literature review systematic research

“My PhD research used systematic review, qualitative synthesis, case study and discourse analysis techniques, each was underpinned and made coherent by a consistent critical inquiry methodology and an overarching research question. “Systematic reviews are becoming increasingly popular as a way to collect evidence of what works across multiple contexts and can be said to address some of the weaknesses of case study designs which provide detail about a particular context – but which is often not replicable in other socio-cultural contexts (such as other countries or states.) Publication of systematic reviews that are done according to well defined methods are quite likely to be published in high-ranking journals – my PhD supervisors were keen on this from the outset and I was encouraged along this path. “Previously I had explored social realist authors and a social realist approach to systematic reviews (Pawson on realist reviews) but they did not sufficiently embrace social relations, issues of power, inclusion/exclusion. My supervisors had pushed me to explain what kind of realist review I intended to undertake, and I found out there was a branch of critical realism which was briefly of interest. By getting deeply into theory and trying out ways of combining theory I also feel that I have developed a deeper understanding of conceptual working and the different ways theories can be used at all stagesof research and even how to come up with novel conceptual frameworks.”

Useful references for Systematic Review & Meta-Analysis: Finfgeld-Connett (2014); Lambert (2020); Siddaway, Wood & Hedges (2019)

Research Methods Handbook by Rob Farrow; Francisco Iniesto; Martin Weller; and Rebecca Pitt is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Share This Book

Literature Review Research

Literature review, what is not a literature review, purpose of the literature review, types of literature review.

Chat with us!

Education Librarian

A literature review is important because it:

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

Not an essay

Not an annotated bibliography in which you summarize each article you reviewed. A literature review goes beyond basic summarizing to critically analyze the reviewed works and their relationship to your research question.

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

A literature review serves several purposes. For example, it

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

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

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

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

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

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

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

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

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

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

Systematic Reviews

What Makes a Systematic Review Different from Other Types of Reviews?

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

Purdue Online Writing Lab College of Liberal Arts

Writing a Literature Review

Welcome to the Purdue OWL

This page is brought to you by the OWL at Purdue University. When printing this page, you must include the entire legal notice.

Copyright ©1995-2018 by The Writing Lab & The OWL at Purdue and Purdue University. All rights reserved. This material may not be published, reproduced, broadcast, rewritten, or redistributed without permission. Use of this site constitutes acceptance of our terms and conditions of fair use.

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:

Conclusion:

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:

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:

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.

Harvey Cushing/John Hay Whitney Medical Library

Ysn doctoral programs: steps in conducting a literature review.

What is a literature review?

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

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

Why is it important?

A literature review is important because it:

APA7 Style resources

APA Style Blog - for those harder to find answers

1. Choose a topic. Define your research question.

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search.

Where to find databases:

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

Review the literature

Some questions to help you analyze the research:

Tips:

Research and Writing Guides

Writing a paper? Don't get lost.

How to write a systematic literature review

What is a systematic literature review?

A systematic literature review is a summary, analysis, and evaluation of all the existing research on a well-formulated and specific question. Put simply, it’s a study of studies.

Where are systematic literature reviews used?

Systematic literature reviews can be utilized in various contexts, but they’re often relied on in clinical or healthcare settings.

Medical professionals read systematic literature reviews to stay up-to-date in their field, and granting agencies sometimes need them to make sure there’s justification for further research in an area. They can even be used as the starting point for developing clinical practice guidelines.

What types of systematic literature review are there?

A classic systematic literature review can take different approaches:

Writing a systematic literature review can feel like an overwhelming undertaking. After all, they can often take 6 to 18 months to complete. But, as with any documentation, we can break them down into the sections that should be included. Below we’ve prepared a step-by-step guide on how to write a systematic literature review.

1. Decide on your team

When carrying out a systematic literature review, you should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

You may also need to team up with a librarian to help with the search, literature screeners, a statistician to analyze the data, and the relevant subject experts.

2. Formulate your question

Define your answerable question. Then ask yourself, “has someone written a systematic literature review on my question already?” If so, yours may not be needed. A librarian can help you answer this.

You should formulate a ‘Well-Built Clinical Question’ – this is the process of generating a good search question. To do this, run through PICO:

Now you need a detailed strategy for how you’re going to search for and evaluate the studies relating to your question.

The protocol for your systematic literature review should include:

For a full guide on how to systematically develop your protocol, take a look at the PRISMA checklist . PRISMA has been designed primarily to improve the reporting of systematic literature reviews and meta-analyses.

4. Search for the literature

When writing a systematic literature review, your goal is to find all of the relevant studies relating to your question, so you need to search thoroughly .

This is where your librarian will come in handy again. They should be able to help you formulate a detailed search strategy, and point you to all of the best databases for your topic.

The places to consider in your search are electronic scientific databases (the most popular are PubMed, MEDLINE, and Embase), controlled clinical trial registers, non-English literature, raw data from published trials, references listed in primary sources, and unpublished sources known to experts in the field.

But don’t miss out on ‘grey literature’ sources – those sources outside of the usual academic publishing environment. They include non-peer-reviewed journals, pharmaceutical industry files, conference proceedings, pharmaceutical company websites, and internal reports. Grey literature sources are more likely to contain negative conclusions, so you’ll improve the reliability of your findings by including them.

You should document details such as:

This should be performed by your two reviewers, using the criteria documented in your research protocol. The screening is done in two phases:

Make sure reviewers keep a log of which studies they exclude, with reasons why.

6. Assess the quality of the studies

Your reviewers should evaluate the methodological quality of your chosen full-text articles. Make an assessment checklist that closely aligns with your research protocol, including a consistent scoring system, calculations of the quality of each study, and sensitivity analysis.

The kinds of questions you'll come up with are:

Every step of the data extraction must be documented for transparency and replicability. Create a data extraction form and set your reviewers to work extracting data from the qualified studies.

Here’s a free detailed template for recording data extraction, from Dalhousie University, Canada. It should be adapted to your specific question.

8. Analyze the results

Establish a standard measure of outcome which can be applied to each study on the basis of its effect size.

Measures of outcome for studies with:

Design a table and populate it with your data results. Draw this out into a forest plot , which provides a simple visual representation of variation between the studies. Then analyze the data for issues. These can include heterogeneity, which is when studies’ lines within the forest plot don’t overlap with any other studies.

Again, record any excluded studies here for reference.

9. Interpret and present the results

Consider different factors when interpreting your results. These include limitations, strength of evidence, biases, applicability, economic effects, and implications for future practice or research.

Apply appropriate grading of your evidence and consider the strength of your recommendations.

It’s best to formulate a detailed plan for how you’ll present your systematic review results – take a look at these guidelines from the Cochrane Institute.

Registering your systematic literature review

Before writing your systematic literature review, you can register it with OSF for additional guidance along the way.

Or, maybe you'd prefer to register your completed work with PROSPERO or TUScholarShare .

Frequently Asked Questions about writing a systematic literature review

Systematic literature reviews are often found in clinical or healthcare settings. Medical professionals read systematic literature reviews to stay up-to-date in their field and granting agencies sometimes need them to make sure there’s justification for further research in an area.

The first stage in carrying out a systematic literature review is to put together your team. You should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

Your systematic review should include the following details:

A literature review simply provides a summary of the literature available on a topic. A systematic review, on the other hand, is more than just a summary. It also includes an analysis and evaluation of existing research. Put simply, it's a study of studies.

The final stage of conducting a systematic literature review is interpreting and presenting the results. It’s best to formulate a detailed plan for how you’ll present your systematic review results, guidelines can be found for example from the Cochrane institute .

Have a language expert improve your writing

Run a free plagiarism check in 10 minutes, generate accurate citations for free.

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

Published on January 2, 2023 by Shona McCombes .

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:

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.

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, frequently asked questions, introduction.

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:

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.

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.

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

Download Word doc Download Google doc

Prevent plagiarism. Run a free check.

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.

Search for relevant sources

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

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:

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

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

Take notes and cite your sources

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

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

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

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.

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:

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:

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

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

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

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

Open Google Slides Download PowerPoint

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:

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 .

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

McCombes, S. (2023, January 02). How to Write a Literature Review | Guide, Examples, & Templates. Scribbr. Retrieved February 27, 2023, from https://www.scribbr.com/dissertation/literature-review/

Is this article helpful?

Shona McCombes

Other students also liked, what is a theoretical framework | guide to organizing, what is a research methodology | steps & tips, how to write a research proposal | examples & templates, what is your plagiarism score.

Please note that Internet Explorer version 8.x is not supported as of January 1, 2016. Please refer to this page for more information.

Systematic Literature Review

Possibilities of Systematic Literature Reviews (SLRs): SLRs are a means of aggregating knowledge about an SE topic or research question.

From: Advances in Computers , 2014

Related terms:

Smart cities, urban sensing, and big data: mining geo-location in social networks

D. Sacco , ... T.-y. Ma , in Big Data and Smart Service Systems , 2017

5.2.2 Source Selection

SLR has been performed on English-based web search engines and has only been taken into account in documents written in English (as only a small number of relevant documents are written in other languages):

IEEE Computer Society ( www.computer.org )

ISI Web of Knowledge ( apps.isiknowledge.com )

ACM Digital Library ( portal.acm.org )

Google Scholar ( scholar.google.com )

Science Direct ( www.sciencedirect.com )

SCOPUS Database ( info.scopus.com )

Documents have been selected using criteria stemming from the RQ. We have included only the following “study types”:

Case study: an exhaustive investigation of a single individual, group, incident, community, or enterprise.

Theory: a study of guidelines, an introduction to a particular subject or, finally, a theoretical analysis of the research issue.

Survey: a study with a statistical treatment of collected data.

Simulation: a study on simulation methods and related results.

Position paper: an opinion about a specific issue.

Instrument development: a new methodology or modeling language.

Literature review: collecting information about a particular topic through the analysis of the literature.

According to the above criteria, studies have been selected using the following steps:

The search string runs on selected sources. An initial set of studies is obtained by reading the title, abstract, and introduction. Studies that were unrelated to any aspect of the RQ are discarded.

Short papers, non-English papers, non-International Conference papers, and non-International Workshop papers are not considered.

We did not consider the publication of keywords as the same topic that may be referenced using different terms or acronyms. For each publication we have defined our own specific tags to classify the topics discussed. Our classification framework refers to publications on (1) location mining and (2) mobility mining. Publications dealing with mobility patterns are considered a subset as they are already location aware, as shown in Fig. 5.1 .

Figure 5.1 . Analysis framework definition.

Green Construction Project Financing: Policies, Practices, and Research Efforts

Hwang Bon-Gang , in Performance and Improvement of Green Construction Projects , 2018

7.2 Methods

A systematic literature review of green construction project financing was conducted. Beyond looking at the research findings obtained in academia, an assessment of the policies and practices implemented by the authorities and industry was undertaken. The literature reviewed in this chapter contains three sections, the policies and practices of green construction project financing implemented by representative developed economies, the efforts and initiatives launched by selected international organizations, and research outcomes presented in peer-reviewed journals and books.

Compared to undeveloped economies, developed economies are more active in green construction. This is because developed economies normally have better economic conditions to address sustainable built environment development ( Olubunmi et al., 2016 ). Therefore, four representative developed economies were selected for review of their policies and practices adopted for green construction. These four developed economies are the United States (US), the United Kingdom (UK), Singapore, and Australia, all of which are active players in promoting green construction globally ( Zuo and Zhao, 2014 ). In addition to developed economies, some international organizations are keen on promoting green construction as well ( Haapio and Viitaniemi, 2008 ). They have launched various guidelines and initiatives to finance the development of a sustainable built environment over the past two decades ( Olubunmi et al., 2016 ). Therefore, this chapter also selected three notable and typical international organizations, namely, the United Nations, The Organization for Economic Co-operation and Development (OECD), and International Finance Corporation, to review their efforts and initiatives in green construction.

The research findings published in peer-reviewed journals and books from 2008 to 2017 has been reviewed to understand the research on green construction project financing. Web of Science is a powerful, widely-recognized academic search engine used by researchers worldwide to track the latest research progress in various areas ( Zhao, 2017 ; He et al., 2017 ; Le et al., 2014 ). Thus, Web of Science was selected to track down those published journal articles relating to sustainable construction project financing. Four concise codes, including “TITLE: (green) AND TITLE: (finance),” “TITLE: (green) AND TITLE: (financial),” “TITLE: (sustainable) AND TITLE: (finance),” and “TITLE: (sustainable) AND TITLE: (financial),” were searched in Web of Science within the collections of Science Citation Index Expanded, Social Sciences Citation Index, and Emerging Sources Citation Index. Initially, a total of 148 papers were identified from the search. Then a careful visual examination was made to check the relevance of the identified papers. The visual examination results showed that the majority of the identified papers were irrelevant to the area of green construction and only 11 identified papers examined green construction project financing specifically. Thus, these 11 papers were selected for further review. Table 7.1 presents the details of these papers. In addition to peer-reviewed journals, an increasing number of books that discuss green construction have been published over the past decade ( Finnegan, 2017 ). This makes books also an important source of literature for this chapter. Hence, an exhaustive search was conducted in Google Books to try to identify books related to green construction project financing. Finally, seven books that investigate green construction project financing were identified. The details of these seven books are summarized in Table 7.2 .

Table 7.1 . Journal Articles Identified From Literature Search

Table 7.2 . Books Identified from Literature Search

The following sections review the green construction project financing practices implemented by selected developed economies, the green construction project financing initiatives launched by selected international organizations, and the research outcomes relating to green construction project financing published in peer-reviewed journals and books.

Advances in Using Agile and Lean Processes for Software Development

Pilar Rodríguez Mika Mäntylä Markku Oivo Lucy Ellen Lwakatare Pertti Seppänen Pasi Kuvaja , in Advances in Computers , 2019

8.1 Metrics in Agile and Lean Software Development

Our SLR about the use of software metrics in Agile software development [68] revealed both similarities and differences between Agile and traditional software development. The top goals of both development approaches are similar, that is, to improve productivity and quality. The majority of the metrics are in one way or the other tied to those goals. However, we found value-based differences in means how those goals are to be reached. Traditional software development utilizes software metrics from the viewpoint of scientific management by Taylor, i.e., controlling software development from outside. The traditional measurement programs use ideas stemming from industrial product lines and manufacturing industry such as Six Sigma. Traditional metrics programs were often large-scale corporate initiatives, which emphasized following a pregiven plan. Agile principles, such as empowering the team, focusing on rapid customer value, simplicity, and willingness to embrace changes, form a contrast to the traditional measurement programs.

Fig. 16 shows the top six metrics used in Agile software development. We selected the top metrics based on the number of occurrences and the perceived importance of each metric in the sources (for more details, see Ref. [68] ).

Fig. 16 . Top six metrics used in Agile software development.

Velocity was found as the most important software metric in Agile development. Velocity indicates how fast is the team working or how much a team can achieve in a certain time-boxed period, e.g., in a sprint of 4 weeks. Velocity is used in sprint planning. Velocity is also used to determine different scopes for the sprint such as having a minimum scope of features that can be delivered for sure and having a stretch goal for the iteration. Having two different scopes can help in customer communication as the minimum can be promised and the maximum indicates all the changes that may happen during a sprint. Velocity enables finding bottlenecks in a software process where progress is slower than desired. Making process improvement or automation to these parts results in an excellent cost benefit ratio for the improvement. However, our study also found cases where attempts to maintain velocity led to cutting corners and lowered the product quality.

Effort estimate , which indicates the anticipated work cost of a particular feature or story, was found as the second most important metric. Effort estimates are important in feature prioritizations as all features with equal value can be sorted by the effort estimates to provide a sprint scope with the highest possible value. However, No Estimates movement started by Ron Jefferies, approximately says that making effort estimates can be counterproductive as the accuracy of the estimates is too poor to make the effort spent in estimation worthwhile. Nevertheless, effort estimates were often used and found important in the sources of our literature review.

Customer satisfaction was found as the third ranked metric, although it could be claimed that it should be the most important due to the customer centric nature of Agile software development. Yet, it was less frequently mentioned in our sources than Velocity or Effort estimate. Customer satisfaction is a metric with many possible operationalizations. We found several measures of customer satisfaction such as the number of change requests by the customer, net promoter score (the probability that a customer would recommend the product or producer to another potential customers), Kano analysis (quality model that distinguishes between must-be, one-dimensional, attractive, indifference, and negative quality), and postrelease defects found by the customers. We found that most successful projects measured customer satisfaction more often than other projects.

We find that the core books giving advice on Agile software development are missing some core software engineering metrics such as the defect count . In our review of industrial empirical studies, it was ranked in the fourth place indicating its importance in Agile software development. Defect count can have many uses. It may be a measure of software testing as the number of defects found per time unit in testing measures in-house software quality. Furthermore, the defects experienced in customer usage can be a measure of the software quality in the wild.

Technical debt , which is covered in more detail next, was among the top metrics used by Agile teams. Technical debt hinderers day-to-day software development and reduces velocity. In one company, a technical debt board was used to make technical debt visible in order to ensure that enough resources and motivation were given to removing the debt. The board was also used to make plans how to remove technical debt. The board made sure that developers picked the highest priority technical debt items instead of cherry picking lower priority but more interesting tasks.

Build status is an important measure in Agile software development. It is an indication of the agile principle working code. If builds are not passing, this indicates that no progress according to Agile principles has been made. Build status often encompasses quality gates in addition to the simple assertion that the software has been successfully built. It can include the results of automated unit testing. Frequently, successful build requires that certain end-to-end automated acceptance test is passed. When working on software with very high reliability requirements, even violations from static code analysis tools, such as Findbugs or Coverity, may be treated as build breakers.

We also studied the purposes of using metrics in Agile software development, which are depicted in Fig. 17 .

Fig. 17 . Reasons for using metrics in Agile teams.

We found that over 70% sources used metrics for planning and progress tracking of sprints or projects. Understanding and improving quality were found as a reason for using metrics in roughly one-third of the studies. Fixing process problems inspired roughly half of the studies in using metrics. Finally, motivating people was found as the reason for using metrics in 25% of the studies, for example displaying a technical debt board can motivate people to reduce technical debt. The percentage does not add up to 100% because many studies had multiple motivations in using metrics.

Advances in Computers

Adam Trendowicz , Sylwia Kopczyńska , in Advances in Computers , 2014

3.1.1 Review Process

We designed a systematic literature review (SLR) based on the guidelines described in [46,11,17] . The SLR involved the following steps (presented in Fig. 2 ):

Figure 2 . Design of SLR process. It contains the numbers of the primary studies analyzed, in each step divided into groups depending on the source of retrieval, i.e., AS—items retrieved in automatic search, SR—items retrieved while scanning reference for relevant publications, MCDA—items retrieved while scanning reference for publications containing a description of the most popular MCDA methods.

Identification of the need for the review: Having defined the research goal and questions, we decided that the best possible method for finding the answers was to conduct an SLR.

Research protocol formulation: We identified the relevant information sources, using also recommendations from external experts in corresponding knowledge fields, then formulated search queries and defined the study selection criteria and procedures. We prepared the quality assessment checklists, data extraction forms, and procedures. The initial data analysis approach was specified.

Automatic Search: One of the reviewers searched for the primary studies using the selected search engines with the defined searched queries.

Primary Study Selection: One of the reviewers initially reviewed the title, abstract, and keywords of the primary studies, and, based on the defined inclusion criteria, decided where each primary study was relevant. In case of doubts, the other reviewer was consulted. If both reviewers were uncertain, the item was included.

Primary Study Quality Assessment: The next step was about assessing the quality of the primary studies to ensure that only high-quality items were analyzed further.

Data Extraction: The data from the primary studies with acceptable quality was extracted by both reviewers (each researcher reviewed 50% of the primary studies).

Manual Search: According to the guidelines by Jørgensen and Shepperd [43] , the reviewers looked for potentially relevant publications in the references of the primary studies while extracting the data. Moreover, the reviewers were to identify the references to publications about MCDA methods mentioned in the papers, e.g., if a primary study was about using TOPSIS for SQA, a reviewer was to look for a reference to the paper describing TOPSIS.

Synthesis of Data: We analyzed the extracted data and drew conclusions.

Reporting Results: We documented the results.

Introduction

Cong Lu , ... Yoke San Wong , in Collaborative Product Assembly Design and Assembly Planning , 2011

1.4 Organization of the book

Chapter 2 is a systematic literature review of the previous works on assembly design and assembly planning, and the contributions of this book are clarified based on the review.

Chapter 3 discusses the design modification issues in collaborative assembly design to realize effective collaborative assembly design. An assembly representation model is presented and a new definition of the assembly feature is given to resolve the collaborative assembly design issues. In order to realize the design modification, a design modification propagation control mechanism is presented, and a system framework that is suitable for realizing the design modification is also presented and developed.

Chapter 4 presents an approach to evaluate the product assembability in different assembly sequences considering the influence of tolerance and assembly clearance. This approach will be used to assist the downstream assembly planning system to find optimal assembly sequences with good assemblability, and can also help the designer to identify design problems.

Chapter 5 presents an advanced assembly planning approach using a multi-objective genetic algorithm. The influence of tolerance and clearance on product assemblability in different assembly sequences is considered and used as a constraint in assembly planning. For more comprehensive search for feasible non-dominated solutions, this chapter presents a multi-objective genetic algorithm which establishes different fitness functions through a fuzzy weight distribution algorithm. It also considers the experience of the decision maker.

Chapter 6 discusses the potential design problems which can be identified through the evaluation of the assembly planning results, and further discusses redesign guidelines to help the designer make an appropriate design modification or to redesign considering the detailed assembly process in the design stage.

Chapter 7 presents a collaborative assembly planning approach based on the GA-based assembly planning approach proposed in Chapter 5 . The system framework and working mechanism are discussed and developed, and the detailed collaborative assembly planning procedure is illustrated.

Chapter 8 concludes by summarizing the main contributions of the research, and suggesting proposals for future research.

Biomass and Biofuel Production

Hangyong Lu , Ali El Hanandeh , in Comprehensive Renewable Energy (Second Edition) , 2022

This article presents a quantitative systematic literature review and a meta-analysis of the latest life cycle assessment studies in the energy from biomass with emphasis on the biomass production phase. Global warming potential, acidification and eutrophication are identified as major impactors of the biomass production. Use of wood and forestry residues, short rotation forestry species, such as poplar and willow, are the most promising sources of woody biomass to reduce the environmental impacts. The article also recommends methods to further reduce the environmental impacts of energy from biomass and identifies gaps in knowledge for future research.

The screening phase in systematic reviews: Can we speed up the process?

Igor Rožanc , Marjan Mernik , in Advances in Computers , 2021

1.3 Research method

The proper management of an SLR or SMS must follow a rigorous protocol, thus a detailed insight into various aspects of both types of research are given first. Next, the problem of the most time-consuming parts of SR process is explored to find out possible points where time could be saved. Focusing on the step of the article's screening, a solution for the automation of this step is proposed. The solution is configurable and it is based on the principle of the statistical analysis of the article's contents. The automated screening approach is implemented by a tool. To demonstrate its value, an experiment is performed, too. The actual context of the experiment (i.e., the SMS on examining the different processes while developing DS(M)L) is explained first. The experiment compares the results of the manual vs automated screening execution. Several variants of tool's improvement strategies are explored in the experiment discussing four issues: the necessary size of the pilot set to be manually screened, the improvement strategy, the number and type of keywords, and the structure of decision rules. The presentation of results is accompanied by a short discussion. Finally, the related work is presented to compare our approach with similar solutions.

Helping structural designers to use recycled aggregate concrete

Rui Vasco Silva , Jorge de Brito , in New Trends in Eco-efficient and Recycled Concrete , 2019

19.6 Conclusions

This study is a result of an extensive systematic literature review on the use of RAs in the production of structural concrete where there is a vast amount of experimental studies. Still, in spite of the proven technical feasibility, there are several obstacles for their use in structural applications. One of those barriers is the vague concept handed down by some specifications on the use of RA, which do not contain specific provisions for the expected physical and structural performance of RAC. Therefore, by combining the results of a vast number of studies, it was possible to carry out a statistically significant meta-analysis capable of leading to strongly supported evidence-based decisions, thereby increasing the viability of the proposed methods.

The classification of RA, based on their physical properties, rather than on their composition alone, apart from being the most practical approach for their proper categorisation, has also shown to be strongly correlated with the performance of their resulting concrete products. The formulae resulting from the authors’ previous studies have shown that this method can be used to successfully predict the behaviour of RAC and, by adapting it to existing codes for structural concrete, it will be easier in the future to use it in a safer and more comprehensive manner. Indeed, the implementation of the proposed method, apart from being very conservative, also demonstrates its flexibility for a wide range of applications when compared with existing specifications, which are severely restrictive.

Although the proposed method is highly adaptable to several conditions as demonstrated in the authors’ previous studies, experience has shown that professionals in the construction industry prefer a familiar and simple approach. In the two scenarios considered in this study, wherein different environmental conditions were evaluated, RAC were considered to have the same strength class as that of a conventional NAC. From practical design viewpoint, this would only mean a slight adjustment to the mix design and in the structural element’s geometry to reduce long-term deformations. Furthermore, even though a slight increase in the concrete element’s height would be needed, which would mean additional costs and environmental impacts, in some cases, a lower amount of steel reinforcements would be required. For this reason, further research is warranted on this matter consisting of a life cycle assessment considering the aforementioned aspects.

In spite of the proposed method’s ability to allow the design of a structural RAC element with the same load bearing capacity, deformation and service life as those of a conventional concrete, this is only possible within the parameters mentioned throughout the study. Extrapolating the results and formulae for scenarios with cement types other than CEM I or the use of RAs as a sand substitute, for example, may lead to erroneous findings, which must be further backed up by evidence. For this reason, it is important to proceed with further experimental investigation, minding the gaps in the literature, in order to adapt and create provisions in existing structural codes.

Introducing Ubiquity in Noninvasive Measurement Systems for Agile Processes

Luigi Benedicenti , in Adaptive Mobile Computing , 2017

1.2.4 Ubiquity

Ubiquity is a complex topic, which at times seems to defy analysis. In fact, a comprehensive systematic literature review of 128 papers identified 132 different approaches to the development of ubiquitous systems [14] . The general principle, however, is simple: to guarantee the availability of a system or service regardless of the location of the entity that attempts to access such system and service.

In our case, ubiquity is a secondary requirement. We wish to complement our noninvasive measurement system with information on the person or persons responsible for the software artifacts we measure. This requires to match the workstation from which a certain artifact was created, worked on, and uploaded; and the people present at that workstation when the activities mentioned above were carried out.

The use of a ubiquitous system, however, offers additional advantages that may further improve the usefulness of the measurement system in identifying the model's parameters. The most important such advantage comes by employing a device like a mobile smartphone, which a developer often carries during the entire workday, and that can thus be considered a reasonable approximation of the location of that developer.

Adopting a smartphone as a ubiquitous device is not new. In fact, it has been envisioned since software engineers have been alerted to the challenges of developing a ubiquitous system [15] . Furthermore, the definition of a ubiquitous system is well known and adopted. The novelty of our approach is in the role that the ubiquitous system plays, i.e., a subsystem of the measurement system that allows us to increase the accuracy of the measures collected in order to refine the identification of the parameters of the Bayesian model we use for early prediction of the time and effort required for a new project.

The Importance of Magnesium in the Human Body

Sidsel-Marie Glasdam , ... Günther H. Peters , in Advances in Clinical Chemistry , 2016

4 Discussion

In this section, pathophysiologic states related to alterations in magnesium homeostasis and difficulties in measurement will be addressed. There will be concluded with an assessment of this systematic literature review .

Intracellular magnesium ranges from 5 to 20 mmol/L; 1–5% is ionized and the remainder bound to protein and negatively charged molecules such as ATP [64] . Normally, extracellular magnesium ranges from 0.70 to 1.10 mmol/L [24,26] . Serum magnesium can be categorized as free/ionized, bound to protein, or complexed with anions such as phosphate, bicarbonate, and citrate, or sulfate. Ionized magnesium has the greatest biologic activity, and it is that form that is involved in many essential biochemical processes. Total serum magnesium is not the best indicator of magnesium status as changes in serum protein may affect the ionized fraction without necessarily affecting total magnesium. This issue likely contributes to our poor understanding between total magnesium and actual body status.

This systematic literature review reports that the average need for magnesium in humans depends on several factors including gender, age, body habitus, and individual variation in the intestinal and renal reabsorption, and excretion. These factors need consideration when attempting to magnesium status with disease states and treatment thereof. As such, the “normal” magnesium concentration should be individually assessed versus a generalized reference interval. Clearly, this approach is challenging and requires strategies to estimate the “normal” magnesium concentration and may be complicated by extraneous factors.

Magnesium status may be influenced by various drugs such as digoxin, gentamicin, and loop diuretics [65] . Cancer cells contain increased magnesium concentration to stimulate cell proliferation, tumor growth, and potential regulation of cancer-associated enzymes [66] . Magnesium has been correlated to neurologic disease including epilepsy, depression, anxiety, Alzheimer’s, and Parkinson’s. Magnesium plays an important role for NMDA receptors essential for excitatory synaptic transmission, neuronal plasticity, and excitotoxicity [66] . At normal membrane potential (− 70 mV), magnesium ions block the ability of NMDA receptors to bind glutamate. At increased membrane potential, magnesium is displaced thus triggering glutamate binding. Growth retardation is associated with alterations in bone magnesium concentration. Influence on the bone metabolism can be explained by the continuous exchange of magnesium between the bone and blood compartments. In bone, magnesium binds to the surface of hydroxyapatite increasing the solubility of phosphorus and calcium. Magnesium deficiency may result in decreased bone formation via osteoclast proliferation [66] .

Methods for measurement of magnesium and its form (ionized vs. total) have improved. For example, Altura and Altura [67] reported normal total magnesium and ionized magnesium concentration ranges of 0.70–1.05 and 0.53–0.67 mmol/L, respectively. Similarly, Jahnen-Dechent and Ketteler [64] reported a normal total magnesium serum concentration of 0.65–1.05 mmol/L of which 55–70% (0.55–0.75 mmol/L) was determined free by ultrafiltration. Since free ionized magnesium is biologically active, small changes in concentration may have considerable impact physiologically [67] .

Accurate determination of ionized magnesium by ISE is dependent on using an ionophore specific for magnesium [68] . This limitation as well as differences inherent to various analytical platforms [12] likely contributes to the variance in measured ionized magnesium ( Table 1 ) [69–76] .

Finally, the methods of this literature review can be discussed. The literature search was dependent on the selected search words. It cannot be excluded that use of alternative search words would have led to additional relevant studies. Another possible limitation is the choice of databases. Two databases (SciFinder® and PubMed®) were used due to their relevance in chemistry and biomedicine, respectively. Language was a constraint. Studies in other languages, i.e., Chinese, were excluded. The time span of 10 years eliminated other potentially relevant analytical techniques such as ion chromatography [77] and ion-exchange chromatography [78] . Stripping voltammetry, an effective means for lead determination, was excluded since no applications were found for magnesium during this time span [79–82] . It should be mentioned that stripping voltammetry was performed on magnesium-chelated complexes [83,84] . Unfortunately, these studies were performed in nonblood specimens. Although a wider time span might have proven useful to cover more analysis methods in this systematic review, no rules for choice of time spans are found, as other reviews with both shorter or wider time spans have been published in the field of chemistry too [85–88] .

The review process was guided by an established study protocol (matrix). Although a standardized approach might have been useful to assess publication quality, it may not be applicable for chemical analytical studies in medical fields [89,90] .

Systematic reviews

What is a systematic review.

A systematic review is a complex piece of research that aims to identify, select and synthesise all research published on a particular question or topic.

Systematic reviews adhere to a strict scientific design based on pre-specified and reproducible methods. They provide reliable estimates about the effects of interventions.

As well as illustrating knowledge about a particular intervention, systematic reviews can also show where knowledge is lacking. You can use this to guide future research.

Usually, a systematic review will include a search methodology, in which you document where, when and how you looked for information, as well as who you consulted.

To find out more about the process of a systematic review, you may find Oxford University’s in-depth Systematic Reviews guide useful.

If you want to see examples of successful systematic reviews, you can search for them in various places such as on Cochrane library . Our search information on clinical trials and systematic reviews provides more information.

Research Process

Systematic Literature Review or Literature Review?

3 minute read

Table of Contents

As a researcher, you may be required to conduct a literature review. But what kind of review do you need to complete? Is it a systematic literature review or a standard literature review? In this article, we’ll outline the purpose of a systematic literature review, the difference between literature review and systematic review, and other important aspects of systematic literature reviews.

What is a Systematic Literature Review?

The purpose of systematic literature reviews is simple. Essentially, it is to provide a high-level of a particular research question. This question, in and of itself, is highly focused to match the review of the literature related to the topic at hand. For example, a focused question related to medical or clinical outcomes.

The components of a systematic literature review are quite different from the standard literature review research theses that most of us are used to (more on this below). And because of the specificity of the research question, typically a systematic literature review involves more than one primary author. There’s more work related to a systematic literature review, so it makes sense to divide the work among two or three (or even more) researchers.

Your systematic literature review will follow very clear and defined protocols that are decided on prior to any review. This involves extensive planning, and a deliberately designed search strategy that is in tune with the specific research question. Every aspect of a systematic literature review, including the research protocols, which databases are used, and dates of each search, must be transparent so that other researchers can be assured that the systematic literature review is comprehensive and focused.

Most systematic literature reviews originated in the world of medicine science. Now, they also include any evidence-based research questions. In addition to the focus and transparency of these types of reviews, additional aspects of a quality systematic literature review includes:

Systematic Review vs Literature Review

The difference between literature review and systematic review comes back to the initial research question. Whereas the systematic review is very specific and focused, the standard literature review is much more general. The components of a literature review, for example, are similar to any other research paper. That is, it includes an introduction, description of the methods used, a discussion and conclusion, as well as a reference list or bibliography.

A systematic review, however, includes entirely different components that reflect the specificity of its research question, and the requirement for transparency and inclusion. For instance, the systematic review will include:

As you can see, contrary to the general overview or summary of a topic, the systematic literature review includes much more detail and work to compile than a standard literature review. Indeed, it can take years to conduct and write a systematic literature review. But the information that practitioners and other researchers can glean from a systematic literature review is, by its very nature, exceptionally valuable.

This is not to diminish the value of the standard literature review. The importance of literature reviews in research writing is discussed in this article . It’s just that the two types of research reviews answer different questions, and, therefore, have different purposes and roles in the world of research and evidence-based writing.

Systematic Literature Review vs Meta Analysis

It would be understandable to think that a systematic literature review is similar to a meta analysis. But, whereas a systematic review can include several research studies to answer a specific question, typically a meta analysis includes a comparison of different studies to suss out any inconsistencies or discrepancies. For more about this topic, check out Systematic Review VS Meta-Analysis article.

Language Editing Plus

With Elsevier’s Language Editing Plus services , you can relax with our complete language review of your systematic literature review or literature review, or any other type of manuscript or scientific presentation. Our editors are PhD or PhD candidates, who are native-English speakers. Language Editing Plus includes checking the logic and flow of your manuscript, reference checks, formatting in accordance to your chosen journal and even a custom cover letter. Our most comprehensive editing package, Language Editing Plus also includes any English-editing needs for up to 180 days.

Publication Recognition

How to Make a PowerPoint Presentation of Your Research Paper

Manuscript Preparation

Research Paper Conclusion: Know How To Write It

Choosing the Right Research Methodology: A Guide for Researchers

Navigating the Reproducibility Crisis: A Guide to Analytical Method Validation

Why is data validation important in research?

Writing a good review article

Scholarly Sources: What are They and Where can You Find Them?

Research Designs: Types and Differences

The Top 5 Qualities of Every Good Researcher

What do reviewers look for in a grant proposal?

Input your search keywords and press Enter.

Results of meta-analyses on behavioral and neuropsychiatric total scores between the behavioral variant of Alzheimer disease (bvAD) and typical Alzheimer disease (tAD) (A) and bvAD and the behavioral variant of frontotemporal dementia (bvFTD) (B). Mean weighted percentages of participants per diagnostic group fulfilling specific bvFTD core clinical features proposed by Rascovsky et al 14 (C) or presence of specific neuropsychiatric symptoms measured using the Neuropsychiatric Inventory (NPI) (D). DCQ indicates Dépistage Cognitif de Québec; FAB, Frontal Assessment Battery; PBAC, Philadelphia Brief Assessment of Cognition; SMD, standardized mean difference.

a P < .05.

Results of meta-analyses on Mini-Mental State Examination (MMSE; A and B), episodic memory (C and D), and executive function (E and F) for the contrast of behavioral variant of Alzheimer disease (bvAD) vs typical Alzheimer disease (tAD) and the behavioral variation of frontotemporal dementia (bvFTD). SMD indicates standardized mean difference.

A and B, Two cases that serve as examples of 2 distinct bvAD neuroimaging phenotypes: an Alzheimer disease–like atrophy and tau load pattern with relative frontal sparing and a more behavioral variant of frontotemporal dementia (bvFTD)–like atrophy and tau load pattern with both posterior and anterior involvement. The tau positron emission tomography (PET) scans were performed using [ 18 F]flortaucipir, and magnetic resonance imaging (MRI) was conducted on a 3-T scanner. C-F, Proposed neuroimaging phenotypes as part of a spectrum that ranges from a typical Alzheimer disease regional distribution to a classical bvFTD regional distribution. The brain template images were obtained from https://smart.servier.com/ . G, Literature-informed estimated distribution of the regional distribution in bvAD, indicating that typical AD and bvAD-AD–like patterns are more common than bvAD-bvFTD–like and typical bvFTD. FDG indicates fluorodeoxyglucose; SPECT, single-photon emission computed tomography; SUVR, standardized uptake value ratio.

eTable 1. Full database queries

eTable 2. Selection of frontal regions in autopsy studies

eTable 3. Risk of bias assessment

eTable 4. Characteristics of included studies

eTable 5. Percentage of bvFTD features and NPI items in bvAD, bvFTD and tAD

eTable 6. Functional connectivity and white matter hyperintensities in bvAD

eFigure 1. Funnel plots for behavioral/neuropsychiatric data in meta-analysis

eFigure 2. Funnel plots for cognitive data in meta-analysis

eFigure 3. Funnel plots for neuropathological data in meta-analysis

eFigure 4. Risk of bias assessment summary

eFigure 5. Flow chart of study inclusion

eFigure 6. Results of meta-analysis for behavioral and neuropsychiatric separately

eFigure 7. Meta-analyses for neuropathological data in bvAD vs typical AD

eFigure 8. Differences and overlap between bvAD and dysexecutive AD

eReferences. Reference list Supplement

See More About

Select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

Others Also Liked

Ossenkoppele R, Singleton EH, Groot C, et al. Research Criteria for the Behavioral Variant of Alzheimer Disease : A Systematic Review and Meta-analysis . JAMA Neurol. 2022;79(1):48–60. doi:10.1001/jamaneurol.2021.4417

Download citation file:

Permissions

Research Criteria for the Behavioral Variant of Alzheimer Disease : A Systematic Review and Meta-analysis

Question How is the behavioral variant of Alzheimer disease (bvAD) associated with typical AD (tAD) and behavioral variant frontotemporal dementia (bvFTD) in terms of clinical presentation and neuroimaging signatures?

Findings This systematic review and meta-analysis found that, at time of diagnosis, bvAD showed more severe neuropsychiatric symptoms and other behavioral deficits compared with tAD. Two distinct neuroimaging phenotypes were observed across reported bvAD cases: an AD-like pattern with relative frontal sparing and a relatively more bvFTD-like pattern with both posterior and anterior involvement, with the AD-like bvAD neuroimaging phenotype being the most prevalent.

Meaning This analysis found that bvAD is clinically most reminiscent of bvFTD, while it shares most pathophysiological features with tAD; the research criteria are aimed at improving the consistency and reliability of future research and potentially aiding in the clinical assessment of bvAD.

Importance The behavioral variant of Alzheimer disease (bvAD) is characterized by early and predominant behavioral deficits caused by AD pathology. This AD phenotype is insufficiently understood and lacks standardized clinical criteria, limiting reliability and reproducibility of diagnosis and scientific reporting.

Objective To perform a systematic review and meta-analysis of the bvAD literature and use the outcomes to propose research criteria for this syndrome.

Data Sources A systematic literature search in PubMed/MEDLINE and Web of Science databases (from inception through April 7, 2021) was performed in duplicate.

Study Selection Studies reporting on behavioral, neuropsychological, or neuroimaging features in bvAD and, when available, providing comparisons with typical amnestic-predominant AD (tAD) or behavioral variant frontotemporal dementia (bvFTD).

Data Extraction and Synthesis This analysis involved random-effects meta-analyses on group-level study results of clinical data and systematic review of the neuroimaging literature. The study was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Main Outcomes and Measures Behavioral symptoms (neuropsychiatric symptoms and bvFTD core clinical criteria), cognitive function (global cognition, episodic memory, and executive functioning), and neuroimaging features (structural magnetic resonance imaging, [ 18 F]fluorodeoxyglucose-positron emission tomography, perfusion single-photon emission computed tomography, amyloid positron emission tomography, and tau positron emission tomography).

Results The search led to the assessment of 83 studies, including 13 suitable for meta-analysis. Data were collected for 591 patients with bvAD. There was moderate to substantial heterogeneity and moderate risk of bias across studies. Cases with bvAD showed more severe behavioral symptoms than tAD (standardized mean difference [SMD], 1.16 [95% CI, 0.74-1.59]; P < .001) and a trend toward less severe behavioral symptoms compared with bvFTD (SMD, −0.22 [95% CI, −0.47 to 0.04]; P = .10). Meta-analyses of cognitive data indicated worse executive performance in bvAD vs tAD (SMD, −1.03 [95% CI, −1.74 to −0.32]; P = .008) but not compared with bvFTD (SMD, −0.61 [95% CI, −1.75 to 0.53]; P = .29). Cases with bvAD showed a nonsignificant difference of worse memory performance compared with bvFTD (SMD, −1.31 [95% CI, −2.75 to 0.14]; P = .08) but did not differ from tAD (SMD, 0.43 [95% CI, −0.46 to 1.33]; P = .34). The neuroimaging literature revealed 2 distinct bvAD neuroimaging phenotypes: an AD-like pattern with relative frontal sparing and a relatively more bvFTD-like pattern characterized by additional anterior involvement, with the AD-like pattern being more prevalent.

Conclusions and Relevance These data indicate that bvAD is clinically most similar to bvFTD, while it shares most pathophysiological features with tAD. Based on these insights, we propose research criteria for bvAD aimed at improving the consistency and reliability of future research and aiding the clinical assessment of this AD phenotype.

Alzheimer disease (AD) is a heterogenous disease that can manifest with both amnestic and nonamnestic clinical presentations. 1 Several atypical (ie, non–memory predominant) variants of AD have been described, including posterior cortical atrophy, logopenic variant primary progressive aphasia, corticobasal syndrome due to AD, and dysexecutive AD. 2 The behavioral variant of Alzheimer disease (bvAD) represents another, rare variant of AD that is characterized by early and predominant behavioral deficits and personality changes caused by AD pathology. The bvAD clinical syndrome overlaps substantially with that of the behavioral variant of frontotemporal dementia (bvFTD) and approximately 10% to 40% of clinically diagnosed bvFTD cases have positive AD biomarkers and/or neuropathologically confirmed AD. 3 - 6 This highlights a major diagnostic challenge, which is even more pertinent with the recent accelerated approval of aducanumab by the US Food and Drug Administration to reduce cerebral amyloid-β in early symptomatic AD. 7 Although bvAD is acknowledged as a clinical entity in recent diagnostic and research criteria for AD dementia, 8 , 9 currently no criteria exist that provide specific recommendations for the diagnosis of bvAD. This is in contrast with other AD variants 10 - 12 and limits reliable and reproducible classification of bvAD as well as uniform scientific reporting.

The current literature on bvAD includes relatively few studies with typically small sample sizes that have reported several inconsistent findings. To better understand the bvAD phenotype, we performed a systematic review and meta-analysis of the clinical, neuroimaging, and neuropathology bvAD literature and applied the outcomes to develop research criteria for bvAD. With this work, we aim to improve the consistency and reliability of future research and potentially aid in the clinical assessment of bvAD.

This study was conducted following prespecified methods (PROSPERO registration number: CRD42021243497 ) and reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses ( PRISMA ) reporting guidelines. We performed a systematic literature search in PubMed/MEDLINE and Web of Science databases. We searched studies including clinically diagnosed (1) AD cases with so-called frontal or behavioral presentations or (2) bvFTD cases with neuropathological evidence of AD (full database queries are in eTable 1 in the Supplement ). We included peer-reviewed articles, written in English, and presenting original research with human data only. Screening was first conducted at the title or abstract level in Rayyan. 13 Reference lists were additionally cross-checked for eligible studies. Two independent reviewers (R.O. and E.H.S.) screened titles and abstracts. Ambiguous records were discussed with a third author (Y.A.L.P.) to reach consensus. Studies were eligible when (1) they included cases or groups of patients presenting with early and predominant behavioral changes with a clinical diagnosis, biomarker support, and/or neuropathological evidence of AD and (2) behavioral/neuropsychiatric, neuropsychological, neuroimaging, and/or neuropathological data were presented. Studies were excluded when (1) they described patients with isolated executive dysfunction in the absence of behavioral symptoms and (2) there was biomarker and/or neuropathological evidence for a non-AD pathology as the primary pathology. Studies were only eligible for the meta-analysis if a bvAD group was compared with typical AD (tAD) and/or bvFTD groups. We extracted demographic (age and sex), clinical (behavioral features per bvFTD criteria 14 or neuropsychiatric symptoms per Neuropsychiatric Inventory [NPI 15 ]), neuropsychological (Mini-Mental State Examination [MMSE] and memory and executive function tests), neuroimaging (structural magnetic resonance imaging [MRI], [ 18 F]fluorodeoxyglucose [FDG]–positron emission tomography [PET], perfusion single-photon emission computed tomography, amyloid-PET, and tau-PET), and neuropathological (amyloid-β and tau) characteristics from all studies. After eligibility assessment for inclusion, meta-analyses were constructed using pooled clinical data (behavioral or neuropsychiatric questionnaires), neuropsychological data (MMSE and memory and executive functioning tests), and neuropathological data (amyloid-β and tau load in medial temporal lobe, occipital cortex, and frontal regions; eTable 2 in the Supplement ). The lack of uniform reporting of effect sizes among neuroimaging methods across studies did not allow a meta-analysis; hence these findings were analyzed using systematic review ( Table ).

Meta-analysis was used to examine whether bvAD differed from tAD and bvFTD in terms of behavioral/neuropsychiatric and neuropsychological features and bvAD differed from tAD in the distribution of amyloid-β and tau pathology defined at autopsy. Missing data were requested from the authors of 3 studies (and all 3 responded). 18 , 27 , 28 We calculated the pooled standardized mean differences and 95% CIs using Hedges g random-effects models in the “meta” package of R version 4.0.2 (R Foundation for Statistical Computing), with a significance level of P < .05. We used random effects because we assumed that the true effect size would be study dependent because of high heterogeneity in samples, methods, and outcomes among studies.

Statistical heterogeneity for the meta-analyses was assessed using the I 2 statistic, with I 2 greater than 75% indicating substantial heterogeneity. Heterogeneity across studies was substantial for analyses including behavioral and neuropsychiatric symptoms, memory and executive measures ( I 2 range, 70%-96%), and moderate for analyses including neuropathological data ( I 2 range, 0%-51%). Publication bias was assessed by visual inspection of funnel plots, which indicated substantial publication bias (eFigures 1-3 in the Supplement ). Two authors (E.H.S. and C.G.) independently assessed risk of bias using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) risk of bias tool for nonrandomized studies. The overall risk of bias was serious for 2 studies and moderate for 11 studies in the meta-analysis (eTable 3 and eFigure 4 in the Supplement ).

We additionally calculated the prevalence of each behavioral feature in the core clinical bvFTD criteria 14 (ie, presence of disinhibition, apathy, lack of empathy, compulsiveness, and hyperorality) and the 12 items of the neuropsychiatric inventory (NPI and prevalence score ≥1) across studies and compared bvAD, bvFTD, and tAD groups using χ 2 tests. For the NPI analysis only, we examined 769 amyloid-β–positive patients with tAD from the Amsterdam Dementia Cohort. 30

The systematic literature search yielded 1257 records, of which 116 studies were assessed at full-text level for eligibility and 83 studies 5 , 16 - 24 , 26 - 28 , 31 - 97 met inclusion criteria (eFigure 5 in the Supplement for flowchart). Confirmation of AD pathology was present in 91.1% of cases with bvAD based on autopsy data (36 studies 5 , 16 - 20 , 22 , 29 , 31 , 33 - 35 , 39 , 40 , 42 , 44 , 49 , 51 , 52 , 54 - 57 , 59 , 62 , 66 , 69 , 70 , 76 , 77 , 79 , 81 , 82 , 87 , 90 , 96 ; n = 334), genetic data (9 studies 47 , 50 , 60 , 63 , 65 , 67 , 68 , 80 , 86 ; n = 21), or biomarker data (31 studies 3 , 18 - 21 , 24 - 29 , 32 , 38 , 63 , 70 - 75 , 77 , 83 - 85 , 88 , 89 , 91 , 92 , 94 , 95 , 97 ; n = 262), while no information was available in 9.9% of cases (11 studies 22 , 23 , 36 , 37 , 41 , 43 , 45 , 46 , 53 , 64 , 78 including 68 cases of bvAD). Thirteen studies were eligible for meta-analysis. eTable 4 in the Supplement provides an overview of the participant characteristics for all 83 included studies. Across these studies, 591 patients with bvAD were enrolled, with a mean (SD) age at diagnosis of 62.0 (7.3) years, and 226 participants (38.2%) were women. The mean (SD) MMSE score was 20.1 (5.9), and 281 participants (47.5%) carried an APOE ε4 allele.

Meta-analysis indicated that patients with bvAD showed more severe behavioral and neuropsychiatric symptoms than patients with tAD (standardized mean difference [SMD], 1.16 [95% CI, 0.74-1.59]; P < .001) and a nonsignificant difference in severe behavioral/neuropsychiatric symptoms compared with bvFTD (SMD, −0.22 [95% CI, −0.47 to 0.04]; P = .10; Figure 1 A). Results remained similar when separating bvFTD core criteria and neuropsychiatric features (eFigure 6 in the Supplement ).

Next, we compared proportions of bvFTD features and NPI items as reported in previous studies ( Figure 1 B; eTable 5 in the Supplement 16 , 17 , 19 , 31 - 34 ). We used amyloid-β–positive patients with tAD from the Amsterdam Dementia Cohort (mean [SD] age, 65.9 [7.7] years; 403 women [52.4%]; mean [SD] MMSE score, 20.3 [5.1]). Compared with bvFTD, patients with bvAD less frequently showed compulsive behaviors (45.0% vs 68.5%; χ 2 = 22.5; P < .001) and hyperorality (35.9% vs 64.1%; χ 2 = 32.8; P < .001) but showed no differences on disinhibition (60.8% vs 68.6%; χ 2 = 2.8; P = .10), apathy (68.8% vs 77.4%; χ 2 = 3.7; P = .05), and lack of empathy (54.6% vs 53.6%; χ 2 = 0.1; P = .83). On the NPI, patients with bvAD more frequently showed agitation (67.9% vs 43.4%; χ 2 = 8.8), hallucinations (28.2% vs 9.0%; χ 2 = 12.8), and delusions (36.6% vs 13.4%; χ 2 = 13.4) compared with bvFTD ( P < .001). Furthermore, those with bvAD more frequently showed nighttime behaviors (39.6% vs 19.5%; χ 2 = 12.9), euphoria (16.6% vs 6.8%; χ 2 = 7.9), anxiety (54.2% vs 31.7%; χ 2 = 10.8), agitation (67.9% vs 14.8%; χ 2 = 90.3), hallucinations (28.2% vs 3.1%; χ 2 = 71.2), delusions (36.6% vs 9.2%; χ 2 = 37.2), and motor behaviors (50.4% vs 19.8%; χ 2 = 26.2) compared with patients with tAD ( P < .01).

Meta-analyses of cognitive data indicated that at initial assessment bvAD, patients showed no differences on MMSE compared with tAD (SMD, −0.18 [95% CI, −0.56 to 0.20]; P = .35) and bvFTD (SMD, −0.22 [95% CI, −0.78 to 0.35]; P = .46; Figure 2 ). Patients with bvAD showed worse executive performance compared with tAD (SMD, −1.03 [95% CI, −1.74 to −0.32]; P = .008) but not compared with bvFTD (SMD, −0.61 [95% CI, −1.75 to 0.53]; P = .29). Finally, bvAD showed a trend toward worse memory performance compared with bvFTD (SMD, −1.31 [95% CI, −2.75 to 0.14]; P = .08) but did not differ from tAD (SMD, 0.43 [95% CI, −0.46 to 1.33]; P = .34).

The Table provides an overview of neuroimaging studies in bvAD. Structural MRI studies (16 studies; 92 participants) showed temporoparietal-predominant, 16 frontotemporal-predominant and insular-predominant, 17 - 19 or frontoparietal-predominant 21 atrophy patterns across patients with bvAD. Cases of bvAD did not differ from tAD in 3 studies 16 , 20 , 21 and showed moderately more involvement of frontal regions in bvAD compared with tAD in 3 other studies. 17 - 19 Studies assessing glucose metabolism with [ 18 F]FDG-PET or perfusion with single-photon emission computed tomography (7 studies; 88 participants) also showed heterogeneous results, ranging from a predominantly temporoparietal hypometabolic pattern 20 , 25 to a mixed frontal and temporoparietal 23 , 26 - 28 or predominantly frontal pattern. 24 Amyloid-PET studies (2 studies 21 , 24 ; 28 participants) showed no differences in amyloid-β burden or distribution between patients with bvAD vs tAD. For tau-PET (2 studies; 22 participants), 1 study 21 showed a temporoparietal pattern with higher uptake in anterior regions in bvAD compared with tAD, whereas another 29 study showed heterogeneous patterns across patients with bvAD. Findings on functional connectivity (3 studies 19 , 20 , 24 ; 54 participants) and white matter hyperintensities (1 study 20 ; 29 participants) in bvAD are presented in eTable 6 in the Supplement .

We distilled 2 distinct bvAD neuroimaging phenotypes from the literature, characterized by either relative frontal sparing (more AD-like) or by both posterior and anterior involvement (more bvFTD-like) ( Figure 3 A). We propose that these phenotypes occur on a continuum ( Figure 3 B), with the more AD-like phenotype being most prevalent ( Figure 3 C).

In line with amyloid and tau PET findings, the meta-analyses on neuropathological data 18 , 29 , 31 , 35 showed that bvAD and tAD did not differ in the neuropathological burden of amyloid-β (3 studies 18 , 31 , 35 ; 20 participants) across frontal regions (SMD, 0.23 [95% CI, −0.36 to 0.81]; P = .45), medial temporal lobe (SMD, −0.06 [95% CI, −0.65 to 0.53]; P = .84), or occipital cortex (SMD, −0.16 [95% CI, −1.05 to 0.73]; P = .73; eFigure 7 in the Supplement ). Furthermore, there was no difference in tau burden (4 studies 18 , 29 , 31 , 35 ; 28 participants) across frontal regions (SMD, −0.05 [95% CI, −0.56 to 0.46]; P = .84), medial temporal lobe (SMD, 0.32 [95% CI, −0.19 to 0.83]; P = .22), or occipital cortex (SMD, −0.36 [95% CI, −0.95 to 0.23]; P = .24; eFigure 7 in the Supplement ).

In this systematic review and meta-analysis, we found that bvAD is clinically most reminiscent of bvFTD while it shares most pathophysiological features with tAD. Based on these insights, we provide research criteria for bvAD aimed at improving the consistency and reliability of future research and aiding in future clinical assessments.

bvAD phenotype typically presents at a young age (mean [SD] age, 62.0 [7.3] years at diagnosis), is more frequently found in men than women (61.7% vs 38.2%, in line with bvFTD but in contrast with tAD 98 ), and has a lower frequency of APOE ε4 carriership compared with tAD (47.5% vs 66.1% 99 ). Clinically, bvAD shows a milder behavioral profile compared with bvFTD, with less compulsivity and hyperorality but greater prevalence of neuropsychiatric symptoms, such as agitation, delusions, and hallucinations. By definition, bvAD shows greater impairment on a range of behavioral and neuropsychiatric measures compared with tAD. The directionality of findings in the meta-analyses of cognitive data suggest that bvAD might show greater memory and executive function deficits compared with bvFTD and relatively better memory function and worse executive functioning compared with tAD, but further research in larger cohorts is needed to confirm the significance of these findings. The neuroimaging methods were too heterogenous across studies to conduct a formal meta-analysis, but a systematic review revealed 2 distinct phenotypes of brain atrophy, hypometabolism, and tau pathology in bvAD, with many cases likely occurring on a continuum. The most prevalent bvAD neuroimaging phenotype is an AD-like pattern involving bilateral temporoparietal regions with limited involvement of the frontal cortex. This observation is congruent with our meta-analysis on neuropathological data showing that patients with bvAD were indistinguishable from patients with tAD in both amyloid-β and tau load and spatial distribution. The other bvAD phenotype is characterized by a more bvFTD-like neuroimaging pattern, including posterior and anterior regions (eg, anterior cingulate cortex, frontal insula, temporal poles) located in brain networks (eg, the salience network) that are engaged during socioemotional processing of information. 100 Altogether, our systematic review and meta-analyses further refine the bvAD phenotype but also highlight the need for larger studies with more uniform methods and inclusion and exclusion criteria.

Our main objective was to propose research criteria for bvAD guided by the results of the systematic review and meta-analyses. The criteria are based on consensus between all authors, including neurologists, neuropsychologists, neuropathologists, and neuroscientists. To facilitate widespread use but also take into account the complexity of this phenotype, we offer 4 levels of evidence ( Box ). The first level (clinical bvAD) can be established solely based on clinical information, while the second and third levels (possible bvAD and probable bvAD) add biomarker confirmation of amyloid-β and tau pathology. The fourth level (definite bvAD) is assigned through histopathological or genetic confirmation of AD (ie, by the presence of pathogenic APP, PSEN1 , or PSEN2 genetic variations) in conjunction with a bvAD clinical syndrome.

Research Criteria for the Behavioral Variant of Alzheimer Disease (bvAD)

Clinical bvad.

The clinical syndrome is characterized by:

Early, persistent, predominant, and progressive change or exacerbation of at least 2 of 5 core behavioral features of the diagnostic criteria for behavioral variant frontotemporal dementia (Rascovsky et al 14 ):

Behavioral disinhibition (1 of the following symptoms must be present):

Socially inappropriate behavior

Loss of manners or decorum

Impulsive, rash, or careless actions

Apathy or inertia (1 of the following symptoms must be present):

Loss of empathy or sympathy (1 of the following symptoms must be present):

Diminished response to other people’s needs and feelings

Diminished social interest, interrelatedness, or personal warmth

Perseverative, stereotyped, or compulsive or ritualistic behavior (1 of the following symptoms must be present):

Simple, repetitive movements

Complex, compulsive, or ritualistic behaviors

Stereotypy of speech

Hyperorality and dietary changes (1 of the following symptoms must be present):

Altered food preferences

Binge eating or increased consumption of alcohol or cigarettes

Oral exploration or consumption of inedible objects

In addition, documented impairment in executive functions and/or episodic memory with relatively preserved language and visuospatial abilities.

Criteria for clinical bvAD are not met if the behavioral deficits are (better) accounted for by another concurrent (active) neurological (eg, Lewy body dementia) or nonneurological medical (eg, psychiatric) comorbidity, a known genetic variant associated with familial behavioral variant of frontotemporal dementia, or the use of medication.

Supportive features (not mandatory; categories A and B must be met):

Presence of hallucinations and/or delusions.

Alzheimer disease–specific (ie, temporoparietal pattern) and/or behavioral variant of frontotemporal dementia–specific neuroimaging features (ie, frontotemporal pattern) on magnetic resonance imaging, computed tomography, perfusion single-photo emission computed tomography, and/or fluorodeoxyglucose–positron emission tomography.

Possible bvAD

Meets criteria for clinical bvAD and

There is in vivo biomarker evidence for the presence of (1) β-amyloid pathology on amyloid positron emission tomography and/or in cerebrospinal fluid and/or (2) tau pathology in cerebrospinal fluid and/or plasma.

Probable bvAD

Meets criteria for clinical bvAD or possible bvAD, with additional in vivo tau positron emission tomography evidence for the presence of neocortical tau aggregates.

Definite bvAD

Meets criteria for clinical bvAD, possible bvAD, or probable bvAD, and

Presence of AD is established by

Histopathological indication of AD as the primary pathology on biopsy or at autopsy, or

Presence of a known genetic variant associated with familial AD.

Several issues warrant further explanation. First, both the literature and our clinical experience align with the notion that bvAD is a combined cognitive and behavioral clinical syndrome. We previously showed that cognitive impairment was among the first symptoms reported by patients and caregivers in approximately 75% of bvAD cases. 16 In addition, our meta-analysis suggests that episodic memory performance in bvAD is intermediate between tAD and bvFTD, while bvAD shows greater executive dysfunction compared with bvFTD ( Figure 2 ). To enhance the discriminative accuracy between bvAD and bvFTD, objectively confirmed impairment in either memory or executive domains is therefore mandatory. To achieve this, we recommend a full neuropsychological evaluation rather than use of relatively crude dementia screening tests. In addition, 2 of 5 behavioral features of the diagnostic criteria for bvFTD 14 (ie, disinhibition, apathy, lack of empathy, compulsiveness, and hyperorality) must be present. Note that the sixth bvFTD criterion (ie, a dysexecutive neuropsychological profile) was removed because documented memory and/or executive function deficits are required for a bvAD diagnosis. The 2-of-5 criterion was selected to sufficiently distinguish bvAD from tAD but also acknowledge the generally milder behavioral profile in bvAD compared with bvFTD (in which 3 of 6 bvFTD criteria must be present). Second, despite clinically significant differences between bvAD and both bvFTD and tAD ( Figure 1 ), we deemed it premature to include hallucinations and delusions in the core research criteria because these observations were derived from only 2 studies. 33 , 34 Instead, they were added as supportive features, and future prospective studies are needed to assess whether they should be incorporated in the core criteria for bvAD. Third, most AD variants have a clear neurodegenerative signature on MRI and/or [ 18 F]FDG-PET that corresponds with their clinical phenotype, such as left-hemispheric predominance in logopenic variant primary progressive aphasia or occipitotemporal or occipitoparietal damage in posterior cortical atrophy. 10 , 11 However, the neuroimaging literature in bvAD is highly inconsistent. Some studies (mainly case studies or case series) showed anterior neurodegenerative patterns that resemble bvFTD, but most group studies showed either a mix of anterior and posterior involvement or a posterior-predominant pattern. 16 - 22 , 25 , 36 , 37 Contrary to posterior cortical atrophy and logopenic variant primary progressive aphasia, we therefore did not incorporate MRI, computed tomography, single-photon emission computed tomography, or [ 18 F]FDG-PET readouts into the core bvAD research criteria but only added them as supportive features. Fourth, evidence of amyloid-β pathology provided by PET, cerebrospinal fluid, or plasma biomarkers can upgrade the diagnosis from clinical bvAD to possible bvAD. Positive amyloid-β biomarkers substantially increase the likelihood that AD is the primary causative mechanism, but given their limited specificity, the possibility of amyloid-β as comorbid pathology cannot be ruled out, especially in older individuals and those who carry APOE ε4. 38 , 101 The addition of biomarker evidence for tau pathology further increases the certainty for a bvAD diagnosis (ie, probable bvAD). Here, we make the distinction between biofluid and neuroimaging markers of tau pathology. For cerebrospinal fluid and plasma biomarkers of tau pathology, the differential diagnostic value for distinguishing AD from bvFTD is less well established, and as with amyloid-β markers, they become abnormal relatively early in the disease course, which lowers their specificity. 102 , 103 Hence, a full AD-like fluid biomarker profile with abnormalities in both amyloid-β and phosphorylated tau supports a level II diagnosis of possible bvAD. Instead, the currently most widely used tau PET ligands (ie, [ 18 F]flortaucipir, [ 18 F]MK6240, and [ 18 F]RO948) have consistently shown to bind selectively and with high affinity to the tau aggregates formed in AD (ie, combinations of 3R/4R tau in paired helical filaments), while neocortical tau PET uptake in sporadic bvFTD is negligible, resulting in excellent discriminative accuracy between AD and bvFTD. 104 , 105 Furthermore, since tau PET uptake in the neocortex almost exclusively occurs in individuals positive for amyloid-β 104 , 106 we consider a level I diagnosis (clinical bvAD) plus tau PET–positive results in an AD-like pattern 107 supportive of a level III diagnosis of probable bvAD. Given the rapid developments in the blood-based biomarker field, the current distinction between neuroimaging and biofluid markers should be reevaluated in the future. Fifth, although the question of whether bvAD and dysexecutive AD exist on a single continuum or represent distinct clinical entities is yet unresolved, we deliberately developed criteria specific to bvAD. This was motivated by our previous study showing that only approximately 25% of bvAD cases additionally met dysexecutive AD criteria 16 ; hence, bvAD occurs in isolation in most cases, as well as a recent article 12 proposing specific dysexecutive AD criteria that explicitly exclude behavioral features. Therefore, while dysexecutive AD is considered if dysexecutive functioning and positive AD biomarkers are present in the absence of behavioral deficits, a diagnosis of bvAD is established when early behavioral alterations are observed in conjunction with either memory or executive functioning deficits and positive AD biomarkers (eFigure 8 in the Supplement ).

There are several limitations. First, bvAD is a rare AD phenotype that, for the most part, has been described in single case studies and case series. The bvAD literature therefore consists of relatively few cohort studies generally characterized by modest sample sizes, which resulted in reduced statistical power to detect differences between bvAD vs bvFTD and tAD. This was further complicated by substantial heterogeneity in patient samples and outcome measures and subsequent substantial risk of bias across studies. Second, the variability across neuroimaging studies did not allow a meta-analytical approach; hence, we interpreted this literature using a systematic review. Third, in the behavioral, cognitive, and neuropathological meta-analyses, we combined comparable yet distinct study outcome measures, such as different neuropsychological tests for memory and executive functions, questionnaires for neuropsychiatric/behavioral features, or staining methods and selection of brain regions for histopathological assessment of amyloid-β and tau. Fourth, we did not account for possible copathologies (eg, Lewy bodies) that may contribute to the clinical phenotype. Fifth, the classification of possible bvAD and probable bvAD may be influenced by inherent differences in diagnostic accuracy of various amyloid and tau PET tracers, as well as assays for cerebrospinal fluid and plasma analysis, and centers likely vary in the reliability of their biomarker result interpretation. Sixth, there were only limited data on behavioral presentations of AD in diverse populations.

Akin to the development of diagnostic criteria for posterior cortical atrophy, we consider the currently proposed research criteria as a stepping stone toward internationally established consensus criteria for bvAD. For posterior cortical atrophy, research criteria were first proposed by 2 research groups and were subsequently applied by other groups to establish a posterior cortical atrophy diagnosis for several years, 108 , 109 followed by widely supported formal diagnostic criteria based on consensus by an international working group. 10 Similarly, our bvAD criteria should improve the consistency and reliability of future research and possibly aid in the clinical assessment of bvAD, which in turn would enhance the diagnostic accuracy of future bvAD criteria to be established by a working group of worldwide experts. There are several promising novel biomarkers and behavioral features that could be included in future bvAD criteria, such as more objective measurements of behavior, such as social cognition in conjunction with biometric information (eg, eye tracking, face reading, galvanic skin response) 110 or blood-based biomarkers of AD pathology (eg, phosphorylated tau, amyloid-β) and neurodegeneration (eg, neurofilament light chain). 111 Furthermore, the diagnostic utility of potential bvAD-specific features (eg, relatively preserved disease insight, presence of hallucinations, and delusions) or measures of disease severity (eg, the frontotemporal lobar degeneration-modified Clinical Dementia Rating scale 112 ) should be further investigated.

Although the existence of bvAD is acknowledged in the most recent diagnostic and research criteria for AD dementia, 8 , 9 there currently does not exist a set of criteria that provide specific recommendations for the diagnosis of bvAD. Our systematic review and meta-analyses of the current bvAD literature indicate that bvAD is clinically most similar to bvFTD, while it shares most pathophysiological features with tAD. Based on these insights, we provide the first research criteria for bvAD aimed at improving the consistency and reliability of future research and potentially facilitating clinical assessment of bvAD.

Accepted for Publication: October 8, 2021.

Published Online: December 6, 2021. doi: 10.1001/jamaneurol.2021.4417

Corresponding Author: Rik Ossenkoppele, PhD, Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, Amsterdam, Noord-Holland 1007 MB, the Netherlands ( [email protected] ).

Author Contributions: Dr Ossenkoppele and Ms Singleton had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ossenkoppele, Singleton, Eikelboom, Miller, Laforce, Scheltens, Papma, Rabinovici, Pijnenburg.

Acquisition, analysis, or interpretation of data: Ossenkoppele, Singleton, Groot, Dijkstra, Seeley, Miller, Laforce, Scheltens, Rabinovici.

Drafting of the manuscript: Ossenkoppele, Singleton, Laforce, Pijnenburg.

Critical revision of the manuscript for important intellectual content: Singleton, Groot, Dijkstra, Eikelboom, Seeley, Miller, Laforce, Scheltens, Papma, Rabinovici, Pijnenburg.

Statistical analysis: Ossenkoppele, Singleton, Groot.

Obtained funding: Ossenkoppele, Seeley, Miller, Scheltens, Papma, Rabinovici.

Administrative, technical, or material support: Ossenkoppele, Singleton, Seeley, Miller, Laforce, Scheltens.

Supervision: Seeley, Miller, Scheltens, Pijnenburg.

Conflict of Interest Disclosures: Dr Rabinovici reported grants from National Institutes of Health, Alzheimer’s Association, and Rainwater Charitable Foundation during the conduct of the study; grants from Avid Radiopharmaceuticals, GE Healthcare, Life Molecular Imaging, and Genentech and personal fees from Genentech, Eisai, Roche, and Johnson & Johnson outside the submitted work. Dr Seeley reported personal fees from BridgeBio, GLG Council, Guidepoint Global, and Corcept Therapeutics outside the submitted work. Dr Miller reported grants from National Institutes of Health/National Institute of Aging and University of California, San Francisco/Quest Diagnostics outside the submitted work; and royalties from Cambridge University Press, Guilford Publications Inc, Johns Hopkins Press, Oxford University Press, Taylor & Francis Group, Elsevier Inc, and UpToDate. Dr Scheltens reported receiving consultancy fees (paid to the institution) from AC Immune, Alkermes, Alnylam, Alzheon, Anavex, Biogen, Brainstorm Cell, Cortexyme, Denali, EIP, ImmunoBrain Checkpoint, GemVax, Genentech, Green Valley, Novartis, Novo Nordisk, PeopleBio, Renew LLC, and Roche; being a principal investigator with AC Immune, CogRx, FUJI-film/Toyama, IONIS, UCB, and Vivoryon; being a part-time employee of Life Sciences Partners Amsterdam; and being on the boards of Brain Research Center and New Amsterdam Pharma. Dr Papma reported grants from ZonMw Memorabel and Alzheimer Nederland during the conduct of the study. No other disclosures were reported.

Funding/Support: This project has received funding from the Netherlands Organization for Health Research and Development (70-73305-98-1214 [Drs Ossenkoppele and Papma]). Research of the Alzheimer Center Amsterdam is part of the neurodegeneration research programme of Amsterdam Neuroscience. The Alzheimer Center Amsterdam is supported by Stichting Alzheimer Nederland and Stichting VUmc fonds. Research at University of California, San Francisco, is supported by the National Institutes of Health (grants P30-AG062422 [Drs Miller and Rabinovici], P01-AG019724 [Drs Miller and Rabinovici], R35 AG072362 [Dr Rabinovici], R01-AG038791 [Dr Rabinovici], and R01 AG045611 [Dr Rabinovici]) and the Rainwater Charitable Foundation (Dr Rabinovici). Research at Centre Hospitalier Universitaire de Québec is supported by the Chaire de Recherche sur les Aphasies Primaires Progressives–Fondation de la Famille Lemaire (Dr Laforce).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Information: Data and codes used in this manuscript are available on reasonable request to the authors.

Additional Contributions: The authors thank Jeffrey Phillips, PhD (University of Pennsylvania), Dennis Irwin, PhD (University of Pennsylvania), David Bergeron, MD, PhD (CHU de Québec), and Claire Boutoleau-Bretonnière, PhD (CHU de Nantes), for providing missing data from their studies that could be used in the meta-analyses presented here. We also thank Oskar Hansson, MD, PhD (Lund University), and Sebastian Palmqvist, MD, PhD (Lund University), for their advice on how to incorporate biofluid vs neuroimaging biomarkers into the research criteria for the behavioral variant of Alzheimer disease. They were not compensated for their contributions.

Library Services

UCL LIBRARY SERVICES

What are systematic reviews?

Systematic reviews are a type of literature review of research which require equivalent standards of rigour as primary research. They have a clear, logical rationale that is reported to the reader of the review. They are used in research and policymaking to inform evidence-based decisions and practice. They differ from traditional literature reviews particularly in the following elements of conduct and reporting.

Systematic reviews:

For example, systematic reviews (like all research) should have a clear research question, and the perspective of the authors in their approach to addressing the question is described. There are clearly described methods on how each study in a review was identified, how that study was appraised for quality and relevance and how it is combined with other studies in order to address the review question. A systematic review usually involves more than one person in order to increase the objectivity and trustworthiness of the reviews methods and findings.

Research protocols for systematic reviews may be peer-reviewed and published or registered in a suitable repository to help avoid duplication of reviews and for comparisons to be made with the final review and the planned review.

A 'non-systematic review' might use some of the same methods as systematic reviews, such as systematic approaches to identify studies or quality appraise the literature. There may be times when this approach can be useful. In a student dissertation, for example, there may not be the time to be fully systematic in a review of the literature if this is only one small part of the thesis. In other types of research, there may also be a need to obtain a quick and not necessarily thorough overview of a literature to inform some other work (including a systematic review). Another example, is where policymakers, or other people using research findings, want to make quick decisions and there is no systematic review available to help them. They have a choice of gaining a rapid overview of the research literature or not having any research evidence to help their decision-making.

Just like any other piece of research, the methods used to undertake any literature review should be carefully planned to justify the conclusions made.

Finding out about different types of systematic reviews and the methods used for systematic reviews, and reading both systematic and other types of review will help to understand some of the differences.

Typically, a systematic review addresses a focussed, structured research question in order to inform understanding and decisions on an area. (see the Formulating a research question section for examples).

Sometimes systematic reviews ask a broad research question, and one strategy to achieve this is the use of several focussed sub-questions each addressed by sub-components of the review.

Another strategy is to develop a map to describe the type of research that has been undertaken in relation to a research question. Some maps even describe over 2,000 papers, while others are much smaller. One purpose of a map is to help choose a sub-set of studies to explore more fully in a synthesis. There are also other purposes of maps: see the box on systematic evidence maps for further information.

Reporting standards specify minimum elements that need to go into the reporting of a review. The reporting standards refer mainly to methodological issues but they are not as detailed or specific as critical appraisal for the methodological standards of conduct of a review.

A number of organisations have developed specific guidelines and standards for both the conducting and reporting on systematic reviews in different topic areas.

Useful books about systematic reviews

Systematic approaches to a successful literature review

An introduction to systematic reviews

Cochrane handbook for systematic reviews of interventions

Systematic reviews: crd's guidance for undertaking reviews in health care.

Finding what works in health care: Standards for systematic reviews

Systematic Reviews in the Social Sciences

Meta-analysis and research synthesis.

Research Synthesis and Meta-Analysis

Doing a Systematic Review

Literature reviews.

SYSTEMATIC LITERATURE REVIEW: PART 3...

SYSTEMATIC LITERATURE REVIEW: PART 3 ANNOTATED BIBLIOGRAPHY ASSIGNMENT

Citations APA format: Develop an annotated bibliography of the 50 sources collected from the Systematic Literature Review: Part 2 - References List Assignment below: That provides a narrative account for each source identified in the reference list: the nature of the study, the methodology, and the findings generated. 1. Generate annotations for each of the documents you reviewed to help you answer your Research question. 2. Elaborate on points of commonality and differences between the voices on the subject. 3. Identify points of controversy and the implications for arriving at an answer to your Research question. 4. Assess the merits of each argument rendered to arrive at indisputable points.

Answer & Explanation

Unlock access to this and over 10,000 step-by-step explanations

Have an account? Log In

Step-by-step explanation

Get unstuck with a cliffsnotes subscription.

Related Q&A

Barriers and facilitators to physical activity for young adult women: a systematic review and thematic synthesis of qualitative literature

International Journal of Behavioral Nutrition and Physical Activity volume 20 , Article number: 23 ( 2023 ) Cite this article

300 Accesses

2 Altmetric

Metrics details

Physical activity (PA) has many benefits in preventing diseases and maintaining physical and mental health. Women, in particular, can benefit from regular PA. However, women’s PA did not increase over the past decade globally, and the situations faced by women are often gender-specific. Healthy young adult women's PA does not receive as much attention as older women and adolescent girls, yet, they face the same situation of low level of PA. This review aims to explore and synthesise the self-identified barriers and facilitators to young adult women's participation in PA from qualitative research studies and offer suggestions for future studies and programs designed for this population.

A systematic search was conducted in Pubmed, Web of Science, Scopus, Medline, and SPORTDiscus for studies published between January 2000 to February 2022 to identify qualitative studies on the barriers and facilitators of young adult women’s PA between ages 18 to 40. The search yielded 694 studies initially, of which 23 were included. The research quality of included studies was appraised using the Critical Appraisal Skills Programme (CASP) tool. Data were extracted and thematically analysed based on the tenets of the social-ecological model (SEM).

Identified barriers and facilitators were grouped into different levels of the SEM, with the most frequently cited factors being time, body image and societal beauty standards, family duty and social support, religious and cultural norms, organisation and community facilities and environment, safety issues and physical environment. Descriptive data were thematically analysed and synthesised in line with the five levels: body image, health and beauty; multiple roles, support, and PA; religious identity, cultural identity, and PA; safety issues and women’s fears.

Conclusions

This qualitative synthesis revealed in-depth information on barriers and facilitators influencing young adult women’s PA. It highlighted that the factors young adult women face are diverse at different levels yet holistic and intertwined. Future studies on young adult women’s PA should address the social-cultural influence and would benefit from applying multilevel strategies employing the SEM model. It is critical to create an open and inclusive environment and offer more opportunities for women.

Trial registration

PROSPERO CRD42021290519.

Introduction

It is well-documented that women of all ages benefit from regular physical activity (PA) [ 1 ] in preventing diseases and maintaining physical and mental health [ 2 , 3 , 4 , 5 , 6 ]. However, physical inactivity is already a pandemic with far-reaching health, economic, environmental and social consequences [ 7 ]. Women were nearly 8% less active than men worldwide and remained at a lower level of PA in the past decades [ 8 ]. A global study across 142 countries concluded that without any change in men’s PA, only a slight increase in women’s PA [ 9 ] would achieve the WHO global target of reducing physical inactivity by 10% by 2025 [ 10 ]. Thus, there is a need to tackle the gender gap [ 11 ] and improve women’s PA levels.

Despite research showing that men are biologically more active than women [ 12 ], women’s PA may also be negatively influenced by societal expectations and cultural norms. These social-cultural expectations usually become more pronounced and significantly impact young adulthood, about 18 to 40 years [ 13 , 14 ]. Stepping into young adulthood means women are moving into a pivotal point of life transitions characterised by multiple role adaptations and a wide diversity of lifestyles [ 15 ]. During this time, many environmental (e.g., from home to university or work), social (e.g., marriage), and personal life events (e.g., motherhood) [ 16 , 17 ] may occur and, consequently, could have both detrimental and beneficial impacts on women’s well-being and PA [ 18 , 19 , 20 ]. However, women generally face a sharp decline in PA from the transition to young adulthood [ 16 ]. Especially women of today are expected to fulfil various roles, such as being caregivers, mothers, wives, and dedicated employees; while role expectations rise, the level of PA falls even more [ 20 , 21 , 22 ].

Compared to other groups of PA, such as children, adolescents, the elderly, and the population with disease, healthy young adults are sometimes overlooked [ 23 ]. Recent studies found a rising trend in chronic diseases in young adults that usually affect middle-aged and older people [ 24 ]. Further, studies found a strong link between maintaining healthy lifestyles throughout young adulthood and lower cardiovascular disease risk in middle age [ 25 , 26 ]. This suggests that physically active young adult women may become healthy middle-aged to older women and further reduce the burden on healthcare systems. Some existing reviews have presented factors influencing women’s PA at different ages and situations [ 27 , 28 , 29 , 30 , 31 ], but most adopted a quantitative approach. However, the results of these studies were often reported and interpreted without contextual considerations. Without an embedded context, it is difficult to comprehend the reasons and underlying connections between these factors and generate practical implementations. Hence, using the qualitative synthesis technique, this review was grounded in young adult women's perceptions, experiences and narratives and aimed at interpretative rather than only aggregative [ 32 ]. Gathering data and findings from qualitative studies on the same topic across various contexts can present a broad review of young adult women’s behaviours, emotions, and attitudes towards PA [ 33 ].

Research on correlates or determinants of PA has burgeoned and primarily concentrated on individual-level characteristics in high-income countries, namely age, gender, health status, lifestyle, self-efficacy, and motivation [ 34 ]. However, this could sometimes fall into a victim-blaming ideology [ 35 , 36 ] that dismisses the inevitable subliminal influence of the broader context. Hence, this review employed the social-ecological model (SEM) [ 36 ] as the underlying framework. Many studies and reviews also used this model to layer factors that might have influenced individual behaviours. The SEM acknowledges the impact of human behaviour and development beyond the individual level and divides the influences into five levels: intrapersonal, interpersonal, organisational, and environmental or policy levels to present visual depictions of the dynamic relationships between each level [ 37 ]. In health research and practices, the SEM takes a comprehensive view [ 36 ], paying particular attention to influences outside the health sector [ 34 ], such as the social-cultural and physical environment, which is in line with the socio-cultural impact young adult women's may face with their PA that this review aimed to explore.

Based on the above, this study aimed to provide a systematic review of qualitative studies exploring the barrier and facilitators of young adult women’s PA at different levels of SEM for better generalisation and targeting efficiency of PA strategies. The aims were four-fold: 1. describe the characteristics and methodologies of qualitative studies conducted on this topic; 2. identify barriers and facilitators for young adult women’s PA and categorise them into corresponding levels within the SEM; 3. synthesise the narratives from qualitative studies and present themes based on tenets of the SEM; 4. Identify significant barriers and facilitators and their connections to young adult women’s PA.

The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 38 ] and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines [ 33 ]. A protocol for this review was published in PROSPERO (registration number: CRD42021290519).

Search strategy

A systematic search of Medline, Pubmed, Scopus, SPORTDiscus and Web of Science from January 2000 to February 2022 was performed to identify studies that met the inclusion criteria. The search terms included keywords and MeSH headings using Boolean/Phrase on a combination of keywords specifying the physical activity, barriers, facilitators, and young adult women yielded 694 studies. All searches used subject headings where available (see Additional file 1 for an example of search strategy). Citation tracking was also conducted through Google Scholar and Web of Science. The first author also screened the reference lists of included manuscripts to identify other studies that may have met our inclusion criteria.

The first author conducted the initial search from databases and screened the titles and abstracts of the search results; any ambiguity was discussed with the second author. Studies shown as conference abstracts were manually searched for full text on the Web of Science. The first and second authors separately screened the studies that advanced to the full-text screening stage.

Inclusion criteria

The inclusion criteria are displayed in Table 1 .

Selection process

After removing duplicates from the initial 694 studies, hierarchical screening was performed by the first and second authors, respectively, following the PRISMA guidelines [ 38 ] (see Fig. 1 ). Studies that met the following exclusion criteria were removed sequentially in the following order: 1. studies without full-text or not published in English; 2. studies of non-healthy women or not within the 18 to 40 age range (such as disease, rehabilitation, adolescents, old, etc.); 3. studies used quantitative method; 4. studies meet the inclusion criteria yet focused on pregnancy, prenatal and postpartum period of women. Thirty-seven qualitative studies were screened full-text by authors for eligibility. Fourteen studies were excluded because there were no age characteristics (18 to 40 years) in the quotes and results. Two were excluded because they focused on special populations (one with a disease, one with pregnancy-related), and one study was excluded as a review. A total of 23 studies were included for critical appraisal.

PRISMA flow diagram

Quality appraisal

The final 23 studies included were appraised using the Critical Appraisal Skills Programme (CASP) qualitative research quality tool (see Additional file 2 for Critical appraisals by the CASP) [ 39 ], which is a widely used tool for quality appraisal in health-related qualitative evidence syntheses, with endorsement from the Cochrane Qualitative and Implementation Methods Group [ 40 ]. The first and second authors independently conducted the assessment. Any discrepancies were discussed and reached a consensus between all authors. Each study's research design was appropriately justified. Five studies did not state the ethical concerns or whether they used quotes ethically to support their findings. Nine studies failed to adequately disclose the researcher's or interviewer's roles and the potential for bias in the results. Two studies did not display sufficient and vigorous data or provide thick descriptions to support their findings. All the findings were tied to the study's original purpose, and all the studies discussed the findings' trustworthiness. All the twenty-three studies were regarded as valuable; none were excluded for methodological concerns.

Data extraction and analysis

Extracted data from each study include 1. author and year of publication, 2. country, 3. sample characteristics, 4. qualitative data collection methods, 5. type of analysis, and 6. study results or findings (see Additional file 3 for Characteristics of the included qualitative studies). Each study's results were regarded as text in the titled "results," "findings," sections or similar parts. Fort studies’ results not only focused on young adult women (i.e. age from 18 – 60 years) or PA (i.e. health behaviour), data were retrieved including 1. results that were identified as specific to women between the ages of 18 and 40; 2. results that claimed to apply to all participants; 3. results only pertinent to PA.

The first and second authors independently extracted data from studies and coded the information into Excel and Word templates developed for this study. No other software or services were used to manage the review processes.

Synthesis methods

A combined inductive and deductive approach was applied in the analyses. Two authors independently coded the extracted data line-by-line, using thematic analysis inductively to categorise the data and develop new themes ‘beyond’ the reports from the original studies. A combination of direct-to-analysis and extraction techniques were used in the analysis to avoid preconceptions related to original documents abstracted from the context of articles in which they are embedded [ 41 ]. Afterwards, themes were deductively grouped into five different levels of the SEM. Themes from the original studies were then collected and grouped into the SEM for comparison to the newly identified themes. Eventually, the authors compared and combined the new and original themes and reached a consensus on the final result.

Barriers and facilitators of young adult women’s PA

The identified barriers and facilitators of young adult women’s PA were shown in Table 2 and Table 3 , as well as the contribution of each study.

Qualitative synthesis

Intrapersonal & interpersonal & community level: body image, health and beauty

Body dissatisfaction & health.

Health is the fundamental and most common intrapersonal facilitator for everyone's PA participation. However, it may not be the most popular or motivating factor for young adult women. Previous findings from epidemiological studies consistently showed that many, if not most, younger women in industrialised countries are at least moderately dissatisfied with their body weight or shape [ 42 ]. The fact that body dissatisfaction is "normative" does not imply that it is harmless; instead, it should be given more attention as a public health issue (Mond et al., 2013). In line with this, most young adult women reported constantly struggling with the number on the scale and whether they could fit into an ideal size.

“Looking good is the top motivator.” [ 43 ] “I have always wanted to become slim, and I still do.” [ 44 , 45 ] “The scale is probably the biggest motivator.” [ 43 ]

In many cases, the eagerness to lose weight and change body image proceeds the willingness to be healthy; initially, it is a powerful drive. Rather than see PA as a good thing, these women see it as a way to achieve the ideal body shape and weight [ 46 ]. Particularly when some women do not see health as an issue since they are still young, they would devote more effort to reaching an ideal image.

“I really don’t care. If you don’t do anything, what good does endurance do me? I mean really! [laughter].” [ 43 ]

Weight management and body image change typically from a general dissatisfaction toward women’s body; these facilitators often play a starter role for PA, yet, are not ideal for longtime adherence. Research has shown that body dissatisfaction is often posited as an extrinsic motivation (introjected regulation) and will usually backfire in time [ 47 ]. In line with this, young adult women also reported that health benefits and achievement is tempered by the lack of change in their appearance or body image.

“It’s great to have the strength and the cardiovascular ability and everything else but you still, you still look funny in your clothes.” [ 48 ]

The constant dissatisfaction with body image and weight often turns facilitators into barriers which come with pressure, anxiety, embarrassment, lower self-esteem, etc. As negative feelings deepen over time, it is possible to cause further impairment in mental health and physical health, such as body image disorders and eating disorders [ 49 ] and compulsive exercise [ 50 ]. These consequences are not rare, and it violates one of the fundamental goals of PA, which is health.

Weight stigma & social embarrassment

As PA can be an individual activity, very often, the contexts in which it takes place and some activities are social. Apart from the self-perception of body dissatisfaction and weight, the pressured and sensitive mindset leads to social comparisons and feelings of body-focused self-consciousness around others.

“I almost felt embarrassed...when you’re standing in the dressing room and you know that you have gained weight and you’re not comfortable....” [ 44 , 45 ]

Young adult women, particularly overweight women, reported often experiencing weight stigma in a social-based PA environment. They described feeling uncomfortable and humiliated as a barrier to PA. The lower self-esteem and fear of physique judgments from others keep bringing them a sense of failure and embarrassment. This circumstance existed not only in a PA environment but also in daily contexts. Namely, overweight women reported very often being subject to name-calling from peers in social interactions, with terms such as sister boom or fatty boom boom [ 51 ].

“ There is, like, social things that come with being fat. There is the name-calling.” [ 51 ]

Beyond the self-perceived embarrassment, overweight women were frequently advised by others (family, friends, media, etc.) that if they simply moved more, they would lose weight and be healthier [ 52 ]. Under the same logic, PA programs frequently adopted a weight-centric approach, to engage beings to acquire a socially desired body size and, eventually, health. The terms "weight" and "health" are sometimes used interchangeably, which may contribute to PA-related weight stigma [ 52 ]. Namely, this group reported disliking the use of descriptor words with negative connotations, such as “obesity” and “weight loss”; instead, words like “fitness”, “health”, and “well-being” are more acceptable when doing PA as they do not engender weight stigma connotations [ 53 ].

“… And I sort of looked at the wording again and I felt like—it was just really professional and it felt like it was respectful, so I felt pretty confident that it would be a positive experience...” [ 53 ]

When society promotes a healthy weight and unattainable “ideal” body image, it is easier to understand why overweight or obese are stigmatised and denigrated. Epidemiological research has also shown that both the risks of obesity and the advantages of weight loss can be exaggerated. The obesity epidemic rhetoric is fueled partly by political, economic, and socio-cultural forces [ 54 ]. It is argued that this discourse is fuelled by a toxic mix of equivocal scientific information about the causes and consequences of obesity, as well as moral and ideological agendas primarily based on the rhetoric of decline in Western attitudes to diet and PA [ 55 ]. The impact of weight stigma on women’s PA is complicated and contradictory; it motivates young adult women’s PA yet elicits various unpleasant emotions, such as humiliation and shame.

Body image & beauty standards

With most young adult women reporting body dissatisfaction and weight stigma as both facilitators and barriers, some of them also criticised the unattainable contemporary body image and the single beauty standard that kept pressuring them from the societal and cultural level, namely overvalued thinness.

“I don’t think they [the media] say anything about the amount you should be exercising, just that you should be thin.” [ 56 ]

From the media and “others”, no matter for overweight or normal-weight women, thinness is prescribed as equal to health. As aforementioned, many programs also closely link weight to health, which presents a fundamental thought that exercise makes people thinner and that getting thinner is the same as becoming healthier. Yet, only emphasising health seems not as powerful enough for young adult women. Beyond health, there is a further underlying thought which is thinness equal to beauty, equal to self-disciplined success; however, this often falls into a single standard, which is the “Western White standard”. For instance, Non-White women have spoken about feeling under pressure from "White standards of beauty" and cultural conflicts over body image. Black women allegedly felt "bitter" over conforming to the White cultural ideal of beauty.

“This is a country that values appearances … Jennifer Lopez, she looks like an American now. Yeah and she’s lost her uniqueness.” [ 57 ] “I walk into the gym, and they all look like Workout Barbie— blonde-haired, ultra-slim, big chest, super-thin thighs. Only I don’t look like Workout Barbie. If anything, I want to look like Halle Berry. She’s got a nice little shape, she’s got hips.” [ 57 ]

The “Western White standard” could be explained by the ideology of advanced capitalist societies that are reproduced at the site of the body through the mode of working toward bodily perfection. This ideology has encouraged critical evaluation of women's physical attributes, fostering competition and envy among women and encouraging the pursuit of impossible-to-achieve/to-maintain goals [ 58 ]. Namely, women posit that being an overweight man was often regarded as a sign of success (not in all situations), whereas being a perfectly shaped woman was just considered one aspect of success.

“Because I want to be a lawyer, she’s like ‘How are you going to walk around the courtroom in like (that body)?’…… ‘Ooh, but you can’t be fat on the news. You gotta be skinny. You know what I mean?’” [ 57 ]

In fact, the contemporary critique of sociocultural constructions of body aesthetics from many disciplinary perspectives has long existed [ 59 , 60 , 61 , 62 ]. It is argued that the body no longer serves only as an individual's entity but as a mirror of society's culture and ideology. As globalisation advances and people from diverse cultural identities coexist in the same social milieu, the dominant culture (Western-White) pressures minority cultures and is reflected in women's body image. Furthermore, women’s narratives often suggest PA is “fitness,” “gym”, and “working out.” Only a few discuss PA in connection to sports (“being athletic,” “doing sports”). This key distinction indicates that young adult women have appropriated a dominant discourse about sport and PA, a gendered discourse that holds that sport is for men more than women and that exercise or specific body modification toward PA can be ideally marketed to women when it rearticulates a conventional discourse of femininity [ 46 ]. Under this discourse, young adult women equate PA with self-confidence, self-discipline and holistic well-being. They position themselves as a subject within mainstream bodily discourses and construct themselves as subjects who negatively relate to the self (desire a thinner, more beautiful body closer to the Western ideal) [ 46 ]. Women's choice to PA is limited by these underlying social expectations on gender, which advocate for women's liberty to pursue their bodies while simultaneously reinforcing and outlining body standards. Young adult women believe they are making greater choices when they often fall into the “beauty and health” trap society has built for them during this emotional paradox.

Interpersonal & organisational level: multiple roles, social support, and PA

Multiple roles & patriarchal family.

Young adult women’s multiple roles are a critical trait that may stop them from engaging in PA. To begin with, the fact that women bear many duties in multiple roles does not negate the fact that men also confront multiple roles simultaneously. What is discussed here is when women are under more pressure from society when both genders face the same situation. Young adult women are themselves employees, wives and mothers. Multiple roles can be advantageous or problematic to one's overall well-being, depending on one's subjective perception of role management abilities [ 63 , 64 ]. In studies, the role balance between the mother and herself is most acute. Family commitment and lack of time are the two most significant barriers at the interpersonal and organisational levels. Although women also play multiple roles in middle-to-old age, the duties of each role fade over time, namely, less domestic and educational responsibility, their job becomes more stable or retirement, etc.

In a typical family setting in current society, the nuclear family is considered the basic unit of the social order within a patriarchal discourse of the family, meeting emotional and practical needs in different ways depending on whether one is a man or a woman [ 65 ]. Men with a father identity are considered "naturally" suited to be heads of the household. Their significant obligations are tied to attributes such as fortitude and providing material requirements (e.g., food and shelter). When these attributes are fulfilled, they are “encouraged” to seek fulfilment outside of it (e.g., leisure pursuits). Women, the mother identity, are considered “naturally” suited to a domestic role, with their primary responsibility of household labour and childcare because they are positioned as nurturing, patient and understanding. However, it is difficult to measure the fulfilment of women’s family responsibility, so they are often less encouraged to pursue other fulfillments (e.g., exercise, personal hobbies) and identities (e.g., career woman, exerciser, athlete) outside of the home, because they are “fulfilled” through being good mothers [ 66 , 67 ]. In this mentality, when women participate in PA for personal purposes, they not only receive societal judgment but would also feel guilty about their families and children and further believe themselves as bad mothers or not qualified mothers.

“I think that’ll be a difficulty, to not be feeling guilty like ‘now I’m gonna go off and work out without my kids.’” [ 67 ]

Women’s sacrifice is appreciated in the patriarchal society's and family's ethical systems. Nevertheless, it is worth reflecting that though most women regard family responsibilities as a significant barrier to PA, they do not consider that they should change their current priorities. Despite women's frustrations with the sacrifices they made for their families, lack of “me” time, lack of help from others, and “doing it all” were eventually accepted as a normal part of their life and also social norms [ 67 , 68 , 69 , 70 , 71 ].

“I’ve started talking with some of my girlfriends that men do that; they just sit back and relax after work and don’t help out! It’s just the way they are.” [ 67 ] “In our culture men usually do nothing at home. Women do the cooking and the cleaning, even if they work. If they want to do something, they don’t have the chance.” [ 72 ]

With this ongoing lifestyle, many women state that the home chores take the place of their PA, which can be seen as domestic PA.

“I think ladies, they feel like they are doing household work so it is exercise, and they do not need to do anything extra.” [ 73 ]

Motherhood & children’s needs

In terms of the patriarchal social norms of women’s family responsibilities. In truth, the children's expectations also play a vital role. In simple family routines, when children need to eat (often given by their mothers) or participate in activities that necessitate their mothers' company, women frequently re-prioritize their demands and put their children's needs first. PA, a leisure demand rather than a requirement (as opposed to a job, etc.), becomes a sacrifice of the child's needs at such times and is often the first to be pushed aside. Social norms should not be the only condition, part of the pressure in this competition between the priority of the mother and children comes from the child's expectations or demands (external pressure), and part of it comes from the mother's sense of obligation to the child (internal pressure), which is motherhood.

By not emphasising and discussing the political and cultural definition of motherhood, but only the part of women's nature [ 65 , 74 ], women often prioritise their children before them [ 75 , 76 ]. It is not difficult to understand some women willing to give up their own leisure in this context. Young adult women, particularly first-time mothers, have to devote more time and energy to caring for their children, who rely heavily on their mothers. If the child's requirements and the mother's needs are combined, the issue is solved. Many women also note that if the child needs PA, or PA would help her better support the child and family, it is also a feasible option.

“I go to the park daily. My kids insist that ‘Mamma, let’s go to the park’.” [ 73 ]

“I noticed when I exercise, I have more energy for them.” [ 67 ]

“We enjoy being together and doing physical activities and that’s a good point for me and for them [children] and also for the relationship between mom and children.” [ 77 ]

Family commitment is one of the most significant barriers to the multiple-role situation for young adult women. On the other hand, they perceived any support, especially family support, as a strong facilitator.

“Some women don’t have help - the children have dads that don’t help or other family members, so that’s why too. They would have to put the children first. But I have help, luckily. That’s why I decided to start doing something [going to the gym].” [ 69 ]

This helps to explain why young adult women indicate that family support is a crucial facilitator in their PA. When the stress of domestic tasks and caring can be shared with others, time becomes less of an issue, and they may devote more time to themselves. Time restrictions and competing priorities, such as employment, childcare, and household chores, always exist in women's lives. However, picking the priority requires a lot more effort, which cannot be accomplished only by women but by everyone around them.

Intrapersonal and community-level: religious identity, cultural identity, and PA

Muslim identity and pa.

Most studies referred to religious influence in this review on Islam Muslims from various socioeconomic origins, languages, and races. Muslim people commit to their shared faith and continually strive to maintain their identity in non-Islamic, Muslim minority contexts [ 78 ]. At the same time, the argument and research towards Muslim women’s PA have been a popular research topic.

To begin, it's worth noting that while Islam does not prohibit women or its followers from participating in any PA, there are only specific requirements for dressing and socialising that may restrict Muslim women's PA more than other non-religious or non-Islamic women [ 46 , 77 , 78 , 79 ]. From an outsider's view, Muslim women's strict religious rules are often perceived as being somewhat restrictive or conflicting, such as the most well-known rules: dress code and sex segregation. But Muslim women do not hold a contradictory view of the doctrine and their behaviours. Most women believe that their religious stance trumps everything else.

“[Islam] influences almost all [of my everyday decisions]. I always consider what I am doing. Will what I will be doing be Islamicly wrong, or is that okay? …… The Quran, the Holy book…it consists of rules on how you should live your life and you should obey them.” [ 79 ]

They also state that Islamic culture is dynamic so that they can embody complex identities regarding their socialisation, religiosity, and ethnicity. From the belief aspect, Islam is considered a facilitator which encourages Muslim women to be more active.

“I don’t think it is anything to do with religion because it is all about the people and how they want to live their life”, and wearing a hijab will not affect the practice of PA.” [ 77 ]

These women first identify themselves as Muslims. Within this devotion, if they do not obey the rules to participate in PA conveniently, it will be against their religion and threaten their piety. Notably, this does not imply that Muslim women are averse to PA. They share a positive attitude toward PA, seeing it as a way to improve their health, shed weight and shape, and socialise just like others. Only this attitude is founded on religion taking precedence over PA. This was defined as a "modern religious attitude" that usually lies in young Muslim women brought up in the West [ 80 ].

Therefore, the perceived barriers to being more physically active for these devout Muslim women are not rigid adherence to the doctrines but their limited alternatives and places for participation. Studies commonly reported that religious-related barriers are poor opportunities provided for women-only sites in gyms or sports venues, which violates the rule of not mixing with men in Islam. Also, only a few places accept the dress code, such as wearing a Hijab. The mismatch between Western and Islamic cultural traditions is a problem for many Muslim women, especially regarding privacy and their ideas of body modesty. The lack of culturally sensitive PA-related environments for Muslim women indicates they often experience a marginalisation of their recreation needs, and most PA places and programs are designed to cater to the “general” population. This is undeniably a position that ethnic and cultural minorities frequently encounter in society, not just in PA but also in physical education and other social levels. However, when mainstream and cultural outsiders only see the barriers as their strict requirements, it places the idea that minorities are expected to conform to the norms of the dominant society [ 81 ], which this idea and attitude may not be an acceptable and preferred way to Muslim women to volunteer in PA.

Embodied cultures

From the seeming conflict between religious values and the “main” PA promotion, it is worth considering the PA cultural differences. A researcher outside of other cultures is likely, to begin with the notion that PA is significantly vital, regardless of the cultural aspect or health aspect, and that everyone should and wants to engage in it. However, in diverse cultural contexts, it is necessary first to identify the role and credit of the PA behaviour itself.

A common thread across different culture groups was that PA is part of health promotion along with proper nutrition, caring for people’s mental well-being, physical health, and socialising. However, considering the high or low value given to PA by different cultures, the idea of encouraging women to engage in PA, or more precisely, activities that exercise and shape the body, is more Western in origin. Putting the health and gender equality judgment aside, some women state that leisure-time PA was not “normative” in their cultures, such as women who agreed that PA was not prioritised in South Asia culture, especially for girls and women.

“Yeah, especially the older people like the in-laws. They say, ‘you don’t have to go to the gym. You do at home. We never went to the gym.’” [ 73 ]

“Even in the modern family, even in my family, I have seen if a girl is from a good family and she goes to the gym as well as does her study and all. But after marriage, she is doing nothing.” [ 73 ]

Further, women reported the idea that women should be physically active and fit was also intensively conveyed through Western media.

“My dad watches Indian channels, which is where I could see it, but as I say, those channels come from India and they don’t really push health as much as we do here.” [ 56 ]

Women from Pakistani culture also remarked that PA is frowned upon by their communities and relatives. Further, sports are not seen as promoting ideal femininity within Pakistani society.

“I remember I was bullied by the Pakistani boys because they thought I was too Norwegian. I played football. . . . The boys didn’t think I behaved like a Pakistani girl. . . I have got negative comments from people I barely know. They said it isn’t good for girls to exercise a lot.” [ 82 ]

Families tend to urge young women toward "feminine" activities that are perceived as upholding traditional culture's notions of modesty and conventional femininity. [ 83 ]. Women who challenged traditional gender roles faced disapproval or harassment, with consequences ranging from becoming the subject of rumours or being labelled "too Western" [ 84 ]. Although certain cultural traditions impose constraints on women's behaviour, what should not be dismissed entirely is that PA can be merely a way in which these women subvert stereotypes emphasising the passivity, docility, and uncleanliness of women of South-Asian descent. But for women who give less appreciation and priority to it, it may be just a part that can be discarded.

“We can go swimming at school if we want to, but I haven’t. I don’t know if it is because I have become shyer. I don’t feel comfortable in a swimsuit…I had the opportunity, but I couldn’t cope. Not because my parents told me not to, but because I didn’t feel comfortable.” [ 82 ]

Further, in South-Asia cultures, academic achievement was more critical than PA, from parents' and young adult women’s views.

“You’re going to get more in life by studying than going to the gym or playing sports, so (laughs). That’s the way it was when I was growing up to be honest.” [ 56 ]

“There is sports, but us as we grow up, we say we don’t focus to those things…” [ 51 ]

“When I go to the gym, I try to bring my study material and try to study on the elliptical. If I don’t have study material, I feel you know, I am wasting time when I could actually work for the test.” [ 73 ]

In the examples, culture is experienced as a restriction on young adult women’s PA lives since culture and religiosity are perceived as practices that the girls learned as young children, which are often taken for granted. Nevertheless, when different cultures are encountered, they can be points of departure for hybrid and reflexive practices.

“When my sister and I first started playing soccer here, my father would never come to watch us play. He really didn’t approve. But once he saw that everyone else does it here and that we are good—now he comes to all the games. It would have been different if he had a son.” [ 57 ]

Quite different from the abovementioned religious barriers, some women also pointed out that religious community leaders are not giving much attention to PA.

“So, I think that, sometimes, culture goes over religion and overshadows it.” [ 46 ]

From both perspectives, it is evident that religion and culture are overpowering but flexible and embodied in women’s PA practice. Women’s bodies can both be inscribed with vehicles of culture [ 85 ]. These gender-based racial and ethnic disparities in PA are rooted in their cultures, communities and families, which start in childhood, suggesting that culture-specific beliefs about PA's role in women's lives have profound influences on lifelong PA. Yet if merely from a cultural standpoint, it is worthwhile to investigate what values PA stands for in different cultures. Designing culturally based programs for women might also be more beneficial.

Environmental & policy level: safety issues and women’s fears

“No, I don’t feel safe because we have drug addicts, traffic, women trafficking it’s not safe for us to walk in the streets.” [ 51 ]

Women’s safety concerns about the environment are the most outstanding barriers reported at this level. Safety concerns are usually described as fear of personal safety when walking or cycling in the dark or fear of being harassed [ 86 ]. Many women emphasised feeling unsafe being outdoors alone.

“Where I live, you’re “frait long man” (scared of the man); it is not safe anymore. You might be raped or something.” [ 56 ]

The gendered safety concern is one of the primary reasons. Sexual harassment and other forms of sexual violence in public spaces are everyday occurrences for women and girls worldwide, leading them to experience stress and fear in settings of everyday life (Ceccato & Loukaitou-Sideris, 2022).

“I know for a fact that I can’t walk with a miniskirt in Jo’burg. Because [. . .] it’s insults continuously. Because you have men trying to follow you, men trying to ask you this, men trying to say that ...” [ 51 ]

The fear of sexual victimisation may prevent women to participate in PA in school, work, and public life, limiting their opportunities [ 87 , 88 ]. Women believe that men's violence is distributed unevenly across places and times. They learn to recognise the danger of unexpected individuals in public places [ 89 ]. This self-protective awareness and gendered fears are natural and raised early.

“Compared to my male cousins, when I was growing up–there are like one or two who are older than me–I think they were allowed to like, go on the road and ride the bike and stuff like that, but we weren’t allowed to go and I knew that was because I was a girl so I think, but I didn’t stop me from–I don’t know how to describe it but I didn’t feel it was a bad thing that they were not letting us go cos I just thought like because they wanted me to be safe.” [ 56 ]

In line with this, women reported that the potential to do outdoor activities or go out is raised when the environment is safer.

“Safety is higher than in KSA and freedom is more so there is a lot of potential for walking.” [ 77 ]

This qualitative review offered in-depth and holistic evidence of the young adult women's self-identified barriers and facilitators, and there was a relatively even distribution of factors across the five levels of SEM and between barriers and facilitators. The qualitative synthesis showed the contexts of barriers and facilitators and intertwined circumstances between different levels.

In this review, the term PA was used to identify studies without distinguishing its different domains. Still, each of the four domains of PA is covered in the result: the occupational PA is reflected at the organisational level; the transportation PA is reflected at the environmental level; the domestic PA is reflected at the interpersonal level and the organisational level, respectively; and leisure-time PA crosses all barriers and facilitators. In fact, it was noted that although most of the included studies used the term "PA", the participant narratives focus on leisure-time PA in general. The included study also found that PA is frequently perceived as a form of leisure activity rather than any physical movement that can be accumulated across various activities [ 90 ]. Young adult women in this review often referred to PA as planned, structured, and repetitive movements with a set schedule and duration, which fall within the definition of exercise [ 91 ]. Some women also mentioned sports, but “exercise” or “workout” in the gym was more frequently reported. It seems young adult women are prone to amplify leisure-time PA above the other three domains when considering their PA. This may be connected to their attitudes and motives since young adult women perceived having fun, learning new skills, managing weight, improving body image, socialising, relaxing, etc., as facilitators and goals, which typically link to leisure-time PA. Furthermore, being healthy and young may potentially reduce engagement in the other three PA domains, as staying healthy is not the strongest or most urgent facilitator. At the same time, given women's negative attitudes toward domestic activity, such as housework, they may view PA other than the leisure-time domain as an additional burden. Therefore, future strategies towards leisure time PA may be more appealing to young adult women; occupational, transportation and domestic PA may be considered extra-load or less appealing. However, these three domains are also essential for those who genuinely do not have a scheduled time for PA.

Beyond the differences between 18 to 40 years of women, the barriers and facilitators faced by young adult women differed from middle-aged and older women. One of the notable differences was the attitude toward health. Although women across ages generally reported health as the fundamental facilitator and motivation of PA participation, the perspective and priority on health seemed to differ. Previous studies found that health is the most often cited barrier and facilitator for PA by mid to old-age women [ 94 ]. For middle to old-age women, health is a significant and prioritised facilitator to PA, such as maintaining health status, preventing diseases, or as an approach for rehabilitation. Health conditions such as physical limitation and fear of injury are also considered barriers to more vigorous PA. Young adult women, on the other hand, did not see health as the strongest facilitator and rarely reported health conditions as a barrier; instead, social-cultural reasons were perceived to be the main influences. One reason could be that people do not pay too much attention to health when they are in good status since the population in this review is healthy. In addition, another explanation could be that young adult woman is strongly affected by and intensively interact with societal and cultural contexts, which stimulates and cultivate acquire autonomy and keep building a sense of self [ 95 ]. Hence, they sense and realise social-cultural influences fall on their life heavily, which includes their choice and engagement in PA.

Different from older women, a considerable amount of young adult women stated that the body change goals such as weight control (mostly losing weight), getting in better shape, etc., at the intrapersonal level was the strongest motivation and facilitators for PA. This finding is consistent with mounting evidence that suggests that body dissatisfaction is normative and relatively stable across women’s lifespans [ 96 , 97 ]. The previous review found that body dissatisfaction was remarkably stable across the adult life span for women, at least until they were quite elderly, while the importance of body shape, weight and appearance decreased as women aged [ 96 ]. This may explain why body change was a strong facilitator, especially for young adult women. Additionally, social interaction, social culture, and health are all connected to women's irrational desire to alter their body image. For instance, the goal of body change for overweight women was frequently linked to health and social embarrassment of the body, while women with average weight also emphasised body image. More women today aspire to have the ideal body that conforms to cultural and social expectations of beauty and success in the West [ 45 , 97 , 98 ]. Young adult women are inexorably caught up in the chase of the perfect body, despite that some women also pointed out that this notion may not be realistic. It follows that, on the intrapersonal level, body image-oriented PA programs may be more attractive to young adult women. However, participation aimed at body transformation may not be long-lasting. It may come with adverse effects, so there is still a need for a more in-depth and holistic exploration of the relationship between young women regarding body beauty and health and exercise to find a balanced way to promote young adult women's participation in PA.

Research at the end of the last century suggested that one of the most challenging tasks for women was breaking gender stereotypes [ 1 ]. However, women are struggling with gender stereotypes and cultural norms regarding their roles and beauty after two decades. When a woman is mentioned, she is referred to first as a woman and then as a person. A man, on the other hand, is often regarded as a person first and a man second. Women face more environmental, cultural, and social barriers to PA than men. These challenges cannot be conquered only by women's resolution but by a joint effort. Most existing interventions continue to be situated on changes at the intrapersonal level. However, early research pointed out that proponents of individually oriented lifestyle behaviour change strategies were accused of supporting a victim-blaming ideology that serves as justification for retrenching rights and entitlements [ 36 ]. Most environmental toxins are dismissed with a wave of the hand, and it ignores the vital link between individual behaviour and social norms and rewards [ 35 ]. Thus, SEM was an appropriate tool to understand the juxtaposition between the individual and society and the subtle repercussions.

Young adult women’s barriers and facilitators to PA are complex and intertwined. Based on continuous education on personal behaviour change, what needs are progressive, large-scale, multilevel PA promotions in every dimension. Others and women must self-appreciate rather than exercise self-punitively to achieve an impossibly fashion-statement physique. Young adult women should first embrace PA, believing girls and women of all shapes and sizes deserve it [ 1 ] and that PA is beyond merely a means to achieve the ideal body and the consequent admiration. Since the environment and policies have a broad and profound impact on people, national policymakers should work closely with regional governments to support women's initiatives and opportunities for PA at a higher level. At the same time, it's important to note that increasing women's participation in PA won't happen overnight but rather via their continued commitment. Long-term tracking and gentled behaviour-changing approaches may have a more enduring influence than the efficient short-term program.

Strengths, limitations and recommendations

This review employed a widely applied framework, the SEM, to classify barriers and facilitators. Participants' narratives were then used to synthesise the interactions between various levels of outstanding barriers and facilitators. By doing so, this review highlighted barriers and facilitators of PA participation with contexts rather than only as isolated components. The synthesis shows that barriers and facilitators are complex and convertible rather than entirely distinct, revealing the complexity of real-life PA participation and people's attitude toward it. These findings can compensate for the gaps in quantitative research and reviews by providing in-context information. Generally, this review offers vital empirical and practical insights for research and PA interventions for young adult women.

This review has several limitations. The participants' sociodemographic information (including the area of residence, occupation, education level, and income) and PA level was extracted to be analysed during the data extraction process. Yet, the authors were unable to compare the participants' sociodemographics with their reported barriers and facilitators, such as urban and rural women, high-income and low-income women, etc., in a systematic way because only a small number of studies provided detailed and complete sociodemographics, many articles only provided partial or no such data. Moreover, reviewers could not distinguish precisely between the various PA levels and barriers and facilitators because so few publications described participants' daily PA levels. When applying PA strategies and interventions, the components are also crucial; in-depth research on these factors may be done in the future.

This qualitative synthesis revealed in-depth information on barriers and facilitators influencing young adult women’s PA. It highlights that the challenges young adult women face are diverse at different levels yet holistic and intertwined. Future studies of young adult women's targeted PA promotion initiatives should consider the SEM model as a holistic framework. The design and evaluation of upcoming effective programs should also leverage this paradigm, and qualitative study should be taken into account. To improve young adult women’s PA, only targeting personal behaviour change is not enough; organisations, communities, and policymakers must take action to provide opportunities for women’s PA at a higher level and broader range.

Availability of data and materials

All data generated and analysed during this study are included in this published article [and its supplementary files from Additional files 1 , 2 and 3 ].

Abbreviations

Critical Appraisal Skills Programme

World Health Organization

Self-determination theory

Physical education

Brehm BA, Iannotta JG. Women and physical activity: Active lifestyles enhance health and well-being. J Health Educ. 1998;29(2):89–92.

Article Google Scholar

Ahmed HM, Blaha MJ, Nasir K, Rivera JJ, Blumenthal RS. Effects of physical activity on cardiovascular disease. Am J Cardiol. 2012;109(2):288–95.

Article PubMed Google Scholar

Church TS, Earnest CP, Skinner JS, Blair SN. Effects of different doses of physical activity on cardiorespiratory fitness among sedentary, overweight or obese postmenopausal women with elevated blood pressure: a randomized controlled trial. JAMA. 2007;297(19):2081–91.

Article CAS PubMed Google Scholar

Diaz KM, Shimbo D. Physical activity and the prevention of hypertension. Curr Hypertens Rep. 2013;15(6):659–68.

Article PubMed PubMed Central Google Scholar

Dinas PC, Koutedakis Y, Flouris AD. Effects of exercise and physical activity on depression. Ir J Med Sci. 2011;180(2):319–25.

McTiernan A. Mechanisms linking physical activity with cancer. Nat Publ Group. 2008;8:205–11.

CAS Google Scholar

Kohl HW 3rd, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380(9838):294–305.

Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: A pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018;6(10):e1077–86.

Mielke GI, da Silva ICM, Kolbe-Alexander TL, Brown WJ. Shifting the physical inactivity curve worldwide by closing the gender gap. Sports Med. 2017;48(2):481–9.

World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020. World Health Organization; 2013.

The Lancet Public Health. Time to tackle the physical activity gender gap. Lancet Public Health. 2019;4(8):e360.

Rowland TW. The biological basis of physical activity. Med Sci Sports Exerc. 1998;30(3):392–9.

Whitbourne SK, Zuschlag MK, Elliot LB, Waterman AS. Psychosocial development in adulthood: A 22-year sequential study. J Pers Soc Psychol. 1992;63(2):260–71.

Erikson EH. Childhood and society. WW Norton & Company; 1993.

Arnett JJ. Learning to stand alone: The contemporary American transition to adulthood in cultural and historical context. Hum Dev. 1998;41(5–6):295–315.

Brown WJ, Trost SG. Life transitions and changing physical activity patterns in young women. Am J Prev Med. 2003;25(2):140–3.

Poobalan AS, Aucott LS, Precious E, Crombie IK, Smith WCS. Weight loss interventions in young people (18 to 25 year olds): A systematic review. Obes Rev. 2010;11(8):580–92.

Cleland C, Kearns A, Tannahill C, Ellaway A. The impact of life events on adult physical and mental health and well-being: Longitudinal analysis using the GoWell health and well-being survey. BMC Res Notes. 2016;9(1):470.

Allender S, Hutchinson L, Foster C. Life-change events and participation in physical activity: a systematic review. Health Promot Int. 2008;23(2):160–72.

Gropper H, John JM, Sudeck G, Thiel A. The impact of life events and transitions on physical activity: A scoping review. PLoS One. 2020;15(6):e0234794.

Bell S, Lee C. Emerging adulthood and patterns of physical activity among young Australian women. Int J Behav Med. 2005;12(4):227–35.

Ransdell LB, Vener JM, Sell K. International perspectives: The influence of gender on lifetime physical activity participation. J R Soc Promot Health. 2004;124(1):12–4.

Butler SM. How the health system overlooks young adults with chronic conditions. JAMA Health Forum. 2021;2(6):e211685.

Harris ML, Egan N, Forder PM, Loxton D. Increased chronic disease prevalence among the younger generation: Findings from a population-based data linkage study to inform chronic disease ascertainment among reproductive-aged Australian women. PloS One. 2021;16(8):e0254668.

Liu K, Daviglus ML, Loria CM, Colangelo LA, Spring B, Moller AC, et al. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age: The Coronary Artery Risk Development in (Young) Adults (CARDIA) study. Circulation. 2012;125(8):996–1004.

Chomistek AK, Chiuve SE, Eliassen AH, Mukamal KJ, Willett WC, Rimm EB. Healthy lifestyle in the primordial prevention of cardiovascular disease among young women. J Am Coll Cardiol. 2015;65(1):43–51.

Ryan RA, Lappen H, Bihuniak JD. Barriers and facilitators to healthy eating and physical activity postpartum: A qualitative systematic review. J Acad Nutr Diet. 2022;122(3):602–13.

Burse NR, Bhuiyan N, Mama SK, Schmitz KH. Physical activity barriers and resources among black women with a history of breast and endometrial cancer: A systematic review. J Cancer Surviv. 2020;14(4):556–77.

Babakus WS, Thompson JL. Physical activity among South Asian women: A systematic, mixed-methods review. Int J Behav Nutr Phys Act. 2012;9(1):1–18.

Rees R, Kavanagh J, Harden A, Shepherd J, Brunton G, Oliver S, et al. Young people and physical activity: A systematic review matching their views to effective interventions. Health Educ Res. 2006;21(6):806–25.

Mena GP, Mielke GI, Brown WJ. The effect of physical activity on reproductive health outcomes in young women: A systematic review and meta-analysis. Hum Reprod Update. 2019;25(5):542–64.

Jensen LA, Allen MN. Meta-synthesis of qualitative findings. Qual Health Res. 1996;6(4):553–60.

Tong A, Flemming K, McInnes E, Oliver S, Craig J. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol. 2012;12(1):1–8.

Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW, et al. Correlates of physical activity: why are some people physically active and others not? Lancet. 2012;380(9838):258–71.

Tesh S. Disease causality and politics. J Health Polit Policy Law. 1981;6(3):369–90.

McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.

Bronfenbrenner U. Ecological systems theory. Jessica Kingsley Publishers; 1992.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009; 339:b2535.

CASP C. CASP qualitative checklist. Critical Appraisal Skills Programme; 2018.

Long HA, French DP, Brooks JM. Optimising the value of the critical appraisal skills programme (CASP) tool for quality appraisal in qualitative evidence synthesis. Res Methods Med Health Sci. 2020;1(1):31–42.

Tod D. Conducting systematic reviews in sport, exercise, and physical activity. Springer Nature; 2019.

Grogan S. Body image: Understanding body dissatisfaction in men, women, and children. Routledge; 2021.

O'Dougherty M, Kurzer MS, Schmitz KH. Shifting motivations: Young women’s reflections on physical activity over time and across contexts. Health Educ Behav. 2010;37(4):547–67.

Sand A, Emaus N, Lian OS. Motivation and obstacles for weight management among young women – a qualitative study with a public health focus - the Tromsø study: Fit Futures. BMC Public Health. 2017;17:417.

Thompson JK, Stice E. Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Curr Dir Psychol Sci. 2001;10(5):181–3.

Jiwani N, Rail G. Islam, Hijab and Young Shia Muslim Canadian women’s discursive constructions of physical activity. Sociol Sport J. 2010;27(3):251–67.

Edmunds J, Ntoumanis N, Duda JL. Adherence and well-being in overweight and obese patients referred to an exercise on prescription scheme: A self-determination theory perspective. Psychol Sport Exerc. 2007;8(5):722–40.

Sabiston CM, McDonough MH, Sedgwick WA, Crocker PRE. Muscle gains and emotional strains: Conflicting experiences of change among overweight women participating in an exercise intervention program. Qual Health Res. 2009;19(4):466–80.

Mond J, Mitchison D, Latner J, Hay P, Owen C, Rodgers B. Quality of life impairment associated with body dissatisfaction in a general population sample of women. BMC Public Health. 2013;13:920.

Taranis L, Touyz S, Meyer C. Disordered eating and exercise: development and preliminary validation of the compulsive exercise test (CET). Eur Eat Disord Rev. 2011;19(3):256–68.

Ware LJ, PhD, Prioreschi A, PhD, Bosire E, MA, Cohen E, PhD, Draper CE, PhD, Lye SJ, PhD, et al. Environmental, Social, and Structural Constraints for Health Behavior: Perceptions of Young Urban Black Women During the Preconception Period—A Healthy Life Trajectories Initiative. J Nutr Educ Behav. 2019;51(8):946–57.

Myre M, Glenn NM, Berry TR. Exploring the impact of physical activity-related weight stigma among women with self-identified obesity. Qual Res Sport Exerc Health. 2021;13(4):586–603.

Crino ND, Parker HM, Gifford JA, Lau KYK, Greenfield EM, Donges CE, et al. Recruiting young women to weight management programs: Barriers and enablers. Nutr Diet. 2018;76(4):392.

Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiol. 2006;35(1):55–60.

Gard M, Wright J. The obesity epidemic: Science, morality and ideology. Routledge; 2005.

Bhatnagar P, Foster C, Shaw A. Barriers and facilitators to physical activity in second-generation British Indian women: A qualitative study. PloS One. 2021;16(11):e0259248.

D’alonzo KT, Fischetti N. Cultural beliefs and attitudes of Black and Hispanic college-age women toward exercise. J Transcult Nurs. 2008;19(2):175–83.

Parker S, Nichter M, Nichter M, Vuckovic N, Sims C, Ritenbaugh C. Body image and weight concerns among African American and White adolescent females: Differences that make a difference. Hum Organ. 1995;54(2):103–14.

Turner BS. The body and society: Explorations in social theory. Sage; 2008.

Shilling C. The body and social theory. Sage; 2012.

Featherstone M. Body modification: An introduction. Body Soc. 1999;5(2-3):1–13.

Wittels P, Mansfield L. Weight stigma, fat pedagogy and rediscovering the pleasures of movement: Experiencing physical activity and fatness in a public health weight management programme. Qual Res Sport Exerc Health. 2021;13(2):342–59.

Adelmann PK. Multiple roles and psychological well-being in a national sample of older adults. J Gerontol. 1994;49(6):S277–85.

Barnett RC, Hyde JS. Women, men, work, and family. Am Psychol. 2001;56(10):781–96

Weedon C. Feminist practice & poststructuralist theory. Wiley-Blackwell; 1996.

Petrassi D. ‘For me, the children come first’: A discursive psychological analysis of how mothers construct fathers’ roles in childrearing and childcare. Fem Psychol. 2012;22(4):518–27.

McGannon KR, Schinke RJ. “My first choice is to work out at work; then I don't feel bad about my kids”: A discursive psychological analysis of motherhood and physical activity participation. Psychol Sport Exerc. 2013;14(2):179–88.

Hamilton K, White KM. Identifying key belief-based targets for promoting regular physical activity among mothers and fathers with young children. J Sci Med Sport. 2011;14(2):135–42.

Alvarado M, Murphy MM, Guell C. Barriers and facilitators to physical activity amongst overweight and obese women in an Afro-Caribbean population: A qualitative study. Int J Behav Nutr Phys Act. 2015;12:97.

Sumra MK, Schillaci MA. Stress and the Multiple-Role Woman: Taking a Closer Look at the “Superwoman”. PloS One. 2015;10(3):e0120952.

Lansburgh F, Jacques-Aviñó C, Pons-Vigués M, Morgan R, Berenguera A. Time for themselves: Perceptions of physical activity among first and second-generation Pakistani women living in the Raval, Barcelona. Womens Health (Lond). 2022;18.

Caperchione C, Kolt GS, Tennent R, Mummery WK. Physical activity behaviours of Culturally and Linguistically Diverse (CALD) women living in Australia: A qualitative study of socio-cultural influences. BMC Public Health. 2011;11:26.

Dave SS, Craft LL, Mehta P, Naval S, Kumar S, Kandula NR. Life stage influences on US South Asian women's physical activity. Am J Health Promot. 2015;29(3):e100–8.

Ridgeway CL, Correll SJ. Motherhood as a status characteristic. J Soc Iss. 2004;60(4):683–700.

Roach C. Loving your mother: On the woman-nature relation. Hypatia. 1991;6(1):46-59.

Hrdy SB. Mother nature: A history of mothers, infants, and natural selection. Pantheon; 1999.

Almaqhawi A. Perceived barriers and facilitators of physical activity among Saudi Arabian females living in the East Midlands. J Taibah Univ Med Sci. 2021;17(3):384–91.

PubMed PubMed Central Google Scholar

Miles C, Benn T. A case study on the experiences of university-based Muslim women in physical activity during their studies at one UK higher education institution. Sport Educ Soc. 2016;21(5):723–40.

Nakamura Y. Beyond the hijab: Female Muslims and physical activity. Women Sport Phys Act J. 2002;11(2):21–48.

De Knop P, Theeboom M, Wittock H, De Martelaer K. Implications of Islam on Muslim girls' sport participation in Western Europe. Literature review and policy recommendations for sport promotion. Sport Educ Soc. 1996;1(2):147–64.

Yilmaz I. Muslim law in Britain: Reflections in the socio-legal sphere and differential legal treatment. J Muslim Minor Aff. 2000;20(2):353–60.

Walseth K, Strandbu Å. Young Norwegian-Pakistani women and sport. Eur Phy Educ Rev. 2014;20(4):489–507.

Vertinsky P, Batth I, Naidu M. Racism in motion: Sport, physical activity and the Indo-Canadian female. Avante. 1996;2(3):1–23.

Google Scholar

Walseth K. Young Muslim women and sport: The impact of identity work. Leis Stud. 2006;25(1):75–94.

Garrett R. Gendered bodies and physical identities. In Body Knowledge and Control. Routledge; 2004. p. 164–80.

Motherwell S. Are we nearly there yet? Exploring gender and active travel. Sustrans; 2018.

Wesely JK, Gaarder E. The gendered “Nature” of the urban outdoors: Women negotiating fear of violence. Gend Soc. 2004;18(5):645–63.

UN Women. Safe cities and safe public spaces: Global results report. UN Women; 2017.

Valentine G. The geography of women’s fear. Area. 1989;21(4):385–90.

Siefken K, Schofield G, Schulenkorf N. Laefstael Jenses: An investigation of barriers and facilitators for healthy lifestyles of women in an urban Pacific Island context. J Phys Act Health. 2014;11(1):30–7.

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31.

CAS PubMed PubMed Central Google Scholar

Engberg E, Alen M, Kukkonen-Harjula K, Peltonen JE, Tikkanen HO, Pekkarinen H. Life events and change in leisure time physical activity. Sports Med. 2012;42(5):433–47.

Brown WJ, Heesch KC, Miller YD. Life events and changing physical activity patterns in women at different life stages. Ann Behav Med. 2009;37(3):294–305.

Baert V, Gorus E, Mets T, Geerts C, Bautmans I. Motivators and barriers for physical activity in the oldest old: A systematic review. Ageing Res Rev. 2011;10(4):464–74.

Benson JE, Elder GH Jr. Young adult identities and their pathways: A developmental and life course model. Dev Psychol. 2011;47(6):1646–57.

Tiggemann M. Body image across the adult life span: Stability and change. Body Image. 2004;1(1):29–41.

Quittkat HL, Hartmann AS, Düsing R, Buhlmann U, Vocks S. Body dissatisfaction, importance of appearance, and body appreciation in men and women over the lifespan. Front Psychiatry. 2019;10:864.

Schwartz MB, Brownell KD. Obesity and body image. Body Image. 2004;1(1):43–56.

Download references

Acknowledgements

Not applicable.

Author information

Authors and affiliations.

Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China

Bo Peng & Amy S. Ha

Faculty of Education, The Chinese University of Hong Kong, Hong Kong, China

Johan Y. Y. Ng

You can also search for this author in PubMed Google Scholar

Contributions

BP was responsible for conceptualisation, primary searching and screening, data extraction, analysis, interpretation of data, writing original drafts, and substantive review and editing. JN was involved in screening, data extraction, and substantive critique and editing. AH was responsible for project administration, conceptualisation, and substantive review and editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amy S. Ha .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

12966_2023_1411_moesm1_esm.docx.

Additional file 1.

12966_2023_1411_MOESM2_ESM.xlsx

Additional file 2.

12966_2023_1411_MOESM3_ESM.xlsx

Additional file 3.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article.

Peng, B., Ng, J.Y.Y. & Ha, A.S. Barriers and facilitators to physical activity for young adult women: a systematic review and thematic synthesis of qualitative literature. Int J Behav Nutr Phys Act 20 , 23 (2023). https://doi.org/10.1186/s12966-023-01411-7

Download citation

Received : 02 August 2022

Accepted : 22 December 2022

Published : 27 February 2023

DOI : https://doi.org/10.1186/s12966-023-01411-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

International Journal of Behavioral Nutrition and Physical Activity

ISSN: 1479-5868

This paper is in the following e-collection/theme issue:

Published on 2.3.2023 in Vol 12 (2023)

This is a member publication of University of Strathclyde (Jisc)

Promoting Self-management and Patient Activation Through eHealth: Protocol for a Systematic Literature Review and Meta-analysis

Authors of this article:

1 School of Nursing, Faculty of Health, York University, Toronto, ON, Canada

2 University of Strathclyde, Glasgow, United Kingdom

3 Princess Margaret Cancer Centre, Toronto, ON, Canada

4 University of Toronto, Toronto, ON, Canada

5 Western University, London, ON, Canada

6 Shahid-Beheshti University of Medical Sciences, Tehran, Iran

Corresponding Author:

Roma Maguire, BSc, MSc, PhD

University of Strathclyde

Office 13.15 Livingston Tower

Email: [email protected]

Background: Major advances in different cancer treatment modalities have been made, and people are now living longer with cancer. However, patients with cancer experience a range of physical and psychological symptoms during and beyond cancer treatment. New models of care are needed to combat this rising challenge. A growing body of evidence supports the effectiveness of eHealth interventions in the delivery of supportive care to people living with the complexities of chronic health conditions. However, reviews on the effects of eHealth interventions are scarce in the field of cancer-supportive care, particularly for interventions with the aim of empowering patients to manage cancer treatment–related symptoms. For this reason, this protocol has been developed to guide a systematic review and meta-analysis to assess the effectiveness of eHealth interventions for supporting patients with cancer in managing cancer-related symptoms.

Objective: This systematic review with meta-analysis is conducted with the aim of identifying eHealth-based self-management intervention studies for adult patients with cancer and evaluating the efficacy of eHealth-based self-management tools and platforms in order to synthesize the empirical evidence on self-management and patient activation through eHealth.

Methods: A systematic review with meta-analysis and methodological critique of randomized controlled trials is conducted following Cochrane Collaboration methods. Multiple data sources are used to identify all potential research sources for inclusion in the systematic review: (1) electronic databases such as MEDLINE, (2) forward reference searching, and (3) gray literature. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting the review were followed. The PICOS (Population, Interventions, Comparators, Outcomes, and Study Design) framework is used to identify relevant studies.

Results: The literature search yielded 10,202 publications. The title and abstract screening were completed in May 2022. Data will be summarized, and if possible, meta-analyses will be performed. It is expected to finalize this review by Winter 2023.

Conclusions: The results of this systematic review will provide the latest data on leveraging eHealth interventions and offering effective and sustainable eHealth care, both of which have the potential to improve quality and efficiency in cancer-related symptoms.

Trial Registration: PROSPERO 325582; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=325582

International Registered Report Identifier (IRRID): DERR1-10.2196/38758

Introduction

The incidence of cancer is rising, and it is estimated that by 2040, globally, more than 28 million people will experience cancer as new cancer cases [ 1 ]. It is expected that nearly half of Canadians will develop cancer in their lifetimes [ 2 ]. The main goal of a cancer treatment program is to cure or considerably prolong the life of patients and to ensure the best possible quality of life for cancer survivors [ 3 ]. Major advances in different cancer treatment modalities (ie, surgery, chemotherapy, radiotherapy, hormonal therapy, and biological response modifiers) have been made, and people are now living longer with cancer than they were in the past [ 3 - 5 ]. However, patients with cancer experience from a range of physical and psychological symptoms during their cancer journey. These symptoms are either directly related to the adverse effects of cancer or arise from the different types of treatments and may range from mild and temporary to severe, chronic, and life-threatening [ 6 ]. Moreover, symptoms impact daily physical function and can lead to or exacerbate psychological distress and worse health-related quality of life [ 7 , 8 ].

Globally, there is recognition that patients benefit from being actively engaged in their own health [ 9 ]. Active engagement of patients is considered critical to minimize the consequences of disease in daily living, support a better quality of life [ 10 ], and reduce health care costs [ 9 ].

eHealth interventions could potentially enhance the clinical, organizational, and relational aspects of care by integrating patient databases for individualized treatment and real-time decision support. Moreover, it has been reported that electronic technology, by identifying decision support, care coordination, and continuity of care, could improve cancer care delivery [ 11 ]. This approach can empower patients to manage their symptoms, improve patient-professional interactions, prevent unplanned hospital admissions, and reduce health care costs [ 12 , 13 ]. Additionally, for nurses, working with innovations such as mobile health (mHealth) in practice is becoming essential as it may facilitate the provision of quality care [ 14 ].

Even though there is empirical evidence that substantiates the role of eHealth interventions in the delivery of supportive care to people living with the complexities of chronic health conditions [ 15 - 19 ], the effects of eHealth interventions specifically designed for supporting patients with cancer to manage cancer-related symptoms and the effects on outcomes, that is, symptom burden, are less clear [ 20 , 21 ].

Reviews on the effects of eHealth interventions are scarce in the field of cancer supportive care, particularly for interventions to increase patient activation and empower patients to self-manage cancer-related symptoms. There is substantial evidence that patients who have the appropriate information and skills are more likely to engage actively in their care and effectively manage the consequences of treatment, including their physical and psychological symptoms [ 13 , 22 ]. Furthermore, information on how these interventions were planned and carried out and who benefited from these approaches is still required [ 23 ].

We propose to conduct a systematic review with meta-analysis and methodological critique of the literature to answer the following PICO (Population, Intervention, Comparison, Outcomes) research question: What is the efficacy in cancer populations (population: any phase of cancer, treatment, survivorship, palliative, and end of life care) of eHealth interventions (intervention) compared to usual care or other active intervention (comparison) on symptom severity, psychological distress, self-management behaviors, health outcomes, and health use (emergency department use, unplanned visits to the health care provider, hospitalization, patient activation, and patient empowerment; outcomes).

This review aims to explore usage and effectiveness of eHealth interventions designed to support patients with cancer in managing cancer-related symptoms and the effects on outcomes. The findings could inform and promote evidence-informed oncology practice for eHealth interventions targeted at cancer and advance science in the field.

This systematic review to identify randomized controlled trials (RCTs) and meta-analyses follows methods as specified by the Cochrane Collaboration [ 24 ] and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (see Figure 1 ) [ 25 ]. A broad search to identify trial evidence for eHealth interventions to empower cancer patients to manage their symptoms, increase patient activation, and improve patient-professional interactions will be conducted. We posed the following specific research questions.

Primary Research Question

Are eHealth interventions (or programs) effective in reducing the physical or psychological effects of cancer and its treatment or improving other health outcomes (ie, function, health-related quality of life, health use, or costs) compared with usual care or other active treatment?

Secondary Research Questions

Does effectiveness (effect sizes [ESs]) of eHealth interventions (or programs) differ by patient or disease characteristics (age, race or ethnicity, education, cancer type, stage or phase in trajectory, treatment modality, or other antecedent personality variables such as optimism or trait anxiety), that is, effect modifiers?

Does effectiveness (ESs) of eHealth interventions (or programs) differ based on intervention design (delivery setting) or methods (eHealth-based self-management tools and platforms), training and qualities of the interventionist, intervention components, length of the intervention, or other potential mediators, that is, adherence to the intervention?

Literature Search Strategy

Search Terms

The search for eligible studies will include search terms: self-manage* or “self-manage*” or self-car* or “self-care*”, behave* or cognitive* or train* or instruct* or patient education or “patient education” or “management plan*” or “management program* (AND) ehealth* or mHealth* or “mobile Health*” or Telehealth* (AND) terms for neoplasms, cancers, or cancer symptoms (fatigue, nausea or vomiting, pain, depression, anxiety, insomnia) and sensitive search terms for identifying randomized trials as subject headings specified by Cochrane [ 27 ]. The initial search strategy will be developed in MEDLINE ( Multimedia Appendix 1 ) and will be adapted for all other databases.

Types of Studies

Eligible studies will be identified based on the inclusion or exclusion criteria described below.

Inclusion Criteria

The following inclusion criteria were used:

Exclusion Criteria

The following exclusion criteria were used:

Types of Outcome Measures

Primary outcomes.

We will be studying the following primary outcomes:

Secondary Outcomes

We will be studying the following secondary outcomes:

Selection of Studies

Studies will be selected using Covidence software based on a review of the title, keywords, and abstract and coded using the following criteria: (1) include: an RCT, with a focus on cancer patient activation or self-management; (2) exclude: no self-management focus. Selecting studies includes these steps: (1) using a reference management software to merge search results and remove duplicates; (2) examine all titles initially to remove articles that are clearly not eHealth, followed by an abstract review (if there is any uncertainty, the abstract is included for a full text review); and (3) retrieve the full study reports and assess compliance with eligibility criteria independently by 2 reviewers. Agreement will be examined using interrater agreement (<75 nonagreement); disagreements will be resolved by consensus or in consultation with a third reviewer. Authors| will clarify study eligibility criteria or missing data results if necessary. Interventions with more than 1 article will also be retrieved and reviewed to complement the data abstraction and quality assessment of the study ( Multimedia Appendix 2 ).

Data Abstraction and Management

Data will be abstracted using a data abstraction form developed for the review based on Cochrane methods. Data abstraction is independently assessed by 2 reviewers with reliability of coding assessed by computing Kappa, or percentage agreement, for categorical data and the intraclass correlation for continuous data. If any aspect of the study design and conduct is unclear, the study authors will be contacted to complete data abstraction. Two other review authors will check a random sample of the abstractions. Disagreements will be resolved by discussion, with arbitration by a third author if necessary, following an independent review of the study report in question. The data abstraction form will be pretested on a minimum of 5 studies. The abstracted data will include categories as per Cochrane: (1) source and setting; (2) methods; (3) participants; (4) experimental interventions (extent to which specific intervention components delivered as described [adherence]; number, length, and frequency of implementation of intervention components; and characteristics of the interventionists); (5) control treatment; (6) analysis; (7) adverse events; (8) outcome measures; (9) results; (10) conclusions of study authors; and (11) miscellaneous, that is, funding sources.

Assessment of Study Quality

A quality assessment will be performed by 2 review authors and checked by another author. A methodological quality assessment of studies will be conducted based on an adapted version of the Cochrane Collaboration Back Review Group criteria [ 28 ], which were previously used in other systematic reviews of internet-based interventions [ 29 , 30 ]. The Cochrane criteria was modified to better suit the type of examined studies: specification of eligibility criteria, randomized groups, treatment allocation concealed, groups similar at baseline, explicit description of interventions, description of compliance, description of dropout and comparison with completers, long-term follow-up (>3 months after postintervention assessment), timing of outcome assessment comparable, sample size described with power calculation, intention-to-treat analyses, and point estimates and measures of variability. The quality score could range from 0 to 12 points. For each study, all criteria will be scored as yes, no, or unclear, resulting in a maximum quality score of 12. In line with other researchers [ 29 - 31 ], studies obtaining at least two-thirds of the total score (ie, ≥8 points) will be considered high quality. Studies scoring 4 to 7 points will be rated as moderate quality, and studies scoring lower than 4 points will be rated as low quality.

Authors will be contacted with 2 reminders to complete missing data. Reviewers will be blinded to the authors of study reports. For each of these potential sources of bias, a judgment of yes (low risk of bias), no (high risk of bias), or unclear is assigned to each study (number of yeses is the single score or study). A summary table of the risk of bias across studies will be developed for reporting purposes.

Data Analysis and ES Calculation

Outcomes will be analyzed as continuous or dichotomous variables depending on data reporting using standard statistical techniques. For continuous data (ie, symptom severity), a standardized mean difference with 95% CIs will be calculated as appropriate to facilitate comparison between intervention and controls with correction for differences in the direction of the scale. If reported as medians with ranges, means and SDs will be calculated [ 32 ]. For dichotomous outcomes, a relative risk ratio with 95% CIs is calculated.

Assessment of Heterogeneity

As per Cochrane, clinical heterogeneity (variability in the participants, interventions, and outcomes) [ 33 , 34 ] will be examined using the “I” squared statistic [ 35 ]. Random effects meta-analysis will be used if heterogeneity across studies cannot be explained; otherwise, a fixed-effects model will be used [ 33 , 36 ].

Subgroup Analysis

The following subgroup analysis will be conducted if the number of studies available for the analysis is adequate (10 studies for each characteristic modeled by participant characteristics and intervention components) as described below and based on the research questions posed:

Measurement of Treatment Effects and ES Calculation

A summary of findings table will be completed to synthesize the reporting of common primary outcomes: physical effects (function and symptoms), psychological effects (depression, anxiety, and health distress), and secondary outcomes (quality of life, health care use, and satisfaction) using the GRADEpro software. ES computations will be calculated using Hedges g . [ 37 ]. Where g cannot be computed directly from means and SDs based on the source paper, it will be computed indirectly from the available test statistics, for example, t, based on Rosenthal [ 38 ]. The estimates of g will be corrected for small-sample bias [ 37 ]. Given that outcomes could be differentially effective over different dimensions, particularly for symptoms, separate analyses for comparison, that is, physical symptoms (pain, fatigue, nausea or vomiting, insomnia), psychological symptoms (depression, anxiety, health distress), and separately for quality of life and use of health care services, will be conducted. For studies where a primary outcome is possible for the main analysis, this will require the identification of a primary outcome.

Sensitivity Analysis

A sensitivity analysis will be conducted to evaluate the robustness of the meta-analysis, that is, the effects of methodological quality on study outcomes, by assessing for associations between individual items in the methodological quality checklist and the study outcomes. When data can be pooled, sensitivity analysis will be conducted by pooling the “yes” versus “no” responses to risk. When the data cannot be pooled, the sensitivity analysis will be performed using a chi-square analysis as per Cochrane.

The literature search and data collection started in October 2017, after making a work plan to design and run the systematic search strategies in databases and the timeframe for delivery of the search results with the Library and Information Services within the University Health Network. However, to provide a comprehensive snapshot of knowledge since the time of incorporation of data from studies identified during the first search, a second literature search was conducted in February 2022 to ensure new studies were included and increase the validity of the review. The literature search yielded a total of 10,202 publications. Data will be summarized, and if possible, meta-analyses will be performed to evaluate the effectiveness of eHealth interventions on the outcomes. Results are expected to be published in winter 2023.

Recent literature has highlighted the utility of eHealth interventions with promising outcomes in cancer care, although mixed and inconclusive results were also presented [ 39 ]. The main contributions to this review will be the following: the use and effectiveness of eHealth interventions for supporting patients with cancer in managing cancer-related symptoms; identifying the key implications for better design, integration, and implementation that may have important effects on intervention outcomes; and a discussion, based on the data synthesized, on current gaps and limitations to inform better research toward all phases of development and evaluation of these interventions. Therefore, we will provide essential information for developing and implementing these interventions into clinical practice by providing recommendations based on the current best available evidence. The evaluation of the interventions might be limited by explicitly reporting the interventions. Any modifications or revisions made to the protocol will be presented in the final reports .

Acknowledgments

This work is financially supported in part by funding from the Canadian Association of Nurses in Oncology/Association canadienne des infirmières en oncologie (CANO/ACIO) Research Grant Award and York University.

Conflicts of Interest

MB has served an advisory role to Merck, Bristol-Myeers Squib, Novartis, GSK, Sun Pharma, Pfizer, Immunocore, Medison, IDEAYA, Instil Bio, and IOVANCE. He has received grant funding from Merck, Takara Bio, and Novartis. He has served on a safety review committee for Adaptimmune and GSK. He has received financial support for lectures from Merck, BMS, Novartis, Sanofi, and Pfizer.

Ovid MEDLINE search history.

Data abstraction form.

Abbreviations

Edited by A Mavragani; submitted 17.08.22; peer-reviewed by Z Fu, N Winter; comments to author 19.10.22; revised version received 13.11.22; accepted 06.12.22; published 02.03.23

©Saeed Moradian, Roma Maguire, Geoffrey Liu, Monika K Krzyzanowska, Marcus Butler, Chantal Cheung, Marisa Signorile, Nancy Gregorio, Shiva Ghasemi, Doris Howell. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 02.03.2023.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

IMAGES

Write Online: Literature Review Writing Guide
FADIC Calender
Systematic Literature Review Process
Image result for systematic literature review AsterWrite www.ict-m.com
Systematic literature review
🎉 The review of literature for research. Role of the literature review. 2019-01-28

VIDEO

What is Literature Review?
Systematic Literature Review
How to write Literature review in Research?| Important Tips and Examples
How to write literature review of a research
cara install endnote X9
Intro to Research Dissertation and a guide for literature review

COMMENTS

Systematic Review
Systematic review vs. literature review A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method.
How to Do a Systematic Review: A Best Practice Guide for ...
Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of e …
A Research Guide for Systematic Literature Reviews
Creating a systematic review protocol is an important step in the planning process for your review. A review protocol is beneficial for a number of reasons: It helps to ensure that all team members are on the same page when it comes to the research question, inclusion/exclusion criteria, etc.
Literature Review: Systematic literature reviews
A systematic literature review (SLR) identifies, selects and critically appraises research in order to answer a clearly formulated question (Dewey, A. & Drahota, A. 2016). The systematic review should follow a clearly defined protocol or plan where the criteria is clearly stated before the review is conducted.
Steps of a Systematic Review
A 24-step guide on how to design, conduct, and successfully publish a systematic review and meta-analysis in medical research. European Journal of Epidemiology, 35 (1), 49-60. Choi, A. R., Cheng, D. L., & Greenberg, P. B. (2019). Twelve tips for medical students to conduct a systematic review. Medical Teacher, 41 (4), 471-475.
Literature review as a research methodology: An ...
A systematic review can be explained as a research method and process for identifying and critically appraising relevant research, as well as for collecting and analyzing data from said research ( Liberati et al., 2009 ).
SJSU Research Guides: Literature Review vs Systematic Review
Definitions It's common to confuse systematic and literature reviews because both are used to provide a summary of the existent literature or research on a specific topic. Regardless of this commonality, both types of review vary significantly.
Systematic Review of the Literature: Best Practices
Among the various types of reviews, the systematic review of the literature is ranked as the most rigorous since it is a high-level summary of existing … Acad Radiol . 2018 Nov;25(11):1481-1490. doi: 10.1016/j.acra.2018.04.025.
Literature Review, Systematic Review and Meta-analysis
Systematic review is a type of literature review that uses systematic methods to collect secondary data, critically appraise research studies, and synthesise findings. Systematic reviews are designed to provide a comprehensive, exhaustive summary of current theories and/or evidence and published research (Siddaway, Wood & Hedges, 2019) and may ...
What is a Literature Review?
Literature Review is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.
Research Guides: Systematic Reviews: Types of Literature Reviews
Research Guides Systematic Reviews What Makes a Systematic Review Different from Other Types of Reviews? Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91-108. doi:10.1111/j.1471-1842.2009.00848.x Last Updated:
Writing a Literature Review
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).
Steps in Conducting a Literature Review
A literature review is an integrated analysis-- not just a summary-- of scholarly writings and other relevant evidence related directly to your research question.That is, it represents a synthesis of the evidence that provides background information on your topic and shows a association between the evidence and your research question.
PDF SYSTEMATIC LITERATURE REVIEWS: AN INTRODUCTION
Literature reviews and evidence syntheses are important research products that help us advance science incrementally, by building on previous results. In the past two decades, health sciences have been developing a distinctive approach to this process: the systematic literature reviews (SR).
How-to conduct a systematic literature review: A quick guide for
Method details Overview. A Systematic Literature Review (SLR) is a research methodology to collect, identify, and critically analyze the available research studies (e.g., articles, conference proceedings, books, dissertations) through a systematic procedure [12].An SLR updates the reader with current literature about a subject [6].The goal is to review critical points of current knowledge on a ...
How to write a systematic literature review
A classic systematic literature review can take different approaches: Effectiveness reviews assess the extent to which a medical intervention or therapy achieves its intended effect. They're the most common type of systematic literature review.
How to 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. Free lecture slides. Frequently asked questions. Introduction.
From invitation to destination: A systematic literature review of the
Applying a systematic literature review process, this paper examines existing empirical research on the use of picturebooks in formal inquiry-based education contexts. The analysis considers the context in which the picturebooks were used, including curriculum context and class level, the role played by the picturebooks in the inquiries and the ...
(PDF) Knowledge Management Factors and Its Impact on Organizational
This study was based on the Systematic Literature Review (SLR), which includes 37 articles published from 2016 to 2021. ... This research encourages the managers and employees of organizations to ...
Systematic Literature Review
A systematic literature review of green construction project financing was conducted. Beyond looking at the research findings obtained in academia, an assessment of the policies and practices implemented by the authorities and industry was undertaken.
What is a systematic review?
A systematic review is a complex piece of research that aims to identify, select and synthesise all research published on a particular question or topic. Systematic reviews adhere to a strict scientific design based on pre-specified and reproducible methods. They provide reliable estimates about the effects of interventions.
Systematic Literature Review or Literature Review?
The difference between literature review and systematic review comes back to the initial research question. Whereas the systematic review is very specific and focused, the standard literature review is much more general. The components of a literature review, for example, are similar to any other research paper.
Climate change reporting: a systematic literature review
A systematic review was applied, and literature from Google, Google Scholar, and PubMed, as well as relevant gray literature from 2014-2022 were reviewed. Out of 854 identified sources, 24 were ...
Research Criteria for the Behavioral Variant of Alzheimer Disease
Objective To perform a systematic review and meta-analysis of the bvAD literature and use the outcomes to propose research criteria for this syndrome. Data Sources A systematic literature search in PubMed/MEDLINE and Web of Science databases (from inception through April 7, 2021) was performed in duplicate.
What are systematic reviews?
Systematic reviews are a type of literature review of research which require equivalent standards of rigour as primary research. They have a clear, logical rationale that is reported to the reader of the review. They are used in research and policymaking to inform evidence-based decisions and practice. They differ from traditional literature ...
[Solved] SYSTEMATIC LITERATURE REVIEW: PART 3...
SYSTEMATIC LITERATURE REVIEW: PART 3 ANNOTATED BIBLIOGRAPHY ASSIGNMENT. Citations APA format: Develop an annotated bibliography of the 50 sources collected from the Systematic Literature Review: Part 2 - References List Assignment below: That provides a narrative account for each source identified in the reference list: the nature of the study, the methodology, and the findings generated.
Barriers and facilitators to physical activity for young adult women: a
The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [] and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines [].A protocol for this review was published in PROSPERO (registration number: CRD42021290519).
Deeper than Wordplay: A Systematic Review of Critical Quantitative
The purpose of our systematic literature review is twofold: (a) to understand how critical approaches to quantitative inquiry emerged as a new paradigm within quantitative methods and (b) whether there is any distinction between quantitative criticalism, QuantCrit, and critical quantitative inquiries or simply interchangeable wordplay.
Preparing Mental Health Professionals to Work With Survivors of
Research has revealed a direct link between experiencing IPV and having adverse physical, me... Preparing Mental Health Professionals to Work With Survivors of Intimate Partner Violence: A Comprehensive Systematic Review of the Literature - Amber Sutton, Haley Beech, Burcu Ozturk, Debra Nelson-Gardell, 2021
JMIR Research Protocols
Multiple data sources are used to identify all potential research sources for inclusion in the systematic review: (1) electronic databases such as MEDLINE, (2) forward reference searching, and (3) gray literature. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting the review were followed.