it skills literature review

What is a Literature Review? How to Write It (with Examples)

A literature review is a critical analysis and synthesis of existing research on a particular topic. It provides an overview of the current state of knowledge, identifies gaps, and highlights key findings in the literature. 1 The purpose of a literature review is to situate your own research within the context of existing scholarship, demonstrating your understanding of the topic and showing how your work contributes to the ongoing conversation in the field. Learning how to write a literature review is a critical tool for successful research. Your ability to summarize and synthesize prior research pertaining to a certain topic demonstrates your grasp on the topic of study, and assists in the learning process. 

Table of Contents

• What is the purpose of literature review? 
• a. Habitat Loss and Species Extinction: 
• b. Range Shifts and Phenological Changes: 
• c. Ocean Acidification and Coral Reefs: 
• d. Adaptive Strategies and Conservation Efforts: 
• How to write a good literature review 
• Choose a Topic and Define the Research Question: 
• Decide on the Scope of Your Review: 
• Select Databases for Searches: 
• Conduct Searches and Keep Track: 
• Review the Literature: 
• Organize and Write Your Literature Review: 
• Frequently asked questions 

What is a literature review?

A well-conducted literature review demonstrates the researcher’s familiarity with the existing literature, establishes the context for their own research, and contributes to scholarly conversations on the topic. One of the purposes of a literature review is also to help researchers avoid duplicating previous work and ensure that their research is informed by and builds upon the existing body of knowledge.

What is the purpose of literature review?

A literature review serves several important purposes within academic and research contexts. Here are some key objectives and functions of a literature review: 2  

• Contextualizing the Research Problem: The literature review provides a background and context for the research problem under investigation. It helps to situate the study within the existing body of knowledge. 
• Identifying Gaps in Knowledge: By identifying gaps, contradictions, or areas requiring further research, the researcher can shape the research question and justify the significance of the study. This is crucial for ensuring that the new research contributes something novel to the field. 
• Understanding Theoretical and Conceptual Frameworks: Literature reviews help researchers gain an understanding of the theoretical and conceptual frameworks used in previous studies. This aids in the development of a theoretical framework for the current research. 
• Providing Methodological Insights: Another purpose of literature reviews is that it allows researchers to learn about the methodologies employed in previous studies. This can help in choosing appropriate research methods for the current study and avoiding pitfalls that others may have encountered. 
• Establishing Credibility: A well-conducted literature review demonstrates the researcher’s familiarity with existing scholarship, establishing their credibility and expertise in the field. It also helps in building a solid foundation for the new research. 
• Informing Hypotheses or Research Questions: The literature review guides the formulation of hypotheses or research questions by highlighting relevant findings and areas of uncertainty in existing literature. 

Literature review example

Let’s delve deeper with a literature review example: Let’s say your literature review is about the impact of climate change on biodiversity. You might format your literature review into sections such as the effects of climate change on habitat loss and species extinction, phenological changes, and marine biodiversity. Each section would then summarize and analyze relevant studies in those areas, highlighting key findings and identifying gaps in the research. The review would conclude by emphasizing the need for further research on specific aspects of the relationship between climate change and biodiversity. The following literature review template provides a glimpse into the recommended literature review structure and content, demonstrating how research findings are organized around specific themes within a broader topic. 

Literature Review on Climate Change Impacts on Biodiversity:

Climate change is a global phenomenon with far-reaching consequences, including significant impacts on biodiversity. This literature review synthesizes key findings from various studies: 

a. Habitat Loss and Species Extinction:

Climate change-induced alterations in temperature and precipitation patterns contribute to habitat loss, affecting numerous species (Thomas et al., 2004). The review discusses how these changes increase the risk of extinction, particularly for species with specific habitat requirements. 

b. Range Shifts and Phenological Changes:

Observations of range shifts and changes in the timing of biological events (phenology) are documented in response to changing climatic conditions (Parmesan & Yohe, 2003). These shifts affect ecosystems and may lead to mismatches between species and their resources. 

c. Ocean Acidification and Coral Reefs:

The review explores the impact of climate change on marine biodiversity, emphasizing ocean acidification’s threat to coral reefs (Hoegh-Guldberg et al., 2007). Changes in pH levels negatively affect coral calcification, disrupting the delicate balance of marine ecosystems. 

d. Adaptive Strategies and Conservation Efforts:

Recognizing the urgency of the situation, the literature review discusses various adaptive strategies adopted by species and conservation efforts aimed at mitigating the impacts of climate change on biodiversity (Hannah et al., 2007). It emphasizes the importance of interdisciplinary approaches for effective conservation planning. 

How to write a good literature review

Writing a literature review involves summarizing and synthesizing existing research on a particular topic. A good literature review format should include the following elements. 

Introduction: The introduction sets the stage for your literature review, providing context and introducing the main focus of your review. 

• Opening Statement: Begin with a general statement about the broader topic and its significance in the field. 
• Scope and Purpose: Clearly define the scope of your literature review. Explain the specific research question or objective you aim to address. 
• Organizational Framework: Briefly outline the structure of your literature review, indicating how you will categorize and discuss the existing research. 
• Significance of the Study: Highlight why your literature review is important and how it contributes to the understanding of the chosen topic. 
• Thesis Statement: Conclude the introduction with a concise thesis statement that outlines the main argument or perspective you will develop in the body of the literature review. 

Body: The body of the literature review is where you provide a comprehensive analysis of existing literature, grouping studies based on themes, methodologies, or other relevant criteria. 

• Organize by Theme or Concept: Group studies that share common themes, concepts, or methodologies. Discuss each theme or concept in detail, summarizing key findings and identifying gaps or areas of disagreement. 
• Critical Analysis: Evaluate the strengths and weaknesses of each study. Discuss the methodologies used, the quality of evidence, and the overall contribution of each work to the understanding of the topic. 
• Synthesis of Findings: Synthesize the information from different studies to highlight trends, patterns, or areas of consensus in the literature. 
• Identification of Gaps: Discuss any gaps or limitations in the existing research and explain how your review contributes to filling these gaps. 
• Transition between Sections: Provide smooth transitions between different themes or concepts to maintain the flow of your literature review. 

Conclusion: The conclusion of your literature review should summarize the main findings, highlight the contributions of the review, and suggest avenues for future research. 

• Summary of Key Findings: Recap the main findings from the literature and restate how they contribute to your research question or objective. 
• Contributions to the Field: Discuss the overall contribution of your literature review to the existing knowledge in the field. 
• Implications and Applications: Explore the practical implications of the findings and suggest how they might impact future research or practice. 
• Recommendations for Future Research: Identify areas that require further investigation and propose potential directions for future research in the field. 
• Final Thoughts: Conclude with a final reflection on the importance of your literature review and its relevance to the broader academic community. 

Conducting a literature review

Conducting a literature review is an essential step in research that involves reviewing and analyzing existing literature on a specific topic. It’s important to know how to do a literature review effectively, so here are the steps to follow: 1  

Choose a Topic and Define the Research Question:

• Select a topic that is relevant to your field of study. 
• Clearly define your research question or objective. Determine what specific aspect of the topic do you want to explore? 

Decide on the Scope of Your Review:

• Determine the timeframe for your literature review. Are you focusing on recent developments, or do you want a historical overview? 
• Consider the geographical scope. Is your review global, or are you focusing on a specific region? 
• Define the inclusion and exclusion criteria. What types of sources will you include? Are there specific types of studies or publications you will exclude? 

Select Databases for Searches:

• Identify relevant databases for your field. Examples include PubMed, IEEE Xplore, Scopus, Web of Science, and Google Scholar. 
• Consider searching in library catalogs, institutional repositories, and specialized databases related to your topic. 

Conduct Searches and Keep Track:

• Develop a systematic search strategy using keywords, Boolean operators (AND, OR, NOT), and other search techniques. 
• Record and document your search strategy for transparency and replicability. 
• Keep track of the articles, including publication details, abstracts, and links. Use citation management tools like EndNote, Zotero, or Mendeley to organize your references. 

Review the Literature:

• Evaluate the relevance and quality of each source. Consider the methodology, sample size, and results of studies. 
• Organize the literature by themes or key concepts. Identify patterns, trends, and gaps in the existing research. 
• Summarize key findings and arguments from each source. Compare and contrast different perspectives. 
• Identify areas where there is a consensus in the literature and where there are conflicting opinions. 
• Provide critical analysis and synthesis of the literature. What are the strengths and weaknesses of existing research? 

Organize and Write Your Literature Review:

• Literature review outline should be based on themes, chronological order, or methodological approaches. 
• Write a clear and coherent narrative that synthesizes the information gathered. 
• Use proper citations for each source and ensure consistency in your citation style (APA, MLA, Chicago, etc.). 
• Conclude your literature review by summarizing key findings, identifying gaps, and suggesting areas for future research. 

The literature review sample and detailed advice on writing and conducting a review will help you produce a well-structured report. But remember that a literature review is an ongoing process, and it may be necessary to revisit and update it as your research progresses. 

Frequently asked questions

A literature review is a critical and comprehensive analysis of existing literature (published and unpublished works) on a specific topic or research question and provides a synthesis of the current state of knowledge in a particular field. A well-conducted literature review is crucial for researchers to build upon existing knowledge, avoid duplication of efforts, and contribute to the advancement of their field. It also helps researchers situate their work within a broader context and facilitates the development of a sound theoretical and conceptual framework for their studies.

Literature review is a crucial component of research writing, providing a solid background for a research paper’s investigation. The aim is to keep professionals up to date by providing an understanding of ongoing developments within a specific field, including research methods, and experimental techniques used in that field, and present that knowledge in the form of a written report. Also, the depth and breadth of the literature review emphasizes the credibility of the scholar in his or her field.  

Before writing a literature review, it’s essential to undertake several preparatory steps to ensure that your review is well-researched, organized, and focused. This includes choosing a topic of general interest to you and doing exploratory research on that topic, writing an annotated bibliography, and noting major points, especially those that relate to the position you have taken on the topic. 

Literature reviews and academic research papers are essential components of scholarly work but serve different purposes within the academic realm. 3 A literature review aims to provide a foundation for understanding the current state of research on a particular topic, identify gaps or controversies, and lay the groundwork for future research. Therefore, it draws heavily from existing academic sources, including books, journal articles, and other scholarly publications. In contrast, an academic research paper aims to present new knowledge, contribute to the academic discourse, and advance the understanding of a specific research question. Therefore, it involves a mix of existing literature (in the introduction and literature review sections) and original data or findings obtained through research methods. 

Literature reviews are essential components of academic and research papers, and various strategies can be employed to conduct them effectively. If you want to know how to write a literature review for a research paper, here are four common approaches that are often used by researchers.  Chronological Review: This strategy involves organizing the literature based on the chronological order of publication. It helps to trace the development of a topic over time, showing how ideas, theories, and research have evolved.  Thematic Review: Thematic reviews focus on identifying and analyzing themes or topics that cut across different studies. Instead of organizing the literature chronologically, it is grouped by key themes or concepts, allowing for a comprehensive exploration of various aspects of the topic.  Methodological Review: This strategy involves organizing the literature based on the research methods employed in different studies. It helps to highlight the strengths and weaknesses of various methodologies and allows the reader to evaluate the reliability and validity of the research findings.  Theoretical Review: A theoretical review examines the literature based on the theoretical frameworks used in different studies. This approach helps to identify the key theories that have been applied to the topic and assess their contributions to the understanding of the subject.  It’s important to note that these strategies are not mutually exclusive, and a literature review may combine elements of more than one approach. The choice of strategy depends on the research question, the nature of the literature available, and the goals of the review. Additionally, other strategies, such as integrative reviews or systematic reviews, may be employed depending on the specific requirements of the research.

The literature review format can vary depending on the specific publication guidelines. However, there are some common elements and structures that are often followed. Here is a general guideline for the format of a literature review:  Introduction:   Provide an overview of the topic.  Define the scope and purpose of the literature review.  State the research question or objective.  Body:   Organize the literature by themes, concepts, or chronology.  Critically analyze and evaluate each source.  Discuss the strengths and weaknesses of the studies.  Highlight any methodological limitations or biases.  Identify patterns, connections, or contradictions in the existing research.  Conclusion:   Summarize the key points discussed in the literature review.  Highlight the research gap.  Address the research question or objective stated in the introduction.  Highlight the contributions of the review and suggest directions for future research.

Both annotated bibliographies and literature reviews involve the examination of scholarly sources. While annotated bibliographies focus on individual sources with brief annotations, literature reviews provide a more in-depth, integrated, and comprehensive analysis of existing literature on a specific topic. The key differences are as follows: 

References 

• Denney, A. S., & Tewksbury, R. (2013). How to write a literature review.  Journal of criminal justice education ,  24 (2), 218-234. 
• Pan, M. L. (2016).  Preparing literature reviews: Qualitative and quantitative approaches . Taylor & Francis. 
• Cantero, C. (2019). How to write a literature review.  San José State University Writing Center . 

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Try it for free or upgrade to  Paperpal Prime , which unlocks unlimited access to premium features like academic translation, paraphrasing, contextual synonyms, consistency checks and more. It’s like always having a professional academic editor by your side! Go beyond limitations and experience the future of academic writing.  Get Paperpal Prime now at just US$19 a month!

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• Empirical Research: A Comprehensive Guide for Academics 
• How to Write a Scientific Paper in 10 Steps 
• Life Sciences Papers: 9 Tips for Authors Writing in Biological Sciences
• What is an Argumentative Essay? How to Write It (With Examples)

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International Conference on Software Process Improvement

CIMPS 2017: Trends and Applications in Software Engineering pp 147–158 Cite as

Soft Skills for IT Project Success: A Systematic Literature Review

• Carmen Iriarte 19 &
• Sussy Bayona Orè 19  
• Conference paper
• First Online: 12 October 2017

1530 Accesses

6 Citations

Part of the book series: Advances in Intelligent Systems and Computing ((AISC,volume 688))

IT projects continue to fail at a high rate and this represents losses in both money and opportunity organizations. This leads us to continue studying success factors in projects. The aim of this paper is present a systematic literature review focused on soft skills for the IT project success. The literature search was conducted using the electronic databases and the primary articles from 2010 to 2017. The results show that a high number of studies are theoretical, conceptual or based on experience and there are no models that explain the causal relationship between soft skills and project success. All studies agree about the relevance of the project manager soft skills for projects success. The results show that the most influence soft skills for projects success are communication, leadership and conflict resolution skills.

• project success
• soft skills
• systematic review

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Mkoba, E., & Marnewick, C.: IT Project Success: A Conceptual Framework for IT Project Auditing Assurance. Paper presented at the Proceedings of the Annual Conference of the South African Institute of Computer Scientists and Information Technologists (2016).

Google Scholar  

Andersen, E. S., Birchall, D., Arne Jessen, S., & Money, A. H.: Exploring project success. Baltic Journal of Management, 1(2), 127–147 (2006)

Bassellier, G., & Blaize Horner Reich, I. B.: Information technology competence of business managers: A definition and research model. Journal of Management Information Systems, 17(4), 159–182 (2001)

Bono, J. E., & Vey, M. A.: Toward understanding emotional management at work: A quantitative review of emotional labor research Härtel, Charmine E. (Ed); Zerbe, Wilfred J. (Ed); Ashkanasy, Neal M. (Ed). (2005)

Gale, A.: How to know what: Setting the project management competency agenda. PM Days (1999)

Hyväri, I.: Project management effectiveness in project-oriented business organizations. International Journal of Project Management, 24(3), 216–225 (2006)

Pinto, J. K., & Slevin, D. P.: Project success: definitions and measurement techniques. Project Management Journal, 19(1), 67–72 (1988)

Leybourne, S. A.: The changing bias of project management research. Project Management Journal, 38(1), 61–73 (2007)

André, M., Baldoquín, M. G., & Acuña, S. T.: Formal model for assigning human resources to teams in software projects. Information and Software Technology, 53(3), 259–275 (2011)

Chipulu, M., Neoh, J. G., Ojiako, U. U., & Williams, T.: A multidimensional analysis of project manager competences. IEEE Transactions on Engineering Management, 60(3), 506—517 (2013)

Stevenson, D. H., & Starkweather, J. A.: PM critical competency index: IT execs prefer soft skills. International Journal of Project Management, 28(7), 663–671 (2010)

Rose, K. H., A.: Guide to the Project Management Body of Knowledge (PMBOK® Guide)—Fifth Edition. Project Management Journal, 44(3) (2013)

Baccarini, D.: The logical framework method for defining project success. Project Management Journal, 30(4), 25–32 (1999)

Liebowitz, J., IT Project Failures: What Management Can Learn. IT Professional, 17(6), 8—9 (2015).

Lim, C., & Mohamed, M. Z.: Criteria of project success: an exploratory re-examination. International Journal of Project Management, 17(4), 243–248 (1999)

Diallo, A., & Thuillier, D.: The success dimensions of international development projects: the perceptions of African project coordinators. International Journal of Project Management, 22(1), 19—31 (2004)

Munns, A., & Bjeirmi, B. F.: The role of project management in achieving project success. International Journal of Project Management, 14(2), 81—87 (1966)

Crawford, L., & Turner, J.: Developing the project management competence of individuals. Gower handbook of project management, 4, 678–694 (2007)

Association, I. P. M., & Caupin, G.: IPMA competence baseline: ICB; Version 3.0: Internat. Project Management Association (2006)

Committee, P. S.: Project manager competency development (PMCD) framework. Project Management Institute (PMI), Newtown Square, Pennsylvania (2002).

Robles, M. M.: Executive perceptions of the top 10 soft skills needed in today’s workplace. Business Communication Quarterly, 75(4), 453–465 (2012).

Kitchenham, B., & Charters, S.: Guidelines for performing systematic literature reviews in software engineering Technical report, Ver. 2.3 EBSE Technical Report. (2007)

Tore, D., & Torgeir, D.: Empirical studies of agile software development: A systematic review. Information and Software Technology, 50(9-10), 833–859 (2008).

Müller, R., Geraldi, J., & Turner, J. R.: Relationships between leadership and success in different types of project complexities. IEEE Transactions on Engineering Management, 59(1), 77–90 (2012).

Skulmoski, G. J., & Hartman, F. T.: Information systems project manager soft competencies: A project‐phase investigation. Project Management Journal, 41(1), 61–80 (2010)

Creasy, T., & Anantatmula, V. S.: From every direction—How personality traits and dimensions of project managers can conceptually affect project success. Project Management Journal, 44(6), 36–51 (2013).

Keil, M., Lee, H. K., & Deng, T.: Understanding the most critical skills for managing IT projects: A Delphi study of IT project managers. Information & Management, 50(7), 398–414 (2013).

Colomo-Palacios, R., González-Carrasco, I., López-Cuadrado, J. L., Trigo, A., & Varajao, J. E.: I-Competere: Using applied intelligence in search of competency gaps in software project managers. Information Systems Frontiers, 16(4), 607–625 (2014).

Frese, R., & Sauter, V.: Improving your odds for software project success. IEEE Engineering Management Review, 42(4), 125–131 (2014).

Alias, Z., Zawawi, E., Yusof, K., & Aris, N.: Determining critical success factors of project management practice: A conceptual framework. Procedia-Social and Behavioral Sciences, 153, 61–69 (2014).

McCroskey, J. C.: Oral communication apprehension: A summary of recent theory and research. Human communication research, 4(1), 78-96 (1977)

Goleman, D. Emotional Intelligence, Bantam Books, New York, NY, 1995

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Iriarte, C., Bayona Orè, S. (2018). Soft Skills for IT Project Success: A Systematic Literature Review. In: Mejia, J., Muñoz, M., Rocha, Á., Quiñonez, Y., Calvo-Manzano, J. (eds) Trends and Applications in Software Engineering. CIMPS 2017. Advances in Intelligent Systems and Computing, vol 688. Springer, Cham. https://doi.org/10.1007/978-3-319-69341-5_14

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

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

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

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

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

What are the parts of a lit review?

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

Introduction:

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

Conclusion:

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

How should I organize my lit review?

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

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

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

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

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

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

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

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

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• 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:

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

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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COMPUTER SKILLS: A CRITICAL LITERATURE REVIEW AND ITS IMPLICATIONS

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Researching and Writing a Literature Review

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A literature review demonstrates that you have read around your topic and have a broad understanding of previous research, including its limitations.

In the literature review, you summarise the main viewpoints and important facts that you encountered in your reading as they relate to your chosen topic . You will also use the literature review to justify the value of doing research on your topic by showing what is already known, what is not yet known, and how it is relevant.

Your literature review should not simply be descriptive but should also provide a critical analysis of the body of work, and demonstrate that you understand how it fits together as a whole and how your own research fits with previous studies.

A key aspect of a literature review is what sources you select to include, and which you exclude.

Finding Sources

Thanks to the internet, literature searches are now relatively easy, and can be done from the comfort of your own laptop without needing to go anywhere near a library.

However, a word of warning is in order here. The ease with which anybody can access and publish to the internet means that many items published online have not been scrutinised by anybody other than the author.

In other words, content has not necessarily been checked, you have no way of knowing whether the author’s facts and claims are at all accurate and you could easily land yourself in trouble by blindly following or citing from online sources. 

Furthermore, because items on the internet are frequently changed, you may find that something you read yesterday is no longer available in the same form today. However, internet sources can be very useful for up-to-date information, especially current affairs or ongoing or very recent research.

Blogs and sites like the encyclopaedia Wikipedia are particularly prone to these problems.  For these reasons, a general rule of thumb is that you should only rely on internet resources from the websites of organisations whose information you already know to be reputable, like SkillsYouNeed.

See our page: Assessing Internet Information for more.

Do not underestimate how much physical libraries and librarians may be able to help you.

Librarians are usually hugely experienced in using all the search tools and databases, and can often show you much quicker ways of doing things, as well as tips and tricks to help you refine your search.

Furthermore, libraries may have copies of books and academic journals that are not available online. So a trip to your library may prove to be very helpful.

If you haven’t already done so, get yourself an ATHENS account through your university and/or school library. Spend time working out which of the available databases are going to be most useful for your topic, including asking the librarians for advice.

A simple way to get started with finding appropriate materials is simply to ask people who are likely to know.

You might for example ask your tutor or supervisor, or an expert or practitioner working on your chosen topic. Often, they will be able to give you some very helpful ideas about where to begin your reading.

However, be aware that some professionals may find constant requests for information intrudes on their time. Always be courteous and sensitive to the level of demand you may be making on someone’s time.

See our page: Sources of Information for more about the types of resources that you might use and how to access them.

Choosing and Refining your Search Terms

Your search terms are one of the most important elements of finding the right sources for your research project and developing them is an ongoing process.

It’s a good idea to start with a phrase that you think others will have used about the topic, perhaps that you have identified from your lectures and/or earlier study. You will probably find that your first few searches don’t turn up much that’s useful.

Use the one or two articles that you find that are on the right lines to identify alternative search terms, and continue to search until you turn up useful articles.

You can also use a tool such as Google Adword Keyword Research Tool to identify phrases and keywords that are similar to your chosen term(s). This tool is usually used by internet marketing professionals to help them find keywords similar to their own but can be useful for academic research too.

If you’re really struggling to find articles on the right topic, but you’re certain that they must be out there, drop your supervisor a note asking about possible search terms. Tell them what you’ve already used, and ask them for a few alternatives to get you started. However, this should be a last resort, as you don’t want to demonstrate your ignorance too obviously!

Finally, keep searching. You need to read a lot of sources to find the most relevant and will probably end up discarding more than half of what you read. Use abstracts to decide which articles are worth reading, and don’t read those that aren’t relevant: keep checking back to your research questions and decide whether each article is useful. If not, move on.

Critical Reading

Your literature review should not only show that you have been reading a range of materials related to your topic, but also that you have been reading them critically and have thought about the wider contexts and how they apply to your own area of research.

Critical reading is a skill that, like any other skill, is acquired with practice.

In essence, reading critically means that you do not take the claims at face value: you question the basis for claims, why the author may have done and said things in the particular way he or she did, what the wider context is, and whose interests are being served by the claims you encounter.

See our page, Critical Reading for more information.

How Many Sources?

Your university or college supervisor will be able to give you an idea of how many sources you should include in your literature review.

You will probably need to read at least double that number to find enough that are suitable for inclusion. You should also try to find several different sorts of sources: books, journal articles, dissertations, conference papers, working papers, and so on.

You need to make sure that you identify the key texts for the subject. Check a few references, and see which texts are cited most often, or ask the librarians how to use the databases to check how often each article is cited. A good way to identify when you have read enough is if your reading keeps turning up the same points and you’re not learning anything new.

A Note on Dates

There are some theories or articles which are so important in a particular field that they need to be cited, however long ago they were originally published. But those apart, you should generally prefer more recent sources published in the last five or ten years. As a rough guide, the balance of publication dates should be about two thirds from the last 10 years, and no more than one third older than that.

Writing your Literature Review

In general, your literature review should start with one or two broad paragraphs, demonstrating your understanding of the breadth of your area of study.

You should then discuss the literature that deals with your area of research and, finally, consider and critique the studies that are most directly relevant.

You should spend most time on the latter.

Writing your literature review should be an iterative process.

The best way to do it is probably to summarise each source as you go along, referencing it carefully, and grouping your sources by themes.

You will almost certainly find that the themes develop as you go along, and so do your search terms. Use headings to store your summaries and then write a more polished section under that heading when you have enough sources to be able to ‘compare and contrast’ opposing views, and particularly to draw out areas where there is disagreement and/or conflicting evidence as these are the most fruitful for further research.

Where there are gaps, you can then go back and search for more sources on that area. The best literature reviews are not only descriptive, but draw together similar thinking and provide a critical analysis of the previous research, including highlighting really good studies, or identifying flaws and gaps.

To make sure that you carrying out a critical analysis, make sure that you ask yourself the question ‘ Do I agree with this viewpoint? Why? ’, and also consider whether the methods used are strong or weak and why. This will also help you to decide on your own methodology.

Another way of checking whether you are evaluating or merely describing is to look at whether you have discussed work chronologically (likely to be descriptive) or in terms of whether there is general agreement on a topic (much more likely to be evaluative).

Checklist of Questions for Critical Reading

Ask yourself the following questions to decide whether or not a particular piece of work is worth including in your literature review.

• Who is the author? What can I find out about him/her? Has he/she written other books, articles etc.?
• What is the author’s position in the research process, e.g., gender, class, politics, life experience, relationship to research participants?
• Where and when was the document produced? What type of document is it?
• Is it reporting original research that the author has done, or is it presenting second-hand information about a topic?
• Is it formal or informal?
• Is it 'authoritative' (e.g., academic, scientific) or 'popular' (newspaper or magazine article)?
• How has it been produced? Is it glossy, with lots of pictures, diagrams, etc.?
• If it is contained on a website, is the website from a reputable organisation, or is the document drawn from some other reputable source?

The Message

• What is being said?
• What is not being said?
• How is the argument presented? Why?
• What use has been made of diagrams, pictures etc.?
• Who was or is the intended audience?
• Whose interests are being served by this message? Are there political implications, for instance?
• What evidence is presented to support the claims that are made?
• Does the evidence actually support the claims? Is the evidence presented in enough detail for you to make up your own mind whether you agree with the claims?
• Are there errors or inconsistencies?
• What is the significance to my topic and the research that I wish to carry out?

Your literature review should also demonstrate how your study does or will relate to previous work, and how it either fills gaps, or responds to calls for further work.

Your literature review will help you to refine your research question. It should also help you to explain how your methodology fits with previous work, and help you to identify and evaluate possible research methods.

A Note on Tense

When you are describing someone’s findings or opinions, it is probably best to use the past tense.

For example:

“Jones (2001) argued that…”.

Many authors of academic papers prefer the present tense when describing opinions or views (“Jones (2001) argues that…”). However, it is always possible that Jones has subsequently changed his/her view, and therefore the past tense is preferable.

The past tense is always going to be correct for something that was expressed in the past; the present tense may no longer be true.

Citations and References

Your university will almost certainly have a preferred style for citations and references that you will need to use. Make sure you understand how this works before you start writing your literature review and use it consistently throughout.

Keep your references up to date as you go, and make sure that you always cite the reference as you write: it’s much easier than trying to build a reference list at the end.

See our page on Academic Referencing for more information

For scientific subjects, Vancouver (numerical) referencing is often preferred.

However, it is much harder to check that your references are correct using this system. It is therefore better to use a (name, date) system of citations until you are certain that you have finished revising the document.

Alternatively, use a system of end-notes which will automatically update the numbering if you move a citation as you will otherwise end up hopelessly confused.

Draft, Draft and Redraft

Finally, once you have written each section by theme, go back and read the whole thing to check that the sections flow logically one from another, and that the whole literature review reads sensibly and coherently.

As with any essay or extended piece of writing, editing and redrafting will improve the quality of your writing, as will asking someone else to read it over and check for errors or inconsistencies.

You should also do a search to check for consistent use of British or American spellings (-ise and -ize, for example), double spaces after words, and double/single inverted commas around quotations. You might think such details are less important than the content, but the marker may not share your view.

Continue to: Writing a Research Proposal Writing a Dissertation: The Introduction

See also: Writing a Methodology Dissertation Results and Discussion Dissertation Conclusions and Extra Sections

Literature Review & Research Skills Guide: What is a Literature Review?

• Introduction
• What is a Literature Review?
• Your research topic
• Topic Analysis
• Developing a Search Strategy
• Preliminary Reading
• Use Primo Search
• Use Google Scholar
• Use Journal Databases
• Sage Research Methods
• Managing your literature review
• Evaluation & Critical Appraisal
• Referencing

What is a literature review

Once you have defined your topic, the next step is to start a literature review. A literature review summarises, interprets and critically evaluates material that has already been published on a topic. The purpose is to establish current knowledge of a subject, identify gaps, inconsistencies and relations in the literature as well as outline areas for additional research and/or define a topic of inquiry.

Adopted from Charles Sturt University Library. (2017). Literature review.  Retrieved from http://libguides.csu.edu.au/review

Types of literature reviews

The type of literature review you write will depend on your discipline and whether you are a researcher writing your PhD, publishing a study in a journal or completing an assessment task in your undergraduate study.

A literature review for a subject in an undergraduate degree will not be as comprehensive as the literature review required for a PhD thesis.

An undergraduate literature review may be in the form of an annotated bibliography or a narrative review of a small selection of literature, for example ten relevant articles. If you are asked to write a literature review, and you are an undergraduate student, be guided by your subject coordinator or lecturer.

Often the term "review" and "literature" can be confusing and used in the wrong context. Grant and Booth (2009) attempt to clear up this confusion by discussing 14 review types and the associated methodology, and advantages and disadvantages associated with each review.   For research students, especially those in EEB501, ERP502 or doctoral students, they will be undertaking a critical literature review.

Grant, M. J., & 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

What is the purpose or aim of the literature review?

A literature review should demonstrate your knowledge of the research that has been conducted in the past and should place your research in the context of this work. A literature review can have a number of purposes within a research project. These include:

• demonstrating and clarify your understanding of your field of research;
• identifying patterns and trends in the literature;
• identifying gaps in the literature and seek new lines of inquiry;
• identifying similarities and differences in previous research and place your work in perspective;
• justifying your own research;
• increasing your breadth of knowledge of your subject area;
• identifying seminal and influential published works in your field;
• identifying relevant journals, publishers and conferences to search;
• providing the intellectual context for your own work, enabling you to position your project relative to other work;
• identifying experts working in your field (a researcher network is a valuable resource);
• carrying on from where others have already reached.

Onwuegbuzie, A. J., & Frels, R. (2016). 7 steps to a comprehensive literature review : a multimodal & cultural approach . London : Thousand Oaks, California: SAGE Publications.

Randolph, J. J. (2009).  A guide to writing the dissertation literature review . Practical Assessment Research & Evaluation. 14 (Article 13), 1-13.

An Introduction to Literature Reviews

Please watch the following video:

where to start a literature review

There are many different types of resources which might offer information on the topic you are researching, but you need to consider whether the source is scholarly or authoritative enough for a literature review. Typically literature reviews are conducted by using journal articles, conference papers, book chapters, websites or standards.  

In addition, there is a range of new information sources that you may not have come across before, such as: 

• Internet resources
• Tracking citation
• Using Social Media
• Interlibrary loans

To keep your information organised, you might like to consider using a reference manager.  There are a number of different reference managers available to use, and they all have their own advantages and disadvantages. See the EndNote tab   to find further information on Charles Sturt University's bibliographic management software EndNote.

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Reviewing Literature

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Hart, C., (2022). Research Skills: Reviewing Literature. In SAGE Skills: Student Success . SAGE Publications, Inc., [https:// doi. org/10.4135/9781071882405]

Hart, Chris. "Research Skills: Reviewing Literature." In SAGE Skills: Student Success . Thousand Oaks, CA: SAGE Publications, Inc., 2022, [https:// doi. org/10.4135/9781071882405].

Hart, C., 2022. Research Skills: Reviewing Literature in SAGE Skills: Student Success. Thousand Oaks, CA: SAGE Publications, Inc. Available at: doi. org/10.4135/9781071882405]>[Accessed 1 Apr 2024]

Hart, Chris. "Research Skills: Reviewing Literature." SAGE Skills: Student Success . Thousand Oaks, CA: SAGE Publications, Inc., 1 Apr 2024, doi:[https:// doi. org/10.4135/9781071882405].

Hart, Chris, (2022). Research Skills: Reviewing Literature. In SAGE Skills: Student Success . SAGE Publications, Inc., [https:// doi. org/10.4135/9781071882405]

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• Understanding the Purpose of a Review of the Literature
• Searching Literature
• Recognising the Types of Literature Review
• Analysing the Literature
• Using the Literature in Your Research
• By: Chris Hart Edited by: Pam Denicolo
• Module: Research Skills
• Skill: Reviewing Literature
• Publisher: SAGE Publications, Inc.
• Publication year: 2022
• Online pub date: April 13, 2022
• Discipline: Literature Review
• DOI: https:// doi. org/10.4135/9781071882405
• Keywords: Chris Hart , citations , critical reading , databases , information sources , literature reviews , literature search , publications , research questions , research skills Show all Show less
• Online ISBN: 9781071882405 Copyright: © SAGE Publications, Inc. 2022 More information Less information

A literature review is an analysis, critical evaluation, and synthesis of existing knowledge relevant to your research problem, question, or the issue you are aiming to say something intelligent about. In your analysis, you select from different concepts, theories, arguments, and interpretations that seem relevant to the development of your work.

It is important to critically evaluate the concepts, arguments, and different interpretations others have made in the literature. In critically evaluating, you interrogate the work of others (regardless of their standing in the academic community), looking at the chain of reasoning an author has used and the evidence they have offered to support their argument. This is an important skill to develop because you need to be able to demonstrate you have the ability to deconstruct an argument made by someone else and are able to structure your own argument.

Finally, after much reading, note-taking, and organising concepts, arguments and different interpretations that other authors have made, you write your synthesis of the literature – your literature review. Being able to construct your own review of the literature is important because it shows you have a range of skills and have been able to apply them to your own research question.

In this Skill, Reviewing the Literature, you will learn about

• 1. What a literature review looks like
• 2. Why review of the literature on your topic is needed
• 3. What the literature is and how to distinguish between valid and not so valid sources of information
• 4. Why it is important to have the correct words and phrases to search for information
• 5. How to search more effectively and efficiently for sources
• 6. How to find out how to cite your sources (references)
• 7. The need to be systematic in searching for sources
• 8. The main types of literature review you can use
• 9. Questioning evidence in an argument
• 10. Using tools to help organise your information
• 11. Using different structures to write different kinds of literature review

Figures 1 – 4 show some examples of literature reviews.

Figure 1 is an example of a bibliography, a list of academic sources (books and articles) arranged in alphabetical order. It is not a review of the literature, but a list of sources that could be used to write a review of the literature.

The figure shows bibliographical information that are as follows: Adorno, T. W., Frenkel-Brunswik, E., Levinson, D. J., and Sanford, R. N. (1950). The authoritarian personality. New York: Harper and Row. American Education Research Association. (2006). 'Standards for reporting on empirical social science research in AERA publications'. Educational Researcher, 35(6):33-40. Afolabi, M. (1992). "The review of related literature in research’. International Journal of Information and Library Research, vol. 4(1):59-66. Anderson, R.J., Hughes, J.A. and Sharrock, W.W. (1985). The sociology game: an introduction to sociological reasoning. London: Longman. Archer, M. (1995). Realist social theory. Cambridge: Cambridge University Press. Asimov, I. (1963). The genetic code. New York: New American Library. Atkinson, J.M. (1982). Discovering suicide: studies in the social organisation of sudden death. London: Macmillan Press. Ayer, A.J. (1936/1946). Language, truth and logic. London: Victor Gollancz. Baake, K. (2003). Metaphor and knowledge: the challenges of writing science. Albany: State University of New York Press.

Figure 2 is an example of a section from a literature review. Note that it has a number of features such as the focus on one topic, the use of sources (citations) and quotations.

The literature review reads as follows: A strong finding from Franklin's (2004) study was the persistence of early behaviour: those who voted when they first could were more likely to repeat the behaviour, and those who did not vote were likely to not vote again. Surveys of non-voters consistently find that many are repeat nonvoters. In the New Zealand 2002 post-election survey a third of Mori and a fifth of non-Mori nonvoters said that they had not voted in the past either (Vowles et. al., 2004). Some writers suggest that political participation leaves a psychological imprint on those who act (Green & Shachar, 2000). More pragmatically, those who have voted are familiar with the process whilst for some who have not, there may be apprehension at what it entails (Horwitt, 1999) and embarrassment at admitting this lack of knowledge. Like internal efficacy, this orientation concerns one's selfconfidence in a political environment (Green & Shachar, 2000). In contrast, participation by providing familiarity with the process increases confidence and thus internal efficacy (Finkel, 1985). The idea that repetition creates familiarity and confidence is commonplace. There is also evidence that the practice of voting or not is passed across generations. Surveys in the UK and USA (Nestle, 2003; Horwitt, 1999) have found that non-voters are more likely to come from families of nonvoters and that those who vote at their first election have memories of their parents voting Discussion of politics at home also had an impact: "half of those who often talk to their parents about politics said they voted in 1998, compared to one quarter of those who talk to their parents about politics infrequently or never” (Horwitt, 1999). This study concludes that, voting is developed as a habit. Some young people may start voting primarily out of the idealistic sense that their vote makes a difference; after an election or two, they begin to view voting as a duty and are much more likely to turn out to vote primarily because they feel it is something they should do. In this way, “young people come to voting as a personal norm." (from Catt, H., & Hayward, B. (2005). "Now or Never: The Impact of Political Education on Civic Participation.” Australasian Political Studies Conference, Dunedin)

Compare Figure 3 with Figure 2 . What are the main differences?

The figure representing the question if it is a literature review, reads as follows: Simply put, fake news is false or misleading information. Whether you heard it from former President Donald Trump's coining of the term to describe negative press of himself or you saw it on social media, it's everywhere. It becomes especially prominent during times of division among Americans, like during election cycles. With the reappearance of fake news due to the COVID-19 pandemic and the recent election, who keeps posting fake news? Turns out there are troll farms, or businesses rather, that consist of writers who intentionally publish harmful social media posts in order to cause social division and/or spread propaganda. These troll farms have been found in Albania, the Philippines, and most importantly, Russia. In 2014, a Finnish journalist, Jessika Aro, started investigating a "troll farm" named Internet Research Agency (IRA) located in St. Petersburg, Russia. Aro interviewed those who were connected to the IRA and released an article about what she uncovered. It was titled, "Yle Kioski Traces the Origins of Russian Social Media Propaganda – Never-before-seen Material from the Troll Factory." In summary, the IRA hires copywriters and editors to manage social media accounts and spread fake news, whether it be locally or worldwide. One of the recruiters that Aro interviewed said that they primarily work in English. https://www.tommiemedia.com/opinions/opinion-fake-news-in-america-its-past-present-andhopefully-dim-future/

The difference between Figure 2 and Figure 3 is that one is scholarly and the other opinion. Figure 2 uses scholarly (academic) conventions, whereas Figure 3 does not. These conventions include citing the sources of the claims that are being made so that the reader can check the validity of any claim (or interpretation) by looking at the original source.

Now consider Figure 4 . This example will show you what is meant by scholarly (academic) conventions.

Figure 4 shows some of the elements that help to maintain the validity of what is said in academic writing such as the use of different definitions, citing reliable sources, and showing there are different perspectives on the topic.

The figure that represents the essential elements of a literature review, reads as follows: The term "fake news” refers to a range of information types, from low-impact, honest mistakes and satire content to high-impact manipulative techniques and malicious fabrications (HLEG, 2018). There are various definitions (e.g. Egelhofer and Lecheler, 2019) from where we conclude the absence of a universal agreement on the terminology used and the different types of false information. The definition proposed by Allcott and Gentzkow (2017) has been used in many recent studies as a navigator (Conroy et al., 2015; Potthast et al., 2018; Ruchansky et al., 2017; Shu et al., 2017; Wang et al., 2018). However, we deliberately avoid here the use of the term “fake news” as overloaded (Wardle and Derekshan, 2017) and inadequate to describe the complexity of the problem. Instead, we prefer the term “false information” as the broader concept that encompasses a wide spectrum of subtypes. page 1305 Extract from: Kapantai, E., Christopoulou, A., Berberidis, C., & Peristeras, V. (2021). A systematic literature review on disinformation: Toward a unified taxonomical framework. New Media & Society, 23(5), 13011326. https://doi.org/10.1177/1461444820959296

There’s a glossary of terms and concepts available for this entire Module in the Beginning Your Research Skill.

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

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

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

• Ammenwerth E., de Keizer N. An inventory of evaluation studies of information technology in health care. Trends in evaluation research, 1982-2002. International Journal of Medical Informatics. 2004; 44 (1):44–56. [ PubMed : 15778794 ]
• Anderson S., Allen P., Peckham S., Goodwin N. Asking the right questions: scoping studies in the commissioning of research on the organisation and delivery of health services. Health Research Policy and Systems. 2008; 6 (7):1–12. [ PMC free article : PMC2500008 ] [ PubMed : 18613961 ] [ CrossRef ]
• Archer N., Fevrier-Thomas U., Lokker C., McKibbon K. A., Straus S.E. Personal health records: a scoping review. Journal of American Medical Informatics Association. 2011; 18 (4):515–522. [ PMC free article : PMC3128401 ] [ PubMed : 21672914 ]
• Arksey H., O’Malley L. Scoping studies: towards a methodological framework. International Journal of Social Research Methodology. 2005; 8 (1):19–32.
• A systematic, tool-supported method for conducting literature reviews in information systems. Paper presented at the Proceedings of the 19th European Conference on Information Systems ( ecis 2011); June 9 to 11; Helsinki, Finland. 2011.
• Baumeister R. F., Leary M.R. Writing narrative literature reviews. Review of General Psychology. 1997; 1 (3):311–320.
• Becker L. A., Oxman A.D. In: Cochrane handbook for systematic reviews of interventions. Higgins J. P. T., Green S., editors. Hoboken, nj : John Wiley & Sons, Ltd; 2008. Overviews of reviews; pp. 607–631.
• Borenstein M., Hedges L., Higgins J., Rothstein H. Introduction to meta-analysis. Hoboken, nj : John Wiley & Sons Inc; 2009.
• Cook D. J., Mulrow C. D., Haynes B. Systematic reviews: Synthesis of best evidence for clinical decisions. Annals of Internal Medicine. 1997; 126 (5):376–380. [ PubMed : 9054282 ]
• Cooper H., Hedges L.V. In: The handbook of research synthesis and meta-analysis. 2nd ed. Cooper H., Hedges L. V., Valentine J. C., editors. New York: Russell Sage Foundation; 2009. Research synthesis as a scientific process; pp. 3–17.
• Cooper H. M. Organizing knowledge syntheses: A taxonomy of literature reviews. Knowledge in Society. 1988; 1 (1):104–126.
• Cronin P., Ryan F., Coughlan M. Undertaking a literature review: a step-by-step approach. British Journal of Nursing. 2008; 17 (1):38–43. [ PubMed : 18399395 ]
• Darlow S., Wen K.Y. Development testing of mobile health interventions for cancer patient self-management: A review. Health Informatics Journal. 2015 (online before print). [ PubMed : 25916831 ] [ CrossRef ]
• Daudt H. M., van Mossel C., Scott S.J. Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework. bmc Medical Research Methodology. 2013; 13 :48. [ PMC free article : PMC3614526 ] [ PubMed : 23522333 ] [ CrossRef ]
• Davies P. The relevance of systematic reviews to educational policy and practice. Oxford Review of Education. 2000; 26 (3-4):365–378.
• Deeks J. J., Higgins J. P. T., Altman D.G. In: Cochrane handbook for systematic reviews of interventions. Higgins J. P. T., Green S., editors. Hoboken, nj : John Wiley & Sons, Ltd; 2008. Analysing data and undertaking meta-analyses; pp. 243–296.
• Deshazo J. P., Lavallie D. L., Wolf F.M. Publication trends in the medical informatics literature: 20 years of “Medical Informatics” in mesh . bmc Medical Informatics and Decision Making. 2009; 9 :7. [ PMC free article : PMC2652453 ] [ PubMed : 19159472 ] [ CrossRef ]
• Dixon-Woods M., Agarwal S., Jones D., Young B., Sutton A. Synthesising qualitative and quantitative evidence: a review of possible methods. Journal of Health Services Research and Policy. 2005; 10 (1):45–53. [ PubMed : 15667704 ]
• Finfgeld-Connett D., Johnson E.D. Literature search strategies for conducting knowledge-building and theory-generating qualitative systematic reviews. Journal of Advanced Nursing. 2013; 69 (1):194–204. [ PMC free article : PMC3424349 ] [ PubMed : 22591030 ]
• Grady B., Myers K. M., Nelson E. L., Belz N., Bennett L., Carnahan L. … Guidelines Working Group. Evidence-based practice for telemental health. Telemedicine Journal and E Health. 2011; 17 (2):131–148. [ PubMed : 21385026 ]
• Green B. N., Johnson C. D., Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. Journal of Chiropractic Medicine. 2006; 5 (3):101–117. [ PMC free article : PMC2647067 ] [ PubMed : 19674681 ]
• Greenhalgh T., Wong G., Westhorp G., Pawson R. Protocol–realist and meta-narrative evidence synthesis: evolving standards ( rameses ). bmc Medical Research Methodology. 2011; 11 :115. [ PMC free article : PMC3173389 ] [ PubMed : 21843376 ]
• Gurol-Urganci I., de Jongh T., Vodopivec-Jamsek V., Atun R., Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database System Review. 2013; 12 cd 007458. [ PMC free article : PMC6485985 ] [ PubMed : 24310741 ] [ CrossRef ]
• Hart C. Doing a literature review: Releasing the social science research imagination. London: SAGE Publications; 1998.
• Higgins J. P. T., Green S., editors. Cochrane handbook for systematic reviews of interventions: Cochrane book series. Hoboken, nj : Wiley-Blackwell; 2008.
• Jesson J., Matheson L., Lacey F.M. Doing your literature review: traditional and systematic techniques. Los Angeles & London: SAGE Publications; 2011.
• King W. R., He J. Understanding the role and methods of meta-analysis in IS research. Communications of the Association for Information Systems. 2005; 16 :1.
• Kirkevold M. Integrative nursing research — an important strategy to further the development of nursing science and nursing practice. Journal of Advanced Nursing. 1997; 25 (5):977–984. [ PubMed : 9147203 ]
• Kitchenham B., Charters S. ebse Technical Report Version 2.3. Keele & Durham. uk : Keele University & University of Durham; 2007. Guidelines for performing systematic literature reviews in software engineering.
• Kitsiou S., Paré G., Jaana M. Systematic reviews and meta-analyses of home telemonitoring interventions for patients with chronic diseases: a critical assessment of their methodological quality. Journal of Medical Internet Research. 2013; 15 (7):e150. [ PMC free article : PMC3785977 ] [ PubMed : 23880072 ]
• Kitsiou S., Paré G., Jaana M. Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews. Journal of Medical Internet Research. 2015; 17 (3):e63. [ PMC free article : PMC4376138 ] [ PubMed : 25768664 ]
• Levac D., Colquhoun H., O’Brien K. K. Scoping studies: advancing the methodology. Implementation Science. 2010; 5 (1):69. [ PMC free article : PMC2954944 ] [ PubMed : 20854677 ]
• Levy Y., Ellis T.J. A systems approach to conduct an effective literature review in support of information systems research. Informing Science. 2006; 9 :181–211.
• Liberati A., Altman D. G., Tetzlaff J., Mulrow C., Gøtzsche P. C., Ioannidis J. P. A. et al. Moher D. The prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine. 2009; 151 (4):W-65. [ PubMed : 19622512 ]
• Lyden J. R., Zickmund S. L., Bhargava T. D., Bryce C. L., Conroy M. B., Fischer G. S. et al. McTigue K. M. Implementing health information technology in a patient-centered manner: Patient experiences with an online evidence-based lifestyle intervention. Journal for Healthcare Quality. 2013; 35 (5):47–57. [ PubMed : 24004039 ]
• Mickan S., Atherton H., Roberts N. W., Heneghan C., Tilson J.K. Use of handheld computers in clinical practice: a systematic review. bmc Medical Informatics and Decision Making. 2014; 14 :56. [ PMC free article : PMC4099138 ] [ PubMed : 24998515 ]
• Moher D. The problem of duplicate systematic reviews. British Medical Journal. 2013; 347 (5040) [ PubMed : 23945367 ] [ CrossRef ]
• Montori V. M., Wilczynski N. L., Morgan D., Haynes R. B., Hedges T. Systematic reviews: a cross-sectional study of location and citation counts. bmc Medicine. 2003; 1 :2. [ PMC free article : PMC281591 ] [ PubMed : 14633274 ]
• Mulrow C. D. The medical review article: state of the science. Annals of Internal Medicine. 1987; 106 (3):485–488. [ PubMed : 3813259 ] [ CrossRef ]
• Evidence-based information systems: A decade later. Proceedings of the European Conference on Information Systems ; 2011. Retrieved from http://aisel ​.aisnet.org/cgi/viewcontent ​.cgi?article ​=1221&context ​=ecis2011 .
• Okoli C., Schabram K. A guide to conducting a systematic literature review of information systems research. ssrn Electronic Journal. 2010
• Otte-Trojel T., de Bont A., Rundall T. G., van de Klundert J. How outcomes are achieved through patient portals: a realist review. Journal of American Medical Informatics Association. 2014; 21 (4):751–757. [ PMC free article : PMC4078283 ] [ PubMed : 24503882 ]
• Paré G., Trudel M.-C., Jaana M., Kitsiou S. Synthesizing information systems knowledge: A typology of literature reviews. Information & Management. 2015; 52 (2):183–199.
• Patsopoulos N. A., Analatos A. A., Ioannidis J.P. A. Relative citation impact of various study designs in the health sciences. Journal of the American Medical Association. 2005; 293 (19):2362–2366. [ PubMed : 15900006 ]
• Paul M. M., Greene C. M., Newton-Dame R., Thorpe L. E., Perlman S. E., McVeigh K. H., Gourevitch M.N. The state of population health surveillance using electronic health records: A narrative review. Population Health Management. 2015; 18 (3):209–216. [ PubMed : 25608033 ]
• Pawson R. Evidence-based policy: a realist perspective. London: SAGE Publications; 2006.
• Pawson R., Greenhalgh T., Harvey G., Walshe K. Realist review—a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy. 2005; 10 (Suppl 1):21–34. [ PubMed : 16053581 ]
• Petersen K., Vakkalanka S., Kuzniarz L. Guidelines for conducting systematic mapping studies in software engineering: An update. Information and Software Technology. 2015; 64 :1–18.
• Petticrew M., Roberts H. Systematic reviews in the social sciences: A practical guide. Malden, ma : Blackwell Publishing Co; 2006.
• Rousseau D. M., Manning J., Denyer D. Evidence in management and organizational science: Assembling the field’s full weight of scientific knowledge through syntheses. The Academy of Management Annals. 2008; 2 (1):475–515.
• Rowe F. What literature review is not: diversity, boundaries and recommendations. European Journal of Information Systems. 2014; 23 (3):241–255.
• Shea B. J., Hamel C., Wells G. A., Bouter L. M., Kristjansson E., Grimshaw J. et al. Boers M. amstar is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. Journal of Clinical Epidemiology. 2009; 62 (10):1013–1020. [ PubMed : 19230606 ]
• Shepperd S., Lewin S., Straus S., Clarke M., Eccles M. P., Fitzpatrick R. et al. Sheikh A. Can we systematically review studies that evaluate complex interventions? PLoS Medicine. 2009; 6 (8):e1000086. [ PMC free article : PMC2717209 ] [ PubMed : 19668360 ]
• Silva B. M., Rodrigues J. J., de la Torre Díez I., López-Coronado M., Saleem K. Mobile-health: A review of current state in 2015. Journal of Biomedical Informatics. 2015; 56 :265–272. [ PubMed : 26071682 ]
• Smith V., Devane D., Begley C., Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. bmc Medical Research Methodology. 2011; 11 (1):15. [ PMC free article : PMC3039637 ] [ PubMed : 21291558 ]
• Sylvester A., Tate M., Johnstone D. Beyond synthesis: re-presenting heterogeneous research literature. Behaviour & Information Technology. 2013; 32 (12):1199–1215.
• Templier M., Paré G. A framework for guiding and evaluating literature reviews. Communications of the Association for Information Systems. 2015; 37 (6):112–137.
• Thomas J., Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. bmc Medical Research Methodology. 2008; 8 (1):45. [ PMC free article : PMC2478656 ] [ PubMed : 18616818 ]
• Reconstructing the giant: on the importance of rigour in documenting the literature search process. Paper presented at the Proceedings of the 17th European Conference on Information Systems ( ecis 2009); Verona, Italy. 2009.
• Webster J., Watson R.T. Analyzing the past to prepare for the future: Writing a literature review. Management Information Systems Quarterly. 2002; 26 (2):11.
• Whitlock E. P., Lin J. S., Chou R., Shekelle P., Robinson K.A. Using existing systematic reviews in complex systematic reviews. Annals of Internal Medicine. 2008; 148 (10):776–782. [ PubMed : 18490690 ]

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

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Organizing Your Social Sciences Research Paper

• 5. The Literature Review
• Purpose of Guide
• Design Flaws to Avoid
• Independent and Dependent Variables
• Glossary of Research Terms
• Reading Research Effectively
• Narrowing a Topic Idea
• Broadening a Topic Idea
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• Background Information
• The Research Problem/Question
• Theoretical Framework
• Citation Tracking
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• Evaluating Sources
• Primary Sources
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• Tiertiary Sources
• Scholarly vs. Popular Publications
• Qualitative Methods
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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

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• Last Updated: Mar 26, 2024 10:40 AM
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The use of ultrasonography in education for undergraduate nursing students: A literature review

Affiliations.

• 1 School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
• 2 Department of Nursing, University of Miyazaki Hospital, Miyazaki, Japan.
• 3 Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
• PMID: 38527918
• DOI: 10.1111/jjns.12596

Aim: The incorporation of ultrasonography into nursing practice is becoming more common, but how ultrasonography is used or applied in nursing student education is still unclear. This study aimed to review and synthesize relevant literature on the use of ultrasonography in education for undergraduate nursing students.

Methods: An electronic literature search was conducted in June 2022 (updated in June 2023) using MEDLINE, CINAHL, Scopus, and Ichushi-Web databases. Two researchers independently screened/assessed the eligibility of the studies, synthesized extracted data using a narrative synthesis (due to anticipated heterogeneity across studies), and evaluated the methodological quality of quantitative studies using the Medical Education Research Study Quality Instrument.

Results: Thirteen peer-reviewed articles were included in the review. All of the studies were conducted in high-income countries, and the majority of them employed an uncontrolled single-group design. Ultrasonography was used mainly for visualizing the vascular system to improve students' puncture skills, but it was also used with various other applications. The included studies were predominantly of moderate quality and heterogeneous, but all of them reported at least some benefits in nursing student education, such as enhancing knowledge and understanding of subcutaneous anatomical structures, and improving confidence in and/or skills of venipuncture and other visualization/assessment methods.

Conclusions: This review provides a broad perspective and highlights the potential use of ultrasonography in education for undergraduate nursing students. Further research is needed to develop standardized teaching methods/curriculum and competency assessments in order to ensure minimum competency standards for students and to improve clinical outcomes for patients.

Keywords: literature review; nursing education; nursing students; ultrasonography; undergraduate nursing students.

© 2024 Japan Academy of Nursing Science.

Publication types

• Open access
• Published: 20 September 2023

Older adults’ experiences during the COVID-19 pandemic: a qualitative systematic literature review

• Elfriede Derrer-Merk   ORCID: orcid.org/0000-0001-7241-0808 1 ,
• Maria-Fernanda Reyes-Rodriguez   ORCID: orcid.org/0000-0002-2645-5092 2 ,
• Laura K. Soulsby   ORCID: orcid.org/0000-0001-9071-8654 1 ,
• Louise Roper   ORCID: orcid.org/0000-0002-2918-7628 3 &
• Kate M. Bennett   ORCID: orcid.org/0000-0003-3164-6894 1  

BMC Geriatrics volume  23 , Article number:  580 ( 2023 ) Cite this article

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Relatively little is known about the lived experiences of older adults during the COVID-19 pandemic. We systematically review the international literature to understand the lived experiences of older adult’s experiences during the pandemic.

Design and methodology

This study uses a meta-ethnographical approach to investigate the included studies. The analyses were undertaken with constructivist grounded theory.

Thirty-two studies met the inclusion criteria and only five papers were of low quality. Most, but not all studies, were from the global north. We identified three themes: desired and challenged wellbeing; coping and adaptation; and discrimination and intersectionality.

Overall, the studies’ findings were varied and reflected different times during the pandemic. Studies reported the impact of mass media messaging and its mostly negative impact on older adults. Many studies highlighted the impact of the COVID-19 pandemic on participants' social connectivity and well-being including missing the proximity of loved ones and in consequence experienced an increase in anxiety, feeling of depression, or loneliness. However, many studies reported how participants adapted to the change of lifestyle including new ways of communication, and social distancing. Some studies focused on discrimination and the experiences of sexual and gender minority and ethnic minority participants. Studies found that the pandemic impacted the participants’ well-being including suicidal risk behaviour, friendship loss, and increased mental health issues.

The COVID-19 pandemic disrupted and impacted older adults’ well-being worldwide. Despite the cultural and socio-economic differences many commonalities were found. Studies described the impact of mass media reporting, social connectivity, impact of confinement on well-being, coping, and on discrimination. The authors suggest that these findings need to be acknowledged for future pandemic strategies. Additionally, policy-making processes need to include older adults to address their needs. PROSPERO record [CRD42022331714], (Derrer-Merk et al., Older adults’ lived experiences during the COVID-19 pandemic: a systematic review, 2022).

Peer Review reports

Introduction

In March 2020 the World Health Organisation declared a pandemic caused by the virus SARS-CoV2 (COVID-19) [ 1 ]. At this time 118,000 cases in 114 countries were identified and 4,291 people had already lost their lives [ 2 ]. By July 2022, there were over 5.7 million active cases and over 6.4 million deaths [ 2 ]. Despite the effort to combat and eliminate the virus globally, new variants of the virus are still a concern. At the start of the pandemic, little was known about who would be most at risk, but emerging data suggested that both people with underlying health conditions and older people had a higher risk of becoming seriously ill [ 3 ]. Thus, countries worldwide imposed health and safety measures aimed at reducing viral transmission and protecting people at higher risk of contracting the virus [ 4 ]. These measures included: national lockdowns with different lengths and frequencies; targeted shopping times for older people; hygiene procedures (wearing masks, washing hands regularly, disinfecting hands); restricting or prohibiting social gatherings; working from home, school closure, and home-schooling.

Research suggests that lockdowns and protective measures impacted on people’s lives, and had a particular impact on older people. They were at higher risk from COVID-19, with greater disease severity and higher mortality compared to younger people [ 5 ]. Older adults were identified as at higher risk as they are more likely to have pre-existing conditions including heart disease, diabetes, and severe respiratory conditions [ 5 ]. Additionally, recent research highlights that COVID-19 and its safety measures led to increased mental health problems, including increased feelings of depression, anxiety, social isolation, and loneliness, potentially cognitive decline [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Other studies reported the consequences of only age-based protective health measures including self-isolation for people older people (e.g. feeling old, losing out the time with family) [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].

Over the past decade, the World Health Organisation (WHO) has recognised the importance of risk communication within public health emergency preparedness and response, especially in the context of epidemics and pandemics. Risk communication is defined as “the real-time exchange of information, advice and opinions between experts or officials, and people who face a threat (hazard) to their survival, health or economic or social well-being” ([ 31 ], p5). This includes reporting the risk and health protection measurements through media and governmental bodies. Constructing awareness and building trust in society are essential components of risk communication [ 32 ]. In the context of the pandemic, the WHO noted that individual risk perception helped to prompt problem-solving activities (such as wearing face masks, social distancing, and self-isolation). However, the prolonged perception of pandemic-related uncertainty and risk could also lead to heightened feelings of distress and anxiety [ 31 , 33 ], see also [ 34 , 35 , 36 , 37 ].

This new and unprecedented disease provided the ground for researchers worldwide to investigate the COVID-19 pandemic. To date (August 2022), approximately 8072 studies have been recorded on the U.S. National Library of Medicine ClinicalTrials.gov [ 38 ] and 12002 systematic reviews have been registered at PROSPERO, concerning COVID-19. However, to our knowledge, there is little known about qualitative research as a response to the COVID-19 pandemic and how it impacted older adults’ well-being [ 39 ]. In particular, little is known about how older people experienced the pandemic. Thus, our research question considers: How did older adults experience the COVID-19 pandemic worldwide?

We use a qualitative evidence synthesis (QES) recommended by Cochrane Qualitative and Implementation Methods Group to identify peer-reviewed articles [ 40 ]. This provides an overview of existing research, identifies potential research gaps, and develops new cumulative knowledge concerning the COVID-19 pandemic and older adults’ experiences. QES is a valuable method for its potential to contribute to research and policy [ 41 ]. Flemming and Noyes [ 40 ] argue that the evidence synthesis from qualitative research provides a richer interpretation compared to single primary research. They identified an increasing demand for qualitative evidence synthesis from a wide range of “health and social professionals, policymakers, guideline developers and educationalists” (p.1).

Methodology

A systematic literature review requires a specific approach compared to other reviews. Although there is no consensus on how it is conducted, recent systematic literature reviews have agreed the following reporting criteria are addressed [ 42 , 43 ]: (a) a research question; (b) reporting database, and search strategy; (c) inclusion and exclusion criteria; (d) reporting selection methods; (e) critically appraisal tools; (f) data analysis and synthesis. We applied these criteria in our study and began by registering the research protocol with Prospero [ 44 ].

The study is registered at Prospero [ 44 ]. This systematic literature review incorporates qualitative studies concerning older adults’ experiences during the COVID-19 pandemic.

Search strategy

The primary qualitative articles were identified via a systematic search as per the qualitative-specific SPIDER approach [ 45 ]. The SPIDER tool is designed to structure qualitative research questions, focusing less on interventions and more on study design, and ‘samples’ rather than populations, encompassing:

S-Sample. This includes all articles concerning older adults aged 60 +  [ 1 ].

P-Phenomena of Interest. How did older adults experience the COVID-19 pandemic?

D-Design. We aim to investigate qualitative studies concerning the experiences of older adults during the COVID-19 pandemic.

E-Evaluation. The evaluation of studies will be evaluated with the amended Critical Appraisal Skills Programme CASP [ 46 ].

R-Research type Qualitative

Information source

The following databases were searched: PsychInfo, Medline, CINAHL, Web of Science, Annual Review, Annual Review of Gerontology, and Geriatrics. A hand search was conducted on Google Scholar and additional searches examined the reference lists of the included papers. The keyword search included the following terms: (older adults or elderly) AND (COVID-19 or SARS or pandemic) AND (experiences); (older adults) AND (experience) AND (covid-19) OR (coronavirus); (older adults) AND (experience) AND (covid-19 OR coronavirus) AND (Qualitative). Additional hand search terms included e.g. senior, senior citizen, or old age.

Inclusion and exclusion criteria

Articles were included when they met the following criteria: primary research using qualitative methods related to the lived experience of older adults aged 60 + (i.e. the experiences of individuals during the COVID-19 pandemic); peer-reviewed journal articles published in English; related to the COVID-19 pandemic; empirical research; published from 2020 till August 2022.

Articles were excluded when: papers discussed health professionals’ experiences; diagnostics; medical studies; interventions; day-care; home care; or carers; experiences with dementia; studies including hospitals; quantitative studies; mixed-method studies; single-case studies; people under the age of 60; grey literature; scoping reviews, and systematic reviews. We excluded clinical/care-related studies as we wanted to explore the everyday experiences of people aged 60 + . Mixed-method studies were excluded as we were interested in what was represented in solely qualitative studies. However, we acknowledge, that mixed-method studies are valuable for future systematic reviews.

Meta-ethnography

The qualitative synthesis was undertaken by using meta-ethnography. The authors have chosen meta-ethnography over other methodologies as it is an inductive and interpretive synthesis analysis and is uniquely “suited to developing new conceptual models and theories” ([ 47 ], p 2), see also [ 48 ]. Therefore, it combines well with constructivist grounded theory methodology. Meta-ethnography also examines and identifies areas of disagreements between studies [ 48 ].

This is of particular interest as the lived experiences of older adults during the COVID-19 pandemic were likely to be diverse. The method enables the researcher to synthesise the findings (e.g. themes, concepts) from primary studies, acknowledging primary data (quotes) by “using a unique translation synthesis method to transcend the findings of individual study accounts and create higher order” constructs ([ 47 ], p. 2). The following seven steps were applied:

Getting started (identify area of interest). We were interested in the lived experiences of older adults worldwide.

Deciding what was relevant to the initial interest (defining the focus, locating relevant studies, decision to include studies, quality appraisal). We decided on the inclusion and exclusion criteria and an appropriate quality appraisal.

Reading the studies. We used the screening process described below (title, abstract, full text)

Determining how the studies were related (extracting first-order constructs- participants’ quotes and second-order construct- primary author interpretation, clustering the themes from the studies into new categories (Table 3 ).

Translating the studies into one another (comparing and contrasting the studies, checking commonalities or differences of each article) to organise and develop higher-order constructs by using constant comparison (Table 3 ). Translating is the process of finding commonalities between studies [ 48 ].

Synthesising the translation (reciprocal and refutational synthesis, a lines of argument synthesis (interpretation of the relationship between the themes- leads to key themes and constructs of higher order; creating new meaning, Tables 2 , 3 ),

Expressing the synthesis (writing up the findings) [ 47 , 48 ].

Screening and Study Selection

A 4-stage screening protocol was followed (Fig.  1 Prisma). First, all selected studies were screened for duplicates, which were deleted. Second, all remaining studies were screened for eligibility, and non-relevant studies were excluded at the preliminary stage. These screening steps were as follows: 1. title screening; 2. abstract screening, by the first and senior authors independently; and 3. full-text screening which was undertaken for almost all papers by the first author. However, 2 papers [ 9 , 23 ] were assessed independently by LS, LR, and LMM to avoid a conflict of interest. The other co-authors also screened independently a portion of the papers each, to ensure that each paper had two independent screens to determine inclusion in the review [ 49 ]. This avoided bias and confirmed the eligibility of the included papers (Fig.  1 ). Endnote reference management was used to store the articles and aid the screening process.

Prisma flow diagram adapted from Page et al. [ 50 ]. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71 )

Data extraction

After title and abstract screening, 39 papers were selected for reading the full article. 7 papers were excluded after the full-text assessment (1 study was conducted in 2017, but published in 2021; 2 papers were not fully available in English, 2 papers did not address the research question, 1 article was based on a conference abstract only, 1 article had only one participant age 65 +).

The full-text screening included 32 studies. All the included studies, alongside the CASP template, data extraction table, the draft of this article, and translation for synthesising the findings [ 47 , 48 ] were available and accessible on google drive for all co-authors. All authors discussed the findings in regular meetings.

Quality appraisal

A critical appraisal tool assesses a study for its trustworthiness, methodological rigor, and biases and ensures “transparency in the assessment of primary research” ([ 51 ], p. 5); see also [ 48 , 49 , 50 , 51 , 52 , 53 ]. There is currently no gold standard for assessing primary qualitative studies, but different authors agreed that the amended CASPS checklist was appropriate to assess qualitative studies [ 46 , 54 ]. Thus, we use the amended CASP appraisal tool [ 42 ]. The amended CASP appraisal tool aims to improve qualitative evidence synthesis by assessing ontology and epistemology (Table 1 CASP appraisal tool).

A numerical score was assigned to each question to indicate whether the criteria had been met (= 2), partially met (= 1), or not met (= 0) [ 54 ]; see also [ 55 ]. The score 16 – 22 are considered to be moderate and high-quality studies. The studies scored 15 and below were identified as low-quality papers. Although we focus on higher-quality papers, we did not exclude papers to avoid the exclusion of insightful and meaningful data [ 42 , 48 , 52 , 53 , 54 , 55 , 56 , 57 ]. The quality of the paper was considered in developing the evidence synthesis.

We followed the appraisal questions applied for each included study and answered the criteria either ‘Yes’, ‘Cannot tell’, or ‘No’. (Table 1 CASP appraisal criteria). The tenth question asking the value of the article was answered with ‘high’ of importance, ‘middle’, or low of importance. The new eleventh question in the CASP tool concerning ontology and epistemology was answered with yes, no, or partly (Table 1 ).

Data synthesis

The data synthesis followed the seven steps of Meta-Ethnography developed by Noblit & Hare [ 58 ], starting the data synthesis at step 3, described in detail by [ 47 ]. This encompasses: reading the studies; determining how the studies are related; translating the studies into one another; synthesis the translations; and expressing synthesis. This review provides a synthesis of the findings from studies related to the experiences of older adults during the COVID-19 pandemic. The qualitative analyses are based on constructivist grounded theory [ 59 ] to identify the experiences of older adults during the COVID-19 pandemic (non-clinical) populations. The analysis is inductive and iterative, uses constant comparison, and aims to develop a theory. The qualitative synthesis encompasses all text labelled as ‘results’ or ‘findings’ and uses this as raw data. The raw data includes participant’s quotes; thus, the synthesis is grounded in the participant's experience [ 47 , 48 , 60 , 61 ]. The initial coding was undertaken for each eligible article line by line. Please see Table 2 Themes per author and country. Focused coding was applied using constant comparison, which is a widely used approach in grounded theory [ 61 ]. In particular, common and recurring as well as contradicting concepts within the studies were identified, clustered into categories, and overarching higher order constructs were developed [ 47 , 48 , 60 ] (Tables 2 , 3 , 4 ).

We identified twenty-seven out of thirty-two studies as moderate-high quality; they met most of the criteria (scoring 16/22 or above on the CASP; [ 54 ]. Only five papers were identified as low qualitative papers scoring 15 and below [ 71 , 73 , 74 , 86 , 91 ]. Please see the scores provided for each paper in Table 4 . The low-quality papers did not provide sufficient details regarding the researcher’s relationship with the participants, sampling and recruitment, data collection, rigor in the analysis, or epistemological or ontological reasoning. For example, Yildirim [ 91 ] used verbatim notes as data without recording or transcribing them. This article described the analytical process briefly but was missing a discussion of the applied reflexivity of using verbatim notes and its limitations [ 92 ].

This systematic review found that many studies did not mention the relationship between the authors and the participant. The CASP critical appraisal tool asks: Has the relationship between the researcher and participants been adequately considered? (reflecting on own role, potential bias). Many studies reported that the recruitment was drawn from larger studies and that the qualitative study was a sub-study. Others reported that participants contacted the researcher after advertising the study. One study Goins et al., [ 72 ] reported that students recruited family members, but did not discuss how this potential bias impacted the results.

Our review brings new insights into older adults’ experiences during the pandemic worldwide. The studies were conducted on almost all continents. The majority of the articles were written in Europe followed by North America and Canada (4: USA; 3: Canada, UK; 2: Brazil, India, Netherlands, Sweden, Turkey 2; 1: Austria, China, Finland, India/Iran, Mauritius, New Zealand, Serbia, Spain, Switzerland, Uganda, UK/Ireland, UK/Colombia) (see Fig.  2 ). Note, as the review focuses on English language publications, we are unable to comment on qualitative research conducted in other languages see [ 72 ].

Numbers of publications by country

The characteristics of the included studies and the presence of analytical themes can be found in Table 4 . We used the following characteristics: Author and year of publication, research aims, the country conducted, Participant’s age, number of participants, analytical methodology, CASP score, and themes.

We identified three themes: desired and challenged wellbeing; coping and adaptation; discrimination and intersectionality. We will discuss the themes in turn.

Desired and challenged wellbeing

Most of the studies reported the impact of the COVID-19 pandemic on the well-being of older adults. Factors which influenced wellbeing included: risk communication and risk perception; social connectivity; confinement (at home); and means of coping and adapting. In this context, well-being refers to the evidence reported about participants' physical and mental health, and social connectivity.

Risk perception and risk communication

Politicians and media transmitted messages about the response to the pandemic to the public worldwide. These included mortality and morbidity reports, and details of health and safety regulations like social distancing, shielding- self-isolation, or wearing masks [ 34 , 35 , 36 , 37 ]. As this risk communication is crucial to combat the spread of the virus, it is also important to understand how people perceived the reporting during the pandemic.

Seven studies reported on how the mass media impacted participants' well-being [ 23 , 67 , 68 , 70 , 72 , 81 , 85 ]. Sangrar et al. [ 68 ] investigated how older adults responded to COVID-19 messaging: “My reaction was to try to make sure that I listen to everything and [I] made sure I was aware of all the suggestions and the precautions that were being expressed by various agencies …”. (p. 4). Other studies reported the negative impact on participants' well-being of constant messaging and as a consequence stopped watching the news to maintain emotional well-being [ 3 , 67 , 68 , 70 , 72 , 81 , 85 ]. Derrer-Merk et al. [ 23 ] reported one participant said that “At first, watching the news every day is depressing and getting more and more depressing by the day, so I’ve had to stop watching it for my own peace of mind” (p. 13). In addition, news reporting impacted participants’ risk perception. For example, “Sometimes we are scared to hear the huge coverage of COVID-19 news, in particular the repeated message ‘older is risky’, although the message is useful.” ([ 81 ], p5).

• Social connectivity

Social connectivity and support from family and community were found in fourteen of the studies as important themes [ 9 , 62 , 66 , 67 , 68 , 75 , 76 , 77 , 78 , 79 , 80 , 83 , 84 , 90 ].

The impact of COVID-19 on social networks highlighted the diverse experiences of participants. Some participants reported that the size of social contact was reduced: “We have been quite isolated during this corona time” ?([ 80 ], p. 3). Whilst other participants reported that the network was stable except that the method of contact was different: “These friends and relatives, they visited and called as often as before, but of course, we needed to use the telephone when it was not possible to meet” ([ 77 ], p. 5). Many participants in this study did not want to expand their social network see also [ 9 , 77 , 78 , 79 ]. Hafford-Letchfield et al. [ 76 ] reported that established social networks and relationships were beneficial for the participants: “Covid has affected our relationship (with partner), we spend some really positive close time together and support each other a lot” (p. 7).

On the other hand, other studies reported decreases of, and gaps in, social connectedness: “I couldn’t do a lot of things that I’ve been doing for years. That was playing competitive badminton three times a week, I couldn’t do that. I couldn’t get up early and go volunteer in Seattle” [ 9 , 67 , 75 ]. A loss of social connection with children and grandchildren was often mentioned: “We cannot see our grandchildren up close and personal because, well because they [the parents] don’t want us, they don’t want to risk our being with the kids … it’s been an emotional loss exacerbated by the COVID thing” ([ 68 ] p.10); see also [ 9 , 67 , 78 ]. On the contrary, Chemen & Gopalla [ 66 ] note that those older adults who were living with other family members reported that they were more valued: “Last night my daughter-in-law thanked me for helping with my granddaughter” (p.4).

Despite reports of social disconnectedness, some studies highlighted the importance of support from family members and how support changed during the COVID-19 pandemic [ 9 , 62 , 81 , 83 , 90 ]. Yang et al. [ 90 ] argued that social support was essential during the Lockdown in China: “N6 said: ‘I asked my son-in-law to take me to the hospital” (p. 4810). Mahapatra et al. [ 81 ] found, in an Indian study, that the complex interplay of support on different levels (individual, family, and community) helped participants to adapt to the new situation. For example, this participant reported that: “The local police are very helpful. When I rang them for something and asked them to find out about it, they responded immediately” (p. 5).

Impact of confinement on well being

Most articles highlighted the impact of confinement on older adults’ well-being [ 9 , 62 , 63 , 65 , 67 , 69 , 70 , 72 , 75 , 77 , 78 , 79 , 81 , 82 , 83 , 85 , 89 , 90 ].

Some studies found that participants maintained emotional well-being during the pandemic and it did not change their lifestyle [ 79 , 80 , 82 , 83 , 89 , 92 ]: “Actually, I used this crisis period to clean my house. Bookcases are completely cleaned and I discarded old books. Well, we have actually been very busy with those kind of jobs. So, we were not bored at all” ([ 79 ], p. 5). In McKinlay et al. [ 82 ]’s study, nearly half of the participants found that having a sense of purpose helped to maintain their well-being: “You have to have a purpose you see. I think mental resilience is all about having a sense of purpose” (p. 6).

However, at the same time, the majority of the articles (12 out of 18) highlighted the negative impact of confinement and social distancing. Participants talked of increased depressive feelings and anxiety. For example, one of Akkus et al.’s [ 62 ] participants said: “... I am depressed; people died. Terrible disease does not give up, it always kills, I am afraid of it …” (p. 549). Similarly, one of Falvo et al.’s [ 67 ] participants remarked: “I am locked inside my house and I am afraid to go out” (p. 7).

Many of the studies reported the negative impact of loneliness as a result of confinement on participants’ well-being including [ 69 , 70 , 72 , 78 , 79 , 90 , 93 ]. Falvo et al. [ 67 ] reported that many participants experienced loneliness: “What sense does it make when you are not even able to see a family member? I mean, it is the saddest thing not to have the comfort of having your family next to you, to be really alone” (p. 8).

Not all studies found a negative impact on loneliness. For example, a “loner advantage” was found by Xie et al. ([ 82 ], p. 386). In this study participants found benefits in already being alone “It’s just a part of who I am, and I think that helps—if you can be alone, it really is an asset when you have to be alone” ([ 82 ], p. 386).

Bundy et al. [ 80 ] investigated loneliness from already lonely older adults and found that many participants did not attribute the loneliness to the pandemic: “It’s not been a whole lot, because I was already sitting around the house a whole lot anyway ( …). It’s basically the same, pretty well … I’d pretty well be like this anyway with COVID or without COVID” (p. 873) (see also [ 83 ]).

A study from Serbia investigated how the curfew was perceived 15 months afterward. Some participants were calm: “I realized that … well … it was simply necessary. For that reason, we accepted it as a measure that is for the common good” ([ 70 ], p.634). Others were shocked: “Above all, it was a huge surprise and sort of a shock, a complete shock because I have never, ever seen it in my life and I felt horrible, because I thought that something even worse is coming, that I even could not fathom” ([ 70 ], p. 634).

The lockdowns brought not only mental health issues to the fore but impacted the physical health of participants. Some reported they were fearful of the COVID-19 pandemic: “... For a little while I was afraid to leave, to go outside. I didn’t know if you got it from the air” ([ 75 ]. p. 6). Another study reported: “It’s been important for me to walk heartily so that I get a bit sweaty and that I breathe properly so that I fill my lungs—so that I can be prepared—and be as strong as possible, in case I should catch that coronavirus” ([ 77 ], p. 9); see also [ 70 , 78 , 82 , 85 ].

Coping and adaptation

Many studies mentioned older adults’ processes of coping and adaptation during the pandemic [ 63 , 64 , 68 , 69 , 72 , 75 , 79 , 81 , 85 , 87 , 88 , 89 , 90 ].

A variety of coping processes were reported including: acceptance; behavioural adaptation; emotional regulation; creating new routines; or using new technology. Kremers et al. [ 79 ] reported: “We are very realistic about the situation and we all have to go through it. Better days will come” (p. e71). Behavioural adaptation was reported: “Because I’m asthmatic, I was wearing the disposable masks, I really had trouble breathing. But I was determined to find a mask I could wear” ([ 68 ], p. 14). New routines with protective hygiene helped some participants at the beginning of the pandemic to cope with the health threat: “I am washing my hands all the time, my hands are raw from washing them all the time, I don't think I need to wash them as much as I do but I do it just in case, I don’t have anybody coming in, so there is nobody contaminating me, but I keep washing” ([ 69 ], p. 4391); see also [ 72 ]. Verhage et al. [ 87 ] reported strategies of coping including self-enhancing comparisons, distraction, and temporary acceptance: “There are so many people in worse circumstances …” (p. e294). Other studies reported how participants used a new technology: “I have recently learned to use WhatsApp, where I can make video phone calls.” ([ 88 ], p. 163); see also [ 89 ].

Discrimination -intersectionality (age and race/gender identity)

Seven studies reported ageism, racism, and gender discrimination experienced by older adults during the pandemic [ 23 , 63 , 67 , 70 , 76 , 84 , 88 ].

Prigent et al. [ 84 ], conducted in a New Zealand study, found that ageism was reciprocal. Younger people spoke against older adults: “why don’t you do everyone a favour and drop dead you f******g b**** it’s all because of ones like you that people are losing jobs” (p. 11). On the other hand, older adults spoke against the younger generation: “Shame to see the much younger generations often flout the rules and generally risk the gains made by the team. Sheer arrogance on their part and no sanctions applied” (p.11). Although one study reported benevolent ageism [ 23 ] most studies found hostile ageism [ 23 , 63 , 67 , 70 , 76 , 84 ]. One study from Canada exploring 15 older adult’s Chinese immigrants’ experiences reported racism as people around them thought they would bring the virus into the country. The negative impact on existing friendships was told by a Chinese man aged 69 “I can tell some people are blatantly despising us. I can feel it. When I talked with my Caucasian friends verbally, they would indirectly blame us for the problem. Eventually, many of our friendships ended because of this issue” ([ 88 ], p161). In addition, this study reported ageism when participants in nursing homes felt neglected by the Canadian government.

Two papers reported experiences of sexual and gender minorities (SGM) (e.g. transgender, queer, lesbian or gay) and found additional burdens during the pandemic [ 63 , 76 ]. People experienced marginalisation, stereotypes, and discrimination, as well as financial crisis: “I have faced this throughout life. Now people look at me in a way as if I am responsible for the virus.” ([ 63 ], p. 6). The consequence of marginalisation and ignorance of people with different gender identities was also noted by Hafford- Letchfield et al. [ 76 ]: “People have been moved out of their accommodation into hotels with people they don't know …. a gay man committed suicide, community members know of several that have attempted suicide. They are feeling pretty marginalised and vulnerable and you see what people are writing on the chat pages” (p.4). The intersection of ageism, racism, and heterosexism and its negative impact on people’s well-being during the pandemic reflects additional burden and stressors for older adults.

This systematic literature review is important as it provides new insights into the lived experiences of older adults during the COVID-19 pandemic, worldwide. Our study highlights that the COVID-19 pandemic brought an increase in English-written qualitative articles to the fore. We found that 32 articles met the inclusion criteria but 5 were low quality. A lack of transparency reduces the trustworthiness of the study for the reader and the scientific community. This is particularly relevant as qualitative research is often criticised for its bias or lack of rigor [ 94 ]. However, their findings are additional evidence for our study.

Our aim was to explore, in a systematic literature review, the lived experiences of older adults during the COVID-19 pandemic worldwide. The evidence highlights the themes of desired and challenged wellbeing, coping and adaptation, and discrimination and intersectionality, on wellbeing.

Perceived risk communication was experienced by many participants as overwhelming and anxiety-provoking. This finding supports Anwar et al.’s [ 37 ] study from the beginning of the pandemic which found, in addition to circulating information, that mass media influenced the public's behaviour and in consequence the spread of disease. The impact can be positive but has also been revealed to be negative as well. They suggest evaluating the role of the mass media in relation to what and how it has been conveyed and perceived. The disrupted social connectivity found in our review supports earlier studies that reported the negative impact of people’s well-being [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] at the beginning of the pandemic. This finding is important for future health crisis management, as the protective health measures such as confinement or self-isolation had a negative impact on many of the participants’ emotional wellbeing including increased anxiety, feelings of depression, and loneliness during the lockdowns. As a result of our review, future protective health measures should support people’s desire to maintain proximity with their loved ones and friends. However, we want to stress that our findings are mixed.

The ability of older adults to adapt and cope with the health crisis is important: many of the reported studies noted the diverse strategies used by older people to adapt to new circumstances. These included learning new technologies or changing daily routines. Politicians and the media and politicians should recognise both older adults' risk of disease and its consequences, but also their adaptability in the face of fast-changing health measures. This analysis supports studies conducted over the past decades on lifespan development, which found that people learn and adapt livelong to changing circumstances [ 95 , 96 , 97 ].

We found that discrimination against age, race, and gender identity was reported in some studies, in particular exploring participants’ experiences with immigration backgrounds and sexual and gender minorities. These studies highlighted the intersection of age and gender or race and were additional stressors for older adults and support the findings from Ramirez et al. [ 98 ] This review suggests that more research should be conducted to investigate the experiences of minority groups to develop relevant policies for future health crises.

Our review was undertaken two years after the pandemic started. At the cut-off point of our search strategy, no longitudinal studies had been found. However, in December 2022 a longitudinal study conducted in the USA explored older adult’s advice given to others [ 99 ]. They found that fostering and maintaining well-being, having a positive life perspective, and being connected to others were coping strategies during the pandemic [ 100 ]. This study supports the results of the higher order constructs of coping and adaptation in this study. Thus, more longitudinal studies are needed to enhance our understanding of the long-term consequences of the COVID-19 pandemic. The impact of the COVID-19 restrictions on older adults’ lives is evident. We suggest that future strategies and policies, which aim to protect older adults, should not only focus on the physical health threat but also acknowledge older adults' needs including psychological support, social connectedness, and instrumental support. The policies regarding older adult’s protections changed quickly but little is known about older adults’ involvement in decision making [ 100 ]. We suggest including older adults as consultants in policymaking decisions to ensure that their own self-determinism and independence are taken into consideration.

There are some limitations to this study. It did not include the lived experiences of older adults in care facilities or hospitals. The studies were undertaken during the COVID-19 pandemic and therefore data collection was not generally undertaken face-to-face. Thus, many studies included participants who had access to a phone, internet, or email, others could not be contacted. Additionally, we did not include published papers after August 2022. Even after capturing the most commonly used terms and performing additional hand searches, the search terms used might not be comprehensive. The authors found the quality of the papers to be variable, and their credibility was in question. We acknowledge that more qualitative studies might have been published in other languages than English and were not considered in this analysis.

To conclude, this systematic literature review found many similarities in the experiences of older adults during the Covid-19 pandemic despite cultural and socio-economic differences. However, we stress to acknowledge the heterogeneity of the experiences. This study highlights that the interplay of mass media reports of the COVID-19 pandemic and the policies to protect older adults had a direct impact on older adults’ well-being. The intersection of ‘isms’ (ageism, racism, and heterosexism) brought an additional burden for some older adults [ 98 ]. These results and knowledge about the drawbacks of health-protecting measures need to be included in future policies to maintain older adults’ well-being during a health crisis.

Availability of data and materials

The systematic literature review is based on already published articles. And all data analysed during this study are included in this manuscript. No additional data was used.

World Health Organisation (WHO): WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020. Retrieved from https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.

WorldOMeter: Coronavirus toll update: Cases & deaths by country. 2022. Worldometers. https://www.worldometers.info/coronavirus/ .

World Health Organisation (WHO): Coronavirus disease. 2022. https://www.who.int/health-topics/coronavirus#tab=tab . Aaccessed 5 Oct 2022.

Ayouni I, Maatoug J, Dhouib W, Zammit N, Fredj SB, Ghammam R, Ghannem H. Effective public health measures to mitigate the spread of COVID-19: a systematic review. BMC Public Health. 2021;21(1):1015.

PubMed   PubMed Central   CAS   Google Scholar  

Cerasoli B. The frail future of geriatrics. Lancet Healthy Longev. 2020;1(1):e11.

PubMed   PubMed Central   Google Scholar  

Allen K-A, Arslan G, Craig H, Arefi S, Yaghoobzadeh A, Sharif Nia H. The psychometric evaluation of the sense of belonging instrument (SOBI) with Iranian older adults. BMC Geriatr. 2021;21(1):211.

Bailey L, Ward M, DiCosimo A, Baunta S, Cunningham C, Romero-Ortuno R, Kenny RA, Purcell R, Lannon R, McCarroll K, et al. Physical and mental health of older people while cocooning during the COVID-19 pandemic. QJM. 2021;114(9):648–53.

Dahlberg L. Loneliness during the COVID-19 pandemic. Aging Ment Health. 2021;25(7):1161–4.

PubMed   Google Scholar  

Derrer-Merk E, Ferson S, Mannis A, Bentall R, Bennett KM. Older people's family relationships in disequilibrium during the COVID-19 pandemic. What really matters? Ageing Soc. 2022:1–18.

Derrer-Merk E, Ferson S, Mannis A, Bentall RP, Bennett KM. Belongingness challenged: Exploring the impact on older adults during the COVID-19 pandemic. PLoS ONE. 2022;17(10):e0276561.

Heidinger T, Richter L. The effect of COVID-19 on loneliness in the elderly. An empirical comparison of pre-and peri-pandemic loneliness in community-dwelling elderly. Front Psychol. 2020;11:(585308).

Richter L, Heidinger T. Hitting close to home: the effect of COVID-19 illness in the social environment on psychological burden in older adults. Front Psychol. 2021;12:(737787).

Krendl AC, Perry BL. The impact of sheltering in place during the COVID-19 pandemic on older adults’ social and mental well-being. J Gerontol B Psychol Sci Soc Sci. 2021;76(2):e53–8.

Litwin, H., & Levinsky, M. Social networks and mental health change in older adults after the Covid-19 outbreak. Aging Ment Health. 2021:1–6. https://doi.org/10.1080/13607863.2021.1902468 .

De Pue S, Gillebert C, Dierckx E, Vanderhasselt MA, De Raedt R, Van den Bussche E. The impact of the COVID-19 pandemic on wellbeing and cognitive functioning of older adults. Sci Rep. 2021;11(1):4636.

Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D, Patel R, Aggarwal CS, Vunnam R, Sahu N, Bhatt D, et al. COVID-19 and older adults: what we know. J Am Geriatr Soc. 2020;68(5):926–9.

Smith M, Steinman L, Casey E. Combatting social isolation among older adults in a time of physical distancing: the COVID-19 social connectivity paradox. Front Public Health. 2020;8:403.

Cohn-Schwartz E, Finlay JM, Kobayashi LC. Perceptions of societal ageism and declines in subjective memory during the COVID-19 pandemic: longitudinal evidence from US adults aged ≥55 years. J Soc Issues. 2022;78(4):924–38.

Tsoukalis-Chaikalis N, Demsia S, Stamatopoulou A, Chaniotis D, Tel Nu. Systematic Mapping Study of Covid-19 Psychological Impact. 2021;15(3):820.

van Gerwen M, Alsen M, Little C, Barlow J, Genden E, Naymagon L, Tremblay D. Risk factors and outcomes of COVID-19 in New York City; a retrospective cohort study. J Med Virol. 2021;93(2):907–15.

Victor CR, Rippon I, Barreto M, Hammond C, Qualter P. Older adults’ experiences of loneliness over the lifecourse: an exploratory study using the BBC loneliness experiment. Arch Gerontol Geriatr. 2022;102:104740.

Vrach IT, Tomar R. Mental health impacts of social isolation in older people during COVID pandemic. Prog Neurol Psychiatry. 2020;24(4):25–9.

Google Scholar  

Derrer-Merk E, Reyes-Rodriguez M-F, Salazar A-M, Guevara M, Rodríguez G, Fonseca A-M, Camacho N, Ferson S, Mannis A, Bentall RP, et al. Is protecting older adults from COVID-19 Ageism? A comparative cross-cultural constructive grounded theory from the United Kingdom and Colombia. J Soc Issues. 2022;78(4):900–23.

Lytle A, Levy SR. Reducing ageism toward older adults and highlighting older adults as contributors during the COVID-19 pandemic. J Soc Issues. 2022;78(4):1066–84.

McDarby M, Ju CH, Picchiello MC, Carpenter BD. Older adults’ perceptions and experiences of ageism during the COVID-19 pandemic. J Soc Issues. 2022;78(4):939–64.

Drury L, Abrams D, Swift HJ. Intergenerational contact during and beyond COVID-19. J Soc Issues. 2022;78(4):860–82.

Kanık B, Uluğ ÖM, Solak N, Chayinska M. “Let the strongest survive”: Ageism and social Darwinism as barriers to supporting policies to benefit older individuals. J Soc Issues. 2022;00:1–25.

Spaccatini F, Giovannelli I, Pacilli MG. “You are stealing our present”: Younger people's ageism towards older people predicts attitude towards age-based COVID-19 restriction measures. J Soc Issues. 2022;78(4):769–89.

Sutter A, Vaswani M, Denice P, Choi KH, Bouchard H, Esses VM. Ageism toward older adults during the COVID-19 pandemic: Intergenerational conflict and support. J Soc Issues. 2022;78(4):815–41.

Swift H, Chasteen A. Ageism in the time of COVID-19. Group Process Intergroup Relat. 2021;24:246–52.

World Health Organisation (WHO): Risk Communication in times of an epidemic or pandemic. Asset paper series Epidemics and Pandemics: 2017. https://www.who.int/emergencies/risk-communicationsWHORCaCERaoSAo .

Bailey A, Harris MA, Bogle D, Jama A, Muir SA, Miller S, Walters CA, Govia I. Coping with COVID-19: health risk communication and vulnerable groups. Disaster Med Public Health Prep. 2021;17:e22.

Li X, Lyu H. Epidemic risk perception PS, and mental health during COVID-19 pandemic: a moderated mediating model. Front Psychol. 2021;11:563741. https://doi.org/10.3389/fpsyg.2020.563741 .

Article   PubMed   PubMed Central   Google Scholar  

Sandman P M & American Industrial Hygiene Association: Responding to community outrage: strategies for effective risk communication. American Industrial Hygiene Association. 2003.

Sandman, P M. Introduction and orientation index.  https://www.psandman.com/index-intro.htm . Retrieved 13 October 2022.

Anderson M, Pitchforth E, Asaria M, Brayne C, Casadei B, Charlesworth A, Coulter A, Franklin BD, Donaldson C, Drummond M, et al. LSE-Lancet Commission on the future of the NHS: re-laying the foundations for an equitable and efficient health and care service after COVID-19. Lancet. 2021;397(10288):1915–78.

PubMed   CAS   Google Scholar  

Anwar A, Malik M, Raees V, Anwar A. Role of mass media and public health communications in the COVID-19 pandemic. Cureus. 2020;12(9):e10453.

U.S. National Library of Medicine: COVID-19 - Search Details - ClinicalTrials.gov: Clinicaltrials.gov 2022. Retrieved October 13, 2022, from https://clinicaltrials.gov/ct2/results/details?cond=COVID-19 .

Tremblay S, Castiglione S, Audet L-A, Desmarais M, Horace M, Peláez S. Conducting qualitative research to respond to COVID-19 challenges: reflections for the present and beyond. Int J Qual Methods. 2021;20:16094069211009680.

Flemming K, Noyes J. Qualitative evidence synthesis: where are we at? Int J Qual Methods. 2021;20:1609406921993276.

Booth A. Searching for qualitative research for inclusion in systematic reviews: a structured methodological review. Syst Rev. 2016;5(1):74.

Krnic Martinic M, Pieper D, Glatt A, Puljak L. Definition of a systematic review used in overviews of systematic reviews, meta-epidemiological studies and textbooks. BMC Med Res Methodol. 2019;19(1):203.

Phillips V, Barker E. Systematic reviews: structure, form and content. J Perioper Pract. 2021;31(9):349–53.

Derrer-Merk E, Soulsby L, Reyes Rodriguez M, Ferson S, Mannis A, Bennett KM. Older adults' lived experiences during the COVID-19 pandemic: a systematic review. 2022. PROSPERO 2022 CRD42022331714. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022331714 .

Cooke A, Smith D, Booth A. Beyond PICO: the SPIDER tool for qualitative evidence synthesis. Qual Health Res. 2012;22:1435–43.

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.

Sattar R, Lawton R, Panagioti M, Johnson J. Meta-ethnography in healthcare research: a guide to using a meta-ethnographic approach for literature synthesis. BMC Health Serv Res. 2021;21(1):50.

Soundy A, Heneghan NR. Meta-ethnography. Int Rev Sport Exerc Psychol. 2022;15(1):266–86.

Fallon V, Groves R, Halford JCG, Bennett KM, Harrold JA. Postpartum anxiety and infant-feeding outcomes: a systematic review. J Hum Lact. 2016;32(4):740–58.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Med. 2021;18(3):e1003583.

Tod D, Booth A, Smith B. Critical appraisal. Int Rev Sport Exerc Psychol. 2022;15(1):52–72.

Morse J. Why the Qualitative Health Research (QHR) review process does not use checklists. Qual Health Res. 2021;31(5):819–21.

Munthe-Kaas HM, Glenton C, Booth A, Noyes J, Lewin S. Systematic mapping of existing tools to appraise methodological strengths and limitations of qualitative research: first stage in the development of the CAMELOT tool. BMC Med Res Methodol. 2019;19(1):113.

Njau B, Covin C, Lisasi E, Damian D, Mushi D, Boulle A, Mathews C. A systematic review of qualitative evidence on factors enabling and deterring uptake of HIV self-testing in Africa. BMC Public Health. 2019;19(1):1289.

Butler A, Hall H, Copnell B. A guide to writing a qualitative systematic review protocol to enhance evidence-based practice in nursing and health care. Worldviews Evid Based Nurs. 2016;13(3):241–9.

Soilemezi D, Linceviciute S. Synthesizing qualitative research: reflections and lessons learnt by two new reviewers. Int J Qual Methods. 2018;17(1):1609406918768014.

Booth A. Harnessing energies, resolving tensions: acknowledging a dual heritage for qualitative evidence synthesis. Qual Health Res. 2019;29(1):18–31.

Carroll C, Booth A. Quality assessment of qualitative evidence for systematic review and synthesis: Is it meaningful, and if so, how should it be performed? Res Synth Methods. 2015;6(2):149–54.

Charmaz K. Constructing Grounded Theory. 2nd ed. London: Sage; 2014.

Toye F, Seers K, Allcock N, Briggs M, Carr E, Barker K. Meta-ethnography 25 years on: challenges and insights for synthesising a large number of qualitative studies. BMC Med Res Methodol. 2014;14(1):80.

Noblit GW, Hare RD. Meta-ethnography: synthesizing qualitative studies. California: Sage Publications Ltd; 1988.

Akkus Y, Parlak A, Karacan Y, Karatay G. Perceptions and experiences of older people regarding the COVID-19 pandemic process: a phenomenological study. Turk Geriatri Dergisi. 2021;24:546–56.

Banerjee D, Rao TSS. “The Graying Minority”: lived experiences and psychosocial challenges of older transgender adults during the COVID-19 pandemic in India, A qualitative exploration. Front Psychiatry. 2021;11:604472.

Brooke J, Jackson D. Older people and COVID-19: Isolation, risk and ageism. J Clin Nurs. 2020;29(13-14):2044–6.

Bundy H, Lee HM, Sturkey KN, Caprio AJ. The lived experience of already-lonely older adults during COVID-19. Gerontologist. 2021;61(6):870–7.

Chemen S, Gopalla YN. Lived experiences of older adults living in the community during the COVID-19 lockdown - The case of mauritius. J Aging Stud. 2021;57:100932.

Falvo I, Zufferey MC, Albanese E, Fadda M. Lived experiences of older adults during the first COVID-19 lockdown: a qualitative study. PLoS ONE. 2021;16(6):e0252101.

Fiocco AJ, Gryspeerdt C, Franco G. Stress and adjustment during the COVID-19 pandemic: a qualitative study on the lived experience of Canadian older adults. Int J Environ Res Public Health. 2021;18(24):12922.

Fristedt S, Carlsson G, Kylén M, Jonsson O, Granbom M. Changes in daily life and wellbeing in adults, 70 years and older, in the beginning of the COVID-19 pandemic. Scand J Occup Ther. 2022;29(6):511–21.

Gazibara T, Maksimovic N, Dotlic J, Jeremic Stojkovic V, Cvjetkovic S, Milic M. Experiences and aftermath of the COVID-19 lockdown among community-dwelling older people in Serbia: a qualitative study. J Eval Clin Pract. 2022;28(4):631–40.

Giebel C, Ivan B, Ddumba I. COVID-19 public health restrictions and older adults’ well-being in Uganda: psychological impacts and coping mechanisms. Clin Gerontol. 2022;45(1):97–105.

Goins RT, Anderson E, Minick H, Daniels H. Older adults in the United States and COVID-19: a qualitative study of perceptions, finances, coping, and emotions. Front Public Health. 2021;9:660536.

Gomes MACFC, Fontenele NAO, Galindo Neto NM, Barros LM, Frota NM. Elderly people’s experience facing social isolation in the COVID-19 pandemic. Rev Rene. 2021;22:e69236. https://doi.org/10.15253/2175-6783.20212269236 .

Article   Google Scholar  

Gonçalves AR, Barcelos JLM, Duarte AP, Lucchetti G, Gonçalves DR. Silva e Dutra FCM, Gonçalves JRL: Perceptions, feelings, and the routine of older adults during the isolation period caused by the COVID-19 pandemic: a qualitative study in four countries. Aging Ment Health. 2022;26(5):911–8.

Greenwood-Hickman MA, Dahlquist J, Cooper J, Holden E, McClure JB, Mettert KD, Perry SR, Rosenberg DE. “They’re Going to Zoom It”: a qualitative investigation of impacts and coping strategies during the COVID-19 pandemic among older adults. Front Public Health. 2021;9:679976.

Hafford-Letchfield T, Toze M, Westwood S. Unheard voices: a qualitative study of LGBT+ older people experiences during the first wave of the COVID-19 pandemic in the UK. Health Soc Care Community. 2022;30(4):e1233–43.

Huntley R, Bratt AS. An interpretative phenomenological analysis of the lived experiences of older adults during the covid-19 pandemic in sweden. Nordic Psychol. 2022;75(1)3–19.

Jiménez-Etxebarria E, Bernaras Iturrioz E, Jaureguizar J. Impact of the COVID-19 pandemic as perceived by older people in Northern Spain. Psychol Res Behav Manag. 2021;14:1789–803.

Kremers EM, Janssen JHM, Nieuwboer MS, Olde Rikkert MGM, Peeters GMEE. The psychosocial adaptability of independently living older adults to COVID-19 related social isolation in the Netherlands: a qualitative study. Health Soc Care Community. 2022;30(1):e67–74.

Kulmala J, Tiilikainen E, Lisko I, Ngandu T, Kivipelto M, Solomon A. Personal social networks of community-dwelling oldest old during the Covid-19 pandemic—A qualitative study. Front Public Health. 2021;9:1–10.

Mahapatra P, Sahoo KC, Desaraju S, Pati S. Coping with COVID-19 pandemic: reflections of older couples living alone in urban Odisha India. Prim Health Care Res Dev. 2021;22:e64.

McKinlay AR, Fancourt D, Burton A. A qualitative study about the mental health and wellbeing of older adults in the UK during the COVID-19 pandemic. BMC Geriatr. 2021;21(1):1–10.

Pfabigan J, Wosko P, Pichler B, Reitinger E, Pleschberger S. Under reconstruction: the impact of COVID-19 policies on the lives and support networks of older people living alone. Int J Care Caring. 2022;6(1-2):211–28.

Prigent C, Morgan T, Wiles J, Morgan K, Williams L, Gott M. Intergenerational tension or cohesion during the covid-19 pandemic?: A letter-writing study with older new zealanders. J Intergenerational Relationsh. 2022;20(4):386–405.

Sangrar R, Porter MM, Chesser S. Exploring the interpretation of COVID-19 messaging on older adults. Experiences of vulnerability. Can J Aging Rev Can Vieil. 2021;40(4):533–42.

Sattari S, Billore S. Bring it on Covid-19: being an older person in developing countries during a pandemic. Working Older People. 2020;24(4):281–91.

Verhage M, Thielman L, Kock L, Lindenberg J. Coping of older adults in times of COVID-19: considerations of temporality among dutch older adults. J Gerontol B. 2021;76(7):e290–9.

Wang Q, Liu JKK, Walsh CA. Identities: experiences and impacts of the COVID-19 pandemic from the perspectives of older Chinese immigrants in Canada. China J Soc Work. 2021;14(2):153–71.

Xie B, Shiroma K, De Main AS, Davis NW, Fingerman K, Danesh V. Living through the COVID-19 pandemic: community-dwelling older adults’ experiences. J Aging Soc Policy. 2021;33(4–5):380–97.

Yang Q, Wang Y, Tian C, Chen Y, Mao J. The Experiences of Community-dwelling older adults during the COVID-19 lockdown in Wuhan: a qualitative study. J Adv Nurs (John Wiley & Sons, Inc). 2021;77(12):4805–14.

Yıldırım H. Psychosocial status of older adults aged 65 years and over during lockdown in Turkey and their perspectives on the outbreak. Health Soc Care Community. 2022;30(3):899–907.

Hill Z, Tawiah-Agyemang C, Kirkwood B, Kendall C. Are verbatim transcripts necessary in applied qualitative research: experiences from two community-based intervention trials in Ghana. Emerg Themes Epidemiol. 2022;19(1):5.

Giles D. Performed across Europe and written up in English: the double challenge for qualitative psychologists. Qual Res Psychol. 2019;16(3):503–7.

Anderson C. Presenting and evaluating qualitative research. Am J Pharm Educ. 2010;74(8):141.

Nikitin J, Freund A. The Adaptation Process of Aging. The Cambridge Handbook of Successful Aging. Chapter: 17. Cambridge University Press. 2019. p. 281–98.

Deimling GT, Kahana B, Bowman KF, Schaefer ML. Cancer survivorship and psychological distress in later life. Psychooncology. 2002;11(6):479–94.

Baltes PB, Staudinger UM, Lindenberger U. Lifespan psychology: theory and application to intellectual functioning. Annu Rev Psychol. 1999;50:471–507.

Ramirez L, Monahan C, Palacios-Espinosa X, Levy SR. Intersections of ageism toward older adults and other isms during the COVID-19 pandemic. J Soc Issues. 2022;78(4):965–90.

Van Vleet B, Fuller HR, Hofmann B, Huseth-Zosel A. Untapped insight: a longitudinal qualitative analysis of older adults’ advice during the COVID-19 pandemic. Innov Aging. 2022;6(7):igac071.

Gietel-Basten S, Matus K, Mori R. COVID-19 as a trigger for innovation in policy action for older persons? Evid Asia Policy Soc. 2022;41(1):168–86.

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Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study

• Louis Camard 1 ,
• Roxane Liard 1 ,
• Sophie Duverne 1 ,
• Gladys Ibanez 1 , 3 &
• Mariela Skendi 1 , 2  

BMC Medical Education volume  24 , Article number:  341 ( 2024 ) Cite this article

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Point-of-Care Ultrasound (POCUS) has become an important tool in the clinical practice of many specialties, but its use and impact in General Practice in France remains to be explored.

The objective of this study is to obtain a consensus among experienced French general practitioners on a list of relevant POCUS skills in General Practice in 4 anatomical regions.

We used a two-round Delphi method to obtain a consensus. An initial list of skills was drawn by conducting a literature review. To rate each skill, we used a nine-point Likert scale. An interactive meeting between experts took place between Delphi rounds. POCUS experts in General Practice were defined as general practitioners with theoretical training in ultrasound who regularly perform ultrasound, who have performed ultrasound for more than five years and/or are involved in providing ultrasound training.

11 French general practitioners screened 83 skills in 4 anatomical regions: abdominal, urogenital, vascular, gynecology and obstetrics. An agreement was obtained for 36 POCUS skills as to their appropriateness in General Practice. There were 17 skills with a strong appropriate agreement (100% of “7–9” ratings) and 19 skills with a relative agreement (100% of “5–9” ratings).

These skills could serve as a basis for guidelines on the use and curriculum of POCUS in General Practice in France as well as in other countries with similar healthcare systems.

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Introduction

The use of ultrasound discovered in the nineteenth century is progressing in different medical specialties [ 1 ]. This technique is not solely used as a complementary examination, but it has evolved into the clinical point-of-care tool it is today through miniaturization and cost reduction. However, it is a dynamic, operator-dependent imaging technique that requires specific knowledge and skills [ 2 ]. Its use is growing in General Practice and some skills seem relevant both in terms of validity and impact on patient care even if the training arrangements have still to be specified [ 3 ].

In 2017, ​​T he American Academy of Family Physicians (AAFP) created curriculum guidelines for POCUS in graduate medical education [ 4 ]. Since 2020, several European studies have tried to describe a list of indications and applications in General Practice obtained by consensus of Scandinavian [ 5 ] and Spanish [ 6 ] general practitioners. In France, the French Health Authority conducted a literature review in 2022 that identified a lack of data on the use of POCUS by general practitioners [ 7 ]. It is necessary to have a framework of relevant POCUS skills in general practice, to precise the modalities of use, the clinical situations where they have an impact on patient care and their training requirements [ 7 ].

The objective of the study was to determine a consensus on relevant POCUS skills in General Practice, among experienced French general practitioners, on a list of relevant POCUS skills in General Practice in the following fields: abdominal and digestive, urogenital, vascular, gynecological and obstetrics.

This study was conducted in France from November 2021 to July 2022. We used the Delphi method to ascertain the degree of agreement within a group of selected individuals. This is a qualitative method used to address subjects for which few studies are available and/or where there is a low level of evidence. It enables structured interaction between experts through several self-completed questionnaires and successive meetings. It follows three key principles: data anonymity, repeated collection of data with comments and data analysis with feedback given to the various participants [ 8 , 9 , 10 ].

The search for experts was carried out with the help of the French College of General Practice Ultrasound group, made up of 16 members, representing all French College of General Practice structures (unions and training organizations). The invitation email including a questionnaire on the characteristics of general practitioners practicing ultrasound was relayed by the members of the group to the 14 structures represented and distributed via the mailing lists or the website of each structure with a follow-up after 1 month. We do not know the total number of general partitioners (GP) addressed but the invitation email was sent to all GPs that were union members, that had participated in continuous medical education or were part of the network of "ECHO-MG", an ongoing study on POCUS in general practice [ 11 ]. The responses from interested physicians were analyzed and those who met the inclusion criteria were contacted.

The inclusion criteria for the experts were:

to be a general practitioner in France;

to practice ultrasound regularly: more than once a week and for more than two years;

to have theoretical training in ultrasound: university program that includes theoretical courses (physics of ultrasound, normal and pathological findings) followed by hands-on internships in each area;

to have practiced ultrasound for more than five years and/or be involved in providing ultrasound training.

Delphi process

Questionnaire drafting phase.

The initial questionnaire was created by the authors of this study. The documentary research strategy involved a review of international recommendations and published studies about the relevant indications and skills for the use of POCUS in primary care (general practitioners and emergency physicians) covering the abdominal and digestive, gynecological and obstetric, urogenital and vascular fields. We used various scientific databases PubMed® and Google Scholar®. The Medical subject headings (MeSH) terms used were: "general practitioner", "primary care", "family practice", “ultrasonography”. To precise our search, we used the following keywords: "clinical ultrasound", "POCUS", "Point-of-Care Ultrasound", "bedside ultrasound". A synthesis was produced and a list of skills, as exhaustive as possible, was drawn up by two co-authors LC and MS. The experts did not take part in this process. During the Delphi process, the experts were asked to rate each skill according to the 9-point Likert scale, from 1 “totally inappropriate skill” to 9 “totally appropriate”. Strong appropriate agreement was defined as 100% of “7–9” ratings. Strong inappropriate agreement was defined as 100% of “1–3” ratings. Relative agreement was defined as 100% of “1–5” or “5–9” ratings. We communicated with the experts by email and suggested they attend an information meeting. At each stage, the questionnaire was proposed via the LymeSurvey® online software.

Delphi round

The research team sent each expert the first questionnaire, in which they should rate and comment on each skill. They were allowed to propose new skills (not featured on the list provided).

Intermediate meetings

Between the two questionnaires, two successive intermediate meetings were organized one month apart. Each meeting was recorded, and a summary was produced. The skills that obtained a strong agreement (appropriate or inappropriate) in the first questionnaire were not discussed. The aim was to return the anonymized answers from the first round to the experts and discuss each non-consensual item and their respective answers.

Delphi round 2

A second questionnaire was created based on the initial list of skills with the addition of the changes suggested by the experts. It was sent to the experts with a summary of the discussions held at the intermediate meetings. The aim was to obtain a final consensus.

Data processing was done on a secured platform according to French General Data Protection Regulation . This project was conformed to the National Commission of Computing and Freedom and submitted to the Data Protection Officer of Sorbonne University. The protocol of the study was submitted to the Ethics committee of Sorbonne University. The Ethics committee answered that there is no need to seek ethical advice for work that relies on a Delphi round consensus method among professionals.

Forty-six positive responses by general practitioners interested in participating in this study were received. Thirteen general practitioners were eligible and 11 responded to the first questionnaire (Fig.  1 ). A summary of the characteristics of the general practitioners experts in POCUS is given in Table  1 . Nine of the 11 experts (82%) were ultrasound instructors. The two experts who were not instructors had more than five years of experience in POCUS.

Study flowchart  (n  =  number of experts)

The first questionnaire included 62 skills divided into: 16 abdominal and digestive items, 19 gynecological and obstetric items, 13 urogenital items and 14 vascular items. The first Delphi round resulted in 9 skills with strong agreement (Table  2 ).

The responses of the first round included 21 supplementary skills proposed by the experts. The supplementary skills were added to the second questionnaire, composed of 74 skills. The intermediate meetings were summarized. In total, 83 POCUS skills (Appendix 1 ) were screened.

The second round resulted in 8 skills with strong agreement and 19 skills with relative agreement . Three of the 11 experts did not answer the last questionnaire. Table 3 shows the final list of the 17 skills that obtained a consensus with strong agreement and the 19 skills that obtained relative agreement including 4 skills with inappropriate agreement. The number of experts who rated each skill for which a consensus was obtained is available on Table  3 .

Using the Delphi method, this study made it possible to create a list of relevant skills in POCUS that are useful to general practitioners: this includes 36 skills that obtained expert consensus in the abdominal, urogenital, vascular, gynecological and obstetric fields (Table  3 ).

Strengths and limitations

This study is to our knowledge the first French general practice consensus on POCUS skills in abdominal, urogenital, vascular, gynecological and obstetrical fields.

The number of experts included is in line with the literature [ 12 , 13 ]. They had solid practical experience: 80% of them had been practicing for more than five years or were ultrasound instructors.

The proposals from the first questionnaire were the result of a synthesis of two types of publication:

international publications that made it possible to obtain a list of indications in General Practice or which assessed the use of targeted ultrasound in some indications [ 3 , 5 , 14 , 15 ].

the recommendations of French-speaking and international learned societies such as the AAFP [ 4 ], the French Society of Emergency Medicine [ 16 , 17 ], the French Good Practice Guidelines for the Clinical Use of Medical Imaging and the French Guidelines for Requesting Radiology examinations and Medical Imaging [ 18 , 19 ].

With the skills proposed by the experts, 83 items were assessed (Appendix 1 ). We decided to conduct two Delphi rounds to reduce the attrition bias and a bandwagon effect [ 20 ]. Any authority bias was limited by making the answers anonymous and giving space to experts to comment on each skill. For a consensus, we required 100% of the highest scores (“7–9”); consequently, the consensus for each validated skills was total between the experts.

We faced difficulties in organizing the intermediate meetings: only three to six experts were present at the same time. Three of the 11 experts did not finish the process. This could affect the comprehensiveness of the final list so we precised the number of experts who rated each skill for which a consensus was reached. External factors such as COVID-19 pandemic, the winter season, the workload of GPs working in private practices in a context of lack of GPs in France might have affected the feasibility and execution of the study. We suggest these factors should be taken into consideration before the execution of future studies.

In order to reduce the effect on the Delphi method of the 3 non-respondents during the 2nd round, we considered that a strong or relative agreement should include 100% of the participants.

A single disagreement resulted in a non-consensual skill. For example: the proposition "affirm or not splenomegaly" did not obtain agreement even though the median of the responses was “8” because one expert’s rating was “3”.

In a qualitative study, « transferability» replaces the notion of external validity [ 21 ]. Our study cannot be generalized to all general practitioners. It would be interesting to interview « non-expert» physicians on the possibility of the use of this list of skills in common practice [ 10 ]. The non-expert perspectives might contextualize the need for certain ultrasound skills and describe different needs according to their type of practice and specific interest. Some skills that did not obtain consensus and were left out might be questionable in the context of a remote setting where the waiting time for an ultrasound is long. An observational study describing the use and impact of POCUS in real-world settings might provide further insights into the acceptance of the identified skills [ 11 ]. The consensual list could be compared to the variety of the actual skills used, the type and frequency of organs scanned.

Discussion of the results

This study is a response to the prerequisite set by the French Health Authority [ 7 ] by identifying relevant skills in routine general practice, making it possible to specify the clinical situations in which POCUS is useful or POCUS training methods.

The AAFP work identified the basic applications, which include most of our final list, and the more advanced applications, such as searching for urinary lithiasis and hydroceles, which both obtained strong agreement in our study. The overlap was assessed for each field: 80% for obstetrical applications (first trimester), 25% for gynecology, 57% for abdominal (100% basic skills), 67% for urogenital and 67% for arterial applications in the vascular field. The skills proposed by the AAFP in 2017 overlap in total by 36% (19/53) with our list, an apparently low rate but a discordance is mainly due to the inclusion of obstetrical skills in the 2nd and 3rd trimester of pregnancy. In France, GPs play a role in the diagnosis of early pregnancy, in the follow-up of non-pathological pregnancies and in the voluntary interruption of pregnancy. They do not perform obstetrical deliveries. The experts focused on the value of POCUS before the 11th week of amenorrhea. The 2 skills that received an inappropriate agreement illustrate this ("estimate fetal weight, in the second or third trimester of pregnancy" and "affirm or not a sufficient quantity of amniotic fluid, in the second and third trimester of pregnancy"). Some skills are not mentioned, such as searching for bladder masses, bladder diverticula and testicular masses [ 4 ]. During the discussions, the experts pointed out that bladder diverticula were often a consequence of urinary tract obstruction and could be the reason for repetitive urinary infections. The “affirm of not the presence of bladder diverticula” was added to other skills that received strong agreement in the urogenital area like "affirm or not post-micturition residue" or "measure prostate volume". The experts pointed out that diagnosing complications of bladder diverticula such as urinary tract infections or stones was common in general practice.

Løkkegaard et al. obtained a list of 30 POCUS skills in general practice from Scandinavian general practitioners. In the 4 fields discussed in this study, the final list overlaps theirs by 85%. Some of our skills were not retained in their final list, such as searching for testicular and bladder masses. Others were not mentioned, such as searching for urinary lithiasis, bladder diverticula, and assessing post-micturition residue [ 5 ]. The 12 skills concerning with musculoskeletal ultrasound were not investigated in our study. The diagnosis of deep vein thrombosis was not included in our study because of a disagreement over the technical methods used (full ultrasound examination or point-by-point examination). Conangla-Ferrin et al. conducted a study similar to our study in 2022 by the Catalan society of Family and Community Medicine. Our results overlap 50% of the skills described in their final list. The skill mentioning appendicitis got only relatively agreed in our study. The gynecological applications were not very detailed [ 6 ]. The assessment of pancreatitis was not proposed in our initial list and was not added by the experts after the 1st round.

The differences in the composition of the expert group that rated the skills and the participants in the intermediate meetings might explain some of the discrepancies observed. Some skills were considered as advanced (e.g. appendicitis) or too specialized (assessment of pancreatitis) and did not obtain consensus. In the Spanish study, other specialists than general practitioners, as radiologists, participated in intermediate meetings. We do not know the level of expertise of the GPs in the Spanish study. But the participation of other specialists than general practitioners in the intermediate meetings might influence participants to include more advanced objectives and skills.

Another reason for discrepancies might be the different rating methods. In the Spanish study, the 75th percentile limit for obtaining consensus might have enabled a larger list to be obtained.

In France, the French Society of Emergency Medicine issued recommendations on clinical ultrasound skills in emergency medicine according to 2 skill levels that include part of our list [ 16 , 17 ].

The skill « affirm or not the presence of bladder diverticula» proposed by one of the experts and which obtained strong agreement, is not mentioned in these various publications.

Sorensen et al. conducted a literature review of the clinical studies assessing POCUS in relevant indications in General Practice. Most of the publications focus on emergency doctors and not general practitioners [ 22 ]. Lindgaard et al. did assess general practitioners and found satisfactory results for the following skills: biliary lithiasis (se. 92% and sp. 92%), ascites (se. 100%, sp. 100%), abdominal aortic aneurysm (se. 100%, sp. 100%), developing intrauterine pregnancy (se. 100%, sp. 100%) [ 23 ]. Esquerrà et al. found notably similar results for the detection of biliary lithiasis by general practitioners [ 24 ]. Bravo et al. [ 25 ], Blois [ 26 ] and Bailey et al. [ 27 ] arrived at the same conclusions for abdominal aortic aneurysms. Nixon et al. assessed general practitioners in rural hospitals in New Zealand in renal POCUS and found good performance in relation to hydronephrosis (se. 90%, sp. 96%) and urine retention (se. 100% and sp. 100%) [ 28 ].

Perspectives

Echoing the proposals made by the French Health Authority , the experts raised the need to conduct research enabling study, to a sufficient standard of proof, of the diagnostic performance of POCUS associated with a clinical examination, versus a clinical examination alone, in addition to assessing POCUS versus a reference test [ 29 ].

It seems crucial to provide details of the modalities for each skill: the corresponding clinical situations (e.g. suspect cholecystitis in the presence of acute, continuous abdominal epigastric pain increased by deep inspiration), the expected impact on decision-making in the patient’s care (e.g. referral to an emergency service, to specialist radiologists or only reassurance), the conditions required to achieve this act (e.g. stationary or ultra-portable device, type of ultrasound technology available such as B-mode, color Doppler, pulsed Doppler or the type of probe to be used or scanning technique) and its technical limitations (e.g. in cholecystitis, a gallbladder completely filled with stones can be difficult to see or stones located in the fundus or collum may therefore go unnoticed), as well as the learning outcomes for each skill (e.g. know the ultrasound characteristics of gallstones, know that the normal wall of the gallbladder is less than 3 mm thick) [ 30 ]. These details would make it possible to create support tools for the practice, such as the “action cards” proposed by the Danish Society for Ultrasound in General Practice, which are accessible from the Danish public health portal [ 31 ]. GPs using POCUS engage their own responsibility. Indeed, the experts raised the medico-legal risk that GPs are exposed to when they carry out POCUS (particularly in gynaecology/obstetrics). They stress the importance of explaining, in their clinical observations and to their patients, the impossibility of excluding a pathology in the absence of any visualised sign, or of specifying that "no morphological study has been carried out on this examination" (e.g. in targeted obstetric ultrasound during the first trimester of pregnancy). The description of the modalities helps physicians faced with the limitations of POCUS. By delimiting the field of reliability of POCUS exams, GPs will be encouraged not to perform POCUS outside the indications by being informed of the possible risks (e.g.: delaying treatment due to a falsely reassuring ultrasound).

This study made it possible to obtain a consensus concerning 36 POCUS skills relevant in General Practice in the digestive (3 strong agreement/6 relative agreement), urogenital (10 strong agreement/5 relative agreement), gynecological-obstetrical (2 strong agreement/4 relative agreement) and vascular fields (2 strong agreement/1 relative agreement). This list of skills provides a basis for future clinical guidelines and training programs by identifying useful skills for general practitioners. It also acts as a guardrail by distinguishing between appropriate and inappropriate skills in general practice: it enables GPs to use POCUS to reach safe conclusions for their patient by making faster and more targeted referrals, and for themselves from a medico-legal perspective. This consensual list is not exhaustive, since new indications and possibilities for semiological examinations are emerging, meaning that the list should be continuously updated. Further studies should include other areas of interest such as thyroid, musculoskeletal, cardiac, soft tissue and pulmonary ultrasound.

Availability of data and materials

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

Abbreviations

Point-Of-Care Ultrasound

American Academy of Family Physicians

General Practitioner

Inappropriate

Appropriate

Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364:749–57. https://doi.org/10.1056/NEJMra0909487 .

Article   Google Scholar  

Piscaglia F, Dietrich CF, Nolsoe C, Gilja OH, Gaitini D. Birth of ‘“echoscopy”’: the EFSUMB point of view. Ultraschall Med. 2013;34:92. https://doi.org/10.1055/s-0032-1319207 .

Andersen CA, Holden S, Vela J, Rathleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice: A Systematic Review. Ann Fam Med. 2019;17(1):61–9. https://doi.org/10.1370/afm.2330 .

American Academy of Family Physicians. Recommended curriculum guidelines for family medicine residents: point of care ultrasound. AAFP Reprint No 290D. 2016. Available from: https://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint290D_POCUS.pdf . Accessed 2023.

Løkkegaard T, Todsen T, Nayahangan LJ, Andersen CA, Jensen MB, Konge L. Point-of-care ultrasound for general practitioners: a systematic needs assessment. Scand J Prim Health Care. 2020;38(1):3–11. https://doi.org/10.1080/02813432.2020.1711572 . Epub 2020. PMID: 31955658; PMCID: PMC7054965.

Conangla-Ferrin L, Guirado-Vila P, Solanes-Cabús M, et al. Ultrasound in primary care: Consensus recommendations on its applications and training. Results of a 3-round Delphi study. Eur J Gen Pract. 2022;28(1):253–9. https://doi.org/10.1080/13814788.2022.2150163 .

Haute Autorité de Santé. Évaluation de l’utilisation de l’échoscopie (ou échographie clinique ciblée) par le médecin généraliste (French). Available on: https://www.has-sante.fr/jcms/p_3357680/fr/evaluation-de-l-utilisation-de-l-echoscopie-ou-echographie-clinique-ciblee-par-le-medecin-generaliste . Accessed 2023.

McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques. Int J Clin Pharm. 2016;38(3):655–62. https://doi.org/10.1007/s11096-016-0257-x . Epub 2016. PMID: 26846316; PMCID: PMC4909789.

Bourrée F, Michel P, Salmi LR. Méthodes de consensus: revue des méthodes originales et de leurs grandes variantes utilisées en santé publique Consensus methods: review of original methods and their main alternatives used in public health. Rev Epidemiol Sante Publique. 2008;56(6):415–23. https://doi.org/10.1016/j.respe.2008.09.006 . Epub 2008. PMID: 19013039; PMCID: PMC3838316.

Haute Autorité de Santé. Recommandations par consensus formalisé [French]. Available on : https://www.has-sante.fr/jcms/c_272505/fr/recommandations-par-consensus-formalise-rcf . Accessed 2023.

Sorbonne University. How Point-of-care Ultrasound Affects the Diagnostic and Therapeutic Process in General Practice. A Prospective Follow-up Study in France. clinicaltrials.gov; 2021 mai. Report No.: NCT04583670. Available on : https://clinicaltrials.gov/ct2/show/NCT04583670 . cité 2022

Wattel H. L, D. E. Johnson, L. R. Meiller, L. C. Miller, & G. F. Summers. Review of Needs Assessment: Theory and Methods, by D. E. Johnson, L. R. Meiller, L. C. Miller, & G. F. Summers. J Consum Aff. 1989;23(1):200–2. http://www.jstor.org/stable/23859128 .

Google Scholar  

Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. The RAND/UCLA Appropriateness Method User’s Manual. RAND Corporation; 2001 janv. Available on: https://www.rand.org/pubs/monograph_reports/MR1269.html . Accessed 2023.

Lemanissier M. Validation d’une première liste d’indications d’échographies réalisables par le médecin généraliste [Thèse d'exercice, French]. Université Toulouse III - Paul Sabatier. 2013. Available on: http://thesesante.ups-tlse.fr/172/ . Accessed 2023.

Homar V, Gale ZK, Lainscak M, Svab I. Knowledge and skills required to perform point-of-care ultrasonography in family practice - a modified Delphi study among family physicians in Slovenia. BMC Fam Pract. 2020;21(1):56. https://doi.org/10.1186/s12875-020-01130-z . PMID:32216753;PMCID:PMC7098073.

Duchenne J, Martinez M, Rothmann C. Premier niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé. Ann Fr Med Urgence 2016;6:284–95. https://doi.org/10.1007/s13341-016-0649-5 .

Martinez M, Duchenne J, Bobbia X, et al. Deuxième niveau de compétence pour l’échographie clinique en médecine d’urgence. Recommandations de la Société française de médecine d’urgence par consensus formalisé. Ann Fr Med Urgence. 2018;8:193–202. https://doi.org/10.3166/afmu-2018-0047 .

Société française de radiologie (SFR) et de médecine nucléaire. Guide du bon usage des examens d'imagerie médicale French. 2013. Available on : http://gbu.radiologie.fr/ . Accessed 2023.

Société Française de Radiologie et d'Imagerie Médicale. Référentiel des bonnes pratiques à l’usage des médecins - Aide à la demande d’examens de radiologie et imagerie médicale (ADERIM) [French]. Disponible sur: https://aderim.radiologie.fr/home . Accessed 2023.

Blumenthal-Barby JS, Krieger H. Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making. 2015;35(4):539–57. https://doi.org/10.1177/0272989X14547740 .

Proulx J. Recherches qualitatives et validités scientifiques [French]. Recherches qualitatives. 2019;38(1):53–70. https://doi.org/10.7202/1059647ar .

Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J. 2019;11(1):31. https://doi.org/10.1186/s13089-019-0145-4.PMID:31749019;PMCID:PMC6868077 .

Lindgaard K, Riisgaard L. Validation of ultrasound examinations performed by general practitioners. Scand J Prim Health Care. 2017;35(3):256–61. https://doi.org/10.1080/02813432.2017.1358437 . Epub 2017. PMID: 28776457; PMCID: PMC5592352.

Esquerrà M, Roura Poch P, Masat Ticó T, Canal V, Maideu Mir J, Cruxent R. Ecografía abdominal: una herramienta diagnóstica al alcance de los médicos de familia Abdominal ultrasound: a diagnostic tool within the reach of general practitioners. Aten Primaria. 2012;44(10):576–83. https://doi.org/10.1016/j.aprim.2011.07.016 . Spanish Epub 2011. PMID: 22018792; PMCID: PMC7025941.

Bravo-Merino L, González-Lozano N, Maroto-Salmón R, Meijide-Santos G, Suárez-Gil P, Fañanás-Mastral A. Validez de la ecografía abdominal en Atención Primaria para detección de aneurisma de aorta abdominal en varones de entre 65 y 75 años Validity of the abdominal ecography in primary care for detection of aorta abdominal aneurism in male between 65 and 75 years. Aten Primaria. 2019;51(1):11–7. https://doi.org/10.1016/j.aprim.2017.10.005 . Spanish Epub 2017. PMID: 29225000; PMCID: PMC6837097.

Blois B. Office-based ultrasound screening for abdominal aortic aneurysm. Can Fam Physician. 2012;58(3):e172–8 PMID: 22518906; PMCID: PMC3303671.

Bailey RP, Ault M, Greengold NL, Rosendahl T, Cossman D. Ultrasonography performed by primary care residents for abdominal aortic aneurysm screening. J Gen Intern Med. 2001;16(12):845–9. https://doi.org/10.1111/j.1525-1497.2001.01128.x.PMID:11903764;PMCID:PMC1495301 .

Nixon G, Blattner K, Muirhead J, Kerse N. Rural point-of-care ultrasound of the kidney and bladder: quality and effect on patient management. J Prim Health Care. 2018;10(4):324–30. https://doi.org/10.1071/HC18034 . (PMID: 31039961).

Colli A, Prati D, Fraquelli M, Segato S, Vescovi PP, Colombo F, Balduini C, Della Valle S, Casazza G. The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study. PLoS ONE. 2015;10(3):e0122181. https://doi.org/10.1371/journal.pone.0122181.PMID:25793296;PMCID:PMC4368724 .

Skendi M, Liard R, Besacier C, Correas J M, Moussaoui S, Chastang J, Ibanez G, et al. Intrauterine Pregnancy Detection and Gestational Age Assessment During Early Pregnancy by a Handheld Point-Of-Care Ultrasound Device Compared to a High-End Ultrasound System.An Accuracy and Reliability Study. POCUS J. 2022;7(2):225–31. https://doi.org/10.24908/pocus.v7i2.15458 .

Andersen CA, Hedegård HS, Løkkegaard T, Frølund J, Jensen MB. Education of general practitioners in the use of point-of-care ultrasonography: a systematic review. Fam Pract. 2021;38(4):484–94. https://doi.org/10.1093/fampra/cmaa140 . (PMID: 33367766).

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Acknowledgements

The authors would like to thank the participating GPs for their individual contributions and the Department of General Practice of Sorbonne University for non-financial support of the study.

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Louis Camard, Roxane Liard, Sophie Duverne, Gladys Ibanez & Mariela Skendi

Department of Adult Radiology, Necker Hospital, Paris, France

Mariela Skendi

Pierre-Louis Institute of Epidemiology and Public Health, Paris, France

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L.C, M.S, R.L, S.D took part in data collection L.C, M.S, G.I wrote the main manuscript text. All authors reviewed the manuscript.

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Correspondence to Louis Camard or Mariela Skendi .

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The protocol of the study was approved by the Ethics committee of Sorbonne University. The Ethics committee answered that there is no need to seek ethical advice for work that relies on a Delphi round consensus method among professionals. Informed Consent was obtained from all participants.

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Supplementary Information

Additional file 1: appendix 1..

List of 83 skills proposed in both Delphi rounds with the respective level of expert agreement, classified according to the skills field studied.

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Camard, L., Liard, R., Duverne, S. et al. Consensus on relevant point-of-care ultrasound skills in General Practice: a two-round French Delphi study. BMC Med Educ 24 , 341 (2024). https://doi.org/10.1186/s12909-024-05072-3

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Received : 09 August 2023

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Published : 26 March 2024

DOI : https://doi.org/10.1186/s12909-024-05072-3

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