review types in research

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Review Typologies

There are many types of evidence synthesis projects, including systematic reviews as well as others. The selection of review type is wholly dependent on the research question. Not all research questions are well-suited for systematic reviews.

• Review Typologies (from LITR-EX) This site explores different review methodologies such as, systematic, scoping, realist, narrative, state of the art, meta-ethnography, critical, and integrative reviews. The LITR-EX site has a health professions education focus, but the advice and information is widely applicable.

Review the table to peruse review types and associated methodologies. Librarians can also help your team determine which review type might be appropriate for your project. 

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

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• Last Updated: Mar 20, 2024 2:21 PM
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Systematic Reviews & Evidence Synthesis Methods

Types of reviews.

• Formulate Question
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Not sure what type of review you want to conduct?

There are many types of reviews ---  narrative reviews ,  scoping reviews , systematic reviews, integrative reviews, umbrella reviews, rapid reviews and others --- and it's not always straightforward to choose which type of review to conduct. These Review Navigator tools (see below) ask a series of questions to guide you through the various kinds of reviews and to help you determine the best choice for your research needs.

• Which review is right for you? (Univ. of Manitoba)
• What type of review is right for you? (Cornell)
• Review Ready Reckoner - Assessment Tool (RRRsAT)
• A typology of reviews: an analysis of 14 review types and associated methodologies. by Grant & Booth
• Meeting the review family: exploring review types and associated information retrieval requirements | Health Info Libr J, 2019

Reproduced from Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies . Health Info Libr J. 2009 Jun;26(2):91-108. doi: 10.1111/j.1471-1842.2009.00848.x

• Last Updated: Feb 27, 2024 12:53 PM
• URL: https://guides.lib.utexas.edu/systematicreviews

Systematic Reviews

• Introduction to Systematic Reviews

Traditional Systematic Reviews

Meta-analyses, scoping reviews, rapid reviews, umbrella reviews, selecting a review type.

• Reading Systematic Reviews
• Resources for Conducting Systematic Reviews
• Getting Help with Systematic Reviews from the Library
• History of Systematic Reviews
• Acknowledgements

Systematic Reviews are a family of review types that include:

This page provides information about the most common types of systematic reviews, important resources and references for conducting them, and some tools for choosing the best type for your research question .

Additional Information

• A typology of reviews: an analysis of 14 review types and associated methodologies This classic article is a valuable reference point for those commissioning, conducting, supporting or interpreting reviews.
• Traditional Systematic Reviews follow a rigorous and well-defined methodology to identify, select, and critically appraise relevant research articles on a specific topic and within a specified population of subjects
• The primary goal of this type of study is to comprehensively find the empirical data available on a topic, identify relevant articles, synthesize their findings and draw evidence-based conclusions to answer a clinical question
• Cochrane Handbook for Systematic Reviews of Interventions The Cochrane Handbook for Systematic Reviews of Interventions provides direction on the standard methods involved in conducting a systematic review. It is the official guide to the process involved in preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
• JBI Manual for Evidence Synthesis The JBI Manual for Evidence Synthesis is designed to provide authors with a comprehensive guide to conducting JBI systematic reviews. It describes in detail the process of planning, undertaking and writing up a systematic review using JBI methods. The JBI Manual for Evidence Synthesis should be used in conjunction with the support and tutorials offered at the JBI SUMARI Knowledge Base.

These are some places where protocols for systematic reviews might be published.

• PROSPERO: International prospective register of systematic reviews PROSPERO is an international database of prospectively registered systematic reviews in health and social care, welfare, public health, education, crime, justice, and international development, where there is a health related outcome. Key features from the review protocol are recorded and maintained as a permanent record. PROSPERO aims to provide a comprehensive listing of systematic reviews registered at inception to help avoid duplication and reduce opportunity for reporting bias by enabling comparison of the completed review with what was planned in the protocol.
• Guidance Notes for Registering A Systematic Review Protocol with PROSPERO
• OSF Registries Open Science Framework (OSF) Registries is an open network of study registgrations and pre-registrations. It can be used to pre-register a systematic review protocol. Note that OSF pre-registrations are not reviewed.
• OSF Preregistration Initiative This page explains the motivation behind preregistrations and best practices for doing so.
• Protocols.io A secure platform for developing and sharing reproducible methods, including protocols for systematic reviews.
• PRISMA 2020 Statement The PRISMA 2020 Statement was published in 2021. It consists of a checklist and a flow diagram, and is intended to be accompanied by the PRISMA 2020 Explanation and Elaboration document.
• Meta-analysis is a statistical method that can be applied during a systematic review to extract and combine the results from multiple studies
• This pooling of data from compatible studies increases the statistical power and precision of the conclusions made by the systematic review
• Systematic reviews can be done without doing a meta-analysis, but a meta-analysis must be done in connection with a systematic review
• Scoping reviews identify the existing literature available on a topic to help identify key concepts, the type and amount of evidence available on a subject, and what research gaps exist in a specific area of study
• They are particularly useful when a research question is broad and the goal is to provide an understanding of the available evidence on a topic rather than providing a focused synthesis on a narrow question
• JBI Manual Chapter 11: Scoping Reviews
• Updated methodological guidance for the conduct of scoping reviews The objective of this paper is to describe the updated methodological guidance for conducting a JBI scoping review, with a focus on new updates to the approach and development of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (the PRISMA-ScR).
• Steps for Conducting a Scoping Review This article in the Journal of Graduate Medical Education provides a comprehensive yet brief overview of the scoping review process.

Note: Protocols for scoping reviews can be published in all the same places as traditional systematic reviews except PROSPERO.

• Best practice guidance and reporting items for the development of scoping review protocols The purpose of this article is to clearly describe how to develop a robust and detailed scoping review protocol, which is the first stage of the scoping review process. This paper provides detailed guidance and a checklist for prospective authors to ensure that their protocols adequately inform both the conduct of the ensuing review and their readership.
• PRISMA for Scoping Reviews (PRISMA-ScR) The PRISMA extension for scoping reviews was published in 2018. The checklist contains 20 essential reporting items and 2 optional items to include when completing a scoping review. Scoping reviews serve to synthesize evidence and assess the scope of literature on a topic. Among other objectives, scoping reviews help determine whether a systematic review of the literature is warranted.
• Touro College: What is a Scoping Review? This page describes scoping reviews, including their limitations, alternate names, and how they differ from traditional systematic reviews.
• What are scoping reviews? Providing a formal definition of scoping reviews as a type of evidence synthesis This article from JBI Evidence Synthesis provides a thorough definition of what scoping reviews are and what they are for.
• The role of scoping reviews in reducing research waste This article from the Journal of Clinical Epidemiology looks at how scoping reviews can reduce research waste.
• Rapid reviews streamline the systematic review process by omitting certain steps or accelerating the timeline
• They are useful when there is a need for timely evidence synthesis, such as in response to questions concerning an urgent policy or clinical situation such as the COVID-19 pandemic
• Rapid Review Guidebook This document provides guidance on the process of conducting rapid reviews to use evidence to inform policy and program decision making.
• Rapid reviews to strengthen health policy and systems: a practical guide This guide from the World Health Organization offers guidance on how to plan, conduct, and promote the use of rapid reviews to strengthen health policy and systems decisions. The Guide explores different approaches and methods for expedited synthesis of health policy and systems research, and highlights key challenges for this emerging field, including its application in low- and middle-income countries. It touches on the utility of rapid reviews of health systems evidence, and gives insights into applied methods to swiftly conduct knowledge syntheses and foster their use in policy and practice.
• Cochrane Rapid Reviews Methods Group offers evidence-informed guidance to conduct rapid reviews The Cochrane Rapid Reviews Methods Group offers new, interim guidance to support the conduct of Rapid Reviews.
• Touro College: What is a Rapid Review? This page describes rapid reviews, including their limitations, alternate names, and how they differ from traditional systematic reviews.
• Umbrella reviews synthesize evidence from multiple systematic reviews and meta-analyses on a specific topic
• They provide a next-generation level of evidence synthesis, analyzing evidence taken from multiple systematic reviews to offer a broader perspective on a given subject
• JBI Manual Chapter 10: Umbrella reviews
• Preferred Reporting Items for Overviews of Reviews (PRIOR) Overviews of reviews (i.e., overviews) compile information from multiple systematic reviews to provide a single synthesis of relevant evidence for healthcare decision-making. Despite their increasing popularity, there are currently no systematically developed reporting guidelines for overviews. This is problematic because the reporting of published overviews varies considerably and is often substandard. Our objective is to use explicit, systematic, and transparent methods to develop an evidence-based and agreement-based reporting guideline for overviews of reviews of healthcare interventions (PRIOR, Preferred Reporting Items for Overviews of Reviews).
• Touro College: What is an Overview of Reviews? This page describes umbrella reviews, including their limitations, alternate names, and how they differ from traditional systematic reviews.
• Cornell University Systematic Review Decision Tree This decision tree is designed to assist researchers in choosing a review type.
• Right Review This tool is designed to provide guidance and supporting material to reviewers on methods for the conduct and reporting of knowledge synthesis.
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• Last Updated: Mar 27, 2024 4:35 PM
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Evidence Synthesis and Systematic Reviews

Systematic reviews, rapid reviews, scoping reviews.

• Other Review Types
• Resources for Reviews by Discipline and Type
• Tools for Evidence Synthesis
• Grey Literature

Definition : A systematic review is a summary of research results (evidence) that uses explicit and reproducible methods to systematically search, critically appraise, and synthesize on a specific issue. It synthesizes the results of multiple primary studies related to each other by using strategies that reduce biases and errors.

When to use : If you want to identify, appraise, and synthesize all available research that is relevant to a particular question with reproduceable search methods.

Limitations : It requires extensive time and a team

Resources :

• Systematic Reviews and Meta-analysis: Understanding the Best Evidence in Primary Healthcare
• The 8 stages of a systematic review
• Determining the scope of the review and the questions it will address
• Reporting the review

Definition : Rapid reviews are a form of evidence synthesis that may provide more timely information for decision making compared with standard systematic reviews

When to use : When you want to evaluate new or emerging research topics using some systematic review methods at a faster pace

Limitations : It is not as rigorous or as thorough as a systematic review and therefore may be more likely to be biased

• Cochrane guidance for rapid reviews
• Steps for conducting a rapid review
• Expediting systematic reviews: methods and implications of rapid reviews

Definition : Scoping reviews are often used to categorize or group existing literature in a given field in terms of its nature, features, and volume.

When to use : Label body of literature with relevance to time, location (e.g. country or context), source (e.g. peer-reviewed or grey literature), and origin (e.g. healthcare discipline or academic field) It also is used to clarify working definitions and conceptual boundaries of a topic or field or to identify gaps in existing literature/research

Limitations : More citations to screen and takes as long or longer than a systematic review.  Larger teams may be required because of the larger volumes of literature.  Different screening criteria and process than a systematic review

• PRISMA-ScR for scoping reviews
• JBI Updated methodological guidance for the conduct of scoping reviews
• JBI Manual: Scoping Reviews (2020)
• Equator Network-Current Best Practices for the Conduct of Scoping Reviews
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• Last Updated: Feb 14, 2024 8:15 AM
• URL: https://guides.temple.edu/systematicreviews

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Systematic reviews and other evidence synthesis projects

Types of reviews, a summary of review types, further reading on review types.

• Systematic Reviews
• 0. Plan your Review
• 1. Define the Question
• 2. Check for Recent Systematic Reviews and Protocols
• 3. Write and register your protocol
• Developing your Search Terms
• Database Search Tips and Filters
• Grey Literature
• Record and Report your Search Strategy
• Covidence This link opens in a new window
• 6. Appraise the Studies
• 7. Extract Data
• 8. Analyze / Synthesize Data
• 9. Write the Review
• Rapid Reviews
• Scoping Reviews
• Equity in Evidence Synthesis
• Automation, AI, and other upcoming review technologies
• Librarian Support

Although systematic reviews are one of the most well-known review types, there are a variety of different types of reviews that vary in terms of scope, comprehensiveness, time constraints, and types of studies included.

The best review for your project depends on the intersection of:

• your research goals
• your research question
• your time frame
• your research team

Several tools are provided below to help you identify which type of review is best suited for your research.

Identifying the right review type for your project - start here!

• Review Methodology Decision Tree from Cornell University Library
• Flow chart for selecting review type from Yale's Cushing/Whitney Medical Library
• What review is right for you? is a tool to help guide your choice of an appropriate knowledge synthesis method when looking at quantitative studies.

Based on University of North Carolina at Chapel Hill Health Sciences Library. Types of Reviews. Systematic Reviews website. Updated January 29, 2021. Accessed September 21, 2021. https://guides.lib.unc.edu/systematic-reviews

• Meeting the review family: exploring review types and associated information retrieval requirements ; by Sutton A, Clowes M, Preston L, Booth A. Health Info Libr J . 2019;36(3):202-222. doi:10.1111/hir.12276
• A typology of reviews: an analysis of 14 review types and associated methodologies ; by Grant MJ, Booth A. Health Info Libr J . 2009;26(2):91-108. doi:10.1111/j.1471-1842.2009.00848.x
• Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach ; by Zachary Munn, Micah D. J. Peters, Cindy Stern, Catalin Tufanaru, Alexa McArthur & Edoardo Aromataris. BMC Med Res Methodol 18, 143 (2018). https://doi.org/10.1186/s12874-018-0611-x
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Systematic Reviews: Types of literature review, methods, & resources

• Types of literature review, methods, & resources
• Protocol and registration
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• Medical Literature Databases to search
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• Manage citations using RefWorks This link opens in a new window
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Analytical reviews

GUIDELINES FOR HOW TO CARRY OUT AN ANALYTICAL REVIEW OF QUANTITATIVE RESEARCH

Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network. (Tracking and listing over 550 reporting guidelines for various different study types including Randomised trials, Systematic reviews, Study protocols, Diagnostic/prognostic studies, Case reports, Clinical practice guidelines, Animal pre-clinical studies, etc). http://www.equator-network.org/resource-centre/library-of-health-research-reporting/

When comparing therapies :

PRISMA (Guideline on how to perform and write-up a systematic review and/or meta-analysis of the outcomes reported in multiple clinical trials of therapeutic interventions. PRISMA  replaces the previous QUORUM statement guidelines ):  Liberati, A,, Altman, D,, Moher, D, et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.  Plos Medicine, 6 (7):e1000100. doi:10.1371/journal.pmed.1000100 

When comparing diagnostic methods :

Checklist for Artificial Intelligence in Medical Imaging (CLAIM). CLAIM is modeled after the STARD guideline and has been extended to address applications of AI in medical imaging that include classification, image reconstruction, text analysis, and workflow optimization. The elements described here should be viewed as a “best practice” to guide authors in presenting their research. Reported in Mongan, J., Moy, L., & Kahn, C. E., Jr (2020). Checklist for Artificial Intelligence in Medical Imaging (CLAIM): A Guide for Authors and Reviewers.  Radiology. Artificial intelligence ,  2 (2), e200029. https://doi.org/10.1148/ryai.2020200029

STAndards for the Reporting of Diagnostic accuracy studies (STARD) Statement. (Reporting guidelines for writing up a study comparing the accuracy of competing diagnostic methods)  http://www.stard-statement.org/

When evaluating clinical practice guidelines :

AGREE Research Trust (ART) (2013).  Appraisal of Guidelines for Research & Evaluation (AGREE-II) . (A 23-item instrument for as sessing th e quality of Clinical Practice Guidelines. Used internationally for evaluating or deciding which guidelines could be recommended for use in practice or to inform health policy decisions.)

National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument (2019). (A 15-item instrument using scales of 1-5 to evaluate a guideline's adherence to the Institute of Medicine's standard for trustworthy guidelines. It has good external validity among guideline developers and good interrater reliability across trained reviewers.)

When reviewing genetics studies

Human genetics review reporting guidelines.  Little J, Higgins JPT (eds.). The HuGENet™ HuGE Review Handbook, version 1.0 . 

When you need to re-analyze individual participant data

If you wish to collect, check, and re-analyze individual participant data (IPD) from clinical trials addressing a particular research question, you should follow the  PRISMA-IPD  guidelines as reported in  Stewart, L.A., Clarke, M., Rovers, M., et al. (2015). Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data: The PRISMA-IPD Statement. JAMA, 313(16):1657-1665. doi:10.1001/jama.2015.3656 .

When comparing Randomized studies involving animals, livestock, or food:

O’Connor AM, et al. (2010).  The REFLECT statement: methods and processes of creating reporting guidelines for randomized controlled trials for livestock and food safety by modifying the CONSORT statement.  Zoonoses Public Health. 57(2):95-104. Epub 2010/01/15. doi: 10.1111/j.1863-2378.2009.01311.x. PubMed PMID: 20070653.

Sargeant JM, et al. (2010).  The REFLECT Statement: Reporting Guidelines for Randomized Controlled Trials in Livestock and Food Safety: Explanation and Elaboration.  Zoonoses Public Health. 57(2):105-36. Epub 2010/01/15. doi: JVB1312 [pii] 10.1111/j.1863-2378.2009.01312.x. PubMed PMID: 20070652.

GUIDELINES FOR HOW TO WRITE UP FOR PUBLICATION THE RESULTS OF ONE QUANTITATIVE CLINICAL TRIAL

When reporting the results of a Randomized Controlled Trial :

Consolidated Standards of Reporting Trials (CONSORT) Statement. (2010 reporting guideline for writing up a Randomized Controlled Clinical Trial).  http://www.consort-statement.org . Since updated in 2022, see Butcher, M. A., et al. (2022). Guidelines for Reporting Outcomes in Trial Reports: The CONSORT-Outcomes 2022 Extension . JAMA : the Journal of the American Medical Association, 328(22), 2252–2264. https://doi.org/10.1001/jama.2022.21022

Kilkenny, C., Browne, W. J., Cuthill, I. C., Emerson, M., & Altman, D. G. (2010). Improving bioscience research reporting: The ARRIVE guidelines for reporting animal research. PLoS Biology, 8(6), e1000412–e1000412. https://doi.org/10.1371/journal.pbio.1000412 (A 20-item checklist, following the CONSORT approach, listing the information that published articles reporting research using animals should include, such as the number and specific characteristics of animals used; details of housing and husbandry; and the experimental, statistical, and analytical methods used to reduce bias.)

Narrative reviews

GUIDELINES  FOR HOW TO CARRY OUT  A  NARRATIVE REVIEW / QUALITATIVE RESEARCH /  OBSERVATIONAL STUDIES

Campbell, M. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ, 368. doi: https://doi.org/10.1136/bmj.l6890  (guideline on how to analyse evidence for a narrative review, to provide a recommendation based on heterogenous study types).

Community Preventive Services Task Force (2021).  The Methods Manual for Community Guide Systematic Reviews . (Public Health Prevention systematic review guidelines)

Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network. (Tracking and listing over 550 reporting guidelines for various different study types including Observational studies, Qualitative research, Quality improvement studies, and Economic evaluations). http://www.equator-network.org/resource-centre/library-of-health-research-reporting/

Cochrane Qualitative & Implementation Methods Group. (2019). Training resources. Retrieved from  https://methods.cochrane.org/qi/training-resources . (Training materials for how to do a meta-synthesis, or qualitative evidence synthesis). 

Cornell University Library (2019). Planning worksheet for structured literature reviews. Retrieved 4/8/22 from  https://osf.io/tnfm7/  (offers a framework for a narrative literature review).

Green, B. N., Johnson, C. D., & Adams, A. (2006).  Writing narrative literature reviews for peer-reviewed journals: secrets of the trade . Journal of Chiropractic Medicine, 5(3): 101-117. DOI: 10.1016/ S0899-3467 (07)60142-6.  This is a very good article about what to take into consideration when writing any type of narrative review.

When reviewing observational studies/qualitative research :

STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) statement. (Reporting guidelines for various types of health sciences observational studies).  http://www.strobe-statement.org 

Meta-analysis of Observational Studies in Epidemiology (MOOSE)  http://jama.jamanetwork.com/article.aspx?articleid=192614

RATS Qualitative research systematic review guidelines.  https://www.equator-network.org/reporting-guidelines/qualitative-research-review-guidelines-rats/

Methods/Guidance

Right Review , this decision support website provides an algorithm to help reviewers choose a review methodology from among 41 knowledge synthesis methods.

The Systematic Review Toolbox , an online catalogue of tools that support various tasks within the systematic review and wider evidence synthesis process. Maintained by the UK University of York Health Economics Consortium, Newcastle University NIHR Innovation Observatory, and University of Sheffield School of Health and Related Research.

Institute of Medicine. (2011).  Finding What Works in Health Care: Standards for Systematic Reviews . Washington, DC: National Academies  (Systematic review guidelines from the Health and Medicine Division (HMD) of the U.S. National Academies of Sciences, Engineering, and Medicine (formerly called the Institute of Medicine)).

International Committee of Medical Journal Editors (2022).  Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals . Guidance on how to prepare a manuscript for submission to a Medical journal.

Cochrane Handbook of Systematic Reviews of Interventions (International Cochrane Collaboration systematic review guidelines). The various Cochrane review groups comporise around 30,000 physicians around the world working in the disciplines on reviews of interventions with very detailed methods for verifying the validity of the research methods and analysis performed in screened-in Randmized Controlled Clinical Trials. Typically published Cochrane Reviews are the most exhaustive review of the evidence of effectiveness of a particular drug or intervention, and include a statistical meta-analysis. Similar to practice guidelines, Cochrane reviews are periodically revised and updated.

Joanna Briggs Institute (JBI) Manual of Evidence Synthesis . (International systematic review guidelines). Based at the University of Adelaide, South Australia, and collaborating with around 80 academic and medical entities around the world. Unlike Cochrane Reviews that strictly focus on efficacy of interventions, JBI offers a broader, inclusive approach to evidence, to accommodate a range of diverse questions and study designs. The JBI manual provides guidance on how to analyse and include both quantitative and qualitative research.

Cochrane Methods Support Unit, webinar recordings on methodological support questions 

Cochrane Qualitative & Implementation Methods Group. (2019). Training resources. Retrieved from https://methods.cochrane.org/qi/training-resources . (How to do a meta-synthesis, or qualitative evidence synthesis). 

Center for Reviews and Dissemination (University of York, England) (2009).  Systematic Reviews: CRD's guidance for undertaking systematic reviews in health care . (British systematic review guidelines). 

Agency for Health Research & Quality (AHRQ) (2013). Methods guide for effectiveness and comparative effectiveness reviews . (U.S. comparative effectiveness review guidelines)

Hunter, K. E., et al. (2022). Searching clinical trials registers: guide for systematic reviewers.  BMJ (Clinical research ed.) ,  377 , e068791. https://doi.org/10.1136/bmj-2021-068791

Patient-Centered Outcomes Research Institute (PCORI).  The PCORI Methodology Report . (A 47-item methodology checklist for U.S. patient-centered outcomes research. Established under the Patient Protection and Affordable Care Act, PCORI funds the development of guidance on the comparative effectivess of clinical healthcare, similar to the UK National Institute for Clinical Evidence but without reporting cost-effectiveness QALY metrics). 

Canadian Agency for Drugs and Technologies in Health (CADTH) (2019). Grey Matters: a practical tool for searching health-related grey literature. Retrieved from https://www.cadth.ca/resources/finding-evidence/grey-matters . A checklist of N American & international online databases and websites you can use to search for unpublished reports, posters, and policy briefs, on topics including general medicine and nursing, public and mental health, health technology assessment, drug and device regulatory, approvals, warnings, and advisories.

Hempel, S., Xenakis, L., & Danz, M. (2016). Systematic Reviews for Occupational Safety and Health Questions: Resources for Evidence Synthesis. Retrieved 8/15/16 from http://www.rand.org/pubs/research_reports/RR1463.html . NIOSH guidelines for how to carry out a systematic review in the occupational safety and health domain.

A good source for reporting guidelines is the  NLM's  Research Reporting Guidelines and Initiatives .

Grading of Recommendations Assessment, Development and Evaluation (GRADE). (An international group of academics/clinicians working to promote a common approach to grading the quality of evidence and strength of recommendations.) 

Phillips, B., Ball, C., Sackett, D., et al. (2009). Oxford Centre for Evidence Based Medicine: Levels of Evidence. Retrieved 3/20/17 from https://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf . (Another commonly used criteria for grading the quality of evidence and strength of recommendations, developed in part by EBM guru David Sackett.) 

Systematic Reviews for Animals & Food  (guidelines including the REFLECT statement for carrying out a systematic review on animal health, animal welfare, food safety, livestock, and agriculture)

Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies . Health Information & Libraries Journal, 26(2), 91-108. doi:10.1111/j.1471-1842.2009.00848.x. (Describes 14 different types of literature and systematic review, useful for thinking at the outset about what sort of literature review you want to do.)

Sutton, A., Clowes, M., Preston, L., & Booth, A. (2019). Meeting the review family: exploring review types and associated information retrieval requirements . Health information and libraries journal, 36(3), 202–222. doi:10.1111/hir.12276  (An updated look at different types of literature review, expands on the Grant & Booth 2009 article listed above).

Garrard, J. (2007).  Health Sciences Literature Review Made Easy: The Matrix Method  (2nd Ed.).   Sudbury, MA:  Jones & Bartlett Publishers. (Textbook of health sciences literature search methods).

Zilberberg, M. (2012).  Between the lines: Finding the truth in medical literature . Goshen, MA: Evimed Research Press. (Concise book on foundational concepts of evidence-based medicine).

Lang, T. (2009). The Value of Systematic Reviews as Research Activities in Medical Education . In: Lang, T. How to write, publish, & present in the health sciences : a guide for clinicians & laboratory researchers. Philadelphia : American College of Physicians.  (This book chapter has a helpful bibliography on systematic review and meta-analysis methods)

Brown, S., Martin, E., Garcia, T., Winter, M., García, A., Brown, A., Cuevas H.,  & Sumlin, L. (2013). Managing complex research datasets using electronic tools: a meta-analysis exemplar . Computers, Informatics, Nursing: CIN, 31(6), 257-265. doi:10.1097/NXN.0b013e318295e69c. (This article advocates for the programming of electronic fillable forms in Adobe Acrobat Pro to feed data into Excel or SPSS for analysis, and to use cloud based file sharing systems such as Blackboard, RefWorks, or EverNote to facilitate sharing knowledge about the decision-making process and keep data secure. Of particular note are the flowchart describing this process, and their example screening form used for the initial screening of abstracts).

Brown, S., Upchurch, S., & Acton, G. (2003). A framework for developing a coding scheme for meta-analysis . Western Journal Of Nursing Research, 25(2), 205-222. (This article describes the process of how to design a coded data extraction form and codebook, Table 1 is an example of a coded data extraction form that can then be used to program a fillable form in Adobe Acrobat or Microsoft Access).

Elamin, M. B., Flynn, D. N., Bassler, D., Briel, M., Alonso-Coello, P., Karanicolas, P., & ... Montori, V. M. (2009). Choice of data extraction tools for systematic reviews depends on resources and review complexity .  Journal Of Clinical Epidemiology ,  62 (5), 506-510. doi:10.1016/j.jclinepi.2008.10.016  (This article offers advice on how to decide what tools to use to extract data for analytical systematic reviews).

Riegelman R.   Studying a Study and Testing a Test: Reading Evidence-based Health Research , 6th Edition.  Lippincott Williams & Wilkins, 2012. (Textbook of quantitative statistical methods used in health sciences research).

Rathbone, J., Hoffmann, T., & Glasziou, P. (2015). Faster title and abstract screening? Evaluating Abstrackr, a semi-automated online screening program for systematic reviewers. Systematic Reviews, 480. doi:10.1186/s13643-015-0067-6

Guyatt, G., Rennie, D., Meade, M., & Cook, D. (2015). Users' guides to the medical literature (3rd ed.). New York: McGraw-Hill Education Medical.  (This is a foundational textbook on evidence-based medicine and of particular use to the reviewer who wants to learn about the different types of published research article e.g. "what is a case report?" and to understand what types of study design best answer what types of clinical question).

Glanville, J., Duffy, S., Mccool, R., & Varley, D. (2014). Searching ClinicalTrials.gov and the International Clinical Trials Registry Platform to inform systematic reviews: what are the optimal search approaches? Journal of the Medical Library Association : JMLA, 102(3), 177–183. https://doi.org/10.3163/1536-5050.102.3.007

Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan a web and mobile app for systematic reviews.  Systematic Reviews, 5 : 210, DOI: 10.1186/s13643-016-0384-4. http://rdcu.be/nzDM

Kwon Y, Lemieux M, McTavish J, Wathen N. (2015). Identifying and removing duplicate records from systematic review searches. J Med Libr Assoc. 103 (4): 184-8. doi: 10.3163/1536-5050.103.4.004. https://www.ncbi.nlm.nih.gov/pubmed/26512216

Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. (2016). De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc. 104 (3):240-3. doi: 10.3163/1536-5050.104.3.014. Erratum in: J Med Libr Assoc. 2017 Jan;105(1):111. https://www.ncbi.nlm.nih.gov/pubmed/27366130

McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol. 2016;75:40–46. doi: 10.1016/j.jclinepi.2016.01.021 . PRESS is a guideline with a checklist for librarians to critically appraise the search strategy for a systematic review literature search.

Clark, JM, Sanders, S, Carter, M, Honeyman, D, Cleo, G, Auld, Y, Booth, D, Condron, P, Dalais, C, Bateup, S, Linthwaite, B, May, N, Munn, J, Ramsay, L, Rickett, K, Rutter, C, Smith, A, Sondergeld, P, Wallin, M, Jones, M & Beller, E 2020, 'Improving the translation of search strategies using the Polyglot Search Translator: a randomized controlled trial',  Journal of the Medical Library Association , vol. 108, no. 2, pp. 195-207.

Journal articles describing systematic review methods can be searched for in PubMed using this search string in the PubMed search box: sysrev_methods [sb] . 

Software tools for systematic reviews

• Covidence GW in 2019 has bought a subscription to this Cloud based tool for facilitating screening decisions, used by the Cochrane Collaboration. Register for an account.
• NVIVO for analysis of qualitative research NVIVO is used for coding interview data to identify common themes emerging from interviews with several participants. GW faculty, staff, and students may download NVIVO software.
• RedCAP RedCAP is software that can be used to create survey forms for research or data collection or data extraction. It has very detailed functionality to enable data exchange with Electronic Health Record Systems, and to integrate with study workflow such as scheduling follow up reminders for study participants.
• SRDR tool from AHRQ Free, web-based and has a training environment, tutorials, and example templates of systematic review data extraction forms
• RevMan 5 RevMan 5 is the desktop version of the software used by Cochrane systematic review teams. RevMan 5 is free for academic use and can be downloaded and configured to run as stand alone software that does not connect with the Cochrane server if you follow the instructions at https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman/revman-5-download/non-cochrane-reviews
• Rayyan Free, web-based tool for collecting and screening citations. It has options to screen with multiple people, masking each other.
• GradePro Free, web application to create, manage and share summaries of research evidence (called Evidence Profiles and Summary of Findings Tables) for reviews or guidelines, uses the GRADE criteria to evaluate each paper under review.
• DistillerSR Needs subscription. Create coded data extraction forms from templates.
• EPPI Reviewer Needs subscription. Like DistillerSR, tool for text mining, data clustering, classification and term extraction
• SUMARI Needs subscription. Qualitative data analysis.
• Dedoose Needs subscription. Qualitative data analysis, similar to NVIVO in that it can be used to code interview transcripts, identify word co-occurence, cloud based.
• Meta-analysis software for statistical analysis of data for quantitative reviews SPSS, SAS, and STATA are popular analytical statistical software that include macros for carrying out meta-analysis. Himmelfarb has SPSS on some 3rd floor computers, and GW affiliates may download SAS to your own laptop from the Division of IT website. To perform mathematical analysis of big data sets there are statistical analysis software libraries in the R programming language available through GitHub and RStudio, but this requires advanced knowledge of the R and Python computer languages and data wrangling/cleaning.
• PRISMA 2020 flow diagram generator The PRISMA Statement website has a page listing example flow diagram templates and a link to software for creating PRISMA 2020 flow diagrams using R software.

GW researchers may want to consider using Refworks to manage citations, and GW Box to store the full text PDF's of review articles. You can also use online survey forms such as Qualtrics, RedCAP, or Survey Monkey, to design and create your own coded fillable forms, and export the data to Excel or one of the qualitative analytical software tools listed above.

Forest Plot Generators

• RevMan 5 the desktop version of the software used by Cochrane systematic review teams. RevMan 5 is free for academic use and can be downloaded and configured to run as stand alone software that does not connect with the Cochrane server if you follow the instructions at https://training.cochrane.org/online-learning/core-software-cochrane-reviews/revman/revman-5-download/non-cochrane-reviews.
• Meta-Essentials a free set of workbooks designed for Microsoft Excel that, based on your input, automatically produce meta-analyses including Forest Plots. Produced for Erasmus University Rotterdam joint research institute.
• Neyeloff, Fuchs & Moreira Another set of Excel worksheets and instructions to generate a Forest Plot. Published as Neyeloff, J.L., Fuchs, S.C. & Moreira, L.B. Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 5, 52 (2012). https://doi-org.proxygw.wrlc.org/10.1186/1756-0500-5-52
• For R programmers instructions are at https://cran.r-project.org/web/packages/forestplot/vignettes/forestplot.html and you can download the R code package from https://github.com/gforge/forestplot
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• Literature Review Types, Taxonomies

Evidence Synthesis, Systematic Review Services : Literature Review Types, Taxonomies

• Develop a Protocol
• Develop Your Research Question
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Choosing a Literature Review Methodology

Growing interest in evidence-based practice has driven an increase in review methodologies. Your choice of review methodology (or literature review type) will be informed by the intent (purpose, function) of your research project and the time and resources of your team. 

• Decision Tree (What Type of Review is Right for You?) Developed by Cornell University Library staff, this "decision-tree" guides the user to a handful of review guides given time and intent.

Types of Evidence Synthesis*

Critical Review - Aims to demonstrate writer has extensively researched literature and critically evaluated its quality. Goes beyond mere description to include degree of analysis and conceptual innovation. Typically results in hypothesis or model.

Mapping Review (Systematic Map) - Map out and categorize existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature.

Meta-Analysis - Technique that statistically combines the results of quantitative studies to provide a more precise effect of the results.

Mixed Studies Review (Mixed Methods Review) - Refers to any combination of methods where one significant component is a literature review (usually systematic). Within a review context it refers to a combination of review approaches for example combining quantitative with qualitative research or outcome with process studies.

Narrative (Literature) Review - Generic term: published materials that provide examination of recent or current literature. Can cover wide range of subjects at various levels of completeness and comprehensiveness.

Overview - Generic term: summary of the [medical] literature that attempts to survey the literature and describe its characteristics.

Qualitative Systematic Review or Qualitative Evidence Synthesis - Method for integrating or comparing the findings from qualitative studies. It looks for ‘themes’ or ‘constructs’ that lie in or across individual qualitative studies.

Rapid Review - Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research.

Scoping Review or Evidence Map - Preliminary assessment of potential size and scope of available research literature. Aims to identify nature and extent of research.

State-of-the-art Review - Tend to address more current matters in contrast to other combined retrospective and current approaches. May offer new perspectives on issue or point out area for further research.

Systematic Review - Seeks to systematically search for, appraise and synthesis research evidence, often adhering to guidelines on the conduct of a review. (An emerging subset includes Living Reviews or Living Systematic Reviews - A [review or] systematic review which is continually updated, incorporating relevant new evidence as it becomes available.)

Systematic Search and Review - Combines strengths of critical review with a comprehensive search process. Typically addresses broad questions to produce ‘best evidence synthesis.’

Umbrella Review - Specifically refers to review compiling evidence from multiple reviews into one accessible and usable document. Focuses on broad condition or problem for which there are competing interventions and highlights reviews that address these interventions and their results.

*These definitions are in Grant & Booth's "A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies."

Literature Review Types/Typologies, Taxonomies

Grant, M. J., and A. Booth. "A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies."  Health Information and Libraries Journal  26.2 (2009): 91-108.  DOI: 10.1111/j.1471-1842.2009.00848.x  Link

Munn, Zachary, et al. “Systematic Review or Scoping Review? Guidance for Authors When Choosing between a Systematic or Scoping Review Approach.” BMC Medical Research Methodology , vol. 18, no. 1, Nov. 2018, p. 143. DOI: 10.1186/s12874-018-0611-x. Link

Sutton, A., et al. "Meeting the Review Family: Exploring Review Types and Associated Information Retrieval Requirements."  Health Information and Libraries Journal  36.3 (2019): 202-22.  DOI: 10.1111/hir.12276  Link

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• URL: https://researchguides.library.wisc.edu/literature_review

• University Libraries
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• Reviewing Research: Literature Reviews, Scoping Reviews, Systematic Reviews
• Differentiating the Three Review Types

Reviewing Research: Literature Reviews, Scoping Reviews, Systematic Reviews: Differentiating the Three Review Types

• Framework, Protocol, and Writing Steps
• Working with Keywords/Subject Headings
• Citing Research

The Differences in the Review Types

Grant, M.J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. H ealth Information & Libraries Journal , 26: 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x   The objective of this study is to provide descriptive insight into the most common types of reviews, with illustrative examples from health and health information domains.

• What Type of Review is Right for you (Cornell University)

Literature Reviews

Literature Review: it is a product and a process.

As a product , it is a carefully written examination, interpretation, evaluation, and synthesis of the published literature related to your topic. It focuses on what is known about your topic and what methodologies, models, theories, and concepts have been applied to it by others.

The process is what is involved in conducting a review of the literature.

• It is ongoing
• It is iterative (repetitive)
• It involves searching for and finding relevant literature.
• It includes keeping track of your references and preparing and formatting them for the bibliography of your thesis

• Literature Reviews (University of North Carolina at Chapel Hill) This handout will explain what literature reviews are and offer insights into the form and construction of literature reviews in the humanities, social sciences, and sciences.

Scoping Reviews

Scoping reviews are a " preliminary assessment of potential size and scope of available research literature . Aims to identify nature and extent of research evidence (usually including ongoing research)." Grant and Booth (2009).

Scoping reviews are not mapping reviews: Scoping reviews are more topic based and mapping reviews are more question based.

• examining emerging evidence when specific questions are unclear - clarify definitions and conceptual boundaries
• identify and map the available evidence
• a scoping review is done prior to a systematic review
• to summarize and disseminate research findings in the research literature
• identify gaps with the intention of resolution by future publications

• Scoping review timeframe and limitations (Touro College of Pharmacy

Systematic Reviews

Many evidence-based disciplines use ‘systematic reviews," this type of review is a specific methodology that aims to comprehensively identify all relevant studies on a specific topic, and to select appropriate studies based on explicit criteria . ( https://cebma.org/faq/what-is-a-systematic-review/ )

• clearly defined search criteria
• an explicit reproducible methodology
• a systematic search of the literature with the defined criteria met
• assesses validity of the findings - no risk of bias
• a comprehensive report on the findings, apparent transparency in the results

• Better evidence for a better world Browsable collection of systematic reviews
• Systematic Reviews in the Health Sciences by Molly Maloney Last Updated Jan 8, 2024 368 views this year
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• UNC Libraries
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• Step 1: Complete Pre-Review Tasks

Systematic Reviews: Step 1: Complete Pre-Review Tasks

Created by health science librarians.

Watch Systematic Review Workshop videos

Recruit team members, choose review tools, develop and refine research question, specify eligibility criteria.

• Pre-Review FAQs
• Step 2: Develop a Protocol
• Step 3: Conduct Literature Searches
• Step 4: Manage Citations
• Step 5: Screen Citations
• Step 6: Assess Quality of Included Studies
• Step 7: Extract Data from Included Studies
• Step 8: Write the Review

  Check our FAQ's

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Search the FAQs

About step 1: complete pre-review tasks.

This step will help you prepare to conduct your systematic review. You will:

• Develop your research question.
• Look at literature to decide if you need to do a systematic review.
• Build your research team.
• Decide which citation manager and systematic review software you will use.

This page has information about research questions and systematic review teams. Librarians can help you edit your research question based on the literature.

Click an item below to see how it applies to Step 1: Pre-Review Tasks.

Reporting your review with PRISMA

The PRISMA (Preferred Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines detail what you should report about your systematic review methods.

• Checklist - your guideline for essential reporting in the final manuscript.
• Flow Diagram - your visualization of the exclusion/inclusion process.
• Statement - the standards of systematic review reporting.
• Explanation and Elaboration - additional details and examples of items.

For this step of the process, you can review the PRISMA checklist and flow diagram and download the PRISMA flow diagram template that matches your review type and sources, then list out the databases and other sources you plan to search.

Managing your review with Covidence

Covidence is the tool we use at UNC to help manage the systematic review screening process. For this step, you can create a Covidence account , set up a review, add reviewers, list inclusion and exclusion criteria, and edit other review settings.

How a librarian can help with Step 1

Before you begin conducting a systematic review, a librarian can help you :

• Develop and refine your research question framework 
• Determine if any prior reviews have been published on the same or similar topics
• Determine how much literature might be available on your topic

The Introduction to Conducting a Systematic Review workshop, offered in October 2020, covered recommended standards, methods, and tools for completing a systematized, scoping, or systematic review at UNC. This workshop recording is available as a series of short videos on the process of conducting a review. It is recommended for those who have not yet conducted such a review, but are planning to do so. 

• Workshop - Part 1 (General Introduction to Systematic Review Methodology)
• Workshop - Part 2 (Developing Research Questions)
• Workshop - Part 3 (Developing a Review Protocol and Creating Your Team)
• Workshop - Part 4 (Overview of Literature Searching for Systematic Reviews)
• Workshop - Part 5 (Screening)
• Workshop - Part 6 (Overview of Quality Assessment, Data Extraction, and Writing the Review)
• SR Workshop slides
• Systematic Review Summer Workshop Series 2023 Slides

There are also a number of free systematic review methods courses you can take online.

• Systematic Reviews and Meta-Analysis — Open & Free (Open Learning Initiative) The course follows guidelines and standards developed by the Campbell Collaboration, based on empirical evidence about how to produce the most comprehensive and accurate reviews of research
• Introduction to Systematic Review and Meta-Analysis (Coursera) We will introduce methods to perform systematic reviews and meta-analysis of clinical trials. We will cover how to formulate an answerable research question, define inclusion and exclusion criteria, search for the evidence, extract data, assess the risk of bias in clinical trials, and perform a meta-analysis.

• Odd number simplifies tie-breaking process
• Depending on the size of the literature, you may want to add additional team members. A team of up to ten or twelve people is not unusual for a large systematic review.
• Conscientiously create a diverse team to ensure different voices and perspectives are represented.
• Collaborate with a librarian to develop a search strategy.
• Work with a statistician if conducting a meta-analysis.
• Define roles and expectations early in the review process.

Citation manager software

Citation managers are recommended to collect citations, remove duplicates, and manage your systematic review citations.  UNC offers Sciwheel for free and Endnote Desktop at a discount. Endnote Basic and Zotero are free for anyone to use.

While citation managers are not required to complete a systematic review, we highly recommend using one, as they can assist with organizing citations and screening levels, deduplication, and finding PDFs of articles for full text screening.

View the citation manager comparison table

Systematic review software.

There are many tools that can be useful for organizing the screening process including Covidence, Rayyan, Abstrackr, and HAWC.   

UNC currently has an institutional subscription to Covidence making it available for free to UNC-affiliated users. HSL can provide classes and support for Covidence. To learn more visit the Covidence LibGuide .

HSL does not currently offer in-house support for screening tools other than Covidence.

View the systematic review software comparison table

If the tools above don't meet your needs, you can also try this Excel tool called the VonVille Method.   

Information about screening tools and features: Van der Mierden, S., Tsaioun, K., Bleich, A., & Leenaars, C. H. C. (2019). Software tools for literature screening in systematic reviews in biomedical research. ALTEX : Alternativen zu Tierexperimenten, 36 (3), 508-517.

Screening tool feature definitions

Quality Assessment: The tool supports risk of bias and quality assessment. 

Data Extraction: The tool supports data extraction. 

Allows Multiple User Support: It is possible for two or more users to work on the same project at the same time, without seeing how others have voted.

Reference Allocation: It is possible to assign references to reviewers. 

Discrepancy Resolving: There is official support for resolving conflict between reviewers. 

Show Project Progress: the tool can display the progress of each reviewer and the overall project.

Attaching Comments: It is possible to add comments to a reference while screening.

Attaching PDFs: It is possible to upload PDFs for full-text screening. 

Keyword Highlighting: It is possible to display highlighted keywords during screening.

Deduplication: The tool will identify and remove duplicate citations. 

PRISMA Diagram: The tool can automatically generate a PRISMA flow diagram. 

Import Multiple File Types: It is possible to import formatted references and the tool supports multiple file types. 

Interrater Reliability: The tool can calculate and display interrater reliability.

Mobile Friendly Version: It is possible to screen on a mobile device. 

Export Results File Types: References can be exported from the screening tool into the listed file types. 

Systematic reviews aim to answer a specific research question. There are frameworks to help in question development and identification of search terms. PICO is the most popular framework utilized for clinical research topics.

The PICO question framework is useful for quantitative research topics. PICO questions identify four concepts: population, intervention, comparison, and outcome.

Research question : In infants diagnosed with necrotizing enterocolitis (NEC), what is the effect of early enteral re-feeding on NEC recurrence compared to late enteral re-feeding?

Did you know?

Did you know there are at least 25 other question frameworks besides variations of PICO?  Frameworks like PEO, SPIDER, SPICE, ECLIPSE, and others  can help you formulate a focused research question. The table and example below were created by the  Medical University of South Carolina (MUSC) Libraries .

Click on a framework below to learn more and see an example of its use.

The PEO question framework is useful for qualitative research topics. PEO questions identify three concepts: population, exposure, and outcome.

Research question : What are the daily living experiences of mothers with postnatal depression?

The SPIDER question framework is useful for qualitative or mixed methods research topics focused on "samples" rather than populations.

SPIDER questions identify five concepts: sample, phenomenon of interest, design, evaluation, and research type.

Research question : What are the experiences of young parents in attendance at antenatal education classes?

The SPICE question framework is useful for qualitative research topics evaluating the outcomes of a service, project, or intervention. SPICE questions identify five concepts: setting, perspective, intervention/exposure/interest, comparison, and evaluation.

Research question : For teenagers in South Carolina, what is the effect of provision of Quit Kits to support smoking cessation on number of successful attempts to give up smoking compared to no support ("cold turkey")?

The ECLIPSE framework is useful for qualitative research topics investigating the outcomes of a policy or service. ECLIPSE questions identify six concepts: expectation, client group, location, impact, professionals, and service.

Research question : How can I increase access to wireless internet for hospital patients?

In order to reduce bias, eligibility criteria (also known as inclusion and exclusion criteria) refer to what you plan to include and exclude from your systematic review. These criteria are decided after the research question is developed but before searches are completed. Below are examples of criteria that may be used to determine inclusion or exclusion.

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Literature Reviews

• Getting Started

Selecting a Review Type

Defining the scope of your review, four common types of reviews.

• Developing a Research Question
• Searching the Literature
• Searching Tips
• ChatGPT [beta]
• Documenting your Search
• Using Citation Managers
• Concept Mapping
• Writing the Review
• Further Resources

More Review Types

This article by Sutton & Booth (2019) explores 48 distinct types of Literature Reviews:

Which Review is Right for You?

The  Right Review tool  has questions about your lit review process and plans. It offers a qualitative and quantitative option. At completion, you are given a lit review type recommendation.

You'll want to think about the kind of review you are doing. Is it a selective or comprehensive review? Is the review part of a larger work or a stand-alone work ?

For example, if you're writing the Literature Review section of a journal article, that's a selective review which is part of a larger work. Alternatively, if you're writing a review article, that's a comprehensive review which is a stand-alone work. Thinking about this will help you develop the scope of the review.

This exercise will help define the scope of your Literature Review, setting the boundaries for which literature to include and which to exclude.

A FEW GENERAL CONSIDERATIONS WHEN DEFINING SCOPE

• Which populations to investigate — this can include gender, age, socio-economic status, race, geographic location, etc., if the research area includes humans.
• What years to include — if researching the legalization of medicinal cannabis, you might only look at the previous 20 years; but if researching dolphin mating practices, you might extend many more decades.
• Which subject areas — if researching artificial intelligence, subject areas could be computer science, robotics, or health sciences
• How many sources  — a selective review for a class assignment might only need ten, while a comprehensive review for a dissertation might include hundreds. There is no one right answer.
• There will be many other considerations that are more specific to your topic. 

Most databases will allow you to limit years and subject areas, so look for those tools while searching. See the Searching Tips tab for information on how use these tools.

LITERATURE REVIEW

• Often used as a generic term to describe any type of review
• More precise definition:  Published materials that provide an examination of published literature . Can cover wide range of subjects at various levels of comprehensiveness.
• Identifies gaps in research, explains importance of topic, hypothesizes future work, etc.
• Usually written as part of a larger work like a journal article or dissertation

SCOPING REVIEW

• Conducted to address broad research questions with the goal of understanding the extent of research that has been conducted.
• Provides a preliminary assessment of the potential size and scope of available research literature. It aims to identify the nature and extent of research evidence (usually including ongoing research) 
• Doesn't assess the quality of the literature gathered (i.e. presence of literature on a topic shouldn’t be conflated w/ the quality of that literature)

SYSTEMATIC REVIEW

• Common in the health sciences ( Taubman Health Sciences Library guide to Systematic Reviews )
• Goal: collect all literature that meets specific criteria (methodology, population, treatment, etc.) and then appraise its quality and synthesize it
• Follows strict protocol for literature collection, appraisal and synthesis
• Typically performed by research teams 
• Takes 12-18 months to complete
• Often written as a stand alone work

META-ANALYSIS

• Goes one step further than a systematic review by statistically combining the results of quantitative studies to provide a more precise effect of the results. 
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Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

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

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• About Covidence and systematic reviews

What are the different types of review?

Systematic literature reviews (slrs).

SLR’s attempt to collate all empirical evidence that fit pre-specified eligibility criteria in order to answer a specific clearly-formulated research question.  A SLR uses explicit and reproducible systematic methods that are selected with a view to minimizing bias, thus providing more reliable findings from which conclusions can be drawn and decisions made.

The process starts with a research question and a protocol or research plan. A review team searches for studies to answer the question using a highly sensitive search strategy. The retrieved studies are then screened for eligibility using pre-specified inclusion and exclusion criteria (this is done by at least two people working independently). Next, the reviewers extract the relevant data and assess the quality of the included studies. Finally, the review team synthesizes the extracted study data and presents the results. 

A SLR may contain meta-analyses (statistical analysis). A SLR which is continually updated, incorporating relevant new evidence as it becomes available is often known as a living SLR.

Rapid reviews

Rapid reviews aim to produce a rigorous synthesis quickly (due to time constraints/urgency), based on a pre-defined research question. The review process for rapid reviews is the same as for a more traditional systematic review: the emphasis is on a replicable pre-specified search, and screening methods that minimize the risk of bias, although potentially isn’t as stringent as a formal systematic review.

The process operates within pre-specified limits (for example, by restricting searches to articles published during a specific timeframe) and is usually run by a multidisciplinary team with expertise in systematic review methods.

Umbrella reviews or Overview of reviews

An umbrella review is a review of multiple systematic reviews. The process uses explicit and systematic methods to search for, and identify, systematic reviews on related research questions in the same topic area. The purpose of an umbrella review is to synthesize the results of the systematic reviews across important outcomes. 

Scoping reviews

Scoping reviews are exploratory and they typically address a broad question, compared to a systematic review that typically has a more targeted question. 

Researchers conduct scoping reviews to assess the extent of the available evidence, to organize it into groups and to highlight gaps. If a scoping review finds no studies, this might help researchers to decide that a systematic review is likely to be of limited value and that resources could be better directed elsewhere.

Literature reviews or narrative reviews

Literature, or narrative, reviews provide an overview of what is known about a particular topic. They evaluate the material, rather than simply restating it, but the methods used to do this are not usually prespecified and they are not described in detail in the review. The search might be comprehensive but it does not aim to be exhaustive. Literature reviews are often topic based  and can take the form of a discussion. Literature reviews lack precision and replicability and can  present their findings in the context of what has come before. Often, this sort of synthesis does not attempt to control for the author’s own bias. The results or conclusion of a literature review is likely to be presented in a narrative format rather than statistical methods.

Take a look at the articles about the different types of review on the Covidence blog:

• Systematic review types: meet the family
• The difference between a systematic review and a literature review
• The difference between a systematic review and a meta-analysis

• Locations and Hours
• UCLA Library
• Research Guides
• Biomedical Library Guides

Systematic Reviews

• Types of Literature Reviews

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

• Planning Your Systematic Review
• Database Searching
• Creating the Search
• Search Filters & Hedges
• Grey Literature
• Managing & Appraising Results
• Further Resources

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

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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In recent years, the Water-Energy-Food (WEF) nexus has gained significant attention in global research. Spatial inequality in water-energy-food security (WEF) and its impact on public health and how this is affected by climate change remains a grand adaptation challenge. South Africa is extremely vulnerable and exposed to the impacts of climate change due to its socio-economic and environmental context. While alternative nexus types have garnered interest, this paper pioneers an extension of the conventional WEF framework to encompass health, giving rise to the Water-Energy-Food-Health (WEF-H) nexus. Despite a plethora of WEF nexus studies focused on South Africa, a substantial knowledge gap persists due to the lack of a comprehensive overview of the enablers and barriers to realizing the WEF-H nexus. South Africa boasts diverse policies related to water, energy, food, and health; however, their alignment remains an ongoing challenge. This study seeks to bridge this critical gap by conducting an exhaustive review of existing literature. Its primary aim is to delve into the intricate mechanisms that either facilitate or impede the actualization of the WEF-H nexus in South Africa. By synthesizing insights from a wide array of literature sources, this research strives to illuminate the challenges and opportunities stemming from the integration of health considerations into the established WEF nexus framework. This exploration holds immense significance, not only for unraveling the multifaceted interactions between these pivotal sectors but also for guiding policy development and decision-making processes in South Africa towards a more holistic and sustainable approach to resource management.

1 Introduction

Despite three decades of democracy, South Africa still struggles with the legacy of apartheid, including extreme inequality across racial and regional lines ( Klug, 2021 ), widening gulfs between the rich and poor ( Naidoo, 2005 ; Sibanda and Batisai, 2021 ) compounded with increased frequency of climate-induced hazards. The 1994 transition to majority rule in South Africa aimed to reduce socio-economic inequality, expand basic services, and embrace human rights principles as the foundation of constitutional solutions ( Klug, 2021 ). Access to water, food, health, and energy services are basic human rights, but the struggle for these rights continues to echo the popular struggles of the apartheid era. The South African government is committed to eliminating poverty and reducing inequality by 2030, as set out in its key national policy documents, e.g., National Development Plan 2030 ( NPC, 2011 ) and National Climate Change Response Policy (NCCRP) ( DEA, 2011 ) as well as the international agenda for Sustainable Development Goals (SDGs) to which the government has subscribed. Despite the government’s valiant efforts, many South Africans continue to face socio-economic challenges and the ramifications of climate change ( Naidoo, 2005 ; Sibanda and Batisai, 2021 ). This reality is particularly pronounced among the country’s black African population.

Like many developing countries, South Africa faces the challenge of balancing economic growth with environmental sustainability, what Simpson coined “reconciling growth with planetary boundaries” ( Simpson and Jewitt, 2019 ). This means developing the economy in a way that is equitable, inclusive, and does not irreversibly damage renewable resources or fail to realize the full potential of non-renewable resources. However, South Africa’s political economy has tended to prioritise an economic approach that transfers problems to a wide range of sectors. For example, mining rights often trump conservation of strategic water resource areas, agriculture lands and even human health considerations. As a result, tensions are growing between the increasing demand for, and use of natural resources (e.g., water, land, and energy) to support development and the availability and quality of those resources.

Coupled with its developmental challenges, the country is also water-stressed, with climate change ( Nhamo et al., 2020 ) further compounding existing socio-economic challenges. Escalating food prices ( Simpson and Jewitt, 2019 ) are leaving a large portion of the population highly food insecure, unable to meet their basic nutritional needs. Even more urgent and complex is the issue of the ailing energy system. Eskom, the national power utility has failed to meet the energy demand resulting in frequent power outages ( Baker and Phillips, 2019 ; International Energy Agency, 2022 ) and increased rationing of the available energy ( Lawrence, 2020 ).

South Africa has many policies related to water, food, and energy, which aim to make these sectors more sustainable. However, many stakeholders are increasingly recognizing the importance of managing the complex interactions between water, energy and food (WEF). The WEF nexus, an approach that considers these three sectors together, has been suggested as a governance solution to complex resource management challenges ( Srigiri and Dombrowsky, 2022 ). This paper examines the implementation of the WEF-H nexus in a country case study, with a focus on the key bottlenecks and enablers. The paper acknowledges that more than a decade after the introduction of the WEF Nexus as a governance ( Keskinen et al., 2016 ), analytical ( Nhamo et al., 2020 ) and ideological tool, the transition from “nexus thinking” to “nexus doing” remains essential to foster appropriate policy development, effective decision-making and practical implementation, in the context of water, energy, food, and health interlinkages.

The paper explores developments in the WEF-H nexus through an extensive literature review, unpacking its complexity and challenges within the South African context, and examining the key ingredients for successful implementation.

2 Understanding the nexus concept

The term “nexus” is central to the WEF-H Nexus, and it refers to a polycentric approach to problem solving ( Srigiri and Dombrowsky, 2022 ). As such, the nexus concept is a useful framework ( Keskinen et al., 2016 ) for action that brings together multiple actors and institutions at different levels of governance to address complex challenges. It is both an analytical tool and a discourse centred on the theory of polycentricity ( Thiel, 2016 ) and polycentric governance ( Ostrom, 2010 ) which means that power and decision-making are distributed across multiple centres.

In simpler terms, a nexus approach is a systems-based way of thinking about complex problems by considering how different sectors are connected and how decisions made in one sector can impact on others. This may be especially useful for identifying the inter-relatedness and interdependencies between sectors when making decisions about projects, strategies, policies and investment options in complex socio-environmental systems ( DeLaurentis and Callaway, 2004 ). It aims to integrate research, management and governance across sectors and scales. The nexus approach assumes that there are biophysical and environmental limits to the degree to which resources can be exploited or pollutants can be absorbed, and that exceeding these limits will have potentially catastrophic impacts, either now or in the future.

Moreover, it is understood that there are complex feedbacks within and between sectors ( Mutanga et al., 2016 ), often resulting in non-linear responses, and tipping points beyond which systems cannot easily recover ( Cabrera et al., 2008 ). The nexus approach allows for a more holistic understanding of (un-)intended consequences of policies, technologies and practices whilst highlighting areas of opportunity for further exploration ( Trist, 1981 ; Mutanga et al., 2016 ). It aims to enhance resource-use efficiency (resource-use getting more from less) and political cohesion by reducing resource trade-offs and increasing synergies. The nexus concept needs to be interdisciplinary and transdisciplinary, accepting a plurality of views ( Geels, 2004 ). It is also participatory, requiring stakeholders to engage with researchers in jointly deriving potential solutions. Given the above dimensions, resource-use remains clear that no single definition can be used to define nexus and its applications, it remains an evolving concept. What is clear though is that it forms the basis within which the WEF nexus is defined and understood.

3 The water-energy-food-health (WEF-H) nexus approach

The Water-Energy-Food-Health (WEF-H) Nexus is a complex concept with no single agreed-upon definition or framework. It is often used to describe the interconnectedness of these four sectors, and how challenges in one sector can have cascading impacts on the others ( Rasul and Sharma, 2016 ). The number of sectors included in the Nexus can vary, depending on the discipline or perspective and can sometimes add additional lenses such as livelihoods, ecosystems, and climate change ( Keskinen et al., 2016 ). For example, those in the water sector may refer to the Nexus as WEF, while those in the energy sector may refer to it as EWF. The agriculture sector may define it as FEW, and the health sector may add the ‘H’ ( Nhamo et al., 2020 ). This lack of common understanding can make it difficult to collaborate and develop effective policies and solutions.

Despite the lack of consensus on a definition, the WEF-H Nexus is a useful concept for understanding the complex challenges facing our world. It can be used as an analytical tool, a conceptual framework, or a discourse ( Keskinen et al., 2016 ). Instead of passively acknowledging the existence of the WEF-H nexus, this paper argues that it is a critical driver of resilience in both our economy and society. Recognizing its interconnectedness demands proactive measures – not just awareness, but concrete policies and actions. By effectively managing this complex system, we can harness its synergies and mitigate challenges, ensuring the WEF-H nexus becomes a potent force for resilience in the face of interconnected water, energy, food, and health concerns.

Nexus studies equip us with the knowledge and tools to tackle complex challenges head-on. By delving into resource efficiency, institutional dynamics, and policy integration, they provide a roadmap for action through methods like integrated models and stakeholder engagement. The WEF-H nexus is not just a concept; it's a powerful framework for shaping a sustainable future.

For example, it enables consideration of ways to:

i. Address energy security without impacting further on food or water resources.

ii. Improve water security without increasing the energy burden of water management.

iii. Create a more circular system by integrating food production with water and energy utilization. Wastewater can be treated and reused for irrigation, renewable energy can power agricultural processes, and food waste can be converted into biofuels or compost.

iv. Encourage sustainable food production practices that prioritize nutrient-rich crops and diversified diets which can contribute to improved public health and reduced malnutrition.

v. Create new green jobs in renewable energy, resource recovery, and precision agriculture, thereby meeting job creation ambitions in a sluggish agricultural economy without overextending water and energy resources.

The four most important interfaces in the water-energy-food-health (WEF-H) nexus are:

• Water which plays a vital role in both food and energy production, and for sustaining the ecosystems that support agriculture and other economic activities that are critical for food security.

• Energy, which is required for food production (especially irrigation) and for water supply, including the extraction, purification, and distribution of water.

• The role of food production as a consumer of land, energy, and water as well as their interlinkage with health.

• Health which is an intrinsic component of the WEF-H nexus, as the wellbeing of individuals is intricately linked to the quality and availability of water, the energy required for sustenance, and the nutritional aspects of food production. Recognition of the interconnections between addressing the challenges and opportunities within this interconnected system.

Agriculture, which is responsible for growing food, is a major user of water (more than 70% of all water use globally) and energy ( Rasul and Sharma, 2016 ). Agriculture and food production also affect the water sector through land degradation, changes in runoff, and disruption of groundwater discharge (Shinde, 2017). Recognizing the intricate connections within the Water-Energy-Food-Health (WEF-H) nexus is paramount. Health, as a crucial facet of this nexus, is intricately linked to the availability and quality of water, the energy required for sustenance, and the nutritional aspects of food production. A holistic understanding of these interdependencies is essential for comprehensive and sustainable management within the WEF-H nexus.

4 Taxonomy of nexus approaches

According to Bian & Liu, (2021) , there are four globally recognized nexus types:

• Water-energy: This nexus focuses on the interconnectedness of water and energy systems. For example, energy production often requires large amounts of water for cooling, while water distribution and treatment require energy ( Wilson et al., 2021 ).

• Water-food: This nexus focuses on the connections between water resources and agriculture. Agriculture, particularly irrigation, is a major consumer of water resources. Consequently, fluctuations in water availability directly impact food production.

• Water-energy-food: This nexus adopts a holistic approach, bringing together the three core elements of water, energy, and food. It underscores the need for integrated planning and management, recognizing the interconnectedness and interdependence of these essential domains.

• Water-energy and climate: In this context, the nexus signifies the interplay between water, energy, and climate factors. It acknowledges the substantial influence of climate change on water resources, energy production, and food security. For instance, altered precipitation patterns can disrupt water availability, and extreme weather events have the potential to damage energy infrastructure and disrupt food supply chains. The discussion aims to clarify that the nexus represents the combination of these sectors, emphasizing the importance of a comprehensive understanding and strategic planning within the broader WEF-H context.

In recent years, additional nexus types have emerged:

• The Water-energy-food-ecosystems (WEFE) nexus: This nexus recognizes the pivotal role of ecosystems in shaping and sustaining the interconnections among water, energy, and food systems. Ecosystems provide indispensable services, including clean water, pollination, climate regulation, and biodiversity, which underpin the functionality of water, energy, and food systems ( De Roo et al., 2021 ). The WEFE nexus highlights the profound interdependence between ecosystems and the essential sectors of water, energy, and food. It emphasises the need for holistic, integrated resource management approaches that recognize the intrinsic value of ecosystems in sustaining human wellbeing and promoting environmental resilience.

• Nuwayhid and Mohtar, 2022 contends that Water-Energy-Food-Health (WEF-H) nexus is a comprehensive framework that explores the intricate relationships between water resources, energy production, food systems, and public health. Unlike the WEFE which advances ecosystems as a critical physical component this nexus advances the health wellbeing. Equally it recognizes that changes in one domain can have significant impacts on the others though with an inherent interlinkage between physical components and human wellbeing. For instance, water is crucial for human survival and agricultural production, while energy is essential for water treatment and food processing. Similarly, food quality and availability directly affect public health. This approach underscores the need for integrated, sustainable strategies in resource management and policymaking, emphasizing that decisions in one sector can have far-reaching consequences for the others. By embracing the WEF-H nexus, stakeholders can better address complex challenges related to resource scarcity, environmental sustainability, and community wellbeing through collaborative and innovative solutions refer to ( Figure 1 ).

• Another nexus type, the water-energy-food-biodiversity-health (WEFBH) nexus, encompasses the complex interdependencies between water utilization, energy generation, food supply chains, and environmental and public health ( Hirwa et al., 2021 ).

Figure 1 . WEF-H nexus adaptation framework.

The interrelationships between the nexuses are illustrated in Figure 1 . Essentially the framework for WEF-H Nexus not only captures the traditional WEF but encapsulates the health dimension as an equal sectoral lens to the nexus thus providing a holistic dimension. Policy framing is broadened to include issues around “healthy water,” “sustainable energy for health,” and “nutritious food for wellbeing.” Health metrics can be tracked alongside traditional WEF indicators to monitor the Nexus’s impact on health and identify areas needing improvement. Moreover, the nexus adaptation framework recognizes that the nexus is influenced by several exogenous factors including the impact of climate change, the policy sphere, institutional mechanisms as well as the financial mechanisms all of which have an inherent effect on each of the sectors identified in this nexus.

Building on the foundation of previous nexus typologies that excluded health, the Water-Energy-Food-Health (WEF-H) nexus is a powerful tool at the socio-political level. It can alleviate tensions caused by poor coordination among non-state actors and inadequate service provision by the state. The WEF-H nexus also presents a unique opportunity to shift the focus from governance challenges to community empowerment, fostering self-reliance and sustainability. This empowerment includes showcasing alternative livelihood possibilities.

Furthermore, the WEF-H nexus has the potential to bridge the gap created by inequitable partnerships, whether rooted in gender, wealth disparities, racial divides, educational levels, or social statuses which have become pervasive in South African society. The nexus approach can contribute to what we term “societal hope,” instilling a profound belief within communities that they can chart a course away from hopelessness, even in the face of governance inefficiencies and limited access to opportunities. The principles thereof illustrated in Figure 1 include environmental stewardship which advocates for investment in sustaining ecosystems services, social equity, resource use efficiency as well as the integrative perspective. These principles provide a foundation for merging effective pathways for successful implementation of NEXUS.

The adaptability of the Water-Energy-Food-Health (WEF-H) nexus, in contrast to other aspects of the economy, lies in its capacity to cater to communities with varying levels of knowledge and information. Unlike traditional economic frameworks, the WEF-H nexus is inherently versatile, offering a more inclusive approach that accommodates diverse communities. This adaptability stems from its comprehensive consideration of interconnected elements, allowing for nuanced solutions that address the complex and dynamic challenges present in the realms of water, energy, food, and health. By embracing a holistic perspective and fostering collaboration among stakeholders, including academics, civil society organizations, the private sector, government bodies, and international partners, the WEF-H nexus creates a platform that encourages innovation and technological advancements across multiple sectors and scales.

The WEF-H nexus holds the most promise for regions facing significant development gaps or struggling with complex socio-economic issues. It offers a powerful, unified approach to tackling these challenges and unlocking new opportunities. We characterize the opportunity presented by the WEF-H nexus as “extraordinary” due to its unique capacity to simultaneously address multiple facets of development challenges. The extraordinary nature lies in the nexus’s holistic approach, integrating water, energy, food, and health considerations. This all-encompassing strategy allows for comprehensive and interconnected solutions, offering a more effective and sustainable response to the complex socio-economic challenges and developmental hurdles that regions may face. The extraordinary nature of this opportunity is underscored by the potential for transformative and inclusive development outcomes, some of which are illustrated on Figure 1 as sustainable adaptation outcomes.

5 Key characteristics of the water-energy-food-health (WEF-H) nexus approach

The WEF-H nexus approach is inherently accessible and requires no demystification. It is conceptually straightforward and designed to be inclusive, catering to individuals of all backgrounds and levels of expertise. Recognizing that, for the general public, concepts such as the WEF nexus and the WEF-H nexus may benefit from some explanation, we emphasize the fundamental nature of this approach. It relates to some of the most essential human needs: water, energy, food, and health. In this paper, we have identified ten salient characteristics that are recognized by many scholars and in the literature on the WEF-H nexus, aiming to enhance clarity and promote a more inclusive understanding:

a. Multi-sectoral focus : The WEF-H approach unites a diverse range of stakeholders around a common set of goals, providing a platform for intentional and focused interaction. This cross-sectional coordination promotes convergence of perspectives and facilitates collaborative solutions.

b. Interconnectedness : WEF-H nexus broadens the understanding of interlinkages ( Simpson and Jewitt, 2019 ) recognizing the interdependencies ( Leck et al., 2015 ) between sectors i.e., water, food, and energy.

c. Social embeddedness. Beyond the physical/environmental connections of the nexus approach is the ability to recognize the social interactions among actors which may be referred to as social embeddedness interactions ( Srigiri and Dombrowsky, 2022 ). WEF thus considers the political and cognitive factors that are central to policy change within sectors ( Weitz et al., 2017 ).

d. Complexity : The multifaceted nature and interactions between and within different subsystems ( Mutanga et al., 2016 ) create complex dimensions that must be addressed. As a result, there is no one-size-fits-all model to deal with WEF-related issues ( Simpson and Jewitt, 2019 ). Instead, time-bound and place-bound solutions are encouraged.

e. Governance modes : Scholars studying the WEF nexus agree that integrative coordination across sectors, actors and levels of governance is essential, given the interconnected nature of the nexus ( Welsch et al., 2015 ). It is important to note that the WEF-H nexus approach does not seek to replace focus and attention on actions (planning, investments, implementation, etc.) related to related to water, energy, food and health. Rather, it aims to break down the siloed approach to managing these resources and promote coherent and balanced planning and implementation.

f. Holistic Approach : WEF-H nexus is a holistic approach that is consistent with well-established analytical frameworks such as Institutional analysis and development (IAD) framework ( Ostrom, 2010 ) value chain analysis ( Villamayor-Tomas et al., 2015 ), network of adjacent action situations (NAAS) ( Srigiri and Dombrowsky, 2022 ), multi-criteria decision-making models (MCDM) ( Kumar et al., 2017 ), Integrative Model ( Nhamo et al., 2020 ), as well as systems dynamics models ( Wen et al., 2022 ). All these tools share a common structure for solving complex decision and planning problems, but their application and impact vary across sectors.

g. Implementation : WEF-H nexus implementation is not an event, rather, it is a process that requires access to information about on-going plans and activities to ensure building-on and complementing those activities.

6 Barriers/bottlenecks for implementing nexus

The WEF-H is anchored in prioritizing the management of the four interconnected resources (water, energy, food, and health) in a sustainable way. However, implementing this nexus comes with different barriers and bottlenecks that hinder progress (detailed below and in Table 1 ).

Table 1 . Identified bottlenecks drawn from literature and recommendations for implementing WEF-H Nexus.

South Africa currently lacks a singular policy document that explicitly addresses the Water-Energy-Food-Health (WEF-H) nexus. This does not necessarily imply a lack of commitment but reflects the intricate task of navigating trade-offs and resource constraints. This, position reflects the broader global context where numerous nations are yet to formulate comprehensive policies on the WEF-H nexus. In many instances, the implementation of WEF-H activities remains imbalanced, with sectors such as water, energy, food, and health often managed in a sectoral or “silo” approach ( Nhamo et al., 2018 ). Despite the acknowledgment of the WEF-H nexus approach, these sectors frequently treat resources independently, guided by institutional structures ( Adom et al., 2022 ). The reluctance to enforce integrative policies is a complex challenge influenced by trade-offs embedded across sectors, particularly in resource-limited countries. South Africa, being a water-scarce nation, has ambitious plans to transition from coal-based to renewable energy, including hydropower ( Pegels, 2010 ; Ololade et al., 2017 ). This puts pressure on the water sector which has to prioritise maintaining the supply of its limited water resource to water provision, energy generation and agricultural production (the latter has a very high-water consumption factor of 62% due to irrigation ( Adom et al., 2022 ).

The reluctance to enforce integrative policies, driven by trade-offs across sectors in resource-limited countries like South Africa, poses significant challenges. As a water-scarce nation with ambitious plans for transitioning to renewable energy, the pressure on the water sector is pronounced ( Rasul and Sharma, 2016 ).

Global climate change, and climate variability exacerbates the challenges of WEF-nexus in South Africa. Increasing aridity has a direct knock-on effect on food security ( Schreiner and Baleta, 2015 ; Mabhaudhi et al., 2016 ), leading to hunger and a decline in the supply of nutritious food ( Wlokas, 2008 ). Extreme weather events such as floods and heat waves also cause health issues such as food and waterborne diseases and heat stroke ( Mabhaudhi et al., 2019 ) and exacerbates land degradation, especially of agricultural lands ( Wlokas, 2008 ).

Water and land are key natural resources that are already under pressure from competing interests. Climate change exacerbates these challenges, as it increases the demand for resources. In regions where land and water are limited, an upsurge in multi-service projects aiming to tackle food insecurity and promote clean energy could exacerbate competition for these vital resources.

The lack of dedicated funding to provide integrated solutions is another reason why the sectoral approach persists, as the implementation of the nexus requires significant investment. The current funding landscape in South Africa prioritizes individual WEF sectors, with cross-sectoral funding streams being scarce ( Mabhaudhi et al., 2018 ). This siloed approach creates several challenges among which includes:

• Competing priorities: Crises like the COVID-19 pandemic necessitate diverting limited resources to immediate needs like health and hunger alleviation ( Wlokas, 2008 ; Mabhaudhi et al., 2019 ). This can exacerbate other critical issues like energy insecurity and poverty, further hindering progress on the WEF-H nexus.

• Limited impact: Sector-specific funding often fails to account for the interconnected nature of the WEF-H nexus, hindering the development of holistic solutions that address multiple challenges simultaneously.

The implementation of the WEF-H nexus requires innovative technologies and robust data, yet South Africa faces significant limitations:

• Data scarcity and comparability: Data availability is limited, and existing data often suffers from inconsistencies in spatial scales and temporal trends, hindering effective analysis and planning.

• Technological lag: Access to and expertise in innovative technologies like smart agriculture and early warning systems is limited, impeding the development of solutions to address challenges like climate change and disease outbreaks.

• Amid unpredictable extreme weather events and the prevalence of diseases, there is also a lack of innovative technologies tailored to alleviate the resultant impacts imposed by these events. Even though they come at a hefty cost, technologies such as smart agriculture (to alleviate a 15% decline in agricultural yields by 2050 if global warming increased by 2°C ( Mabhaudhi et al., 2019 )), early warming or detection systems and cutting edge health facilities are a necessity for an integrated response. Another bottleneck in this is that these innovative and sophisticated technologies require, trained personnel to operate them, which is still a scarce skill in the country.

Lack of functional, effective, efficient, and equitable partnerships or collaborations to drive implementation is another barrier. The implementation of the WEF-H nexus requires partnerships as individual experts rarely have expertise across all its dimensions. All this comes with effective communication across all relevant stakeholders including communities, technicians and government officials to promote dialogue among partners towards balancing the decision-making process. At the moment there is ambiguity regarding the roles of communities and relevant stakeholders in the implementation of the nexus framework (D. Naidoo et al., 2021 ). Some of the stakeholders are also in need of capacity development and awareness which hinders collaboration and results in a lack of stakeholder involvement in the nexus framework ( Adom et al., 2022 ). For instance, about 73% of the participants in an interview study agreed that there are major gaps within stakeholder engagement in the nexus ( Adom et al., 2022 ).

The WEF-H nexus faces the challenge of navigating complex political and socio-cultural landscapes, where historical biases towards isolated sectors hinder balanced implementation. Achieving consensus across spheres and sectors requires addressing these challenges and fostering equitable development.

By design, the implementation of the WEF-H programme ideally requires a long period of time. It is possible that while implementing the WEF-H programme, the breadth and coverage of activities of WEF-H approach lend themselves to unintended delays that derail achievement of outcomes and impact. Pressured by the short terms in government, politicians and decision-makers may face pressure to show immediate results to meet political or economic agendas. This can lead to biased prioritization of short-term goals at the expense of the more comprehensive long-term goals of the nexus. Developing and revising policies to effectively enforce the WEF-H nexus demands meticulous consideration of numerous factors, inherently leading to a time-intensive process.

Getting the private sector to actively contribute to the implementation of the WEF-H nexus is another bottleneck. The focus of the private sector is profit. ‘What is in it for us’ has been the dominant and acceptable main focus of the private sector. The private sector is risk averse. Waiting for, encouraging, or coercing the government to absorb the inherent transactional risks has been one of the approaches that the private has used to minimize their exposure and ensure their profitability and sustainability. Despite these basic attributes of the private sector, it is evident that most sections of the private sector are looking for opportunities where they can make a positive societal impact. The WEF-H nexus provides such an opportunity. This leaves us with the question: Why has the private sector not seized the opportunities to implement the WEF-H nexus, especially in communities wherein they operate? Is it likely that there are actions inherent in the implementation of the WEF-H nexus that are laden with risks that the private sector is not willing to absorb?

7 Enablers for implementing the WEF-H nexus

Several ingredients for transitioning from “nexus thinking” to “nexus doing” are required for a successful implementation of the WEF-H nexus. This approach holds immense potential to provide lucrative opportunities for South Africa. This paper adapts the scaling framework and classify the nexus under a three-pronged scaling principles system consisting of (i) scaling up, (ii) scaling deep, and (iii) scaling out as illustrated in Figure 2 . Scaling up focusses on enabling factors that are policy and institutionally oriented, while scaling deep focus on culture and beliefs and scaling out centers on factors impacting greater numbers, the replication and dissemination of information on the WEF-H nexus. This results in an increased number of people or communities impacted. Lastly, scaling deep looks at enabling factors impacting on the cultural roots including aspects such as changing relationships, culture, and beliefs.

Figure 2 . Nexus enabling principles.

For this procedural and transformative transition to happen, several enabling factors have been identified in the literature which foster the adoption and implementation of the WEF-H nexus. The first factor identified is the investment in Capacity Development. To unlock the full potential of the WEF-H nexus, robust capacity development initiatives are required across stakeholders, encompassing government agencies, researchers, and local communities ( Chibarabada et al., 2022 ). These initiatives should encompass comprehensive training programs and knowledge-sharing platforms aimed at enhancing the understanding of nexus interlinkages. By equipping stakeholders with the necessary skills and insights, we empower them to make informed decisions that align with the holistic goals of the WEF-H nexus, thus catalyzing its effectiveness ( Ramos et al., 2022 ). Local communities can also benefit from educational programs on sustainable water and energy practices, alongside leadership development workshops to empower them to participate in decision-making processes.

Secondly, mobilization of finance is also an imperative factor when it comes to the WEF-H nexus implementation. Securing finances is pivotal to translating the WEF-H nexus from theory into impactful practice, regardless of the chosen institutional approach ( Hejnowicz et al., 2022 ). Southern Africa has witnessed a surge in research projects and publications concerning the nexus since 2013 ( Naidoo et al., 2021 ). For instance, the Southern African Development Community-European Union (SADC-EU) nexus dialogue-funded project has been instrumental in driving the WEF nexus from abstract research to tangible action across southern Africa. This initiative has led to the organization of numerous workshops, symposia, and science-policy dialogues within the region. Such financial commitments not only facilitate research and data generation but also provide the necessary resources for practical interventions and policy implementations that promote the sustainable integration of water, energy, food, and health systems.

Decision Support Systems and Frameworks are also a necessary ingredient. The development of robust decision support systems and frameworks is paramount in navigating the complex terrain of the WEF-H nexus ( Nhamo et al., 2020 ). These technological tools serve as indispensable guides for systematic analysis of intricate nexus linkages, enabling policymakers to scrutinize diverse scenarios and their potential ramifications on water, energy, food, and health systems. Decision support systems are the linchpin of informed and effective decision-making within the multifaceted landscape of the WEF-H nexus, fostering data-driven, evidence-based solutions that optimize resource allocation, minimize vulnerabilities, and bolster resilience across these interconnected sectors.

Innovative Policy Frameworks have also been identified as one of the enabling factors ( Naidoo et al., 2021 ). The dynamic nature of the WEF-H nexus necessitates adaptive and forward-thinking policy frameworks capable of accommodating its complexity. These policies should transcend sectoral boundaries, encouraging seamless integration and collaboration while emphasizing sustainability and resilience. The shared resources within the SADC region highlight the importance of harmonizing existing policies and linking them, as illustrated by the Revised Regional Indicative Strategic Development Plan. Such initiatives promote holistic resource management, acknowledge the interdependence of different sectors, and pave the way for comprehensive, cross-cutting policies that effectively address the WEF-H nexus’s challenges.

Regional Cooperation is also an important enabling factor that has been identified within the literature ( Decoppet et al., 2023 ) . Recognizing that environmental and resource challenges often transcend national borders, robust regional cooperation is essential. Collaborative efforts between South Africa and neighboring countries can effectively address shared WEF-H nexus issues, enhancing stability and mutual benefits while ensuring harmonized resource management. Given the overarching nature of environmental and resource challenges, regional cooperation may serve as a fundamental pillar in addressing the complexities of the WEF-H nexus. The SADC regional integration framework (Saurombe, 2010) could transcend beyond trade to include developmental trajectories that have a bearing on WEF-H nexus. South Africa’s geographical proximity to neighboring countries accentuates the necessity for collaborative endeavors. By forging strategic partnerships and alliances with neighboring nations, South Africa and other member states can collectively tackle shared WEF-H nexus challenges that transcend political borders. Such collaborative efforts foster stability, mutual benefit, and regional cohesion. Whether it is addressing transboundary water management, cross-border energy initiatives, harmonizing agricultural practices, or jointly responding to health crises, regional cooperation can yield synergistic solutions that are more effective and sustainable than isolated efforts within national boundaries. Additionally, regional cooperation can lead to enhanced resilience in the face of resource-related uncertainties and bolster collective capacity for responding to emerging WEF-H nexus issues.

Political will is another important enabling factor that fosters the adoption and implementation of the WEF-H nexus. A bedrock of strong political will is fundamental to prioritize the WEF-H nexus and commit to sustainable resource management and public health. Such commitment provides the foundation for integrated policies and action plans that genuinely address the nexus’s intricate challenges. A robust and unwavering political will stands as the cornerstone of meaningful progress within the WEF-H nexus. National leaders hold the key to prioritizing this integrated approach, committing to sustainable resource management, and safeguarding public health. Their dedication paves the way for the development and implementation of comprehensive policies and action plans that genuinely confront the intricate challenges posed by the nexus. It sends a resounding message that these issues are of paramount importance, transcending political cycles and short-term interests, and underscoring a commitment to the long-term wellbeing of both the environment and the populace.

Another necessary ingredient noted in the literature is the clear demarcation of WEF-H operational boundaries: Defining distinct operational boundaries for WEF-H initiatives is crucial as it ensures that roles, responsibilities, and accountabilities are well-understood, preventing overlaps or gaps in resource management, and fostering efficient and effective governance. This not only prevents wasteful overlaps and dangerous gaps in resource management but also fosters efficient and effective governance. By delineating the boundaries of action and influence, stakeholders can coordinate their efforts more effectively, resulting in streamlined operations and more impactful outcomes.

360-Degree stakeholder engagement that leaves no one behind is also another important enabling factor. This underscores the principle of inclusivity’s paramount importance is recognized. Engaging all stakeholders, including marginalized communities, is essential for equitable resource allocation and access ( Bruns et al., 2022 ; Hejnowicz et al., 2022 ). Such comprehensive engagement ensures that diverse perspectives and needs are considered. Engaging all stakeholders, without exception, is not only a moral imperative but also a strategic necessity. This comprehensive involvement ensures that the benefits and burdens of resource management are equitably distributed. Marginalized communities, often disproportionately affected by environmental and health challenges, must have their voices heard and their needs addressed. Inclusivity makes the WEF-H nexus genuinely holistic, drawing on a wealth of perspectives and insights to inform more equitable and effective policies and actions. To operationalize this approach, we propose several pathways for engaging all relevant stakeholders in the WEF-H nexus. Firstly, the establishment of inclusive platforms, such as community forums and online portals, can facilitate ongoing communication and collaboration. Secondly, targeted outreach and awareness campaigns can ensure that marginalized communities are actively involved. Thirdly, leveraging technology, such as mobile applications and social media, can enhance accessibility and engagement. Additionally, incorporating participatory approaches, like co-design sessions and citizen science initiatives, fosters a sense of ownership among stakeholders.

Unlocking the full potential of the WEF-H Nexus, demands breaking down siloed governance. Effective collaboration among government departments, private sector entities, civil society organizations, and academia creates a fertile ground for innovation which enables the sharing of knowledge, identify synergies, and address challenges holistically ( Lazaro et al., 2022 ). Imagine a fertile ecosystem where engineers, farmers, policymakers, and community leaders, all contribute to cross-pollination of ideas. This is the power of a multidisciplinary approach to the WEF-H nexus, where collaboration sparks innovation and ensures no facet is overlooked. From policy blueprints to grassroots implementation, every strand contributes to a more comprehensive and impactful solution, ultimately leading to more sustainable and equitable outcomes for food, water, energy, and health.

Establishment of open access databases and encouraging data sharing can also positively impact on the adoption and the implementation of the WEF-H nexus. Data transparency and sharing are cornerstones of the WEF-H nexus approach. Open access databases facilitate the exchange of information, supporting evidence-based decision-making and research that can drive sustainable resource management and public health improvements ( Mabhaudhi et al., 2021 ). Open access databases facilitate the seamless exchange of information among stakeholders, underpinning evidence-based decision-making, and research. With access to comprehensive and up-to-date data, policymakers and researchers can identify trends, track progress, and make informed choices that drive sustainable resource management and improvements in public health.

Innovative Technology is another enabling factor positively impacting on the adoption and implementation of the WEF-H nexus. Examples of these cutting-edge technologies include, but are not limited to, precision agriculture techniques that optimize water use, the integration of renewable energy sources to power nexus-related activities, and advanced health monitoring systems. Embracing cutting-edge technology within the WEF-H nexus enhances monitoring, data collection, and resource management. This includes the adoption of technologies that promote efficient water use, harness renewable energy sources, advance sustainable agriculture practices, and facilitate health monitoring, thereby driving innovation and progress across the nexus. Embracing cutting-edge technology is a catalyst for progress across the WEF-H nexus. By harnessing innovative solutions, stakeholders can drive meaningful change. Technology enhances monitoring, data collection, and resource management, leading to more efficient and sustainable practices that benefit both the environment and public health. It also fosters a culture of innovation, inspiring continuous progress within the nexus.

8 Conclusion

The exploration of water-energy-food-health (WEF-H) remains key in broadening our understanding of the nexus complexity. This article contributes to the body of knowledge which reveals a paradigm-shifting approach to addressing the intricate interdependencies among these critical sectors. Integration of the health dimension goes beyond conventional WEF frameworks, as it introduces a comprehensive understanding of human wellbeing and resilience. The study contribute to the ongoing discourse surrounding the WEF nexus demonstrating the advantages of linking the health sector. By synthesizing insights from various disciplines, our work advances the understanding of how health interplays with water, energy, and food dynamics. This contribution positions the WEF-H nexus as an innovative solution to complex global challenges. To realize its full potential, there is a need for dedicated champions who can not only navigate the enablers and barriers outlined in this study but also translate concepts into actionable plans and sustainable programs. The success of the WEF-H nexus requires collaborative efforts from governments, stakeholders, and communities, providing a unique and impactful framework for addressing the multifaceted challenges at the intersection of water, energy, food, and health. South Africa, like many nations, aspires to build capable governance, but the complexity of the WEF-H nexus approach may strain government resources. The nexus approach acknowledges the existence of various policies, plans, systems, and programs, but also recognizes that their impact can be amplified when integrated into a cohesive implementation framework from the outset. This should not discourage governments to invest resources in the nexus approach but highlights the inherent challenges in aligning governance structures with its holistic nature.

While the Water-Energy-Food-Health (WEF-H) nexus presents a promising solution to urgent global challenges, its successful implementation necessitates meticulous planning, dedicated champions, and strategic governance. Recognizing the need for a nuanced approach, our paper emphasizes the imperative of capacity development, cross-sectoral collaboration, and the formulation of integrated governance frameworks. These elements are not merely suggested but they could be integral components that address the complexities involved. By strategically integrating these aspects into the implementation process, we ensure that the WEF-H nexus may be closer to reaching its full potential without imposing undue burdens on existing systems. Throughout the paper, we have enhanced the discussion, providing earlier argumentation to articulate the critical role of capacity development and integrated governance, thereby reinforcing the foundation for our proposed strategies.

In conclusion the WEF-H nexus presents an extraordinary opportunity to break the mold of traditional development paradigms. Its unprecedented focus on interconnectedness allows us to address multifaceted challenges from water scarcity, energy and food security to health disparities in a truly comprehensive manner. This holistic approach promises not just incremental progress, but a paradigm shift towards sustainable and equitable development.

Author contributions

SSM: Conceptualization, Writing–original draft, Writing–review and editing, Funding acquisition, Investigation, Project administration. BKM: Writing–review and editing, Funding acquisition, Project administration, Supervision. SM: Writing–review and editing. MSM: Writing–review and editing. FVS: Writing–review and editing. TL: Writing–review and editing. SN: Writing–review and editing. TT: Writing–review and editing. JJ: Writing–review and editing.

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The author(s) acknowledge that the financial support for the research, authorship and publication of this article was received from the Department of Science and Innovation (DSI) through a CSIR Parliamentary Grant (P1EGC02).

Conflict of interest

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

Publisher’s note

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

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Keywords: WEF-H nexus, South Africa, enablers, barriers, policy alignment, sustainability

Citation: Mutanga SS, Mantlana BK, Mudavanhu S, Muthige MS, Skhosana FV, Lumsden T, Naidoo S, Thambiran T and John J (2024) Implementation of water energy food-health nexus in a climate constrained world: a review for South Africa. Front. Environ. Sci. 12:1307972. doi: 10.3389/fenvs.2024.1307972

Received: 06 October 2023; Accepted: 14 March 2024; Published: 25 March 2024.

Reviewed by:

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

*Correspondence: Shingirirai S. Mutanga, [email protected]

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Blood sugar lows, highs hamper brain function in individuals with Type 1 diabetes

Large swings in blood glucose tied to Type 1 diabetes may impact the brain’s ability to quickly process information, according to a study led by scientists at Washington State University and McLean Hospital in Massachusetts. The research also showed that some individuals are more severely impacted by these changes, which includes older people and those with certain health conditions.

Published in npj Digital Medicine , the study found that very low and very high glucose levels were associated with slower and less accurate cognitive processing speed, with the most dramatic effect seen at low glucose levels. Optimal cognitive processing speed — the ability to respond to and process information quickly — is important for a wide variety of everyday tasks and contexts, from driving and operating machinery to decision-making in fast-paced environments.  

“Our findings suggest that minimizing blood glucose extremes could help people with Type 1 diabetes to improve not just their health but their cognition as well,” said co-senior author Naomi Chaytor, a professor and chair in the WSU Elson S. Floyd College of Medicine. “And because diabetes is a cognitively demanding disease that requires hourly decisions on how much insulin to take based on various factors, this could also potentially prevent a situation where glucose lows and spikes send people into a spiral of worsening diabetes self-management.”

While previous studies had established a connection between low blood glucose and cognitive function in a laboratory setting, the researchers said theirs is the first to look at the impact of glucose fluctuations on cognition in individuals with Type 1 diabetes going about their daily lives. Using digital sensors that measure glucose every few minutes and smartphone-based cognitive testing, the research team captured repeated data on glucose levels and cognitive performance in 200 participants recruited at four major U.S. diabetes centers. Throughout the 15-day study, participants completed cognitive tests three times a day and had glucose measurements taken every five minutes.

Relating cognitive test performance to glucose levels measured at the time of testing, the researchers determined that cognitive processing speed was worse when glucose was much lower or much higher than usual. They also tested participants’ sustained attention, an element of cognition that represents the ability to stay focused on a task over an extended amount of time but found that it was not significantly impacted by glucose fluctuations.

“It’s possible that sustained attention is impacted by high or low glucose that persists over longer periods of time, even though it does not appear to be affected by the short-term, moment-to-moment fluctuations in glucose that we looked at in this study,” said Laura Germine, co-senior author and director of McLean Hospital’s Laboratory for Brain and Cognitive Health Technology.

Comparing between participants, the researchers saw differences in the extent to which changes in glucose affected cognition and identified factors that could predict who might be more at risk of severe impacts. They found this to be the case for older people, as well as those with certain health conditions, such as diabetes-related eye, kidney and nerve damage; fatigue; and sleep apnea risk.

“In trying to understand how diabetes impacts the brain, our research shows that it is important to consider not only how people are similar, but also how they differ,” said first author Zoë Hawks, a research investigator at McLean Hospital. 

One surprise discovery was that participants’ peak cognitive performance coincided with glucose levels that were slightly above their normal range, though performance dropped off as glucose levels rose even further.

“This was an important finding because people with diabetes often report feeling better at a glucose level that is higher than what is considered healthy,” Chaytor said, adding that it’s possible that the brain habituates itself to a glucose level that it is used to.

She said a next step in this research is to see whether the glucose level associated with peak performance shifts down into the normal range when the amount of time spent above range is reduced, which can be achieved through use of automated diabetes management systems.

Ultimately, the researchers hope to find ways to help people with Type 1 diabetes function at their best cognitively. Given rising evidence that people with Type 1 diabetes may be more at risk for cognitive decline and dementia, this could also potentially have long-term health benefits.

Primary funding for the study came from the National Institute of Diabetes and Digestive and Kidney Diseases, an agency within the National Institutes of Health.

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