challenges remain, the country has made progress on multiple fronts, including building out a Health Patient Registration System as a first step towards a portable, longitudinal patient record system and releasing a Health Normative Standards Framework to improve data flow across institutional and geographic boundaries 10 .

Leaders should adopt policies in their organizations, and encourage adoption in their province and country, that simplify data governance and sharing while providing appropriate privacy protections – including building foundations of trust with patients and the public as previously discussed. Privacy-preserving innovations include ways to “share” data without movement from protected systems using approaches like federated analyses, data sandboxes, or synthetic data. In addition to exploring privacy-preserving approaches to data sharing, countries and health systems may need to consider broad and dynamic approaches to consent 11 , 12 . As we look to a future where a patient may have thousands of algorithms churning away at their data, efforts to improve data quality and sharing should include enabling patients’ access to and engagement with their own data to encourage them to actively partner in their health and provide transparency on how their data are being used to improve health care. For example, the Understanding Patient Data program in the United Kingdom produces research and resources to explain how the National Health Service uses patients’ data 13 . Community engagement efforts can further assist with these efforts by building trust and expanding understanding.

FOH members also stressed the importance of timely data access. Health systems should work together to establish re-usable governance and privacy frameworks that allow stakeholders to clearly understand what data will be shared and how it will be protected to reduce the time needed for data use agreements. Trusted third-party data coordinating centers could also be used to set up “precertification” systems around data quality, testing, and cybersecurity to support health organizations with appropriate data stewardship to form partnerships and access data rapidly.

Incentivizing progress for AI impact

“Unless it’s tied to some kind of compensation to the organization, the drive to help implement those tools and overcome that risk aversion is going to be very high… I do think that business driver needs to be there.”

AI tools and data quality initiatives have not moved as quickly in health care due to the lack of direct payment, and often, misalignment of financial incentives and supports for high-quality data collection and predictive analytics. This affects both the ability to purchase and safely implement commercial AI products as well as the development of “homegrown” AI tools.

FOH members recommended that leaders should advocate for paying for value in health – quality, safety, better health, and lower costs for patients. This better aligns the financial incentives for accelerating the development, evaluation, and adoption of AI as well as other tools designed to either keep patients healthy or quickly diagnose and treat them with the most effective therapies when they do become ill. Effective personalized health care requires high-quality, standardized, interoperable datasets from diverse sources 14 . Within value-based payments themselves, data are critical to measuring quality of care and patient outcomes, adjusted or contextualized for factors outside of clinical control. Value-based payments therefore align incentives for (1) high-quality data collection and trusted use, (2) building effective AI tools, and (3) ensuring that those tools are improving patient outcomes and/or health system operations.

Data have become the most valuable commodity in health care, but questions remain about whether there will be an AI “revolution” or “evolution” in health care delivery. Early AI applications in certain clinical areas have been promising, but more advanced AI tools will require higher quality, real-world data that is interoperable and secure. The steps health care organization leaders and policymakers take in the coming years, starting with short-term opportunities to develop meaningful AI applications that achieve measurable improvements in outcomes and costs, will be critical in enabling this future that can improve health outcomes, safety, affordability, and equity.

Data availability

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

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Acknowledgements

The authors acknowledge Oranit Ido and Jonathan Gonzalez-Smith for their contributions to this work. This study was funded by The Future of Health, LLC. The Future of Health, LLC, was involved in all stages of this research, including study design, data collection, analysis and interpretation of data, and the preparation of this manuscript.

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Charles N. Kahn III

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David W. Bates

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C.S., K.H., N.R., and R.S. conducted initial background research and analyzed qualitative data from stakeholders. All authors (C.S., E.Z., K.H., N.R., R.S., M.M., C.K., C.A.S., and D.B.) assisted with conceptualization of the project and strategic guidance. C.S., K.H., and N.R. wrote initial drafts of the manuscript. All authors contributed to critical revisions of the manuscript and read and approved the final manuscript.

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C.S., K.H., N.R., and C.A.S. declare no competing interests. E.Z. reports personal fees from Arkin Holdings, personal fees from Statista and equity from Valera Health, Profility and Hello Heart. R.S. has been an external reviewer for The John A. Hartford Foundation, and is a co-chair for the Health Evolution Summit Roundtable on Value-Based Care for Specialized Populations. M.M. is an independent director on the boards of Johnson & Johnson, Cigna, Alignment Healthcare, and PrognomIQ; co-chairs the Guiding Committee for the Health Care Payment Learning and Action Network; and reports fees for serving as an adviser for Arsenal Capital Partners, Blackstone Life Sciences, and MITRE. C.K. is a Profility Board member and additionally reports equity from Valera Health and MDClone. D.W.B. reports grants and personal fees from EarlySense, personal fees from CDI Negev, equity from Valera Health, equity from Clew, equity from MDClone, personal fees and equity from AESOP, personal fees and equity from Feelbetter, equity from Guided Clinical Solutions, and grants from IBM Watson Health, outside the submitted work. D.W.B. has a patent pending (PHC-028564 US PCT), on intraoperative clinical decision support.

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Silcox, C., Zimlichmann, E., Huber, K. et al. The potential for artificial intelligence to transform healthcare: perspectives from international health leaders. npj Digit. Med. 7 , 88 (2024). https://doi.org/10.1038/s41746-024-01097-6

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Active involvement in scientific research of persons living with dementia and long-term care users: a systematic review of existing methods with a specific focus on good practices, facilitators and barriers of involvement

• Janneke M. Groothuijse 1 , 2 ,
• Lisa S. van Tol 1 , 2 ,
• C. C. M. (Toos) Hoeksel-van Leeuwen 1 , 2 ,
• Johannes J. M. van Delden 3 ,
• Monique A. A. Caljouw 1 , 2 &
• Wilco P. Achterberg 1 , 2  

BMC Geriatrics volume  24 , Article number:  324 ( 2024 ) Cite this article

119 Accesses

Metrics details

Active involvement of persons living with dementia (PLWD) and long-term care (LTC) users in research is essential but less developed compared to other patient groups. However, their involvement in research is not only important but also feasible. This study aims to provide an overview of methods, facilitators, and barriers for involving PLWD and LTC users in scientific research.

A systematic literature search across 12 databases in December 2020 identified studies involving PLWD, LTC users, or their carers beyond research subjects and describing methods or models for involvement. Qualitative descriptions of involvement methods underwent a risk of bias assessment using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist 2018. A data collection sheet in Microsoft Excel and thematic analysis were used to synthesize the results.

The eighteen included studies delineated five core involvement methods spanning all research phases: advisory groups, formal and informal research team meetings, action groups, workshops, and co-conducting interviews. Additionally, two co-research models with PLWD and carers were found, while only two studies detailed LTC user involvement methods. Four distinct involvement roles were identified: consulting and advisory roles, co-analysts, co-researchers, and partners. The review also addressed barriers, facilitators, and good practices in the preparation, execution, and translation phases of research, emphasizing the importance of diversity, bias reduction, and resource allocation. Trust-building, clear roles, ongoing training, and inclusive support were highlighted.

Conclusions

Planning enough time for active involvement is important to ensure that researchers have time to build a trusting relationship and meet personal needs and preferences of PLWD, LTC users and carers. Researchers are advised not to presume the meaning of burden and to avoid a deficit perspective. A flexible or emergent design could aid involved persons’ ownership of the research process.

Trial registration

Prospero 2021: CRD42021253736.

Peer Review reports

In research characterized by active involvement, the target group plays a pivotal role in shaping research decisions and outcomes, directly impacting them. Involving patients in health research offers significant benefits [ 1 , 2 ]: it enhances participant recruitment [ 2 ], refines research questions [ 2 ], aligns study results with the target population [ 1 , 2 ], and promotes effective implementation of findings [ 1 ]. Active involvement of patients has also benefits for themselves, namely an enhanced understanding of research, building relationships, personal development, improved health and wellbeing, and enjoyment and satisfaction [ 3 , 4 ]. It gives them a sense of purpose and satisfaction through their tangible impact.

However, for long-term care (LTC) users and persons living with dementia (PLWD) active involvement in research is less developed than for other patient groups [ 5 , 6 ]. PLWD and LTC users share similar care needs, encompassing assistance with activities of daily living (ADLs), medication management, medical condition monitoring, and emotional support. Furthermore, a substantial portion of LTC users comprises individuals living with dementia [ 7 ]. Additionally, statistical data from the United States reveals that one in four older individuals is likely to reside in long-term care (LTC) facilities [ 8 ], and approximately forty to eighty percent of LTC residents in the United States, Japan, Australia, and England experience dementia or severe memory problems [ 7 , 9 ].

Due to these considerations, we have chosen to combine the target audiences of PLWD and LTC users in our systematic review. However, it's important to note that while there are potential advantages to combining these target groups, there may also be challenges. PLWD and LTC users may have varying needs, preferences, and experiences, including differences in care requirements driven by individual factors like the stage of dementia, coexisting conditions, and personal preferences. Therefore, it's imperative to conduct comprehensive research and involve these communities to ensure that involvement approaches are not only inclusive but also tailored to meet their specific requirements.

Given our ageing population and the intricate health challenges faced by PLWD and LTC users, including their vulnerability and shorter life expectancy in old age, it's crucial to establish effective research involvement methods. These individuals have unique needs and preferences that require attention. They possess a voice, and as researchers, it is our responsibility to not only listen to them but also actively involve them in the research process. Consequently, it is essential to identify means through which the voices of PLWD and LTC users can be effectively heard and ensure that their input is incorporated into research.

Fortunately, publication of studies on involvement of PLWD and LTC users in scientific research is slowly increasing [ 5 , 9 , 10 , 11 ]. A few reviews have described how PLWD and LTC users were involved [ 5 , 9 , 10 ]. However, with the increasing attention for involvement, the understanding of when involvement is meaningful grows and stricter requirements can be imposed to increase the quality of active involvement [ 12 , 13 ]. To our knowledge there is no up to date overview of involvement methods used with either or both PLWD and LTC users. Such an overview of involvement methods for PWLD and LTC users would provide a valuable, comprehensive resource encompassing various stages of the research cycle and different aspects of involvement. It would equip researchers with the necessary guidance to navigate the complexities of involving PLWD and LTC users in their research projects.

Recognizing the need to enhance the involvement of PLWD and LTC users in scientific research, this systematic review aims to construct a comprehensive overview of the multiple methodologies employed in previous studies, along with an examination of the facilitators and barriers of involvement. Our overarching goal is to promote inclusive and effective involvement practices within the research community. To achieve this objective, this review will address the following questions: (1) What kind of methods are used and how are these methods implemented to facilitate involvement of PLWD and LTC users in scientific research? (2) What are the facilitators and barriers encountered in previous research projects involving PLWD and LTC users?

Protocol and registration

The search and analysis methods were specified in advance in a protocol. The protocol is registered and published in the PROSPERO database with registration number CRD42021253736. The search and analysis methods are also described below more briefly.

Information sources, search strategy, and eligibility criteria

In preparation of the systematic literature search, key articles and reviews about involvement of PLWD and LTC users in research were screened to identify search terms. In addition, Thesaurus and MeSH terms were used to broaden the search. The search was conducted on December 10, 2020, across multiple databases: PubMed, Medline, Embase, Emcare, Web of Science, Cochrane Library, PsycINFO, Academic Search Premier, JSTOR, Social Services Abstracts, Sociological Abstracts, Psychology and Behavioral Sciences Collection. The search terms were entered in "phrases". The search strategy included synonymous and related terms for dementia, LTC user, involvement, research, method, and long-term care. The full search strategy is provided in supplement 1 .

After conducting the search, records underwent initial screening based on titles and abstracts. Selected reports were retrieved for full-text assessment, and studies were evaluated for eligibility based on several criteria. However, no restriction was made regarding publication date. First, to be included studies had to be written in English, German, French, or Dutch. Second, we only included original research studies. Third, studies were excluded when the target group or their representatives were not involved in research, but only participated as research subjects. Fourth, studies were excluded when not describing involvement in research. Therefore, studies concerning involvement in care, policy, or self-help groups were excluded. Fifth, the focus of this systematic review is on methods. Therefore, studies with a main focus on the results, evaluation, ethical issues, and impact of involvement in research were excluded. Additionally, we have not set specific inclusion or exclusion criteria based on study design since our primary focus is on involvement methodologies, regardless of the chosen research design. Sixth, the included studies had to concern the involvement in research of PLWD or adult LTC users, whether living in the community or in institutional settings, as well as informal caregivers or other representatives of these groups who may represent PLWD and LTC users facing limitations. Studies that involved LTC users that were children or ‘young adults’, or their representatives, were excluded. Studies were also excluded if they involved mental healthcare users if it remained unclear if the care that they received entailed more than only treatment from mental healthcare providers, but for example also assistance with ADL.

Terminology

For readability purposes, we use the abbreviation PLWD to refer to persons diagnosed with dementia, and we use the abbreviation LTC users to refer to persons receiving long-term care, at home or as residents living in nursing homes or other residential facilities. We use the term carers to refer to informal caregivers and other representatives of either PLWD or LTC users. As clear and consistent definitions regarding participatory research remains elusive [ 14 , 15 ], we formulated a broad working definition of involvement in research so as not to exclude any approach to participatory research. We defined involvement in research as “research carried out ‘with’ or ‘by’ the target group” [ 16 ], where the target group or their representatives take part in the governance or conduct of research and have some degree of ownership of the research [ 12 ]. It concerns involvement in research in which lived experienced experts work alongside research teams. We use the terms participation and participants, to refer to people being part of the research as study subjects.

Selection process, data-collection process, and data items

Titles and abstracts were independently screened by the first and second author (JG and LT). Only the studies that both reviewers agreed and met the inclusion criteria were included in the full-text screening process. Any uncertainty about whether the studies truly described a model or approach for involvement, was resolved by a quick screening of the full-text paper. The full-text screening process was then conducted according to the same procedure by JG and LT. Any disagreement was resolved by discussion until consensus was reached. If no agreement could be reached, a third researcher (MC) was consulted. References of the included studies were screened for any missing papers.

The following information was collected on a data collection sheet in Microsoft Excel: year and country of publication, topic, research aim, study design, living situation of involved persons (at home or institutionalized), description of involved persons, study participants (study subjects), theories and methods used, type/role(s) of involvement, research phase(s), recruitment, consent approach, study setting, structure of participatory activities, training, resources, facilitators, barriers, ethics, benefits, impact, and definition of involvement used.

JG independently extracted data from all included studies, the involved co-researcher (THL) independently extracted data from two studies, the second author (LT) from five. Differences in the analysis were discussed with the co-researcher (THL) and second author (LT) until consensus was reached. As only minor differences emerged, limited to the facilitator and barrier categories, data from the remaining studies was extracted by JG.

Risk of bias assessment

Every research article identified through the systematic review exclusively comprised qualitative descriptions of the involvement method(s) employed. Consequently, all articles underwent evaluation using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist 2018 [ 17 ], as opposed to the checklists intended for quantitative or mixed methods research. All included studies were independently assessed on quality by two reviewers (JG,LT) and any disagreement was resolved by discussion until consensus was reached. The CASP Qualitative Checklist consists of ten questions. The checklist does not provide suggestions on scoring, the first author designed a scoring system: zero points if no description was provided (‘no’), one point if a minimal description was provided (‘can’t tell’) and two points when the question was answered sufficiently (‘yes’). The second question of the checklist, “is a qualitative methodology appropriate”, was not applicable to the aims (i.e., to describe involvement) of the included studies and was therefore excluded. The tenth question was translated into a ‘yes’, ‘can’t tell’, or ‘no’ score to fit the scoring system. A maximum of eighteen points could be assigned.

Synthesis methods

Tables were used to summarize the findings and to acquire an overview of (1) the kinds of methods used to enable involvement of PLWD, LTC users, or carers in scientific research, and (2) the facilitators and barriers for involving this target group in scientific research. As to the first research aim, the headings of the first two tables are based on the Guidance for Reporting Involvement of Patients and the Public, long form version 2 (GRIPP2-LF) [ 18 ]. Because our systematic review focusses on methods, only the topics belonging to sections two, three, and four were included. Following Shippee et al., three main research phases were distinguished: preparation, execution, and translation [ 19 ]. Furthermore, the following fields were added to the GRIPP2-LF: First author, year of publication, country of study, setting of involvement, frequency of meetings, and a summary description of activities.

Concerning the second research aim, the extracted facilitators, barriers, and good practices were imported per study in ATLAS.ti for qualitative data analysis. Following the method for thematic synthesis of qualitative studies in systematic reviews [ 20 ], all imported barriers, facilitators and good practices were inductively coded staying 'close' to the results of the original studies, which resulted in 50 initial codes. After multiple rounds of pile sorting [ 21 ], based on similarities and differences and discussions in the research team, this long code list was grouped into a total of 27 categories, which were thereafter subsequently organized into 14 descriptive themes within the three research phases (preparation, execution, translation).

Study selection and characteristics

The Prisma Flow Diagram was used to summarize the study selection process [ 22 ]. In the full text screening, 72 of the 93 remaining studies were excluded because they were not original research articles (n = 5), not about involvement (n = 8), not about involvement in a research project (n = 1), they did not describe a model or method for involvement (n = 34), or they were not about PLWD or LTC users (n = 24). The search resulted in 18 publications eligible for analysis (Fig.  1 ).

Preferred Reporting items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram

Table 1 presents the general study characteristics. Two studies explicitly aimed to develop a model for involvement or good practice, and both focus on co-research either with PLWD [ 23 ] or their carers [ 13 ]. The other sixteen provide a description of the involvement of PLWD [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ] or LTC users in their research projects [ 35 , 36 , 37 , 38 , 39 ].

Quality assessment

Table 1 presents the CASP-score per study [ 17 ]. Five scored 16 to 18 points [ 13 , 28 , 29 , 32 , 35 ], indicating high quality with robust methods, clear aims, and strong data analysis. Eleven scored 12 to 15 [ 23 , 24 , 26 , 30 , 32 , 33 , 34 , 36 , 37 , 38 , 39 ], showing generally strong methodologies but with some limitations. Two scored 9 or lower [ 25 , 27 ], signifying significant methodological and analytical shortcomings. Notably, these low-scoring studies were short articles lacking clear recommendations for involvement in research.

Design and implementation of involvement

Phases and methods of involvement.

Table 2 describes the involvement methods used for and the implementation of involvement in research. The included studies jointly presented methods for involvement in the three main research phases [ 19 ]. Regarding the preparation phase, which involves the preparatory work for the study, only three studies provided detailed descriptions of the methods employed [ 26 , 30 , 32 ]. The execution phase, encompassing the actual conduct of the research, was most frequently discussed [ 23 , 24 , 25 , 26 , 27 , 28 , 29 ]. Five studies addressed the translation phase [ 13 , 25 , 31 , 36 , 37 ], where the focus shifts to translating research findings into actionable outcomes.

The eighteen studies introduced a variety of involvement methods, categorizable into five groups: 1) advisory groups, 2) research team meetings (both formal and informal), 3) action groups, 4) workshops, and 5) co-research in interviews. In five studies, individuals including PLWD, LTCF residents, carers, and health professionals participated in advisory/reference groups [ 25 , 26 , 27 , 32 ], working groups [ 27 ], and panels [ 28 ]. These groups offered valuable feedback on research aspects, spanning protocols, design, questionnaires, and implementation of research. Meetings occurred at varying frequencies - monthly, quarterly, or biannually.

Two studies exemplify diverse research collaboration settings. One involving older individuals within an academic research team of five [ 37 ], and another featuring a doctoral student and a co-researcher conducting informal monthly discussions at a local coffee shop [ 31 ]. Brown et al. sought to minimize power differentials and enhance inclusivity [ 37 ], while Mann and Hung focused on benefiting people with dementia and challenging negative discourse on dementia [ 31 ].

An additional five studies employed methods involving frequent meetings, including action [ 35 , 39 ], inquiry [ 23 ], and discussion groups [ 29 , 36 ] In these groups, involved persons with lived experience contributed to developing a shared vision and community improvements, such as enhancing the mealtime experience in care facilities [ 35 ].

Seven studies involved individuals through workshops, often conducted over one or two sessions. These workshops contributed to generating recommendations [ 37 ], informing future e-health designs [ 29 , 30 ], and ensuring diverse perspectives and lived experiences were included in data analysis [ 13 , 24 , 32 , 33 ]. In three studies, representatives worked as co-researchers in interviews, drawing on personal experiences to enhance the interview process, making it more dementia-appropriate and enriching data collection [ 13 , 32 , 34 ]. Finally, one study involved representatives in the recruitment and conduct of interviews [ 38 ].

People involved

The number of persons involved varied from a single co-researcher [ 31 ] to 34 panel individuals providing feedback on their experiences in a clinical trial [ 28 ]. Thirteen studies focussed on PLWD: eleven involved PLWD themselves [ 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 ], one exclusively focused on caregivers [ 13 ], and another one involved people without or with mild cognitive impairment, who participated in a study examining the risks of developing Alzheimer's disease [ 28 ]. Although not all articles provided descriptions of the dementia stage, available information indicated that individuals involved typically fell within the early to mid-stages of dementia [ 29 , 30 , 32 , 33 , 34 ]. Next to PLWD and carers, two studies additionally involved organizational or advocacy representatives [ 25 , 27 ]. The other five studies concerned older adults living in a LTC facility. Two of them involved older residents themselves [ 35 , 39 ], the other three carers, older community/client representatives or health care practitioners [ 36 , 37 , 38 ].

Roles and level of involvement

Four general roles could be identified. First, consultation and advisory roles were held by PLWD and carers [ 25 , 26 , 27 , 28 , 29 , 30 , 32 ], where involved persons share knowledge and experiences to make suggestions [ 32 ], but the research team retained formal decision-making power [ 25 ]. Second, PLWD were involved as co-analysts in data analysis [ 24 , 32 , 33 ]. Co-analysts influence data analysis, but the decision-making power remained with academic researchers [ 24 ]. Third, in six studies the co-researcher role was part of the research design in which involved persons and researchers steer and conduct research together [ 13 , 23 , 31 , 32 , 34 , 36 ]. Finally, two studies partnered with LTC residents [ 35 , 39 ], with residents at the core of the group, and positioned as experts by experience [ 39 ]. Residents had the decision-making authority regarding how to improve life in LTC facilities [ 35 ].

Models for involvement in research

Only two studies designed a model for co-research with PLWD [ 23 ] or their carers [ 13 ] across all research phases. These models underscored the importance of iterative training for co-researchers [ 13 , 23 ] and academic researchers [ 23 ]. Furthermore, these studies advocate involving co-researchers early on in the research process [ 13 ] and in steering committees [ 23 ]. Co-researchers can be involved in designing research materials [ 23 ], conducting interviews [ 13 , 23 ], analysing data [ 13 ], and co-disseminating findings [ 13 , 23 ]. Additionally, one study stressed involving PLWD in identifying (future) research priorities [ 23 ].

Barriers, facilitators, and good practices in research phases

Preparation phase.

Table 3 describes the barriers, facilitators, and good practices per main research phase. Lack of diversity in ethnicity and stages of dementia in the recruitment of involved persons is mentioned as a recurring barrier [ 26 , 28 , 32 , 33 ]. The exclusion of people with cognitive impairments is partly due to gatekeepers’ and recruiters’ bias towards cognitively healthy people [ 28 , 32 ]. It is stressed that researchers should refrain from making assumptions about the abilities of PLWD and ask the person what he/she is willing to do [ 31 ]. It is considered good practice to involve people regardless of cognitive abilities [ 23 ], based on skills, various personal characteristics [ 13 ] and, if possible, relevant prior experience [ 38 ].

Many studies stress the importance of building a mutual trusting relationship between involved persons and academic researchers [ 13 , 23 , 31 , 33 , 34 , 37 ]. A good relationship is believed to break down social barriers [ 37 ], foster freedom of expression [ 33 ], and thereby avoiding tokenistic involvement [ 13 ]. In addition, spending time with these persons is important to become familiar with an individual’s strengths and limitations [ 31 ].

Opting for naturally evolving involvement roles was mentioned as a barrier, as this may result in conflicting expectations and irrelevant tasks [ 37 ]. A clear role description and clarification of tasks is key to balancing potentially different expectations of the involved persons and researchers [ 26 , 28 , 29 , 32 , 38 ]. When designing a role for involvement in research, good practices dictate taking into account personal skills, preferences, development goals, and motivation for involvement [ 13 , 32 ]. This role should ideally be designed in collaboration with involved persons [ 13 , 32 ].

The perception of providing training to involved persons is ambivalent. Studies cited that training should not aim to transform them into “pseudo-scientist” [ 32 , 37 ] and that it raises the costs for involvement [ 28 ]. However, multiple scholars emphasize the importance of providing iterative training to facilitate meaningful involvement and development opportunities [ 13 , 23 , 28 , 31 , 32 , 33 , 36 , 37 ]. Training can empower involved persons to engage in the research process equally and with confidence, with the skills to fulfil their role [ 13 , 33 , 38 ]. However, the implementation of training may present a potential conflict with the fundamental principle of valuing experiential knowledge [ 37 ] and should avoid the objective of transforming co-researchers into 'expert' researchers [ 32 ]. Academic researchers should also be offered training on how to facilitate meaningful involvement [ 13 , 23 , 28 , 31 ].

Limited time and resources were mentioned as barriers to involvement that can delay the research process [ 13 , 33 , 36 , 39 ], restrict the involvement [ 28 ] and hinder the implementation of developed ideas [ 39 ]. Financial compensation for involvement is encouraged [ 25 , 26 , 27 , 32 ], as it acknowledges the contribution of involved persons [ 13 ]. Thus, meaningful involvement in research requires adequate funding and infrastructure to support the involvement activities [ 13 , 28 , 33 , 37 ].

Execution phase

The use of academic jargon and rapid paced discussions [ 13 , 37 ], power differentials, and the dominant discourse in biomedical research on what is considered “good science” can limit the impact of involvement [ 13 , 24 , 32 , 36 , 37 ]. Facilitating researchers should reflect on power differentials [ 35 ] and how decision-making power is shared [ 31 ]. Other facilitating factors are making a glossary of terms used and planning separate meetings for “technical topics” [ 37 ]. In addition, an emergent research design [ 35 ] or a design with flexible elements [ 28 ] can increase ownership in the research project and provide space for involvement to inform the research agenda [ 28 , 35 ]. This requires academic researchers to value experiential knowledge and to have an open mind towards the evolving research process [ 13 , 23 , 31 ].

Furthermore, managing the involvement process and ensuring equity in the collaboration [ 13 , 32 , 33 ], facilitating researchers must encourage involved persons to voice their perspectives. This means that they sometimes need to be convinced that they are experts of lived experience [ 32 , 33 , 36 , 37 , 39 ]. To enable involvement of PLWD, the use of visual and creative tools to prompt memories can be considered [ 24 , 30 , 33 , 34 ], as well as flexibility in relation to time frames and planning regular breaks to avoid too fast a pace for people who may tire easily [ 24 , 25 , 29 , 30 ].

Involvement can be experienced as stressful [ 13 , 32 , 38 ] and caring responsibilities may interfere [ 26 ]. Tailored [ 29 ] physical and emotional support should therefore be offered [ 13 , 23 , 38 ] without making assumptions about the meaning of burden [ 30 , 31 ]. Moreover, being the only PLWD involved in an advisory group was experienced as intimidating [ 25 ] and, ideally, a larger team of PLWD is involved to mitigate responsibilities [ 37 ]. PLWD having a focal point of contact [ 28 , 37 ] and involving nurses or other staff with experience working with PLWD and their carers [ 29 , 30 ] are mentioned as being beneficial. Some stress the importance of involving carers when engaging with PLWD in research [ 25 , 29 , 30 ].

To avoid an overload of information that is shared with the involved persons, tailoring information-sharing formats to individual preferences and abilities is essential to make communication effective [ 27 , 37 ].

Translation

Two studies indicated a need for more robust evaluation measures to assess the effect of involvement [ 28 , 33 ]. Reflection and evaluation of the involvement serves to improve the collaboration and to foster introspective learning [ 13 , 23 , 26 , 31 ]. The included studies evaluated involvement through the use of reflective diaries [ 13 ] or a template [ 38 ] with open-ended questions [ 33 ].

Two studies postulate that findings should benefit and be accessible to PLWD [ 23 , 31 ]. The use of creative tools not only enables involvement of PLWD, but can also increase accessibility of research findings and expand the present representation of PLWD [ 23 ].

The 18 included studies presented multiple methods for involvement in all three research phases. We found five types of involvement: advisory groups, (formal and informal) research team meetings, action groups, workshops, and co-conducting interviews. Only two studies described methods for involvement of LTC users in research. Involved persons were most often involved in consulting and advisory roles, but also as co-analysts, co-researchers, and partners. Involved persons’ roles can evolve and change over time. Especially as involved persons grow into their role, and gain confidence and knowledge of the specific research project, a more active role with shared responsibilities can become part of the research project. In addition, multiple involvement roles can be used throughout the research depending on the research phase.

Compared to the five types of involvement that we identified, other literature reviews about involvement methods for LTC users and PLWD in research also described advisory groups [ 10 ] and workshops [ 5 , 11 ], and methods that were similar to research team meetings (drop-in sessions and meetings [ 11 ]). Methods for action research (action groups) and co-conducting research (interviews) were not included by these other review studies. In addition to our findings, these other reviews also described as involvement methods interviews and focus groups [ 5 , 10 ] surveys [ 10 ], reader consultation [ 11 ]. Those types of methods were excluded from our study, because our definition of involvement is more strict; collecting opinions is not involvement per se, but sometimes only study participation. Moreover, compared to these previous reviews we set a high standard for transparency about the participation methods and the level of detail at which they are described.

Engaging the target group in research, particularly when collaborating with PLWD, LTC users, and carers, involves navigating unforeseen challenges [ 40 ]. This requires academic researchers to carefully balance academic research goals and expectations, and the expectations, personal circumstances and development goals related to the involved person. The aim is to maximize involvement while being attentive to the individual’s needs and avoiding a deficit perspective. Effective communication should be established, promoting respect, equality, and regular feedback between all stakeholders, including individuals living with dementia and LTCF staff. Building a mutual trusting relationship between involved persons and academic researchers through social interaction and clear communication is key to overcome barriers and ensure meaningful involvement. Inclusivity and empowerment, along with fostering an environment where diverse voices are heard, are crucial for the success of involvement in research. Our results are in line with a recent study concerning the experiences of frail older persons with involvement in research, confirming the importance of avoiding stereotypic views of ageing and frailty, building a trusting relationship, and being sensitive to older persons’ preferences and needs [ 41 ].

Furthermore, our results show that training academic researchers and involved persons is essential to develop the skills to facilitate involvement and to fulfil their role with confidence, respectively. Whilst the need for training is acknowledged by others [ 41 , 42 ], there are legitimate objections to the idea of training involved persons, as the professionalization underpinning the concept of training is at odds with voicing a lay perspective [ 43 , 44 ]. Furthermore, it is argued that experiential knowledge is compromised when training is structured according to the dominant professional epistemology of objectivity [ 45 ]. Therefore, training of involved persons should not focus on what researchers think they ought to know, but on what they want to learn [ 41 ].

Academic culture was frequently mentioned as a barrier to meaningful involvement. This result resonates with the wider debate related to involvement in health research which is concerned about active or “authentic involvement” being replaced with the appropriation of the patient voice as an add-on to conventional research designs [ 12 , 46 ]. It is argued that such tokenistic involvement limits the involved persons’ ability to shape research outcomes [ 46 ]. To reduce tokenism requires a culture shift [ 13 ]. We believe that due to the strict definition of involvement and high transparency standard used in this review, tokenistic approaches were excluded. This may set an example for how to stimulate making this culture shift.

Furthermore, the importance of practical aspects such as funding and, by extension, the availability of time should not be underestimated. Adequate funding is necessary for compensation of involvement, but also to ensure that researchers have ample time to plan involvement activities and provide personalized support for PLWD, LTC residents and their carers. Funding bodies increasingly require involvement of the public to be part of research proposals. Yet, support in terms of financial compensation and time for the implementation of involvement in research is rarely part of funding grants [ 42 ]. In addition, whereas an emergent design could aid the impact of involvement, funders often require a pre-set research proposal in which individual components are already fixed [ 5 , 47 ]. This indicates that not only do academic researchers and culture need to change, academic systems also need to be modified in order to facilitate and nurture meaningful involvement [ 47 ].

Strengths and limitations

A key strength of this review is the inclusion of over ten scientific databases, with a reach beyond the conventional biomedical science databases often consulted in systematic reviews. Besides, we believe that we have overcome the inconsistent use of terminology of involvement in research by including also other terms used, such as participation and engagement, in our search strategy. However, there was also inconsistency in length of publications and precision of the explanation of the process of involvement. E.g., involvement in the execution phase was often elaborated on, contributions to the research proposal and co-authoring research findings were only stated and not described. This presented challenges for data extraction and analysis, as it was not always possible to identify how the target group was involved. Involvement in these research phases is therefore not fully represented in this review.

The included studies in this review, the majority of which are of high quality, provide methods for involvement of PLWD and LTC users in research and they do not explicitly attend to the effectiveness or impact of the method for involvement used. Therefore, a limitation of this review is that it cannot make any statements regarding the effectiveness of the involvement methods included. Moreover, our target population was broad, although PLWD and LTC users are largely overlapping in their care needs and share important features, this may have led to heterogeneous results. In future research, it would be interesting to interpret potential differences between involvement of PLWD, LTC users, and their carers. However, as we expected, the amount of literature included in our analyses was too limited to do so. Furthermore, whereas the broad target group is a limitation it is also a strength of our review. Limiting our search to specifically persons living in LTC facilities would have provided limited methods for involvement of persons living with dementia. Our broad target groups enabled us to learn from research projects in which people living with early staged dementia are directly involved from which we can draw lessons on the involvement of people with more advanced stages of dementia and persons living with cognitive problems who live within LTC facilities.

Since January 2021 quite some research has been published about the importance of involvement in research. Although we had quickly screened for new methods, we realise that we may have missed some involvement methods in the past years. There will be a need for a search update in the future.

Implications for future research

Our review shows that a flexible and emergent design may help to increase involved persons' influence on and ownership in the research process. However, not all research objectives may be suitable for the implementation of an emergent design. Future research should therefore examine how aspects of a flexible emergent design can be integrated in, e.g., clinical research without compromising the validity of research outcomes.

Alzheimer Europe has called for the direct involvement of persons living with dementia in research [ 48 ]. In addition, Swarbrick et al. (this review) advise to involve persons regardless of their cognitive abilities [ 23 ]. These statements question the involvement of proxies, such as carers, professional caregivers and others involved in the care of PLWD. While PLWD and persons with other cognitive problems constitute a significant group within residential and nursing homes [ 7 ], none of the studies included in this review have provided methods to directly involve persons with more advanced stages of dementia. This raises the question if research methods should be adapted to allow those with more advanced stages of dementia to be involved themselves or if, concerning the progressive nature of the disease, it is more appropriate to involve proxies. And secondly who should these proxies be? Those that care for and live with persons with an advanced stage of dementia, or for example a person living with an early stage of dementia to represent the voices of persons with more advanced stages of dementia [ 31 ]?

Future research should adopt our example for stricter requirements for involvement and transparency about the involvement methods used. This will reduce tokenistic involvement and further promote the culture shift towards meaningful involvement. In addition, future research should assess the impact of the involvement methods that are described in this review. One of the first instruments that that may be used to do so in varying healthcare settings is the Public and Patient Engagement Evaluation Tool (PPEET) [ 49 ]. Moreover, scholars in this review stress, and we agree with this, that future research is needed on the involvement of persons with more advanced stages of dementia to ensure their voices are not excluded from research [ 33 , 34 ].

This review provides an overview of the existing methods used to actively involve PLWD, LTC users, and carers in scientific research. Our findings show that their involvement is feasible throughout all research phases. We have identified five different methods for involvement, four different roles, and two models for co-research. Our results suggest that planning enough time for involving PLWD, LTC users, and carers in research, is important to ensure that researchers have time to build a trusting relationship and meet their personal needs and preferences. In addition, researchers are advised not to presume the meaning of burden and to avoid a deficit perspective. A flexible or emergent design could aid involved persons’ ownership in the research process.

Availability of data and materials

The full search strategy is provided in supplement 1 . The data extraction form can be provided by the corresponding author on reasonable request.

Abbreviations

Critical Appraisal Skills Programme

Guidance for Reporting Involvement of Patients and the Public, long form version 2

• Long-term care

Persons living with dementia

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Acknowledgements

We thank Jan W. Schoones, information specialist Directorate of Research Policy (formerly: Walaeus Library, Leiden University Medical Centre, Leiden, the Netherlands), for helping with the search.

This systematic review received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Groothuijse, J.M., van Tol, L.S., Leeuwen, C.C.M.(.Hv. et al. Active involvement in scientific research of persons living with dementia and long-term care users: a systematic review of existing methods with a specific focus on good practices, facilitators and barriers of involvement. BMC Geriatr 24 , 324 (2024). https://doi.org/10.1186/s12877-024-04877-7

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Retirement planning – a systematic review of literature and future research directions

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Rising life expectancy and an aging population across nations are leading to an increased need for long-term financial savings and a focus on the financial well-being of retired individuals amidst changing policy framework. This study is a systematic review based on a scientific way of producing high-quality evidence based on 191 articles from the Scopus and Web of Science databases. It adopts the Theory, Context, Characteristics, and Method (TCCM) framework to analyze literature. This study provides collective insights into financial decision-making for retirement savings and identifies constructs for operationalizing and measuring financial behavior for retirement planning. Further, it indicates the need for an interdisciplinary approach. Though cognitive areas were studied extensively, the non-cognitive areas received little attention. Qualitative research design is gaining prominence in research over other methods, with the sparse application of mixed methods design. The study’s TCCM framework explicates several areas for further research. Furthermore, it guides the practice and policy by integrating empirical evidence and concomitant findings. Coherent synthesis of the extant literature reconciles the highly fragmented field of retirement planning. No research reports prospective areas for further analysis based on the TCCM framework on retirement planning, which highlights the uniqueness of the study.

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Ingale, K.K., Paluri, R.A. Retirement planning – a systematic review of literature and future research directions. Manag Rev Q (2023). https://doi.org/10.1007/s11301-023-00377-x

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How diverse is the toolbox? A review of management actions to conserve or restore coregonines

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