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Writing a Literature Review

Phase 1: scope of review, it's a literature review of what, precisely.

Need to Have a Precise Topic It is essential that one defines a research topic very carefully. For example, it should not be too far-reaching. The following is much too broad:

"Life and Times of Sigmund Freud"

However, this is more focused and specific and, accordingly, a more appropriate topic:

"An Analysis of the Relationship of Freud and Jung in the International Psychoanalytic Association, 1910-1914"

Limitations of Study In specifying precisely one's research topic, one is also specifying appropriate limitations on the research. Limiting, for example, by time, personnel, gender, age, location, nationality, etc. results in a more focused and meaningful topic.  

Scope of the Literature Review It is also important to determine the precise scope of the literature review. For example,

  • What exactly will you cover in your review?
  • How comprehensive will it be?
  • How long? About how many citations will you use?
  • How detailed? Will it be a review of ALL relevant material or will the scope be limited to more recent material, e.g., the last five years.
  • Are you focusing on methodological approaches; on theoretical issues; on qualitative or quantitative research?
  • Will you broaden your search to seek literature in related disciplines?
  • Will you confine your reviewed material to English language only or will you include research in other languages too?

In evaluating studies, timeliness is more significant for some subjects than others. Scientists generally need more recent material. However, currency is often less of a factor for scholars in arts/humanities. Research published in 1920 about Plato's philosophy might be more relevant than recent studies.

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

literature review

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

Table of Contents

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

What is a literature review?

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

literature review scope example

What is the purpose of literature review?

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

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

Literature review example

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

Literature Review on Climate Change Impacts on Biodiversity:

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

a. Habitat Loss and Species Extinction:

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

b. Range Shifts and Phenological Changes:

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

c. Ocean Acidification and Coral Reefs:

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

d. Adaptive Strategies and Conservation Efforts:

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

literature review scope example

How to write a good literature review

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

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

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

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

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

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

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

what is a literature review

Conducting a literature review

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

Choose a Topic and Define the Research Question:

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

Decide on the Scope of Your Review:

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

Select Databases for Searches:

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

Conduct Searches and Keep Track:

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

Review the Literature:

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

Organize and Write Your Literature Review:

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

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

Frequently asked questions

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

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

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

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

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

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

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


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

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Writing a literature review.

  • Definitions

Determine the scope of your review

A review of what, planning your literature review.

  • Finding sources
  • Annotating sources
  • Organizing the review
  • Writing the review
  • Practical Tips

The length of the review depends on your objective. 

  • Are you writing a research paper as the final project in a specific course?
  • Are you writing a senior or honor's capstone project or thesis? 
  • Are you writing for an undergraduate or graduate course? 
  • Are you writing a master's thesis? 
  • Are you writing a dissertation?

The majority of these projects will require a selective examination of the literature.  Discuss the length of your review with your instructor or paper advisor.

  • You must have a precise question to study. For example, your question cannot be too broad, nor too narrow. 
  • You must understand the limitations of your research. Limiting by time, geographic area, gender, age, and/or nationality are all good ways to develop a more focused topic.
  • what will you cover?
  • will your coverage be selective or exhaustive?
  • are you focusing on a specific theory or methodology; a specific type of research?
  • will you include information published in other languages?
  • will you include information from related disciplines?

It will take time to locate and review the literature relevant to your research question.  Starting early will allow you sufficient time to gather and review your sources.  The process of writing a literature review normally includes the following elements:

1. Defining your research question

2. Planning the approach to your review and research

3. Searching the literature

4. Analyzing the material you find

5. Organizing the review

6. Writing the review

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Literature review.

  • Introduction to Literature Reviews
  • Purpose and Scope
  • Types of Lit Reviews
  • Finding Published Literature Reviews
  • Writing the Lit Review
  • Books and Websites

The literature review analyzes relationships and connections among different works. This differs from an annotated bibliography which provides a list and brief description of articles, books, theses, and other documents. The literature review should not merely list and summarize one piece of research after another. 

Through analysis of major works and subsequent scholarship the lit review lays out the evolution of scholarship on a topic and establishes a context for further research. This will help you to establish why the topic is important and place your research in a theoretical context.

A literature review will help you to avoid redundancy in your own research and to identify new problems, possibilities for further research, and to expand upon or ask new questions. The literature review allows you as a researcher to enter into an ongoing conversation with other scholars and researchers.

A literature review may be comprehensive or selective but should examine seminal or principal works and works that have been consequential in the field. The scope of a literature review will vary by assignment and discipline. The literature review may be part of a larger work or a stand-alone article, meaning that it is the entirety of a paper. The literature review may be part of the introduction, or a separate section to a thesis, dissertation, or research report setting up the context for the author's original research.   The literature review:

  • Compares and contrasts
  • Identifies areas of consensus and dissent
  • Reveals gaps or oversights
  • Indicates areas needing further research
  • Points out trends, themes, approaches, methodologies, theories, and frames of analysis
  • Discusses major debates in the field
  • Examines methodological or theoretical strengths and weaknesses

The importance of currency (timeliness of information) will vary by discipline and the purpose of the assignment. The sciences are typically more concerned with current research, practice, and findings. For example, in fields like health or medicine the lit review may only draw on recent literature which has been published within 5-10 years. However, inclusion of much older works is often relevant in fields such as the arts, humanities, philosophy, or history.

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

  • Quick Run-through
  • Step 1 & 2

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

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

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

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

Literature review guide

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

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

For each publication, ask yourself:

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

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

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

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

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


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

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

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

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


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


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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

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

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

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

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

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

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  • 04 December 2020
  • Correction 09 December 2020

How to write a superb literature review

Andy Tay is a freelance writer based in Singapore.

You can also search for this author in PubMed   Google Scholar

Literature reviews are important resources for scientists. They provide historical context for a field while offering opinions on its future trajectory. Creating them can provide inspiration for one’s own research, as well as some practice in writing. But few scientists are trained in how to write a review — or in what constitutes an excellent one. Even picking the appropriate software to use can be an involved decision (see ‘Tools and techniques’). So Nature asked editors and working scientists with well-cited reviews for their tips.

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Interviews have been edited for length and clarity.

Updates & Corrections

Correction 09 December 2020 : An earlier version of the tables in this article included some incorrect details about the programs Zotero, Endnote and Manubot. These have now been corrected.

Hsing, I.-M., Xu, Y. & Zhao, W. Electroanalysis 19 , 755–768 (2007).

Article   Google Scholar  

Ledesma, H. A. et al. Nature Nanotechnol. 14 , 645–657 (2019).

Article   PubMed   Google Scholar  

Brahlek, M., Koirala, N., Bansal, N. & Oh, S. Solid State Commun. 215–216 , 54–62 (2015).

Choi, Y. & Lee, S. Y. Nature Rev. Chem . (2020).

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Reference management. Clean and simple.

What is a literature review? [with examples]

Literature review explained

What is a literature review?

The purpose of a literature review, how to write a literature review, the format of a literature review, general formatting rules, the length of a literature review, literature review examples, frequently asked questions about literature reviews, related articles.

A literature review is an assessment of the sources in a chosen topic of research.

In a literature review, you’re expected to report on the existing scholarly conversation, without adding new contributions.

If you are currently writing one, you've come to the right place. In the following paragraphs, we will explain:

  • the objective of a literature review
  • how to write a literature review
  • the basic format of a literature review

Tip: It’s not always mandatory to add a literature review in a paper. Theses and dissertations often include them, whereas research papers may not. Make sure to consult with your instructor for exact requirements.

The four main objectives of a literature review are:

  • Studying the references of your research area
  • Summarizing the main arguments
  • Identifying current gaps, stances, and issues
  • Presenting all of the above in a text

Ultimately, the main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

The format of a literature review is fairly standard. It includes an:

  • introduction that briefly introduces the main topic
  • body that includes the main discussion of the key arguments
  • conclusion that highlights the gaps and issues of the literature

➡️ Take a look at our guide on how to write a literature review to learn more about how to structure a literature review.

First of all, a literature review should have its own labeled section. You should indicate clearly in the table of contents where the literature can be found, and you should label this section as “Literature Review.”

➡️ For more information on writing a thesis, visit our guide on how to structure a thesis .

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, it will be long. If your paper does not depend entirely on references, it will be short.

Take a look at these three theses featuring great literature reviews:

  • School-Based Speech-Language Pathologist's Perceptions of Sensory Food Aversions in Children [ PDF , see page 20]
  • Who's Writing What We Read: Authorship in Criminological Research [ PDF , see page 4]
  • A Phenomenological Study of the Lived Experience of Online Instructors of Theological Reflection at Christian Institutions Accredited by the Association of Theological Schools [ PDF , see page 56]

Literature reviews are most commonly found in theses and dissertations. However, you find them in research papers as well.

There is no set amount of words for a literature review, so the length depends on the research. If you are working with a large amount of sources, then it will be long. If your paper does not depend entirely on references, then it will be short.

No. A literature review should have its own independent section. You should indicate clearly in the table of contents where the literature review can be found, and label this section as “Literature Review.”

The main goal of a literature review is to provide the researcher with sufficient knowledge about the topic in question so that they can eventually make an intervention.

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Grad Coach

How To Write An A-Grade Literature Review

3 straightforward steps (with examples) + free template.

By: Derek Jansen (MBA) | Expert Reviewed By: Dr. Eunice Rautenbach | October 2019

Quality research is about building onto the existing work of others , “standing on the shoulders of giants”, as Newton put it. The literature review chapter of your dissertation, thesis or research project is where you synthesise this prior work and lay the theoretical foundation for your own research.

Long story short, this chapter is a pretty big deal, which is why you want to make sure you get it right . In this post, I’ll show you exactly how to write a literature review in three straightforward steps, so you can conquer this vital chapter (the smart way).

Overview: The Literature Review Process

  • Understanding the “ why “
  • Finding the relevant literature
  • Cataloguing and synthesising the information
  • Outlining & writing up your literature review
  • Example of a literature review

But first, the “why”…

Before we unpack how to write the literature review chapter, we’ve got to look at the why . To put it bluntly, if you don’t understand the function and purpose of the literature review process, there’s no way you can pull it off well. So, what exactly is the purpose of the literature review?

Well, there are (at least) four core functions:

  • For you to gain an understanding (and demonstrate this understanding) of where the research is at currently, what the key arguments and disagreements are.
  • For you to identify the gap(s) in the literature and then use this as justification for your own research topic.
  • To help you build a conceptual framework for empirical testing (if applicable to your research topic).
  • To inform your methodological choices and help you source tried and tested questionnaires (for interviews ) and measurement instruments (for surveys ).

Most students understand the first point but don’t give any thought to the rest. To get the most from the literature review process, you must keep all four points front of mind as you review the literature (more on this shortly), or you’ll land up with a wonky foundation.

Okay – with the why out the way, let’s move on to the how . As mentioned above, writing your literature review is a process, which I’ll break down into three steps:

  • Finding the most suitable literature
  • Understanding , distilling and organising the literature
  • Planning and writing up your literature review chapter

Importantly, you must complete steps one and two before you start writing up your chapter. I know it’s very tempting, but don’t try to kill two birds with one stone and write as you read. You’ll invariably end up wasting huge amounts of time re-writing and re-shaping, or you’ll just land up with a disjointed, hard-to-digest mess . Instead, you need to read first and distil the information, then plan and execute the writing.

Free Webinar: Literature Review 101

Step 1: Find the relevant literature

Naturally, the first step in the literature review journey is to hunt down the existing research that’s relevant to your topic. While you probably already have a decent base of this from your research proposal , you need to expand on this substantially in the dissertation or thesis itself.

Essentially, you need to be looking for any existing literature that potentially helps you answer your research question (or develop it, if that’s not yet pinned down). There are numerous ways to find relevant literature, but I’ll cover my top four tactics here. I’d suggest combining all four methods to ensure that nothing slips past you:

Method 1 – Google Scholar Scrubbing

Google’s academic search engine, Google Scholar , is a great starting point as it provides a good high-level view of the relevant journal articles for whatever keyword you throw at it. Most valuably, it tells you how many times each article has been cited, which gives you an idea of how credible (or at least, popular) it is. Some articles will be free to access, while others will require an account, which brings us to the next method.

Method 2 – University Database Scrounging

Generally, universities provide students with access to an online library, which provides access to many (but not all) of the major journals.

So, if you find an article using Google Scholar that requires paid access (which is quite likely), search for that article in your university’s database – if it’s listed there, you’ll have access. Note that, generally, the search engine capabilities of these databases are poor, so make sure you search for the exact article name, or you might not find it.

Method 3 – Journal Article Snowballing

At the end of every academic journal article, you’ll find a list of references. As with any academic writing, these references are the building blocks of the article, so if the article is relevant to your topic, there’s a good chance a portion of the referenced works will be too. Do a quick scan of the titles and see what seems relevant, then search for the relevant ones in your university’s database.

Method 4 – Dissertation Scavenging

Similar to Method 3 above, you can leverage other students’ dissertations. All you have to do is skim through literature review chapters of existing dissertations related to your topic and you’ll find a gold mine of potential literature. Usually, your university will provide you with access to previous students’ dissertations, but you can also find a much larger selection in the following databases:

  • Open Access Theses & Dissertations
  • Stanford SearchWorks

Keep in mind that dissertations and theses are not as academically sound as published, peer-reviewed journal articles (because they’re written by students, not professionals), so be sure to check the credibility of any sources you find using this method. You can do this by assessing the citation count of any given article in Google Scholar. If you need help with assessing the credibility of any article, or with finding relevant research in general, you can chat with one of our Research Specialists .

Alright – with a good base of literature firmly under your belt, it’s time to move onto the next step.

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literature review scope example

Step 2: Log, catalogue and synthesise

Once you’ve built a little treasure trove of articles, it’s time to get reading and start digesting the information – what does it all mean?

While I present steps one and two (hunting and digesting) as sequential, in reality, it’s more of a back-and-forth tango – you’ll read a little , then have an idea, spot a new citation, or a new potential variable, and then go back to searching for articles. This is perfectly natural – through the reading process, your thoughts will develop , new avenues might crop up, and directional adjustments might arise. This is, after all, one of the main purposes of the literature review process (i.e. to familiarise yourself with the current state of research in your field).

As you’re working through your treasure chest, it’s essential that you simultaneously start organising the information. There are three aspects to this:

  • Logging reference information
  • Building an organised catalogue
  • Distilling and synthesising the information

I’ll discuss each of these below:

2.1 – Log the reference information

As you read each article, you should add it to your reference management software. I usually recommend Mendeley for this purpose (see the Mendeley 101 video below), but you can use whichever software you’re comfortable with. Most importantly, make sure you load EVERY article you read into your reference manager, even if it doesn’t seem very relevant at the time.

2.2 – Build an organised catalogue

In the beginning, you might feel confident that you can remember who said what, where, and what their main arguments were. Trust me, you won’t. If you do a thorough review of the relevant literature (as you must!), you’re going to read many, many articles, and it’s simply impossible to remember who said what, when, and in what context . Also, without the bird’s eye view that a catalogue provides, you’ll miss connections between various articles, and have no view of how the research developed over time. Simply put, it’s essential to build your own catalogue of the literature.

I would suggest using Excel to build your catalogue, as it allows you to run filters, colour code and sort – all very useful when your list grows large (which it will). How you lay your spreadsheet out is up to you, but I’d suggest you have the following columns (at minimum):

  • Author, date, title – Start with three columns containing this core information. This will make it easy for you to search for titles with certain words, order research by date, or group by author.
  • Categories or keywords – You can either create multiple columns, one for each category/theme and then tick the relevant categories, or you can have one column with keywords.
  • Key arguments/points – Use this column to succinctly convey the essence of the article, the key arguments and implications thereof for your research.
  • Context – Note the socioeconomic context in which the research was undertaken. For example, US-based, respondents aged 25-35, lower- income, etc. This will be useful for making an argument about gaps in the research.
  • Methodology – Note which methodology was used and why. Also, note any issues you feel arise due to the methodology. Again, you can use this to make an argument about gaps in the research.
  • Quotations – Note down any quoteworthy lines you feel might be useful later.
  • Notes – Make notes about anything not already covered. For example, linkages to or disagreements with other theories, questions raised but unanswered, shortcomings or limitations, and so forth.

If you’d like, you can try out our free catalog template here (see screenshot below).

Excel literature review template

2.3 – Digest and synthesise

Most importantly, as you work through the literature and build your catalogue, you need to synthesise all the information in your own mind – how does it all fit together? Look for links between the various articles and try to develop a bigger picture view of the state of the research. Some important questions to ask yourself are:

  • What answers does the existing research provide to my own research questions ?
  • Which points do the researchers agree (and disagree) on?
  • How has the research developed over time?
  • Where do the gaps in the current research lie?

To help you develop a big-picture view and synthesise all the information, you might find mind mapping software such as Freemind useful. Alternatively, if you’re a fan of physical note-taking, investing in a large whiteboard might work for you.

Mind mapping is a useful way to plan your literature review.

Step 3: Outline and write it up!

Once you’re satisfied that you have digested and distilled all the relevant literature in your mind, it’s time to put pen to paper (or rather, fingers to keyboard). There are two steps here – outlining and writing:

3.1 – Draw up your outline

Having spent so much time reading, it might be tempting to just start writing up without a clear structure in mind. However, it’s critically important to decide on your structure and develop a detailed outline before you write anything. Your literature review chapter needs to present a clear, logical and an easy to follow narrative – and that requires some planning. Don’t try to wing it!

Naturally, you won’t always follow the plan to the letter, but without a detailed outline, you’re more than likely going to end up with a disjointed pile of waffle , and then you’re going to spend a far greater amount of time re-writing, hacking and patching. The adage, “measure twice, cut once” is very suitable here.

In terms of structure, the first decision you’ll have to make is whether you’ll lay out your review thematically (into themes) or chronologically (by date/period). The right choice depends on your topic, research objectives and research questions, which we discuss in this article .

Once that’s decided, you need to draw up an outline of your entire chapter in bullet point format. Try to get as detailed as possible, so that you know exactly what you’ll cover where, how each section will connect to the next, and how your entire argument will develop throughout the chapter. Also, at this stage, it’s a good idea to allocate rough word count limits for each section, so that you can identify word count problems before you’ve spent weeks or months writing!

PS – check out our free literature review chapter template…

3.2 – Get writing

With a detailed outline at your side, it’s time to start writing up (finally!). At this stage, it’s common to feel a bit of writer’s block and find yourself procrastinating under the pressure of finally having to put something on paper. To help with this, remember that the objective of the first draft is not perfection – it’s simply to get your thoughts out of your head and onto paper, after which you can refine them. The structure might change a little, the word count allocations might shift and shuffle, and you might add or remove a section – that’s all okay. Don’t worry about all this on your first draft – just get your thoughts down on paper.

start writing

Once you’ve got a full first draft (however rough it may be), step away from it for a day or two (longer if you can) and then come back at it with fresh eyes. Pay particular attention to the flow and narrative – does it fall fit together and flow from one section to another smoothly? Now’s the time to try to improve the linkage from each section to the next, tighten up the writing to be more concise, trim down word count and sand it down into a more digestible read.

Once you’ve done that, give your writing to a friend or colleague who is not a subject matter expert and ask them if they understand the overall discussion. The best way to assess this is to ask them to explain the chapter back to you. This technique will give you a strong indication of which points were clearly communicated and which weren’t. If you’re working with Grad Coach, this is a good time to have your Research Specialist review your chapter.

Finally, tighten it up and send it off to your supervisor for comment. Some might argue that you should be sending your work to your supervisor sooner than this (indeed your university might formally require this), but in my experience, supervisors are extremely short on time (and often patience), so, the more refined your chapter is, the less time they’ll waste on addressing basic issues (which you know about already) and the more time they’ll spend on valuable feedback that will increase your mark-earning potential.

Literature Review Example

In the video below, we unpack an actual literature review so that you can see how all the core components come together in reality.

Let’s Recap

In this post, we’ve covered how to research and write up a high-quality literature review chapter. Let’s do a quick recap of the key takeaways:

  • It is essential to understand the WHY of the literature review before you read or write anything. Make sure you understand the 4 core functions of the process.
  • The first step is to hunt down the relevant literature . You can do this using Google Scholar, your university database, the snowballing technique and by reviewing other dissertations and theses.
  • Next, you need to log all the articles in your reference manager , build your own catalogue of literature and synthesise all the research.
  • Following that, you need to develop a detailed outline of your entire chapter – the more detail the better. Don’t start writing without a clear outline (on paper, not in your head!)
  • Write up your first draft in rough form – don’t aim for perfection. Remember, done beats perfect.
  • Refine your second draft and get a layman’s perspective on it . Then tighten it up and submit it to your supervisor.

Literature Review Course

Psst… there’s more!

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

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Derek Jansen

You’re welcome, Yinka. Thank you for the kind words. All the best writing your literature review.

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Thank you for a very useful literature review session. Although I am doing most of the steps…it being my first masters an Mphil is a self study and one not sure you are on the right track. I have an amazing supervisor but one also knows they are super busy. So not wanting to bother on the minutae. Thank you.

You’re most welcome, Renee. Good luck with your literature review 🙂

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You’re welcome, Maithe. Good luck writing your literature review 🙂


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Mthuthuzeli Vongo

Thank you so much Derek for such useful information on writing up a good literature review. I am at a stage where I need to start writing my one. My proposal was accepted late last year but I honestly did not know where to start


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Very comprehensive and eye opener for me as beginner in postgraduate study. Well explained and easy to understand. Appreciate and good reference in guiding me in my research journey. Thank you

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Thank you. I requested to download the free literature review template, however, your website wouldn’t allow me to complete the request or complete a download. May I request that you email me the free template? Thank you.

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Writing a Literature Review

  • Getting Started

Defining the topic

Limiting the scope.

  • Finding the Literature
  • Developing a Search Strategy
  • Managing Your Research
  • Writing the Review
  • Systematic Reviews and Other Review Types
  • Useful Books
  • Useful Videos
  • Useful Links
  • Commonly Used Terms

Identifying a well-defined research question is the first step for writing a literature review. It should focus on something from the research field that needs to be explored, where there are gaps in the information. This will ensure that your contribution is valuable and that you are providing readers with a different angle or perspective on an issue or problem.

Your topic needs to be given careful consideration. A research question like “why are social networking sites harmful?” is too broad; there will be too much information to write a concise literature review. Change it to “how are online users experiencing or addressing privacy issues on Twitter and Facebook?" and it is more specific. It gives you a niche within the research field to focus on and explore.

Sometimes a broad topic can be narrowed by using one or more extra criteria, which can include:

  • population group
  • culture/ethnicity
  • theoretical framework
  • methodology (e.g., qualitative or quantitative, fieldwork/ethnography)

How you narrow the scope can be done in two broad ways, detailed in Developing a Search Strategy :

  • add more search strands using AND to give fewer results (see Combining your terms: search operators )
  • use "filters" in a database to eliminate results from outside those limits (see Using methodological search filters )
  • << Previous: Getting Started
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  • Last Updated: Oct 10, 2023 1:52 PM
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A literature review surveys prior research published in books, scholarly articles, and any other sources relevant to a particular issue, area of research, or theory, and by so doing, provides a description, summary, and critical evaluation of these works in relation to the research problem being investigated. Literature reviews are designed to provide an overview of sources you have used in researching a particular topic and to demonstrate to your readers how your research fits within existing scholarship about the topic.

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

Importance of a Good Literature Review

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

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

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

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

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

Types of Literature Reviews

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

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

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

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

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

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

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

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

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

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

Structure and Writing Style

I.  Thinking About Your Literature Review

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

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

The critical evaluation of each work should consider :

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

II.  Development of the Literature Review

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

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

III.  Ways to Organize Your Literature Review

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

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

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

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

IV.  Writing Your Literature Review

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

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

V.  Common Mistakes to Avoid

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

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

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

Writing Tip

Break Out of Your Disciplinary Box!

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

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

Another Writing Tip

Don't Just Review for Content!

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

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

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

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

Yet Another Writing Tip

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

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

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

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

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Literature reviews: Scoping and planning

  • Reviewing for research
  • Stand-alone review
  • Scoping and planning
  • Screening and appraising
  • The process of reviewing
  • Planning a search strategy

On this page:

“Organization and planning are the key factors to successfully completing a systematic review.” Boland et al., Doing a systematic review: a student's guide.

It's crucial to initially scope your review before starting. Consider whether a systematic review is necessary and whether you have the time and resources to conduct one. You need to establish whether one has been done on your topic already, or is about to be conducted. 

Scoping searches

scope icon

Once you've identified a topic area that interests you, you will need to conduct an initial scoping search . This will help identify the body of literature that has been written on the topic and identify whether systematic reviews have already been conducted in your topic area. Unfortunately it is often the case that you have your heart set on a specific topic only to find that it has already been done or that there is very limited literature available. Better to find out at this stage before you do any further work on it though!

document icon

Whilst running your scoping searches on the electronic database you will notice if a systematic review has already been conducted . Protocols of new reviews will be registered on  PROSPERO so you would also need to check there in addition to databases such as the Cochrane Library and Campbell Collaboration to establish if any have been published.

question icon

Once you have conducted these initial searches you are ready to start to formulate your own research question based on your findings. Make sure it is not too wide that there is too much literature and not too specific so that there is not enough literature.

search icon

Use your scoping searches to help formulate your search strategy by identifying different terminology, spellings, alternative terms and appropriate subject headings.

Formulating a research question

The development and refinement of the question is the most important phase. The question will determine the nature and scope of the review; will identify the key concepts to be used in your search strategy; and will guide which papers you are searching for. The question needs to be clear, well defined, appropriate, manageable and relevant to the outcomes you are seeking. As your question should be comprehensive and specific, it should only include one question and ideally have three for four elements.

There are many frameworks available to help formulate your research question such as PICO, PICOS, PICOT, SPIDER etc. One example is given below: 

P atient - the person affected by what you are researching - what are their defining characteristics and what is the condition they are experiencing?

I ntervention -   how are they being treated?

C omparison -   is there another treatment method that you would like to compare the intervention to?

O utcome -  what is the result of the intervention? These can be primary and secondary outcomes?

The breadth of your review

The breadth of the review will depend on the nature of the literature, your aims, time constraints, and pragmatics. If an undergraduate or masters student then the topic will need to be quite narrow to make it achievable. PhD students or other researchers may work with a team over a much longer period of time allowing for a much broader review to be conducted. It's useful to determine which kind of studies you wish to include in your review before starting the search and this will help with your decisions around inclusion and exclusion criteria.

The table below gives an outline of the types of studies you might come across:

Inclusion and exclusion criteria

Once you have your research question you need to consider your inclusion and exclusion criteria.

Inclusion criteria define the attributes studies must have to be included, sometimes also known as eligibility criteria.

Exclusion criteria identify which papers you want to specifically exclude from your results. These should map onto your review question and contain sufficient detail to help you screen through the results.

Create an initial list that will help you to:

  • specifically address the research question
  • ensure the quality and similarity of included studies
  • clearly define the boundaries of the review

Developing a review protocol

Now you have your question you need to write a review protocol. This will outline how you will answer your question. Every piece of quality research is guided by a research protocol.

A good protocol

  • describes the current evidence base
  • identifies the question addressed
  • outlines the methods that will be used to answer the question

It typically includes:

  • Research question

Examples of published protocols can be found on the PROSPERO site. Students doing training or mini-reviews should not register their own on this site however. Students can use the system to create and store a record by saving but not submitting.

Creating record keeping systems

It is strongly recommended that you create a record keeping system to document your decisions at different stages of the review.

Record keeping allows you to keep an up-to-date and accurate account of what you have achieved at different stages of the review.

If you need to repeat or check anything this record will save you time in the future. You can use this information to help write the Methods section of the review.

Record keeping options

There are many ways to keep records from pen and paper to saving searches and papers within a folder in the electronic databases. Keeping tables of decisions on excluded papers can help you further down the line if you need to revisit these. Keep your files in order and importantly make back-ups!

You should make a record of the details of the searches you conduct and a list of the number of studies excluded at the screening stage. Adhere to recommended reporting standards such as  PRISMA .

Reference management software

Use reference management software to help you organise, annotate and integrate the required references into your text. RefWorks or EndNote are both support by the University and can help with this.

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Cochrane Training

Chapter 2: determining the scope of the review and the questions it will address.

James Thomas, Dylan Kneale, Joanne E McKenzie, Sue E Brennan, Soumyadeep Bhaumik

Key Points:

  • Systematic reviews should address answerable questions and fill important gaps in knowledge.
  • Developing good review questions takes time, expertise and engagement with intended users of the review.
  • Cochrane Reviews can focus on broad questions, or be more narrowly defined. There are advantages and disadvantages of each.
  • Logic models are a way of documenting how interventions, particularly complex interventions, are intended to ‘work’, and can be used to refine review questions and the broader scope of the review.
  • Using priority-setting exercises, involving relevant stakeholders, and ensuring that the review takes account of issues relating to equity can be strategies for ensuring that the scope and focus of reviews address the right questions.

Cite this chapter as: Thomas J, Kneale D, McKenzie JE, Brennan SE, Bhaumik S. Chapter 2: Determining the scope of the review and the questions it will address. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Available from .

2.1 Rationale for well-formulated questions

As with any research, the first and most important decision in preparing a systematic review is to determine its focus. This is best done by clearly framing the questions the review seeks to answer. The focus of any Cochrane Review should be on questions that are important to people making decisions about health or health care. These decisions will usually need to take into account both the benefits and harms of interventions (see MECIR Box 2.1.a ). Good review questions often take time to develop, requiring engagement with not only the subject area, but with a wide group of stakeholders (Section 2.4.2 ).

Well-formulated questions will guide many aspects of the review process, including determining eligibility criteria, searching for studies, collecting data from included studies, structuring the syntheses and presenting findings (Cooper 1984, Hedges 1994, Oliver et al 2017) . In Cochrane Reviews, questions are stated broadly as review ‘Objectives’, and operationalized in terms of the studies that will be eligible to answer those questions as ‘Criteria for considering studies for this review’. As well as focusing review conduct, the contents of these sections are used by readers in their initial assessments of whether the review is likely to be directly relevant to the issues they face.

The FINER criteria have been proposed as encapsulating the issues that should be addressed when developing research questions. These state that questions should be F easible, I nteresting, N ovel, E thical, and R elevant (Cummings et al 2007). All of these criteria raise important issues for consideration at the outset of a review and should be borne in mind when questions are formulated.

A feasible review is one that asks a question that the author team is capable of addressing using the evidence available. Issues concerning the breadth of a review are discussed in Section 2.3.1 , but in terms of feasibility it is important not to ask a question that will result in retrieving unmanageable quantities of information; up-front scoping work will help authors to define sensible boundaries for their reviews. Likewise, while it can be useful to identify gaps in the evidence base, review authors and stakeholders should be aware of the possibility of asking a question that may not be answerable using the existing evidence (i.e. that will result in an ‘empty’ review, see also Section 2.5.3 ).

Embarking on a review that authors are interested in is important because reviews are a significant undertaking and review authors need sufficient commitment to see the work through to its conclusion.

A novel review will address a genuine gap in knowledge, so review authors should be aware of any related or overlapping reviews. This reduces duplication of effort, and also ensures that authors understand the wider research context to which their review will contribute. Authors should check for pre-existing syntheses in the published research literature and also for ongoing reviews in the PROSPERO register of systematic reviews before beginning their own review.

Given the opportunity cost involved in undertaking an activity as demanding as a systematic review, authors should ensure that their work is relevant by: (i) involving relevant stakeholders in defining its focus and the questions it will address; and (ii) writing up the review in such a way as to facilitate the translation of its findings to inform decisions. The GRADE framework aims to achieve this, and should be considered throughout the review process, not only when it is being written up (see Chapter 14 and Chapter 15 ).

Consideration of opportunity costs is also relevant in terms of the ethics of conducting a review, though ethical issues should also be considered primarily in terms of the questions that are prioritized for answering and the way that they are framed. Research questions are often not value-neutral, and the way that a given problem is approached can have political implications which can result in, for example, the widening of health inequalities (whether intentional or not). These issues are explored in Section 2.4.3 and Chapter 16 .

MECIR Box 2.1.a Relevant expectations for conduct of intervention reviews

2.2 Aims of reviews of interventions

Systematic reviews can address any question that can be answered by a primary research study. This Handbook focuses on a subset of all possible review questions: the impact of intervention(s) implemented within a specified human population. Even within these limits, systematic reviews examining the effects of intervention(s) can vary quite markedly in their aims. Some will focus specifically on evidence of an effect of an intervention compared with a specific alternative, whereas others may examine a range of different interventions. Reviews that examine multiple interventions and aim to identify which might be the most effective can be broader and more challenging than those looking at single interventions. These can also be the most useful for end users, where decision making involves selecting from a number of intervention options. The incorporation of network meta-analysis as a core method in this edition of the Handbook (see Chapter 11 ) reflects the growing importance of these types of reviews.

As well as looking at the balance of benefit and harm that can be attributed to a given intervention, reviews within the ambit of this Handbook might also aim to investigate the relationship between the size of an intervention effect and other characteristics, such as aspects of the population, the intervention itself, how the outcome is measured, or the methodology of the primary research studies included. Such approaches might be used to investigate which components of multi-component interventions are more or less important or essential (and when). While it is not always necessary to know how an intervention achieves its effect for it to be useful, many reviews will aim to articulate an intervention’s mechanisms of action (see Section 2.5.1 ), either by making this an explicit aim of the review itself (see Chapter 17 and Chapter 21 ), or when describing the scope of the review. Understanding how an intervention works (or is intended to work) can be an important aid to decision makers in assessing the applicability of the review to their situation. These investigations can be assisted by the incorporation of results from process evaluations conducted alongside trials (see Chapter 21 ). Further, many decisions in policy and practice are at least partially constrained by the resource available, so review authors often need to consider the economic context of interventions (see Chapter 20 ).

2.3 Defining the scope of a review question

Studies comparing healthcare interventions, notably randomized trials, use the outcomes of participants to compare the effects of different interventions. Statistical syntheses (e.g. meta-analysis) focus on comparisons of interventions, such as a new intervention versus a control intervention (which may represent conditions of usual practice or care), or the comparison of two competing interventions. Throughout the Handbook we use the terminology experimental intervention versus comparator intervention. This implies a need to identify one of the interventions as experimental, and is used only for convenience since all methods apply to both controlled and head-to-head comparisons. The contrast between the outcomes of two groups treated differently is known as the ‘effect’, the ‘treatment effect’ or the ‘intervention effect’; we generally use the last of these throughout the Handbook .

A statement of the review’s objectives should begin with a precise statement of the primary objective, ideally in a single sentence ( MECIR Box 2.3.a ). Where possible the style should be of the form ‘To assess the effects of [ intervention or comparison ] for [ health problem ] in [ types of people, disease or problem and setting if specified ]’. This might be followed by one or more secondary objectives, for example relating to different participant groups, different comparisons of interventions or different outcome measures. The detailed specification of the review question(s) requires consideration of several key components (Richardson et al 1995, Counsell 1997) which can often be encapsulated by the ‘PICO’ mnemonic, an acronym for P opulation, I ntervention, C omparison(s) and O utcome. Equal emphasis in addressing, and equal precision in defining, each PICO component is not necessary. For example, a review might concentrate on competing interventions for a particular stage of breast cancer, with stage and severity of the disease being defined very precisely; or alternately focus on a particular drug for any stage of breast cancer, with the treatment formulation being defined very precisely.

Throughout the Handbook we make a distinction between three different stages in the review at which the PICO construct might be used. This division is helpful for understanding the decisions that need to be made:

  • The review PICO (planned at the protocol stage) is the PICO on which eligibility of studies is based (what will be included and what excluded from the review).
  • The PICO for each synthesis (also planned at the protocol stage) defines the question that each specific synthesis aims to answer, determining how the synthesis will be structured, specifying planned comparisons (including intervention and comparator groups, any grouping of outcome and population subgroups).
  • The PICO of the included studies (determined at the review stage) is what was actually investigated in the included studies.

Reaching the point where it is possible to articulate the review’s objectives in the above form – the review PICO – requires time and detailed discussion between potential authors and users of the review. It is important that those involved in developing the review’s scope and questions have a good knowledge of the practical issues that the review will address as well as the research field to be synthesized. Developing the questions is a critical part of the research process. As such, there are methodological issues to bear in mind, including: how to determine which questions are most important to answer; how to engage stakeholders in question formulation; how to account for changes in focus as the review progresses; and considerations about how broad (or narrow) a review should be.

MECIR Box 2.3 . a Relevant expectations for conduct of intervention reviews

2.3.1 Broad versus narrow reviews

The questions addressed by a review may be broad or narrow in scope. For example, a review might address a broad question regarding whether antiplatelet agents in general are effective in preventing all thrombotic events in humans. Alternatively, a review might address whether a particular antiplatelet agent, such as aspirin, is effective in decreasing the risks of a particular thrombotic event, stroke, in elderly persons with a previous history of stroke. Increasingly, reviews are becoming broader, aiming, for example, to identify which intervention – out of a range of treatment options – is most effective, or to investigate how an intervention varies depending on implementation and participant characteristics.

Overviews of reviews (see  Chapter V ), in which multiple reviews are summarized, can be one way of addressing the need for breadth when synthesizing the evidence base, since they can summarize multiple reviews of different interventions for the same condition, or multiple reviews of the same intervention for different types of participants. It may be considered desirable to plan a series of reviews with a relatively narrow scope, alongside an Overview to summarize their findings. Alternatively, it may be more useful – particularly given the growth in support for network meta-analysis – to combine comparisons of different treatment options within the same review (see Chapter 11 ). When deciding whether or not an overview might be the most appropriate approach, review authors should take account of the breadth of the question being asked and the resources available. Some questions are simply too broad for a review of all relevant primary research to be practicable, and if a field has sufficient high-quality reviews, then the production of another review of primary research that duplicates the others might not be a sensible use of resources.

Some of the advantages and disadvantages of broad and narrow reviews are summarized in Table 2.3.a . While having a broad scope in terms of the range of participants has the potential to increase generalizability, the extent to which findings are ultimately applicable to broader (or different) populations will depend on the participants who have actually been recruited into research studies. Likewise, heterogeneity can be a disadvantage when the expectation is for homogeneity of effects between studies, but an advantage when the review question seeks to understand differential effects (see Chapter 10 ).A distinction should be drawn between the scope of a review and the precise questions within, since it is possible to have a broad review that addresses quite narrow questions. In the antiplatelet agents for preventing thrombotic events example, a systematic review with a broad scope might include all available treatments. Rather than combining all the studies into one comparison though, specific treatments would be compared with one another in separate comparisons, thus breaking a heterogeneous set of treatments into narrower, more homogenous groups. This relates to the three levels of PICO, outlined in Section 2.3 . The review PICO defines the broad scope of the review, and the PICO for comparison defines the specific treatments that will be compared with one another; Chapter 3 elaborates on the use of PICOs.

In practice, a Cochrane Review may start (or have started) with a broad scope, and be divided up into narrower reviews as evidence accumulates and the original review becomes unwieldy. This may be done for practical and logistical reasons, for example to make updating easier as well as to make it easier for readers to see which parts of the evidence base are changing. Individual review authors must decide if there are instances where splitting a broader focused review into a series of more narrowly focused reviews is appropriate and implement appropriate methods to achieve this. If a major change is to be undertaken, such as splitting a broad review into a series of more narrowly focused reviews, a new protocol must be written for each of the component reviews that documents the eligibility criteria for each one.

Ultimately, the selected breadth of a review depends upon multiple factors including perspectives regarding a question’s relevance and potential impact; supporting theoretical, biologic and epidemiological information; the potential generalizability and validity of answers to the questions; and available resources. As outlined in Section 2.4.2 , authors should consider carefully the needs of users of the review and the context(s) in which they expect the review to be used when determining the most optimal scope for their review.

Table 2.3.a Some advantages and disadvantages of broad versus narrow reviews

2.3.2 ‘Lumping’ versus ‘splitting’

It is important not to confuse the issue of the breadth of the review (determined by the review PICO) with concerns about between-study heterogeneity and the legitimacy of combining results from diverse studies in the same analysis (determined by the PICOs for comparison).

Broad reviews have been criticized as ‘mixing apples and oranges’, and one of the inventors of meta-analysis, Gene Glass, has responded “Of course it mixes apples and oranges… comparing apples and oranges is the only endeavour worthy of true scientists; comparing apples to apples is trivial” (Glass 2015). In fact, the two concepts (‘broad reviews’ and ‘mixing apples and oranges’) are different issues. Glass argues that broad reviews, with diverse studies, provide the opportunity to ask interesting questions about the reasons for differential intervention effects.

The ‘apples and oranges’ critique refers to the inappropriate mixing of studies within a single comparison, where the purpose is to estimate an average effect. In situations where good biologic or sociological evidence suggests that various formulations of an intervention behave very differently or that various definitions of the condition of interest are associated with markedly different effects of the intervention, the uncritical aggregation of results from quite different interventions or populations/settings may well be questionable.

Unfortunately, determining the situations where studies are similar enough to combine with one another is not always straightforward, and it can depend, to some extent, on the question being asked. While the decision is sometimes characterized as ‘lumping’ (where studies are combined in the same analysis) or ‘splitting’ (where they are not) (Squires et al 2013), it is better to consider these issues on a continuum, with reviews that have greater variation in the types of included interventions, settings and populations, and study designs being towards the ‘lumped’ end, and those that include little variation in these elements being towards the ‘split’ end (Petticrew and Roberts 2006).

While specification of the review PICO sets the boundary for the inclusion and exclusion of studies, decisions also need to be made when planning the PICO for the comparisons to be made in the analysis as to whether they aim to address broader (‘lumped’) or narrower (‘split’) questions (Caldwell and Welton 2016). The degree of ‘lumping’ in the comparisons will be primarily driven by the review’s objectives, but will sometimes be dictated by the availability of studies (and data) for a particular comparison (see Chapter 9 for discussion of the latter). The former is illustrated by a Cochrane Review that examined the effects of newer-generation antidepressants for depressive disorders in children and adolescents (Hetrick et al 2012).

Newer-generation antidepressants include multiple different compounds (e.g. paroxetine, fluoxetine). The objectives of this review were to (i) estimate the overall effect of newer-generation antidepressants on depression, (ii) estimate the effect of each compound, and (iii) examine whether the compound type and age of the participants (children versus adolescents) is associated with the intervention effect. Objective (i) addresses a broad, ‘in principle’ (Caldwell and Welton 2016), question of whether newer-generation antidepressants improve depression, where the different compounds are ‘lumped’ into a single comparison. Objective (ii) seeks to address narrower, ‘split’, questions that investigate the effect of each compound on depression separately. Answers to both questions can be identified by setting up separate comparisons for each compound, or by subgrouping the ‘lumped’ comparison by compound ( Chapter 10, Section 10.11.2 ). Objective (iii) seeks to explore factors that explain heterogeneity among the intervention effects, or equivalently, whether the intervention effect varies by the factor. This can be examined using subgroup analysis or meta-regression ( Chapter 10, Section 10.11 ) but, in the case of intervention types, is best achieved using network meta-analysis (see Chapter 11 ).

There are various advantages and disadvantages to bear in mind when defining the PICO for the comparison and considering whether ‘lumping’ or ‘splitting’ is appropriate. Lumping allows for the investigation of factors that may explain heterogeneity. Results from these investigations may provide important leads as to whether an intervention operates differently in, for example, different populations (such as in children and adolescents in the example above). Ultimately, this type of knowledge is useful for clinical decision making. However, lumping is likely to introduce heterogeneity, which will not always be explained by a priori specified factors, and this may lead to a combined effect that is clinically difficult to interpret and implement. For example, when multiple intervention types are ‘lumped’ in one comparison (as in objective (i) above), and there is unexplained heterogeneity, the combined intervention effect would not enable a clinical decision as to which intervention should be selected. Splitting comparisons carries its own risk of there being too few studies to yield a useful synthesis. Inevitably, some degree of aggregation across the PICO elements is required for a meta-analysis to be undertaken (Caldwell and Welton 2016).

2.4 Ensuring the review addresses the right questions

Since systematic reviews are intended for use in healthcare decision making, review teams should ensure not only the application of robust methodology, but also that the review question is meaningful for healthcare decision making. Two approaches are discussed below:

  • Using results from existing research priority-setting exercises to define the review question.
  • In the absence of, or in addition to, existing research priority-setting exercises, engaging with stakeholders to define review questions and establish their relevance to policy and practice.

2.4.1 Using priority-setting exercises to define review questions

A research priority-setting exercise is a “collective activity for deciding which uncertainties are most worth trying to resolve through research; uncertainties considered may be problems to be understood or solutions to be developed or tested; across broad or narrow areas” (Sandy Oliver, referenced in Nasser 2018). Using research priority-setting exercises to define the scope of a review helps to prevent the waste of scarce resources for research by making the review more relevant to stakeholders (Chalmers et al 2014).

Research priority setting is always conducted in a specific context, setting and population with specific principles, values and preferences (which should be articulated). Different stakeholders’ interpretation of the scope and purpose of a ‘research question’ might vary, resulting in priorities that might be difficult to interpret. Researchers or review teams might find it necessary to translate the research priorities into an answerable PICO research question format, and may find it useful to recheck the question with the stakeholder groups to determine whether they have accurately reflected their intentions.

While Cochrane Review teams are in most cases reviewing the effects of an intervention with a global scope, they may find that the priorities identified by important stakeholders (such as the World Health Organization or other organizations or individuals in a representative health system) are informative in planning the review. Review authors may find that differences between different stakeholder groups’ views on priorities and the reasons for these differences can help them to define the scope of the review. This is particularly important for making decisions about excluding specific populations or settings, or being inclusive and potentially conducting subgroup analyses.

Whenever feasible, systematic reviews should be based on priorities identified by key stakeholders such as decision makers, patients/public, and practitioners. Cochrane has developed a list of priorities for reviews in consultation with key stakeholders, which is available on the Cochrane website. Issues relating to equity (see Chapter 16 and Section 2.4.3 ) need to be taken into account when conducting and interpreting the results from priority-setting exercises. Examples of materials to support these processes are available (Viergever et al 2010, Nasser et al 2013, Tong et al 2017).

The results of research priority-setting exercises can be searched for in electronic databases and via websites of relevant organizations. Examples are: James Lind Alliance , World Health Organization, organizations of health professionals including research disciplines, and ministries of health in different countries (Viergever 2010). Examples of search strategies for identifying research priority-setting exercises are available (Bryant et al 2014, Tong et al 2015).

Other sources of questions are often found in ‘implications for future research’ sections of articles in journals and clinical practice guidelines. Some guideline developers have prioritized questions identified through the guideline development process (Sharma et al 2018), although these priorities will be influenced by the needs of health systems in which different guideline development teams are working.

2.4.2 Engaging stakeholders to help define the review questions

In the absence of a relevant research priority-setting exercise, or when a systematic review is being conducted for a very specific purpose (for example, commissioned to inform the development of a guideline), researchers should work with relevant stakeholders to define the review question. This practice is especially important when developing review questions for studying the effectiveness of health systems and policies, because of the variability between countries and regions; the significance of these differences may only become apparent through discussion with the stakeholders.

The stakeholders for a review could include consumers or patients, carers, health professionals of different kinds, policy decision makers and others ( Chapter 1, Section 1.3.1 ). Identifying the stakeholders who are critical to a particular question will depend on the question, who the answer is likely to affect, and who will be expected to implement the intervention if it is found to be effective (or to discontinue it if not).

Stakeholder engagement should, optimally, be an ongoing process throughout the life of the systematic review, from defining the question to dissemination of results (Keown et al 2008). Engaging stakeholders increases relevance, promotes mutual learning, improves uptake and decreases research waste (see Chapter 1, Section 1.3.1 and Section 1.3.2 ). However, because such engagement can be challenging and resource intensive, a one-off engagement process to define the review question might only be possible. Review questions that are conceptualized and refined by multiple stakeholders can capture much of the complexity that should be addressed in a systematic review.

2.4.3 Considering issues relating to equity when defining review questions

Deciding what should be investigated, who the participants should be, and how the analysis will be carried out can be considered political activities, with the potential for increasing or decreasing inequalities in health. For example, we now know that well-intended interventions can actually widen inequalities in health outcomes since researchers have chosen to investigate this issue (Lorenc et al 2013). Decision makers can now take account of this knowledge when planning service provision. Authors should therefore consider the potential impact on disadvantaged groups of the intervention(s) that they are investigating on disadvantaged groups, and whether socio-economic inequalities in health might be affected depending on whether or how they are implemented.

Health equity is the absence of avoidable and unfair differences in health (Whitehead 1992). Health inequity may be experienced across characteristics defined by PROGRESS-Plus (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socio-economic status, Social capital, and other characteristics (‘Plus’) such as sexual orientation, age, and disability) (O’Neill et al 2014). Issues relating to health equity should be considered when review questions are developed ( MECIR Box 2.4.a ). Chapter 16 presents detailed guidance on this issue for review authors.

MECIR Box 2.4 . a Relevant expectations for conduct of intervention reviews

2.5 Methods and tools for structuring the review

It is important for authors to develop the scope of their review with care: without a clear understanding of where the review will contribute to existing knowledge – and how it will be used – it may be at risk of conceptual incoherence. It may mis-specify critical elements of how the intervention(s) interact with the context(s) within which they operate to produce specific outcomes, and become either irrelevant or possibly misleading. For example, in a systematic review about smoking cessation interventions in pregnancy, it was essential for authors to take account of the way that health service provision has changed over time. The type and intensity of ‘usual care’ in more recent evaluations was equivalent to the interventions being evaluated in older studies, and the analysis needed to take this into account. This review also found that the same intervention can have different effects in different settings depending on whether its materials are culturally appropriate in each context (Chamberlain et al 2017).

In order to protect the review against conceptual incoherence and irrelevance, review authors need to spend time at the outset developing definitions for key concepts and ensuring that they are clear about the prior assumptions on which the review depends. These prior assumptions include, for example, why particular populations should be considered inside or outside the review’s scope; how the intervention is thought to achieve its effect; and why specific outcomes are selected for evaluation. Being clear about these prior assumptions also requires review authors to consider the evidential basis for these assumptions and decide for themselves which they can place more or less reliance on. When considered as a whole, this initial conceptual and definitional work states the review’s conceptual framework . Each element of the review’s PICO raises its own definitional challenges, which are discussed in detail in the Chapter 3 .

In this section we consider tools that may help to define the scope of the review and the relationships between its key concepts; in particular, articulating how the intervention gives rise to the outcomes selected. In some situations, long sequences of events are expected to occur between an intervention being implemented and an outcome being observed. For example, a systematic review examining the effects of asthma education interventions in schools on children’s health and well-being needed to consider: the interplay between core intervention components and their introduction into differing school environments; different child-level effect modifiers; how the intervention then had an impact on the knowledge of the child (and their family); the child’s self-efficacy and adherence to their treatment regime; the severity of their asthma; the number of days of restricted activity; how this affected their attendance at school; and finally, the distal outcomes of education attainment and indicators of child health and well-being (Kneale et al 2015).

Several specific tools can help authors to consider issues raised when defining review questions and planning their review; these are also helpful when developing eligibility criteria and classifying included studies. These include the following.

  • Taxonomies: hierarchical structures that can be used to categorize (or group) related interventions, outcomes or populations.
  • Generic frameworks for examining and structuring the description of intervention characteristics (e.g. TIDieR for the description of interventions (Hoffmann et al 2014), iCAT_SR for describing multiple aspects of complexity in systematic reviews (Lewin et al 2017)).
  • Core outcome sets for identifying and defining agreed outcomes that should be measured for specific health conditions (described in more detail in Chapter 3 ).

Unlike these tools, which focus on particular aspects of a review, logic models provide a framework for planning and guiding synthesis at the review level (see Section 2.5.1 ).

2.5.1 Logic models

Logic models (sometimes referred to as conceptual frameworks or theories of change) are graphical representations of theories about how interventions work. They depict intervention components, mechanisms (pathways of action), outputs, and outcomes as sequential (although not necessarily linear) chains of events. Among systematic review authors, they were originally proposed as a useful tool when working with evaluations of complex social and population health programmes and interventions, to conceptualize the pathways through which interventions are intended to change outcomes (Anderson et al 2011).

In reviews where intervention complexity is a key consideration (see Chapter 17 ), logic models can be particularly helpful. For example, in a review of psychosocial group interventions for those with HIV, a logic model was used to show how the intervention might work (van der Heijden et al 2017). The review authors depicted proximal outcomes, such as self-esteem, but chose only to include psychological health outcomes in their review. In contrast, Bailey and colleagues included proximal outcomes in their review of computer-based interventions for sexual health promotion using a logic model to show how outcomes were grouped (Bailey et al 2010). Finally, in a review of slum upgrading, a logic model showed the broad range of interventions and their interlinkages with health and socio-economic outcomes (Turley et al 2013), and enabled the review authors to select a specific intervention category (physical upgrading) on which to focus the review. Further resources provide further examples of logic models, and can help review authors develop and use logic models (Anderson et al 2011, Baxter et al 2014, Kneale et al 2015, Pfadenhauer et al 2017, Rohwer et al 2017).

Logic models can vary in their emphasis, with a distinction sometimes made between system-based and process-oriented logic models (Rehfuess et al 2018). System-based logic models have particular value in examining the complexity of the system (e.g. the geographical, epidemiological, political, socio-cultural and socio-economic features of a system), and the interactions between contextual features, participants and the intervention (see Chapter 17 ). Process-oriented logic models aim to capture the complexity of causal pathways by which the intervention leads to outcomes, and any factors that may modify intervention effects. However, this is not a crisp distinction; the two types are interrelated; with some logic models depicting elements of both systems and process models simultaneously.

The way that logic models can be represented diagrammatically (see Chapter 17 for an example) provides a valuable visual summary for readers and can be a communication tool for decision makers and practitioners. They can aid initially in the development of a shared understanding between different stakeholders of the scope of the review and its PICO, helping to support decisions taken throughout the review process, from developing the research question and setting the review parameters, to structuring and interpreting the results. They can be used in planning the PICO elements of a review as well as for determining how the synthesis will be structured (i.e. planned comparisons, including intervention and comparator groups, and any grouping of outcome and population subgroups). These models may help review authors specify the link between the intervention, proximal and distal outcomes, and mediating factors. In other words, they depict the intervention theory underpinning the synthesis plan.

Anderson and colleagues note the main value of logic models in systematic review as (Anderson et al 2011):

  • refining review questions;
  • deciding on ‘lumping’ or ‘splitting’ a review topic;
  • identifying intervention components;
  • defining and conducting the review;
  • identifying relevant study eligibility criteria;
  • guiding the literature search strategy;
  • explaining the rationale behind surrogate outcomes used in the review;
  • justifying the need for subgroup analyses (e.g. age, sex/gender, socio-economic status);
  • making the review relevant to policy and practice;
  • structuring the reporting of results;
  • illustrating how harms and feasibility are connected with interventions; and
  • interpreting results based on intervention theory and systems thinking (see Chapter 17 ).

Logic models can be useful in systematic reviews when considering whether failure to find a beneficial effect of an intervention is due to a theory failure, an implementation failure, or both (see Chapter 17 and Cargo et al 2018). Making a distinction between implementation and intervention theory can help to determine whether and how the intervention interacts with (and potentially changes) its context (see Chapter 3 and Chapter 17 for further discussion of context). This helps to elucidate situations in which variations in how the intervention is implemented have the potential to affect the integrity of the intervention and intended outcomes.

Given their potential value in conceptualizing and structuring a review, logic models are increasingly published in review protocols. Logic models may be specified a priori and remain unchanged throughout the review; it might be expected, however, that the findings of reviews produce evidence and new understandings that could be used to update the logic model in some way (Kneale et al 2015). Some reviews take a more staged approach, pre-specifying points in the review process where the model may be revised on the basis of (new) evidence (Rehfuess et al 2018) and a staged logic model can provide an efficient way to report revisions to the synthesis plan. For example, in a review of portion, package and tableware size for changing selection or consumption of food and other products, the authors presented a logic model that clearly showed changes to their original synthesis plan (Hollands et al 2015).

It is preferable to seek out existing logic models for the intervention and revise or adapt these models in line with the review focus, although this may not always be possible. More commonly, new models are developed starting with the identification of outcomes and theorizing the necessary pre-conditions to reach those outcomes. This process of theorizing and identifying the steps and necessary pre-conditions continues, working backwards from the intended outcomes, until the intervention itself is represented. As many mechanisms of action are invisible and can only be ‘known’ through theory, this process is invaluable in exposing assumptions as to how interventions are thought to work; assumptions that might then be tested in the review. Logic models can be developed with stakeholders (see Section 2.5.2 ) and it is considered good practice to obtain stakeholder input in their development.

Logic models are representations of how interventions are intended to ‘work’, but they can also provide a useful basis for thinking through the unintended consequences of interventions and identifying potential adverse effects that may need to be captured in the review (Bonell et al 2015). While logic models provide a guiding theory of how interventions are intended to work, critiques exist around their use, including their potential to oversimplify complex intervention processes (Rohwer et al 2017). Here, contributions from different stakeholders to the development of a logic model may be able to articulate where complex processes may occur; theorizing unintended intervention impacts; and the explicit representation of ambiguity within certain parts of the causal chain where new theory/explanation is most valuable.

2.5.2 Changing review questions

While questions should be posed in the protocol before initiating the full review, these questions should not prevent exploration of unexpected issues. Reviews are analyses of existing data that are constrained by previously chosen study populations, settings, intervention formulations, outcome measures and study designs. It is generally not possible to formulate an answerable question for a review without knowing some of the studies relevant to the question, and it may become clear that the questions a review addresses need to be modified in light of evidence accumulated in the process of conducting the review.

Although a certain fluidity and refinement of questions is to be expected in reviews as a fuller understanding of the evidence is gained, it is important to guard against bias in modifying questions. Data-driven questions can generate false conclusions based on spurious results. Any changes to the protocol that result from revising the question for the review should be documented at the beginning of the Methods section. Sensitivity analyses may be used to assess the impact of changes on the review findings (see Chapter 10, Section 10.14 ). When refining questions it is useful to ask the following questions.

  • What is the motivation for the refinement?
  • Could the refinement have been influenced by results from any of the included studies?
  • Does the refined question require a modification to the search strategy and/or reassessment of any decisions regarding study eligibility?
  • Are data collection methods appropriate to the refined question?
  • Does the refined question still meet the FINER criteria discussed in Section 2.1 ?

2.5.3 Building in contingencies to deal with sparse data

The ability to address the review questions will depend on the maturity and validity of the evidence base. When few studies are identified, there will be limited opportunity to address the question through an informative synthesis. In anticipation of this scenario, review authors may build contingencies into their protocol analysis plan that specify grouping (any or multiple) PICO elements at a broader level; thus potentially enabling synthesis of a larger number of studies. Broader groupings will generally address a less specific question, for example:

  • ‘the effect of any antioxidant supplement on …’ instead of ‘the effect of vitamin C on …’;
  • ‘the effect of sexual health promotion on biological outcomes ’ instead of ‘the effect of sexual health promotion on sexually transmitted infections ’; or
  • ‘the effect of cognitive behavioural therapy in children and adolescents on …’ instead of ‘the effect of cognitive behavioural therapy in children on …’.

However, such broader questions may be useful for identifying important leads in areas that lack effective interventions and for guiding future research. Changes in the grouping may affect the assessment of the certainty of the evidence (see Chapter 14 ).

2.5.4 Economic data

Decision makers need to consider the economic aspects of an intervention, such as whether its adoption will lead to a more efficient use of resources. Economic data such as resource use, costs or cost-effectiveness (or a combination of these) may therefore be included as outcomes in a review. It is useful to break down measures of resource use and costs to the level of specific items or categories. It is helpful to consider an international perspective in the discussion of costs. Economics issues are discussed in detail in Chapter 20 .

2.6 Chapter information

Authors: James Thomas, Dylan Kneale, Joanne E McKenzie, Sue E Brennan, Soumyadeep Bhaumik

Acknowledgements: This chapter builds on earlier versions of the Handbook . Mona Nasser, Dan Fox and Sally Crowe contributed to Section 2.4 ; Hilary J Thomson contributed to Section 2.5.1 .

Funding: JT and DK are supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust. JEM is supported by an Australian National Health and Medical Research Council (NHMRC) Career Development Fellowship (1143429). SEB’s position is supported by the NHMRC Cochrane Collaboration Funding Program. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or the NHMRC.

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Virtual and augmented reality to develop empathy: a systematic literature review

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Recent research suggests that Virtual Reality (VR) and Augmented Reality (AR) as immersive technologies are effective in developing empathy. The main reason behind this assumption is that immersive technologies allow people to experience perspective-taking. However, there is a lack of systematic literature reviews that summarize the current state of research on VR and AR to elicit empathy. This paper reports a systematic literature review of 37 academic papers published between 2007 and 2023. The following categories were analyzed in this review: field of education, data collection instruments, sample size, statistically significant results, technologies used, research design, advantages, limitations, and future research. The main findings of this review provide an overview of the current state of research on immersive technologies to elicit empathy and the future challenges in this field. Some of the main findings involve: VR/AR immersion devices are effective and appealing to participants; the Interpersonal Reactivity Index was found to be the most relevant self-report measure; and larger sample sizes (over 100 participants) are vital in VR/AR-based empathy research to provide a quantitative perspective on participants distribution.

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1 Introduction

The rise of disruptive technologies has redefined patterns of social interaction, showcasing an adaptation in the ways individuals engage with one another. Virtual reality (VR) is a collection of hardware, including computers, head-mounted displays (HMD), and sensors, designed to experience telepresence [ 1 ]. Moreover, VR is also considered a computer system that enables users to create artificial environments in which they can interact, navigate, and immerse themselves in a three-dimensional space [ 2 ]. Augmented Reality (AR) is a technology that allows a real-time combination of virtual objects and real objects so that it seems that the virtual objects are part of the real world [ 3 ]. The main difference between VR and AR is that in VR the participant is completely immersed in a computer-generated visual environment and everything that the participant sees is artificial while in AR the participant sees the real world with some virtual objects superimposed that seem to co-exist in the real world.

VR and AR have emerged as cutting-edge tools that allow users to immerse themselves in simulated environments and experience sensory sensations that simulate real life. Considering this, VR and AR often refers to “enhanced user interfaces.” This encompasses viewing and navigating a 3D environment and interacting with its components in real time. For these creators, the user’s interactive experience in the real world can be received through stimulation of the five human senses (sight, hearing, touch, taste, and smell). In the same line of thought, VR and AR can be an enhancer of prosocial behaviors through empathy, using tools intertwined with current technological developments. In other words, VR enables immersion in a simulated environment like real life, and through interaction with this sensory environment, it can strengthen communication and understanding of others’ perspectives [ 4 ]. In that regard, VR has been considered a medium for perspective-taking [ 5 ]. It allows users of this technology to directly experience feelings and perspectives in a controlled and safe environment. Thus, VR can be understood as a set of computer technologies that provide access to simulated spaces through visual devices, where a person can acquire the sensation of presence, interact within that space and be in the shoes of others.

AR and VR can be used in different contexts for creating empathy and pro-social behaviors [ 6 , 7 ]. From an etymological perspective, empathy can be understood from its Greek root Παθεûv (epathón, to feel) and the prefix εv (an inseparable preposition meaning within). The origin of the term empathy dates back to 1873 when the philosopher Robert Vischer used the German term “Einfühlung” (feeling into) as an expression in art appreciation. Later, the term was used in English in the book “Lectures on the Experimental Psychology of the Thought-processes” in 1909, with a meaning of “feeling oneself into the other, being interpenetrated” [ 8 , p.1].

Empathy can be initially defined as the emotional communication between one person and another, responding assertively within their social environment. Empathy is the ability to identify one’s own emotions and those of others and respond to them constructively [ 9 , p.40]. In other words, the development of these skills not only influences personal well-being but also has a significant impact on various areas of individual adjustment. In simpler terms, it can be understood as the process by which an individual has the ability to understand the feelings of others, allowing them to perceive reality from the other person’s perspective rather than their own. Empathy is usually divided into emotional empathy and cognitive empathy [ 10 ]. One the one hand, emotional empathy means that the person is emotionally moved by a situation. On the other hand, cognitive empathy involves understanding thoughts and the emotion of others and this has been regarded as perspective taking.

It is worth mentioning that applications of VR and AR to develop empathy, while diverse and booming in various fields of study, lack extensive systematic research that reviews data from multiple individual studies to determine a general estimation of the effects of interventions, scope, limitations, variables of interest, and to assess the consistency and variability of results among individual studies. Therefore, it is of methodological importance to conduct a systematic review of current technological trends in various areas and fields of research where VR has been used as a medium for empathy development.

In alignment with this perspective, the present systematic review seeks to comprehensively address 11 research inquiries aimed at elucidating the correlation between exposure to immersive experiences in virtual reality (VR) or augmented reality (AR) and the cultivation of empathy. These 11 research questions have been categorized into four dimensions for the sake of facilitating understanding, organization, and presentation of information. The ensuing research questions steer the course of this review:

Application-domain related research questions

The primary objective of these inquiries is to delineate how AR and VR have been employed to foster empathy across diverse professional domains and to ascertain the prevalence of significant findings in related studies. The relevance of these research questions lies in their capacity to enable researchers to pinpoint specific professional fields wherein AR/VR could potentially be applied to nurture empathy. Additionally, they aid in identifying research lacunae within various professional domains. The consequential significance of results in these studies provides valuable insights for researchers to recognize potential benefits conferred by these immersive technologies.

What are the professional fields of study where virtual reality or augmented reality have been used to promote empathy?

How many studies have reported statistically significant effectiveness percentages in research utilizing virtual reality or augmented reality to foster empathy?

Research questions about methodological aspects

the objective of this set of research questions is to elucidate the methodological intricacies employed in studies investigating the promotion of empathy through AR and VR. The significance of these research questions lies in their capacity to provide insights into the methodologies utilized within the field. This comprehension is instrumental in evaluating the robustness and reliability of findings, fostering a deeper understanding of the research landscape in this domain.

What data collection instruments have been most used in studies utilizing virtual reality or augmented reality to foster empathy?

How many participants or research sample have been used most frequently in studies where virtual reality or augmented reality has been used to foster empathy?

What research design has been predominantly employed in studies where virtual reality or augmented reality has been used to foster empathy?

What percentage of studies have been reported as scientific articles versus conference papers?

Advantages, limitations and future research directions

this set of research queries seeks to elucidate the merits, constraints, and prospective avenues for further investigation as documented in the literature pertaining to the application of AR and VR in empathy development. These inquiries hold significance as their responses encapsulate a concise overview of primary discoveries within the field, the principal constraints and challenges encountered, and the potential avenues for future research endeavors. Exploring these research questions contributes to a comprehensive understanding of the current state of knowledge, facilitating informed discussions on the advancements, challenges, and potential future directions in the domain of AR and VR’s impact on empathy.

What advantages have been described in studies where virtual reality or augmented reality has been used to foster empathy?

What limitations have been reported in studies where virtual reality or augmented reality has been used to foster empathy?

What have been the most frequent recommendations for future research in studies utilizing virtual reality or augmented reality to foster empathy?

Technology-related research questions

this set of questions seeks to ascertain the specific technological hardware and software utilized in studies focused on the utilization of AR and VR in empathy development. The intent behind these questions is to discern the capabilities of particular devices and explore potential avenues for further enhancement, aligning with the imperative for increased research in this domain emphasized by Ventura et al. [ 11 ].

What equipment or technological tools have been used for immersion in virtual or augmented reality in the analyzed studies?

Which software has been used to develop immersive environments in research studies where virtual reality or augmented reality has been used to foster empathy?

In essence, the research team has formulated this set of research questions with the aim of delineating the research landscape concerning empathy development through AR and VR applications. From our standpoint, these research questions serve the purpose of offering a comprehensive survey of studies within this domain, enabling fellow researchers to pinpoint existing gaps in the literature and identify potential avenues for further research.

The rest of this paper is organized as follows: Section 2 describes the related work; Section 3 describes the method followed to conduct the systematic literature review. Section 4 presents the results organized by each research question. Section 5 presents the risk of bias analysis. Section 6 discuss the results obtained in this review. Section 7 describes the limitations of this review. Finally, Section 8 describes the implications of this review for education and training and Section 9 presents the conclusions of this study.

2 Related work

There is a large and growing body of literature that has demonstrated that VR can be effectively utilized as a tool for the development of social and emotional skills, such as empathy. In this context, various studies have investigated the viability of virtual reality in enhancing empathy in individuals. In this section, we present a summary of similar systematic reviews and meta-analysis on VR and empathy and we show how our systematic review extend previous studies in the field and how the systematic review fills a gap in the literature. Table 1 shows a summary of previous studies in the field.

Overall, previous systematic reviews, surveys and meta-analysis on VR and empathy have shown an overview of how VR has been used to create empathy and how some associated factors such as prejudice and intergroup bias might mediate or moderate the influence of VR on empathy. However, the systematic review presented in this article extend previous reviews by updating the research up to 2023 and addressing research questions that have not been addressed in previous reviews. The systematic review presented in this paper holds significant importance in the academic domain as its primary objective is to address aspects that have not been thoroughly explored in other systematic reviews, surveys or meta-analysis such as the ones reported in [ 11 , 12 , 13 ]. Particularly, by providing detailed information, it establishes a solid foundation for future investigations, facilitating the path for researchers who seek to consult tools and technologies utilized within the study’s context, as well as identifying statistically significant impacts on empathy. Moreover, a rigorous examination of limitations encountered in previous research is proposed to establish a critical and reflective framework concerning the current frontiers of knowledge in the field. Considering the above, this systematic literature review contributes to the body of knowledge in the field of VR and AR to develop empathy and is a valuable resource to guide and suggest future research, offering clear and well-founded recommendations that will contribute to the advancement of this field.

The main contribution of this paper is that it summarizes previous research done on the use of VR and AR to develop empathy. This literature review updates previous literature reviews and surveys on VR to develop empathy and, to the best of our knowledge, is the first literature review that also summarizes research on AR to develop empathy.

Following the guidelines outlined by Botella and Zamora [ 22 ], a systematic literature review is structured as follows:

Problem Formulation

Study Search

Study Coding

Analysis and Interpretation


Figure 1 depicts the PRISMA flow diagram. This diagram was generated based on the PRISMA 2020 statement [ 23 ]. It depicts the process of study identification and selection for the current systematic review. First, a total of 738 records were found after conducting the search. By excluding those published prior to 2007, those written in a language different to English or Spanish, and those different to articles, conference papers or book chapters, the dataset resulted in 636 records. Following the screening process, 58 records were excluded as the key terms (empathy and AR/VR) were merely mentioned in the paper but did not constitute the primary focus. Instances included references to AR and VR technologies without the main topic centering on empathy, or the co-occurrence of empathy, AR, and VR terms without the primary objective of fostering empathy through these technologies. Consequently, 578 records underwent evaluation for eligibility. During this phase, the authors meticulously reviewed the abstracts of each document to confirm its relevance to the designated topic. If the abstract did not provide sufficient clarity regarding the study’s suitability, a comprehensive examination of the full text was undertaken to determine inclusion in the review. Ultimately, 37 studies met the criteria for inclusion. The authors then scrutinized the full text of these 37 articles to extract pertinent information and address the research questions.

figure 1

PRISMA flowchart and selection of bibliographic material

It should be noted that the three authors of this article were in charge of collecting the articles (identification phase in Fig. 1 ) and the screening process. Then, two of the authors coded the selected articles through a matrix where all the inclusion and exclusion criteria were established. Then the third author also validated the coding process.

Taking into account the aforementioned aspects and the model proposed by Botella and Zamora [ 22 ], the impact of VR and AR to develop empathy was addressed through a systematic literature review of 37 articles retrieved from SCOPUS, using the search string ( TITLE-ABS-KEY ( “virtual reality” ) OR TITLE-ABS-KEY ( “augmented reality” ) ) AND TITLE-ABS-KEY ( “empathy” ). Scopus was selected as the primary database for retrieving studies because it is one of the largest abstracts and citation databases with a high quality of indexed publications. In this systematic review, we did not consider other databases because we had restrictions in accessing other databases such as Web of Science. Other databases such as APA PsycArticles were not included because the pilot searches did not retrieve relevant results for the scope of this systematic review.

In this review, we did not include any other term related to empathy because in the pilot searches before conducting the final search the inclusion of other terms such as prejudice, intergroup, perspective-taking among others restricted the number of results obtained and the results overlapped other existing systematic reviews. In that regard, we decided to maintain a more general search string to collect articles on the topic of VR and AR to develop empathy. In this way, we are able to provide a more general landscape of research instead of a more focused review that might overlap previous reviews.

The inclusion criteria considered in the systematic review were as follows:

Studies conducted between 2007 and 2023. The timeframe was selected and studies before 2007 were not included because the pilot searches conducted prior to the main search for this systematic review showed that the articles before 2007 provided important background and foundations on the use of VR to develop empathy but did not provide insights into the effect of VR to develop empathy due to the maturity of VR before 2007.

Research about the use of virtual reality and/or augmented reality to develop empathy.

Studies written in English or Spanish.

Journal papers, conference papers and book chapters.

Exclusion criteria was:

Studies in languages other than English and Spanish, studies prior to 2007.

Other systematic reviews (these were reported in the related work of this paper), and those that did not involve virtual reality and/or augmented reality as technologies for fostering empathy.

Book reviews, notes, erratum, editorials, letters to the editor, doctoral theses, master’s dissertations, and other non-scientific documents.

The 37 articles were thoroughly read and analyzed by two of the authors and each article was coded according to the categories defined by the researchers to consolidate and answer the research questions. The categories emerged from the research questions. Table 2 shows the 11 research questions grouped into the four dimensions (as presented in the introduction) and each research question has the category that was used to code each study.

Once the analysis categories were defined, they were coded into two groups based on their unit of measurement. On one hand, categories that could be numerically evaluated were included, organizing them into subcategories and tallying the number of identified studies and their respective percentages. This process was carried out using software such as Excel and JASP. On the other hand, categories with nominal characteristics that required interpretation were considered as the second group for coding, thus providing answers to the research questions. It is important to note that the coding matrix design and article consolidation were conducted by two researchers and validated by a third party.

This section in the systematic literature review answers the research questions previously formulated. Through a detailed analysis of the existing scientific literature, relevant data has been collected and subsequently encoded according to the categories defined to be presented in the form of tables and structured subcategories with corresponding percentages. These tools allowed for a clear and comparative visualization of the results, facilitating the understanding of the patterns and trends identified in the research. The percentage analysis provides a deeper understanding of the data distribution and enables significant conclusions to be drawn regarding the research questions. This was achieved by dividing the frequency of each subcategory by the total number of subcategories mentioned and multiplying by 100 to obtain the percentage value. The following sub-section presents the results in detail, offering a comprehensive and rigorous overview of the collected data organized for each research question.

4.1 Application-domain related research questions

4.1.1 what are the professional fields of study where virtual reality or augmented reality have been used to promote empathy.

Table 3 describes the areas where studies on virtual and/or augmented reality have been reported, along with their respective nominal quantity of studies and percentages.

The analysis examined the different areas in which virtual or augmented reality has been used to promote empathy. The results revealed that research has been conducted in fields such as Experimental Psychology, Medicine, Education, Organizational Psychology, Social Psychology, Art, Marketing, and Neuroscience. When looking at the percentages, it was observed that most of the studies focused on Education (29.73%), followed by Experimental psychology (24,32%), and Medicine (16.22%).

4.1.2 How many studies have reported statistically significant effectiveness rates in research where virtual reality or augmented reality has been used to foster empathy?

Table 4 shows the results obtained for studies that have reported statistically significant results, as well as those where, due to the nature of the research, such significance does not apply.

The percentages mentioned address the question regarding the number of studies that have reported statistically significant effectiveness in research using virtual reality or augmented reality to foster empathy. It is noteworthy that 59.46% of the reviewed studies reported statistically significant differences. On the other hand, only 2.70% reported that there were no statistically significant differences.

4.2 Research questions about methodological aspects

4.2.1 what data collection instruments have been most used in studies utilizing virtual reality or augmented reality to foster empathy.

Table 5 shows the data collection instruments used, as well as the number of studies that report them and their respective percentages.

Table 5 reveals valuable information regarding the data collection instruments used in empathy studies. The Interpersonal Reactivity Index (IRI) stands out with a significantly high percentage of 18.75%, indicating its relevance and frequent use in empathy assessment. Furthermore, the results highlight the importance of two research approaches: the Likert-type surveys and interviews, both of which obtained similar percentages around 16,67%. This suggests that these methods are considered significant in measuring and understanding empathy. On the other hand, categories such as Multidimensional empathy scale, Virtual reality quiz, Cognitive and affective empathy test, Jefferson Empathy Scale (JSE) questionnaire presented lower percentages, approximately ranging from 2,08–4,17%. Additionally, other instruments such as questionnaires accounted 14.58%.

4.2.2 How many participants or research sample have been used most frequently in studies where virtual reality or augmented reality has been used to foster empathy?

Table 6 shows the number of participants in virtual reality or augmented reality studies, along with their respective percentages.

The participants were classified into different categories based on sample size. The category with the highest percentage corresponds to studies that included more than 100 participants, representing approximately 35.14% of the total. On the other hand, there were groups with lower representation, such as those with less than 51–75 and cases of 76–100 participants both with a percentage 8,11% and 10,81%, respectively. The intermediate categories show a range where sample size was not applicable due to the type of study,13,51% and, the studies with a range of participants between 25 and 50, accounting 16,22%.

4.2.3 What research design has been predominantly employed in studies where virtual reality or augmented reality has been used to foster empathy?

Table 7 contains the information on the percentages of research design types where virtual reality or augmented reality has been used to foster empathy.

Regarding the methodological design, five different types of research were found in the total number of studies reviewed. In terms of classification by types, experimental studies accounted for a total of 19 studies, representing 51.35% of the total studies reviewed. Following that, descriptive studies accounted for 7 studies, accounting for 18,92%. Qualitative studies accounted for a total of 4 studies, with an equivalent average of 10.81%. Quasi-experimental and mixed methods came next, each comprising 3 studies, and a percentage of 8.11%. Finally, Exploratory methods studies accounted for 1 article representing 2,70%.

4.2.4 What percentage of studies have been reported both as scientific articles and conference papers?

Table 8 shows a summary of the studies reviewed classified according to the typology as journal articles, conference papers or book chapters.

Regarding the analyzed articles that used virtual or augmented reality for empathy enhancement, there is a percentage of 83.78% of studies reported as journal articles, which represents a total of 31 articles from all the reviewed documents. This is followed by 4 conference papers, equivalent to 10.81%, and finally, two book chapter with a percentage value of 5.40%.

4.3 Advantages, limitations and future research directions

4.3.1 what advantages have been described in studies where virtual reality or augmented reality has been used to foster empathy.

Regarding the advantages described in studies where virtual reality or augmented reality has been used to foster empathy, it has been found that statistically significant changes occurred in various empathy-related aspects, increasing participants’ ability to understand others’ perspectives through the alteration of their virtual bodies. This is supported in the study by Wilding et al. [ 4 ], where participants gained a greater understanding of the challenges faced by individuals with disabilities when experiencing frustration within the virtual world.

Furthermore, Fisher [ 24 ] argues that although empathy in virtual reality is not directly established between a user and the subject of a real-life experience, the medium’s capacity to place a body within a new space provides an opportunity for enhanced understanding of others through empathic realities. Additionally, statistical results and user testimonials reveal that the functionalities and elements implemented in the developed application contribute to the promotion of empathy compared to conventional methods of visualization and annotation in 360-degree videos. Findings indicate that experiencing news through a head-mounted display for 360-degree videos resulted in higher self-location and co-presence compared to interacting with the same video on a desktop or reading a textual version. Therefore, the use of virtual reality as a medium to support empathy generation holds promise due to the benefits and advantages it offers.

It is worth noting the significant contributions that VR offers to educational spaces, particularly in terms of additional pedagogical considerations regarding the use of VR in historical education, including incorporating virtual reality into constructivist approaches. According to Castaño & Gonzalez [ 25 ], university students attribute importance to AR and VR in the educational context: it improves academic performance, changes the way of teaching and learning, enables more experimental learning, increases the level of understanding, offers models of relevant experiences, and enhances possibilities for engagement and interaction in the educational context. Furthermore, by generating a highly stimulating space for understanding the reality faced by others, a sense of shared frustration and pain is incorporated within the virtual world, leading participants to gain a greater understanding of the challenges faced by individuals with disabilities, autism, among others.

Parra Vargas et al. [ 26 ] illustrate the potential of a new VR organizational environment combined with machine learning to discriminate empathy dimensions. Additionally, this multi-method approach can increase knowledge about attention and behavior patterns and decision-making processes carried out by workers with different levels of empathy in complex work situations. Furthermore, unlike most assessments that use subjective self-report measures, this method combines neuroscience with VR, attributing greater objectivity and ecological validity to the results.

In summary, the findings suggest that augmented reality (AR) and virtual reality (VR) hold significance in enhancing individuals’ capacity to comprehend others’ perspectives. A primary advantage of AR and VR lies in their capability to immerse individuals in novel environments, fostering a deeper understanding of others’ thoughts and conditions. Additionally, the heightened levels of interaction facilitated by AR and VR surpass the efficacy of 360-degree videos in empathy development. Finally, the integration of artificial intelligence methods with AR and VR technologies introduces novel possibilities for empathy cultivation, as applications can adapt to individual participants, offering more personalized scenarios to enhance empathic experiences.

4.3.2 What limitations have been reported in studies where virtual reality or augmented reality has been used to foster empathy?

Regarding the limitations evidenced in studies where virtual reality or augmented reality has been used to foster empathy, several aspects have been identified. One limitation is the sample size, as in many cases, the total number of participants was not significant enough to establish generalizability of the findings. This lack of a representative sample also reflects limited socio-demographic information, and in some instances, the absence of a control group, pretest and posttest data, and long-term follow-up of the results. Additionally, participants’ unfamiliarity with virtual reality tools was detected, which were often presented in foreign languages or with proprietary licenses that limited their use. Furthermore, difficulties related to the COVID-19 pandemic were reported in studies that started before the preventive isolation measures were implemented. These studies had to change their initially planned methodology, requiring new organization and logistics to carry out the interventions in a timely manner, as mentioned by Villalba [ 27 ].

In terms of the content and format of empathy-building interventions, problems have been identified. Previous studies have shown that people exposed to persuasive messages can experience a psychological reaction, perceiving these messages as a threat to their freedom. As a result, a “boomerang” effect can occur, where the recipient acts in the opposite direction to that advocated by the message. This limitation implies not fully utilizing all emotions, as participants’ responses may be influenced by individual differences or previous experiences with the displayed content, resulting in a poor and somewhat biased understanding of empathy and prosocial moral reasoning.

In line with the issues, inadequate methodologies have been implemented, which in turn present inconveniences. This includes qualitative data being used inappropriately, risking objectivity, and studies that are solely descriptive, making it impossible to compare theory and practice to validate theoretical assumptions. Additionally, studies solely relying on self-reported measures limit researchers’ ability to draw conclusions about how the use of virtual reality devices influenced participants’ behavior, particularly their ability to empathetically communicate with individuals experiencing auditory verbal hallucinations (AVH). Since self-reported measures are based on participants’ subjective perceptions, it cannot be certain if the perceived changes in empathetic communication would translate into empathetic behavior in real life. As mentioned by Libera et al. [ 28 ], researchers face challenges in drawing conclusions about how the use of devices influenced participants’ behavior, especially their ability to empathetically communicate with individuals experiencing AVH. Due to the subjective nature of self-reported measures, it is uncertain whether these perceived changes in empathetic communication would translate into empathetic behavior in real-life situations.

In summary, the limitations identified in the reviewed studies revolve around factors such as small sample sizes, impeding the generalizability of results and the demonstration of genuine effects. The absence of long-term follow-ups and a scarcity of studies employing longitudinal research designs further underscore limitations within the research landscape. These findings align with Ventura et al.‘s [ 11 ] observations. Additionally, the restricted familiarity with augmented reality (AR) and virtual reality (VR) equipment hampers the potential impact of these technologies on empathy, complicating researchers’ efforts to measure their effects. The influence of individual differences on participants’ responses introduces another layer of complexity, potentially leading to unexpected results in the effects of AR and VR. Lastly, the reliance on self-reported measures in some studies introduces a potential source of bias, as these measures may not fully capture participants’ attitudes.

4.3.3 What have been the most frequent recommendations for future research in studies that have used virtual reality or augmented reality to promote empathy?

Regarding the recommendations for future research, one is to conduct longitudinal studies that assess empathy [ 29 ]. In longitudinal studies, the novelty of the technology effect can be controlled and determine the real affordances of VR and AR to develop empathy. Additionally, for upcoming research on virtual tools, empathy, and prosocial moral reasoning, these studies can be conducted with larger sample sizes and implemented in other countries to determine the effect of cultural differences on empathy. It is also emphasized the importance of research that integrates VR embodiment with clinical assessments and patient experiences, as stated by Aya Briñez et al. [ 30 ]. Embodiment is relevant for perspective-taking because the participant can take the body of another person and have a better experience that might increase empathy. Furthermore, future research is needed to explore the use of virtual reality for disability advocacy. On a different note, there were some comments about technical issues, such as interruptions during the presentation due to network problems or getting lost in the virtual world, especially for those who experienced VR for the first time. Li & Kyung Kim [ 31 ] suggest that future work should further examine the distinctions between visual perspectives and perspective-taking in virtual reality.

4.4 Technology-related research questions

4.4.1 what equipment or technological tools have been used for immersion in virtual reality or augmented reality in the analyzed studies.

Table 9 shows the technological means used for immersion in virtual reality environments, along with the number of related studies for this analysis and their respective percentages.

In this research question, the sub-category with the lowest number of studies were “Mobile AR”, “Augmented Reality Cards”, “Oculus Go 360”, “Google Cardboard” and “NVIS nVisor SX111” each accounting for 2.70% of the studies. “360 Immersion Device” is the category with the highest percentage of studies after “Not specified,” representing 18,92% of the total. Moreover, the subcategory “Not specified” has the highest number of studies, accounting for 37.84% of the total. An explanation of this result might be that some of the articles reviewed are theoretical so in the research the authors did not use a particular device.

4.4.2 Which software has been used to develop immersive environments in research studies where virtual reality or augmented reality has been used to foster empathy?

Table 10 shows the software that have been used to build immersive environments in research studies where virtual reality or augmented reality has been used to promote empathy.

Regarding programming languages and software, we found that software developed by Embodiedlabs*, Autopano Video, ImercyVE, AR Foundation, Optitrack Arena Motion, Ataturk, Skybox, Unreal, and AR Core accounted for only 2.5%, with each being the focus of a single study. Unity was used in 6 articles, representing a percentage of 15%. Additionally, it is found that 22 articles did not specify the programming language, or the tool used to develop de immersive experience, accounting for 55%. Finally, the software developed by is mentioned, which was present in two of the reviewed articles, resulting in a percentage of 5%.

5 Risk of bias analysis

A risk of bias analysis of the selected literature was carried out using the analysis tool proposed by Sterne et al. [ 32 ]. To perform this analysis, both qualitative and quantitative research designs, including experimental, non-experimental, and correlational designs, were considered. This is because these types of designs can be assessed using the tool, and a total of 32 articles were analyzed and the results are shown in Table 11 . In this table, 5 dimensions are assessed by using a group of criterions and finally the overall bias for each study is calculated. Table 11 shows the average score obtained for each dimension for the total of articles analyzed Fig. 2 .

The Table 11 with the case analysis shows the percentage values ​​of the categories or dimensions and the slight biases.

figure 2

Risk of bias analysis

On one hand, it can be observed that all the dimensions analyzed by the instrument meet or exceed the 74,1% threshold for low risk of bias overall. However, it is relevant to note that the dimensions of randomization, measurement of the outcome, and selection of the reported outcome show a percentage of medium risk or are categorized as ‘some concerns,’ with a maximum of 22,2% for the first, 3,7% and 7,4% for the latter two, respectively. It is important to highlight that only one study, in a single dimension (variation in the intervention), presents a high risk of bias due to a lack of information when assessing research criteria.

In general, a predominantly low risk of bias trend was obtained in the studies analyzed, with at least 74,10% assessed by both the researchers and the instrument’s algorithm. However, the remaining 25,90% of the studies analyzed presented a moderate or high risk of bias. These studies may be more susceptible to systematic errors that could influence the results and conclusions, emphasizing the importance of caution when interpreting these findings and considering potential limitations in the available evidence.

6 Discussion

Although the different bibliographical sources consulted differ slightly in their focus of interest, such as the systematic review by Lee et al. [ 19 ], who explored the design and effectiveness of virtual patient-based medical communication skills training systems through 14 mostly quantitative studies, finding that effective virtual patient systems include well-designed educational interventions, human feedback, and reflection after the activity. Similar results to the systematic review presented in this paper are presented because it confirms that virtual reality increases and improves empathy processes, a result that is also present in the meta-analysis by Ventura et al. [ 14 ] whose main interest is focused on clarifying the existing research on virtual reality as a means to provoke empathy. The results reveal statistically significant positive changes in perspective taking after VR exposure. Likewise, Gerry et al. [ 11 ] investigated the efficacy of VR training for empathy and compassion. These components correspond to three key design characteristics of immersive VR technologies: biofeedback, perspective taking, and simulation, thus demonstrating that empathy can be trained and promoted thanks to different immersive technologies. This is something that is intended to be emphasized throughout this systematic review. Finally, Foxman et al. [ 20 ] propose that empathy is a term that journalists and researchers aspire to show the potential of immersive media for prosocial change, building on fundamental research in the field. However, it is not the only field of interest. Therefore, our systematic review seeks to delve into various areas such as the arts, education, marketing, neurosciences, and other previously mentioned areas in which VR, AR, and empathy are treated as an area of interest. The main purpose of this systematic literature review is to show an overview of the research done in the field of VR and AR to promote empathy. In this section, the results and identified trends are interpreted, the effects and relationships found will be examined, as well as the differences or similarities between subgroups and analyzed variables. Furthermore, these results will be contextualized with the existing literature, allowing for the establishment of connections and significant contributions to the field of study.

6.1 Is AR and VR effective for fostering empathy?

By analyzing current research in the field of AR and VR to develop empathy, the main conclusion is that: It is premature at this early stage to consider VR as a medium that generates empathy over other media such as film, television or photography. This finding is also in line with the findings by Sora-Domenjó [ 33 ]. This finding is also supported by previous research stating that there still a lack of empirical support for the popular claim of VR as the “ultimate empathy machine” [ 34 ]. It is clear from the research that, under certain conditions, alterations in one’s own digital representation of oneself can have a significant impact on how a person behaves in a virtual environment and that also affects their behaviors and attitudes, promoting some of the qualities of empathy. The results also indicate a lack of consensus when considering VR as a narrative medium that provokes empathy due to its immersive qualities. Empathy is a complex phenomenon where cultural and personal implications can affect VR experiences, modulating and differentiating empathy awareness depending on each person.

As shown in this article, some VR experiences designed to elicit empathy could generate negative and counterproductive effects in relation to the outgroup, depending on the subjects and the experimental design. It has been widely demonstrated that empathy in virtual reality films includes, at a minimum, social, cultural, and physical biases that can hinder empathic responses, and that different technical configurations may also be related to these affective responses. The role of interactivity and action in arousing empathy in virtual reality experiences using current technical configurations does not appear to be particularly relevant.

Furthermore, although some results suggest that VR cinematic experiences can modulate emotions and empathy in a short period of time for a specific group of people, the long-term effects of exposure with VR is still unclear, as researchers point out [ 33 ]. Based on the previous effects of mobile and web exposure, one can predict that immersive virtual reality technologies could eventually have similar or even worse results, affecting the same limbic areas involved in sympathetic resonance.

A related comment has been made about the need to consider the “conceptual position of the subject” in relation to the personal narratives developed (especially in VR social films) and the audience. Furthermore, at these stages of VR development, the reflection on the future consequences of using VR is necessary because the impact of VR on society is difficult to predict [ 33 ]. According to Sora-Domenjó [ 33 ], VR experiences could be defined as part of a collective reflection. In that regard, co-design and co-creation methodologies could be effective so that stakeholders can actively participate in the design and development process so that VR experiences can be more effective to develop empathy in certain fields.

6.2 Methodological aspects of studies about AR and VR to develop empathy

It is important to contrast the results considering the findings by Dhar et al. [ 18 ], where it is stated that virtual reality immersion devices are safe, effective, and appealing to participants despite their interdisciplinary variations. From this perspective, it can be confirmed that these findings demonstrate the wide range of areas, especially education and medicine, that have explored the potential of virtual and augmented reality as tools for fostering empathy in a transdisciplinary manner, as evidenced in the Section 4 (Table 3 ). Additionally, the importance of considering multiple data collection instruments in the study of empathy is highlighted, with the IRI report being the most relevant. This result echoes the findings by Mestre Escrivá et al. [ 35 ]: “The Interpersonal Reactivity Index (IRI) (Davis, 1980, 1983) is one of the most widely used self-report measures to assess empathy. It has been applied in different studies to evaluate gender differences in empathic disposition” (p. 255). Furthermore, adapted questionnaires on the use of virtual reality enrich the understanding of this field and have vast potential to be explored as information gathering tools for subsequent social interventions, as presented in Section 4 (Table 5 ). Moreover, this result is in line with the results of the survey of literature by Christofi [ 13 ], who found that most of the research on VR and empathy has used self-reported instruments. An implication of this result might be that future researchers in this field should validate adaptations of the questionnaires to other languages or tailor-made questionnaires to ensure the reliability and validity of the instrument.

Moving on to the population perspective, the reported findings emphasize the need to consider studies with more than 100 participants, as corroborated in Section 4 (Table 6 ). This is relevant as it underscores the importance of sample size, offering a quantitative perspective on how participants are distributed in the context of fostering empathy through the use of virtual reality, as supported by García-García et al. [ 36 ]: “Calculating the number of participants to be included in a study (…) enables researchers to know how many individuals need to be studied to estimate the desired degree of confidence or difference between study groups” (p. 218). A bigger sample size allows researchers to conduct more robust studies that are less sensible to biased, reduce error, and increase precision. According to García-García et al. [ 36 ]. “a study with an insufficient sample size will estimate a parameter with low precision or will be unable to detect differences between groups, leading to erroneous conclusions” (p. 218).

Regarding the technological means for virtual immersion, Useche Rodríguez [ 37 ] pointed out that “360 videos can be used to present audiovisual content aimed at generating empathy in viewers. The research evaluates the effectiveness of the tool developed to support empathy in 360 videos” (p. 8). These technological means encompass a wide range of equipment used in various disciplines, with the most common being 360° video immersion devices and Oculus Rift mixed reality headsets, as evidenced in the Section 4 (Table 9 ). A possible interpretation of this result is that 360° videos are easy to deploy in VR devices, are cheaper to produce and provide more realism when compared to the development of a tailor-made VR or AR experience because VR/AR experiences require the support of software developers, and their development is more time-consuming and expensive. Moreover, in 360° videos the interaction is more limited whereas in VR/AR environments the interaction is higher. Thus, we call for more research studies that involve the development of VR/AR experiences to really exploit the potential of this technologies and uncover the real affordances of the technology to foster empathy.

Another finding in this review of literature deals with the reporting of statistically significant results in research where virtual reality or augmented reality has been used to foster empathy. In total 45.95% of the studies (as shown in Table 4 ) report statistically significant results. This finding is in line with previous research that has found that VR is effective for perspective-taking but there are still some inconclusive results regarding empathy [ 14 ] so further research is needed. Connected to this idea, according to Ordoñez [ 38 ], some of the advantages of VR and AR include “multisensory learning (sight, sound, touch), cognitive improvement, effective combination of physical and virtual worlds, high-quality 3D content and animations in real space, elimination of geographical and temporal limits, content enrichment, and user-friendliness” (p.13). In this literature review, we confirmed that another advantage of VR and AR is that these technologies are effective for developing empathy and this finding contributes to the body of knowledge on the advantages of these technologies.

Experimental research designs have been used in studies of VR and AR to develop empathy (Table 7 ). Experimental research design can be useful to identify the affordances and benefits of VR and AR to foster empathy when compared to other technologies or strategies. Moreover, changes in empathy can be identified by using pre-post tests in experimental research designs. We recommend that, in future studies, researchers use experimental research designs and more robust statistical methods such as Structural Equation Modeling (SEM) to identify some predictors of empathy during VR and AR experiences that are used to foster empathy. Moreover, there is still a lack of research on the features of VR and AR that positively influence empathy and the personal traits that might moderate the factors that influence empathy. Thus, further research is needed in this aspect.

Additionally, it is highlighted that 83.78% of the research has been published in academic journals (31 out of 37 studies reviewed as depicted in Table 8 ) and only 4 studies were published in conference papers and 2 in book chapters. This result shows that most of the research conducted in the field has been peer-reviewed and this ensures the quality of the findings in each paper.

Research has demonstrated the potential of the new organizational context of VR combined with machine learning to distinguish empathy dimensions. Unlike most evaluations that use subjective self-report measures, this approach combines neuroscience with VR, providing greater objectivity and validity to the results. This, in turn, facilitates systematic reviews analyzing the role of these techniques in the importance of immersion in different contexts, as mentioned by Parra Vargas et al. [ 26 ].

6.3 Technological aspects

In this review, we identified some technologies used to create experiences in VR and AR to develop empathy. A remarkable result is that most of the studies analyzed in this review used 360° video in VR headsets. This means that participants were, in most of the cases, passive subjects in the VR experience and therefore the effect on empathy might have been diminished as a result of the lack of interaction with some elements in the experience. However, a positive aspect of using 360° videos is that the VR experience is closer to the reality. Previous research have demonstrated that social presence (which involves the sense of being there in VR) in 360° videos has a positive effect on prosocial behaviors [ 39 ]. In that regard, future studies in which the participants’ sense of presence can be maximized could contribute to a better experience increasing the levels of empathy. Moreover, another feature of VR that can be exploited for developing empathy is embodiment. Previous research has shown that empathy might increase when some features of embodiment are present [ 40 ]. The engagement and sense of presence created by VR experiences might intensify some emotional reactions such as empathy [ 41 ]. According to Ventura et al. [ 14 ], further research should determine if the sense of presence is better than the embodiment or not. The use of other VR headsets or fully immersive VR experiences is still limited so further research on the effect of highly interactive VR experiences (apart from 360° video) might provide more insights into the real effect of VR on empathy. To date, it is unclear which device would be the most effective for presenting VR or AR experiences and this is line with the call for more research stated by Ventura et al. [ 14 ].

Research on AR or Mixed Reality (MR) to develop empathy is still in its infancy. There are few studies that use AR or MR as immersive technologies to create empathy when compared to the number of studies using VR. An interpretation of this result might be that VR as a more immersive technology could be seen as a more powerful to develop empathy when compared to less immersive technologies such as AR or MR. However, further research needs to be conducted to determine the affordances of AR and MR to develop empathy. Mobile AR could be a more affordable way of creating experiences to develop empathy because smartphones are, in general, cheaper than VR headsets and most people own smartphones that can be used to deploy mobile AR apps. Mobile AR can be used to situate experiences in the user’s context to develop empathy in certain physical contexts instead of recreating the entire context in VR.

Regarding the software used to develop immersive experiences to create empathy, most of the studies do not specify the software used and some other studies use general purpose commercial software. In that regard, there are no open source frameworks for designing and developing immersive experiences to create empathy. We call for more research to fill this gap in the literature so that the software allows to configure certain parameters to effectively create the experiences and save time in the development process.

Finally, the combination of VR/AR/MR technologies and artificial intelligence (AI) for training empathy is another field that deserves more research. The possibilities offered by generative AI might provide more personalized and adaptive experiences for empathy development and current research in this aspect is still in its infancy.

6.4 Limitations and future research directions

Finally, we found some limitations in the reviewed studies. First, the sample size was not significant, which affected the generalizability of the findings. In this sense, we suggest that future research consider larger research samples. Stavroulia & Lanitis [ 42 ] conducted a study with 69 participants. On the other hand, regarding the instructions given, some were not given adequately, guaranteeing that the participants understood and complied with them, causing confusion among the participants during the execution of the test. Additionally, in terms of descriptive studies, 9 studies were used (Table 7 ), which received negative criticism since the authors suggest that they reflected deficiencies such as the qualitative use of data, which prevented a comparison between theory and theory. the practice.

However, as a future recommendation, delving into qualitative studies is suggested since this methodology also has valuable theoretical support. According to Quecedo & Castaño [ 43 ], “a qualitative study allows us to know the personal aspect, inner life, perspectives, beliefs, concepts (…) successes and failures, moral struggle, efforts,” which are close and congruent traits when fostering empathy.

7 Limitations of this review

The main limitation of this study is that some papers might have been published in other bibliographic databases such as Web of Science and those papers were not included in this review. The categories considered in this review of literature are not unique. Other categories might be considered in the systematic literature review to obtain more information about the current state of research in the field of VR and AR to develop empathy.

8 Implications for education and training

In the realm of education, it is well-established that basic empathy is a trainable trait rather than an inherent quality [ 44 ]. This implies that individuals do not possess a predetermined amount of empathy at birth but instead develop and acquire this attribute over time. Consequently, the pivotal implication drawn from the review presented in this paper is that virtual reality (VR) emerges as an effective medium for training and fostering empathy across various educational levels, including primary, secondary, and higher education. VR’s unique capabilities allow for intricate and nuanced empathy training programs that surpass the possibilities offered by other technologies [ 45 ]. Such training programs hold significant potential for students, teachers, and society at large, fostering better relationships within the educational community, cultivating prosocial behaviors among students, broadening perspectives, promoting understanding of global inequalities, and contributing to conflict resolution and mediation.

While there exists an expanding body of literature on empathy training within healthcare, medicine, and related disciplines [ 46 ], a noticeable research gap is observed in the training of empathy within other educational domains such as psychology, marketing, and art. Consequently, future research endeavors should concentrate on investigating how empathy can be effectively trained in these diverse fields, exploring the unique variables that influence this trait within specific disciplines.

Within this review, the Empathy Index (IRI) emerged as the most employed instrument for measuring empathy. However, future studies in the realm of education and training should consider validating this instrument within educational contexts or developing new instruments tailored to educational settings. In accordance with Villalba et al.‘s [ 27 ] recommendations, a periodic revision of the IRI instrument is suggested to incorporate current discussions and advancements in empathy research. Additionally, the incorporation of physiological measures and eye-tracking technologies holds promise in offering a more objective assessment of the impact of VR on empathy.

Despite the progress in research on empathy development utilizing augmented reality (AR) and VR, a notable research gap persists in understanding how to effectively train empathy across different educational levels using these technologies. Thus, an additional implication derived from this review is the imperative need for further research dedicated to elucidating mechanisms, frameworks, and methodologies for empathy training across diverse educational levels.

9 Conclusions

This systematic review underscores the potential of VR and AR as effective tools for fostering empathy in various domains. It emphasizes the importance of larger sample sizes, validated questionnaires, and rigorous research designs to advance our understanding of the VR/AR-empathy relationship and shed light on the specific factors and personal traits that influence empathetic experiences in virtual environments. It is important to note that there is a lack of research on the use of AR or MR to develop empathy and this is a gap in the literature that requires more attention. This systematic review presents a comprehensive analysis of the relationship between VR/AR and empathy, yielding significant findings:

VR/AR immersion devices are not only safe but also effective and appealing to participants, corroborating previous research. These results confirm the broad application of VR and AR in fostering empathy, particularly in education and medicine. However, more research is needed to identify the real affordances of VR/AR to develop empathy.

To study empathy, it is crucial to employ multiple data collection instruments, with the IRI report emerging as the most relevant self-report measure. However, we suggest that future research can combine self-reported instruments with more objective measures such as physiological measurements to have more insights into the effect of AR/VR technologies on empathy.

The use of adapted questionnaires tailored to VR/AR enhances the understanding of the field and holds potential as information-gathering tools for social interventions. Future researchers should validate questionnaire adaptations in different languages or develop customized instruments to ensure the reliability and validity of the assessment.

Large sample sizes (over 100 participants) are vital in VR/AR-based empathy research to provide a quantitative perspective on participant distribution. Robust studies with larger sample sizes minimize biases, reduce errors, enhance precision, and facilitates generalizability of results.

Technological means for virtual immersion, such as 360° videos and VR headsets, have gained popularity in fostering empathy across diverse disciplines. While 360° videos offer cost-effective and realistic experiences, VR environments provide higher interaction possibilities. Furthermore, the noticeable absence of research on augmented reality (AR) and mixed reality (MR) for empathy development becomes apparent in the studies scrutinized. Consequently, it is imperative for future research endeavors to delve deeper into and explore the untapped potential of AR or MR experiences in promoting and enhancing empathy.

Approximately 45.95% of the studies reported statistically significant results regarding the effectiveness of VR or AR in fostering empathy. However, the field still lacks conclusive evidence, necessitating further research to gain a comprehensive understanding of the impact of VR/AR/MR on empathy.

VR and AR offer various advantages, including multisensory learning, cognitive improvement, content enrichment, and user-friendliness. This review adds to the body of knowledge by highlighting their effectiveness in developing empathy.

Experimental research designs have commonly been employed in VR/AR empathy studies to identify the affordances and benefits of these technologies. Pre-post tests in experimental designs enable the identification of changes in empathy. Future studies should utilize experimental designs and robust statistical methods, such as Structural Equation Modeling (SEM), to identify predictors of empathy during VR/AR experiences and explore the influential features and personal traits.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Open Access funding provided by Colombia Consortium. This research was funded by COMISIÓN DE REGULACIÓN DE COMUNICACIONES - CRC and MINISTERIO DE CIENCIA, TECNOLOGIA E INNOVACIÓN from Colombia. This article belongs to the products of the research project entitled “Co-creación de narrativas inmersivas sobre migración en Colombia: una propuesta metodológica” presented and approved under the research call 908 from MINCIENCIAS “Nuevo conocimiento, desarrollo tecnológico e innovación para el fortalecimiento de los sectores de TIC, postal y de contenidos audiovisuales”. This study was developed by researchers from Fundación Universitaria Konrad Lorenz.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jose Ignacio Lacle-Melendez and Sofia Vanesa Silva-Medina. The first draft of the manuscript was written by Jose Ignacio Lacle-Melendez and Sofia Vanesa Silva-Medina. Jorge Bacca-Acosta commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Lacle-Melendez, J., Silva-Medina, S. & Bacca-Acosta, J. Virtual and augmented reality to develop empathy: a systematic literature review. Multimed Tools Appl (2024).

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Received : 21 July 2023

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Published : 04 May 2024


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