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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

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• What is a Literature Review? | Guide, Template, & Examples

What is a Literature Review? | Guide, Template, & Examples

Published on 22 February 2022 by Shona McCombes . Revised on 7 June 2022.

What is a literature review? A literature review is a survey of scholarly sources on a specific topic. It provides an overview of current knowledge, allowing you to identify relevant theories, methods, and gaps in the existing research.

There are five key steps to writing a literature review:

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

A good literature review doesn’t just summarise sources – it analyses, synthesises, and critically evaluates to give a clear picture of the state of knowledge on the subject.

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Table of contents

Why write a literature review, examples of literature reviews, step 1: search for relevant literature, step 2: evaluate and select sources, step 3: identify themes, debates and gaps, step 4: outline your literature review’s structure, step 5: write your literature review, frequently asked questions about literature reviews, introduction.

• Quick Run-through
• Step 1 & 2

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

• Demonstrate your familiarity with the topic and scholarly context
• Develop a theoretical framework and methodology for your research
• Position yourself in relation to other researchers and theorists
• Show how your dissertation addresses a gap or contributes to a debate

You might also have to write a literature review as a stand-alone assignment. In this case, the purpose is to evaluate the current state of research and demonstrate your knowledge of scholarly debates around a topic.

The content will look slightly different in each case, but the process of conducting a literature review follows the same steps. We’ve written a step-by-step guide that you can follow below.

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

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

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

Download Word doc Download Google doc

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

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

If you are writing a literature review as a stand-alone assignment, you will have to choose a focus and develop a central question to direct your search. Unlike a dissertation research question, this question has to be answerable without collecting original data. You should be able to answer it based only on a review of existing publications.

Make a list of keywords

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

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

Search for relevant sources

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

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

You can use boolean operators to help narrow down your search:

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

To identify the most important publications on your topic, take note of recurring citations. If the same authors, books or articles keep appearing in your reading, make sure to seek them out.

You probably won’t be able to read absolutely everything that has been written on the topic – you’ll have to evaluate which sources are most relevant to your questions.

For each publication, ask yourself:

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

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

You can find out how many times an article has been cited on Google Scholar – a high citation count means the article has been influential in the field, and should certainly be included in your literature review.

The scope of your review will depend on your topic and discipline: in the sciences you usually only review recent literature, but in the humanities you might take a long historical perspective (for example, to trace how a concept has changed in meaning over time).

Remember that you can use our template to summarise and evaluate sources you’re thinking about using!

Take notes and cite your sources

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

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

You can use our free APA Reference Generator for quick, correct, consistent citations.

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

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

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

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

There are various approaches to organising the body of a literature review. You should have a rough idea of your strategy before you start writing.

Depending on the length of your literature review, you can combine several of these strategies (for example, your overall structure might be thematic, but each theme is discussed chronologically).

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

If you are writing the literature review as part of your dissertation or thesis, reiterate your central problem or research question and give a brief summary of the scholarly context. You can emphasise the timeliness of the topic (“many recent studies have focused on the problem of x”) or highlight a gap in the literature (“while there has been much research on x, few researchers have taken y into consideration”).

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

As you write, make sure to follow these tips:

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

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

If the literature review is part of your dissertation or thesis, reiterate how your research addresses gaps and contributes new knowledge, or discuss how you have drawn on existing theories and methods to build a framework for your research. This can lead directly into your methodology section.

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

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

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

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

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

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

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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

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Literature Review: 3 Essential Ingredients

The theoretical framework, empirical research and research gap

By: Derek Jansen (MBA) | Reviewer: Eunice Rautenbach (DTech) | July 2023

Writing a comprehensive but concise literature review is no simple task. There’s a lot of ground to cover and it can be challenging to figure out what’s important and what’s not. In this post, we’ll unpack three essential ingredients that need to be woven into your literature review to lay a rock-solid foundation for your study.

This post is based on our popular online course, Literature Review Bootcamp . In the course, we walk you through the full process of developing a literature review, step by step. If it’s your first time writing a literature review, you definitely want to use this link to get 50% off the course (limited-time offer).

Overview: Essential Ingredients

• Ingredients vs structure
• The theoretical framework (foundation of theory)
• The empirical research
• The research gap
• Summary & key takeaways

Ingredients vs Structure

As a starting point, it’s important to clarify that the three ingredients we’ll cover in this video are things that need to feature within your literature review, as opposed to a set structure for your chapter . In other words, there are different ways you can weave these three ingredients into your literature review. Regardless of which structure you opt for, each of the three components will make an appearance in some shape or form. If you’re keen to learn more about structural options, we’ve got a dedicated post about that here .

1. The Theoretical Framework

Let’s kick off with the first essential ingredient – that is the theoretical framework , also called the foundation of theory . 

The foundation of theory, as the name suggests, is where you’ll lay down the foundational building blocks for your literature review so that your reader can get a clear idea of the core concepts, theories and assumptions (in relation to your research aims and questions) that will guide your study. Note that this is not the same as a conceptual framework .

Typically you’ll cover a few things within the theoretical framework:

Firstly, you’ll need to clearly define the key constructs and variables that will feature within your study. In many cases, any given term can have multiple different definitions or interpretations – for example, different people will define the concept of “integrity” in different ways. This variation in interpretation can, of course, wreak havoc on how your study is understood. So, this section is where you’ll pin down what exactly you mean when you refer to X, Y or Z in your study, as well as why you chose that specific definition. It’s also a good idea to state any assumptions that are inherent in these definitions and why these are acceptable, given the purpose of your study.

Related to this, the second thing you’ll need to cover in your theoretical framework is the relationships between these variables and/or constructs . For example, how does one variable potentially affect another variable – does A have an impact on B, B on A, and so on? In other words, you want to connect the dots between the different “things” of interest that you’ll be exploring in your study. Note that you only need to focus on the key items of interest here (i.e. those most central to your research aims and questions) – not every possible construct or variable.

Lastly, and very importantly, you need to discuss the existing theories that are relevant to your research aims and research questions . For example, if you’re investigating the uptake/adoption of a certain application or software, you might discuss Davis’ Technology Acceptance Model and unpack what it has to say about the factors that influence technology adoption. More importantly, though, you need to explain how this impacts your expectations about what you will find in your own study . In other words, your theoretical framework should reveal some insights about what answers you might expect to find to your research questions .

If this sounds a bit fluffy, don’t worry. We deep dive into the theoretical framework (as well as the conceptual framework) and look at practical examples in Literature Review Bootcamp . If you’d like to learn more, take advantage of the limited-time offer (60% off the standard price).

Need a helping hand?

2. The Empirical Research

Onto the second essential ingredient, which is  empirical research . This section is where you’ll present a critical discussion of the existing empirical research that is relevant to your research aims and questions.

But what exactly is empirical research?

Simply put, empirical research includes any study that involves actual data collection and analysis , whether that’s qualitative data, quantitative data, or a mix of both . This contrasts against purely theoretical literature (the previous ingredient), which draws its conclusions based exclusively on logic and reason , as opposed to an analysis of real-world data.

In other words, theoretical literature provides a prediction or expectation of what one might find based on reason and logic, whereas empirical research tests the accuracy of those predictions using actual real-world data . This reflects the broader process of knowledge creation – in other words, first developing a theory and then testing it out in the field.

Long story short, the second essential ingredient of a high-quality literature review is a critical discussion of the existing empirical research . Here, it’s important to go beyond description . You’ll need to present a critical analysis that addresses some (if not all) of the following questions:

• What have different studies found in relation to your research questions ?
• What contexts have (and haven’t been covered)? For example, certain countries, cities, cultures, etc.
• Are the findings across the studies similar or is there a lot of variation ? If so, why might this be the case?
• What sorts of research methodologies have been used and how could these help me develop my own methodology?
• What were the noteworthy limitations of these studies?

Simply put, your task here is to present a synthesis of what’s been done (and found) within the empirical research, so that you can clearly assess the current state of knowledge and identify potential research gaps , which leads us to our third essential ingredient.

The Research Gap

The third essential ingredient of a high-quality literature review is a discussion of the research gap (or gaps).

But what exactly is a research gap?

Simply put, a research gap is any unaddressed or inadequately explored area within the existing body of academic knowledge. In other words, a research gap emerges whenever there’s still some uncertainty regarding a certain topic or question.

For example, it might be the case that there are mixed findings regarding the relationship between two variables (e.g., job performance and work-from-home policies). Similarly, there might be a lack of research regarding the impact of a specific new technology on people’s mental health. On the other end of the spectrum, there might be a wealth of research regarding a certain topic within one country (say the US), but very little research on that same topic in a different social context (say, China).

These are just random examples, but as you can see, research gaps can emerge from many different places. What’s important to understand is that the research gap (or gaps) needs to emerge from your previous discussion of the theoretical and empirical literature . In other words, your discussion in those sections needs to start laying the foundation for the research gap.

For example, when discussing empirical research, you might mention that most studies have focused on a certain context , yet very few (or none) have focused on another context, and there’s reason to believe that findings may differ. Or you might highlight how there’s a fair deal of mixed findings and disagreement regarding a certain matter. In other words, you want to start laying a little breadcrumb trail in those sections so that your discussion of the research gap is firmly rooted in the rest of the literature review.

But why does all of this matter?

Well, the research gap should serve as the core justification for your study . Through your literature review, you’ll show what gaps exist in the current body of knowledge, and then your study will then attempt to fill (or contribute towards filling) one of those gaps. In other words, you’re first explaining what the problem is (some sort of gap) and then proposing how you’ll solve it.

Key Takeaways

To recap, the three ingredients that need to be mixed into your literature review are:

• The foundation of theory or theoretical framework
• The empirical or evidence-based research

As we mentioned earlier, these are components of a literature review and not (necessarily) a structure for your literature review chapter. Of course, you can structure your chapter in a way that reflects these three components (in fact, in some cases that works very well), but it’s certainly not the only option. The right structure will vary from study to study , depending on various factors.

If you’d like to get hands-on help developing your literature review, be sure to check out our private coaching service , where we hold your hand through the entire research journey, step by step. 

Psst… there’s more!

This post is an extract from our bestselling Udemy Course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

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very good , as the first writer of the thesis i will need ur advise . please give me a piece of idea on topic -impact of national standardized exam on students learning engagement . Thank you .

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.

Handbook of eHealth Evaluation: An Evidence-based Approach [Internet].

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

Literature reviews play a critical role in scholarship because science remains, first and foremost, a cumulative endeavour ( vom Brocke et al., 2009 ). As in any academic discipline, rigorous knowledge syntheses are becoming indispensable in keeping up with an exponentially growing eHealth literature, assisting practitioners, academics, and graduate students in finding, evaluating, and synthesizing the contents of many empirical and conceptual papers. Among other methods, literature reviews are essential for: (a) identifying what has been written on a subject or topic; (b) determining the extent to which a specific research area reveals any interpretable trends or patterns; (c) aggregating empirical findings related to a narrow research question to support evidence-based practice; (d) generating new frameworks and theories; and (e) identifying topics or questions requiring more investigation ( Paré, Trudel, Jaana, & Kitsiou, 2015 ).

Literature reviews can take two major forms. The most prevalent one is the “literature review” or “background” section within a journal paper or a chapter in a graduate thesis. This section synthesizes the extant literature and usually identifies the gaps in knowledge that the empirical study addresses ( Sylvester, Tate, & Johnstone, 2013 ). It may also provide a theoretical foundation for the proposed study, substantiate the presence of the research problem, justify the research as one that contributes something new to the cumulated knowledge, or validate the methods and approaches for the proposed study ( Hart, 1998 ; Levy & Ellis, 2006 ).

The second form of literature review, which is the focus of this chapter, constitutes an original and valuable work of research in and of itself ( Paré et al., 2015 ). Rather than providing a base for a researcher’s own work, it creates a solid starting point for all members of the community interested in a particular area or topic ( Mulrow, 1987 ). The so-called “review article” is a journal-length paper which has an overarching purpose to synthesize the literature in a field, without collecting or analyzing any primary data ( Green, Johnson, & Adams, 2006 ).

When appropriately conducted, review articles represent powerful information sources for practitioners looking for state-of-the art evidence to guide their decision-making and work practices ( Paré et al., 2015 ). Further, high-quality reviews become frequently cited pieces of work which researchers seek out as a first clear outline of the literature when undertaking empirical studies ( Cooper, 1988 ; Rowe, 2014 ). Scholars who track and gauge the impact of articles have found that review papers are cited and downloaded more often than any other type of published article ( Cronin, Ryan, & Coughlan, 2008 ; Montori, Wilczynski, Morgan, Haynes, & Hedges, 2003 ; Patsopoulos, Analatos, & Ioannidis, 2005 ). The reason for their popularity may be the fact that reading the review enables one to have an overview, if not a detailed knowledge of the area in question, as well as references to the most useful primary sources ( Cronin et al., 2008 ). Although they are not easy to conduct, the commitment to complete a review article provides a tremendous service to one’s academic community ( Paré et al., 2015 ; Petticrew & Roberts, 2006 ). Most, if not all, peer-reviewed journals in the fields of medical informatics publish review articles of some type.

The main objectives of this chapter are fourfold: (a) to provide an overview of the major steps and activities involved in conducting a stand-alone literature review; (b) to describe and contrast the different types of review articles that can contribute to the eHealth knowledge base; (c) to illustrate each review type with one or two examples from the eHealth literature; and (d) to provide a series of recommendations for prospective authors of review articles in this domain.

9.2. Overview of the Literature Review Process and Steps

As explained in Templier and Paré (2015) , there are six generic steps involved in conducting a review article:

• formulating the research question(s) and objective(s),
• searching the extant literature,
• screening for inclusion,
• assessing the quality of primary studies,
• extracting data, and
• analyzing data.

Although these steps are presented here in sequential order, one must keep in mind that the review process can be iterative and that many activities can be initiated during the planning stage and later refined during subsequent phases ( Finfgeld-Connett & Johnson, 2013 ; Kitchenham & Charters, 2007 ).

Formulating the research question(s) and objective(s): As a first step, members of the review team must appropriately justify the need for the review itself ( Petticrew & Roberts, 2006 ), identify the review’s main objective(s) ( Okoli & Schabram, 2010 ), and define the concepts or variables at the heart of their synthesis ( Cooper & Hedges, 2009 ; Webster & Watson, 2002 ). Importantly, they also need to articulate the research question(s) they propose to investigate ( Kitchenham & Charters, 2007 ). In this regard, we concur with Jesson, Matheson, and Lacey (2011) that clearly articulated research questions are key ingredients that guide the entire review methodology; they underscore the type of information that is needed, inform the search for and selection of relevant literature, and guide or orient the subsequent analysis. Searching the extant literature: The next step consists of searching the literature and making decisions about the suitability of material to be considered in the review ( Cooper, 1988 ). There exist three main coverage strategies. First, exhaustive coverage means an effort is made to be as comprehensive as possible in order to ensure that all relevant studies, published and unpublished, are included in the review and, thus, conclusions are based on this all-inclusive knowledge base. The second type of coverage consists of presenting materials that are representative of most other works in a given field or area. Often authors who adopt this strategy will search for relevant articles in a small number of top-tier journals in a field ( Paré et al., 2015 ). In the third strategy, the review team concentrates on prior works that have been central or pivotal to a particular topic. This may include empirical studies or conceptual papers that initiated a line of investigation, changed how problems or questions were framed, introduced new methods or concepts, or engendered important debate ( Cooper, 1988 ). Screening for inclusion: The following step consists of evaluating the applicability of the material identified in the preceding step ( Levy & Ellis, 2006 ; vom Brocke et al., 2009 ). Once a group of potential studies has been identified, members of the review team must screen them to determine their relevance ( Petticrew & Roberts, 2006 ). A set of predetermined rules provides a basis for including or excluding certain studies. This exercise requires a significant investment on the part of researchers, who must ensure enhanced objectivity and avoid biases or mistakes. As discussed later in this chapter, for certain types of reviews there must be at least two independent reviewers involved in the screening process and a procedure to resolve disagreements must also be in place ( Liberati et al., 2009 ; Shea et al., 2009 ). Assessing the quality of primary studies: In addition to screening material for inclusion, members of the review team may need to assess the scientific quality of the selected studies, that is, appraise the rigour of the research design and methods. Such formal assessment, which is usually conducted independently by at least two coders, helps members of the review team refine which studies to include in the final sample, determine whether or not the differences in quality may affect their conclusions, or guide how they analyze the data and interpret the findings ( Petticrew & Roberts, 2006 ). Ascribing quality scores to each primary study or considering through domain-based evaluations which study components have or have not been designed and executed appropriately makes it possible to reflect on the extent to which the selected study addresses possible biases and maximizes validity ( Shea et al., 2009 ). Extracting data: The following step involves gathering or extracting applicable information from each primary study included in the sample and deciding what is relevant to the problem of interest ( Cooper & Hedges, 2009 ). Indeed, the type of data that should be recorded mainly depends on the initial research questions ( Okoli & Schabram, 2010 ). However, important information may also be gathered about how, when, where and by whom the primary study was conducted, the research design and methods, or qualitative/quantitative results ( Cooper & Hedges, 2009 ). Analyzing and synthesizing data : As a final step, members of the review team must collate, summarize, aggregate, organize, and compare the evidence extracted from the included studies. The extracted data must be presented in a meaningful way that suggests a new contribution to the extant literature ( Jesson et al., 2011 ). Webster and Watson (2002) warn researchers that literature reviews should be much more than lists of papers and should provide a coherent lens to make sense of extant knowledge on a given topic. There exist several methods and techniques for synthesizing quantitative (e.g., frequency analysis, meta-analysis) and qualitative (e.g., grounded theory, narrative analysis, meta-ethnography) evidence ( Dixon-Woods, Agarwal, Jones, Young, & Sutton, 2005 ; Thomas & Harden, 2008 ).

9.3. Types of Review Articles and Brief Illustrations

EHealth researchers have at their disposal a number of approaches and methods for making sense out of existing literature, all with the purpose of casting current research findings into historical contexts or explaining contradictions that might exist among a set of primary research studies conducted on a particular topic. Our classification scheme is largely inspired from Paré and colleagues’ (2015) typology. Below we present and illustrate those review types that we feel are central to the growth and development of the eHealth domain.

9.3.1. Narrative Reviews

The narrative review is the “traditional” way of reviewing the extant literature and is skewed towards a qualitative interpretation of prior knowledge ( Sylvester et al., 2013 ). Put simply, a narrative review attempts to summarize or synthesize what has been written on a particular topic but does not seek generalization or cumulative knowledge from what is reviewed ( Davies, 2000 ; Green et al., 2006 ). Instead, the review team often undertakes the task of accumulating and synthesizing the literature to demonstrate the value of a particular point of view ( Baumeister & Leary, 1997 ). As such, reviewers may selectively ignore or limit the attention paid to certain studies in order to make a point. In this rather unsystematic approach, the selection of information from primary articles is subjective, lacks explicit criteria for inclusion and can lead to biased interpretations or inferences ( Green et al., 2006 ). There are several narrative reviews in the particular eHealth domain, as in all fields, which follow such an unstructured approach ( Silva et al., 2015 ; Paul et al., 2015 ).

Despite these criticisms, this type of review can be very useful in gathering together a volume of literature in a specific subject area and synthesizing it. As mentioned above, its primary purpose is to provide the reader with a comprehensive background for understanding current knowledge and highlighting the significance of new research ( Cronin et al., 2008 ). Faculty like to use narrative reviews in the classroom because they are often more up to date than textbooks, provide a single source for students to reference, and expose students to peer-reviewed literature ( Green et al., 2006 ). For researchers, narrative reviews can inspire research ideas by identifying gaps or inconsistencies in a body of knowledge, thus helping researchers to determine research questions or formulate hypotheses. Importantly, narrative reviews can also be used as educational articles to bring practitioners up to date with certain topics of issues ( Green et al., 2006 ).

Recently, there have been several efforts to introduce more rigour in narrative reviews that will elucidate common pitfalls and bring changes into their publication standards. Information systems researchers, among others, have contributed to advancing knowledge on how to structure a “traditional” review. For instance, Levy and Ellis (2006) proposed a generic framework for conducting such reviews. Their model follows the systematic data processing approach comprised of three steps, namely: (a) literature search and screening; (b) data extraction and analysis; and (c) writing the literature review. They provide detailed and very helpful instructions on how to conduct each step of the review process. As another methodological contribution, vom Brocke et al. (2009) offered a series of guidelines for conducting literature reviews, with a particular focus on how to search and extract the relevant body of knowledge. Last, Bandara, Miskon, and Fielt (2011) proposed a structured, predefined and tool-supported method to identify primary studies within a feasible scope, extract relevant content from identified articles, synthesize and analyze the findings, and effectively write and present the results of the literature review. We highly recommend that prospective authors of narrative reviews consult these useful sources before embarking on their work.

Darlow and Wen (2015) provide a good example of a highly structured narrative review in the eHealth field. These authors synthesized published articles that describe the development process of mobile health ( m-health ) interventions for patients’ cancer care self-management. As in most narrative reviews, the scope of the research questions being investigated is broad: (a) how development of these systems are carried out; (b) which methods are used to investigate these systems; and (c) what conclusions can be drawn as a result of the development of these systems. To provide clear answers to these questions, a literature search was conducted on six electronic databases and Google Scholar . The search was performed using several terms and free text words, combining them in an appropriate manner. Four inclusion and three exclusion criteria were utilized during the screening process. Both authors independently reviewed each of the identified articles to determine eligibility and extract study information. A flow diagram shows the number of studies identified, screened, and included or excluded at each stage of study selection. In terms of contributions, this review provides a series of practical recommendations for m-health intervention development.

9.3.2. Descriptive or Mapping Reviews

The primary goal of a descriptive review is to determine the extent to which a body of knowledge in a particular research topic reveals any interpretable pattern or trend with respect to pre-existing propositions, theories, methodologies or findings ( King & He, 2005 ; Paré et al., 2015 ). In contrast with narrative reviews, descriptive reviews follow a systematic and transparent procedure, including searching, screening and classifying studies ( Petersen, Vakkalanka, & Kuzniarz, 2015 ). Indeed, structured search methods are used to form a representative sample of a larger group of published works ( Paré et al., 2015 ). Further, authors of descriptive reviews extract from each study certain characteristics of interest, such as publication year, research methods, data collection techniques, and direction or strength of research outcomes (e.g., positive, negative, or non-significant) in the form of frequency analysis to produce quantitative results ( Sylvester et al., 2013 ). In essence, each study included in a descriptive review is treated as the unit of analysis and the published literature as a whole provides a database from which the authors attempt to identify any interpretable trends or draw overall conclusions about the merits of existing conceptualizations, propositions, methods or findings ( Paré et al., 2015 ). In doing so, a descriptive review may claim that its findings represent the state of the art in a particular domain ( King & He, 2005 ).

In the fields of health sciences and medical informatics, reviews that focus on examining the range, nature and evolution of a topic area are described by Anderson, Allen, Peckham, and Goodwin (2008) as mapping reviews . Like descriptive reviews, the research questions are generic and usually relate to publication patterns and trends. There is no preconceived plan to systematically review all of the literature although this can be done. Instead, researchers often present studies that are representative of most works published in a particular area and they consider a specific time frame to be mapped.

An example of this approach in the eHealth domain is offered by DeShazo, Lavallie, and Wolf (2009). The purpose of this descriptive or mapping review was to characterize publication trends in the medical informatics literature over a 20-year period (1987 to 2006). To achieve this ambitious objective, the authors performed a bibliometric analysis of medical informatics citations indexed in medline using publication trends, journal frequencies, impact factors, Medical Subject Headings (MeSH) term frequencies, and characteristics of citations. Findings revealed that there were over 77,000 medical informatics articles published during the covered period in numerous journals and that the average annual growth rate was 12%. The MeSH term analysis also suggested a strong interdisciplinary trend. Finally, average impact scores increased over time with two notable growth periods. Overall, patterns in research outputs that seem to characterize the historic trends and current components of the field of medical informatics suggest it may be a maturing discipline (DeShazo et al., 2009).

9.3.3. Scoping Reviews

Scoping reviews attempt to provide an initial indication of the potential size and nature of the extant literature on an emergent topic (Arksey & O’Malley, 2005; Daudt, van Mossel, & Scott, 2013 ; Levac, Colquhoun, & O’Brien, 2010). A scoping review may be conducted to examine the extent, range and nature of research activities in a particular area, determine the value of undertaking a full systematic review (discussed next), or identify research gaps in the extant literature ( Paré et al., 2015 ). In line with their main objective, scoping reviews usually conclude with the presentation of a detailed research agenda for future works along with potential implications for both practice and research.

Unlike narrative and descriptive reviews, the whole point of scoping the field is to be as comprehensive as possible, including grey literature (Arksey & O’Malley, 2005). Inclusion and exclusion criteria must be established to help researchers eliminate studies that are not aligned with the research questions. It is also recommended that at least two independent coders review abstracts yielded from the search strategy and then the full articles for study selection ( Daudt et al., 2013 ). The synthesized evidence from content or thematic analysis is relatively easy to present in tabular form (Arksey & O’Malley, 2005; Thomas & Harden, 2008 ).

One of the most highly cited scoping reviews in the eHealth domain was published by Archer, Fevrier-Thomas, Lokker, McKibbon, and Straus (2011) . These authors reviewed the existing literature on personal health record ( phr ) systems including design, functionality, implementation, applications, outcomes, and benefits. Seven databases were searched from 1985 to March 2010. Several search terms relating to phr s were used during this process. Two authors independently screened titles and abstracts to determine inclusion status. A second screen of full-text articles, again by two independent members of the research team, ensured that the studies described phr s. All in all, 130 articles met the criteria and their data were extracted manually into a database. The authors concluded that although there is a large amount of survey, observational, cohort/panel, and anecdotal evidence of phr benefits and satisfaction for patients, more research is needed to evaluate the results of phr implementations. Their in-depth analysis of the literature signalled that there is little solid evidence from randomized controlled trials or other studies through the use of phr s. Hence, they suggested that more research is needed that addresses the current lack of understanding of optimal functionality and usability of these systems, and how they can play a beneficial role in supporting patient self-management ( Archer et al., 2011 ).

9.3.4. Forms of Aggregative Reviews

Healthcare providers, practitioners, and policy-makers are nowadays overwhelmed with large volumes of information, including research-based evidence from numerous clinical trials and evaluation studies, assessing the effectiveness of health information technologies and interventions ( Ammenwerth & de Keizer, 2004 ; Deshazo et al., 2009 ). It is unrealistic to expect that all these disparate actors will have the time, skills, and necessary resources to identify the available evidence in the area of their expertise and consider it when making decisions. Systematic reviews that involve the rigorous application of scientific strategies aimed at limiting subjectivity and bias (i.e., systematic and random errors) can respond to this challenge.

Systematic reviews attempt to aggregate, appraise, and synthesize in a single source all empirical evidence that meet a set of previously specified eligibility criteria in order to answer a clearly formulated and often narrow research question on a particular topic of interest to support evidence-based practice ( Liberati et al., 2009 ). They adhere closely to explicit scientific principles ( Liberati et al., 2009 ) and rigorous methodological guidelines (Higgins & Green, 2008) aimed at reducing random and systematic errors that can lead to deviations from the truth in results or inferences. The use of explicit methods allows systematic reviews to aggregate a large body of research evidence, assess whether effects or relationships are in the same direction and of the same general magnitude, explain possible inconsistencies between study results, and determine the strength of the overall evidence for every outcome of interest based on the quality of included studies and the general consistency among them ( Cook, Mulrow, & Haynes, 1997 ). The main procedures of a systematic review involve:

• Formulating a review question and developing a search strategy based on explicit inclusion criteria for the identification of eligible studies (usually described in the context of a detailed review protocol).
• Searching for eligible studies using multiple databases and information sources, including grey literature sources, without any language restrictions.
• Selecting studies, extracting data, and assessing risk of bias in a duplicate manner using two independent reviewers to avoid random or systematic errors in the process.
• Analyzing data using quantitative or qualitative methods.
• Presenting results in summary of findings tables.
• Interpreting results and drawing conclusions.

Many systematic reviews, but not all, use statistical methods to combine the results of independent studies into a single quantitative estimate or summary effect size. Known as meta-analyses , these reviews use specific data extraction and statistical techniques (e.g., network, frequentist, or Bayesian meta-analyses) to calculate from each study by outcome of interest an effect size along with a confidence interval that reflects the degree of uncertainty behind the point estimate of effect ( Borenstein, Hedges, Higgins, & Rothstein, 2009 ; Deeks, Higgins, & Altman, 2008 ). Subsequently, they use fixed or random-effects analysis models to combine the results of the included studies, assess statistical heterogeneity, and calculate a weighted average of the effect estimates from the different studies, taking into account their sample sizes. The summary effect size is a value that reflects the average magnitude of the intervention effect for a particular outcome of interest or, more generally, the strength of a relationship between two variables across all studies included in the systematic review. By statistically combining data from multiple studies, meta-analyses can create more precise and reliable estimates of intervention effects than those derived from individual studies alone, when these are examined independently as discrete sources of information.

The review by Gurol-Urganci, de Jongh, Vodopivec-Jamsek, Atun, and Car (2013) on the effects of mobile phone messaging reminders for attendance at healthcare appointments is an illustrative example of a high-quality systematic review with meta-analysis. Missed appointments are a major cause of inefficiency in healthcare delivery with substantial monetary costs to health systems. These authors sought to assess whether mobile phone-based appointment reminders delivered through Short Message Service ( sms ) or Multimedia Messaging Service ( mms ) are effective in improving rates of patient attendance and reducing overall costs. To this end, they conducted a comprehensive search on multiple databases using highly sensitive search strategies without language or publication-type restrictions to identify all rct s that are eligible for inclusion. In order to minimize the risk of omitting eligible studies not captured by the original search, they supplemented all electronic searches with manual screening of trial registers and references contained in the included studies. Study selection, data extraction, and risk of bias assessments were performed inde­­pen­dently by two coders using standardized methods to ensure consistency and to eliminate potential errors. Findings from eight rct s involving 6,615 participants were pooled into meta-analyses to calculate the magnitude of effects that mobile text message reminders have on the rate of attendance at healthcare appointments compared to no reminders and phone call reminders.

Meta-analyses are regarded as powerful tools for deriving meaningful conclusions. However, there are situations in which it is neither reasonable nor appropriate to pool studies together using meta-analytic methods simply because there is extensive clinical heterogeneity between the included studies or variation in measurement tools, comparisons, or outcomes of interest. In these cases, systematic reviews can use qualitative synthesis methods such as vote counting, content analysis, classification schemes and tabulations, as an alternative approach to narratively synthesize the results of the independent studies included in the review. This form of review is known as qualitative systematic review.

A rigorous example of one such review in the eHealth domain is presented by Mickan, Atherton, Roberts, Heneghan, and Tilson (2014) on the use of handheld computers by healthcare professionals and their impact on access to information and clinical decision-making. In line with the methodological guide­lines for systematic reviews, these authors: (a) developed and registered with prospero ( www.crd.york.ac.uk/ prospero / ) an a priori review protocol; (b) conducted comprehensive searches for eligible studies using multiple databases and other supplementary strategies (e.g., forward searches); and (c) subsequently carried out study selection, data extraction, and risk of bias assessments in a duplicate manner to eliminate potential errors in the review process. Heterogeneity between the included studies in terms of reported outcomes and measures precluded the use of meta-analytic methods. To this end, the authors resorted to using narrative analysis and synthesis to describe the effectiveness of handheld computers on accessing information for clinical knowledge, adherence to safety and clinical quality guidelines, and diagnostic decision-making.

In recent years, the number of systematic reviews in the field of health informatics has increased considerably. Systematic reviews with discordant findings can cause great confusion and make it difficult for decision-makers to interpret the review-level evidence ( Moher, 2013 ). Therefore, there is a growing need for appraisal and synthesis of prior systematic reviews to ensure that decision-making is constantly informed by the best available accumulated evidence. Umbrella reviews , also known as overviews of systematic reviews, are tertiary types of evidence synthesis that aim to accomplish this; that is, they aim to compare and contrast findings from multiple systematic reviews and meta-analyses ( Becker & Oxman, 2008 ). Umbrella reviews generally adhere to the same principles and rigorous methodological guidelines used in systematic reviews. However, the unit of analysis in umbrella reviews is the systematic review rather than the primary study ( Becker & Oxman, 2008 ). Unlike systematic reviews that have a narrow focus of inquiry, umbrella reviews focus on broader research topics for which there are several potential interventions ( Smith, Devane, Begley, & Clarke, 2011 ). A recent umbrella review on the effects of home telemonitoring interventions for patients with heart failure critically appraised, compared, and synthesized evidence from 15 systematic reviews to investigate which types of home telemonitoring technologies and forms of interventions are more effective in reducing mortality and hospital admissions ( Kitsiou, Paré, & Jaana, 2015 ).

9.3.5. Realist Reviews

Realist reviews are theory-driven interpretative reviews developed to inform, enhance, or supplement conventional systematic reviews by making sense of heterogeneous evidence about complex interventions applied in diverse contexts in a way that informs policy decision-making ( Greenhalgh, Wong, Westhorp, & Pawson, 2011 ). They originated from criticisms of positivist systematic reviews which centre on their “simplistic” underlying assumptions ( Oates, 2011 ). As explained above, systematic reviews seek to identify causation. Such logic is appropriate for fields like medicine and education where findings of randomized controlled trials can be aggregated to see whether a new treatment or intervention does improve outcomes. However, many argue that it is not possible to establish such direct causal links between interventions and outcomes in fields such as social policy, management, and information systems where for any intervention there is unlikely to be a regular or consistent outcome ( Oates, 2011 ; Pawson, 2006 ; Rousseau, Manning, & Denyer, 2008 ).

To circumvent these limitations, Pawson, Greenhalgh, Harvey, and Walshe (2005) have proposed a new approach for synthesizing knowledge that seeks to unpack the mechanism of how “complex interventions” work in particular contexts. The basic research question — what works? — which is usually associated with systematic reviews changes to: what is it about this intervention that works, for whom, in what circumstances, in what respects and why? Realist reviews have no particular preference for either quantitative or qualitative evidence. As a theory-building approach, a realist review usually starts by articulating likely underlying mechanisms and then scrutinizes available evidence to find out whether and where these mechanisms are applicable ( Shepperd et al., 2009 ). Primary studies found in the extant literature are viewed as case studies which can test and modify the initial theories ( Rousseau et al., 2008 ).

The main objective pursued in the realist review conducted by Otte-Trojel, de Bont, Rundall, and van de Klundert (2014) was to examine how patient portals contribute to health service delivery and patient outcomes. The specific goals were to investigate how outcomes are produced and, most importantly, how variations in outcomes can be explained. The research team started with an exploratory review of background documents and research studies to identify ways in which patient portals may contribute to health service delivery and patient outcomes. The authors identified six main ways which represent “educated guesses” to be tested against the data in the evaluation studies. These studies were identified through a formal and systematic search in four databases between 2003 and 2013. Two members of the research team selected the articles using a pre-established list of inclusion and exclusion criteria and following a two-step procedure. The authors then extracted data from the selected articles and created several tables, one for each outcome category. They organized information to bring forward those mechanisms where patient portals contribute to outcomes and the variation in outcomes across different contexts.

9.3.6. Critical Reviews

Lastly, critical reviews aim to provide a critical evaluation and interpretive analysis of existing literature on a particular topic of interest to reveal strengths, weaknesses, contradictions, controversies, inconsistencies, and/or other important issues with respect to theories, hypotheses, research methods or results ( Baumeister & Leary, 1997 ; Kirkevold, 1997 ). Unlike other review types, critical reviews attempt to take a reflective account of the research that has been done in a particular area of interest, and assess its credibility by using appraisal instruments or critical interpretive methods. In this way, critical reviews attempt to constructively inform other scholars about the weaknesses of prior research and strengthen knowledge development by giving focus and direction to studies for further improvement ( Kirkevold, 1997 ).

Kitsiou, Paré, and Jaana (2013) provide an example of a critical review that assessed the methodological quality of prior systematic reviews of home telemonitoring studies for chronic patients. The authors conducted a comprehensive search on multiple databases to identify eligible reviews and subsequently used a validated instrument to conduct an in-depth quality appraisal. Results indicate that the majority of systematic reviews in this particular area suffer from important methodological flaws and biases that impair their internal validity and limit their usefulness for clinical and decision-making purposes. To this end, they provide a number of recommendations to strengthen knowledge development towards improving the design and execution of future reviews on home telemonitoring.

9.4. Summary

Table 9.1 outlines the main types of literature reviews that were described in the previous sub-sections and summarizes the main characteristics that distinguish one review type from another. It also includes key references to methodological guidelines and useful sources that can be used by eHealth scholars and researchers for planning and developing reviews.

Typology of Literature Reviews (adapted from Paré et al., 2015).

As shown in Table 9.1 , each review type addresses different kinds of research questions or objectives, which subsequently define and dictate the methods and approaches that need to be used to achieve the overarching goal(s) of the review. For example, in the case of narrative reviews, there is greater flexibility in searching and synthesizing articles ( Green et al., 2006 ). Researchers are often relatively free to use a diversity of approaches to search, identify, and select relevant scientific articles, describe their operational characteristics, present how the individual studies fit together, and formulate conclusions. On the other hand, systematic reviews are characterized by their high level of systematicity, rigour, and use of explicit methods, based on an “a priori” review plan that aims to minimize bias in the analysis and synthesis process (Higgins & Green, 2008). Some reviews are exploratory in nature (e.g., scoping/mapping reviews), whereas others may be conducted to discover patterns (e.g., descriptive reviews) or involve a synthesis approach that may include the critical analysis of prior research ( Paré et al., 2015 ). Hence, in order to select the most appropriate type of review, it is critical to know before embarking on a review project, why the research synthesis is conducted and what type of methods are best aligned with the pursued goals.

9.5. Concluding Remarks

In light of the increased use of evidence-based practice and research generating stronger evidence ( Grady et al., 2011 ; Lyden et al., 2013 ), review articles have become essential tools for summarizing, synthesizing, integrating or critically appraising prior knowledge in the eHealth field. As mentioned earlier, when rigorously conducted review articles represent powerful information sources for eHealth scholars and practitioners looking for state-of-the-art evidence. The typology of literature reviews we used herein will allow eHealth researchers, graduate students and practitioners to gain a better understanding of the similarities and differences between review types.

We must stress that this classification scheme does not privilege any specific type of review as being of higher quality than another ( Paré et al., 2015 ). As explained above, each type of review has its own strengths and limitations. Having said that, we realize that the methodological rigour of any review — be it qualitative, quantitative or mixed — is a critical aspect that should be considered seriously by prospective authors. In the present context, the notion of rigour refers to the reliability and validity of the review process described in section 9.2. For one thing, reliability is related to the reproducibility of the review process and steps, which is facilitated by a comprehensive documentation of the literature search process, extraction, coding and analysis performed in the review. Whether the search is comprehensive or not, whether it involves a methodical approach for data extraction and synthesis or not, it is important that the review documents in an explicit and transparent manner the steps and approach that were used in the process of its development. Next, validity characterizes the degree to which the review process was conducted appropriately. It goes beyond documentation and reflects decisions related to the selection of the sources, the search terms used, the period of time covered, the articles selected in the search, and the application of backward and forward searches ( vom Brocke et al., 2009 ). In short, the rigour of any review article is reflected by the explicitness of its methods (i.e., transparency) and the soundness of the approach used. We refer those interested in the concepts of rigour and quality to the work of Templier and Paré (2015) which offers a detailed set of methodological guidelines for conducting and evaluating various types of review articles.

To conclude, our main objective in this chapter was to demystify the various types of literature reviews that are central to the continuous development of the eHealth field. It is our hope that our descriptive account will serve as a valuable source for those conducting, evaluating or using reviews in this important and growing domain.

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• Cite this Page Paré G, Kitsiou S. Chapter 9 Methods for Literature Reviews. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
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Literature Review and Theoretical Framework: Understanding the Differences

Table of Contents

A literature review and a theoretical framework are both important components of academic research. However, they serve different purposes and have distinct characteristics. In this article, we will examine the concepts of literature review and theoretical framework, explore their significance, and highlight the key differences between the two.

Defining the Concepts: Literature Review and Theoretical Framework

Before we dive into the details, let's clarify what a literature review and a theoretical framework actually mean.

What is a Literature Review?

A literature review is a critical analysis and synthesis of existing research and scholarly articles on a specific topic. It involves reviewing and summarizing the current knowledge and understanding of the subject matter. By examining previous studies, the scholar can identify knowledge gaps, assess the strengths and weaknesses of existing research, and present a comprehensive overview of the topic.

When conducting a literature review, the scholar delves into a vast array of sources, including academic journals, books, conference proceedings, and reputable online databases. This extensive exploration allows them to gather relevant information, theories, and methodologies related to their research topic.

Furthermore, a literature review provides a solid foundation for the research by establishing the context and significance of the study. It helps researchers identify the key concepts, theories, and variables that are relevant to their research objectives. By critically analyzing the existing literature, scholars can identify research gaps and propose new avenues for scientific investigation.

Moreover, a literature review is not merely a summary of previous studies. It requires a critical evaluation of the methodologies used, the quality of the data collected, and the validity of the conclusions drawn.

Researchers must assess the credibility and reliability of the sources they include in their review to ensure the accuracy and robustness of their analysis.

What is a Theoretical Framework?

A theoretical framework provides a conceptual explanation for the research problem or question being investigated. It serves as a foundation that guides the formulation of hypotheses and research objectives. A theoretical framework helps researchers to analyze and interpret their findings by establishing a set of assumptions, concepts, and relationships that underpin their study. It provides a structured framework for organizing and presenting research outcomes.

When developing a theoretical framework, researchers draw upon existing theories and concepts from relevant disciplines to create a conceptual framework that aligns with their research objectives. This framework helps researchers to define the variables they will study, establish the relationships between these variables, and propose hypotheses that can be tested through empirical research.

Furthermore, a theoretical framework provides a roadmap for researchers to navigate through the complexities of their study. It helps them to identify the key constructs and variables that need to be measured and analyzed. By providing a clear structure, the theoretical framework ensures that researchers stay focused on their research objectives and avoid getting lost in a sea of information.

Moreover, a theoretical framework allows researchers to make connections between their study and existing theories or models. By building upon established knowledge, researchers can contribute to the advancement of their field and provide new insights and perspectives. The theoretical framework also helps researchers interpret their findings in a meaningful way and draw conclusions that have theoretical and practical implications.

In summary, both a literature review and a theoretical framework play crucial roles in the research process. While a literature review provides a comprehensive overview of existing knowledge and identifies research gaps, a theoretical framework establishes the conceptual foundation for the study and guides the formulation of research objectives and hypotheses. Together, these two elements contribute to the development of a robust and well-grounded research study.

The Purpose and Importance of Literature Reviews

Now that we have a clear understanding of what a literature review is, let's explore its purpose and significance.

A literature review plays a crucial role in academic research. It serves several purposes, including:

• Providing a comprehensive understanding of the existing literature in a particular field.
• Identifying the gaps, controversies, or inconsistencies in the current knowledge.
• Helping researchers to refine their research questions and objectives.
• Ensuring that the research being conducted is novel and contributes to the existing body of knowledge.

The Benefits of Conducting a Literature Review

There are numerous benefits to conducting a literature review, such as:

• Enhancing the researcher's knowledge and understanding of the subject area.
• Providing a framework for developing research hypotheses and objectives.
• Identifying potential research methodologies and approaches.
• Informing the selection of appropriate data collection and analysis methods.
• Guiding the interpretation and discussion of research findings.

The Purpose and Importance of Theoretical Frameworks

Moving on to theoretical frameworks, let us discuss their purpose and importance.

When conducting research, theoretical frameworks play a crucial role in providing a solid foundation for the study. They serve as a guiding tool for researchers, helping them navigate through the complexities of their research and providing a framework for understanding and interpreting their findings.

The Function of Theoretical Frameworks in Research

Theoretical frameworks serve multiple functions in research:

• Providing a conceptual framework enables researchers to clearly define the scope and direction of their study.
• Acting as a roadmap, guiding researchers in formulating their research objectives and hypotheses. It helps them identify the key variables and relationships they want to explore, providing a solid foundation for their research.
• Helping researchers identify and select appropriate research methods and techniques. When it comes to selecting research methods and techniques, theoretical frameworks are invaluable. They provide researchers with a lens through which they can evaluate different methods and techniques, ensuring that they choose the most appropriate ones for their study. By aligning their methods with the theoretical framework, researchers can enhance the validity and reliability of their research.
• Supporting the interpretation and explanation of research findings. Once the data has been collected, theoretical frameworks help researchers make sense of their findings. They provide a framework for interpreting and explaining the results, allowing researchers to draw meaningful conclusions. By grounding their analysis in a theoretical framework, researchers can provide a solid foundation for their findings and contribute to the existing body of knowledge.
• Facilitating the integration of new knowledge with existing theories and concepts. Theoretical frameworks also play a crucial role in the advancement of knowledge. By integrating new findings with existing theories and concepts, researchers can contribute to the development of their field.

The Advantages of Developing a Theoretical Framework

Developing a theoretical framework offers several advantages:

• Enhancing the researcher's understanding of the research problem. By developing a theoretical framework, researchers gain a deeper understanding of the research problem they are investigating.  This enhanced understanding allows researchers to approach their study with clarity and purpose.
• Facilitating the selection of an appropriate research design. Choosing the right research design is crucial for the success of a study. A well-developed theoretical framework helps researchers select the most appropriate research design by providing a clear direction and focus. It ensures that the research design aligns with the research objectives and hypotheses, maximizing the chances of obtaining valid and reliable results.
• Helping researchers organize their thoughts and ideas systematically. This organization helps researchers stay focused and ensures that all aspects of the research problem are considered. By structuring their thoughts, researchers can effectively communicate their ideas and findings to others.
• Guiding the analysis and interpretation of research findings. When it comes to analyzing and interpreting research findings, a theoretical framework provides researchers with a framework to guide their process. It helps researchers identify patterns, relationships, and themes within the data, allowing for a more comprehensive analysis.

Developing a theoretical framework is essential for ensuring the validity and reliability of a study. By aligning the research with established theories and concepts, researchers can enhance the credibility of their study. A well-developed theoretical framework provides a solid foundation for the research, increasing the chances of obtaining accurate and meaningful results.

Differences Between Literature Reviews and Theoretical Frameworks

Now, let's explore the key differences between literature reviews and theoretical frameworks.

Key Differences:

• Focus: A literature review focuses on summarizing existing research, while a theoretical framework focuses on providing a conceptual foundation for the study.
• Scope: A literature review covers a broad range of related research, while a theoretical framework is more specific to the research problem at hand.
• Timing: A literature review is typically conducted early in the research process, while a theoretical framework is often developed alongside the research design.
• Purpose: A literature review aims to inform the research and establish its context, while a theoretical framework aims to guide the interpretation and analysis of findings.

In conclusion

Understanding the distinction between a literature review and a theoretical framework is crucial for conducting effective and meaningful academic research. While a literature review provides an overview of existing research, a theoretical framework guides the formulation, analysis, and interpretation of research. Both components are essential for building a strong foundation of knowledge in any field. By comprehending their purpose, significance, and key differences, researchers can enhance the quality and rigor of their research endeavors.

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• Published: 13 December 2023

Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review

• Jeongok Park   ORCID: orcid.org/0000-0003-4978-817X 1 ,
• Sang Bin You   ORCID: orcid.org/0000-0002-1424-4140 2 ,
• Gi Wook Ryu   ORCID: orcid.org/0000-0002-4533-7788 3 &
• Youngkyung Kim   ORCID: orcid.org/0000-0002-3696-5416 4  

Systematic Reviews volume  12 , Article number:  230 ( 2023 ) Cite this article

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Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature.

This scoping review was conducted using the framework proposed by Arksey and O’Malley and PRISMA-ScR. Overall, four databases—PubMed, Web of Science, EMBASE, and CINAHL—were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar.

A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs.

Conclusions

Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system.

Peer Review reports

Medication errors are closely associated with patient safety and the quality of care [ 1 , 2 ]. In particular, medication errors, which denote a clinical issue of global importance for patient safety, negatively affect patient morbidity and mortality and lead to delays in discharge [ 3 , 4 ]. The National Health Service in the UK estimates that 237 million medication errors occur each year, of which 66 million cause clinically significant harm [ 5 ]. The US Food and Drug Administration reported that they received more than 100,000 reports each year associated with suspected medication errors [ 6 ]. Additionally, it was estimated that 40,000–98,000 deaths per year in the USA could be attributed to errors by healthcare providers (HCPs) [ 7 ]. Previous studies have revealed that medication errors account for 6–12% of hospital admissions [ 8 ].

Intravenous (IV) medication is a common treatment in hospitalized patient care [ 9 ]. It is used in wards, intensive care units (ICUs), emergency rooms, and outpatient clinics in hospitals [ 9 , 10 ]. As direct HCPs, nurses are integral in patient safety during the IV medication process which could result in unintended errors or violations of recommendations [ 3 ]. As many drugs injected via the IV route include high-risk drugs, such as chemotherapy agents, insulin, and opioids [ 10 ], inappropriate dose administration could lead to adverse events (AEs), such as death and life-threatening events [ 11 , 12 ].

IV medication process is a complex and multistage process. There are 12 stages in the IV medication process, which can be classified as follows: (1) obtain the drug for administration, (2) obtain the diluent, (3) reconstitute the drug in the diluent, (4) take the drug at the patient’s bedside, (5) check for the patient’s allergies, (6) check the route of drug administration, (7) check the drug dose, (8) check the patency of the cannula, (9) expel the air from the syringe, (10) administer the drug, (11) flush the cannula, and (12) sign the prescription chart [ 13 ]. IV medication errors can occur at any of these stages. It is imperative to administer the drug at the correct time and rate during the IV medication process [ 13 ]. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defined an error in IV medication rates as “too fast or too slow rate than that intended” [ 14 ]. Maintaining the correct rate of IV medication is essential for enhancing the effectiveness of IV therapy and reducing AEs [ 9 ].

Infusion pumps are devices designed to improve the accuracy of IV infusions, with drug flow, volume, and timing programmed by HCPs [ 15 ]. A smart pump is an infusion pump with a software package containing a drug library. During programming, the smart pump software warns users about entering drug parameters that deviate from the recommended parameters, such as the type, dose, and dosage unit of the drug [ 15 ]. In the absence of a device for administering IV medication, such as an infusion pump or smart pump, the IV rate is usually controlled by counting the number of fluid drops falling into the drip chamber [ 9 ].

According to the previous study, applying an incorrect rate was the most prevalent IV medication error, accounting for 536 of 925 (57.9%) total IV medication errors [ 16 ]. Although rate control of IV medications is critical to patient safety and quality care, few studies review and map the relevant literature on rate control of IV medications. Therefore, this study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing the existing literature.

The specific research questions of this study are as follows:

What are the general characteristics of the studies related to rate control of IV medications?

What are the attributes of errors associated with rate control of IV medications?

What are the facilitators and barriers to rate control of IV medications?

This scoping review followed the framework suggested by Arksey and O’Malley [ 17 ] and developed by Levac et al. [ 18 ] and Peters et al. [ 19 ]. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) developed in 2020 by the Joanna Briggs Institute (JBI) were used to ensure reliability in the reporting of methodology (Additional file 1 ) [ 19 ].

Search strategy

According to the JBI Manuals for Evidence Synthesis, a three-step search strategy was adopted [ 19 ]. First, a preliminary search in PubMed was conducted based on the title, abstract, keywords, and index terms of articles to develop our search strategy. In the preliminary search, we used keywords such as “patients,” “nurse,” “IV therapy,” “monitoring,” “rate,” and “medication error.” The search results indicated that studies on medical devices and system-related factors were excluded. Therefore, we decided to exclude the keywords “patients” and “nurse” and focus on “IV therapy,” “monitoring,” “rate,” and “medication error” to comprehensively include studies on factors associated with rate control of infusion medications. Secondly, we used all identified keywords and index terms across all included databases following consultations with a research librarian at Yonsei University Medical Library to elaborate our search strategy. Four databases—PubMed, CINAHL, EMBASE, and Web of Science—were searched using the keywords, index terms, and a comprehensive list of keyword variations to identify relevant studies published before January 2023. The details of the search strategy are described in Additional file 2 . All database search results were exported into Endnote version 20. Finally, we manually searched the reference lists of the included articles identified from the database search. Furthermore, we manually searched two journals related to medication errors and patient safety, and Google Scholar to comprehensively identify the relevant literature. When performing a search on Google Scholar, keywords such as “medication,” “rate,” “IV therapy,” “intravenous administration,” and “medication error” were appropriately combined using search modifiers.

Eligibility criteria

Inclusion criteria were established according to the participants, concept, and context (PCC) framework recommended by the JBI manuals for scoping reviews [ 19 ]. The participants include patients receiving IV therapy, HCPs involved in administering IV medications, and experts from non-healthcare fields related to rate control of IV medications. The concepts were facilitators and barriers to rate control of IV medications, and the contexts were the environments or situations in which errors in rate control of IV medications occurred. While screening the literature identified by the three-step search based on the inclusion criteria, we refined the exclusion criteria through discussion among researchers. The exclusion criteria were as follows: (1) not available in English, (2) not an original article, (3) studies of medication errors in general, (4) not accessible, or (5) prescription error.

Study selection

Once duplicates were automatically removed through Endnote, two independent researchers assessed the eligibility of all articles by screening the titles and abstracts based on the inclusion and exclusion criteria. Studies identified via database searches were screened by GWR and YK and studies identified via other methods were screened by SBY and YK. Full-text articles were obtained either when the studies met the inclusion criteria or when more information was needed to assess eligibility and the researchers independently reviewed the full-text articles. In case of any disagreement in the study selection process, a consensus was reached through discussion among three researchers (GWR, SBY, and YK) and a senior researcher (JP).

Data extraction

Through consensus among the researchers, a form for data extraction was developed to extract appropriate information following the JBI manuals for scoping reviews [ 19 ]. The following data were collected from each study: author information, publication year, country, study design, study period, aims, participants or events (defined as the occurrences related to patient care focused on in the study), contexts, methods, errors related to the control of IV medications (observed results or intervention outcomes), error severity, facilitators, and barriers according to the NCC MERP criteria. Three researchers (GWR SBY, and YK) independently conducted data charting and completed the data extraction form through discussion.

Data synthesis

The general characteristics of included studies such as publication year, country, study design, and study period were analyzed using descriptive statistics to identify trends or patterns. The aims, participants, events, contexts, and methods of the included studies were classified into several categories through a research meeting including a senior researcher (JP) to summarize and analyze the characteristics of the included studies comprehensively. Attributes of errors associated with rate control of IV medications were analyzed and organized through consensus among researchers based on extracted data. Facilitators and barriers to rate control of IV medications were independently classified according to NCC MERP criteria by three researchers (GWR, SBY, and YK) and iteratively modified. Discrepancies were resolved by discussion and re-reading the articles, with the final decision made in consultation with the senior researcher (JP).

A total of 1211 studies were selected through a database search. After reviewing the titles and abstracts of the studies, 42 studies were considered for a detailed assessment by the three researchers. In particular, 2 were not available in English, 3 were not original articles, 24 were studies of medication error in general without details on rate control of IV medications, 2 were regarding prescription errors, and 1 was not accessible. Finally, 10 studies were identified through a database search. Additionally, 23 studies were identified from a manual search. Among the 23, 5 were not original articles, and 6 were studies on medication error in general. Finally, 12 studies were identified via other methods. Hence, 22 studies were included in the data analysis (Fig.  1 , Additional file 3 ).

PRISMA flow chart for literature selection

Characteristics of the studies

General characteristics.

Table 1 presents the general characteristics of the included studies. Two of the included studies had a publication year before 2000 [ 20 , 21 ], and more than half of the studies ( n  = 15) were published in 2010 and later. A majority of the included studies were conducted in Western countries ( n  = 15) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], four were conducted in Asia [ 20 , 37 , 38 , 39 ], two were conducted in Australia [ 21 , 40 ], and one was conducted in Egypt [ 2 ]. In terms of the study design, most studies were project studies ( n  = 7) [ 22 , 24 , 27 , 28 , 30 , 34 , 39 ] or prospective observational studies ( n  = 5) [ 2 , 20 , 29 , 32 , 40 ], followed by retrospective studies ( n  = 3) [ 21 , 25 , 35 ], qualitative or mixed-methods studies ( n  = 3) [ 23 , 26 , 33 ], and descriptive cross-sectional studies ( n  = 2) [ 36 , 38 ]. Additionally, there was one controlled pre-posttest study [ 37 ] and one simulation laboratory experiment study [ 31 ]. The study period also varied greatly from 2 days [ 32 ] to 6 years [ 25 ].

The aims of the included studies were divided into two main categories. First, 13 studies identified the current status, causes, and factors influencing errors that could occur in healthcare settings [ 2 , 20 , 21 , 23 , 25 , 26 , 29 , 32 , 33 , 35 , 36 , 38 , 40 ]. Among these, three studies were on errors that may occur in specific healthcare procedures, such as anesthesia [ 20 ], vascular access [ 21 ], and pediatric chemotherapy [ 25 ]. Additionally, three studies explored possible errors associated with specific settings and medications, such as an obstetric emergency ward [ 2 ], cardiac critical care units [ 38 ], and high-alert medications [ 36 ], and three studies investigated the errors associated with the overall IV medication preparation or administration [ 23 , 33 , 40 ]. Moreover, three studies aimed at identifying potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and one study was about errors in medication preparation and administration that could occur in a setting using a specific system connected to electronic medical records [ 29 ]. Second, nine studies described the procedure of developing interventions or identified the effect of interventions [ 22 , 24 , 27 , 28 , 30 , 31 , 34 , 37 , 39 ].

Participants and events

Participants in the 22 studies included HCPs such as nurses, doctors, pharmacists, and patients. Notably, four of these studies were only for nurses [ 31 , 37 , 38 , 40 ] and there was also one study involving only pharmacists [ 36 ]. Furthermore, there were five studies wherein people from various departments or roles participated [ 23 , 26 , 27 , 28 , 39 ]. There were three studies wherein the patients were participants, and two studies included both patients and medical staff [ 29 , 33 ].

Among the included studies, nine studies focused on errors in IV medication preparation and administration as events [ 23 , 26 , 30 , 32 , 33 , 34 , 37 , 38 , 40 ] and five studies focused on the administration process only [ 30 , 32 , 34 , 37 , 40 ]. Four studies focused on problems in the administration of all types of drugs including errors associated with rate control of IV medications [ 2 , 22 , 28 , 29 ]. Additionally, four studies focused on events that occurred with IV medication infusion devices [ 24 , 27 , 35 , 39 ], two studies explored the events that occurred during chemotherapy [ 22 , 25 ], and some analyzed events with problems in vascular access [ 21 ], iatrogenic events among neonates [ 28 ], and critical events in anesthesia cases [ 20 ].

Contexts and methods

The contexts can be largely divided into healthcare settings, including hospitals and laboratory settings. Three hospital-based studies were conducted in the entire hospital [ 20 , 22 , 24 ], eight studies were conducted at several hospitals, and the number of hospitals involved varied from 2 to 132 [ 23 , 26 , 32 , 33 , 34 , 35 , 38 , 40 ]. Furthermore, four studies were conducted in different departments within one hospital [ 29 , 30 , 37 , 39 ], three studies were conducted in only one department [ 2 , 27 , 28 ], two studies considered other healthcare settings and were not limited to hospitals [ 21 , 25 ], and one study was conducted in a simulation laboratory setting that enabled a realistic simulation of an ambulatory chemotherapy unit [ 31 ].

Specifically, seven out of the nine studies developed or implemented interventions based on interdisciplinary or multidisciplinary collaboration [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Two studies developed and identified the effectiveness of interventions that created an environment for nurses to improve performance and correct errors associated with medication administration [ 31 , 39 ], and two intervention studies were on error reporting methods or observation tools and the processes of addressing reported errors [ 28 , 30 ]. There were also a study on a pharmacist-led educational program for nurses [ 37 ], a comprehensive intervention from drug prescription to administration to reduce chemotherapy-related medication errors [ 22 ], infusion safety intervention bundles [ 34 ], the implementation of a smart IV pump equipped with failure mode and effects analysis (FMEA) [ 24 ], and a smart system to prevent pump programming errors [ 27 ].

Data collection methods were classified as a review of reported incidents [ 20 , 21 , 22 , 25 , 35 ], a review of medical charts [ 26 ], observations [ 23 , 29 , 30 , 31 , 32 , 33 , 34 , 37 , 40 ], follow-up on every pump alert [ 27 ], and self-reporting questionnaires or surveys [ 36 , 38 ]. Some studies utilized retrospective reviews of reported incidents and self-report questionnaires [ 39 ]. Also, in the study by Kandil et al., observation, nursing records review, and medical charts review were all used [ 2 ].

Attributes of errors associated with rate control of IV medications

Table 2 presents the attributes of errors related to rate control of IV medications in observed results or intervention outcomes, and error severity. Notably, 6 of 13 studies presenting observed results reported errors related to IV medication infusion devices among the rate control errors [ 20 , 25 , 32 , 33 , 35 , 36 ]. Additionally, four studies reported errors in bolus dose administration or IV push and flushing lines among IV rate errors [ 2 , 23 , 36 , 40 ]. Among the 13, nine studies reported error severity, and among these, three studies used NCC MERP ratings [ 25 , 32 , 33 ]. In four studies, error severity was reported by describing several cases in detail [ 2 , 21 , 23 , 25 ], and two studies reported no injuries or damages due to errors [ 26 , 29 ]. Among the nine studies that developed interventions and identified their effectiveness, four presented the frequency of incorrect rate errors as an outcome variable [ 28 , 30 , 34 , 37 ]. Moreover, two studies suggested compliance rates for intervention as outcome variables [ 24 , 31 ].

Among the nine project or experiment studies, three showed a decrease in error rate as a result of the intervention [ 28 , 31 , 34 ]. Three studies developed interventions to reduce rate errors but did not report the frequency or incidence of rate errors [ 22 , 24 , 27 ]. A study reported the frequency of rate errors only after the intervention; the effect of the intervention could not be identified [ 30 ]. Also, three studies showed the severity of errors related to rate control of IV medications [ 24 , 30 , 34 ], two used NCC MERP severity ratings [ 30 , 34 ], and one reported that all errors caused by smart IV pumps equipped with FMEA resulted in either temporary harm or no harm [ 24 ].

Facilitators and barriers to rate control of IV medications

Table 3 presents the facilitators and barriers related to rate control of IV medications according to the NCC MERP taxonomy based on the 22 included studies. Sub-categories of human factors were classified as knowledge deficit, performance deficit, miscalculation of dosage or infusion rate, and stress. The sub-category of design factor was device. System-related contributing factors were classified as frequent interruptions and distractions, inadequate training, poor assignment or placement of HCPs or inexperienced personnel, policies and procedures, and communication systems between HCPs [ 14 ].

Human factors

Among the barriers extracted from the 22 studies, 11 factors belonged to the “knowledge deficit,” “performance deficit,” “miscalculation of dosage or infusion rate,” and “stress (high-volume workload)” in this category. Half of these factors are related to the “performance deficit.” Barriers identified in two or more studies were tubing misplacement [ 24 , 35 ] and non-compliance with protocols and guidelines [ 2 , 25 ], all of which belonged to the “performance deficit.” Additionally, the high workload and environmental characteristics of the ICU, which corresponded to the “stress,” were also identified as barriers to rate control of IV medications [ 23 , 37 ].

Most factors in this category were related to IV medication infusion devices such as infusion pumps and smart pumps. In the study by Lyons et al., the use of devices, such as patient-controlled analgesia pumps and syringe drivers, was a facilitator of rate control of IV medications [ 33 ]. In addition to the use of these devices, the expansion of capabilities [ 26 ], monitoring programming [ 27 ], and standardization [ 22 ] were also facilitators. Unexpected equipment faults, a barrier, were identified in five studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the complex design of the equipment [ 23 , 24 ] and incomplete drug libraries in smart pumps [ 33 , 35 ] were identified in two studies each. Factors such as the misassembly of an unfamiliar infusion pump [ 21 ] and smart pumps not connected to electronic systems [ 30 ] were also barriers.

Contributing factors (system related)

The factors belonging to the “frequent interruptions and distractions” in this category were all barriers. Specifically, running multiple infusions at once [ 24 , 27 ], air-in-line alarms, or cleaning air [ 24 ] were identified as barriers. Among the facilitators of the “training,” there were education and training on the use of smart IV pumps [ 24 ] and chemotherapy errors [ 22 ]. There are two factors in the “assignment or placement of a HCP or inexperienced personnel,” where ward-based pharmacists were facilitators [ 36 ], but nurses with less than 6 years of experience were barriers [ 40 ]. The sub-category with the most factors was “policies and procedures,” where the facilitators extracted in the four studies were double-checks through the process [ 22 , 24 , 28 , 36 ]. Among the barriers, two were related to keep-the-vein-open, which was identified in three studies [ 30 , 32 , 33 ]. The lack of automated infusion pumps [ 2 ], the absence of culture for use [ 32 , 33 ], and problems in the drug prescription process [ 33 ] were also identified as barriers. Communication with physicians in instances of doubt identified was the only identified facilitator in the “communication systems between HCPs” [ 28 ].

Resolutions for the barriers to rate control of IV medications

Table 4 presents the resolutions for the barriers to rate control of IV medications in the included studies. The suggested resolutions primarily belonged to the “contributing factors (system-related)” category. Resolutions in the “human factors” category were mainly related to the knowledge and performance of individual healthcare providers, and there were no studies proposing resolutions specifically addressing stress (high-volume workload), which is one of the barriers. Resolutions in the “design” category focused on the development [ 26 , 30 ], appropriate use [ 24 , 33 ], evaluation [ 26 ], improvement [ 24 , 26 , 30 ], and supply [ 23 ] of infusion pumps or smart pumps. Resolutions addressing aspects within the “contributing factors (system-related)” category can be classified into six main areas: interdisciplinary or inter-institution collaboration [ 23 , 25 , 28 , 30 , 34 , 35 , 36 , 37 ], training [ 24 , 37 , 40 ], implementation of policies or procedures [ 29 , 31 , 34 , 35 , 37 , 39 ], system improvement [ 25 , 30 , 32 ], creating a patient safety culture [ 25 , 37 , 38 ], and staffing [ 2 , 38 ].

This scoping review provides the most recent evidence on the attributes of errors, facilitators, and barriers related to rate control of IV medications. The major findings of this study were as follows: (1) there were a few intervention studies that were effective in decreasing the errors related to rate control of IV medications; (2) there was limited research focusing on the errors associated with IV medication infusion devices; (3) a few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications; and (4) the facilitators and barriers related to rate control of IV medications were identified by NCC MERP taxonomy as three categories (human factors, design, and system-related contributing factors).

Among the nine project or experiment studies, only two interventions showed statistically significant effectiveness for IV rate control [ 28 , 31 ]. Six studies did not report the specific statistical significance of the intervention [ 22 , 24 , 27 , 30 , 37 , 39 ], and one study found that the developed intervention had no statistically significant effect [ 34 ]. In another study, administration errors, including rate errors, increased in the experimental group and decreased in the control group [ 37 ]. IV rate control is a major process in medication administration that is comprehensively related to environmental and personal factors [ 3 , 41 ]. According to previous studies, interdisciplinary or multidisciplinary cooperation is associated with the improvement in patient safety and decreased medical errors [ 42 , 43 , 44 ]. Seven of the included studies were also project or experiment studies that developed interventions based on an interdisciplinary or multidisciplinary approach [ 22 , 24 , 28 , 30 , 34 , 37 , 39 ]. Additionally, an effective intervention was developed by a multidisciplinary care quality improvement team [ 28 ]. Therefore, it is crucial to develop effective interventions based on an interdisciplinary or multidisciplinary approach to establish practice guidelines with a high level of evidence related to IV rate control.

Of the 22 included studies, three identified potential problems associated with the use of IV medication infusion devices [ 26 , 32 , 35 ], and four described the application of interventions or explored the effects of the intervention developed to reduce errors that occur when using IV medication infusion devices [ 24 , 27 , 34 , 39 ]. IV medication infusion devices, such as infusion pumps and smart pumps, are widely used in healthcare environments and allow more rigorous control in the process of administering medications that are continuously infused [ 45 ]. Smart pumps are recognized as useful devices for providing safe and effective nursing care [ 15 ]. However, the use of IV medication infusion devices requires an approach different from traditional rate monitoring by counting the number of fluid drops falling into the drip chamber [ 9 ]. However, there exist many problems, such as bypassing the drug library, device maintenance, malfunction, tubing/connection, and programming in the use of IV medication infusion devices [ 32 , 35 ]. None of the four studies that described the application of interventions or explored the effects of the intervention demonstrated statistically significant effects. All four studies had no control group [ 24 , 27 , 34 , 39 ] and two studies had only post-test designs [ 24 , 27 ]. Therefore, further research needs to be conducted to analyze errors in rate control related to IV medication infusion devices and develop effective interventions.

A few studies have systematically evaluated and analyzed the severity of errors associated with rate control of IV medications. Among the 12 studies that reported the severity of errors associated with rate control of IV medications, five studies used NCC MERP, an internationally validated and reliable tool for assessing error severity, and one study used the Severity Assessment Code (SAC) developed by the New South Wales Health Department. Six studies did not use tools to assess error severity. The term “error severity” means the degree of potential or actual harm to patients [ 46 ]. Evaluating the severity of medication errors is a vital point in improving patient safety throughout the medication administration process. This evaluation allows for distinguishing errors based on their severity to establish the development of risk mitigation strategies focused on addressing errors with the great potential to harm patients [ 47 , 48 ]. Specifically, errors associated with rate control of IV medications were categorized as A to E on the NCC MERP and to groups 3 and 4 on the SAC. Additionally, errors associated with rate control of IV medications caused direct physical damage [ 2 , 21 ] and necessitated additional medication to prevent side effects or toxicity [ 23 ]. Therefore, as errors in rate control of IV medications are likely to cause actual or potential harm to the patient, research systematically evaluating and analyzing error severity should be conducted to provide the basis for developing effective risk reduction strategies in the rate control of IV medications.

Facilitators and barriers were identified as human, design, and system-related contributing factors. Among the human factors, “performance deficit” included failure to check equipment properly, tubing misplacement, inadequate monitoring, non-compliance with protocols and guidelines, and human handling errors with smart pumps. Nurses play a major role in drug administration; thus, their monitoring and practices related to IV medication infusion devices can influence patient health outcomes [ 3 , 49 ]. A major reason for the lack of monitoring was overwork, which was related to the complex working environment, work pressure, and high workload [ 3 , 11 , 49 ]. Moreover, two of the included studies identified high workload as a barrier to rate control of IV medications [ 23 , 37 ]. Therefore, to foster adequate monitoring of rate control of IV medications, a systematic approach to alleviating the complex working environment and work pressure should be considered.

Most facilitators and barriers in the devices category were related to IV medication infusion devices. In particular, expanding pump capabilities [ 26 ], monitoring pump programming [ 27 ], standardization [ 22 ], and using a pump [ 33 ] can facilitate rate control of IV medications. However, unexpected equipment faults are significant barriers, as identified in five studies among the included studies [ 2 , 20 , 25 , 35 , 38 ]. Moreover, the design [ 23 , 24 ], user-friendliness [ 21 ], connectivity to electronic systems [ 30 ], and completeness of drug libraries [ 33 , 35 ] are factors that can affect rate control of IV medications. Therefore, it is important to improve, monitor, and manage IV medication infusion devices so that they do not become barriers. Moreover, because rate errors caused by other factors can be prevented by devices, active utilization and systematic management of devices at the system level are required.

Although there are many benefits of infusion and smart pumps for reducing errors in rate control of IV medications, they cannot be used in all hospitals because of the limitation of medical resources. The standard infusion set, which is a device for controlling the rate of IV medication by a controller [ 9 ], is widely used in outpatient as well as inpatient settings [ 32 ]. Devices for monitoring the IV infusion rate, such as FIVA™ (FIVAMed Inc, Halifax, Canada) and DripAssist (Shift Labs Inc, Seattle, USA), which can continuously monitor flow rate and volume with any gravity drip set, have been commercialized [ 33 ]. However, they have not been widely used in hospitals. Therefore, developing novel IV infusion rate monitoring devices that are simple to use, can be used remotely, and are affordable for developing and underdeveloped countries can help nurses to reduce their workloads in monitoring IV infusion rates and thus maintain patient safety.

Most facilitators and barriers were system-related contributing factors, most of which belonged to the “policies and procedures.” In four studies, the absence of hospital policies or culture related to rate control of IV medications was identified as a barrier [ 2 , 30 , 32 , 33 ]. Medication errors related to incorrect rate control are problems that should be approached from macroscopic levels, such as via institutional policies and safety cultures. Therefore, large-scale research including more diverse departments and institutions needs to be conducted.

The second most common categories in system-related contributing factors were “frequent interruptions and distractions” and “training.” Although nurses experienced frequent interruptions and distributions during work, only one of the included studies was on interventions that were developed to create an environment with reduced interruptions [ 31 ]. Additionally, four studies found that education for nurses who are directly associated with medication administration is mandatory [ 22 , 23 , 24 , 36 ]. Therefore, education and a work environment for safety culture should be created to improve IV rate control.

Based on resolutions for barriers to rate control of IV medications, key groups relevant to rate control of IV medications include HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices. HCPs directly involved in the preparation and administration of IV medications need to enhance their knowledge of drugs, raise awareness for the importance of rate control of IV medications, and improve performance related to IV infusion device monitoring. Engineers specializing in IV medication infusion devices should develop these devices by integrating various information technologies used in clinical settings. Additionally, they should identify issues related to these devices and continuously enhance both software and hardware. Healthcare administrators play a crucial role in establishing and leading interdisciplinary or inter-institution collaborations. They should foster leadership, build a patient safety culture within the organization, and implement training, interventions, and policies for correct rate control of IV medications. Decreasing medication errors, including errors in IV rate control, is closely linked to the various key groups [ 50 , 51 , 52 , 53 ], and multidisciplinary collaboration is emphasized for quality care [ 54 , 55 , 56 , 57 ]. Therefore, each key group should perform its role and cooperate for appropriate IV rate control within a structured system.

This review has some limitations that should be considered. As there was no randomized controlled trial in this review, the causal relationship between wrong rate errors and their facilitators or barriers could not be determined. Moreover, only limited literature may have been included in this review because we included literature published in English and excluded gray literature. Since we did not evaluate the quality of the study, there may be a risk of bias in data collection and analysis. Despite these limitations, this study provides a meaningful assessment of published studies related to rate control of IV medications. This contribution will provide an important basis for new patient safety considerations in IV medication administration when determining future policies and device development.

The findings of this review suggest that further research is needed to be conducted to develop effective interventions to improve the practice of IV rate control. Moreover, given the rapid growth of technology in medical settings, research on IV medication infusion devices should be conducted. Additionally, to establish effective risk reduction strategies, it is necessary to systematically evaluate and analyze the severity of errors related to the rate control of IV medications. Several facilitators and barriers to rate control of IV medications were identified in this review to ensure patient safety and quality care, interventions and policy changes related to education and the work environment are required. Additionally, the development of a device capable of monitoring the flow of IV medication is necessary. This review will be useful for HCPs, hospital administrators, and engineers specializing in IV medication infusion devices to minimize errors in rate control of IV medications and improve patient safety.

Availability of data and materials

The corresponding author can provide the datasets that were utilized and/or examined during the present study upon reasonable request.

Abbreviations

Adverse event

Healthcare provider

Intensive care unit

Intravenous

Joanna Briggs Institute

The National Coordinating Council for Medication Error Reporting and Prevention

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L Naseralallah D Stewart M Price V Paudyal 2023 Prevalence, contributing factors, and interventions to reduce medication errors in outpatient and ambulatory settings: a systematic review Int J Clin Pharm https://doi.org/10.1007/s11096-023-01626-5

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This research was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: RS-2020-KD000077) and Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (No. 2020R1A6A1A03041989). This work also supported by the Brain Korea 21 FOUR Project funded by National Research Foundation (NRF) of Korea, Yonsei University College of Nursing.

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Studies included in the data analysis.

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Park, J., You, S.B., Ryu, G.W. et al. Attributes of errors, facilitators, and barriers related to rate control of IV medications: a scoping review. Syst Rev 12 , 230 (2023). https://doi.org/10.1186/s13643-023-02386-z

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Active Student Participation in Whole-School Interventions in Secondary School. A Systematic Literature Review

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This review presents a reasoned synthesis of whole-school interventions seeking to improve the overall school environment by fostering active student participation (ASP) in school activities and decision-making processes. The aims are to describe the selected programs, assess their methodological quality, and analyze the activities soliciting ASP. Among the 205 publications initially provided by the literature search in the academic databases PsycINFO and Education Research Complete, 22 reports met the inclusion criteria of presenting whole-school interventions that solicit ASP in secondary schools, and were thus included in the review. Such publications referred to 13 different whole-school programs, whose implemented activities were distinguished on a 5-point scale of ASP levels, ranging from Very high ASP , when students were involved in a decision-making role, to Very low ASP , when students were the passive recipients of content provided by adults. This review contributes to the literature by proposing an organizing structure based on different levels of ASP, which provides clarity and a common ground for future studies on student participation. Overall, the in-depth description of activities offers a framework to researchers and practitioners for planning interventions aimed at improving the learning environment and contributing meaningfully to the far-reaching goal of encouraging student participation in school life.

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Introduction

Research in educational psychology is consistent in showing that the quality of the school environment largely affects student well-being. Indeed, students’ experiences of a supportive school context have a significant impact on positive behaviors, such as academic achievement (Brand et al., 2008 ; Hoy, 2012 ) and good relationships among students and between students and staff (Cohen et al., 2009 ; Thapa et al., 2013 ). Conversely, the poor quality of the learning environment predicts negative outcomes, such as substance use (Weatherson et al., 2018 ) or bullying (Låftman et al., 2017 ).

In view of this, schools need to face the challenge of implementing interventions aimed at changing and improving the learning environment in the direction of promoting positive behaviors and reducing negative outcomes. One of the most promising directions in this regard is based on the adoption of whole-school approaches whose key features are the focus on overall school systems instead of on specific problems (Bonell et al., 2018 ).

The literature on whole-school interventions is broad (see, for example, Charlton et al., 2021 , for an extensive review on whole-school interventions focused on school climate), but it suffers from two major gaps. First, it relies primarily on programs applicable to elementary schools, while studies on high school populations are rarer, presumably because of the multiple challenges derived from the implementation of programs in such complex contexts (Estrapala et al., 2021 ; Vancel et al., 2016 ). Second, despite the importance generally attributed to the active involvement of students in the programs, to our knowledge, no previous reviews have specifically investigated the degree and the characteristics of student participation in such interventions. To address these limitations, in this article, we present a systematic literature review on whole-school interventions carried out in secondary schools and based on programs that envisage students’ active participation and involvement.

Whole-School Interventions for Improving the Learning Environment

In educational research, some reviews and meta-analyses (Charlton et al., 2021 ; Merrell et al., 2008 ; Voight & Nation, 2016 ) have critically synthesized and discussed studies on school interventions aimed at improving the learning environment. These programs have considered different outcomes of improvement, ranging from a general focus on school climate dimensions—e.g., relational aspects, institutional organization, and safety—to more specific aspects, such as bullying, violence, or substance use. However, the degree of effectiveness of such programs remains controversial. For example, a meta-analysis by Ttofi et al. ( 2008 ) indicated that school-based bullying prevention programs were able to bring about positive results, while another meta-analysis on the same topic (Merrel et al., 2008 ) concluded that evidence in this direction was only modest.

More positive results concerning the effectiveness of interventions were reported by Allen ( 2010 ) with reference to programs conducted by means of a whole-school approach. In her literature overview of studies designed to reduce bullying and victimization, the author concluded that whole-school interventions generally showed at least marginal evidence of improvement. Despite these encouraging findings, the studies conducted with a whole-school approach in secondary education contexts were rare. Among these, a well-established framework of whole-school interventions mostly implemented in middle schools is the School-Wide Positive Behavior Support program (for reviews, see Gage et al., 2018 ; Noltemeyer et al., 2019 ), which is a multi-tiered framework engaging students, school staff, and families for the delivery of evidence-based behavioral support aligned to students’ needs (Horner et al., 2004 ). By and large, the study results in this framework are again promising in suggesting a connection between such programs and school improvement, although the evidence is generally moderate and only regards a few of the considered outcome measures.

The mixed or weak results reported in the cited reviews solicit further exploration of the specific characteristics of whole-school interventions. In particular, a major limitation of the literature is the lack of an in-depth analysis of the types of activities proposed to students in each program, especially as far as their direct involvement is concerned. Given the importance attributed to student engagement in school life (Markham & Aveyard, 2003 ), this is a relevant area of inquiry that can inform researchers and practitioners willing to design and conduct whole-school interventions calling for students’ involvement.

Student Involvement in School Intervention

The importance of students’ involvement and participation finds a theoretical ground in the self-determination theory (see Ryan & Deci, 2017 ), according to which people who are self-determined perceive themselves as causal agents in life experiences, being proactive and engaged in the social environment. Studies examining such human disposition in adolescence supported the relevance of self-determination for quality of life and identity development (Griffin et al., 2017 ; Nota et al., 2011 ) and as a full mediator in the negative association between stress and school engagement (Raufelder et al., 2014 ).

In the light of these assumptions, educational and school psychologists have launched scientific and professional debates on the ways in which schools can implement favorable conditions for students to feel active and co-responsible for their educational and academic pathways (Carpenter & Pease, 2013 ; Helker & Wosnitza, 2016 ; Schweisfurth, 2015 ). These debates have reached consensus across-the-board on the recognition that school change and improvement are best fostered by intervention programs in which students are offered opportunities to get actively involved in school life (Baeten et al., 2016 ; Voight & Nation, 2016 ). For this goal to be achieved, all educational agencies are called upon to promote interventions capable of supporting activities that require student involvement and participation (Antoniou & Kyriakides, 2013 ).

The importance of students’ active participation in the school environment has also been confirmed by a substantial amount of literature investigating over time the association between high student involvement and positive learning environments. Mitchell ( 1967 ) reported that school climate is related to the extent of student participation and interaction during school life. Epstein and McPartland ( 1976 ) showed that student opportunities for school involvement were related to satisfactory outcomes. In a 1982 review published, Anderson claimed that “the type and extent of student interaction that is possible within a school appears to be a significant climate variable” (Anderson, 1982 ; p.401). A few years later, Power et al. ( 1989 ) described a program implemented in several contexts and characterized by high student involvement, whose results showed that a high rate of student participation led to their capacity to take on responsibility for building an effective learning environment and positive climate. More recent studies (Vieno et al., 2005 ) have confirmed that democratic school practices, such as student participation in decision-making processes, play a significant role in the development of a sense of community at individual, class, and school levels. The review by Thapa et al. ( 2013 ) confirmed the importance of student classroom participation as a variable affecting school climate and academic achievement.

On these theoretical and empirical grounds, providing space to student voices in decision-making and school change emerges as a powerful strategy for improving school environments and enforcing the success of programs (Mitra, 2004 ). The construct of student agency fits in well with this approach, as it refers to the students’ willingness and skill to act upon activities and circumstances in their school lives (Lipponen & Kumpulainen, 2011 ). Representing adolescents’ authentic, proactive, and transformative contributions to school life (Grazia et al., 2021 ), agency is fostered by school environments capable of soliciting and valorizing students’ active participation in educational practices and school decisions (Makitalo, 2016 ) and encouraging them to feel co-responsible with teachers and staff for their school lives (Mameli et al., 2019 ). The value of agency has been confirmed by research showing its positive associations with motivation and the fulfilment of basic psychological needs (Jang et al., 2012 ) as well as with the perception of supportive teaching (Matos et al., 2018 ).

Despite the agreement on student participation as a crucial feature for the success of programs capable of improving students’ school life, to our knowledge, previous literature reviews on school interventions have not focused specifically on the extent and way in which students are given a voice and are involved in the programs. In view of this, in the present work, we set out to search, in the existing literature, for interventions specifically based on activities in which students were not just the recipients of activities but rather took on an active and decision-making role. For our purposes, we use the notion of active student participation (ASP) to include the variety of ways in which students are given the opportunity to participate actively in school activities and decisions that will shape their own lives and those of their peers.

Review’s Aims

Previous reviews (Charlton et al., 2021 ; Estrapala et al., 2021 ; Voight & Nation, 2016 ) have provided extensive descriptions of whole-school interventions aimed at improving school environments or reducing school problems, suggesting their effectiveness. Moreover, a growing amount of literature has found that students’ active involvement in their school life is a crucial feature for improvement. Our general goal was to move forward by conducting an in-depth examination of existing whole-school interventions based on activities promoting ASP in secondary schools, by providing a reasoned synthesis of their characteristics and implementation. The choice to focus on secondary schools was driven by the evidence that this developmental stage has so far received less attention in whole-school intervention research (Estrapala et al., 2021 ; Vancel et al., 2016 ).

Given the large heterogeneity of existing intervention programs, both in terms of participants (specific subgroups vs general student population) and targets of improvement (specific abilities vs general school environment), it was essential to set clear boundaries for the study selection. As this was a novel undertaking, we chose to focus on whole-school interventions directed to the overall student population and aimed at improving the school climate as a whole. This allowed us to select a reasonably homogeneous sample of studies, with the confidence that future reviews will advance our knowledge by considering more specific fields and populations.

The review’s aims were (a) to describe the selected programs on the basis of their focus, country, duration, age of participants, and research design; (b) to assess the soundness of the research design and methodologies adopted in each study in order to provide evidence of the methodological quality of the selected programs; and (c) to differentiate among various levels of ASP in the program’s activities and, for each of these levels, to describe methods and activities carried out in the programs.

The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 updated statement (PRISMA 2020; Page et al., 2021 ). In line with the terminology proposed by the authors, in the following sections, we use the term study for every investigation that includes a well-defined group of participants and one or more interventions and outcomes, report for every document supplying information about a particular study (a single study might have multiple reports), and record for the title and/or abstract of a report indexed in a database. In addition, for the specific purposes of the present review, we use the term program when referring to an implemented whole-school intervention that has specific characteristics and is usually named, since more than one study may be conducted with the same program.

Eligibility Criteria

Studies were eligible for inclusion in the review if they were (i) written in English language; (ii) published in peer-reviewed academic journals; and (iii) aimed at assessing psychological effects of whole-school interventions that solicit ASP in secondary schools; thus, studies in which students were involved solely as recipients of activities delivered by adults were excluded. Moreover, in line with the review’s aims described above, studies were excluded from the review if they were (i) focused on specific subgroups of students (e.g., ethnical minorities or LGBTQ students); (ii) solely aimed at improving specific skills (e.g., literacy or mathematics); and (iii) solely focused on physical health (e.g., nutrition or physical activity).

Information Sources and Search Strategy

A literature search was conducted via EBSCO, including the academic databases PsycINFO and Education Research Complete, last consulted on April 9, 2022. The entered search terms were school-wide interventions OR whole-school interventions OR school-wide programs OR whole-school programs OR school-wide trainings OR whole-school trainings AND secondary school OR high school OR secondary education. By means of the software’s automated procedure, we searched these terms in the abstracts and filtered the results according to the first two inclusion criteria, selecting articles in English and published in peer-reviewed academic journals.

Selection and Data Collection Process

The records of each study were screened by two researchers, and the potentially relevant studies were further assessed for eligibility by three researchers, who read the full text independently. Moreover, some records relevant to the purposes of the research were identified through the references of the included documents ( forward snowballing ; Wohlin, 2014 ). Data from each included report were searched by two researchers, who worked independently to extrapolate the information relevant to the review, which were (a) the study characteristics; (b) the indicators of methodological quality; and (c) the program activities.

Detailed information about the selection process is provided in the PRISMA flow diagram (Fig.  1 ). The literature search provided 205 total records, and reduced to 169 after the automatic deduplication provided by EBSCO. After the application of our inclusion and exclusion criteria, 62 records were selected for full text reading. Of the 107 excluded records, 37 did not report interventions (e.g., they presented only school surveys), 25 were informative papers on initiatives and/or interventions without assessments, 15 focused only on academic skills attainment, 11 referred to primary schools, 10 focused on minorities, 6 were reviews of books or DVDs, and 3 only evaluated physical health as an outcome. After the full text reading of the 62 selected reports, 48 were excluded as they only discussed aspects related to implementation (e.g., feasibility or fidelity) without assessing the psychological effects of the intervention on students ( n  = 23) or did not solicit ASP during the intervention ( n  = 25). Thus, 14 reports were included in the sample. In addition, 10 reports were identified by sifting through the references of the selected documents ( forward snowballing ; Wohlin, 2014 ). After the full text reading, two of them were excluded as they did not assess the effects of the intervention. At the end of the selection process, the final sample of the present review included 22 reports, which referred to 16 studies and 13 programs.

PRISMA flow diagram

Study Characteristics

The main information about each study is reported in Table 1 . As for the focus of the interventions, three macro-areas were identified: (a) prevention of violence (nine studies and twelve reports), including programs for less bullying, cyberbullying, dating violence, sexual violence, and aggression; (b) promotion of mental health (five studies and seven reports), including programs for addressing depression and suicide risk and for promoting general psychological health; (c) promotion of positive emotional and relational school climate (two studies and three reports), including programs for enhancing school connectedness and school climate.

Within each macro-area, in Table 1 , the programs are listed following the alphabetical order of the program name. Out of the studies focused on preventing violence, three referred to unnamed anti-bullying programs, which in the present review were labeled Anti-bullying_1 , Anti-bullying_2 , and Anti-bullying_3 ; the other studies on the topic referred to an anti-cyberbullying program named Cyber Friendly School ; an anti-bullying program named Friendly School ; a bystander program aimed at preventing dating violence and sexual violence, named Green Dots ; a program aimed at preventing bullying and aggression, named Learning Together ; and an anti-bullying program named STAC , which stands for Stealing the show, Turning it over, Accompanying others, Coaching compassion. The studies focused on promoting mental health comprised a school research initiative aimed at preventing depression, named Beyond blue ; an intervention aimed at promoting mental health, named Gatehouse Project ; and a program to prevent suicide risk, named Sources of Strengths . Out of the studies focused on promoting positive emotional and relational school climate, one referred to the Restorative Justice program, aimed at promoting healthy and trusting relationships within the school, and the other referred to a program aimed at the promotion of a good school climate, named SEHER , which stands for Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health.

A large majority of the studies were conducted in the USA, some were carried out in Australia and the UK, and a few studies in India and China. The studies varied in duration, ranging from one to seven school years, and the number of schools involved in the intervention, ranging from 1 to 75. About half of the studies involved students from all grades while the other half was targeted only for some grades. Lastly, the reports varied in its research design: the majority conducted experimental group comparisons (EGC), but also other quantitative research designs (O) were present along with some qualitative designs (QUAL). To make text and tables more readable, the 13 included programs were renamed with a program ID consisting of the initials of the program name. Similarly, the 22 included reports were renamed with a report ID , consisting in the program ID followed by the surname of the first author and the publication year, all separated by underscores. Report ID and Program ID are reported in Table 1 .

Assessment of Methodological Quality

To assess each report’s methodological quality, we searched in the literature for a rigorous and comprehensive set of indicators and eventually decided to use as a reference the standards for evidence-based practices identified by the Council for Exceptional Children (CEC, 2014 ), which include indicators on setting and program description, fidelity, and reliability of outcome measures. Although the standards were originally recommended for the specific field of special education, they are considered appropriate to evaluate studies in all educational settings and were previously used by Charlton et al. ( 2021 ) in a systematic review studying the effects of school-wide interventions on school climate perceptions. Given that our aim was not to identify evidence-based practices but more generally to assess the methodological quality of the reports included in the review, some of the identified indicators were not applicable to our material. For this reason, among all the indicators described in the document (CEC, 2014), we selected those that provided a general overview of each report’s methodological quality. The selected indicators, their corresponding number in the CEC document, and a short description for each are reported in Table 2 .

In more detail, we applied a more extensive set of indicators to reports which fit the CEC definition of experimental group comparison design (EGC, as reported in Table 1 ), where participants were divided into two or more groups, both randomly and non-randomly, to test the effects of the interventions. For reports based on qualitative analyses and on quantitative analyses not consistent with the EGC design (QUAL and O, as reported in Table 1 ), we used a more limited set of indicators (indicators 1 to 6, as described in Table 2 ) and included a brief description of the research aims and methods. In the assessment of methodological quality, interrater reliability was achieved as three independent researchers read each report in detail, and the attribution of each indicator was discussed and agreed upon.

The assessment of methodological quality for the EGC reports is summarized in Table 3 . The findings show that most studies were strong in contextualizing the research, clearly describing the intervention program (either directly or with references to previous work) and conducting quality analyses. Weak points emerged to be related to the assessment of fidelity implementation (indicators 4 and 5 in Table 3 ), both with reference to adherence to the intervention program and to the dosage received by participants. Results for studies with qualitative analyses or quantitative analyses not EGC are reported in Table 4 . Like the ECG reports, most of these studies appeared strong in contextualizing the research and describing the intervention program, while fidelity of implementation received less attention (indicators 4 and 5 in Table 4 ).

Levels of Active Student Participation

As required by our inclusion criteria, all the selected programs were based on interventions that solicited ASP. However, from the careful analysis of the studies, we realized that the program activities promoted very different forms of ASP. Three independent researchers thus considered in detail each activity described in the programs and eventually agreed to score it on a 5-point scale (see Table 5 ), distinguishing among activities that solicit various levels of ASP. The scale partly followed the school participation scale of the HBSC questionnaire as defined by De Róiste et al. ( 2012 ). It ranged from Very high levels of ASP, attributed to activities in which students were given a fully decision-making role, to Very low levels of ASP, given to activities in which students were just the recipients of activities delivered by adults. In line with our inclusion criteria, in no programs, students were involved solely as recipients of activities delivered by adults (Very low ASP). Moreover, levels were not mutually exclusive, so that each program might include different levels of ASP.

In Table 5 , we report all the considered ASP levels, with the specifically related activities, and the coding of each program. It should be specified that the distribution of activities in the various levels was based on a qualitative accurate analysis of the role attributed to students and not on the number of students involved in each program’s activities, which varied to a great extent. In more detail, Very high ASP was attributed to interventions in which students were involved in processes with a direct organizational impact on school roles, curricula, and policies; this included two types of activities, i.e., student involvement in decision-making processes and the formation of school action teams comprising students. High ASP was recognized when students were still involved in organizational activities, but their role was limited to the implementation of activities and did not directly impact on school curricula and policies; it consisted of three activities, i.e., presentation of students’ works, leading of activities for peers, and leading of activities for adults. Moderate ASP was attributed when students were asked to express their viewpoints and opinions, without having a decision-making power, however; it comprised activities in which students were called to express their points of view on various school issues, either by the provision of platforms to share ideas, concerns, or suggestions, or by the organization of interactive school assemblies, or by their involvement in surveys based on data collection (e.g., by means of questionnaires) on specific aspects of their school life. Low ASP was attributed when the students’ activation was limited to a specific task required within a structured format designed by other people, including training for student leaders, interactive group activities, and individual activities. Finally, activities were coded as Very low ASP when students were involved as the passive recipients of contents provided by adults, through lecture-style lessons, viewing of videos, or distribution of didactic material. The activities provided for in each program are described at length in the following paragraphs, considering activities scored in every specific level of ASP.

For the sake of completeness, in Table 5 , we added a final column in which we indicated additional program activities that involved the staff. They comprised the formation of school action teams made up of adults, training, and the provision of materials for the staff. As the description of these activities goes beyond the scope of our investigation, we will not describe them in detail.

Very High ASP: Making School Rules

As can be seen in Table 5 , activities implying involvement of students in decision-making processes were identified in six programs. In AB3, during a school assembly, students were invited to develop a whole-school anti-bullying policy, while in later activities, they were asked to identify strategies to be implemented in the school to prevent bullying. In CFS, school staff and student leaders conducted whole-school activities helping students to review school policies to promote a positive use of technology. In FS, the intervention aimed to help the transition between primary and secondary school was co‐developed with students who had already made such a transition. In GP, the use of peer support and leadership was encouraged to increase opportunities and skills for students to participate in decision-making processes within the school; in addition, at a classroom level, rules were negotiated by teachers and students and displayed in each classroom. In RJ, during the first year of implementation, staff and students developed a plan for pathways of primary, secondary, and tertiary restorative interventions; in the following years, students’ leadership roles and collective decision-making activities increased, so that students themselves were able to advance whole-school initiatives and activities, to map out course goals and determine which projects they would embrace. Finally, in SE, some health policies were discussed with the principal, teachers, and students before being finalized in a school action team meeting and disseminated at whole-school level.

Activities consisting in the creation of school action teams (or school action groups) including students and teachers were identified in three programs (see Table 5 ). In AB2, a school action group with both students and staff was formed to define action plans and training for staff on restorative practices at whole-school level and to implement a new school curriculum focusing on social and emotional skills. In LT, a school action group comprising around six students and six staff was formed to lay down school policies and coordinate interventions, based on the feedback from the student data collection. In SE, a school health promotion committee, consisting of representatives from the school board, parents, teachers, and students, was formed to discuss issues submitted by the students and to plan the activities for the future years based on the feedback from the activities already carried out. In addition, a peer group of 10 and 15 students from each class discussed health topics and student concerns with adult facilitators, in order to develop an action plan and to help in organizing various activities, such as contests and school assemblies.

High ASP: Organizing School Events

Three types of activities were included in this level of ASP. As reported in Table 5 , five programs solicited the creation of different student artifacts . AB1 included a student-made video on bullying to be presented to all the students. In GP, student artifacts were presented to audiences such as parents, other students, teachers, and members of the community. In SS, student leaders made presentations for peers to share personal examples of using the strengths provided by the program. In RJ, students engaged in collaborative, interactive writing activities based on analytical reflection for the realization of a rubric co-developed by students. SE included the contribution of all the students, teachers, and the principal in the realization of works like write-ups, poems, pictures, or artwork, on specific topics for a monthly wall magazine publication. SE also envisaged contests among students, such as poster-making and essay writing, linked to the monthly topic of the wall magazine.

Activities regarding the organization of student-led activities for peers were found in four programs (see Table 5 ). In CFS, student leaders (four to six in each intervention school) conducted at least three important whole-school activities to promote students’ positive use of technology for raising students’ awareness of their rights and responsibilities online; they also provided cyberbullying prevention trainings for peers. In SS, student leaders (up to six in the school) conducted activities aimed at raising awareness of Sources of Strengths , generating conversations with other students, providing presentations about the strengths proposed by the program, and engaging peers to identify their own trusted adults. RJ included student-led restorative circles with students, workshops for students, and peer-to-peer mentorship on restorative practices. In SE, student leaders (between 10 and 15 in each class) conducted peer group meetings to discuss on relevant health topics.

In two programs, student-led activities for adults were organized (see Table 5 ). In CFS, student-led activities provided information to the teaching staff about the technologies used by students and cyberbullying prevention training given to parents. In RJ, circles and workshops on restorative practices were implemented by the students for the staff.

Moderate ASP: Expressing Personal Views

Three types of activities were included in this level of ASP. As can be seen in Table 5 , two programs provided platforms where students could express their personal views on various topics. In BB, students, families, and school staff were provided with platforms to share information and communication on mental health issues. In SE, platforms were used to raise concerns, make complaints, and give suggestions, either anonymously or by self-identifying, on the intervention topics.

Interactive assemblies for students to discuss on the main intervention topics were organized in three programs (see Table 5 ). AB1 provided a first interactive school assembly to discuss respect and bullying, and later assemblies at class level to further discuss the themes emerged during the whole-school assembly. Similarly, AB3 included a school assembly where students were encouraged to get involved in the development of a whole-school anti-bullying policy, followed by three lessons during which the class teacher facilitated a discussion in each class aimed to raise awareness about bullying and to think about school-based solutions. SE included group discussions for generating awareness about health issues, to be discussed during the school assemblies that took place four times a month.

In six programs, students were given a voice by data collections to be used in the process of school changes (see Table 5 ). AB1 included a bullying report form that students, in addition to staff and parents, filled in to report bullying incidents. AB3 provided feedback from student data collection during the school assembly as a basis for discussing whole-school anti-bullying strategies. In LT, annual reports on students’ needs, drawing from student surveys in relation to bullying, aggression, and school experiences, guided the action teams to define school policies and coordinate interventions. In BB, summaries of student and staff data on current school structures, policies, programs, and practices related to student well-being, collected annually, were used by the team to create an “action plan” for changes across the school, both at the classroom and whole-school level. In GP, the profile emerging from the student surveys on school environment guided school teams in the definition of priority areas and strategies within each school, both by coordinating existing health promotional work and introducing new strategies that met the needs of a specific school. In SE, the school action team planned school activities based on reports and discussions on issues presented by the students.

Low ASP: Trainings

A low level of ASP was identified in three types of activities. As can be seen in Table 5 , four programs included trainings for student peer leaders . CFS provided a 10-h training for peer leaders to lead whole-school activities on the positive use of technology. GD provided a 5-h bystander training for student leaders to recognize situations and behaviors that could lead to violence or abuse and to identify active bystander behaviors to be performed either individually or collectively to reduce the risk or effect of violence. ST provided a 90-min training session and two 15-min booster sessions on bullying, which included icebreaker exercises, hands-on activities, and role plays. SS provided a 4-h interactive training for peer leaders aimed at developing protective resources in themselves and encouraging peers to grow such resources as well.

Eight programs included interactive group activities (see Table 5 ). In AB3, students worked in small groups to identify the types of bullying in the school and to discuss strategies to prevent bullying, with the support of bullying scenarios with discussion questions. In CFS, interactive activities included problem-solving, quizzes, and case studies on the use of technology to prevent cyberbullying. LT included various interactive activities aimed at preventing violence, ranging from informal practice, for example, using “affective” statements to communicate feelings, to formal practices, for example hosting a restorative “circle” where participants were encouraged to express emotions and create emotional bonds after problematic or disruptive behavior. BB provided a range of interactive teaching methods, such as small-group exercises, role plays, and quizzes, for reflecting on mental health issues. GP provided activities as small group work and class discussion, by also implementing interactive teaching strategies, such as using questions to kindle discussions and emphasizing the importance to consider different perspectives on a topic, encourage challenges, and debate ideas. SS included peer-to-peer messages and activities wherein student leaders shared examples of strengths that have helped them to overcome personal challenges and invited their peers to participate in interactive tasks. RJ included many interactive practices, such as restorative circles, interactive writing activities, and peer-to-peer mentorship to broaden the impact of restorative practices. SE included monthly contests for students, such as elocution, debates, and quiz games.

Finally, in BB program, some individual activities , in addition to group tasks, were conducted (see Table 5 ). Such activities consisted of individual writings and self-reflection on specific topics, aimed at building or enhancing sense of self-worth, belonging, control, purpose, future, and humor, which were considered to protect against mental health problems.

Very Low ASP: Students as Recipients

Activities in which student’s role was overall that of the recipients of actions taken from adults were of three types. As can be seen in Table 5 , six programs included lecture-style lessons . AB1 included the speech by a nationally known speaker about respect and bullying and the presentation of the Social Support System to students by their English teachers. AB3 included the presentation of summary feedback from the pre-test questionnaires during a school assembly and three lessons, delivered by the class teachers, on school bullying. CFS included lessons led by class teachers, aimed at improving online social skills, focusing, in particular, on positive communication, resilience, self-management, conflict resolution, and social responsibility. GD included a 50-min persuasive lesson led by adults focused on violence victimization, perpetration, and prosocial behaviors. LT included adult-led lessons on social and emotional skills. SE organized workshops led by teachers or program facilitators on effective study skills, such as time management, learning style, note-taking, reading comprehension, memorization techniques, and concentration techniques.

Three programs included the viewing of videos during the implementation (see Table 5 ). AB1 and AB3 provided a video on school bullying for all the students. BB provided video or DVD materials on mental health issues.

Finally, three programs provided students with informative materials (see Table 5 ). AB1 provided a form with several responses for intervening against bullying, which offered alternatives to the traditional method of apportioning blame and punishing bullies. Similarly, AB3 provided a worksheet on possible responses to bullying. FS provided educational magazines on bullying issues. BB provided many materials, such as individual student workbooks, a review poster, master copies of resources for all activities, and homework worksheets.

The aim of this systematic review was to provide a reasoned synthesis of whole-school interventions in secondary school capable of improving the school environment by assigning an active role to students. The first result that warrants consideration regards the number of publications that met our eligibility criteria to select whole-school interventions based on activities soliciting ASP in secondary schools. Despite the wide interest of researchers on the topic of whole-school interventions in general (see Bonell et al., 2018 ; Charlton et al., 2021 ), our selection and data collection process eventually provided only 22 reports referring to 16 studies that fostered ASP during the intervention. This result calls for further work in the field. Based on the emphasis given by educational and political agendas about the importance of empowering students in their role as active participants in schools, first of all, and in societies, subsequently, research should not overlook the question of how to improve their participatory skills by involving them in school activities and decisions (Markham & Aveyard, 2003 ). More investment in this direction is needed to evaluate the consistency and efficacy of the existing programs, to eventually reach consensus on the intervention protocols that schools can implement to improve their learning environment. Results related to each of our specific aims will be discussed in the following paragraphs.

Characteristics of the Selected Programs

As for the first aim of the review, concerning the description of the identified literature, several reflections arise from our results. Considering the year of publication, we found growing interest by researchers in the field, as most reports were published in the last few years, i.e., from 2018 to 2021. This may be considered positive indication that research has identified student participation in school interventions as a crucial topic on which to invest for future works. As for the focus of the selected literature, most of the included studies concerned the reduction of violent behaviors, referring for the most part to bullying, while the promotion of a more general positive emotional and relational school climate is the less investigated topic. Notwithstanding the overall need to fill in this limitation of research, these results suggest that future studies should address the issue of how it is possible to create better school environments for students starting from their own involvement and decision-making roles. This is consistent with the direction indicated by Bonell et al. ( 2018 ), who upheld the importance of focusing more on overall school systems rather than on specific problems. The implementation of a larger number of programs fostering ASP in order to improve school climate and learning environments would thus be important to understand how to support students in dealing with the variety of non-specific problems that can arise during school life. Indeed, as confirmed by the literature, a positive school climate is related to higher academic achievement (Berkowitz et al., 2017 ; Kutsyuruba et al., 2015 ) and fewer problematic behaviors, violence (Reaves et al., 2018 ), and psychological malaise at school (Aldridge and McChesney, 2018 ). Finally, looking at the country of the selected program implementation, most of the studies were conducted in the USA, some in Australia and the UK, and a few in India and China. To our knowledge, with the exception of the two anti-bullying programs carried out in the UK and included in the current review, no other studies were conducted in European countries. With caution, as in many other countries researchers may have developed programs that could not be included in this review due to the inclusion criteria, we consider this as a gap in the literature that future work should fill, especially considering that school policies and organizations are very different between continents. In this regard, it would be interesting both to replicate existing programs and to develop revisited or new interventions specifically adapted to the context of the country’s school system, a work that would also fulfil the aim to increase the ecological validity of the proposed activities.

Methodological Quality of the Selected Reports

The second aim of the review was to assess the soundness of the research design and methodologies adopted in the selected studies. In this regard, we found that the considered reports were robust overall, as they met most of the considered indicators of methodological quality. In particular, most of the studies, based both on EGC or on other designs, described and contextualized the intervention and provided adequate analyses. Beyond the generally good methodological quality of the included studies, consistently with previous examinations of intervention programs (Charlton et al., 2021 ), we found a weakness concerning the fidelity of implementation, as this indicator was observed in only about half of the considered programs. Given that fidelity is a fundamental aspect for the evaluation of the intervention efficacy (O’Donnell, 2008 ), future studies should consider this important factor, by adding it to the evaluation of the programs for providing adequate monitoring tools that include qualitative and process indicators. Overall, however, the literature on the interventions meeting the criteria for our review, albeit limited, relies on methodologically sound grounds that allow us to draw some conclusions on programs and activities actively involving students and to offer suggestions for researchers and practitioners in the field.

Program Activities and Levels of ASP

As for the third and last aim of the review, i.e., concerning the analysis and description of ASP activities proposed in the various programs, our results offer material for an innovative way to look at the programs and points the way to future research in the field. In particular, some points should be highlighted. First, we were able to show that a variety of ASP activities can be used in interventions, from those requiring students to directly act on school programs and policies to those in which students are merely involved as recipients of contents delivered by school staff. From the careful and independently conducted analysis of all program activities, we were also able to grade such activities on a scale ranging from very high to very low levels of ASP. This may be a useful tool for researchers, as it advances a way to develop and organize interventions fostering different levels of ASP activities, to be selected on the basis of the research focus and aims. The effort to identify different levels of ASP also has the merit of introducing some degree of clarity and order in the great variability of program activities. While the importance of student involvement and participation was generally recognized in the literature (Baeten et al., 2016 ; Schweisfurth, 2015 ), our in-depth description shows that not all forms of participation are equal, and thus offers a tool to differentiate between them. This advances our understanding of the concept of student participation both on a theoretical and methodological level.

Beyond this general picture of ASP activities, our findings show that the interventions based on the highest levels of ASP are those aimed at generally improving the school environment, i.e., the Restorative Justice and SEHER programs. These programs included all but one of the activities defined as Very High ASP or High ASP , while all other programs usually provided only one or two of them. This result can offer interesting insights if taken together with the above-reported considerations on the importance to promote overall school improvement, and not to restrict the focus on one or few specific problems. On the basis of this result, we tentatively advance that when the study scope is broad and the theoretical approach is systemic, interventions are more directly centered on lending a voice to students and assigning to them a decision-making role. This again supports the importance of promoting whole-school interventions targeted toward the general learning environment.

Limitations and Conclusion

We are aware that the findings of the present literature review should be considered in the light of certain limitations. First of all, our choice to include only studies published in peer-reviewed journals in English requires some caution. While this selection criteria allowed us to provide a picture of the international literature, this might entail the loss of programs published in other languages that nonetheless contribute to the issue and deserve to be explored in future reviews. Secondly, in the present work, we did not address the issue of cross-cultural similarities and differences in schooling and education, which may influence the way ASP is conceived and valorized in the school context. However, the levels of ASP activities we proposed have the strength of resulting from the analysis of programs from several countries and may thus offer a basis for future discussions on the cross-cultural validity of practices fostering ASP. Furthermore, the present review has focused only on secondary school programs. While this choice was needed for guaranteeing clear references and boundaries to our findings, it also leaves to be explored whether our proposed classification of ASP activities could also be applied to younger students. Given the developmental and organizational differences between primary and secondary levels of education, this issue certainly merits further exploration in future reviews.

As the aim of our review was to provide an in-depth and reasoned description of existing studies based on ASP and of the activities adopted to promote the active role of students, testing the efficacy of these studies was beyond the scope of the present work. While future research may advance this line of inquiry, based on the evidence that different outcomes are considered in such a small number of studies, it seems premature to move toward extensive efficacy testing such as meta-analyses. Rather, at present, it is probably more feasible and desirable to have an increasing amount of literature focusing on ASP in whole-school interventions, to collect further evidence of robust programs and activities, especially with regard to high ASP. As a possible further research question in this direction, we suggest it would also be useful to assess whether the ways of actively involving students may change depending on the intervention target outcomes or on the number of students taking part in the activities. Lastly, while this is true for any review of the literature, it should nonetheless be acknowledged that our syntheses and reflections are dependent upon the choices made in the article selection process. For example, our inclusion and exclusion criteria (i.e., focusing on general participants and targets of intervention) may have restricted our sample. With this in mind, we followed closely the PRISMA guidelines and detailed each step of the process, so that readers can be well informed and future research may build as seamlessly as possible from our work.

Despite the mentioned limitations, this review provides a literature advance in its in-depth examination of existing whole-school interventions that include active student participation in secondary school. Their description and reasoned synthesis make available to researchers and practitioners an overview of specific programs and activities that are being used to actively involve students in processes of change. This in turn can inform reflections and experimentations as to how to integrate and improve the existing provision. In this direction, the major effort and contribution of the present review is the proposal of an organizing structure based on different levels of ASP for analyzing interventions, which allows to classify the specific activities included in each program. Such an effort provides a common ground for reflections and future studies on active student participation, as a shared classification can be instrumental for planning new interventions or evaluating the actual degree of students’ active involvement in the implemented programs. Overall, this work significantly contributes to the far-reaching goal of encouraging student participation in school life, and more specifically in the transformation of their learning environment, so that they can be empowered in shaping it to be increasingly responsive to their insights, ideas, and needs.

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All the authors contributed to the study conception and design. Literature search was conducted by Sara Berti; assessment of methodological quality was supervised by Valentina Grazia; draft of the introduction and overall supervision were performed by Luisa Molinari. All the authors contributed to data analyses, draft of the manuscript, and critical revisions of the work and they eventually approved the final manuscript.

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Berti, S., Grazia, V. & Molinari, L. Active Student Participation in Whole-School Interventions in Secondary School. A Systematic Literature Review. Educ Psychol Rev 35 , 52 (2023). https://doi.org/10.1007/s10648-023-09773-x

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DOI : https://doi.org/10.1007/s10648-023-09773-x

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