what is literature review of training and development

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In This Article Expand or collapse the "in this article" section Training and Development

Introduction, general overviews.

Reference Works
Instructional Systems Design
Needs Assessment
Training Methods
Pre-training Interventions
Training Media
Training Teams
Training Evaluation
Learner Characteristics
Learning Context
Employee Development
Macroperspectives

Other Subject Areas

Forthcoming articles expand or collapse the "forthcoming articles" section.

Corporate Globalization
Organization Design
Organizational Learning and Knowledge Transfer
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Training and Development by Kenneth G. Brown LAST REVIEWED: 13 July 2020 LAST MODIFIED: 26 October 2015 DOI: 10.1093/obo/9780199846740-0013

Training and development is the study of how structured experiences help employees gain work-related knowledge, skill, and attitudes. It is like many other topics in management in that it is inherently multidisciplinary in nature. At its core is the psychological study of learning and transfer. A variety of disciplines offer insights into this topic, including, but not limited to, industrial and organizational psychology, educational psychology, human resource development, organizational development, industrial and labor relations, strategic management, and labor economics. The focus of this bibliography is primarily psychological with an emphasis on theory and practice that examines training processes and the learning outcomes they seek to influence. Nevertheless, literature from other perspectives will be introduced on a variety of topics within this area of study.

These articles and chapters provide background for the study of training and development, particularly as studied by management scholars with backgrounds in human resource management, organizational behavior, human resource development, and industrial and organizational psychology. Kraiger 2003 examines training from three different perspectives. Aguinis and Kraiger 2009 provides a narrative review of ten years of research on training and employee development, focusing on the many benefits of providing structured learning experiences to employees. Brown and Sitzmann 2011 also reviews the literature and emphasizes research on the processes that are required to ensure that training benefits emerge. Arthur, et al. 2003 meta-analyzes the literature on training effectiveness. Russ-Eft 2002 proposes a typology of training designs. Salas, et al. 2012 offers recommendations for evidence-based training practice. Noe, et al 2014 examines training in a broader context, relative to the roles of informal learning and knowledge transfer.

Aguinis, Herman, and Kurt Kraiger. “Benefits of Training and Development for Individuals and Teams, Organizations, and Society.” Annual Review of Psychology 60.1 (January 2009): 451–474.

DOI: 10.1146/annurev.psych.60.110707.163505

A comprehensive review of training and development literature from 1999 to 2009 with an emphasis on the benefits that training offers across multiple levels of analysis.

Arthur, Winfred A., Jr., Winston Bennett Jr., Pamela S. Edens, and Suzanne T. Bell. “Effectiveness of Training in Organizations: A Meta-analysis of Design and Evaluation Features.” Journal of Applied Psychology 88.2 (April 2003): 234–245.

DOI: 10.1037/0021-9010.88.2.234

Offers a comprehensive meta-analysis of the relationships among training design and evaluation features and various training effectiveness outcomes (reaction, learning, behavior, and results).

Brown, Kenneth G., and Traci Sitzmann. “Training and Employee Development for Improved Performance.” In APA Handbook of Industrial and Organizational Psychology . Vol. 2, Selecting and Developing Members for the Organization . Edited by Sheldon Zedeck, 469–503. Washington, DC: American Psychological Association, 2011.

DOI: 10.1037/12170-000

A comprehensive review of training and development in work organizations with an emphasis on the processes necessary for training to be effective for improving individual and team performance.

Kraiger, Kurt. “Perspectives on Training and Development.” In Handbook of Psychology . Vol. 12. Edited by Irving B. Weiner and Walter C. Borman, Daniel R. Ilgen, and Richard J. KIlimoski, 171–192. Hoboken, NJ: John Wiley, 2003.

DOI: 10.1002/0471264385

Reviews training literature from three perspectives: instruction, learning, and organizational change.

Noe, Raymond A., Alena D. M. Clarke, and Howard J. Klein. “Learning in the Twenty-first-century Workplace.” Annual Review of Organizational Psychology and Organizational Behavior 1 (2014): 245–275.

DOI: 10.1146/annurev-orgpsych-031413-091321

A review that places training and development in a broader context with other learning-related interventions and practices such as informal learning and knowledge sharing. The chapter explains factors that facilitate learning in organizations.

Russ-Eft, Darlene. “A Typology of Training Design and Work Environment Factors Affecting Workplace Learning and Transfer.” Human Resource Development Review 1 (March 2002): 45–65.

DOI: 10.1177/1534484302011003

Presents a typology summarizing elements of training and work environments that foster transfer of training.

Salas, Eduardo, Scott I. Tannenbaum, Kurt Kraiger, and Kimberly A. Smith-Jentsch. “The Science of Training and Development in Organizations: What Matters in Practice.” Psychological Science in the Public Interest 13.2 (2012): 74–101.

DOI: 10.1177/1529100612436661

Reviews meta-analytic evidence and offers evidence-based recommendations for maximizing training effectiveness.

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[66.249.64.20|193.7.198.129]
193.7.198.129

Benefits of training and development for individuals and teams, organizations, and society

Affiliation.

1 The Business School, University of Colorado Denver, Denver, Colorado 80217-3364, USA. [email protected]
PMID: 18976113
DOI: 10.1146/annurev.psych.60.110707.163505

This article provides a review of the training and development literature since the year 2000. We review the literature focusing on the benefits of training and development for individuals and teams, organizations, and society. We adopt a multidisciplinary, multilevel, and global perspective to demonstrate that training and development activities in work organizations can produce important benefits for each of these stakeholders. We also review the literature on needs assessment and pretraining states, training design and delivery, training evaluation, and transfer of training to identify the conditions under which the benefits of training and development are maximized. Finally, we identify research gaps and offer directions for future research.

Publication types

Health Services Needs and Demand
Inservice Training*
Organizational Objectives
Outcome and Process Assessment, Health Care
Social Values
Staff Development*
Transfer, Psychology

A literature review on training and development and quality of work life

The authors suggest that training and development is a process leading to qualitative as well as quantitative advancements in an organization, especially at the managerial level. It is stated that training has specific areas and objectives whilst development is a continuous process less concerned with physical skills than with knowledge, values, attitudes and behavior. The authors discuss the process in which an organization recognizes their responsibility for optimal organizational performance and development of organizational motives for optimum quality of employee working life. ... Show more

This paper focuses and analyses the literature findings on importance of training and development and its relation with the employees' quality of work life.

Edited excerpts from published abstract. Show less

Authors: Kulkarni, Pallavi P.

Published: Nashik, India, Researchers World, 2013

Resource type: Article

Journal title: Journal of arts science and commerce

Journal volume: 4

Journal number: 2

Journal date: 2013

Pages: pp. 136-143

ISSN: 2231-4172; 2229-4686 (online)

Peer reviewed: Yes

Document number: TD/TNC 116.440

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what is literature review of training and development

Subjects: Management Teaching and learning Employment Workforce development Research

Keywords: Human resources Training Quality of working life Human resource development Literature review

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A LITERATURE REVIEW ON TRAINING & DEVELOPMENT AND QUALITY OF WORK LIFE

In this competitive world, training plays an important role in the competent and challenging format of business. Training is the nerve that suffices the need of fluent and smooth functioning of work which helps in enhancing the quality of work life of employees and organizational development too. Development is a process that leads to qualitative as well as quantitative advancements in the organization, especially at the managerial level, it is less considered with physical skills and is more concerned with knowledge, values, attitudes and behaviour in addition to specific skills. Hence, development can be said as a continuous process whereas training has specific areas and objectives. So, every organization needs to study the role, importance and advantages of training and its positive impact on development for the growth of the organization. Quality of work life is a process in which the organization recognizes their responsibility for excellence of organizational performance as well as employee skills. Training implies constructive development in such organizational motives for optimum enhancement of quality of work life of the employees. These types of training and development programs help in improving the employee behaviour and attitude towards the job and also uplift their morale. Thus, employee training and development programs are important aspects which are needed to be studied and focused on. This paper focuses and analyses the literature findings on importance of training and development and its relation with the employees' quality of work life.

Related Papers

IAEME Publication

Quality of Work Life (QWL) of employees in any organization plays a very vital role in shaping of both the employees and the organization. The objective of this research is to highlight the prominence of training and development programmes adopted in manufacturing industries encompassing the private and public sectors and the impact that it exerts on the quality of work life of employees in these sectors. It is assumed that employees who undergo T & D programme either in private or public sectors enjoy better QWL. Here a comparative study among the employees of private and public manufacturing industries is carried out to measure the QWL of employees in these respective sectors. Hence the research concludes that the QWL enjoyed by the employees of private industries is superior to the QWL of employees of public industries.

Noble Academic Publisher

josiah emmanuel

International Journal of Latest Technology in Engineering, Management & Applied Science -IJLTEMAS (www.ijltemas.in)

In this era where competition is increasing day by day in the corporate world training and development has become one of the important key to achieve success. Training is an important subsystem of Human Resource Development. It is a specialized function and is one of the fundamental operative functions for known resource management. Development is a long-term educational process utilizing a systematic and organized procedure by which managerial personnel get conceptual and theoretical knowledge. Basically, it is an attempt to improve the current or future employee performance of the employee by increasing his or her ability to perform through learning, usually by changing the employee’s attitude or increasing his or her skills and knowledge. These types of training and development programs help in improving the employee behavior and attitude towards the job and also uplift their morale. Thus, employee training and development programs are important aspects which are needed to be studied and focused on. This paper focusses on the advantages of the training and development for the employee’s.

International Journal of Scientific Research in Science and Technology IJSRST

The purpose of this paper is to present a conceptual study established on the employee training and development program and its benefits. This paper will inspect the structure and elements of employee training and development program and later the study present what are the positive outcomes for employees and organizations. Training and development play an important role in the effectiveness of organizations and to the experiences of people in work. Training has implications for productivity, health and safety at work and personal development. Modern organizations therefore use their resources (money, time, energy, information, etc.) for permanent training and advancement of their employees. Training and development is an instrument that aid human capital in exploring their dexterity. Therefore training and development is vital to the productivity of organization " s workforce. The study described here is a vigilant assessment of literature on fundamental of employee development program and its benefits to organizations and employees.

Dr Yashpal D Netragaonkar

“ To Study the Effectiveness of Employees Training & Development Program ”. The prime objective of research is to study the changes in skill , attitude, knowledge, behavior of Employees after Training program. It also studies the effectiveness of Training on both Individual and Organizational levels. Due to this research we are able to absorb current trends related to whole academic knowledge a nd its practical use. Such research is exposed us to set familiar with professional environment, working culture, behavior, oral communication & manners. Since the training is a result oriented process and a lot of time and expenditure, it is necessary tha t the training program should be designed with a great care. For evaluating effectiveness if training a questionnaire has to be carefully prepared for participants in order to receive feedback.

Venkata Sandeep

Tolulope J Ogunleye

Overtime, study had shown that to be relevant in any field of work there is need for continuous learning through training and development. The study is aimed at finding out the need for employees training and development in an organization. The need for improvement to change the phenomenon of low productivity and poor service delivery attributed to the employee’s in-adequate experience, calls for investigation on how effective training and development of employee can facilitate improved corporate performance using the banking industry as a field of discuss.. The study concluded that training and development brings about career growth for the employees and bankers thus the study recommended that all organization must do induction training at entry point into the banking sector.

International Journal of Research Publication (IJRP)

IAEME PUBLICATION

Training and development enables to develop skills and competencies necessary to enhance bottom-line results for their organization. It is a key ingredient for organizational performance improvement. It ensures that randomness is reduced and learning or behavioural change takes place in structured format. Training and Development helps in increasing the job knowledge and skills of employees at each level and helps to expand the horizons of human intellect and an overall personality of the employees. This paper analyses the link between various Training and Development programs organized in Larsen &Toubro Group of Companies and their impacts on employee satisfaction and performance. Data for the paper have been collected through primary source that are from questionnaire, surveys. There were two variables: Training and Development (independent) and Employees satisfaction and performance (dependent). The goal was to see whether Training and development has an impact on employee’s satisfaction and performance

Outcomes and Impact of Training and Development in Health Management and Leadership in Relation to Competence in Role: A Mixed-Methods Systematic Review Protocol

Reuben olugbenga ayeleke.

1 Health Systems Section, School of Population Health, University of Auckland, Auckland, New Zealand.

Nicola North

Katharine ann wallis.

2 Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand.

Zhanming Liang

3 Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.

Annette Dunham

Background: The need for competence training and development in health management and leadership workforces has been emphasised. However, evidence of the outcomes and impact of such training and development has not been systematically assessed. The aim of this review is to synthesise the available evidence of the outcomes and impact of training and development in relation to the competence of health management and leadership workforces. This is with a view to enhancing the development of evidence-informed programmes to improve competence.

Methods and Analysis: A systematic review will be undertaken using a mixed-methods research synthesis to identify, assess and synthesise relevant empirical studies. We will search relevant electronic databases and other sources for eligible studies. The eligibility of studies for inclusion will be assessed independently by two review authors. Similarly, the methodological quality of the included studies will be assessed independently by two review authors using appropriate validated instruments. Data from qualitative studies will be synthesised using thematic analysis. For quantitative studies, appropriate effect size estimate will be calculated for each of the interventions. Where studies are sufficiently similar, their findings will be combined in meta-analyses or meta-syntheses. Findings from quantitative syntheses will be converted into textual descriptions (qualitative themes) using Bayesian method. Textual descriptions and results of the initial qualitative syntheses that are mutually compatible will be combined in mixed-methods syntheses.

Discussion: The outcome of data collection and analysis will lead, first, to a descriptive account of training and development programmes used to improve the competence of health management and leadership workforces and the acceptability of such programmes to participants. Secondly, the outcomes and impact of such programmes in relation to participants’ competence as well as individual and organisational performance will be identified. If possible, the relationship between health contexts and the interventions required to improve management and leadership competence will be examined

The healthcare system is complex, dynamic, constantly evolving, and a target of repeated reforms. These reforms have brought about changes to roles of those in health management and leadership and to the associated competence required to perform these roles. 1

The importance of developing and improving the competence of health management and leadership workforces through training and development programmes have been emphasised. 2 , 3 However, the effects of such programmes on competence and individual or organisational performance have not been assessed and synthesised systematically. Thus, questions arise as to whether or not the various interventions aimed at addressing the gaps in health management and leadership competence actually lead to improvement in individual and organisational performance. 4

Health management and leadership workforces play a crucial role in effective healthcare delivery, and in maximising the gains of the various reforms in the sector. 3 It is, therefore, pertinent to review available evidence of the overall effects of interventions to improve management and leadership competence. This, in turn, will inform appropriate policy formulation to enable competence improvement, and the development of evidence-informed and sustainable training and development programmes. With the recent upsurge in research in health management and leadership competence, this review is timely and necessary to ascertain where further research is required.

This review will make use of a mixed-methods research synthesis which could provide answers to a wide range of research questions which a single method approach might not address comprehensively.

Aim and Objectives

This review aims to critically appraise and synthesise empirical evidence of the outcomes and impact of training and development programmes in relation to the competence of health management and leadership workforces.

Review Questions

This review aims to answer the following questions:

What training and development programmes are used to improve the competence of health management and leadership workforces, and are acceptable to participants?
Do training and development programmes improve the competence of health management and leadership workforces?
What are the characteristics of training and development programmes that are effective and appropriate for improving the competence of health management and leadership workforces?

This review will make use of the segregated approach to mixed-methods research synthesis. 5 Thus, qualitative and quantitative studies as well as the respective components of primary level mixed-methods studies will be analysed into two separate sets of syntheses. Where appropriate, quantitative and qualitative data will then be integrated into a single synthesis using Bayesian method. 6

The review will, therefore, involve:

A synthesis of studies on the views, perspectives, or experiences of health management and leadership workforces on the outcomes and impact of the various training and development initiatives in relation to their competence and performance in roles;
A synthesis of evidence of the effectiveness of training and development initiatives for improving the competence of health management and leadership workforces.

Inclusion and Exclusion Criteria

Types of study.

Only empirical studies with qualitative, quantitative, or mixed-methods designs will be eligible for inclusion. Studies reporting the findings of empirical research without giving details of the primary studies will be excluded. Reviews and commentaries will also not be eligible for inclusion;
Qualitative research of any design which focused on the perspectives, experiences, or narratives of participants will be considered for inclusion. This will include designs such as general inductive design, grounded theory, action research, ethnography, among others;
Quantitative design will include experimental, quasi-experimental and non-experimental, or epidemiological study designs;
Mixed-methods design will be studies that employed mixed primary level qualitative and quantitative research approaches;
Only studies published in English language from 2000 to date will be eligible for inclusion as we consider the most recent publications to be more relevant to the current research efforts. However, seminal or germinal studies published prior to 2000 will be considered for inclusion.

Contexts or Settings

This review will examine the managerial and leadership competence of health managers and clinical leaders of health services and health organisations from different countries in relation to the health context in which the identified competence is required. Health context will be considered from the angle of the types of work and setting, which could include any of the following organisational settings:

Public sector;
Private sector;
Non-governmental organisations, charitable or voluntary organisations.

Studies that selected participants from the following work settings will be included in this review:

Hospital, including secondary and tertiary level care;
Primary healthcare services;
Community health services;
Residential care services;
Government ministries, departments and agencies responsible for policy formulation, funding, regulation, and administration;
Other work settings considered by the reviewers to be health sector or related to health sector.

Participants

Participants of the primary studies will be individuals with existing roles as managers or leaders in the health sector;
Generalist managers, professional health service managers, and individuals trained in other professions (eg, clinicians, IT personnel) but were involved in management and/or leadership development activities by virtue of their roles or positions as managers and/or leaders (eg, project managers, team leaders) will be eligible for inclusion;
All levels of management or leadership positions will be included: frontline, middle, senior, and executive levels;
Studies examining the competence of health professionals who perform dual roles eg, clinical and management/leadership roles, will be eligible for inclusion, providing separate data are available for management and/or leadership roles;
Studies investigating the competence of both management and non-management staff will be included, providing separate data are provided for participants in management and/or leadership roles;
Studies examining the competence of prospective or newly employed health managers and/or leaders with no prior management and/or leadership experience will be excluded; studies investigating the competence of individuals previously engaged in management and/or leadership positions will also be excluded.

Interventions or Exposures

This review will consider ‘interventions’ as any specific initiatives (both formal and informal) intended to improve the competence of personnel responsible for management and leadership roles in healthcare organisations;
Such initiatives may include coaching, mentoring, supervision, continuing professional development, training, formal education, contextualised learning, or other specific initiatives which are considered by this review to be appropriate for improving the competence of health managers and leaders;
Studies on measures or incentives to improve the performance of health workers, including management and leadership workforces, but which did not address management or leadership competence, will be excluded.

Comparators or Control

Where applicable, comparators or control will be non-exposure to the intervention of interest or exposure to an intervention which is considered by this review not to be related to improving the competence of health management and leadership workforces.

Outcome and Impact Measures

In this review, the terms ‘outcomes and impact’ will be defined, using the operational definitions of the Centre for Non-profit Management (CNM), the United States 7 as guides. Thus, outcomes refer to the measurable and specific effects of interventions (in the short and medium terms) such as the number of participants demonstrating changes in competence at the end of interventions. Impact, on the other hand, refer to the broad and long-term effects of interventions, either negative or positive, intended or un-intended; for example, changes in individual and organisational performance following completion of interventions.

Outcome and impact measures that will be considered in this review are those that will assist in addressing the research questions. Studies will not be excluded solely on the basis of not reporting any relevant outcome or impact measures, providing their designs, settings, participants and interventions meet the eligibility criteria for inclusion. Authors of such studies will be contacted for information on outcome and/or impact measures that could be relevant to the review. Final assessment of the outcomes and impact of training and development programmes will be based on studies that reported those data and on studies whose authors provided relevant information on outcome and/or impact measures following contact.

For the purpose of data synthesis and because of the possibility of studies reporting their findings at different end points, studies assessing the effects of interventions within each of the following time intervals will be regarded as similar in relation to timing of effect measures (such studies may be combined in meta-analysis or meta-synthesis, providing they are similar with respect to other characteristics ie, settings, participants, interventions and outcome or impact measures):

Immediately at the end of intervention and up to three months after completion of intervention (short-term measures);
More than three months and up to six months after completion of interventions (medium-term measures);
More than six months and up to 12 months after completion of interventions (long-term measures).

The following primary and secondary outcome and impact measures will be considered:

Primary Outcome and Impact Measures

These will be assessed as the direct effects of interventions related to participants’ managerial and/or leadership competence and performance in roles.

Primary outcome measures will consist of the following:

Objective assessment of competence or proficiency by participants, using standardised instruments;
Objective assessment of competence or proficiency by stakeholders eg, participants’ superior officers and professional colleagues, using validated instruments;
Subjective assessment of competence or proficiency from participants’ perspectives;
Subjective assessment of competence or proficiency from stakeholders’ perspectives eg, participants’ superior officers and professional colleagues.

Primary impact measures will be:

Participants’ performance in the related area following specific training or professional development inputs eg, financial performance, managerial and/or leadership performance.

Secondary Outcome and Impact Measures

These will be considered as the indirect effects of interventions related to individuals (participants) and/or organisations.

Secondary outcome measures will consist of:

Costs associated with the intervention;
Participants’ evaluation of the intervention in terms of their level of satisfaction with and acceptability of the interventions.

Secondary impact measures will consist of:

Organisational performance in the related area following specific training or professional development inputs eg, quality of service, customer satisfaction, change in infection rates, morbidity and mortality rates, staff turnover.

Search Strategy

A comprehensive search for relevant studies will be undertaken. The main concepts addressed in the review (ie, impact, health leadership or management, competence, training or development and performance or outcome) will be searched using strings of subject headings (from either the controlled vocabulary or thesaurus as appropriate) and free-text. The search strategy will be designed by combining search strings for each of the key concepts so as to identify studies that focus on, for example, health AND (management or leadership) AND (training or development) AND competence. A number of search strategies will be combined and utilised, depending on the database, to locate studies,

Only studies published in English language from 2000 to date will be included in this review. However, seminal studies published prior to 2000 will be considered for inclusion. Subject-specific electronic databases will be searched to identify studies relevant to the review. Other electronic sources will be databases dedicated to review of research, dissertations and theses. For the full list of electronic databases and catalogue to be searched, see Appendix 1 .

Other potential sources will be searched to identify relevant studies. These will include hand searching of reference lists of included studies, conference proceedings, grey literature and websites of relevant health professional bodies, World Health Organization (WHO), and appropriate government agencies.

Data Extraction and Analysis

Selection of studies.

Search results will be uploaded into RefWorks or EndNote so as to identify and remove any duplicates. The list of titles and abstracts generated by the search will be screened independently by two reviewers to identify potentially relevant articles. Full-text articles of potentially relevant articles will be retrieved and assessed independently for eligibility by two reviewers in accordance with the inclusion and exclusion criteria described above. Any difference in opinion between the two reviewers will be resolved through discussion or consultation with a third reviewer.

Data Extraction and Management

Two reviewers will extract data independently from the included studies using data extraction forms specifically developed for each study design. Disagreement, if any, between the reviewers will be resolved through discussion or by seeking the opinion of a third reviewer. Data will be extracted from each of the included studies with respect to study designs, settings, participants, interventions, and outcome and impact measures considered relevant to the review questions. For qualitative studies, key themes will be coded according to the content of the findings of each study, using NVIVO software. For quantitative research, descriptive and outcome data will be checked and double entered into RevMan data management software. Where data are missing, unclear or presented in a form that cannot easily be extracted, study authors will be contacted for clarification or assistance with the process of data extraction.

Assessment of Methodological Quality/Risk of Bias of Studies

This review will make use of methodologically appropriate tools to critically appraise the methodological quality of included studies. These are the Effective Public Health Practice Project (EPHPP) tool for quantitative studies, 8 the Critical Appraisal Skill Programme (CASP) tool for qualitative studies, 9 and a combination of these tools for mixed-methods designs.

The methodological quality of quantitative studies (ie, the risk of bias) will be assessed with respect to appropriateness of study design, process used in selecting participants, control for confounding factors, blinding of participants and/or personnel, including outcome assessors (researcher’s role and influence), follow up length, withdrawals/losses to follow up and reasons for withdrawals, data collection and analysis methods.

Qualitative studies will be assessed in relation to the appropriateness of qualitative design for the research question, appropriateness of the recruitment process, adequate description of data collection process and data analysis (rigor), researcher’s role and influence (bias) as well as the process to ensure credibility of the findings through, for example, triangulation and respondent validation.

Mixed-methods studies will be separated into their respective quantitative and qualitative components and assessed using the respective assessment tool for each study design. The outcomes of the assessment of the two separate components will be incorporated into the respective findings of the methodological assessment of the primary level quantitative and qualitative studies.

The overall quality of each study will be graded as ‘very good’ (high quality), ‘moderate’ or ‘weak’ (low quality) based on the average score for the domains assessed. No studies will be excluded on the basis of being of low quality; rather, the effect of inclusion of such low quality studies will be explored by using sensitivity analysis where appropriate. This will be done by considering the effect of removal of studies rated as low quality on the findings of both quantitative and qualitative studies.

Two reviewers will assess independently the methodological quality of studies. Any disagreement will be resolved through discussion or by consulting with a third reviewer.

Data Synthesis

Quantitative studies.

The effectiveness or otherwise of each intervention in improving the competence of participants will be determined by calculating, where appropriate, the effect size estimate for each intervention. Effect sizes will be expressed as odds ratio (OR) or risk ratio (RR) for categorical data and weighted mean difference (MD) for continuous data and 95% CIs will be calculated.

Studies that are sufficiently similar with respect to settings, participants, interventions and outcome or impact measures will be combined in meta-analysis. Where it is not possible to conduct meta-analysis due to substantial heterogeneity among studies, findings from individual studies will be presented in narrative analysis, using tables and figures as appropriate.

Qualitative Studies

Data from studies that examined the views, perspectives or experiences of participants will be synthesised thematically by two reviewers in accordance with the existing methods for thematic synthesis of qualitative research. 10 Findings of the included studies will be assembled and rated according to their quality and then categorised into themes and sub-themes based on their similarity in meaning. The emerging themes and sub-themes will be examined to see how they are related to the research questions.

Where studies are sufficiently similar with respect to settings, participants, interventions and outcome or impact measures, a single set of synthesised findings will be produced by pooling the emerging themes in a meta-synthesis. Otherwise, the findings from each study will be presented in narrative form in an evidence table, taking into consideration the quality and consistency of the findings as well as their applicability to the research questions.

Mixed-Methods Studies

Findings of mixed-methods studies will be separated into their respective quantitative and qualitative components. Where possible, the quantitative component will be included in the quantitative synthesis while the qualitative component will be incorporated into the qualitative synthesis.

Aggregation of Data/Mixed-Methods Synthesis

Findings from quantitative and qualitative studies will be analysed separately (as previously described) using the segregated approach 5 and integrated into two separate sets of data. Results from the initial quantitative syntheses will then be converted into textual descriptions (qualitative themes) using Bayesian method as described by Crandell and colleagues. 6 Textual descriptions and the initial synthesised findings from qualitative studies that are mutually compatible or sufficiently similar will then be combined to generate mixed-methods syntheses using appropriate mixed-methods research analytical/assessment instrument. However, where it is not possible to conduct meta-analysis or meta-synthesis due to insufficient studies or substantial heterogeneity (differences) among studies, findings from individual quantitative studies will be converted into textual forms and then combine with compatible themes from individual or synthesised qualitative findings.

Subgroup Analysis

Subject to the availability of sufficient studies, subgroup analysis will be conducted to examine the influence of health system contexts on training and development needs of health management and leadership workforces. Studies will be subgrouped by:

Type of health sector (public, private; hospital, community health services);
Location of health facility (urban, rural);
Management and leadership level (front-line/middle, senior).

Descriptive statistics will be used to summarise information on training and development programmes which are used to improve the competence of health management and leadership workforces and the acceptability of such programmes to participants. The review will identify common characteristics of: (1) interventions found to have improved the competence of participants, and (2) those interventions considered to be ineffective. Success of interventions or otherwise will be determined by examining outcomes and impact at the individual level only. If possible, the effects of such interventions on organisational performance, mediated through improved competence, will be identified.

The contextual effects of health settings on the interventions, ie, the relationship between health contexts and the interventions required to improve management and leadership competence, will be examined. This will help guide the applicability of the findings of the review to other health settings not identified by the included studies. If possible, any relationship between management levels and effectiveness of interventions will also be investigated. The outcome of this systematic review will be an understanding of the evidence for the relationship between training and professional development interventions and improved health management and leadership competence.

Acknowledgments

The authors wish to thank Vanessa Jordan of the University of Auckland, Auckland, New Zealand for reviewing the methods section of the protocol.

Ethical issues

Not applicable.

Competing interests

Authors declare that they have no competing interests.

Authors’ contributions

The protocol was conceived by ROA and NN. Both authors contributed to the development of the protocol. ROA wrote the draft copy and final version of the manuscript. NN, KAW, ZL, and AD commented on the draft copy and revised the final version of the manuscript. All authors approved the final version of the manuscript.

Authors’ affiliations

1 Health Systems Section, School of Population Health, University of Auckland, Auckland, New Zealand. 2 Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand. 3 Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.

Search Sources

The following electronic databases and catalogues will be searched:

Cochrane databases of Systematic Reviews (CDSR)
Current contents
Database of Abstracts of Review of Effects (DARE)
Database of Public Health Effectiveness Reviews (DOPHER)
Health Promis (Database of the Health Development Agency)
Health Management Information Consortium (HMIC)
Health Services Technology Assessment Texts (HSTAT)
Public Affairs Information Service (PAIS)
ScienceDirect
System for Information on Grey Literature in Europe Archive (SIGLE)
Trials Register of Public Health Interventions (TROPHI)

Citation: Ayeleke RO, North N, Wallis KA, Liang Z, Dunham A. Outcomes and impact of training and development in health management and leadership in relation to competence in role: a mixed-methods systematic review protocol. Int J Health Policy Manag. 2016;5(12):715–720. doi:10.15171/ijhpm.2016.138

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Home » Research Literature Reviews » Literature Review – Employee Training and Development

Literature Review – Employee Training and Development

Introduction.

Human resources are considered by many to be the most important asset of an organization, yet very few employers are able to harness the full potential from their employees (Radcliffe, 2005). Human resource is a productive resource consisting of the talents and skills of human beings that contribute to the production of goods and services (Kelly, 2001). Lado and Wilson (1994) define human resource system as a set of distinct but interrelated activities, functions, and processes that are directed at attracting, developing, and maintaining a firm’s human resources. According to Gomez-Mejia, Luis R., David B. Balkin and Robert L. Cardy, (2008), it is the process of ensuring that the organization has the right kind of people in the right places at the right time. The objective of Human Resources is to maximize the return on investment from the organization’s human capital and minimize financial risk. It is the responsibility of human resource managers to conduct these activities in an effective, legal, fair, and consistent manner (Huselid, 1995).

Employee Training and Development

Training and development is a subsystem of an organization that emanate from two independent yet interdependent words training and development. Training is often interpreted as the activity when an expert and learner work together to effectively transfer information from the expert to the learner (to enhance a learner’s knowledge, attitudes or skills) so the learner can better perform a current task or job. Training activity is both focused upon, and evaluated against, the job that an individual currently holds (Learner R., 1986). On the other hand development is often viewed as a broad, ongoing multi-faceted set of activities (training activities among them) to bring someone or an organization up to another threshold of performance. This development often includes a wide variety of methods, e.g., orienting about a role, training in a wide variety of areas, ongoing training on the job, coaching, mentoring and forms of self-development. Some view development as a life-long goal and experience. Development focuses upon the activities that the organization employing the individual, or that the individual is part of, may partake in the future, and is almost impossible to evaluate (Nadler Leonard, 1984).

Training and development ensures that randomness is reduced and learning or behavioral change takes place in structured format. In the field of human resource management , training and development is the field concerned with organizational activity aimed at bettering the performance of individuals and groups in organizational settings. It has been known by several names, including employee development, human resource development , and learning and development (Harrison Rosemary, 2005).

As the generator of new knowledge, employee training and development is placed within a broader strategic context of human resources management , i.e. global organizational management, as a planned staff education and development, both individual and group, with the goal to benefit both the organization and employees. To preserve its obtained positions and increase competitive advantage , the organization needs to be able to create new knowledge , and not only to rely solely on utilization of the existing (Vemic, 2007). Thus, the continuous employee training and development has a significant role in the development of individual and organizational performance . The strategic procedure of employee training and development needs to encourage creativity, ensure inventiveness and shape the entire organizational knowledge that provides the organization with uniqueness and differentiates it from the others.

The Value of Training and Development

According to Beardwell & Holden (1997) human resource management has emerged as a set of prescriptions for managing people at work. Its central claim is that by matching the size and skills of the workforce to the productive requirements of the organization, and by raising the quality of individual employee contributions to production, organizations can make significant improvements on their performance.

The environment of an organization refers to the sum total of the factors or variables that may influence the present and future survival of an organization (Armstrong, 1998). The factors may be internal or external to the organization. Cascio W. F, (1995), uses the terms societal environment to define the varying trends and general forces that do not relate directly to the company but could impact indirectly on the company at some point in time. Four of these forces are identified as economic, technological, legal and political and socio-cultural and demographic forces. The second type of environment is the task environment that comprises elements directly influencing the operations and strategy of the organization. These may include the labour market, trade unions, competition and product markets comprising customers, suppliers and creditors. The task environment elements are directly linked to the company and are influenced by the societal environment.

However, variables in the task, competitive or operative environment as they are variously referred to, affect organizations in a specific industry and it is possible to control them to some extent. As such, environmental change, whether remote or task, disrupts the equilibrium that exists between the organization’s strategy and structure, necessitating adjustment to change. Pfeffer (1998) proposes that there is evidence demonstrating that effectively managed people can produce substantially enhanced economic performance. Pfeffer extracted from various studies, related literature, and personal observation and experience a set of seven dimensions that seem to characterize most if not all of the systems producing profits through people. He named them the seven practices of successful organizations and they are: employment security, selective hiring of new personnel, self-managed teams and decentralization of decision making as the basic principles of organizational design, comparatively high compensation contingent on organizational performance , extensive training, reduced status distinctions and barriers, including dress, language, office arrangements, and wage differences across levels, and extensive sharing of financial and performance information throughout the organization.

Effect of Training and Development on Employee Productivity

McGhee (1997) stated that an organization should commit its resources to a training activity only if, in the best judgment of managers, the training can be expected to achieve some results other than modifying employee behavior. It must support some organizational goals , such as more efficient production or distribution of goods and services, product operating costs, improved quality or more efficient personal relations is the modification of employees behavior affected through training should be aimed at supporting organization objectives.

Effect of Training and Development on Employee Motivation

Motivation is concerned with the factors that influence people to behave in certain ways. Arnold etal (1991), have listed the components as being, direction-what a person is trying to do, effort- how hard a person is trying to and persistence- how long a person keeps on trying. Motivating other people is about getting them to move in the direction you want them to go in order to achieve a result, well motivated people are those with clearly defined goals who take action that they expect will achieve those goals. Motivation at work can take place in two ways. First, people can motivate themselves by seeking, finding and carrying out that which satisfies their needs or at least leads them to expect that their goals will be achieved. Secondly, management can motivate people through such methods as pay, promotion, praise and training (Synderman 1957). The organization as a whole can provide the context within which high levels of motivation can be achieved training the employees in areas of their job performance.

Effect of Training and Development on Competitive Advantage

Competitive advantage is the essence of competitive strategy . It encompasses those capabilities, resources, relationships, and decisions, which permits an organization to capitalize on opportunities in the marketplace and to avoid threats to its desired position, (Lengnick-Hall 1990). Boxall and Purcell (1992) suggest that ‘human resource advantage can be traced to better people employed in organizations with better processes.’ This echoes the resource based view of the firm, which states that ‘distinctive human resource practices help to create the unique competences that determine how firms compete’ (Capelli and Crocker- Hefter, 1996). Intellectual capital is the source of competitive advantage for organizations. The challenge is to ensure that firms have the ability to find, assimilate, compensate, and retain human capital in shape of talented individual who can drive a global organization that both responsive to its customer and ‘the burgeoning opportunities of technology’ (Armstrong, 2005)

Effect of Training and Development on Customer Relations

William Edward Deming , one of the quality Gurus defines quality as a predictable degree of uniformity and dependability at low costs and suitable to the market, he advises that an organization should focus on the improvement of the process as the system rather than the work is the cause of production variation (Gale 1994). Many service organizations have embraced this approach of quality assurance by checking on the systems and processes used to deliver the end product to the consumer. Essentially this checks on; pre-sale activities which encompass the advice and guidance given to a prospective client, customer communications ( how well the customers are informed of the products and services, whether there are any consultancy services provided to help the customers assess their needs and any help line available for ease of access to information on products), the speed of handling a client’s transactions and processing of claims, the speed of handling customers calls and the number of calls abandoned or not answered, on the selling point of Products/Services a customer would be interested to know about the opening hours of the organization, the convenience of the location and such issues (Gale 1994). This is only possible when employees are well trained and developed to ensure sustainability of the same.

Armstrong, M (1998): Human Resource Management: Strategy and Action, Irwin, Boston
Betcherman, G., K. McMullen and K. Davidman (1998), Training for the New Economy: A Synthesis Report, Canadian Policy Research Network, Ottawa, pp. 117
Cascio, W. F. (1995). Whither industrial and organizational psychology in a changing world of work?American Psychologist, 50, 928—939
Harrison Rosemary (2005). Learning and Development.CIPD Publishing. pp. 5
Huselid, M. A. (1995) The impact of human resource management practices on turnover, productivity and corporate financial performance, Academy of Management Journal, 38(3), 635-672
Kelly D, (2001), Dual Perceptions of HRD: Issues for Policy: SME’s, Other Constituencies, and the Contested Definitions of Human Resource Development,
Lado, A., & Wilson, M. (1994) Human resource systems and sustained competitive advantage: A competency-based perspective, Academy of Management Journal, 19(4), 699-727
Learner, R. (1986).Concepts and Theories of Human Development (2nd ed.). New York: Random House).
Nadler, Leonard (1984). The Handbook of Human Resource Development (Glossary). New York: John Wiley & Sons.
Pfeffer J., (1998), The Human Equation; Building Profits by Putting People First, HBS press, Boston
Tessema, M. and Soeters, J. (2006) Challenges and prospects of HRM in developing countries: testing the HRM-performance link in Eritrean civil service, International Journal of Human Resource Management, 17(1), 86 -105

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Leadership identity development, meaning-making and the intersection of marginalized social identities: a scoping review

Journal of Leadership Education

ISSN : 1552-9045

Article publication date: 18 April 2024

The current paper is part of a larger scoping review project investigating the intersection of leader(ship) identity development and meaning-making. In this review, we analyzed 100 articles to determine the current extent of literature that covers the intersection of leader(ship) identity development, meaning-making and marginalized social identities.

Design/methodology/approach

A review of the extant literature is included, and a conceptual model is suggested for further exploration into this critical and under-researched domain.

More research is needed at the intersection of leadership identity development, meaning-making and marginalized social identities.

Originality/value

As this area of study has expanded, scholars have noted an absence of research on the effect of multiple social identities, especially marginalized identities, on meaning-making and leadership identity construction.

Social identity
Meaning-making
Leadership pedagogy
Leadership identity development
Leader identity development

Orsini, J. and Sunderman, H.M. (2024), "Leadership identity development, meaning-making and the intersection of marginalized social identities: a scoping review", Journal of Leadership Education , Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/JOLE-01-2024-0020

Emerald Publishing Limited

Published in Journal of Leadership Education . This article is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this article (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode

Introduction

Identity theory has been an important area of study in the field of leadership development since the turn of the century ( Vogel, Reichard, Batistič, & Černe, 2021 ). Lord and Hall (2005) suggested that a leader’s self-identity was essential to leadership development because it (1) was an essential structure for organizing knowledge, (2) motivated leaders to engage in leadership situations and (3) provided cognitive resources, such as stories or core values, for leaders to engage potential followers. Day and Harrison (2007) described leader(ship) identity as the subcomponent of one’s identity related to “how one thinks of oneself as a leader” and maintained that it was critically important in the “ongoing and continuous development of a leader” (p. 365). Within the field of leadership education, understanding leader(ship) identity development has been identified as one of the most critical aspects of student leadership development ( Komives et al. , 2009 ).

Before proceeding further, it is necessary to note the distinction between a leader and a leadership identity. Several critical works in the leadership literature have distinguished these terms ( Day, 2000 ; DeRue & Ashford, 2010 ; Miscenko, Guenter, & Day, 2017 ). Leader identity involves how one thinks of oneself as a leader. An individual’s self-definition of leadership identity is established through a personal narrative that creates meaning over time ( Miscenko et al. , 2017 ). In contrast, leadership identity is a dynamic process that involves shifting identities following social interactions. While leader identity focuses on the individual’s cognitive internalizations regarding experiences, leadership identity also emphasizes the relational recognition of leadership roles and collective endorsement of leadership activity ( Day, 2000 ; DeRue & Ashford, 2010 ). The current study aimed to investigate the connection between meaning-making and all forms of leader(ship) identity development, regardless of operationalization distinctions. Therefore, we employ the term “leader(ship) identity development” to represent the inclusion of both leader identity development and leadership identity development in this study.

Research has shown that leader(ship) identity development is an outcome of meaning making (sense-making) or how people make meaning of their experiences ( Lord & Hall, 2005 ; Hammond, Clapp-Smith, & Polanski, 2017 ; Zaar, Van Den Bossche, & Gijselaers, 2020 ). In the meaning-making process, identity is critically important because it serves as the primary mechanism through which meanings take form and inform identity work ( Hammond et al. , 2017 ; Weick, 1995 ). In leadership education, meaning-making has been noted as imperative to student development and shown to be reciprocally linked to the development of a leader(ship) identity ( Day & Dragoni, 2015 ; McCain & Matkin, 2019 ; Miscenko et al. , 2017 ). The broader scoping review referenced in this paper is being conducted in response to the importance of meaning-making to the leader(ship) identity development process and the call for more integrative theorizing regarding leadership and identity literature ( Sunderman & Orsini, In Press ; DeRue & Ashford, 2010 ).

However, research into leader(ship) identity development typically has only addressed a single dimension of identity and not intersecting social identities such as race or gender. ( Abes, Jones, & McEwen, 2007 ; Jones & McEwen, 2000 ; McCain & Matkin, 2019 ; Renn, 2007 ). Social identities shape individuals' self-concept as individuals derive meaning from their membership in a social group based on the perceived emotional significance or value attached to that group membership ( Tajfel, 1982 ; Workman, Hull, Hartsell, & Weimann, 2020 ). Consequently, social identities impact how individuals see themselves and are seen by others. The effect of social identities is imperative for developing leader(ship) identity because individuals' sense of self can change depending on the context in which they are leading. For example, several authors ( Abes, 2012 ; Duran, 2021 , etc.) have noted how perceptions of power differential in higher education can influence identity perceptions, how individuals make meaning of the relationships among multiple identities and overall student development for students with marginalized social identities. Given that, leadership scholars must acknowledge intersectionality of social identities to understand the role of privilege and power on leader(ship) identity development ( Duran, 2021 ; Jones, 2016 ; Workman et al. , 2020 ).

In response to the importance of identity theory to meaning-making and leader(ship) identity development scholarship, the current research sought to explore the literature at the intersection of leader(ship) identity development and meaning-making with a specific emphasis on marginalized social identities. The objectives of this project were to (1) explore literature found within the broader scoping review on leader(ship) identity development and meaning making that discusses marginalized social identities and (2) identify key characteristics of scholarship at the intersection of leader(ship) identity development, meaning-making and intersectionality of marginalized social identities. We seek to contribute to the existing literature by synthesizing the relevant articles published in this space and offering a conceptual model for future research that incorporates all three critical components of leadership development. We hope that the synthesized findings contribute to increased clarity around the role of meaning-making and social identities in leader(ship) identity development and provide specific implications for scholars and practitioners, helping to develop future research directions.

Scoping review

The current study analyzed articles selected through a scoping review methodology. The articles were identified for a project investigating the intersection of leader(ship) identity development and meaning making ( Arksey & O’Malley, 2005 ; Sunderman & Orsini, In Press ; Munn et al. , 2018 ). Scoping reviews aim to articulate key concepts of a research area and are used when the topic is complex and needs to be comprehensively reviewed ( Arksey & O’Malley, 2005 ). Munn et al. (2018) present six indicators for the appropriateness of a scoping review: (1) to identify the types of available evidence in a given field, (2) to clarify key concepts, (3) to examine how research has been conducted, (4) to identify essential characteristics, (5) as a precursor to a systemic review and (6) to identify and analyze knowledge gaps. For the current study, the primary goals were to examine how research has been conducted, identify key characteristics and analyze knowledge gaps, particularly around the intersectionality of social identities in leader(ship) identity development.

Identification of sources. As with the broader scoping review on exclusively leader(ship) identity development and meaning-making, we conducted the search process for the current scoping review using four search strings with no date-range limitations. The search phrases were a combination of four terms: ([“leadership identity development” AND “meaning making”] AND [“leadership identity development” AND “sense-making”] AND [“leader identity development” AND “meaning making”] AND [“leader identity development” AND “sense-making”]). Searches were conducted between December 27, 2020 and January 8, 2021, on Google Scholar and EBSCO Academic Search Premier. Google Scholar covers a wide array of information, and EBSCO Academic Search Premier (ASP) has returned more scholarly chapters than other academic databases ( Vinson & Welsh, 2014 ). We organized the search to look for search terms anywhere in the text, which resulted in 119 total documents, of which 100 were found to be peer-reviewed journal articles that were retained for the study.

Coding process to produce articles from broader scoping review. The articles in the broader scoping review were analyzed and coded by a two-person research team. First, the articles were read, analyzed and coded independently. The research team held several meetings to review the coding and used peer debriefing to confirm the validity of the coding by consensus. Ary, Jacobs, Irvine, and Walker (2014) suggest that “validity based on consensus is…agreement among competent others that the description, interpretation, evaluation and thematics are correct” (p. 532). We compiled the results in a Microsoft Excel file containing the article's (1) title, (2) author, (3) year published, (4) knowledge contribution, (5) summary, (6) research codes (i.e. 1. “leader identity development” in general; 2. “meaning making” in general; 3. the importance of leader(ship) identity development; 4. the importance of meaning making and 5. the explicit connection between leader identity development and meaning-making), (7) central theories related to development and (8) central theories related to identity, learning, leader(ship) identity development and meaning-making. We used these codes because we wanted to differentiate between those articles that only generally discussed LID or meaning-making from those that more deeply elaborated their importance and associated outcomes and also from those that explicitly discussed the intersection of the two concepts. Once we completed the initial coding, the research team went back through the articles to determine which fulfilled the following two requirements: (1) coded as having an explicit connection between leader(ship) identity development and meaning-making and (2) referenced the intersectionality of marginalized social identities with leader(ship) identity. Three tables were constructed to (1) share the specific titles that were selected and their associated codes; (2) identify the central theories behind conceptual models promoting the connection between leader(ship) identity development, meaning-making and marginalized social identities and (3) identify the primary methodology used in these articles.

Of the 100 articles in the broader scoping review, 30 included marginalized identities as a variable. Of those 30 articles, only 12 included an explicit connection between leader(ship) identity development and meaning-making, which were requirements for inclusion in the current study. The 12 article titles, year of publication, authors and coding from the scoping review can be seen in Table 1 . The articles were published in ten journals, with only the Journal of Leadership Education and the Journal of College Student Development having more than one (two each). The marginalized identities investigated in these papers included gender (9), race/ethnicity (7), sexual orientation (2) and nationality (1).

Seven of the 12 papers specifically addressed multiple marginalized identities and how the intersectionality of those identities influenced leader(ship) identity development and meaning-making. All but two of the papers were published since 2014 (2007–2008), with six published since 2019, suggesting that researchers are beginning to focus more on the intersection of leadership identity, meaning-making and marginalized social identities.

Analysis of methodology

None of the reviewed articles included quantitative methodology. One article was a conceptual paper and the other was a literature review. The ten remaining articles used qualitative methods. Of the papers using qualitative methodology, four used a case study approach, and two used a phenomenological approach. Narrative inquiry, collaborative autoethnography, content analysis and grounded theory were each utilized in one article. The largest sample size was the content analysis, which included 510 participants, with the others ranging from one to 35. Five papers included longitudinal studies, each lasting at least one year, with the longest being conducted over two years. The most common study participants were undergraduate students (6) and teachers (2), while healthcare professionals and doctoral students were studied once each.

There were several data collection strategies. Personal interviews were the most common data collection technique and were used in seven studies. Three studies used multiple interviews, two of which also used focus groups. The next most common technique was guided written reflection, which was utilized in three studies. Open-ended survey questions were used in one study. The one collaborative autoethnography study used document analysis, self-written narratives and group meaning-making sessions. Notably, seven of the studies used either multiple data collection techniques or multiple time points for collecting data. One of theadvantages of qualitative methodologies when investigating the complex intersection of leader(ship) identity development, meaning-making and marginalized social identities are that humans often understand who they are by creating stories of the self ( McAdams, 1993 ). These stories of the self-change over time and in different groups as social identities become more or less salient, suggesting that identity development is constantly reconstructed via narration throughout an adult’s life ( McAdams & de St. Aubin, 1998 ). Given the flux in identity development, methodologies that allow for written or verbal critical reflection, primarily through storytelling, can be extremely valuable in dissecting the complicated intersection of leader(ship) identity, meaning-making and marginalized social identities.

Primary theories and articles cited to support conceptual models

Three primary research areas served as the theoretical support for the articles in the current scoping review, including leader and leadership identity development, learning and meaning-making and identity and developmental models.

Leadership and leader(ship) identity development theories. The most-cited theory in the current study was the leadership identity development (LID) theory and model proposed by Komives, Owen, Longerbeam, Mainella, and Osteen (2005 , 2006 , 2009) . The research team that developed the LID model produced several articles on this topic, and the 2005 theory and 2006 model were each cited in six papers (eight times total). Other theories of leader(ship) identity development that were often discussed include the following, which were each cited three times: (1) DeRue and Ashford’s (2010) theory of leadership identity construction; (2) Day, Harrison, and Halpin (2008) and Day and Harrison (2007) integrative multilevel identity-based approach to leadership development and (3) Lord and Hall’s (2005) theory of the influence of learning and expertise on leadership development. Kezar and Moriarty’s (2000) study on leadership development in the context of gender and ethnic identity was also heavily cited in three of the articles. For example, Onorato and Musoba (2015) used Kezar and Moriarty (2000) to demonstrate how gender and ethnicity affect the development of leadership skills because leadership is socially constructed. Other articles cited at least two times include the following: (1) Epitropaki, Kark, Mainemelis, and Lord’s (2017) review of leadership and followership identity processes; (2) Hogg’s (2001) social identity theory of leadership; (3) Zheng and Muir’s (2015) multifaceted model of leader identity development; (4) Onorato and Musoba’s (2015) paper on Hispanic women leadership identity development; (5) Renn and Bilodeau’s (2005a , b) work on queer and LGBT student leadership identity development and (6) Van Knippenberg, van Knippenberg, De Cremer, and Hogg’s (2004) review on leadership, self and identity.

Beyond leader(ship) identity development theories, other works in the leadership space that were cited in at least three different papers in this study included (1) Arminio et al. ’s (2000) leadership experiences of students of color, (2) Ely, Ibarra, and Kolb’s (2011) work on accounting for gender in the development of leadership programs and (3) Day’s (2000) review of leadership development. Several leadership studies were cited in at least two papers, most notably Dugan and Komives’s (2007) work on developing leadership capacity in college students, Dugan, Komives, and Segar’s (2008) paper on college student capacity for socially responsible leadership and several papers on transformational leadership (cited seven times) or implicit leadership theory (cited three times). For example, Leigh et al. (2021) cited transformational and implicit leadership theories to differentiate between activism and leadership by contrasting the incremental sanctioned change paradigm of leadership with the “in your face” actions of activism, which can lead individuals to reject personal activist identities.

Learning and meaning making. While the phrases “learning” and “meaning making” can be used interchangeably, it is important to note that they are distinct processes. While meaning-making focuses on individual interpretation, learning centers on knowledge acquisition. According to Zittoun and Brinkman (2012) , learning theories are related to acquiring knowledge and skills that allow learners to act, think and feel in ways individuals identify as important. Meaning-making theories, however, are “the process by which people interpret situations, events, objects or discourses in light of their previous knowledge and experience” ( Zittoun & Brinkmann, 2012 , p. 1).

The most common learning theory cited in the current scoping review was transformative learning theory, which was included in three articles. Several authors were cited in this space, including Brooks (2000 , three times), Kegan (2000 ; two times), Brown (2004 ; two times) and several authors, most notably Mezirow (2009) , were cited one time. Although experiential learning theory was one of the most frequently cited learning theories in the broader scoping review, we were surprised to discover that it was not discussed in any of the articles in the current scoping review ( Sunderman & Orsini, In Press ). Notably, experience in a learning context was only discussed as a part of the meaning-making process of transformation. For example, Collay and Cooper (2008) connected transformational learning with Magolda’s (1998) theory of self-authorship to demonstrate that women do not often participate in transformational learning in graduate education because they require a narrative process in which they can share stories in a safe context to claim their leadership voice.

In the current study, conceptual support for meaning-making came from a diverse group of articles. The most often referenced work was Kegan (1982 , 1994) , which was referenced in five different articles. Kegan’s theory of the evolution of consciousness is often viewed as both a meaning-making and a developmental theory; however, these articles used it to describe how people make meaning of their experiences. Abes and Jones (2004) and Abes et al. (2007) were each referenced in two articles as models of meaning-making and identity. Petriglieri and Petriglieri’s (2010 , 2011) articles on identity work and Koenig Kellas and Kranstuber Horstman’s (2015) and Koenig Kellas’s (2017) model of narrative sense-making were cited in two articles. For example, one article used communicated narrative sense-making (CNSM) as a unique method for understanding how identity is created through family storytelling and how this influences leader(ship) identity development ( Koenig Kellas and Kranstuber Horstman, 2015 ; McCain & Matkin, 2019 ). Finally, Magolda (1998 , 2004 , 2008 , 2009) has several articles published on the concept of self-authorship and meaning-making that were included in two papers as well.

Identity and developmental models. Several identity and development theories were referenced in the 12 articles in the current scoping review. Tajfel (1982) , the original theoretician of social identity theory, was only cited once, although the concept of social identity theory was referenced through other citations in a total of five articles ( Hogg, 2001 ; Jenkins, 2014 ; Ostick & Wall, 2011 ; Van Knippenberg & Hogg, 2003 ). The next most-cited identity and developmental model across multiple articles was the model of multiple dimensions of identity (MMDI) ( Abes & Jones, 2004 ; Abes et al. , 2007 ; Jones, 1997 ), which was referenced in three articles as an identity development model and a meaning-making model. For example, Miller and Vaccaro (2016) referenced MMDI to demonstrate that a person's identity is dynamic and shaped by multiple identities that influence how queer students of color make meaning of their campus leadership experiences.

Adult development models were the least cited in the 12 articles. Although Kegan's work (1982–1994) was referenced in five papers, it was used predominantly as a meaning-making model. Magolda's (2004 , 2008) theory of self-authorship and McCauley, Drath, Palus, O'Connor, and Baker’s (2006) constructive developmental theory were referenced in two articles. For example, Workman et al. (2020) used Magolda's work to demonstrate how women rely on narratives and storytelling to make meaning of their experiences. Arnett’s (2000 , 2001) theory of emerging adulthood, D’Augelli’s (1994) life span model of sexual orientation identity development and Erikson’s (1950 , 1968) theory of psychosocial development were each cited in one article.

In applying the LID model, leadership educators must also acknowledge the ways leadership identity intersects with other dimensions of identity, such as race, culture, sexual orientation, gender, disability, religion and social class. A challenge in using the LID model is recognizing this intersectionality ( Collins, 1998 ) and how students’ multiple identities shift in relative salience depending on context and relationships ( Abes et al. , 2007 ). If, as social constructionist approaches to identity development posit, identity is socially, historically, politically and culturally constructed ( Weber, 2001 ), these factors must be considered in LID application and research (p. 13).

Given this call for action and the heavily cited LID theory and model ( Komives et al. , 2005 , 2006 ), it is surprising that only in the last few years have many of the articles at the intersection of leader(ship) identity development, meaning-making and marginalized identities been published. As scholars and practitioners, we must not examine leadership identity without considering other dynamic social identities and how they influence meaning-making. An individual’s social identities are continually changing, particularly among young adults and often include multiple subidentities related to different social roles that vary depending on the centrality of that particular identity over time ( Day & Harrison, 2007 ; Markus & Kunda, 1986 ). The connection of social identities to leadership identity has a significant impact on leader(ship) identity development research because identity “is the primary site where meanings materialize that inform and constrain identity and action” ( Weick, Sutcliffe, & Obstfeld, 2005 , p. 409). Given that the development of leader(ship) identity is grounded in meaning-making and social identities are central to our self-narratives, researchers must include the social identity lens when exploring the development of leader(ship) identity, particularly among developing adults ( Leigh et al. , 2021 ). Given these findings, we have three recommendations for leadership scholars moving forward:

Recommendation 1

We recommend that leadership scholars continue to employ longitudinal, qualitative methodologies in analyzing the intersection of marginalized social identities, meaning-making and leader(ship) identity development that employ multiple data collection techniques. One primary suggestion would be to conduct studies with larger sample sizes that collect multiple types of qualitative data. For example, Zaar et al. (2020) collected open-ended survey questions from 510 undergraduate students. Although their responses provided strong support for the role of meaning-making in developing leader identity among college-age students, researchers were only able to address the internal cognitive schema of students at one point in time. Without longitudinal data, the researchers could not consider how social interactions with peers may have changed or influenced participant responses in a setting like a focus group.

Understanding the connection between multiple identities, how social interactions influence those identities over time and, finally, how students make meaning of those leadership experiences is an important and understudied area of research in leadership education. For example, DeRue and Ashford (2010) , in their highly influential study on leadership identity construction, suggested that because leadership involves groups of people engaged in mutual influence, scholars must integrate individual internalization, relational recognition and collective endorsement to fully capture the leader(ship) identity process.

Recommendation 2

The central prediction from the social identity theory of leadership is that as people identify more strongly with a group, the basis for leadership perceptions, evaluations, and endorsement becomes increasingly influenced by prototypicality. As a result, prototypical members are more likely to emerge as leaders, and more prototypical leaders will be perceived to be more effective (p. 191).

The actual complexity of multiple, partially overlapping group memberships may or may not be reflected in the individual's subjective representation of his or her multiple identities...When an individual acknowledges and accepts the non-overlapping memberships of multiple ingroups, their subjective identity structure is more inclusive and complex (p. 89).

Understanding how individuals make meaning of their multiple marginalized identities and how they influence leader(ship) identity development requires an investigation into their views on leadership (e.g. the relational and collective claiming and granting of leadership by their group) and an understanding of their meaning-making capacity ( Abes et al. , 2007 ; Hogg, 2001 ; King & Baxter Magolda, 2005 ; Kegan, 1994 ; Roccas & Brewer, 2002 ).

Recommendation 3

Several articles analyzed in this review call for leadership scholars to address issues of intersectionality in leadership research. Intersectionality is a concept derived from Black feminist thought that recognizes how interlocking systems of oppression influence an individual’s social identities and beliefs about their experience of race, gender and other marginalized identities ( Crenshaw, 1989 ; Shields, 2008 ). Shields (2008) states, “The specific definition of intersectionality varies by research context, but a consistent thread across definitions is that social identities which serve as organizing features of social relations, mutually constitute, reinforce, and naturalize one another” (p. 301). In other words, intersectionality recognizes how interlocking systems (e.g. sexism or racism) influence groups of people ( Crenshaw, 1989 ; Shields, 2008 ). For example, Leigh et al. (2021) explains that “intersectionality connects the experiences of Black women as different than the experiences of both white women and Black men due to specific ways that racism and sexism shape the Black woman experience” (p. 177). Intersectional analyses reject treating social identities as separate and instead emphasize the mutual reinforcement and links between social identities and systems of oppression ( Leigh et al. , 2021 ). Collins (1990 , 2000) and others have indicated that understanding individuals’ social location and the context of power relations embedded in social identities is critical to “transform and advance empirically-based research in psychology and allied disciplines, especially through using conventional empirical strategies in innovative ways to investigate intersectionality” ( Shields, 2008 , p. 302).

Anti-categorical approach: The anti-categorical approach can include ethnography, genealogy and deconstruction as research methodologies. Sutherland (2018) = noted that positivist methodology has historically dominated leadership research, and there is a need for new approaches to leadership scholarship. Anti-categorical methodologies emphasize the value of the power dynamics that allow socially dominant groups to define social categories and give them meaning ( Breslin et al. , 2017 ).

Intra-categorical approach: Methodologies used by researchers who adopt this approach include personal narratives, single-group studies and case studies, which are currently common in leadership research ( Breslin et al. , 2017 ). The broader scoping review on leader(ship) identity development and meaning-making also supported the need for more narrative work in leader(ship) identity development ( Sunderman & Orsini, In Press ).

Inter-categorical approach: This approach differs from the previous two because the research focuses on multiple groups, generally using (but not always) comparative quantitative data. Several challenges are associated with this approach, the largest being the struggle to find adequate sample sizes so that statistical methods can detect significant effects and issues regarding a lack of variability in the sample population ( McCall, 2005 ). However, at the time of the review on intersectionality in public leadership ( Sutherland, 2018 ), scholars had yet to attempt an inter-categorical approach to investigating intersectionality in a leadership context ( Breslin et al. , 2017 ). Therefore, leadership scholars have an opportunity to expand our understanding of leader(ship) identity development and meaning-making in the context of marginalized identities using quantitative data, allowing this work to expand into the most respected mainstream psychology journals ( Shields, 2008 ).

Including perspectives of intersectionality in this context is urgent because “it gets researchers to go beyond the individually informed perspective that we each inevitably bring to our scholarship and science” ( Shields, 2008 , p. 309). Research undertaken from this perspective can help to inform public policy and discourse and prepare future leaders for enacting positive social change ( Shields, 2008 ).

Conceptual model and directions for future research

Finally, we suggest that leadership scholars consider a conceptual model, a combination of several different theories central to this scoping review, as a basis for beginning to unravel the complexities of marginalized social identities, multiple overlapping identities, meaning-making and leader(ship) identity development (see Figure 1 ). This conceptual model has several parts:

Moving from left to right, the first section of this model represents a person’s lived experiences within the group context in which they are currently operating. Several leadership scholars as well as scholars in teamwork and team learning behavior, have pointed out that group context heavily influences human learning and decision-making ( Hogg, 2001 ; Van Knippenberg & Hogg, 2003 ).

The model also includes a meaning-making lens. Meaning-making is essential to consider because a person’s meaning-making capacity makes it possible for them to perceive relationships among varied social identities and how individuals make meaning of those identities in different contexts ( Abes et al. , 2007 ). It is important to note that our meaning-making capacity is highly impacted by stages of human and cognitive development and our salient social identities ( Abes et al. , 2007 ; Kegan, 1982 ).

The next part of the model includes intersecting circles, first proposed by Jones and McEwen (2000) . The circles intersect to demonstrate that the identity dimensions are dynamic and interconnected. The closer the black circle on the ring is to the central personal identity of an individual, the more salient the identity is to the person in that context or at that time ( Jones & McEwen, 2000 ).

The last section is adapted from DeRue and Ashford’s (2010) leadership identity construction process. In this process, people co-create “reciprocal and mutually reinforcing identities as leaders though a claiming and granting process” (DeRue & Ashford, p. 628). A person’s internalization, relational recognition, and collective endorsement are all influenced by individual meaning-making and the saliency or prototypicality of identities in the group. It is important to note that the claiming and granting process influences the group context. Therefore, this is a temporal model where claiming and granting leader identity is both an output and an input to future meaning-making processes. We encourage scholars who use or adapt the proposed model to utilize methods that collect data at multiple points because elements of group processes, such as cohesion and psychological safety, will also influence how this process develops.

Limitations

The primary limitation of the current project is that leader(ship) identity development, meaning-making and marginalized identities have many different names and descriptions used in the literature. For example, DeRue and Ashford’s (2010) pivotal article uses the term leadership identity construction, so it was not included in the complete list of the scoping review. A systematic literature review on the full spectrum of all leadership identity literature may still be necessary to capture the breadth of this large and diverse area of research.

Numerous studies have demonstrated that individuals with marginalized identities make meaning of their leadership experiences and identify leadership differently than individuals with more prototypical identities ( Collay & Cooper, 2008 ; Leigh et al. , 2021 ; Haber-Curran & Sulpizio, 2017 ; Ryan et al. , 2020 ; Zaar et al. , 2020 ). Despite this understanding, few publications have investigated the intersection of leader(ship) identity development, meaning-making and marginalized social identities. Given the increase in diversity among college students and the fact that middle-class white men dominate leadership scholarship, leadership scholars must place more emphasis on understanding leader(ship) identity development and meaning-making in the context of marginalized social identities ( Chen, 2017 ; Dugan, 2017 ; Leigh et al. , 2021 ; Wilson & Johnson, 2015 ). In that context, this paper contributes to the national leadership education research agenda, priority five, which specifically calls for the centering of social identity in leadership research. The inclusion of social identities in leader(ship) identity development research is especially critical for leadership educators, as they utilize inclusive practices to teach graduate and undergraduate students, many of whom will have at least one marginalized social identity ( Chunoo, Beatty, & Gruver, 2019 ; Jenkins & Owen, 2016 ). The results of the current scoping review argue for the criticality of including marginalized social identities when discussing leader(ship) identity development and meaning making in both scholarship and practice.

Proposed conceptual model for exploring the intersection of leader(ship) identity development, meaning-making and multiple marginalized social identities

Articles from scoping review that include connections between meaning-making, leader(ship) identity development and marginalized social identities

Note(s): Coding: (1) “leader identity development” in general; (2) “meaning making” in general; (3) the importance of leader(ship) identity development; (4) the importance of meaning making and (5) the explicit connection between leader identity development and meaning-making)

Source(s): Table provided by authors Sunderman and Orsini (in press)

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A Literature Review of Pandemics and Development: the Long-Term Perspective

Original Paper
Published: 27 January 2022
Volume 6 , pages 183–212, ( 2022 )

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Beniamino Callegari ORCID: orcid.org/0000-0001-5513-7299 1 , 2 &
Christophe Feder ORCID: orcid.org/0000-0002-1239-513X 3 , 4

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Pandemics have been a long-standing object of study by economists, albeit with declining interest, that is until COVID-19 arrived. We review current knowledge on the pandemics’ effects on long-term economic development, spanning economic and historical debates. We show that all economic inputs are potentially affected. Pandemics reduce the workforce and human capital, have mixed effects on investment and savings, but potentially positive consequences for innovation and knowledge development, depending on accompanying institutional change. In the absence of an innovative response supporting income redistribution, pandemics tend to increase income inequalities, worsening poverty traps and highlighting the distributional issues built into insurance-based health insurance systems. We find that the effects of pandemics are asymmetric over time, in space, and among sectors and households. Therefore, we suggest that the research focus on the theoretical plausibility and empirical significance of specific mechanisms should be complemented by meta-analytic efforts aimed at reconstructing the resulting complexity. Finally, we suggest that policymakers prioritize the development of organizational learning and innovative capabilities, focusing on the ability to adapt to emergencies rather than developing rigid protocols or mimicking solutions developed and implemented in different contexts.

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Introduction

As the COVID-19 emergency appears to slowly and unevenly recede in the wake of medical breakthroughs and the development of more effective prevention and treatment protocols, the question of the long-term impact of the pandemic grows more urgent. There is little doubt that this global health crisis found economists mostly unprepared, as the analysis of the pandemic’s effects has hardly found its way into the discipline’s most central publication avenues (Noy and Managi 2020 ). However, this does not mean that the economic analysis of pandemics is starting from scratch, as economists and economic historians have never ceased to expand our knowledge on the subject.

The connection between pandemics and economic theory has historically been so relevant that it has directly contributed to labeling economics as the ‘dismal science’. Cipolla ( 1974 ) illustrates how reflections on the plague and its consequences led many scholars to develop Malthusian ideas on the complex long-term relationships between population growth, economic growth, and diseases, well in advance of the Essay on the Principle of Population (Malthus 1798 ). However, the Industrial Revolution and the concomitant development of medical knowledge led to a decreased incidence of catastrophic plagues in the West, and a corresponding decline in the interest in pandemics on the part of economists (Easterlin 1995 ). The demographic boom of the West and the visible lack of corresponding pestilence and famine further discredited Malthusian perspectives, leading to a disconnection between the demographic and economic disciplines. Furthermore, from 1900 to 2019, pandemics were either eclipsed by more disruptive events or had a relatively limited economic impact (Garrett 2008 ; Lee and McKibbin 2004 ; Noy and Managi 2020 ). Finally, the marginalist revolution greatly focused economists’ attention on purely economic elements, eliminating from the discipline those elements perceived as spurious, like the study of pandemics’ effects (Schumpeter 1954 ), relegating it to a debate of mainly historical interest.

The expansion of economic analysis beyond its traditional boundaries that has occurred in the last two decades has gradually re-included the consequences of pandemics within economic theory, although most contributions remain on the periphery of academic debate and are relatively hidden (Arora 2001 ; Dunn 2006 ; Weil 2014 ). As Noy and Managi ( 2020 ) observed, the inherently multidisciplinary nature of pandemics, combined with its poor fit with what are called “hard” methods, have both conspired to make the contribution made by economists to the analysis of pandemics modest. The efforts of economists have been greatly augmented by the continuous work done by economic historians to understand the impact of past pandemics on the long-term development of various socioeconomic systems. Yet, while the total contribution to the economic analysis of the long-term impact of pandemics is significant, it is scattered across different journals, disciplines, academic approaches, and debates, making a review work necessary in order for all these contributions to become accessible.

This paper reviews the long-term economic effects of pandemics, defined as health shocks arising from infectious diseases with global diffusion. Within the definition of long-term effects, we include both those mechanisms that are immediately present and persist for a significant amount of time and those effects that arise in the long term. Due to the focus of our analysis, transient short-term effects are not part of our study. To the best of our knowledge, few literature reviews have studied the connection between pandemics and economic development. Bleakley ( 2010 ) critically reviews how diseases, rather than pandemics specifically, affect human capital formation and income growth at the micro and macro levels. Costa ( 2015 ) describes how health improvements affect economic growth, with a specific focus on the US, concluding that improved health is not sufficient to foster growth. Finally, Boucekkine et al. ( 2008 ) formally analyze how and which growth models are better able to mathematically describe the epidemics’ effects. Moreover, some scholars have also reviewed the long-term economic effects of particular health shocks, like the preindustrial epidemics (Alfani 2021 ), Spanish flu (Beach et al. 2021 ), HIV (Gaffeo 2003 ; Zinyemba et al. 2020 ), and modern pandemics (Bloom et al. 2021 ). We differ from these works because we analyze the long-term impact of pandemics in general on economic development. A similar approach has been adopted by Gries and Naudé ( 2021 ) and Callegari and Feder ( 2021a ), but with an entrepreneurship and not a macroeconomic focus.

Our broad approach has led us to review a large number of studies in order to identify recurrent results across very different pandemic events. Pandemics could affect aggregate demand, aggregate supply, and productivity growth (Basco et al. 2021 ; Dieppe 2021 ; Guerrieri et al. 2020 ; Jinjarak et al. 2021 ; Rassy and Smith 2013 ; World Bank 2020 ). Recalling the Solovian framework, we divide the long-term pandemic economic effects into three categories: labor and human capital; investments and physical capital; and knowledge and innovation. We find that all productive inputs are affected in the long term by the pandemic. More specifically, labor and human capital are negatively affected directly by health shocks. However, the intensity of this effect is heterogeneous among countries, labor markets, and industries. Investments and physical capital are affected by pandemics through complex, interacting, and often contrasting mechanisms, leaving long-term effects ambiguous and usually marginal and non-linear. However, the asymmetric impact of pandemics on the capital market and household income leads to the poverty trap and highlights the weakness of the health insurance system in coping with these shocks. Finally, pandemics could positively affect innovations in public and private institutions and bring about relevant technological changes in industries. The scope and direction of these socioeconomic changes appear to mediate the long-term effects of pandemics, determining both their direction and scope. However, relevant and radical institutional changes are necessary if the impact of pandemics on development is to be positive. We therefore suggest that scholars should develop meta-analysis to understand the complex tapestry of long-term pandemic mechanisms. Many policy implications follow directly: an efficient public intervention must be characterized in the long term by flexibility, pro-market orientation, and design customization.

The paper is structured as follows. Section 2 explains the selection methodology used in the review. Sections 3 , 4 , and 5 describe, respectively, the long-term effects of pandemics on: labor and human capital; investment and physical capital; and knowledge and innovation. Section 6 critically discusses the survey and summarizes the main lessons drawn from the literature for researchers and policymakers. Section 7 concludes.

Methodology

This literature review aims to illustrate, compare, and discuss the mechanisms through which pandemics affect long-term economic development. To achieve this goal, we adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology (Moher et al. 2009 ). First, we defined a list of keywords that express the main aspects of the “pandemic” and “economic development” concepts. Second, we identified which data sets to search: JSTOR, IDEAS/RePEc, Google Scholar, and EconLit. We excluded working papers and unpublished articles from our search, to ensure that the mechanisms presented are accepted by the scientific community. Moreover, we restricted our focus to the fields of economics and economic history, to ensure the economic relevance of the mechanisms described. Finally, we excluded papers focused on the COVID-19 pandemic, as it is too early for a comprehensive evaluation of its long-term effects. Applying these criteria, we obtained a first sample of more than 4800 potential articles. Important contributions were not missed due to excessively strict methodological adherence, we also parsed the references lists of the most influential contributions within our initial corpus, identifying in this way 178 additional relevant manuscripts to potentially include in our review.

From this corpus of potential articles, we operated a further selection by analyzing their abstracts and, in uncertain cases, by searching the main body of the paper concerned for evidence of relevant discourse, thereby identifying 805 potential contributions. We then proceeded to evaluate the selected articles for inclusion according to their relevance to our research topic and their relative originality, evaluated in terms of the mechanisms analyzed. We then proceeded to summarize the resulting papers according to their research questions and aims, their theoretical references, their methodology, and their results, focusing on the featured economic mechanisms, in order to identify the structure of our corpus in terms of the main debates, the empirical object of study, the methods applied, and the theoretical foundations. In this way, after eliminating redundant contributions, we selected 88 articles, each describing specific mechanisms through which pandemics may affect the economic system in the long term. Finally, we identified a criterion to organize the resulting mechanisms, inspired by the well-known Solovian model of long-term growth, dividing them into the following three broad categories: labor, capital, and innovation.

We then identified a corpus of high-quality contributions, each offering a specific contribution to the academic debate in terms of one or more relevant mechanisms, supported by either theoretical or empirical arguments. Figure 1 summarizes the main steps of the selection process by using a PRISMA diagram.

The PRISMA process

Labor and Human Capital

The most intuitive and direct effect of pandemics is the adverse shock to the population and the labor market. Delfino and Simmons ( 2005 ) propose a Lotka-Volterra model showing that a negative demographic effect could become persistent if the pandemic is not eradicated. The magnitude of this effect is, however, mediated by contextual factors. Alfani ( 2013 ) shows that, in southern Europe, the plagues of the XVII century had higher mortality and territorial pervasiveness compared with those affecting northern Europe in the same period and the southern Europe plagues of the previous century. Furthermore, the rate of mortality and territorial pervasiveness was heterogeneous among Italian regions and cities. Using a long-term perspective, Rodríguez-Caballero and Vera-Valdés ( 2020 ) find that pandemics reduced the unemployment rate persistently from 1854 to 2016 in Italy, Spain, the Netherlands, the UK, and the US. They also observe that, in the UK, pandemics reduced the GDP per capita over 1270–2019, and that this effect was increasingly persistent in the last 300 years. Fiaschi and Fioroni ( 2019 ) have built a model which shows how pandemics’ impact on growth trajectories is mediated by the production structure and the mortality reduction brought by technological progress. Bloom and Sachs ( 1998 ) observe that the mortality and morbidity of pandemics are highest in tropical regions. They explain that differences in climate and nature, together with anthropomorphic factors, affect the spread of the virus over the population. However, this direct effect on labor and population could decline in the long term.

The long-term effects of pandemics on the labor supply also depend on their impact on fertility. By analyzing 15 relevant infectious diseases from 75 countries between 1940 and 2000, Acemoglu and Johnson ( 2007 ) find that pandemics reduce demographic equilibria in the long term through their impact on fertility rates. Birth rates are influenced directly, as the pandemic reduces the number of fertile women, and indirectly, as future life expectancy influences decisions to have children in the long term. They empirically confirm that the higher mortality of those affected by infectious diseases sharply reduces births and slightly reduces the share of the young in the population because of their lower life expectancy. Lorentzen et al. ( 2008 ) show that a pandemic affects not only fertility, i.e. the number of births, but also the net fertility, i.e. the fertility of the surviving population. Parents care about the number of surviving newborns: higher infant mortality increases births. Moreover, parents invest time and money in their children, who become irreplaceable when they grow up. Therefore, higher adult mortality increases fertility, even more than infant mortality. Finally, given the family budget constraint, parents must choose between the quantity and quality of their children. Consequently, the uncertainty of the pandemic reduces the investment rent in human capital, leading parents to rationally prefer quantity to quality. The authors find empirical support for these hypotheses, observing that the probability of contracting malaria negatively affects adult and infant life expectancy, and that both expectations improve the fertility rate.

Fertility mechanisms interact with human capital accumulation. Lagerlöf ( 2003 ) describes an overlapping-generations model where adults confront the children’s quality-quantity trade-off. Infant survival is negatively affected by both the chance of random pandemics and population density, which both increase the risk of contagion, but is positively affected by human capital (higher medical knowledge), which is cumulative in time and positively affected by population density (knowledge spillovers). They find that, when pandemics are frequent, where the decision to have children is concerned, parents prefer quantity to quality; human capital does not increase; and population density remains low. When sufficient human capital has accumulated, however, the growth path of the economy is no longer affected by new pandemic waves. Consequently, only if, by chance, pandemics do not strike for a sufficiently long time, will parents then increase their investments in future generations, thus reaching the human capital threshold necessary to achieve robust growth trajectories. Gori et al. ( 2020 ) integrate all previously described mechanisms in a three-stage overlapping-generations growth model, including adolescent, adult, and elderly agents. In this model, only the elderly are sexually inactive and are, therefore, not exposed to HIV infection. The probability of dying from the pandemic is negatively associated with human capital endowment and positively associated with the number of virus-spreaders. The pandemic increases both infant and adult mortality. Adult mortality reduces both labor supply and life expectancy. If life expectancy is reduced below a certain threshold level, parents prefer to have more children; otherwise, they prefer to invest in human capital. Parameterizing the model for the Sub-Saharan African countries, Gori et al. ( 2020 ) find that HIV reduces labor supply and human capital but increases fertility. Cervellati and Sunde ( 2015 ) model an economy where parents confront the children’s quality-quantity trade-off, given the child mortality and the inborn ability of the offspring. Also in this model, higher human capital leads to an improvement in both medical care and adult life expectancy: intensive economic growth follows an initial quasi-stagnation. Cervellati and Sunde ( 2015 ) observe, like Lorentzen et al. ( 2008 ), that adult mortality and human capital affect the economic dynamics more than fertility and child mortality. Cervellati and Sunde ( 2011 ) combine Lorentzen et al. ( 2008 )‘s life expectancy effects on mortality and fertility with the Acemoglu and Johnson ( 2007 )‘s model and find non-monotonic patterns of demographic growth. Before the demographic transition, more newborns could compensate for higher mortality, leaving the overall demographic effect ambiguous; after the demographic transition, parents prefer quality over quantity in regard to children, making pandemic demographic effects definitively negative in the long term.

A pandemic’s negative demographic impact reduces the number of available workers. However, its long-term impact is mixed. Gori et al. ( 2020 ) and Dauda ( 2019 ) provide a comprehensive literature review of the complex link between HIV and growth. They conclude that, while strong evidence exists for a negative link at the micro level, the empirical support for the macro effects is weaker. Keogh-Brown et al. ( 2010 ) find four ways in which the pandemic can affect the work supply. Death and infection of workers result in a temporary reduction of the workforce, partially persistent in the long term. However, they observe that these effects could be mitigated by migration (see also Alfani 2013 ), labor market inefficiencies (see also Bloom and Mahal 1997 ), and inventories. Using a structural econometric model of the UK to estimate the economic effects of a modern pandemic, they conclude that it would reduce production and increase firms’ costs, leading to the emergence of inflation in the long term. Voigtländer and Voth ( 2013 ) describe a model where pandemics reduce population but increase labor in the manufacturing sectors. Since the land supply remains constant, labor productivity increases, and therefore survivors’ wages are higher than they would be without the pandemic in the long term. If the welfare increase is sufficiently high, the demand for manufactured goods increases trade and population density. Moreover, manufactured goods are easily taxable, thus enabling the financing of more wars. All these mechanisms increase the transmission of disease, leading to long-term demographic stagnation. Using data on the Black Death, the calibrated model correctly approximates the growth of both the European urbanization and per capita GDP from 1000 to 1700.

Historical research provides further support for the hypothesis. Herlihy ( 1997 ) confirms that wages and the demand for manufactured goods increased after the Plague; however, he observes higher lethality for adults than for both the young and the elderly. The Black Death first reduced the number of available workers and the length of their productive life. Additionally, the Plague took away both the skill and experience of previous workers and the parent’s investment in the education of their children. Moreover, high turnover increased labor demand, further reducing the productivity of new workers in the long term. Low labor supply increased wages, as land rents decreased. Finally, consumption grew quantitatively, shifting qualitatively towards higher-quality goods, leading to the emergence of a positive long-term impact on the real wages and welfare of the survivors. Pamuk ( 2007 ) supports all Herlihy ( 1997 )‘s results. Moreover, he finds that the great difference in economic growth between North and South Europe, which is observed only some centuries later, originates from the Black Death of the fourteenth century. Indeed, if at first the Plague increased wages across Europe, afterwards, when the population began to grow again, the real wages remained persistently higher in North Europe. The higher flexibility of institutions and guilds allowed a better economic and social response to the Black Death in the North, for example by obtaining lease contracts more advantageous for farmers, or making it easier for women to enter the labor market, and then structurally and radically changing the fertility rate and demographic trends in those countries. Alfani and Percoco ( 2019 ) produce empirical evidence that the plagues that infested Italy in the XVII century also led to long-term reductions in real wages. Indeed, although the population remained below pre-plague levels for more than two centuries, the reduction of skills (as well as of capital and technologies) was particularly large for various reasons. First, these plagues were particularly severe compared with the outbreaks in other European countries. Second, these plagues hit all population strata equally, including the poor, nobles, and bourgeois alike. Moreover, the demographic impact was not compensated by migration flows. Finally, the destruction of human capital reduced the competitiveness of the Italian economy.

Economists disagree on the intensity of the long-term effect of pandemics on the accumulation of human capital. Bleakley ( 2010 ) shows that the effect of the pandemic on schooling is uncertain due to the simultaneous decrease in both benefits (following lessons is more difficult) and opportunity costs (labor productivity is lower). Moreover, he observes that the pandemic could already have negative effects on the intellectual development of the child during gestation. Almond ( 2006 ) supports this argument using 1960–80 decennial microdata to analyze the long-term effects on those US children who were conceived during the Spanish flu. He observes that, if the mother was infected during pregnancy, then her offspring had lower educational attainment and a higher probability of being physically disabled. Both factors reduce their future wages and then increase their participation in illegal activities and, more generally, harm their socioeconomic status 40, 50, and 60 years after the pandemic. Parman ( 2015 ) resizes the effect, affirming that in the US the Spanish flu did not affect human capital in aggregate because parents redirected their investments towards older siblings. Meyers and Thomasson ( 2021 ) show that in 1916 the negative effect of polio on human capital differed between the US states and also depended on the age of students and the family income. However, the effect is usually nonlinear on age and more damaging to the richest because of the specific characteristics of polio.

The relationship between pandemics and human capital accumulation has been studied not only in the US. Odugbesan and Rjoub ( 2019 ) show that, for 26 sub-Saharan African countries from 1990 to 2016, the link between a pandemic and human capital is negative and bidirectional due to persistent short-term effects. Using two Tanzanian databases, Wobst and Arndt ( 2004 ) show that the HIV pandemic has decreased human capital (and then wages and income per capita) in at least four ways. First, the pandemic has directly and persistently reduced labor supply and skills availability. Second, the number of teachers has also decreased, worsening the quality of the process of accumulation of human capital. Third, the lower labor supply has increased the demand for new workers, raising the opportunity cost of education for the young, thus reducing the need for human capital investments. Finally, the pandemic has also reduced the long-term demand for education through an increase in the number of orphans. Novella ( 2018 ) confirms the last link using a Zimbabwean survey for 2007–8. This revealed that orphans leave (secondary) school early and hence enter the labor market early compared with non-orphans. The worst effects emerge when both parents are dead or when the household is blended, i.e., when orphans and non-orphans live together. He also observes that this lower household income after a parent’s death only partially explains the lower investment in the orphans’ human capital. Evans and Miguel ( 2007 ) extend previous results for Kenya. Analyzing an extensive database of over 20,000 children, they observe that not only are orphans more likely to quit primary school, but the probability is higher in those cases where the mother dies and/or their academic performance was already weak. Therefore, they conclude that the inability to pay school fees and the need to find work seem less significant in the long term than the lack of emotional support and the presence of psychological trauma. Fortson ( 2011 ) models the schooling decision that maximizes the expected present value of lifetime utility, considering that HIV reduces its discount rate. He uses data of 15–49-year-olds covering the birth cohorts 1952–91 in 15 sub-Saharan African countries in order to confirm that HIV reduces longevity and human capital investments persistently in the long term. Moreover, the author suggests that both orphans and non-orphans are affected by pandemics, and that decreased schooling provision does not play a key role. Many scholars have analyzed the effects of HIV on educational achievements. Bell and Gersbach ( 2009 ) confirm all previous results by using an overlapping-generations model where both parents and children decide how much to invest in human capital. Moreover, they observe that (i) selective health and educational policies are more effective than comprehensive ones; and (ii) simultaneous health and educational policies are more (less) efficient than sequential ones if disease mortality is above (below) a threshold level.

Young ( 2005 ) combines two fertility effects with the orphan effect. First, if the virus is sexually transmitted, e.g. by HIV infection, then unprotected sexual activities and births are reduced. Second, the labor supply contraction, induced by the pandemic, improves wages and then reduces the mothers’ fertility. Third, lack of parental guidance reduces the human capital of orphans. These emerging long-term effects are mixed. Calibrating the model with South African microdata, he finds that: the female labor supply is more elastic than the male labor supply; fertility effects always prevail in the long term despite pessimistic assumptions; and per capita income tends to increase. Some scholars find that, in addition to human capital, pandemics depress other types of intangible capital. Aassve et al. ( 2021 ) show that the Spanish flu decreased social capital for many generations in the US. They use a long-term social trust survey and discover that: (i) the immigrants born after the Spanish flu and their heirs have lower social trust than those born before; and (ii) the effect is higher for those from countries with less uncensored information on pandemic effects. Using a behavioral experiment in Uganda, McCannon and Rodriguez ( 2019 ) find that grown-up orphans tend to have lower social capital. The probability of prosocial behavior is lower because orphans are more pessimistic about the community’s social contributions. McDonald and Roberts ( 2006 ) analyze data for 112 countries from 1960 to 1998 to determine how much HIV and malaria affect health capital and, consequently, income per capita growth in the long term. They observe that the degree of HIV prevalence in a country negatively affects health capital directly and economic growth indirectly. Moreover, they observe that this mechanism is significant in Africa, through both HIV and malaria, and in Latin America, only through HIV, but not in OECD and Asian Countries. Focusing on sub-Saharan Africa, Odugbesan and Rjoub ( 2019 ) confirm that income plays a key role in explaining the long-term effects of a pandemic. However, the direction of their results is reversed: the bidirectional link between a pandemic and human capital for upper-middle-, low-middle-, and low-income countries is, respectively, negative, positive, and insignificant.

Finally, the majority of effects described in this section are generally more severe in low-income countries. Here, reduced access to medical care, undernourishment, and the presence of other diseases could induce a poverty trap (Beach et al. 2021 ; Bloom et al. 2021 ; Lorentzen et al. 2008 ). A Malthusian equilibrium with low income, underinvestment in schooling and health, and high fertility emerge for tuberculosis (Delfino and Simmons 2005 ) but only partially for malaria (Bloom and Sachs 1998 ; Gallup and Sachs 2001 ). Moreover, the poverty trap is unclear for HIV, where both positive and negative pandemic effects on income distribution could emerge (Bloom and Mahal 1997 ; Bloom and Sachs 1998 ; Mahal 2004 ). Alfani ( 2021 ) suggests that high-mortality pandemics, like the plague, could reduce poverty by either exterminating the poor or redistributing income to the poor. Vice versa, Karlsson et al. ( 2014 ) suggest that low-mortality pandemics, like the Spanish flu, increase poverty due to pandemic-induced unemployment, inability to work for long periods, and general loss of income. As these effects are particularly severe and persistent for poor households, pandemics could aggravate inequality. Therefore, the long-term effects of pandemics on income distribution appear to depend on the medical profile of the disease.

Investments and Physical Capital

While pandemics affect the long-term dynamics of labor supply and human capital also through durable short-term mechanisms, their impact on capital and savings arise in the long term specifically. Acemoglu and Johnson ( 2007 ) argue that, since land and physical capital are not affected in the short term, the lower levels of labor supply and human capital reduce GDP but have an unclear effect on per capita income. Since pandemics reduce GDP and income growth, they also reduce physical capital accumulation, thereby triggering a long-term negative loop between GDP and capital. The authors hypothesize that, in the long term, GDP per capita should drop in high-income countries but not in low-income countries, where land is more relevant than physical and human capital, and the negative loop effect is weaker.

Bai et al. ( 2021 ) confirm that the long-term pandemic effect differs among countries. They show that infectious diseases in the last 15 years have increased permanent volatility in the US, UK, China, and Japan capital markets. However, public policies of correct timing and intensity could reduce the effect. Ru et al. ( 2021 ) find that countries that have already experienced similar pandemics react better and more readily to future pandemics, especially if past pandemics have led to deaths. Analyzing the 65 largest financial markets in the world, the authors note that countries with firsthand SARS experienced the deepest fall in the stock market during the COVID-19 pandemic. This reaction is positively correlated to the pandemic’s mortality. Donadelli et al. ( 2017 ) confirm that, from 2003 to 2014, disease-related news had adversely affected the returns of the pharmaceutical stock market. Analyzing 102 pharmaceutical firms listed on the US stock market, the authors note that investors were too optimistic about the future liquidity of pharmaceutical sector flows after the shock. This irrational behavior has a positive and persistent effect on the returns of the pharmaceutical stock portfolio. Cakici and Zaremba ( 2021 ) extend the previous results outside the pharmaceutical sector. They observe that pandemics induce irrationality among investors, impacting assets across countries and firms heterogeneously. Analyzing 19 international stock markets, they observe that the stock trend signals to investors the firms’ resilience and ability to react to negative shocks, leading to increased future share performance. Summarizing, the literature analyzing the effects of pandemics on equity markets concludes that these health shocks induce irrational behavior of investors, causing positive and negative long-term effects, heterogeneous among countries, sectors, and firms.

Consensus among scholars is lacking in regard to both the size and direction of the long-term pandemic effects on investments and physical capital. Cuddington ( 1993a ) observes that pandemics affect labor demand and capital markets. The total effect on wages is uncertain: supply shock increases wages, but the demand shock reduces them, because infected workers are less effective, as they need to take sick leave and are less productive. Pandemics also affect domestic capital accumulation because health care costs reduce savings. Therefore, the total impact on capital per capita, GDP, and GDP per capita is uncertain; however, calibrating the model with Tanzanian data, he finds that both GDP and GDP per capita sharply decreased from 1985 to 2010. Cuddington and Hancock ( 1994 ) confirm the result for Malawi, although the lower number of infected people reduced the long-term effects on the economy. Moreover, Cuddington (Cuddington 1993b ) observes that previously predicted effects also hold when formal and informal productive sectors coexist, and formal wages are sticky. Basco et al. ( 2021 ) affirm that the Spanish flu in Spain was primarily a demand shock but confirm that the pandemic impact on the real return of capital is ambiguous in the long term. Although at the theoretical level Karlsson et al. ( 2014 ) confirm the ambiguity of the long-term effect of the Spanish flu on the per capita return on capital, this ambiguity is not observed in the empirical analysis of the Swedish counties. Indeed, by analyzing the effects in the decade following the pandemic, the authors estimate no statistically significant effect on earnings per capita, but clear negative effects emerge on capital returns per capita. Finally, Jinjarak et al. ( 2021 ) show that the H3N2 pandemic reduces GDP, consumption, and the investments of 52 countries.

Other scholars demonstrate that the effect of pandemics is heterogeneous among sectors, a trait shared with most disasters (Halkos and Zisiadou 2019 ). In Egypt, pandemics depleted the rural workforce necessary for the maintenance of the crucial centralized irrigation system, which remained in a state of disrepair, hampering the well-being of the region for centuries (Borsch 2005 , 2015 ). Herlihy ( 1997 ) shows that the rise in wages following the Black Death increased demand for more nutritious and elaborate goods, diversifying consumption and improving welfare. Similarly, Pamuk ( 2007 ) shows that the Plague increased the demand for luxury goods in particular. Moreover, he observes a reduction in interest rates and increased investments, although with asymmetric components. Indeed, Alfani ( 2013 ) shows that the XVII century plague depressed Italian industries, in particular, the wool, flax, silk, and construction sectors, due to the loss of skills and the impossibility of procuring raw materials. Alfani and Percoco ( 2019 ) highlight that the shift of investments from urban to rural activities in this period reoriented the post-plague Italian manufacturing sector towards the production of semi-finished and low-quality goods. Summarizing, scholars observe that short-term changes in the relative composition of both demand and supply structures can lead to long-term sectoral effects.

Similar sectoral asymmetric effects have been recorded for more recent pandemics. Analyzing the potential effects of SARS in Asia, Lee and McKibbin ( 2004 ) find that countries specializing in trade and the tertiary sector are more damaged by both temporary and persistent pandemic shocks. Indeed, in these sectors, close contact with other people is often necessary. The retail and tourism sectors are particularly vulnerable. Gallup and Sachs ( 2001 ) provide further support by showing that Mediterranean and Caribbean countries benefited from the rapid and stable development of the tourism industry after the eradication of malaria. Finally, Mahal ( 2004 )‘s literature review on HIV effects shows a similar, although weaker, effect for sub-Saharan tourism. Moreover, the author shows that health, transport, and the primary sectors are also negatively affected by HIV. Pandemics affect the health sector by increasing costs for healthcare services and insurance. Moreover, he shows that workers in the transport and primary sectors belong to the social classes most affected by HIV. Oster ( 2012 ) finds that export is an essential explanation of the spread of HIV in Africa because more truckers and miners, among others, stay away from home for more extended and more numerous periods. As a result, they and their partners are more likely to engage in risky sexual intercourse, putting themselves and their stable partners in danger. She also affirms that trade could further aggravate the effect in the long term, as additional income could increase the amount of money spent on prostitution, or mitigate it, if money is spent on preventive measures. Using a quasi-experimental variation, Adda ( 2016 ) confirms that the new transportation networks and inter-regional trade accelerated disease diffusion in France from 1984 to 2010. Delfino and Simmons ( 2005 ) combine the effect of capital and labor, using a Lotka-Volterra predator-prey model where only healthy individuals are productive. The authors observe that the introduction of capital makes the path more complex, but that the economy still cyclically converges to a stationary equilibrium. Indeed, when labor supply decreases, GDP decreases. Therefore, both savings and investments are lower, and GDP per worker also decreases. Lower welfare reduces health services consumption, but the impact on the disease transmission is uncertain: it increases as the share of infected rises, but it decreases as the contagion period became shorter. When the labor supply increases again, the cycle restarts. Augier and Yaly ( 2013 ) show that complex growth paths could emerge even in a model where the pandemic affects only capital accumulation. The authors describe an overlapping-generations model where the pandemic increases premature deaths, and then only the survivors will use savings previously accumulated. The government proposes a funds system that redistributes rents among the survivors. Young people must decide how much to invest in this public fund, and how much to spend on health or other goods, knowing that better health reduces the chance of dying prematurely. They observe that the pandemic, capital, and health investments are linked in an articulated and recursive way: (i) the pandemic causes health investment to drop; but (ii) health investment reduces the diffusion of the pandemic; (iii) capital directly affects the investment; and then (iv) it indirectly affects the spread of the pandemic. Therefore, the economy converges to a long-term equilibrium only when contagion rates are low. Finally, Stiglitz and Guzman ( 2021 ) show that pandemics act as an unanticipated technology shock, generating unemployment that government intervention can effectively counteract. In the long term, uncertainty does not decline, thus further increasing the desirability of government intervention.

In Section 3 , we showed that, after a pandemic, life expectancy decreases because a healthy lifespan becomes more uncertain than before, leading to decreased investments in human capital. Similarly, scholars observe that the pandemic also reduces investments in physical capital. Lorentzen et al. ( 2008 ) show that the indirect effects of malaria on life expectancy are higher on physical rather than on human capital investments. Analyzing different databases and case studies, Gallup and Sachs ( 2001 ) conclude that the effects on per capita and total income are negative because both foreign investments and the revenues from tourist and business travelers are drastically lower in those countries affected by malaria. Analyzing the effects of HIV on 43 Asian countries from 1990 to 2015, Fawaz et al. ( 2019 ) conclude that investments and savings are usually inversely related to that pandemic. However, they show that both the sign and the intensity of the effect could differ depending on how far-sighted people are. Additionally, in low income countries, the negative effect of investment is independent of gender, but the pandemic affects men’s saving propensity more than women’s. Vice versa, in high income countries, when life expectancy decreases because of pandemic mortality, men save more but do not increase their investments, while women save less but invest more. Bloom and Mahal ( 1997 ) also focus on savings behavior, using it to explain the insignificant effect of HIV on the income per capita growth rate in 51 countries from 1980 to 1992. First, they observe that poor people are most affected by HIV, and that expensive medical treatments further aggravate their disadvantaged situation. However, social and economic mechanisms partially compensate for the high costs of official health services. Second, higher care costs cause both consumption and savings to drop. Moreover, lower life expectancy may increase precautionary savings in favor of surviving family members. Garrett ( 2008 ) studies the economic and social effects of the influenza pandemic 1918–9 in the US, analyzing newspaper articles and academic papers to draw lessons for modern pandemics. He observes that health care is relevant only with ideal health systems that certainly do not collapse after a pandemic, no matter how serious it is. Moreover, he concludes that, although a higher percentage of life insurance mitigates the adverse financial effects of a pandemic on households, the wealthiest households that will need it least will also be the more protected. Gustafsson-Wright et al. ( 2011 ) show that, in the case of pandemics, the private insurance system can be unfair and distortive, even in countries like Namibia, where the quality of public health care is relatively high, and most people have health insurance. The poor who cannot afford health insurance suffer from higher medical expenditure during a pandemic. There are no substantial effects on medical expenditure and family income until the virus starts affecting working capabilities; then, the economic consequences for the poorer strata worsen severely.

The comprehensive review from Hallegatte et al. ( 2020 ) confirms that poor people are disproportionately affected by natural hazards and disasters. Pandemics are no exception. Gaffeo ( 2003 ) provides additional support for the idea that pandemics can lead households into a poverty trap. Higher care costs and physical weakness reduce income capacity: for poor households, this leads to malnutrition, further reducing their physical capabilities, and increasing the pandemic’s morbidity and mortality. Physical and human capital trends reinforce this adverse and cumulative loop. Finally, he observes that pandemics worsen market failures for health insurance and local credit availability. Due to adverse selection and moral hazard, the higher uncertainty and information asymmetries inherent to pandemics lead to higher insurance premiums and reduced access to credit for the needy. Habyarimana et al. ( 2010 ) show that, while private firms could invest in their workers’ medical care, they are unlikely to do so. They describe the case of the pioneering firm Debswana Diamond Company in Botswana, which, since 2001, has invested in a program to improve the health of its workers affected by HIV. They observe that the treatment works, but the investment is unprofitable as the costs are too high, supporting the idea that African firms can only bear a small share of their workers’ health costs, if any.

While the previous literature shows that a pandemic increases income inequalities, Odugbesan and Rjoub ( 2019 ) argue that pandemics could hinder sustainable development. In this connection, these authors analyze the link between HIV and both public and private adjusted net savings, as an indicator of sustainable economic development, for 26 sub-Saharan African countries from 1990 to 2016. They show that HIV negatively and unidirectionally affects saving, and that the effect is particularly intense for upper-middle- and low-income countries. HIV also negatively affects the perception of government efficiency in low-middle-income countries. Odugbesan and Rjoub ( 2020 ) show that, for 23 sub-Saharan African countries from 1993 to 2016, the adverse relationship is bidirectional because the HIV control program and sustainable development compete for the same public spending budget. Keerthiratne and Tol ( 2017 ) show that the financial impact of disasters, pandemics included, is country- and time-specific. Moreover, Chakrabarty and Roy ( 2021 ) propose a model where the future pandemic uncertainty reduces government allocation of non-health expenditures in favor of the health ones. In 143 countries from 2000 to 2017, they found that higher-debt countries present a public misallocation and delay due to public constraints. A similar effect also emerges in low-income countries, but this is due to asymmetric information. Bai et al. ( 2021 ) show that, up to a point, the effects of pandemics could be efficiently mitigated with fiscal and monetary policies. Finally, Cavallo et al. ( 2013 ) confirm that governments and institutions could play a key role in the economic effects of a pandemic. Using a database from the Centre for Research on Epidemiology and Disasters, they observe that natural disasters, such as a pandemic, have a long-term negative economic impact only when they simultaneously cause a high number of deaths and are followed by institutional and political revolutions.

Knowledge and Innovation

Historians have identified numerous cases of pandemics being catalysts of significant, systemic change. In his comprehensive overview of the impact of the Black Death on Europe, Herlihy ( 1997 ) argues that it led to larger economic diversification, improved technology, and better lives, breaking the XIII century Malthusian deadlock by directing technological change towards the now cheaper input, i.e. capital. Although educational institutions were gravely hit, with one-sixth of European universities closed, as a long-term reaction to this short-term impact, a number of new educational institutions were built in reaction to the dearth of scholars. The new universities adopted more flexible curricula, contributing to the revival of classical studies. The need to face the Plague also forced the acceptance and diffusion of anatomical studies, fostering the development of the scientific approach in medicine. Epstein ( 2000 ) offers a similarly positive account, underlining how the Black Death brought much needed renewal. European feudalism was locked in a low-growth pattern, not because of lacking innovative capabilities, or market institutions, but rather due to the intensity of seigniorial rights, and the jurisdictional power of towns and lords, which were used to maximize the extraction of resources, mostly for military purposes, greatly hampering development. The scarcity of workforce caused by the Plague shock reduced the bargaining power of the landowner in favor of the worker. The resulting political and economic struggle is described as a process of “creative destruction”. The centralization process was greatly accelerated, leading to the consolidation of internal markets, the standardization of legal procedures and business norms, and the progressive rationalization of hierarchies. As a result, in the long term, transaction costs and economic uncertainty declined significantly, as testified by the structural decline in interest rates, which quickened the pace of innovation and trade growth. One of the long-lasting consequences of the pandemic for Europe was a more centralized, less predatory authority, able to support the process of economic development.

The institutionally “liquidationist” account of pandemics also applies to other centuries. For example, Alfani ( 2013 ) observes how plagues irrevocably affected the balance of power in Italy, favoring the rise of the House of Savoy, which eventually led to the Italian unification. Pamuk ( 2007 ) describes how the Plague created local skilled labor scarcity, incentivizing migration and fostering the dissemination of knowledge in the long term. Higher wages stimulated the substitution of land and capital for labor, creating conditions favorable to the implementation and diffusion of labor-saving innovations across all economic fields: the printing press, firearms, and high-capacity maritime transportation can all be linked to this general trend. Voigtländer and Voth ( 2013 ) offer what is perhaps the more optimistic view of the long-term impact of the Black Death, arguing that the positive impact of the persistently high European mortality rates dwarfed the effects of technological change for the entire 1500–1700 period. Clark ( 2007 ) provides a useful counterfactual, analyzing how the Far East, relatively less affected by plagues, maintained a growth regime characterized by both low income and low mortality. Not all plagues, however, are described in such a positive light.

Alfani and Percoco ( 2019 ) document the significant negative impact of the plague of 1629–30 on the long-term development of the Italian cities and the Italian economy. In addition to the mechanisms already explored in the previous sections, the authors argue that the significant losses suffered by the urban economic elite, who controlled most of the advanced manufacturing activities, caused an “ingenuity shock”, i.e. decreased both the availability and the willingness of the surviving elite to innovate in the urban industry, preferring agricultural investments instead. The latter took a dramatic hit in terms of production capabilities, which recovered only after decades. The exceptionally late recovery slowed the process of recovery and urbanization, weakening the Italian competitive position vis-à-vis Northern Europe in manufacturing. The almost uniform lack of wage increases signals how the long-term reduction in supply capabilities was not a consequence of lacking a skilled workforce, but rather a significant long-term change in the pattern of capitalist investments. This argument is important to underline how general, systemic renewal might encompass significant relative changes. The hypothesis that the plague did not damage, and perhaps even fostered, European development as a whole, is entirely consistent with the description of significant short- and long-term harm being wrought to large sections of the continental socioeconomic system. This is also consistent with Pamuk ( 2007 )‘s description of the divergence between North and South Europe, which emerged in response to the Plague as a consequence of the greater entrenchment of Southern political and economic elites, and the associated slower degree of institutional flexibility and, consequently, innovation and knowledge diffusion. In his recent overview of the subject, Alfani ( 2021 ) provides further evidence for the relevance of institutional change and policy choices on the long-term impact of pandemics on economic distribution and growth, illustrating how pandemics create opportunities for institutional change while also creating issues that, if not effectively tackled, can severely worsen the economic conditions of the poorer sections of the population.

On the negative side of the debate, Bar and Leukhina ( 2010 ) argue that epidemics have the capability to disrupt knowledge transfer across generations, leading to significant reductions in total factor productivity growth over time. They show that the long-term loss is moderated by the possibility of knowledge diffusion from regions that were spared negative health shocks, implying that the scope of this negative mechanism would be much greater in the case of a pandemic. Karlsson et al. ( 2014 ) document the impact of the Spanish flu on the Swedish economy, finding a long-term negative effect on capital income and a positive effect on the rate of poverty, both possibly driven by a significant persistent loss of skilled workers and consequently a decline in labor productivity. Jinjarak et al. ( 2021 ) show that the H3N2 epidemic can have permanent negative effects on productivity. Indeed, also when the productivity rate returns to its pre-shock level, some opportunities are lost or delayed forever, and then the innovation path will be always lower than without pandemics. Chen et al. ( 2021 ) even state that epidemics have the worst impact on innovation among natural disasters. Indeed, they affirm that epidemics reallocate public expenditure from innovation to health, reducing patent applications and innovation in 49 countries over 1985–2018. In Eastern Europe, feudal lords reacted to epidemics by re-enslaving the peasantry, greatly hampering the diffusion and implementation of new agricultural techniques, and locking the regions in a relative underdevelopment pattern called “second serfdom” (Domar 1970 ; Robinson and Acemoglu 2012 ). Similarly, the plagues affecting the Roman Empire and its successor states led to persistent socioeconomic degradation, aided by conservative political reforms introduced by the surviving elites (Duncan-Jones 1996 ; Sarris 2002 ; Little 2007 ; Harper 2016 ).

Yet pandemics are also great opportunities for the creation and diffusion of new knowledge. Bresalier ( 2012 ) documents how the Spanish influenza pandemic of 1918–9 was a turning point in the modernization of British medicine, leading to the establishment of key institutions and organizations that would shape the long-term development of medical research and healthcare, chief among them the Medical Research Council. The latter led to a wider active involvement of the state in sanitary matters. In general, the author shows that the pandemic’s effects were instrumental in developing the modern medical research system. Hopkins ( 1988 ) provides a description, similar in spirit, of how the successful smallpox eradication campaign conducted by the World Health Organization led to organizational learning, and the development and institutionalization of best practices, thereby greatly enhancing global medical response and prevention capabilities. Furthermore, large shocks, such as pandemics, can create windows of opportunity for change. This is echoed by Cohen ( 2019 )‘s review of the same episode, concluding that, while research and innovation activities played a key role in ensuring the campaign’s success, these efforts were at first greatly hindered by inappropriate practices and institutional routines. Only when the involved organizations implemented new and improved procedures did technological solutions become truly effective. While the scale differs, the argument echoes Pamuk ( 2007 )‘s. Wallace and Ràfols ( 2018 ) show that the avian flu highlighted how both excellence-based funding schemes and economic interests contribute to unduly restrict the field of active research as compared with the broad range of scientific opinions offered by experts, resulting in the development of a limited selection of techniques from the available knowledge base.

Analyzing the impact on the knowledge generation of vaccination subsidies, Finkelstein ( 2004 ) observes that, apart from the direct health impact from the eradication of illnesses, higher expected profitability might lead to socially wasteful competition for market share in the long term. Empirical evidence supports the hypothesis that the outcome depends on the state of the technological frontier and market conditions, as expressed by vaccination rates. In most cases, subsidies appear to lead to purely wasteful competition, but, in the case of the flu, there is evidence of increased product quality and demand, with the associated dynamic benefits outweighing static gains. Consistently, Kremer ( 2000 ) pointed out that market failures are endemic in the markets for both vaccine provision and vaccine research. While this opens up opportunities for policy intervention, it simultaneously underlines the challenges involved in the design of truly effective instruments. Similar challenges are described by Keohane ( 2016 ), in which innovative financial practices developed in the long term as a reaction to large shocks, including pandemics. He argues that “risk transfer for disease is a vital public good that the market has not otherwise provided” (ibid,130), and that new preventive and preparedness measures could be financed through the issue of catastrophe bonds. While these catastrophe bonds are expensive, the benefits of increased resilience in the face of health shocks might be a net gain, especially if the costs are somewhat lessened by pooled funds international initiatives. Although significant overlapping exists in terms of health-crisis preparedness and the organizational capacity of response, such an approach is probably more effective for estimating regional epidemic risks. Such instruments may be particularly useful in light of Confraria and Wang ( 2020 )‘s finding of persistent radical disparity between the disease burden carried by African countries and the amount of medical research dedicated to specifically African issues relative to global efforts.

The discussion so far has been focused on mechanisms that connect pandemics to the development of knowledge and practice, and from those to their economic and financial impact. Easterlin ( 1995 ) provides an original analysis based on a different viewpoint. Analyzing the steep decline in mortality that took place in northwestern Europe in the nineteenth century, he maintains that both the industrial and the health revolutions have a common root: the ascendancy of the scientific approach leading to technological change in both areas. The argument implies, on the one hand, that economic growth is not the main driver of life expectancy improvements, and, on the other, that improvements in health and life expectancy do not have a direct effect on economic outcomes, a position compatible with the relatively weak empirical evidence available (Acemoglu and Johnson 2007 ). The cause of structural change is argued to be found in the extraordinary stream of innovations implemented during the period, supported by a swarm of Schumpeterian “entrepreneurs”, only marginally motivated by profitability. Both those revolutions were triggered by the acceleration in the accumulation of usable empirical knowledge through the establishment and diffusion of the scientific method, the difference in timing to be imputed to the difficulty of developing and implementing the scientific solution. Deaton ( 2004 ) similarly argues that knowledge transfer, in the form of both effective practices and useful information, is key for explaining different national patterns of mortality decline and life expectancy increase, pointing out how globalization could benefit developing countries in this respect.

The argument is further expanded by Easterlin ( 1999 ), who showed that, while private firms have been crucial in fostering economic development, their role in improving health and especially infectious disease control practices has been marginal at best. Indeed, the preventive measures improve life expectancy more than the therapeutic ones, but firms rarely adopt them. However, the actions of households and governments are more important for disease prevention. The role of government is especially relevant because public action is necessary for both health education and prevention programs. Easterlin shows how irreplaceable effective knowledge and healthy practices are in the process of preventing and curing diseases, but how ineffective markets, contracts, and private property institutions have been in fostering their historical development, due to a number of related market failures. In fact, medical practitioners and public servants working towards the diffusion of salubrious norms have often found themselves hindered by economic actors defending their profitable, if deleterious, business. In his account of the US development, Gordon ( 2016 ) confirms both the decisive role of scientific advances and the importance of government intervention and regulation for the drastic improvement in health and life expectancy that took place in the nineteenth and twentieth centuries. However, Birchenall ( 2007 ) proposes an alternative explanation for the manifestly weak correlation between contemporaneous income growth and mortality, highlighting the significant long-term impact of income growth in terms of improved adult health and life expectancy, and subsequent mortality reduction. The argument is supported by a model illustrating how sustained economic growth, no matter the source, is sufficient to escape the Malthusian equilibrium, leading to drastically lower mortality in the process. Cervellati and Sunde ( 2015 ) provide further support by developing a model based on unified growth theory, also characterized by an inevitable take-off triggered by sufficient technological progress.

From the historical description emerges a complex interplay of negative and positive relations between health and business practices, driven by the contrast between short- and long-term interests, on the one hand, and private and public interests, on the other. This complexity is faced by Mokyr ( 2010 ) in his attempt to outline the principles of an evolutionary approach to the study of the development of useful medical knowledge. He begins by highlighting the two key idiosyncratic characteristics of such a knowledge field: the largely inelastic character of its demand, as all humans value their lives and health under all circumstances, and the relevance of negative exogenous shocks, such as the spread of pandemics. Medical knowledge maps to a set of instructions and recipes capable of guiding action, called techniques. According to context-specific selection criteria, only a subset of related techniques will actually be implemented for a given set of knowledge. While the actual usage of techniques is rival, knowledge can endlessly accumulate with only limited downsides. The evolutionary process of knowledge is mostly based on persuasion mechanisms; on the contrary, the related techniques are evaluated on their relative effectiveness. However, persistent empirical failure might not be sufficient as a selection mechanism, if no better technique is available on the basis of the socially accepted set of useful knowledge. This is particularly likely in the case of singleton techniques, based on the limited empirical knowledge that “this works”, and is therefore incapable of adaptation to sudden change. The shift towards scientific knowledge ensures that techniques are based on a more nuanced understanding of natural phenomena, enabling quicker and more efficient adaptation to exogenous shocks. Limits are provided by the path-dependency of knowledge development, which is only indirectly affected by the usefulness of related techniques. While this might result in the generation of “useless” knowledge, degrading response capacity in the present, sudden exogenous changes might lead to equally sudden revaluations. Summarizing, pandemics are a simultaneous shock to both practices and the underlying knowledge, as their often dramatic impact is sufficient to create opportunities for shifting entire development trajectories. The emergence of new knowledge and practices can be further amplified by diffuse and profound institutional change, which in turn may lead to significant upheavals, positive or negative. Owing to the complex nature of the outcomes, however, normative judgment lies beyond the capabilities of purely theoretical analysis.

The first key result of this review is that in the analysis of pandemics’ long-term economic consequences, historical and epidemiological characteristics are key (Donadelli et al. 2021 ; Meyers and Thomasson 2021 ). The extraordinary mortality associated with the Black Death is the most crucial factor in explaining its exceptional long-term consequences for European and global socioeconomic development (Pamuk 2007 ; Voigtländer and Voth 2013 ). Research on the consequences of HIV has rightly focused on its sexual transmission (Young 2005 ; Oster 2012 ; Fawaz et al. 2019 ; Gori et al. 2020 ) and the intergenerational consequences of increased mortality among working-age adults (Wobst and Arndt 2004 ; McDonald and Roberts 2006 ; McCannon and Rodriguez 2019 ). Therefore, the results offered by a general economic analysis of pandemics should be considered a wide collection of potential mechanisms, their empirical applicability and relative importance to be carefully weighed on a case-by-case basis. This does not imply that knowledge is not cumulative in this field, but rather that application of past knowledge should account for contextual factors in order to determine the likely long-term impact of a specific pandemic.

Our review of the literature goes one step further. By aggregating the pandemics by their effects on various economic factors, we observe some recurring trends, allowing some useful general conclusions to emerge. Table 1 provides a comprehensive overview of papers published in English focused on the relationship between pandemics and economic development. Following this paper’s structure, we organize the papers according to the mechanisms investigated into three broad categories: labor and human capital; physical capital and investments; and knowledge and innovation. We show that diseases can potentially affect all the productive factors of an economy in the long term. Most of the articles focus on the pandemic impacts on labor and human capital, all finding negative long-term impacts. However, some authors show that this effect could be partially mitigated in specific geographical areas, workers’ categories, and industrial sectors. The long-term effects on investment and physical capital are ambiguous: many papers show contrasting and complex mechanisms that do not allow us to know a priori the overall economic effects of pandemics on long-term investment trajectories. Notably, all papers which show long-term positive effects of pandemics on economic development focus on knowledge and innovation. However, negative cases also exist, leading many scholars to observe that the effect is potentially mixed, its direction dependent on necessary but not always implemented institutional changes.

The following general picture of the effects of pandemics on economic development emerges from our analysis. First, pandemics tend to reduce population and labor supply in both the short and the long term. This increases labor productivity, and therefore average wages. However, pandemics also hinder human capital accumulation, reducing productivity and per capita income growth. The negative effect is further compounded by the associated loss of knowledge, skills, experience, and innovative capabilities. Investments and savings are also negatively affected, leading to potential long-term hysteresis and the emergence of new, lower-income equilibria.

The pandemic shock can also break old patterns, opening new innovative trajectories previously inaccessible. The aggregate impact of these long-term mechanisms on the economic system is dependent on the relative relevance of, mostly harmful, adaptive mechanisms vis-à-vis potentially fruitful innovative responses. When the latter dominate the picture, negative long-term effects are overwhelmed by the benefits captured by radically new socioeconomic models of production, trade, and consumption. Therefore, the key factor determining the long-term impact of pandemics is identified with the innovation processes to which they give rise, and particularly the necessary accompanying processes of institutional change. While these effects are more difficult to capture using traditional economic methods, they are highlighted by historical analysis and should not be ignored by researchers and policymakers alike (Callegari and Feder 2021b ; Jena et al. 2021 ; Mandel and Veetil 2020 ).

Another important conclusion that can be drawn from this review is that most short-term outcomes, such as the immediate reduction in labor supply (Bloom and Sachs 1998 ; Alfani 2013 ), can bring, in the long term, significantly different consequences in both scope and quality when compared with the transient short-term effects (Delfino and Simmons 2005 ; Acemoglu and Johnson 2007 ; Basco et al. 2021 ). Several specific long-term mechanisms also emerge (e.g., Herlihy 1997 ; Young 2005 ; Augier and Yaly 2013 ), whose impact can hardly be overstated (Lorentzen et al. 2008 ; Voigtländer and Voth 2013 ). Therefore, it is unsurprising that attempts to produce comprehensive quantitative measurements of the economic consequences of pandemics appear to be affected by a significant downward bias (Lee and McKibbin 2004 ; Mahal 2004 ; Keogh-Brown et al. 2010 ). The exceptional nature of the shock brought by the Black Death of 1347–52 has obscured the economic consequences of the other late-medieval plagues, of which we know little. Lack of strong empirical evidence should be understood in the context of the complexity of the phenomena involved, and therefore not be interpreted at first sight as sufficient for falsification purposes. At the same time, however, the mechanisms at work in the most deadly pandemics should not be assumed to apply in exactly the same way to weaker, shorter, or smaller case episodes: the complexity of the phenomena under analysis cannot be reduced to a single formal model. Research on the long-term impacts of pandemics should be understood as a collaborative effort, with single researchers and teams focusing on different, yet compatible, mechanisms. A comprehensive picture can only emerge from subsequent efforts to produce cohesive overviews of the entirety of the debate rather than from a single model, no matter how ambitious.

Some lessons for policymakers also follow. The first is that, in light of the idiosyncratic characteristics of pandemics, precise and detailed analyses of their long-term effects are only possible ex-post. Therefore, preparations for such events should focus on reactive capabilities to ensure that: research efforts can be quickly and adequately supported; their results are credibly communicated to the authorities and the general public; and scientifically-founded counter-measures are rapidly implemented. These characteristics apply to both health measures and economic policy. Furthermore, when these dramatic events occur, the effective public intervention should be timely (Bai et al. 2021 ; Martin et al. 2020 ; Rodríguez-Caballero and Vera-Valdés 2020 ; Stiglitz and Guzman 2021 ) and designed starting from the general characteristics that emerged in this review, and then directed over time by distinctive challenges brought by the specific health shock. The second lesson is that symmetric health shocks will lead to asymmetric economic long-term consequences, as country-specific institutional settings mediate most effects. The tendencies towards the uncritical adoption of global solutions should be tempered by concern for the specific features of local socioeconomic systems, leading to a preliminary process of policy customization. Resistance and push-back from below should not be interpreted automatically as regressive tendencies, but rather as symptoms of the need for policy adaptation to local concerns. Finally, the third lesson is that, while pandemics require careful and extensive public intervention, what matters most in the long term is to avoid crushing the innovative response capabilities of the private sector. A virtuous process of creative destruction may emerge only if public intervention does not attempt to restore the old socioeconomic regime, potentially now unsustainable, at all costs, trampling adaptive bottom-up initiatives in the process. Consequently, while initial efforts should be aimed towards counteracting immediate shocks, they should eventually be complemented by measures aiming to support the positive qualitative developments triggered by the pandemic and curb emerging negative trends. Thus, a potential positive role for policy action can be expected to persist well beyond the outbreak period, focusing on enabling and supporting positive private responses through processes of institutional change.

Conclusions

The COVID-19 pandemic has made evident the need to study the overall economic effects of global health shocks. This literature review collects the main contributions that describe the long-term impact of a pandemic, in order to better understand the lessons from the current economic literature on this topic, and then to better address and analyze the effects on economic development of COVID-19 and of future risks of pandemics. The contributions are organized by discussing, in turn, the mechanisms affecting: labor and human capital; investments and physical capital; and knowledge and innovation. We conclude that pandemics could affect aggregate demand, aggregate supply, and productivity (Jinjarak et al. 2021 ). More precisely, we show that a pandemic reduces labor supply and human capital accumulation in the long term; that the complex interaction of these contrasting and idiosyncratic mechanisms on investments and savings is theoretically indeterminate; and that pandemics, when accompanied by supporting institutional change, can greatly benefit innovation and knowledge development. However, a detailed analysis of the pandemic’s specific characteristics, the affected economic systems, and their response remains necessary to understand which mechanisms can be expected to prevail and which policies should be implemented. The key factors determining their long-term impact are the associated processes of institutional change. We finally identify some general lessons for both researchers and policymakers. The research focuses on the theoretical plausibility and empirical significance of specific mechanisms that should be complemented by meta-analytic efforts aimed at reconstructing the resulting complexity. Policymakers should prioritize developing organizational learning and innovative capabilities, focusing on the ability to quickly adapt to emergencies, rather than developing rigid protocols calibrated over previous pandemics.

We expect the emergence of three new strands of literature in the near future. The first field of research will be on the long-term economic impact of the COVID-19 pandemic (Jordà et al. 2021 ; Poblete-Cazenave 2021 ; Tokic 2020 ). Such research will contribute to testing previously identified mechanisms reviewed here, while potentially also leading to the identification and theorization of new ones (Cacault et al. 2021 ; Silverio-Murillo et al. 2021 ; Costa Junior et al. 2021 ; Favilukis et al. 2021 ; Pagano et al. 2021 ). We also expect significant interest in comparing the impact of COVID-19 with previous pandemics, in order to highlight the relative importance of their respective defining features. The second field of research will be on the public and private responses to the effects of pandemics. The heterogeneity of both the method and timing of the institutional responses for the same health shock can be used to effectively test their efficiency and reduce the impact of future pandemic and epidemic waves (Adolph et al. 2021 ; Caserotti et al. 2021 ; Chakrabarty and Roy 2021 ; Croce et al. 2021 ; Martin et al. 2020 ). The ongoing debate on structural changes as a response to COVID-19 can be seen as a first step in increasing academic attention to the problem of the prediction of possible future pandemics and the precautionary measures to be taken in dealing with these events (Büscher et al. 2021 ; Dosi et al. 2020 ; Leach et al. 2021 ). Finally, we expect a more extensive interaction between, and cross-fertilization of, the medical and economic literatures (Avery et al. 2020 ; Murray 2020 ; Verikios 2020 ). This combination will be needed to better understand how a specific feature of the virus impacts economic development. A taxonomy of pandemics is necessary to group them correctly and then clarify how the different mechanisms move in and impact economic development. In general, we expect the academic debate on the long-term economic impact of pandemics to be renewed and reinforced in the coming years. This survey has the ultimate goal of preparing the basis for this inevitable and intellectually challenging new generation of scientific contributions on the long-term economic effects of pandemics.

Data Availability

Not applicable.

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Callegari, B., Feder, C. A Literature Review of Pandemics and Development: the Long-Term Perspective. EconDisCliCha 6 , 183–212 (2022). https://doi.org/10.1007/s41885-022-00106-w

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MINI REVIEW article

The impact of virtual reality on student engagement in the classroom–a critical review of the literature.

1 Faculty of Education, Silpakorn University, Nakhon Pathom, Thailand
2 Melbourne Graduate School of Education, The University of Melbourne, Melbourne, VIC, Australia
3 Graduate Department, Xi’an Physical Education University, Xi’an, China
4 College of Commerce and Tourism, Hunan Vocational College for Nationalities, Yueyang, China
5 Graduate Department, Sehan University, Yeongam County, Republic of Korea

Objective: The purpose of this review is to identify the impact of virtual reality (VR) technology on student engagement, specifically cognitive engagement, behavioral engagement, and affective engagement.

Methods: A comprehensive search of databases such as Google, Scopus, and Elsevier was conducted to identify English-language articles related to VR and classroom engagement for the period from 2014 to 2023. After systematic screening, 33 articles were finally reviewed.

Results: The use of VR in the classroom is expected to improve student engagement and learning outcomes, and is particularly effective for students with learning disabilities. However, introducing VR into middle school education poses several challenges, including difficulties in the education system to keep up with VR developments, increased demands on students’ digital literacy, and insufficient proficiency of teachers in using VR.

Conclusion: To effectively utilize VR to increase student engagement, we advocate for educational policymakers to provide training and technical support to teachers to ensure that they can fully master and integrate VR to increase student engagement and instructional effectiveness.

Introduction

In recent years, virtual reality (VR) has emerged as a transformative technology in education, providing new avenues for immersive and interactive learning experiences ( Pottle, 2019 ). At its core, VR offers a departure from the tangible, allowing users to delve into an environment transcending conventional reality ( Brooks, 1999 ; Jeong et al., 2019 ). VR’s essence is captured in three pillars: presence, interactivity, and immersion ( Lee et al., 2017 ). Presence grants users access to previously unreachable 3D landscapes, facilitating a unique, experiential insight ( Poux et al., 2020 ). Interactivity kindles user curiosity, enabling dynamic engagements within the virtual milieu ( Steuer et al. 1995 ; Huvila, 2013 ; Song et al., 2023 ). Immersion pushes the boundaries of conventional experiences, reviving or manifesting phenomena outside the realm of everyday life ( Sanchez-Vives and Slater, 2005 ; Poux et al., 2020 ).

The introduction of VR in education might increase student engagement, which is closely related to the cognitive, behavioral, and affective dimensions of the engagement model ( Wang and Degol, 2014 ). Cognitive engagement underscores the depth of students’ attention, comprehension, and retention ( Wang and Degol, 2014 ). Behavioral engagement is observable, characterized by consistent attendance and active classroom participation ( Wang and Degol, 2014 ). Affective engagement delves into the emotional realm, encompassing motivation, passion, and learning efficacy ( Wang and Degol, 2014 ).

Existing literature emphasizes the importance of virtual reality technology in promoting full student engagement in cognitive, behavioral, and affective dimensions, and states that the application of virtual reality technology in education has become a trend ( Mystakidis et al., 2021 ). Some literature shows that higher education institutions are increasingly adopting VR, with adoption rates as high as 46% at US universities and 96% at United Kingdom universities ( United Kingdom Authority, 2019 ; Agbo et al., 2021 ). In addition, the establishment of dedicated VR laboratories at leading universities such as Harvard University and Colorado State University underscores the commitment to using VR for educational innovation and advancement ( Reid, 1987 ; Leidner and Jarvenpaa, 1995 ). This literature shows that the widespread use of VR in education has attracted the attention of a growing number of researchers and educators, with a particular interest in the impact of VR in the classroom in terms of students’ cognitive, behavioral, and affective engagement.

It is worth noting that although existing literature begins to discuss the impact of VR on student engagement, there are still shortcomings in determining the impact of VR on various dimensions of student engagement, which may limit our overall understanding of the topic. Therefore, further discussion is needed to more specifically identify the impact of VR on the various dimensions of student engagement to gain a more comprehensive and concrete understanding. To accomplish this, this review is guided by the following three questions: (1) What are the positive impacts of VR in education? (2) What are the challenges of VR in education? (3) What interventions can address these challenges? With this in mind, the article will first discuss the positive impact of VR on students’ cognitive, behavioral, and affective engagement to help readers understand its potential in education. It will then discuss the challenges facing VR to make constructive recommendations to address the problems in education.

Searching strategy

In our methods, we used critical review. According to Grant and Booth (2009) “an effective critical review presents, analyses and synthesizes material from diverse sources”(p.93). Critical perspectives were used to assess the potential of VR in reforming educational practices and improving teaching and learning outcomes. The purpose of this article was to collect literature on the impact of VR on student engagement. Therefore, this article summarizes the previous studies as follows. First, information was obtained from Google, Scopus, and Elsevier databases: “virtual reality,” “cognitive engagement,” “affective engagement,” “behavioral engagement” and “learning outcomes.” The search was limited to articles published between January 2014 and December 2023 in English. The first search used all combinations of the above keywords and, after an initial review, produced 97 potentially relevant articles (Google: 92, Scopus: 3, Elsevier: 2).

In the second phase, secondary terms such as “affect,” “challenge,” and “education” were added, reducing the number of studies to 63 (Google:60, Scopus:1, Elsevier:2). Of these, 34 did not meet the criteria and were excluded. They were excluded because their target audience was teachers and did not discuss the impact of VR on student engagement from the student’s perspective. In the final stage, another 53 articles were excluded because they were repetitive and their purpose was to discuss either technology or engagement, or both. Finally, their full texts were reviewed to determine if their work fits the focus of this article 20 articles (Google: 17, Scopus: 1, Elsevier: 2) qualified for final review, covered a sample on the impact of VR on student engagement, and were included in the analysis.

Inclusion and exclusion criteria

To ensure the quality of the literature, we selected only peer-reviewed journal articles published in English in the last decade. The main purpose of this article was to review the impact of VR on student engagement. Therefore, we selected only review articles on the impact of VR on student engagement in educational settings. Articles that were not written in English did not discuss the impact on engagement from a student perspective, and were published beyond the previously established time and language were excluded. In addition, a selection of articles was identified and assessed by manually searching the references of articles related to the topic, of which 13 met the eligibility criteria. Therefore, 13 additional articles were added to the 20 identified. In total, 33 articles that met these eligibility criteria were included and reviewed here. Full-text versions of the articles were obtained, with each article being reviewed and confirmed as appropriate by the authors. Finally, to maximize transparency and traceability, we list the rationale and relevant evidence for all articles included (see Table 1 ). The process of article selection followed the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement ( Moher et al., 2009 ; see Figure 1 ). Figure 1 illustrates the process of article selection.

Table 1 . Publications reviewed in full text with reasons for inclusion or exclusion.

Figure 1 . PRISMA flow diagram for article selection.

The review found that the number of publications increased each year from 2014 to 2023, indicating the continued interest of researchers in exploring the impact of VR on student engagement. When reviewing the impact of VR on student engagement, Wang and Degol’s (2014) article had the most citations at 450, suggesting that the article had a strong impact in the area of student use of VR in the classroom. The majority of articles had only 10 or fewer citations, which may have indicated that these articles were relatively new or had less impact in the field. It was worth noting that more recently published articles, such as Rzanova et al. (2023) , did not have enough time to accumulate citations, so their impact on the field may not have been fully reflected in current citations.

To summarize, the differences in the number of citations for these articles highlighted their different levels of influence in the area of VR’s impact on student engagement. However, there were some limitations to the review methods. For example, some articles might not have fully reflected their impact on the field in the current citations due to their short time frames, which might have resulted in less comprehensive findings. Furthermore, the literature included was small, and in the future consideration would be given to expanding the search of literature and databases, such as PubMed and Web of Science databases, as well as expanding the search with keywords, such as “students’ attitudes toward VR.” In addition, the inclusion and exclusion criteria might have limited the generalizability of the results of the review, and therefore more caution was needed when generalizing the results of the review.

The positive impact of VR on education

This section will discuss the impact of VR on students’ cognitive, behavioral, and affective engagement participation. It is important in the field of education. Radianti et al. (2020) noted that student engagement in educational settings was critical to learning outcomes and classroom climate. Yuan and Wang (2021) further noted that the combined effects of cognitive, behavioral, and affective engagement could directly impact student learning outcomes and classroom contextual experiences. Therefore, a deeper understanding of the impact of VR on these three dimensions of engagement can provide valuable insights into educational practices and help educators better optimize classroom environments and teaching methods.

First, Papanastasiou et al. (2019) noted that VR immersive learning experiences promoted students’ cognitive engagement and aided in understanding complex and abstract knowledge. That is, through immersive learning, students can understand and remember what they have learned in greater depth and increase cognitive engagement. Pellas (2016) also found that VR encouraged students to learn through self-directed inquiry and move away from traditional teacher-centered instruction. Pellas (2016) further explained that, through VR scenario reenactments and simulations, students could engage in real-world unavailable learning experiences such as exploring historical sites and visiting distant planets. This means that such learning experiences enable students to explore knowledge in deeper and more varied ways, thus increasing cognitive engagement. Similarly, Maples-Keller et al. (2017) showed that VR was beneficial in engaging different types of students in learning, particularly for at-risk students, including those with learning difficulties, anxiety disorders, and other mental illnesses. VR provided personalized and adaptive learning environments that helped students improve cognitive engagement and achievement ( Maples-Keller et al., 2017 ). In summary, VR facilitates understanding of complex knowledge and promotes cognitive engagement for different types of students through immersive learning experiences and self-directed inquiry learning.

Secondly, Pirker and Dengel (2021) demonstrated that VR could promote student behavioral engagement. They discussed the potential of immersive VR in education through an in-depth analysis of 64 articles. They showed that “learning tasks in 3-D VLEs can foster intrinsic motivation for and engagement with the learning content” (p.77). Sun and Peng (2020) also suggested that by combining classical educational concepts with VR, such as Confucianism’s promotion of teaching for fun, students were better able to engage in learning activities. For example, Rzanova et al. (2023) found that the use of VR in the teaching of poetry to create the scenarios depicted in the verses enabled students to actively participate in classroom activities. Similarly, Freina and Ott (2015) also found that by simulating real school escape scenarios in VR, students could take on different roles to perform escape drills, and this sense of behavioral engagement can help students better master escape techniques and enhance safety awareness. These articles seem to echo that VR helps to enhance student behavioral engagement.

It is worth noting that there is debate about whether VR has a positive impact on student behavioral engagement. Proponents noted that students’ hands-on experience and exploration in virtual environments stimulated interest and behavioral engagement ( Wong et al., 2010 ; Allcoat and Von Mühlenen, 2018 ). This view suggests that VR provides an immersive learning experience that enhances students’ motivation and promotes deeper engagement in classroom activities. However, contrary findings exist, suggesting that the use of VR may have some negative effects. For example, students might have become addicted to the virtual world and neglected their real-life tasks and responsibilities, thus affecting their behavior in the classroom ( Cheng et al., 2015 ; Greenwald et al., 2018 ; Makransky et al., 2019 ). In addition, some other scholars noted that there might have been a gap between learning experiences in virtual environments and real-world learning experiences, which might have affected students’ ability to acquire and apply knowledge ( Makransky and Petersen, 2021 ). These conflicting results remind us that these complexities and diversities need to be taken into account when evaluating the role of VR technology in improving student engagement in the classroom.

Finally, scholars such as Wu et al. (2013) , Schutte and Stilinović (2017) , and Yuen et al. (2011) found that VR helped to promote student affective engagement. For example, Schutte and Stilinović (2017) found that contexts provided by VR for children with emotional impairments or disabilities taught them skills in communicating with people and managing their emotions, thus fostering empathy. This implies that VR may stimulate affective engagement. Wu et al. (2013) and Yuen et al. (2011) also found that VR provided opportunities for affective interaction, enabling students to interact with characters in the virtual environment. In language learning, for example, practicing through conversations with virtual characters could help students improve their oral expression ( Dhimolea et al., 2022 ). This means that affective interactions may increase students’ affective engagement with the learning content. Similarly, Misak (2018) noted that VR allowed students to role-play in virtual literature and experience the affective portrayed in the story. In other words, affective experiences may deepen students’ understanding of literary works and increase affective engagement. This literature seems to reflect that VR can promote student affective engagement.

In general, VR positively impacts students’ cognitive, behavioral, and affective engagement. In terms of cognitive engagement, VR can facilitate students’ cognitive engagement with learning materials and better understanding of abstract and complex knowledge by creating immersive situations. In terms of behavioral engagement, VR stimulates active student engagement and action through interactive learning. Although there is debate about whether VR has a positive impact on student behavioral engagement, literature has demonstrated the positive impact of VR on student behavioral engagement. In terms of affective engagement, VR promotes students’ emotional engagement by triggering affective resonance through affective experience and affective interaction. This full engagement helps students improve their learning and develop empathy.

The following section discusses the challenges faced when introducing VR in education. Through understanding these challenges, we can better understand the problems in the education system and make some constructive suggestions to help address them.

The challenge of VR in education

Despite the positive impact of VR on students’ cognitive, behavioral, and affective engagement, there are still two challenges to introducing VR into middle education, namely the difficulty of the educational system in keeping up with VR developments and the lack of teacher proficiency in VR use ( Islam et al., 2015 ; Zhong, 2017 ; Abich et al., 2021 ). For example, Islam et al. (2015) observed that the pace of technological advancement, including VR, outpaced the ability of the education system to adapt. This phenomenon is due to the slow reform of the education system, which takes time for the acceptance and adoption of emerging technologies ( Islam et al., 2015 ). To this end, the education sector may take longer to standardize the syllabus, resulting in students not having immediate access to VR ( Zhong, 2017 ). In other words, students may not have the opportunity to experience VR in the classroom until the education department completes the standardization process. Sahlberg (2016) further stated that while reform and standardization in the education sector took time, once VR and the education system evolved in tandem, students benefited from an education that matched the VR of the day.

Other scholars observed that VR education faced several challenges in developing digital literacy in students ( Aviram and Eshet-Alkalai, 2006 ; Sahlberg, 2016 ). According to Reddy et al. (2020) , “digital literacy is a set of skills required by 21st Century individuals to use digital tools to support the achievement of goals in their life situations” (p. 66). Digital literacy encompasses the assessment of digital technologies, critical thinking, and the ability to create and express oneself digitally ( Reddy et al., 2020 ). For example, Tsivitanidou et al. (2021) and Necci et al. (2015) emphasized the need for students to identify the differences between the results of simulation experiments and real experiments and to assess the reliability and accuracy of simulation experiments. In other words, students need to judge the plausibility of the results of simulation experiments and interpret and evaluate those results in real-world situations.

Similarly, Farmer and Farmer (2023) found that digital literacy required students to master VR painting and sculpting tools to create art. This involved learning to select appropriate colors and textures and creating three-dimensional effects with VR tools ( Skulmowski et al., 2021 ). Meanwhile, Andone et al. (2018) further noted that students also needed to learn to share and present their work to others in virtual reality. This observation seems to reflect the high demand for students’ creativity, technical skills, and expressive abilities when introducing VR into education. In sum, while the development of VR education benefits students’ learning in conjunction with VR, there are challenges to students’ digital literacy and the technological adaptability of the education system.

In addition, teachers’ lack of proficiency in the use of VR is another major challenge in introducing VR into middle education. For example, Abich et al. (2021) found that teachers might lack proficiency in the operation and application of VR, which might result in teachers not being able to fully utilize VR to supplement instruction. Jensen and Konradsen (2018) claimed that “for HMDs to become a relevant tool for instructors they must have the ability to produce and edit their content” (p.1525). This means that teachers need to spend time familiarizing themselves with HMDs and related software to create, edit, and customize content to meet their specific instructional needs. Similarly, Fransson et al. (2020) discussed the challenges of teachers operating VR equipment and software. They interviewed 28 teachers to understand teachers’ challenges with implementing helmet display VR in educational settings. Fransson et al. (2020) indicated that there might be a technological threshold and learning curve for teachers in controlling and operating VR devices, which might affect the effective use of VR for teaching and learning.

While teachers may lack familiarity with VR, there are solutions to this challenge. For example, Alfalah (2018) noted that proper training and support could help teachers make the most of VR to supplement instruction. That is, teacher training can provide teachers with the technical knowledge and operational skills they need to familiarize themselves with how VR equipment and software work. To this end, Alfalah (2018) found the impact of providing teachers with VR training in schools. They used a quantitative approach by distributing a questionnaire online to 30 IT teachers. Alfalah (2018) indicated that “technology training may be maximized for the integration of VR technology” (P.2634). This finding seems to reflect that proper teacher training and support can be effective in helping teachers overcome the operational and application of VR technology’s difficulties.

In sum, prior literature has shown that introducing VR into middle school education faces several challenges. First, the rapid development of technology makes the educational system keep up with VR, resulting in a disconnect between the educational curriculum and VR. Second, there may be a lack of proficiency in students’ digital literacy and teachers’ handling and application of VR. However, these challenges are not insurmountable. With proper training and support, teachers can make full use of VR to supplement their teaching and learning to realize the potential of VR in education. It is worth noting that through the literature we have found that in practice, due to the rapid development of technology and the limitations of the educational system, achieving a complete balance may take some time and effort. Therefore, considering how to address the gap between the speed of VR development and the education system to better integrate and apply VR in education makes sense.

This article describes the impact of VR on student cognitive, behavioral, and affective engagement and the challenges posed by VR education. The literature review finds that using VR in the classroom can positively impact student engagement and learning outcomes. An interesting finding is that VR can be a promising tool for providing education to students with learning disabilities. For example, the previous literature review section describes how for students with learning difficulties, anxiety disorders, and other mental illnesses, VR can provide personalized and adaptive learning environments that can help students improve cognitive engagement and academic performance. And, for children with emotional disorders or disabilities, VR provides contexts that can teach them skills for communicating with others and managing their emotions, thereby developing empathy and stimulating affective engagement.

However, the potential problems with incorporating VR in middle education are the difficulty of the education system in keeping up with VR developments, the higher demands of student digital literacy, and the lack of teacher proficiency in the use of VR. These challenges require educational policymakers to provide training and technical support to teachers to ensure that they can fully master and integrate VR to improve student engagement and teaching effectiveness.

Author contributions

XL: Writing – original draft, Writing – review & editing. BL: Conceptualization, Writing – original draft, Writing – review & editing. ZNY: Writing – original draft, Writing – review & editing. ZY: Funding acquisition, Supervision, Writing – original draft, Writing – review & editing. MZ: Funding acquisition, Writing – original draft, Writing – review & editing, Supervision.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the General Topics of China’s Hunan Province Social Science Achievement Evaluation Committee Fund [Grant no. XSP2023JYC123].

Acknowledgments

We are deeply appreciative of the editors and reviewers of this journal for their unwavering dedication and contributions that have shaped the publication of this article. Their constructive feedback and invaluable insights were instrumental in bringing this piece to fruition. We extend our heartfelt thanks to the readers with a keen interest in virtual reality technology. It is our sincere hope that this article will inspire enriched discussions within the academic community about the potential and nuances of using virtual reality in educational contexts.

Conflict of interest

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

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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Keywords: virtual reality technology, cognitive engagement, affective engagement, behavioral engagement, learning outcomes

Citation: Lin XP, Li BB, Yao ZN, Yang Z and Zhang M (2024) The impact of virtual reality on student engagement in the classroom–a critical review of the literature. Front. Psychol . 15:1360574. doi: 10.3389/fpsyg.2024.1360574

Received: 23 December 2023; Accepted: 22 March 2024; Published: 10 April 2024.

Reviewed by:

Copyright © 2024 Lin, Li, Yao, Yang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Zhi Yang, [email protected] ; Mingshu Zhang, [email protected]

† These authors have contributed equally to this work and share first authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Open access
Published: 10 April 2024

Development of an index system for the scientific literacy of medical staff: a modified Delphi study in China

Shuyu Liang 2 na1 ,
Ziyan Zhai 2 na1 ,
Xingmiao Feng 2 ,
Xiaozhi Sun 1 ,
Jingxuan Jiao 1 ,
Yuan Gao 1 na2 &
Kai Meng ORCID: orcid.org/0000-0003-1467-7904 2 , 3 na2

BMC Medical Education volume 24 , Article number: 397 ( 2024 ) Cite this article

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Metrics details

Scientific research activity in hospitals is important for promoting the development of clinical medicine, and the scientific literacy of medical staff plays an important role in improving the quality and competitiveness of hospital research. To date, no index system applicable to the scientific literacy of medical staff in China has been developed that can effectively evaluate and guide scientific literacy. This study aimed to establish an index system for the scientific literacy of medical staff in China and provide a reference for improving the evaluation of this system.

In this study, a preliminary indicator pool for the scientific literacy of medical staff was constructed through the nominal group technique ( n = 16) with medical staff. Then, two rounds of Delphi expert consultation surveys ( n = 20) were conducted with clinicians, and the indicators were screened, revised and supplemented using the boundary value method and expert opinions. Next, the hierarchical analysis method was utilized to determine the weights of the indicators and ultimately establish a scientific literacy indicator system for medical staff.

Following expert opinion, the index system for the scientific literacy of medical staff featuring 2 first-level indicators, 9 second-level indicators, and 38 third-level indicators was ultimately established, and the weights of the indicators were calculated. The two first-level indicators were research literacy and research ability, and the second-level indicators were research attitude (0.375), ability to identify problems (0.2038), basic literacy (0.1250), ability to implement projects (0.0843), research output capacity (0.0747), professional capacity (0.0735), data-processing capacity (0.0239), thesis-writing skills (0.0217), and ability to use literature (0.0181).

Conclusions

This study constructed a comprehensive scientific literacy index system that can assess medical staff's scientific literacy and serve as a reference for evaluating and improving their scientific literacy.

Peer Review reports

Due to the accelerated aging of the population and the growing global demand for healthcare in the wake of epidemics, there is an urgent need for medicine to provide greater support and protection. Medical scientific research is a critical element in promoting medical science and technological innovation, as well as improving clinical diagnosis and treatment techniques. It is the main driving force for the development of healthcare [ 1 ].

Medical personnel are highly compatible with clinical research. Due to their close interaction with patients, medical staff are better equipped to identify pertinent clinical research issues and actually implement clinical research projects [ 2 ]. Countries have created favorable conditions for the research and development of medical personnel by providing financial support, developing policies, and offering training courses [ 3 , 4 ]. However, some clinical studies have shown that the ability of most medical staff does not match current health needs and cannot meet the challenges posed by the twenty-first century [ 5 ]. It is clear that highly skilled professionals with scientific literacy are essential for national and social development [ 6 ]. Given the importance of scientific research in countries and hospitals, it is crucial to determine the level of scientific research literacy that medical personnel should possess and how to train them to acquire the necessary scientific research skills. These issues have significant practical implications.

Scientific literacy refers to an individual's ability to engage in science-related activities [ 7 ]. Some scholars suggest that the scientific literacy of medical personnel encompasses the fundamental qualities required for scientific research work, encompassing three facets: academic moral accomplishment, scientific research theory accomplishment, and scientific research ability accomplishment [ 8 ]. The existing research has focused primarily on the research capabilities of medical staff. According to Rillero, problem-solving skills, critical thinking, communication skills, and the ability to interpret data are the four core components of scientific literacy [ 9 ]. The ability to perform scientific research in nursing encompasses a range of abilities, including identifying problems, conducting literature reviews, designing and conducting scientific research, practicing scientific research, processing data, and writing papers [ 10 ]. Moule and Goodman proposed a framework of skills that research-literate nurses should possess, such as critical thinking capacity, analytical skills, searching skills, research critique skills, the ability to read and critically appraise research, and an awareness of ethical issues [ 11 ]. Several researchers have developed self-evaluation questionnaires to assess young researchers' scientific research and innovative abilities in the context of university-affiliated hospitals (UHAs) [ 12 ]. The relevant indicators include sensitivity to problems, sensitivity to cutting-edge knowledge, critical thinking, and other aspects. While these indicators cover many factors, they do not consider the issue of scientific research integrity in the medical field. The lack of detailed and targeted indicators, such as clinical resource collection ability and interdisciplinary cooperation ability, hinders the effective measurement of the current status of scientific literacy among medical staff [ 12 ]. In conclusion, the current research on the evaluation indicators of scientific literacy among medical personnel is incomplete, overlooking crucial humanistic characteristics, attitudes, and other moral literacy factors. Therefore, there is an urgent need to establish a comprehensive and systematic evaluation index to effectively assess the scientific literacy of medical staff.

Therefore, this study utilized a literature search and nominal group technique to screen the initial evaluation index and subsequently constructed an evaluation index system for medical staff's scientific research literacy utilizing the Delphi method. This index system would serve as a valuable tool for hospital managers, aiding them in the selection, evaluation, and training of scientific research talent. Additionally, this approach would enable medical personnel to identify their own areas of weakness and implement targeted improvement strategies.

Patient and public involvement

Patients and the public were not involved in this research.

Study design and participants

In this study, an initial evaluation index system was developed through a literature review and nominal group technique. Subsequently, a more comprehensive and scientific index system was constructed by combining qualitative and quantitative analysis utilizing the Delphi method to consult with experts. Finally, the hierarchical analysis method and the percentage weight method were employed to empower the index system.

The program used for this study is shown in Fig. 1 .

Study design. AHP, analytic hierarchy process

Establishing the preliminary indicator pool

Search process.

A literature search was performed in the China National Knowledge Infrastructure (CNKI), WanFang, PubMed, Web of Science and Scopus databases to collect the initial evaluation indicators. The time span ranged from the establishment of the database to July 2022. We used a combination of several MeSH terms in our searches:(("Medical Staff"[Mesh] OR "Nurses"[Mesh] OR "Physicians"[Mesh])) AND (("Literacy"[Mesh]) OR "Aptitude"[Mesh]). We also used several Title/Abstract searches, including keywords such as: Evaluation, scientific literacy, research ability.

The inclusion criteria were as follows: (1)The subjects were nurses, medicial staff and other personnel engaged in the medical industry; (2) Explore topics related to scientific literacy, such as research ability, and literature that can clarify the structure or dependency between indicators of scientific literacy; (3) Select articles published in countries such as China, the United States, the United Kingdom, Australia and Canada; (4) Research published in English or Chinese is considered to be eligible. The exclusion criteria are as follows: (1) indicators not applicable to medical staff; (2) Conference abstracts, case reports or review papers; (3) Articles with repeated descriptions; (4) There are no full-text articles or grey literature. A total of 78 articles were retrieved and 60 were retained after screening according to inclusion and exclusion criteria.

The research was conducted by two graduate students and two undergraduate students who participated in the literature search and screening. The entire research process was supervised and guided by one professor. All five members were from the fields of social medicine and health management. The professor was engaged in hospital management and health policy research for many years.

Nominal group technique

The nominal group technique was introduced at Hospital H in Beijing in July 2022. This hospital, with over 2,500 beds and 3,000 doctors, is a leading comprehensive medical center also known for its educational and research achievements, including numerous national research projects and awards.

The interview questions were based on the research question: What research literacy should medical staff have? 16 clinicians and nurses from Hospital H were divided into 2 equal groups and asked to provide their opinions on important aspects of research literacy based on their positions and experiences. Once all participants had shared their thoughts, similar responses were merged and polished. If anyone had further inputs after this, a second round of interviews was held until no new inputs were given. The entire meeting, including both rounds, was documented by researchers with audio recordings on a tape recorder.

Scientific literacy dimensions

Based on the search process, the research group extracted 58 tertiary indicators. To ensure the practicality and comprehensiveness of the indicators, the Nominal group technique was used on the basis of the literature search. Panelists summarized the entries shown in the interviews and merged similar content to obtain 32 third-level indicators. The indicators obtained from the literature search were compared. Several indicators with similar meanings, such as capture information ability, language expression ability, communication ability, and scientific research integrity, were merged. Additionally, the indicators obtained from the literature search, such as scientific research ethics, database use ability, feasibility and analysis ability, were added to the 15 indicators. A total of 47 third-level indicators were identified.

Fengling Dai and colleagues developed an innovation ability index system with six dimensions covering problem discovery, information retrieval, research design, practice, data analysis, and report writing, which represents the whole of innovative activity. Additionally, the system includes an innovation spirit index focusing on motivation, thinking, emotion, and will, reflecting the core of the innovation process in terms of competence [ 13 ]. Liao et al. evaluated the following five dimensions in their study on scientific research competence: literature processing, experimental manipulation, statistical analysis, manuscript production, and innovative project design [ 14 ]. Mohan claimed that scientific literacy consists of four core components: problem solving, critical thinking, communication skills, and the ability to interpret data [ 15 ].

This study structured scientific literacy into 2 primary indicators (research literacy and research competence) and 9 secondary indicators (basic qualifications, research ethics, research attitude, problem identification, literature use, professional capacity, subject implementation, data processing, thesis writing, and research output).

Using the Delphi method to develop an index system

Expert selection.

This study used the Delphi method to distribute expert consultation questionnaires online, allowing experts to exchange opinions anonymously to ensure that the findings were more desirable and scientific. No fixed number of experts is required for a Delphi study, but the more experts involved, the more stable the results will be [ 16 ]; this method generally includes 15 to 50 experts [ 17 ]. We selected clinicians from several tertiary hospitals in the Beijing area to serve as Delphi study consultants based on the following inclusion criteria: (1) they had a title of senior associate or above; (2) they had more than 10 years of work experience in the field of clinical scientific research, and (3) they were presiding over national scientific research projects. The exclusion criteria were as follows: (1) full-time scientific researchers, and (2) personnel in hospitals who were engaged only in management. To ensure that the selected experts were representative, this study selected 20 experts from 14 tertiary hospitals affiliated with Capital Medical University, Peking University, the Chinese Academy of Medical Sciences and the China Academy of Traditional Chinese Medicine according to the inclusion criteria; the hospitals featured an average of 1,231 beds each, and 9 hospitals were included among the 77 hospitals in the domestic comprehensive hospital ranking (Fudan Hospital Management Institute ranking). The experts represented various specialties and roles from different hospitals, including cardiology, neurosurgery, neurology, ear and throat surgery, head and neck surgery, radiology, imaging, infection, vascular interventional oncology, pediatrics, general practice, hematology, stomatology, nephrology, urology, and other related fields. This diverse group included physicians, nurses, managers, and vice presidents. The selected experts had extensive clinical experience, achieved numerous scientific research accomplishments and possessed profound knowledge and experience in clinical scientific research. This ensured the reliability of the consultation outcomes.

Design of the expert consultation questionnaire

The Delphi survey for experts included sections on their background, familiarity with the indicator system, system evaluation, and opinions. Experts rated indicators on importance, feasibility, and sensitivity using a 1–10 scale and their own familiarity with the indicators on a 1–5 scale. They also scored their judgment basis and impact on a 1–3 scale, considering theoretical analysis, work experience, peer understanding, and intuition. Two rounds of Delphi surveys were carried out via email with 20 experts to evaluate and suggest changes to the indicators. Statistical coefficients were calculated to validate the Delphi process. Feedback from the first round led to modifications and the inclusion of an AHP questionnaire for the second round. After the second round, indicators deemed less important were removed, and expert discussion finalized the indicator weights based on their relative importance scores. This resulted in the development of an index system for medical staff scientific literacy. The questionnaire is included in Additional file 1 (first round) and Additional file 2 (second round).

Using the boundary value method to screen the indicators

In this study, the boundary value method was utilized to screen the indicators of medical staff's scientific literacy, and the importance, feasibility, and sensitivity of each indicator were measured using the frequency of perfect scores, the arithmetic mean, and the coefficient of variation, respectively. When calculating the frequency of perfect scores and arithmetic means, the boundary value was set as "mean-SD," and indicators with scores higher than this value were retained. When calculating the coefficient of variation, the cutoff value was set to "mean + SD," and indicators with values below this threshold were retained.

The principles of indicator screening are as follows:

To evaluate the importance of the indicators, if none of the boundary values of the three statistics met the requirements, the indicators were deleted.

If an indicator has two aspects, importance, feasibility, or sensitivity, and each aspect has two or more boundary values that do not meet the requirements, then the indicator is deleted.

If all three boundary values for an indicator meet the requirements, the research group discusses the modification feedback from the experts and determines whether the indicator should be used.

The results of the two rounds of boundary values are shown in Table 1 .

Using the AHP to assign weights

After the second round of Delphi expert consultations, the analytic hierarchy process (AHP) was used to determine the weights of the two first-level indicators and the nine second-level indicators. The weights of the 37 third-level indicators were subsequently calculated via the percentage weight method. The AHP, developed by Saaty in the 1980s, is used to determine the priority and importance of elements constituting the decision-making hierarchy. It is based on multicriteria decision-making (MCDM) and determines the importance of decision-makers' judgments based on weights derived from pairwise comparisons between elements. In the AHP, pairwise comparisons are based on a comparative evaluation in which each element's weight in the lower tier is compared with that of other lower elements based on the element in the upper tier [ 18 ].

AHP analysis involves the following steps:

Step 1: Establish a final goal and list related elements to construct a hierarchy based on interrelated criteria.

Step 2: Perform a pairwise comparison for each layer to compare the weights of each element. Using a score from 1 to 9, which is the basic scale of the AHP, each pair is compared according to the expert’s judgment, and the importance is judged [ 19 , 20 ].

Yaahp software was employed to analyze data by creating a judgment matrix based on the experts' scores and hierarchical model. The index system weights were obtained by combining the experts' scores. The percentage weight method used experts' importance ratings from the second round to calculate weights, ranking indicators by importance, calculating their scores based on frequency of ranking, and determining weighting coefficients by dividing these scores by the total of all third-level indicators' scores. The third-level indicator weighting coefficients were then calculated by multiplying the coefficients [ 21 ].

Data analysis

Expert positivity coefficient.

The expert positivity coefficient is indicated by the effective recovery rate of the expert consultation questionnaire, which represents the level of expert positivity toward this consultation and determines the credibility and scientific validity of the questionnaire results. Generally, a questionnaire with an effective recovery rate of 70% is considered very good [ 22 ].

In this study, 20 questionnaires were distributed in both rounds of Delphi expert counseling, and all 20 were effectively recovered, resulting in a 100% effective recovery rate. Consequently, the experts provided positive feedback on the Delphi counseling.

Expert authority coefficient (CR)

The expert authority coefficient (Cr) is the arithmetic mean of the judgment coefficient (Ca) and the familiarity coefficient (Cs), namely, Cr = \(\frac{({\text{Ca}}+{\text{Cs}})}{2}\) . The higher the degree of expert authority is, the greater the predictive accuracy of the indicator. A Cr ≥ 0.70 was considered to indicate an acceptable level of confidence [ 23 ]. Ca represents the basis on which the expert makes a judgment about the scenario in question, while Cs represents the expert's familiarity with the relevant problem [ 24 ].

Ca is calculated on the basis of experts' judgments of each indicator and the magnitude of its influence. In this study, experts used "practical experience (0.4), "theoretical analysis (0.3), "domestic and foreign peers (0.2)" and "intuition (0.1)" as the basis for judgment and assigned points according to the influence of each basis for judgment on the experts' judgment. Ca = 1 when the basis for judgment has a large influence on the experts, and Ca = 0.5 when the influence of the experts' judgment is at a medium level. When no influence on expert judgment was evident, Ca = 0 [ 25 ] (Table 2 ).

Cs refers to the degree to which the expert was familiar with the question. This study used the Likert scale method to score experts’ familiarity with the question on a scale ranging from 0 to 1 (1 = very familiar, 0.75 = more familiar, 0.5 = moderately familiar, 0.25 = less familiar, 0 = unfamiliar). The familiarity coefficient for each expert (the average familiarity for each indicator) was calculated. The average familiarity coefficient was subsequently computed [ 26 ].

The Cr value of the primary indicator in this study was 0.83, and the Cr value of the secondary indicator was 0.82 (> 0.7); hence, the results of the expert consultation were credible and accurate, as shown in Table 3 .

The degree of expert coordination is an important indicator used to judge the consistency among various experts regarding indicator scores. This study used the Kendall W coordination coefficient test to determine the degree of expert coordination. A higher Kendall W coefficient indicates a greater degree of expert coordination and greater consistency in expert opinion, and P < 0.05 indicates that the difference is significant [ 26 ]. The results of the three-dimensional harmonization coefficient test for each indicator in the two rounds of the expert consultation questionnaire were valid ( p < 0.01 ), emphasizing the consistency of the experts' scores. The values of the Kendall W coordination coefficients for both rounds are shown in Table 4 .

Basic information regarding the participants

The 20 Delphi experts who participated in this study were predominantly male (80.0%) rather than female (20.0%). In addition, the participants’ ages were mainly concentrated in the range of 41–50 years old (60.0%). The majority of the experts were doctors by profession (85.0%), and their education and titles were mainly doctoral degree (90.0%) and full senior level (17.0%). The experts also exhibited high academic achievement in their respective fields and had many years of working experience, with the majority having between 21 and 25 years of experience (40.0%) (Table 5 ).

Index screening

The boundary value method was applied to eliminate indicators, leading to the removal of 6 third-level indicators in the first round. One of these, the ability to use statistical software, was associated with a more significant second-level indicator involving data processing, which was kept after expert review. Six indicators were merged into three indicators due to duplication, and 5 third-level indicators were added, resulting in 2 primary indicators, 10 secondary indicators, and 43 third-level indicators.

In the second round of Delphi expert consultation, 5 third-level indicators were deleted, as shown in Additional file 3 , and only one third-level indicator, "Scientific spirit", remained under the secondary indicator "research attitude". The secondary indicator "Research attitude" was combined with "Research ethics" and the third-level indicator "Scientific spirit" was also considered part of "Research ethics". After expert discussion, these were merged into a new secondary indicator "Research attitude" with three third-level indicators: "Research ethics", "Research integrity", and "Scientific spirit". The final index system included two primary indicators, nine secondary indicators, and thirty-eight third-level indicators, as shown in Additional File 3 .

Final index system with weights

The weights of the two primary indexes, research literacy and research ability, were equal. This was determined using the hierarchical analysis method and the percentage weight method based on the results of the second round of Delphi expert consultation (Table 6 ). The primary indicator of research literacy encompasses the fundamental qualities and attitudes medical staff develop over time, including basic qualifications and approach to research. The primary indicator of research ability refers to medical professionals' capacity to conduct scientific research in new areas using suitable methods, as well as their skills needed for successful research using scientific methods.

In this study, the Delphi method was employed, and after two rounds of expert consultation, in accordance with the characteristics and scientific research requirements of medical staff in China, an index system for the scientific literacy of medical staff in China was constructed. The index system for medical staff's scientific literacy in this study consists of 2 first-level indicators, 9 second-level indicators, and 38 third-level indicators. Medical institutions at all levels can use this index system to scientifically assess medical staff's scientific literacy.

In 2014, the Joint Task Force for Clinical Trial Competency (JTF) published its Core Competency Framework [ 27 ]. The Framework focuses more on the capacity to conduct clinical research. These include principles such as clinical research and quality practices for drug clinical trials. However, this framework does not apply to the current evaluation of scientific literacy in hospitals. Because these indicators do not apply to all staff members, there is a lack of practical scientific research, such as information about the final paper output. Therefore, the experts who constructed the index system in this study came from different specialties, and the indicators can be better applied to scientific researchers in all fields. This approach not only addresses clinical researchers but also addresses the concerns of hospital managers, and the indicators are more applicable.

The weighted analysis showed that the primary indicators "research literacy" and "research ability" had the same weight (0.50) and were two important components of scientific literacy. Research ability is a direct reflection of scientific literacy and includes the ability to identify problems, the ability to use literature, professional capacity, subject implementation capacity, data-processing capacity, thesis-writing skills, and research output capacity. Only by mastering these skills can medical staff carry out scientific research activities more efficiently and smoothly. The ability to identify problems refers to the ability of medical staff to obtain insights into the frontiers of their discipline and to identify and ask insightful questions. Ratten claimed that only with keen insight and sufficient sensitivity to major scientific issues can we exploit the opportunities for innovation that may lead to breakthroughs [ 28 ]. Therefore, it is suggested that in the process of cultivating the scientific literacy of medical staff, the ability to identify problems, including divergent thinking, innovative sensitivity, and the ability to produce various solutions, should be improved. Furthermore, this study included three subentries of the secondary indicator "research attitude", namely, research ethics, research integrity, and scientific spirit. This is likely because improper scientific research behavior is still prevalent. A study conducted in the United States and Europe showed that the rate of scientific research misconduct was 2% [ 13 ]. A small survey conducted in Indian medical schools and hospitals revealed that 57% of the respondents knew that someone had modified or fabricated data for publication [ 28 ]. The weight of this index ranked first in the secondary indicators, indicating that scientific attitude is an important condition for improving research quality, relevance, and reliability. Countries and hospitals should develop, implement, and optimize policies and disciplinary measures to combat academic misconduct.

In addition, the third-level indicator "scheduling ability" under the second-level indicator "basic qualification" has a high weight, indicating that medical staff attach importance to management and distribution ability in the context of scientific research. Currently, hospitals face several problems, such as a shortage of medical personnel, excessive workload, and an increase in the number of management-related documents [ 29 , 30 ]. These factors result in time conflicts between daily responsibilities and scientific research tasks, thereby presenting significant obstacles to the allocation of sufficient time for scientific inquiry [ 31 ]. Effectively arranging clinical work and scientific research time is crucial to improving the overall efficiency of scientific research. In the earlier expert interviews, most medical staff believed that scientific research work must be combined with clinical work rather than focused only on scientific research. Having the ability to make overall arrangements is essential to solving these problems. The high weight given to the second-level index of 'subject implementation capacity', along with its associated third-level indicators, highlights the challenges faced by young medical staff in obtaining research subjects. Before implementing a project, researchers must thoroughly investigate, analyze, and compare various aspects of the research project, including its technical, economic, and engineering aspects. Moreover, potential financial and economic benefits, as well as social impacts, need to be predicted to determine the feasibility of the project and develop a research plan [ 32 ]. However, for most young medical staff in medical institutions, executing such a project can be challenging due to their limited scientific research experience [ 33 ]. A researcher who possesses these skills can truly carry out independent scientific research.

The weights of the second-level index "research output capacity" cannot be ignored. In Chinese hospitals, the ability to produce scientific research output plays a certain role in employees’ ability to obtain rewards such as high pay, and this ability is also used as a reference for performance appraisals [ 34 ]. The general scientific research performance evaluation includes the number of projects, scientific papers and monographs, scientific and technological achievements, and patents. In particular, the publication of papers is viewed as an indispensable aspect of performance appraisal by Chinese hospitals [ 35 ]. Specifically, scientific research papers are the carriers of scientific research achievements and academic research and thus constitute an important symbol of the level of medical development exhibited by medical research institutions; they are thus used as recognized and important indicators of scientific research output [ 36 ]. This situation is consistent with the weight evaluation results revealed by this study.

The results of this study are important for the training and management of the scientific research ability of medical personnel. First, the index system focuses not only on external characteristics such as scientific knowledge and skills but also on internal characteristics such as individual traits, motivation, and attitudes. Therefore, when building a research team and selecting and employing researchers, hospital managers can use the index system to comprehensively and systematically evaluate the situation of researchers, which is helpful for optimizing the allocation of a research team, learning from each other's strengths, and strengthening the strength of the research team. Second, this study integrates the content of existing research to obtain useful information through in-depth interviews with medical staff and constructs an evaluation index system based on Delphi expert consultation science, which comprehensively includes the evaluation of the whole process of scientific research activities. These findings can provide a basis for medical institutions to formulate scientific research training programs, help medical personnel master and improve scientific research knowledge and skills, and improve their working ability and quality. Moreover, the effectiveness of the training can also be evaluated according to the system.

In China, with the emergence of STEM rankings, hospitals pay more and more attention to the scientific research performance of medical personnel. Scientific literacy not only covers the abilities of medical personnel engaged in scientific research, but also reflects their professional quality in this field. Having high quality medical personnel often means that they have excellent scientific research ability, and their scientific research performance will naturally rise. In view of this,,medical institutions can define the meaning of third-level indicators and create Likert scales to survey medical staff. Based on the weights assigned to each indicator, comprehensive scores can be calculated to evaluate the level of scientific literacy among medical staff. Through detailed data analysis, they can not only reveal their shortcomings in scientific research ability and quality, but also provide a strong basis for subsequent training and promotion. Through targeted inspection, we can not only promote the comprehensive improvement of the ability of medical staff, but also promote the steady improvement of their scientific research performance, and inject new vitality into the scientific research cause of hospitals.

Limitations

This study has several limitations that need to be considered. First, the participants were only recruited from Beijing (a city in China), potentially lacking geographical diversity. We plan to select more outstanding experts from across the country to participate. Second, the index system may be more suitable for countries with medical systems similar to those of China. When applying this system in other countries, some modifications may be necessary based on the local context. Last, While this study has employed scientific methods to establish the indicator system, the index system has yet to be implemented on a large sample of medical staff. Therefore, the reliability and validity of the index system must be confirmed through further research. In conclusion, it is crucial to conduct further detailed exploration of the effectiveness and practical application of the index system in the future.

This study developed an evaluation index system using the Delphi method to assess the scientific literacy of medical staff in China. The system comprises two primary indicators, nine secondary indicators, and thirty-eight third-level indicators, with each index assigned a specific weight. The index system emphasizes the importance of both attitudes and abilities in the scientific research process for medical staff and incorporates more comprehensive evaluation indicators. In the current era of medical innovation, enhancing the scientific literacy of medical staff is crucial for enhancing the competitiveness of individuals, hospitals, and overall medical services in society. This evaluation index system is universally applicable and beneficial for countries with healthcare systems similar to those of China. This study can serve as a valuable reference for cultivating highly qualified and capable research personnel and enhancing the competitiveness of medical research.

Availability of data and materials

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

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Acknowledgements

The authors thank all who participated in the nominal group technique and two rounds of the Delphi study.

This study was supported by the National Natural Science Foundation of China (72074160) and the Natural Science Foundation Project of Beijing (9222004).

Author information

Shuyu Liang and Ziyan Zhai contributed equally to this work and joint first authors.

Kai Meng and Yuan Gao contributed equally to this work and share corresponding author.

Authors and Affiliations

Aerospace Center Hospital, No. 15 Yuquan Road, Haidian District, Beijing, 100049, China

Xiaozhi Sun, Jingxuan Jiao & Yuan Gao

School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China

Shuyu Liang, Ziyan Zhai, Xingmiao Feng & Kai Meng

Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China

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Contributions

S.L. and Z.Z. contributed equally to this paper. S.L. took charge of the nominal group technique, data analysis, writing the first draft and revising the manuscript; Z.Z. was responsible for the Delphi survey, data analysis, and writing of the first draft of the manuscript; XF was responsible for the rigorous revision of Delphi methods; X.S. and J.J. were responsible for the questionnaire survey and data collection; Y.G. contributed to the questionnaire survey, organization of the nominal group interview, supervision, project administration and resources; and K.M. contributed to conceptualization, methodology, writing—review; editing, supervision, and project administration. All the authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yuan Gao or Kai Meng .

Ethics declarations

Ethics approval and consent to participate.

This study involved human participants and was approved by the Ethical Review Committee of the Capital Medical University (No. Z2022SY089). Participation in the survey was completely voluntary, and written informed consent was obtained from the participants.

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The authors declare no competing interests.

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Liang, S., Zhai, Z., Feng, X. et al. Development of an index system for the scientific literacy of medical staff: a modified Delphi study in China. BMC Med Educ 24 , 397 (2024). https://doi.org/10.1186/s12909-024-05350-0

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DOI : https://doi.org/10.1186/s12909-024-05350-0

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HR’s New Role

Peter Cappelli
Ranya Nehmeh

Though the human resources function was once a strong advocate for employees, in the 1980s things changed. As labor markets became slack, HR shifted its focus to relentless cost cutting. Because it was hard for employees to quit, pay and every kind of benefit got squeezed. But now the pendulum has swung the other way. The U.S. unemployment rate has been below 4% for five years (except during the Covid shutdown), and the job market is likely to remain tight. So today the priorities are keeping positions filled and preventing employees from burning out. Toward that end HR needs to focus again on taking care of workers and persuade management to change outdated policies on compensation, training and development, layoffs, vacancies, outsourcing, and restructuring.

One way to do that is to show leaders what the true costs of current practices are, creating dashboards with metrics on turnover, absenteeism, reasons for quitting, illness rates, and engagement. It’s also critical to prevent employee stress, especially by addressing fears about AI and restructuring. And when firms do restructure, they should take a less-painful, decentralized approach. To increase organizational flexibility and employees’ opportunities, HR can establish internal labor markets, and to promote a sense of belonging and win employees’ loyalty, it should ramp up DEI efforts.

In this tight labor market, cost cutting is out. Championing employee concerns is in.

Idea in Brief

The pendulum swing.

For decades, when U.S. labor markets were slack, HR focused on cost cutting, which meant squeezing employees’ pay, benefits, and training. But now that labor markets are tight, the challenge is to retain workers.

The New Priorities

HR must focus on keeping positions filled and preventing employees from burning out or becoming dissatisfied.

The HR function must educate leaders about the true costs of turnover, address employee anxiety about AI and restructuring, lobby for investments in training, rethink how contract workers and vendors are used, and strengthen diversity, equity, and inclusion efforts.

From World War II through 1980 the focus of the human resources function was advocating for workers—first as a way to keep unions out of companies and later to manage employees’ development in the era when all talent was grown from within. Then things changed. Driven by the stagflation of the 1970s, the recession of the early 1980s, and more recently the Great Recession, HR’s focus increasingly shifted to relentless cost cutting. Decades of slack labor markets made slashing HR expenses easy because it was hard for people to quit. Pay and every kind of benefit, including training and development, got squeezed. Work demands went up, and job security fell.

Peter Cappelli is the George W. Taylor Professor of Management at the Wharton School and the director of its Center for Human Resources. He is the author of several books, including Our Least Important Asset: Why the Relentless Focus on Finance and Accounting Is Bad for Business and Employees (Oxford University Press, 2023).
Ranya Nehmeh is an HR specialist working on topics related to people strategy, human capital, leadership development, and talent management and is the author of The Chameleon Leader: Connecting with Millennials (2019).

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