literature review for change management

Reactions towards organizational change: a systematic literature review

• Published: 13 April 2022
• Volume 42 , pages 19137–19160, ( 2023 )

Cite this article

• Khai Wah Khaw 1 ,
• Alhamzah Alnoor   ORCID: orcid.org/0000-0003-2873-2054 1 , 2 ,
• Hadi AL-Abrrow 3 ,
• Victor Tiberius 4 ,
• Yuvaraj Ganesan 5 &
• Nadia A. Atshan 2  

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Regardless of the prevalence and value of change initiatives in contemporary organizations, these often face resistance by employees. This resistance is the outcome of change recipients’ cognitive and behavioral reactions towards change. To better understand the causes and effects of reactions to change, a holistic view of prior research is needed. Accordingly, we provide a systematic literature review on this topic. We categorize extant research into four major and several subcategories: micro and macro reactions. We analyze the essential characteristics of the emerging field of change reactions along research issues and challenges, benefits of (even negative) reactions, managerial implications, and propose future research opportunities.

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Introduction

During the past two decades, many studies have been conducted that have been interested in organizational change and the mechanisms that promote that process smoothly (Benford & Snow, 2000 ; Bouckenooghe, 2010 ; Caldwell et al., 2009 ; Pettigrew et al., 2001 ). Despite that wide interest in the process of organizational change, these studies reported negative results, as most of those efforts ended with an unsuccessful implementation of the process of organizational change and ultimately failure (Beer & Nohria, 2000 ; Meaney and Pung, 2008; Hussain et al., 2018 ). This is because the focus was on many secondary variables and ignored the most important factor of individual and organizational reactions towards organizational change in those studies (Oreg et al., 2011 ; Penava and Sˇehic, 2014). Herold et al., 2008 ; Holten and Brenner, 2015; Oreg & Berson, 2011 ; Alnoor et al., 2021 ).

A reaction towards a change is a cognitive and behavioral response based on an adaptation and a comprehensive understanding of how to react towards a change (AL-Abrrow et al., 2019b ; Peng et al, 2020 ). This largely depends on how managers introduce a change and on the extent to which others respond. Usually, a negative reaction towards change happens when it is expected to result into more workload, uncertainty, and fatigue, especially when change is rapid and spans the whole organization or large parts of it (Beare et al., 2020 ; Li et al., 2017 ). Individuals’ reactions towards organizational change are expected to be dependent on the individual’s perception and assessment of the change effects on the individual. This suggests that a reaction towards a change is developed through the interactions between attitudes, beliefs, and feelings of an individual towards a change. A successful implementation of a change depends on how individuals interact with organizational change (Oreg et al, 2011 ; Shura et al., 2017 ). Participation in the change process is closely related with reactions towards a change. Practitioners are likely to be able to effectively diagnose and improve the willingness to change when they understand the need for change (Albrecht et al., 2020 ). Besides, people are more inclined to commit to a change if they perceive the change in alignment with their expectations and the resistance to change would be minimal (Helpap, 2016 ).

A positive reaction allows individuals to be more job focused and hence less resistance to change can be expected (Gardner et al., 1987 ). Similarly, a negative reaction towards change often generates a strong resistance to change. This happens if change is perceived as harming. Moreover, individuals’ resort to negative reactions when work relationships are threatened because of a change in a way that causes them to quit their job (Michela & Vena, 2012 ). However, some individuals are indecisive in their reactions towards a change, especially when future outcomes are unpredictable. This results into disruption and anxiety for both organizations and individuals, and thus reactions serve as the method aimed at dealing and engaging with change (Blom, 2018 ).

These considerations suggest that individuals react differently towards organizational change, depending on their respective perceptions. This invites a comprehensive study to understand the differences in reactions and to explain the main role that reactions play towards organizational change. Based on a systematic literature review, we provide a comprehensive framework that can help get an in-depth understanding of the reactions on organizational change. Earlier studies on precedents and consequences of change have been more concerned about reactions to organizational change (Akhtar et al., 2016 ). Despite the need of organizational change, many change initiatives fail (Beer & Nohria, 2000 ), mainly because of differences in individuals’ interactions in the change process (Oreg et al., 2011 ). Rafferty et al. ( 2013 ), developed a model to study individual level willingness to change. It was found that change based on interactions, homogeneous attitudes, and feelings are successful, and vice versa. Still, there is need to present a broader and more comprehensive theoretical framework based on earlier studies to better understand reactions towards change at different levels, i.e., micro and macro level. Although many researchers have contributed to conducting many studies to try to analyze the nature of cognitive and behavioral responses, for example, job satisfaction, individual performance, emotional intelligence, readiness for organizational creativity, and leadership abilities of all kinds (Malik and Masood, 2015; Malik and Masood, 2015). There are rare studies that dealt with reactions to organizational change at all levels, micro and macro (Khan et al., 2018 ). Thus, the number of studies that investigated reactions to change has increased, but the different types of study cases are still unknown to allocate the most critical determinants that contribute to positive and negative reactions to change. Hence, further investigation is needed. This systematic analysis seeks to provide useful insights into contexts of change reactions and to assist the authors in identifying current options and gaps in this type of study. Accordingly, our research meets the stated literary need. Our focus is to find how the subject of reactions towards change has been studied so far. The main goal is to provide a detailed methodological framework based on earlier studies, which explains the differences and trends in prior research. Additionally, we critically assess methodological issues and challenges found in previous research on reactions to organizational change, which can be overcome in future research. We plead for a changed perspective, which disentangles negative employee reactions to change from negative change outcomes. Rather, we argue that negative reactions can be interpreted as constructive criticism, which can improve the outcome process.

Methodology

To archive our research goal, we conducted a systematic literature review. We used ‘reactions to change’ as the main key word to search relevant articles in four databases. We considered only those articles written in English, which is considered to be the predominant scientific language. Only peer-reviewed articles and conference papers were included. The current study was accomplished according to the ‘Preferred Reporting Items for Systematic reviews and Meta Analyses’ (PRISMA) criterions (Moher et al., 2015 ). For systematic reviews, PRISMA suggests that counting on a single database search for literature should be avoided; no single database is likely to contain all relevant references. Therefore, extensive searching is recommended (Berrang-Ford et al., 2015 ; Monroe et al., 2019 ).

In particular, we used four major databases to assemble the literature sample: IEE Xplore, Science Direct, Scopus, and Web of Science. These databases were selected based on their academic reliability and wider availability of relevant articles to discover the research gap and provide critical practical and theoretical implications (Aria & Cuccurullo, 2017 ; Knobloch et al., 2011 ).

The selection process consisted of two phases of screening and filtration. First, duplicate articles found through matching of titles and abstracts were excluded. Second, articles were filtered after reading the entire article. This resulted in 79 articles (Fig.  1 ). Then, the main findings of the remaining articles were extracted and categorized.

Systematic review protocol

Results and discussion

A critical overview of the change reactions literature.

Previous studies of organizational change attempted to reach an increase in organizational effectiveness by focusing on organizational change and how change is implemented (Oreg & Berson, 2011 ; Oreg et al., 2011 ; Tavakoli, 2010 ; Tyler & De Cremer, 2005 ; Vakola et al., 2013 ; Van Dick et al., 2018 ; Walk & Handy, 2018 ; Whelan-Barry et al., 2003 ). The basic logic of such studies is based on the main assumption the positive or negative organizational consequences depend primarily on the extent to which individuals accept organizational change and their reactions to that change. Such a hypothesis is supported by many recent studies (Alfes et al., 2019 ; Borges & Quintas, 2020 ; Beare et al., 2020 ). Through the growing interest in researching the reactions of individuals towards organizational change. For example, the role of individuals’ reactions and how they interact with organizational change was examined within a time frame that spanned six decades from the end of the forties to 2022. A model was built on the basis of this research showing the relationship between the three main axes in the change process represented by the precedents of individuals’ reactions to change and responses to Their public actions and the consequences of that change (Oreg et al., 2011 ).

The vast majority of the total 79 studies relied on the longitudinal design in the research, and the other studies varied, including in adopting the type of design from transverse design to experimental studies, and 90% of those studies relied on data collection on self-reports of the study variables. Three main axes were discussed in terms of their relationship to the process of organizational change and the potential resistance that individuals come up with towards that change. Such three axes were represented by the cognitive axis, which is analyzed based on how individuals think about organizational change. The emotional axis by understanding and measuring the positive or negative feelings of individuals toward organizational change. The behavioral axis through which the extent to which the individual accepts or rejects organizational change appears (Bhatti et al., 2020 ; Constantino et al., 2021 ; Kashefi et al., 2012 ).

In recent years, factors such as the extent to which individuals accept organizational change and reactions to organizational change were the basic logic of previous studies that grew interested in researching the reactions of individuals towards organizational change (i.e., Roczniewska, & Higgins, 2019 ; Borges & Quintas, 2020 ; Du et al., 2020 ; Peng et al., 2020 ; Li et al., 2021 ). Prior studies have been focused on topics such as the psychodynamic explication of emotion, perception, behavior, and learning (Armenakis & Harris, 2009 ; Reiss et al., 2019 ; Tang & Gao, 2012 ; Al-Abrrow et al., 2019a ; Borges & Quintas, 2020 ), the behavior of leadership (Fugate, 2012 ; Matthew, 2009 ; Alnoor et al., 2020 ), the focus of attention (Gardner et al., 1987 ), internal communication (Men & Stacks, 2014 ; Li et al., 2021 ), individual attitudes (Akhtar et al., 2016 ; Jacobs & Keegan, 2018 ; Liu & Zhang, 2019 ; McElroy & Morrow, 2010 ; Sanchez de Miguel et al., 2015 ), openness to change (Straatmann et al., 2016 ), and information systems (Bala & Venkatesh, 2017 ; Beare et al., 2020 ; Thirumaran et al., 2013 ). Figure  2 simplifies the determinants of reactions to change explored and investigated by the previous literature.

Determinants of reactions to change

Taxonomy of reactions to organizational change

The remaining 79 articles were divided into four categories (Fig.  3 ) regarding the level of reactions towards change i.e., micro and macro level. There were 39 articles relating to micro reactions to change and 40 articles on macro reactions. Hence, these major categories were linked to their corresponding subcategories as shown in Fig.  3 , depending on the frequency of relevance to ‘reactions to change’.

Taxonomy of reactions to change

Micro-level reactions

Antecedents of micro-level reactions.

In this category, the research articles discuss aspects the antecedents of individuals’ reactions to organizational change. The subcategory contains major topics where reactions to organizational change was adopted with regards to (1) Emotional, cognitive, and behavioral therapy, (2) Communication between employees, (3) Leadership style, (4) Individual attitude, (5) Openness to change, and (6) Information systems.

Cognitive behavioral therapy

At the individual level, aims to help human resource to relieve emotional stress and reduce the need for associated dysfunctional coping behaviors. Hence, this set of studies discusses reactions to organizational change with psychodynamic perspective and include 19 studies. Four studies (Antonacopoulou & Gabriel, 2001 ; Armenakis & Harris, 2009 ; Reiss et al., 2019 ; Tang & Gao, 2012 ) discuss emotional and motivational responses to organizational change and strategies to overcome these emotional and motivational challenges. The other nine studies discuss perceptions about organizational change. Beside this, to present a systematic analysis of positive psychology, one of the studies emphasized the relationship between perceptions about organizational support and resistance to change (Ming-Chu & Meng-Hsiu, 2015 ; Al-Abrrow et al., 2019a ; Abbas et al., 2021b ). According to Albrecht et al. ( 2020 ) and Hatjidis and Parker ( 2017 ) change engagement influences employees’ perceptions of organizational change. Thus, employees’ cognitive and behavioral reactions influence their perceptions of organizational change (Borges & Quintas, 2020 ). Endrejat et al. ( 2020 ) and Helpap ( 2016 ) argue that organizational communication reinforces employees’ positive perceptions of organizational change and affects their psychological mechanisms. Contrary to this, a negative awareness about organizational change causes psychological withdrawal or distancing from organization (Michela & Vena, 2012 ). Belschak et al. ( 2020 ) found that the Machiavellianism leads to negative perceptions and negative reactions to change. Organizational efforts to induce change are much consistent when employees are more concerned with change target (Gardner et al., 1987 ; Hadi et al., 2018 ). Six studies discuss two aspects of personality and health regarding employees’ reactions towards change. We found two articles, which describe that organizational justice and culture significantly influence employees’ personality. Additionally, job satisfaction, once change occurs, is critical to personality development (Bailey & Raelin, 2015 ; Caldwell & Liu, 2011 ). The remaining four articles encompass employees’ health related concern in relation to organizational change in health sector (Abbas et al., 2020 ; Fournier et al., 2021 ). It was found that organizational change is perceived as causing fear of job insecurity and health and safety issues among doctors, which resulted into less job satisfaction and reduced level of motivation (Størseth, 2006 ; Tavakoli, 2010 ; Al-Abrrow et al., 2021 ).

Communication between employees

Communication between employees originated from the concept of organizational transparency. Communication provides positive and negative information to employees in a timely manner. Furthermore, communication between employees enhances the organizational capacity of employees and holds organizations accountable for practices and policies (Li et al., 2021 ). Communication between employees includes transparency, accountability, participation, and informatics (Men & Stacks, 2014 ). The change can be planned or unplanned. Planned change is the discovery of problems that need improvement in a proactive manner. Unplanned change is imposed by external forces. Therefore, organizations must react flexibly and quickly to survive (Seeger et al., 2005 ; Alnoor et al., 2020 ). However, the lack of communication between employees creates barriers and threats to organizations towards increasing negative reactions to change. Planned and unplanned changes increase people's confusion and uncertainty. Therefore, employees' understanding of changes through communication between them is critical to the success of change (Gillet et al., 2013 ).

Leadership style

Leadership contributes 71% of the success of change amongst employees. Therefore, leadership and leadership traits were critical factors for change reactions for employees (Fugate, 2012 ). The openness of the leader increases the positive reactions to change. However, the resistance of the leader stimulates negative reactions to change from the employees (Matthew, 2009 ). Relationships with employees by leaders are critical determinants of successful change leadership (Alnoor et al., 2020 ). Leadership style affects employees in different ways, such as credibility and trust are important drivers of change for leaders to certify employee interests are considered. The literature confirms the leader-member exchange theory increases the negative reactions of employees to the change linked with corporate merger (Fugate, 2012 ). On the other hand, creative leadership and transformational leadership inspire employees and increase positive employee reactions. Change leaders are creative and transformative leaders (Matthew, 2009 ). In addition, practical leadership reduces employee resistance to change and increases individual interest in implementing change (Herold et al., 2008 ; Khaw et al., 2021 ).

Individual attitude

This set of studies discusses reactions to organizational change in relation to different individual attitude and included eight studies. Two studies discuss gender attitude, especially the reactions of female employees towards organizational change (Sanchez de Miguel et al., 2015 ). Similarly, employees differ in their attitude of reactions to organizational change depending on their age. Additionally, cultural and attitude differences cause numerous employee reactions towards organizational change (McElroy & Morrow, 2010 ). Three studies discussed the influence of employees’ respective experiences on their attitude of reactions towards organizational change. These studies assert that employees’ previous experiences are important to influence employees’ reactions to organizational change (Alas, 2007 ). A frequent exposure to organizational change causes change fatigue and cynicism and accordingly produce employees’ reactions to organizational change (Stensaker & Meyer, 2012 ). Thus, there is a relationship between the frequency of change and the reactions to change represented by exit, voice, loyalty, and neglect (Akhtar et al., 2016 ). On the other hand, the attitude of employees’ reactions towards organizational change in the public sector differs from the private sector in many ways, because the various processes of logistics and implementation. Therefore, the reactions of employees in the public sector are different compared to those in private sector. For this, the attitude of employees’ reactions in South African prisons to transformative changes in leadership were studied (Mdletye et al., 2013 ). In a policing context, 23 interviews were conducted, and it was concluded that the employees’ feedback began with three foci (me, colleagues, and organization) to assess change (Jacobs & Keegan, 2018 ). Moreover, a relationship between employees’ attitude in public service and their commitment to change was found (Liu & Zhang, 2019 ).

Openness to change

Four studies discussed employees’ openness to change in change and suggested that employability is related to positive emotions and higher level of employees’ openness to change in organizational changes (Fugate & Kinicki, 2008 ). Employees’ (dis) openness to change influences their emotional responses to organizational change (Saunders & Thornhill, 2011 ). It was found that the size and age of a company as well as employees’ expectations boost employees’ openness to change for the successful implementation of change (Lines et al., 2015 ). It is common that employees react whenever a new system is introduced. Yan and Jacobs ( 2008 ) studied employees’ trust and openness to change in relation to organizational change under the lean enterprise system. Two studies discuss diagnostic assessments, which are important during change implementation to deal with employees’ reactions to organizational change (Straatmann et al., 2016 ). Hence, creating interpersonal consensus promotes positive perceptions of change (Dickson & Simmons, 1970 ).

Information systems

This set of studies discusses reactions to organizational change in form of Information systems adoption and included six studies. For example, employees’ cognitive evaluation in reaction to Information systems implementation initiatives was discussed, which provided a deeper understanding of employees' feelings and perceptions of change (Kashefi et al., 2012 ). The authors claimed that a system can be designed to measure the feelings of individuals and customers towards the change implementation (Thirumaran et al., 2013 ). In another study, individuals' reactions to changes within supply chains were measured through the implementation of interorganizational business process standards (Bala & Venkatesh, 2017 ). Moreover, another study presented reactions of employees to digitally enabled work events and how digital technology affects employees ‘emotions (Beare et al., 2020 ). Lilly and Durr ( 2012 ), discussed the effect of implementing new technology on increasing the anxiety and stress among employees. Similarly, employees’ reactions towards technological change implemented in a bank were analyzed (Vakola, 2016 ).

Outcomes of micro-level reactions to organizational change

The change reaction leads to many outcomes and at different organizational levels. The range of literature examining employees' reaction to change is wide. Furthermore, the results of the literature review identified four vital categories: Voice behavior, exit behavior, neglect behavior, and loyalty behavior.

Individual voice behavior

Voice behavior is a type of organizational citizenship behavior differs from altruism, conscientiousness, and sportsmanship because such behavior is costly (Chou & Barron, 2016 ). Voice behavior is discussing problems with the administrator or staff, suggesting solutions, solve problems, and whistleblowing (Farrell & Rusbult, 1992 ). There is a high perceived risk of employee voice behavior. Nevertheless, organizations invest in voice behavior to make efficient management decisions and solve problems (Akhtar et al., 2016 ). The change literature has shown one of the consequences of change reactions is the voice behavior (Abdullah et al., 2021 ; Barner, 2008 ; Svendsen & Joensson, 2016 ). According to Ng and Feldman ( 2012 ) the higher employee voice behavior increases creativity, performance, exploration, and exploitation of ideas. Therefore, the voice behavior reduces anxiety and fatigue of individual toward organizational change. Previous literature has demonstrated voice behavior due to change increases employee turnover (Bala & Venkatesh, 2017 ). Individual voice behavior leads to undesirable results. In this context, change affects the social exchange and social relations between employees. Hence, organizational change reduces the quality of social exchange. Employees feel unappreciated and involved, which increases resistance to change (Zellars & Tepper, 2003 ). From a psychological perspective, the reaction to change is crucial for employees to express their opinions (Bhatti et al., 2020 ). Therefore, the voice behavior should be considered as a positive behavior that solves problems rather than identifying them (Whiting et al., 2012 ).

Individual exit behavior

Exit behavior is transferring, thinking about quitting, searching for a different job, and sabotage (Farrell & Rusbult, 1992 ). Most of the literature on reactions to change confirmed the main reason for employees to exit work is change (Akhtar et al., 2016 ; Bryant, 2006 ; Šedžiuvienė & Vveinhardt, 2018 ). However, there are two types of exit behavior, vertical and horizontal. Vertical mobility is moving upwards in the same organization. Horizontal mobility is the employee’s turnover of the organization (Davis & Luthans, 1988 ). Many firms view employee turnover negatively. The literature confirmed the employee turnover can be positive because it renews blood and increases the recruitment of skilled human resources (Elfenbein & Knott, 2015 ). Negative change reactions cause an increase in employee turnover. In this context, many human resources are transferred to other organizations. Such human resources bringing with them competitive advantages that increase innovation and creativity (Walk & Handy, 2018 ). Therefore, the literature confirms organizational inertia reduces organizational development. Hence, turnover allows work to correct organizational errors and provides further improvement for tasks (Piderit, 2000 ). Horizontal mobility due to change reduces organizational loyalty of employees caused by increased desire to search for new work (Carnall, 1986 ). In conclusion the reactions to organizational change contribute to the withdrawal of employees from the organization. However, employee turnover may promote to superior performance.

Individual neglect behavior

The literature indicates that one of the outcomes of micro-level reactions to organizational change is neglectful behavior (Akhtar et al., 2016 ). Employees who experience negative reactions to change contribute less organizational effort (Vantilborgh, 2015 ). Hence, individual neglect behavior is chronic lateness, reduced interest, increased error rate, and using firm time for personal business (Farrell & Rusbult, 1992 ). The change increases uncertainty due to several employees loses their jobs and positions. In this context, many employees underestimate the seriousness of their work (Svendsen & Joensson, 2016 ). Previous studies on organizational change have argued employees' reactions to change are a decisive factor in reducing efforts, decreasing work quality, and increasing absenteeism (Chou & Barron, 2016 ; Withey & Cooper, 1989 ). Therefore, negative reactions to change are negatively related to the time spent by the employee and the efforts made at work (Alnoor et al., 2022 ; McLarty et al., 2021 ).

Individual loyalty behavior

Loyalty behavior is waiting and hoping for improvement, giving support to the organization, being a good soldier, and trusting the organization to do the right thing (Farrell & Rusbult, 1992 ). Organizational change that maintains working relationships and psychological contracts with employees is likely to increase the strength of individuals’ loyalty due to the rule of reciprocity (Davis & Luthans, 1988 ). Individual realization that organizational change fulfills organizational commitment to individuals, strengthens the relationship amongst the organization and the individual (McElroy & Morrow, 2010 ). Negative employee reactions to change reduce individual loyalty (Constantino et al., 2021 ). Individual loyalty is the employee's readiness to maintain affiliation in the organization by giving attention to the goals and values of the organization (Aljayi et al., 2016 ). Individual loyalty receives outstanding consideration in the change literature because individual reactions to change can be a fundamental determinant of individual loyalty to the organization (Akhtar et al., 2016 ). Hence, job satisfaction and a positive reaction to change increase the emotional and mental connection of individuals to the organization (Milton et al., 2020 ).

Macro-level reactions

Antecedents of macro-level reactions.

This category included 40 research articles, which discuss macro-level related aspects of reactions towards organizational change. In this category, the research articles consider aspects the antecedents of macro-level reactions. Major topics are (1) Organizational emotional, cognitive, and behavioral, (2) Organizational communication, (3) Leadership style, (4) Organizational attitude, (5) Organizational openness to change, and (6) Organizational information systems.

Organizational emotional, cognitive, and behavioral

Organizational reactions towards organizational change are informed by emotional, cognitive, and behavioral therapy of strategic changes such as mergers and strategic alliance. Strategic mergers can influence stakeholders’ decisions, which may result into negative reactions towards such merger (Basinger & Peterson, 2008 ; Bowes, 1981 ). This negative reaction is expressed through heightened anxiety levels and reduced emotional attachment (Rafferty and Jimmieson, 2010 ). Such a strategic change can lead to organizational exit (Schilling et al., 2012 ). Moreover, the effect of changes introduced by cross-border processes on organizational reactions was studied and it was found that there is an effect of dynamic cultures on organizational reactions towards change (Chung et al., 2014 ; Khaw et al., 2022 ).

Organizational communication

The second set of studies discusses reactions to organizational change regarding organizational communication. The lack of organizational communication caused organizational imbalances that negatively affected reactions towards organizational change in a way that tends to follow negative reactions such as an exit (Kruglanski et al., 2007 ). Weakness in organizational communication caused tension among employees and resulted into negative reactions towards change (Li et al., 2021 ). In this context, numerous environmental changes and crises have led to weak organizational communication during the change. For example, the recent Covid-19 pandemic that caused many barriers in organizational communication (Milton et al., 2020 ). Hence, when there is an abrupt change due to unexpected circumstances the organizational negative reactions would be increased towards change due to the lack of organizational communication (Fadhil et al., 2021 ).

Transformational leaders’ reactions are affected by organizational change in a way that enhances their readiness for change and motivates them for increased participation and performance to support change (Faupel, & Süß, 2019 ). It was also found transformational leaders and their reactions are significantly related to change. Transformational leaders are committed and willing to bring change and react in a way to defuse resistance to change (Peng, et al., 2020 ). Transformational leadership facilitates a successful implementation of a change (Islam et al., 2021 ; Thomson et al., 2016 ). There is an influence of transformational leaders in supporting the change processes which commensurate with their positive reactions towards change (Bayraktar & Jiménez, 2020 ). Transformational leaders play an important role in shaping positive reactions towards organizational change and supporting the changes process (Busari et al., 2019 ). On the other hand, the success of a change process depends on leaders’ competency in inducing change, and transactional leadership can provide such competency. Transactional leadership encourages critical thinking and participation to ensure success of a change process (Khan, et al., 2018 ). As transactional leadership is supportive to change, it is helpful to reduce resistance to change (Oreg & Berson, 2011 ). Therefore, managers use their authority to support organizational change (Tyler & De Cremer, 2005 ). Organizational confidence in managers is a critical factor that generates positive managerial reactions towards organizational change (Du et al., 2020 ; Harley et al., 2006 ). However, change may generate negative managerial reactions of non-acceptance of change (Huy et al., 2014 ). The magnitude of managers response and their reactions depends on the degree and intensity of a change (Bryant, 2006 ).

Organizational attitude

There is an agreement between leadership and organizational change such that organizational attitude is employed in a way that reflects positive reactions towards organizational change (Fugate, 2012 ). It was found that, acceptance or rejection of change depends on the existing organizational attitude and measures taken to implement change (Bin Mat Zin, 2009 ). Hence, organizational wellness is positively related to the ability to deal with change. Moreover, leaders provide insight about how change affects the organization’s procedures, and this may help to overcome resistance to change (Alfes et al., 2019 ). Although change is inevitable, individuals struggle with change when their vision is unclear, which causes turmoil and increased anxiety. Additionally, individuals find it difficult to engage in organizational change when the organizational policies develop feelings of fear among individuals, and this causes resistance to change (Blom, 2018 ). Firms’ responses to organizational change requires confidence and adaptation necessary to engage with change, and this depends on the self-evaluation and the extent of accept the changes. Therefore, leaders highlight the change and call for a commitment to it (Judge & Kammeyer-Mueller, 2011 ; Rizzuto et al., 2014 ). Reactions towards change are dependent on firms' belief about change. Organizational actions and beliefs induce constructive change (Vakola et al., 2013 ).

Organizational openness to change

The literature found reactions pose a challenge for organization towards change when there is a lack of organizational openness to change. Therefore, employees have negative reactions towards change, while leaders have positive reactions that support the change process and help to get change accepted (Walk & Handy, 2018 ). Individual employees understand that change can create a complex situation, which can give rise to issues for employees, and they refute change. In contrast, leaders perceive change as beneficial to the organization and they support it. Leaders see change as one major requirement for the development of organization. Therefore, they encourage openness to change. Whereas individual employees are not opened to change because they perceive change will create organizational instability. Leaders encourage organizational activities, which facilitate change. In contrast, individuals express lower level of openness and acceptance to change (Rechter & Sverdlik, 2016 ). Leaders see the attainment of organizational and personal goal through change. Contrary to this, the lack of opened to accept change create incompatibility between the organizational goals and the change initiative (Roczniewska & Higgins, 2019 ). Explicit reactions to change can be interpreted in many ways, some of which involve the benefits of change, while others are related to the negative consequences of change (Oreg et al., 2011 ). Thus, employees do not show a stronger commitment to accept change, but leaders tend to understand a change (Mangundjaya et al., 2015 ).

Organizational information systems

Organizational information systems are a vital and significant resource for companies. Consequently, the huge development in information and communication systems led to taking proactive steps towards adopting innovative and modern technology (Hadid & Al-Sayed, 2021 ). The adoption of modern information systems has contributed to increasing organizational anxiety due to fear of change (Paterson & Cary, 2002 ). However, interest in new technology development by companies increases the potential for long-term downtime. Therefore, context conditions must be created to encourage organizational changes (Walk & Handy, 2018 ). Digital technologies have penetrated companies tremendously and rapidly. Rapid technological changes have transformed organizational work designs by increasing flexibility and empowerment (Beare et al., 2020 ). However, digital technologies have negatively affected the organization by not separating personal and work life (Chen & Karahanna, 2014 ). Digital technologies have created enormous social challenges through the constant bombardment of social media messages and emails (Vakola, 2016 ). Therefore, the working hours of employees have increased because they are sometimes obligated to respond. Furthermore, organizational information systems enhanced emotional reactions by increasing feelings of anger, unhappiness, and frustration (Andrade & Ariely, 2009 ).

In conclusion, the level-specific study offers an examination of the antecedents, associations, and implications of reactions to organizational change at the individual and organizational level. However, multilevel theories, methods, and analyses have gained popularity in recent years (Walk & Handy, 2018 ), and the reactions to organizational change have been studied in this manner. Several studies examine how reactions to organizational change operates across levels, while others use cross-level designs to examine how reactions to organizational change is concurrently influenced by variables at different levels. Exemplary studies for both kinds are discussed below and are arranged according to the main predictor variable (or variables) from the preceding categories.

Outcomes of macro-level reactions to organizational change

The change reaction indicates to various consequences at macro-level. Hence, the frequency of macro-level reactions to change, relating to the reaction typology suggested by Akhtar et al. ( 2016 ). Apart from voice, exit, loyalty, and neglect, we added social identity as the most frequently mentioned reaction type at the macro level.

Organizational voice

A positive organizational change results into a voice behavior where employees accept organizational change (Barner, 2008 ). However, change is without organizational support led in negative voice behavior such as employees’ resistance (Peachey & Bruening, 2012 ). Directing organizations has the enormous leadership task of listening to the voices of managers and employees about strategies for change (O'Neill & Lenn, 1995 ). The literature indicates responses to change, such as organizational voice behavior, leave managers stuck between fear of the future and respect for the past (Stylianou et al., 2019 ). Organizational voice behavior affects the professional and personal lives of managers and employees. Consequently, the practice of organizational changes causes the loss of many jobs, which is reflected on the feelings of managers and employees and causes ridicule, anger, anxiety, resentment, and organizational surrender (O'Neill & Lenn, 1995 ). Organizational voices due to change exacerbate organizational problems because of constant blaming of the chief executive officer. Organizational concerns are heightened by the difficulty of expressing opinions. In this context, organizational voices turn into sources of organizational mopping throughout the organization except perhaps the chief executive office (Barner, 2008 ). As a result, the negative reactions cause feelings of organizational anger and anxiety by increasing the difficulty of articulate the organizational voice.

Organizational exit

The literature shows negative reactions to change increase workplace bullying (Barner, 2008 ; Peachey & Bruening, 2012 ). Thus, reactions to organizational procedures encourage behavioral responses to organizational exit (Akhtar et al., 2016 ). Negative responses to organizational change are likely to be stronger in the exit behavior comparative with voice behavior (Balabanova et al., 2019 ). Because exit behavior is an assertive reaction that is associated with change and is not bound by organizational conditions (Farrell & Rusbult, 1992 ). Hence, exit behavior is risky because such behavior increases organizational disruption and stimulates harmful work behavior (Ng et al., 2014 ). Unexpected change leads to the organization's exit from the entrepreneurial work. In this context, organizations leave the entrepreneurial profession. Exiting creative and entrepreneurial businesses affects the company and the economy in general (Shahid and Kundi, 2021b ). Negative reactions to change reduces motivation and self-efficacy, which increases organizational fatigue, impedes the implementation of organizational tasks, and causes exit (Surdu et al., 2018 ).

Organizational loyalty

Panchal and Catwright ( 2001 ) argued that organizational change is a complex process that makes it difficult for employees to accept such a process. Because routine work and many tasks affect change. Employees are significantly affected by frequent organizational change and are reflected in the practice of exit and neglect behaviors and low level of loyalty (Akhtar et al., 2016 ). Adopting successful organizational change increases positive reactions. However, most of the change literature confirms numerous change programs erupt and increase the negative reactions that occur through the practice of neglectful behaviors and lack of organizational loyalty (Bartunek et al., 2006 ). Organizational change increases stress, decreases commitment, and decreases loyalty. Frequent and ineffective changes produce negative responses and cause a decrease in job security. Consequently, the organization will suffer from low loyalty (Guzzo et al., 1994 ). Organizational loyalty decreases due to frequent changes lead to employees rethinking that continuing in this organization is not beneficial (Reiss et al., 2019 ). Such changes create uncertainty and cause organizational mopping (Constantino et al., 2021 ). Organizational change is a critical cause of low loyalty because inefficient changes increase negative organizational perceptions regarding social atmosphere, perceived promise, job content, and rewards (Van der Smissen et al., 2013 ). Therefore, increased negative reactions to change due to frequent and ineffective changes raises organizational perceptions of low loyalty and decreases organizational loyalty.

Organizational neglect

Hirschman ( 1970 ) proposed the employees' enactment of exit, voice, loyalty, and neglect model and was expanded by (Farrell, 1983 ; Rusbult et al., 1988 ). The employees' enactment of exit, voice, loyalty, and neglect model refer the decline of the organization creates many negative reactions that increase the deterioration in performance and reduce efficiency and learning, involving exit, voice, loyalty, and neglect. Reactions contributes to identifying failures and correcting tracks. Therefore, adverse behaviors assist the organization to deal with unfavorable situations, because the behavior of neglect and tardiness for work represents a communication strategy for the members of the organization (Meyers, 2020 ). Organizational neglect represents dishonorable behavior and organizational leniency. Organizational neglect behaviors include reduced attention and delay, reduced effort, increased absenteeism, increased error rates, and concern for personal issues at work (Lee & Varon, 2020 ). Unsuccessful organizational change is a major source of social loafing. Social loafing is the tendency of people to neglect work (Murphy et al., 2003 ). Thus, the reactions of employees at the organizational level contribute to reducing performance and increasing organizational failure (Abbas et al., 2021a ; Akhtar et al., 2016 ).

Social identity

A fantastic reaction is generated by the members of the organization to protect and prove the social identity of the organization. Therefore, managing stability is as important as managing change in the context of social identity (Dutton et al., 1994 ). Organizational change affects some basic features of employees’ social identity, which leads to an imbalance in reactions towards change and causes uncertainty among individuals (Jacobs et al., 2008 ). The intense reactions of the members of the organization highlight the importance of organizational identity. Social identity is useful to understand and analyze reactions to deal positively with organizational change. For example, a weak social identity may lead to a negative reaction towards organizational change, such as disloyalty. Flexible social identity helps to give a quick response to organizational change and facilitates an anticipation of reactions towards change (Aggerholm, 2014 ). The success of organizational change and positive reaction is linked to the recognition of organizational identity based on the intention to remain in the organization and job satisfaction. Developing social identity in change programs reduces negative reactions to change (Clark et al., 2010 ). Łupina-Wegener et al. ( 2015 ) argued shared identity positively influences employees' perceptions of accepting change. Because the shared identity stimulates the transfer of organizational practices between units and departments after the post-change. Therefore, the organization must give employees a sense of continuity for the organization's bright future to practice transferring positive behaviors after implementing change programs (Jacobs et al., 2008 ).

Research issues and challenges

Previous research on reactions to organizational change is subject to several methodological issues and challenges. In the following, we asses methodological issues relating to research design, sector, country, research sample, techniques, and variables (Table 1 ). Compared to a multitude of other management subjects, research on reactions to organizational change shows both its strengths and limitations. Furthermore, it seems that similar problems are relevant at different levels of analysis. To a certain extent, a reaction to organizational change literature advances systematically, while other subject areas have not progressed as much.

Reactions to organizational change as a multidimensional construct

Evidence has collected that a five-factor multi-indicator CFA model fits Akhtar et al. ( 2016 ) and Van Dick et al. ( 2018 ) reactions to organizational change measure at the individual levels of analysis (e.g., Exit, neglect, loyalty, voice, and social identity). Using first-order CFA, Akhtar et al. ( 2016 ) found an “modest fit” with one sample. Elsewhere, both Bryant ( 2006 ) and Šedžiuvienė and Vveinhardt ( 2018 ) found satisfactory fit for a two-factor (i.e., Exit and voice) latent model. Divergent validity of the five-dimensional reactions to organizational change scale was shown by Akhtar et al. ( 2016 ) who discovered that it was different from a single order factor. It should be noted that in addition to obtaining evidence supporting the discriminant validity of the reactions to organizational change dimensions from negative affectivity, job satisfaction, and psychological climate Van Dick et al. ( 2018 ) examined the relationships between social identity and voice behavior. Researcher Aggerholm ( 2014 ) was able to show the discriminant and convergent validity of reactions to organizational change, namely, the capacity to increase organizational misbehavior, working relationship with a supervisor, decrease trust in one's supervisor, and work performance, with unrespect to work engagement and job satisfaction.

There has been relatively little team-level CFA work done as compared to work done at the individual level. It should be clear that this fact comes from the truth that it is very difficult to sample enough teams to do studies for this kind of analyses. Although CFA models have been applied to the Walk and Handy ( 2018 ) individual and organizational outcomes but without respect multilevel model. This produces a discontinuity between the amount of investigation and the amount of theory used (Maynard et al., 2012 ). While we believe this is a promising approach, we encourage researchers to use multilevel CFA methods when conducting analyses that seek to elucidate the construct validity of aggregate variables, with the goal of the study being the total number of teams in the focus population. Concurrently, there is no published research on whether two- and four-dimensional forms of reactions to organizational change provide equivalent criterion-related validity. Here, future studies could compare the two measures, determine whether there are important changes between the various versions, and investigate if the various conceptualizations maintain validity and stability through time and cultures by respecting the assessment of measurement model. In addition, we think that these problems offer valuable topics for future study. In this context, there was vital issue which is related to assessment of structural model. Moreover, there is no study combination of structural equation modeling and artificial neural network. Hence, they did not consider the two mains of benefits the combination of structural equation modeling and artificial neural network is that the use of multi-analytical two-phases SEM–ANN method tool up two vital benefits. First, it allows for further validation of the SEM analysis findings. Second, this approach captures not just linear but also dynamic nonlinear interactions between antecedents and dependent variables and a more accurate measure of each predictor's relative power as well. Furthermore, the potential future work can use SEM-ANN model to determine the reactions to organizational change by adopting multilevel model.

Mono-method issues

At the individual and team levels, most research done on reactions to organizational change consists of questionnaires asking workers about antecedents, correlates, and consequences of such reactions. Any common measurement or percept-percept biases will increase observed associations (Maynard et al., 2012 ). These biases are intensified if both variables are measured at the same time. Three percent of the individual-level research utilized a different source, whereas 97 percent used self-reported criteria measures. Individual-level reactions to organizational change are more likely to be biased by monothiol bias, resulting in inflated correlations, while team-level relationships are less likely to be distorted by monothiol bias. In keeping with this result, Mangundjaya et al. ( 2015 ) showed that task performance correlated more strongly with the reactions of individuals when responses were obtained through self-report measures than when responses were collected by other means. Reactions to organizational change have been operationalized in different ways throughout the literature at each level of study. Reactions to organizational change, as measured and studied at both the individual and team levels, are each shown in the literature as being in two-dimensional, four-dimensional, and aggregated forms. However, yet, there has been no study to account for the disparate measuring methods that may influence the correlations shown in studies like this. Therefore, we believe future studies should examine how measuring approaches influence such correlations.

Mediator and moderator inferences

As mentioned before and shown in Fig.  2 , reactions to organizational change are usually regarded as a mediator between the characteristics of people and environments and outcomes, regardless of the substantive level of study. The validity of mediational effects is contingent on a variety of variables, most notably the accuracy of the assumed causal chain connecting antecedents to reactions to organizational change and to outcomes (Chung et al., 2014 ; Li et al., 2021 ). As shown in the contribution section, 49% of individual-level studies and 16% of team-level studies used cross-sectional designs. The studies conducted so far have shown nothing in the way of causation or association between organizational change and reactions at the level of analysis. Additional work exploring how direct impacts are mediated and/or studying variables that may mitigate such direct effects appears to hold across different levels of analysis in which reactions to organizational change have been examined. Researchers to date have mostly examined things that serve as antecedents to reactions and results that are influenced by reactions to organizational change. According to the authors of the paper Walk and Handy ( 2018 ), job crafting acts as a mediator in explaining the connection between the perceived effect of change and people's reactions to organizational change. Hence, there are many additional possible mediators that have not yet been studied. In fact, the few research that investigate how specific connections within the reactions to organizational change influence other possible moderators are found at different levels of analysis. And thus, we believe that it is the appropriate moment for those interested in the influences that mediate and moderate reactions to organizational change to investigate many facets that are intricately intertwined in these responses.

Research design

Research design refers to a general strategy chosen to integrate various components of a study in a coherent and logical manner. It is always challenging to choose an appropriate research design because sometimes a chosen design does not align with the data. For example, a longitudinal design often used in qualitative studies can be time consuming due to nature of data (Bayraktar & Jiménez, 2020 ; Faupel & Süß, 2019 ; Liu & Zhang, 2019 ). Similarly, the descriptive design may not generate the required results due to inability to control the tendencies of the individuals involved in data collection (Barner, 2008 ; Bin Mat Zin, 2009 ). Some of the studies that have been covered focus on cross-sectional or one-way design, but they are not generalizable because they may be biased (Vakola et al., 2013 ). In addition, future studies should use longitudinal designs that allow tracking of changes at organizational levels and aim to collect data from multiple sources (Barner, 2008 ; Chung et al., 2014 ; Fournier et al., 2021 ; Kashefi et al., 2012 ; Oreg et al., 2011 ), while other studies called to follow the method of interviews that extract information and provide insight into the nature of change processes in organizations (Jacobs & Keegan, 2018 ; Saunders & Thornhill, 2011 ). An improved understanding of the long-term consequences of organizational transformation might enhance the reactions to such studies. Gerwin ( 1999 ) proposed managers could empower teams throughout the life cycle, for example, while the teams are forming, maturing, and growing. According to Gerwin ( 1999 ), organizational change may take place as a cycle, and it is the role of reactions to these changes to push the cycle in one direction or another.

The sector refers to research site where the study is to be conducted and can be public or private organization as per the study requirements. Choosing a public sector as study site may be problematic for change related studies because public sector employees resist change and can generate biasness in responses (Borges & Quintas, 2020 ; Kennedy-Clark, 2010 ; Santos Policarpo et al., 2018 ; Milton et al., 2020 ). Studies conducted in industrial organizations do not allow generalization of the results because these organizations require changes in terms of organizational structures, strategy, and operating procedures, but they are not on a large scale. Thus, results could not be generalized, and such studies should be conducted in other organizations (Mangundjaya et al., 2015 ). Studies in service sector (hotels, hospitals) give great importance to adopting actual change (Hatjidis & Parker, 2017 ). As a result, it must be considered when generalizing to all other service organizations, as there may be fundamental differences between organizations. Future research should focus on other service sectors such as banking (Vakola, 2016 ). Regarding security issues, the effect of the organizational identity on the change processes of national security institutions has been verified, and the results of these studies cannot be generalized because the changes that are made may lead to imbalances with the organizational culture in other organizations (Belschak et al., 2020 ; Jacobs et al., 2008 ). In addition, researchers can focus on industrial companies such as technological industries, digital technologies, wired and wireless communication companies (Tang & Gao, 2012 ).

Countries differ from one another in many ways. Hence, the result of a study conducted in one country may not be generalized to other countries. Similarly, economic, social, and political restrictions among countries may reduce the possibility of generalization of research findings across countries (Fournier et al., 2021 ; Lines et al., 2015 ; Tang & Gao, 2012 ). Some studies focused on one country without considering the role of the social and political factors of other countries, Therefore, the results of these studies cannot be generalized to other countries (Kashefi et al., 2012 ; Mangundjaya et al., 2015 ). As a result, future studies are encouraged to use data from other countries to conduct comparative analyzes, which may allow generalization (Fournier et al., 2021 ; Straatmann et al., 2016 ). A study of Blom ( 2018 ) in manufacturing industries of South Africa, which included a sample of companies interconnected with the parent company, and thus studied the opinions of employees from other countries. As for studies conducted in developing countries, their results are not generalizable, as the behavioral responses in these countries differ from those in European countries (Busari et al., 2019 ; Li et al., 2021 ). Consequently, the country differs in many ways in terms of productive and social capabilities, and this may be a limitation in several countries (Huy et al., 2014 ; McElroy & Morrow, 2010 ).

Research sample

A sample represents a component of population chosen to provide the required data. There is problem when sample size is too small to generalize the result to larger population (Šedžiuvienė & Vveinhardt, 2018 ; Yan & Jacobs, 2008 ). Similarly, a larger sample may provide the data which may not be relevant to the study objectives (Rizzuto et al., 2014 ; Stensaker & Meyer, 2012 ). Most of the studies discussed focused on collecting data from individuals working in different organizations. However, there is a strong tendency to conduct more studies that enable data collection in other contexts to highlight the roles of leaders and managers to participate in providing support for change processes (Antonacopoulou & Gabriel, 2001 ; Barner, 2008 ; Jacobs & Keegan, 2018 ). Moreover, the choice of the sample determines the fate of the study, whether it is possible to generalize or not. The larger sample size, the greater the possibility of generalization (Šedžiuvienė and Vveinhardt, 2018 ; Yan and Jacobs, 2008 ). Sample selection was problematic during the pandemic period because there were difficulties in collecting data and accessing responses (Li et al., 2021 ). In addition, some authors have dealt with specific groups in state-owned organizations, but such studies were hard to generalize as they need more verification and other opinions to prevent bias (Lines et al., 2015 ). More studies shed light on urging researchers to survey the opinions of users and beneficiaries at all organizational levels to reach the results. The researchers were also urged to take into consideration the age composition of the polarized sample before embarking on organizational change initiatives (McElroy & Morrow, 2010 ).

Among the other challenges that some studies faces are the choice of statistical methods to analyze the data because the chosen methods may be not suitable for data and the results are less convincing (Bin Mat Zin, 2009 ; Chung et al., 2014 ). Many researchers have used exploratory studies, which are of great importance in drawing conclusions. However, previous studies focused on use such design in one context and limits the possibility of generalization (Jacobs & Keegan, 2018 ; Vakola et al., 2013 ). Researchers also used interviews for a specific number of employees, which caused biasness in reactions (Jacobs & Keegan, 2018 ; Saunders & Thornhill, 2011 ). Therefore, focusing on other methods such as observation to see the impact of reactions to change will provide motivational cases and ideas worth sharing (Kruglanski et al., 2007 ). Some studies used structural equation modeling, which revealed the suitability of this technique for experimental research (Borges & Quintas, 2020 ; Faupel & Süß, 2019 ; Gardner et al., 1987 ). Likewise, some studies used a questionnaire and performed analysis, such as multiple regression and content analysis, which is considered a qualitative method in analyzing data and interpreting its meaning and provides an opportunity for researchers to choose different issues (Alas, 2007 ; Busari et al., 2019 ; Chung et al., 2014 ; Tavakoli, 2010 ). Although these analyses have proven their worth in extracting results, it requires researchers to use deep statistical analysis to reach generalizable results (Hatjidis & Parker, 2017 ; Huy et al., 2014 ). The researchers urged for future studies to use surveys and conduct comparative analysis between groups that would reduce time bias in the data (McElroy & Morrow, 2010 ).

The selection of incorrect variables may generate the biased result, or the variables may not be able to sufficiently serve the purpose of study and researchers need to add more variable to get rich data (Albrecht et al., 2020 ; Tyler & De Cremer, 2005 ). Table 1 . Explain the issues and challenges of reactions organizational change in this regard. One of the limitations that some studies faced is they did not examine the personal characteristics of individuals, such as the influence of traits and the role of personality in directing reactions, as individuals with a high degree of negative influence of traits tend to follow the opposite reactions, neglecting this aspect may cause bias (Huy et al., 2014 ). It was also noted the studies discussed focused on the pace of change and trust in management and still there is necessity to discuss other variables that are highly related to change such as organizational culture, employee communication, commitment, fairness, job characteristics, resistance to change, psychological context, individual incentives, and anxiety of change (Busari et al., 2019 ; Lines et al., 2015 ; Oreg et al., 2011 ). Given the behavioral aspect is very important in human studies, addressing the use of behavioral support for organizational performance contributes to improving the reaction to change processes (Fournier et al., 2021 ). Moreover, considering technological development and intense competition between current organizations, the use of management information system will reduce behavioral and organizational problems (Dickson & Simmons, 1970 ). Researchers called for attention to the problem of studying the planned organizational change on a large scale in a place where employees do not have a voice, and the opportunities for participation are limited and the resistance to change is extreme (Fugate, 2012 ; Jacobs & Keegan, 2018 ). As a result, the changing organizations face huge challenges and spend massive amounts of resources on training and developing their employees (Antonacopoulou & Gabriel, 2001 ).

Benefits of (Even Negative) reactions to organizational change

The purpose of this systematic review is to expand theory and the understanding on reactions to organizational change by incorporating ideas from several disciplines (e.g., psychology, sociology, complexity sciences, and institutional perspectives). Many studies on organizational change reactions have concentrated on the causes or outcomes of these reactions, with a specific focus on resistance and, therefore, rather negative outcomes. Organizational change is often a necessity caused by external threats, such as intense competition (Oreg et al., 2011 ; Tavakoli, 2010 ). To implement change, the cooperation of employees is required (Antonacopoulou & Gabriel, 2001 ; Hatjidis & Parker, 2017 ; Peng et al., 2020 ). However, a mixture of psychological, social, emotional, and cultural dimensions in employees’ reactions can negatively interfere with the process of organizational change itself (Armenakis & Harris, 2009 ).

In this section, we attempt to change this perspective and, based on the findings in Sect. 3.1, formulate several propositions, which may enable organizations to overcome negative reactions and transform them into positive change outcomes. Basically, we argue that (1) negative reactions can be seen as a source of constructive criticism, (2) which can be used to improve the change process. Employees can be viewed as a critical authority in an organization, which might evoke new perspectives on the change process. The provided constructive criticism points to issues that require further attention by the organization. The antecedents, process, and outcomes of the change process are more thoroughly analyzed regarding possible weaknesses and strengths, which can improve the whole change process (Fournier et al., 2021 ; Straatmann et al., 2016 ). In particular, this encourages those in charge to address shortcomings and help facilitate change processes (Jacobs & Keegan, 2018 ). It can also help increase communication between members of the organization during various stages of organizational change (Li et al., 2021 ). Listening to employees’ objections might reduce the complexity of change (Chung et al., 2014 ; Fugate, 2012 ; Reiss et al., 2019 ) and can motivate and empower them to contribute to the success of change processes (Casey et al., 1997 ; Kruglanski et al., 2007 ; Tavakoli, 2010 ).

Theoretical recommendation

The results of this review revealed several critical variables and factors that had been investigated in previous research on change responses. There are many challenges and benefits that academics should take into consideration. Hence, understanding the negative and positive effects of change reactions can be an essential key concept to the successful implementation of organizational change. The results of an extensive literature review show allowing human resources to participate and rush into change programs increases the likelihood of successful implementation of planned and unplanned change. The leadership style has a strong and significant role in adopting change. Theoretically, the literature has proven the transformational and transactional leadership style are vital leadership styles that raise positive reactions to organizational change (e.g., Bayraktar & Jiménez, 2020 ; Busari et al., 2019 ; Faupel, & Süß, 2019 ; Khan, et al., 2018 ; Oreg & Berson, 2011 ; Peng, et al., 2020 ; Thomson et al., 2016 ). The leadership aspect is of fantastic importance in the success of implementing change because the leader has ability to inspire employees towards increasing levels of motivation and deliver the message of change with the lowest level of negative reactions. Because leadership styles achieve mutual gain between individuals by giving individuals a sense of power to adjust or accept the changes that occur in the organization. This review expanded the communication's vision of change by identifying reactions in four integrated behaviors (i.e., Exit, voice, loyalty, and neglect) that explain why individuals reject, resist, accept and embrace change.

Understanding reactions to change plays a critical role in enhancing individuals' cognitive, emotional experiences, and perceptions of changes. The results of this study shed light on the implementation of change during crises. The results prove epidemics and sudden consequences lead to lack of resources and loss of market share. There is huge benefit in adopting and responding to change programs amid crises, especially in the aftermath of unexpected crises, such as the COVID-19. Although crises add a significant burden to organizations in implementing change, it is necessary to face crises with a fantastic deal of courage, confidence, and communication to reduce exit reactions and disloyalty amongst employees. Supporting human resources and creating a work context with less organizational mopping leads to positive results and increases the success of organizational change adoption (Barner, 2008 ; Qin et al., 2019 ). Adopting organizational change is an emotional process based on individuals' feelings and perceptions of change. Organizational change causes high levels of anxiety and tension. Because the individual adversely interferes with aspects of organizational change in a manner that creates the feeling of anxiety increased and loss of identity. However, reactions to organizational change are varied and may be positive by increasing job satisfaction and granting of responsibility. In this context, the reactions toward change may be negative also by increasing the likelihood of unsuitability of change with the organizational work. Furthermore, academics and practitioners should be concerned with the sensory and emotional aspects of how individuals react to organizational change. Because the organizational changes that include providing importance to the emotions and feelings of staff as part of the change process can encourage employees to change the attitude towards change and cooperate with current events (Beare et al., 2020 ).

Organizational communication is important for understanding people's emotions and perceptions of change. Communication before and post organizational change provides people with suitable and timely information, creates a sense of delegation of responsibility for change, and mitigates negative responses to organizational change (e.g., Basinger & Peterson, 2008 ). Academics can use the results of this review to understand change reactions from an organizational and individual perspective and to highlight challenges and barriers to implementing change. Analyzing and examining organizational elements such as organizational communication and organizational attitudes provides solutions while implementing change. Additionally, sharing responsibilities and integrating roles between participants in the change increases the results achieved from adopting organizational change. This review confirms there is a dearth of investigation into the influence of psychological context factors such as individual incentives, change anxiety, and organizational mopping on post change results at the individual and organizational level. Studying reactions to organizational change at different organizational levels contributes to identifying differences and similarities to reactions at multiple organizational levels. In this context, using the results of this review by academics and practitioners contributes to reducing negative reactions and increases the chances of successful implementation of change programs.

Many studies highlight the importance of change efforts in contemporary organizations to address external threats. However, employees’, i.e., change recipients’, cognitive and behavioral responses to change often result in resistance. A comprehensive perspective of past research is required to have a clear understanding of the causes and consequences of responses to change. For this reason, we have conducted a systematic literature review on this subject. Much of what has been discovered before may be categorized into these four levels: micro and macro level responses. An in-depth analysis of the literature helped identify the antecedents, effects, benefits, challenges, and recommendations associated with reactions to organizational change.

Our findings have managerial implications. Based on the literature review, we derive recommendations for change agents to facilitate the issues experienced by researchers whilst studying reactions to organizational change. Insights from our literature review highlighted both positive and negative aspects of reactions towards change. Accordingly, we divided these studies into two groups discussing positive and negative aspects. The positive aspects highlight the importance of reactions in supporting change and broadening the view of the motives for change (Armenakis & Harris, 2009 ; Gardner et al., 1987 ; Mangundjaya et al., 2015 ). This increases employees’ participation and positively affects their perceptions of change (Faupel & Süß, 2019 ; Straatmann et al., 2016 ; Paterson & Cary, 2002 ; Bin Mat Zin, 2009 ). In addition, there is a significant correlation between reactions, emotional commitment, self-respect, and optimism (Fugate & Kinicki, 2008 ; Liu & Zhang, 2019 ; Vakola, 2016 ), and this depends on administrative support to reduce the negative feelings towards change implementation. The stronger communication between individuals, the more it has a positive effect towards improving reactions to change (Tang & Gao, 2012 ). The leadership plays a big role in directing reactions by providing opportunities to participate in decision-making, build confidence, and give individuals compensation opportunities (Khan et al., 2018 ). Likewise, individuals’perception of change depends on their reactions and behaviors (Hatjidis & Parker, 2017 ; Rechter & Sverdlik, 2016 ; Saunders & Thornhill, 2011 ). As the human being consists of a group of elements (emotional, mental, spiritual, and physical), when one of these elements is disrupted, it affects the other elements, which requires equal attention to these elements in order have a coherence and non-conflicting reactions (Blom, 2018 ).

Negative feelings towards change can occur due to increased fear of losing jobs and lower level of employees’ participation in change process (Barner, 2008 ; Rizzuto et al., 2014 ). When thinking about change, resistance is often the first thing that comes to mind (Walk & Handy, 2018 ). This is because individuals think of change as a shock that inversely affect them to think of negative consequences of change and hence, they resist change or develop an uncertainty about change processes (Størseth, 2006 ). There is also a perception that a poorly planned or poorly implemented change initiatives, in a way that does not consider the organizational or social conditions of individuals, increase stress levels (Blom, 2018 ). Likewise, changes frequently conflict with the organizational identity, which creates an unpleasant impression on individuals, and this leads to distort the intended purpose of the change and exposes the organizational identity to danger (Mdletye et al., 2013 ). It is imperative for practitioners and researchers to adopt broader, more accurate, and positive perspectives on how reactions affect organizational change (Belschak et al., 2020 ; McElroy & Morrow, 2010 ). In addition, some contradictory reactions lead to the deterioration of an organization (Fugate, 2012 ; Ming-Chu & Meng-Hsiu, 2015 ). This is because individuals have resistance to change and ridicule change, which generates internal conflict that negatively affects organization work processes (Jacobs & Keegan, 2018 ; Mdletye et al., 2013 ; Tavakoli, 2010 ). This happens because employees see change as a threat to their survival in organization (Huy et al., 2014 ; Paterson & Cary, 2002 ).

Our findings suggest steps aimed at addressing reactions should be initiated early on in a change process, to prevent negative attitudes from escalating into a desire to leave the organization. Organizations should also be aware that employees’ beliefs about ongoing change play an important role in shaping their work engagement and turnover intentions. Carefully monitoring and managing collective beliefs about a change during the full implementation phase—for instance, through employee participation and careful and timely communication. Therefore, help to avoid a loss in change momentum. Facilitating the change process and reducing the social and organizational costs of change.

This study also shows the theoretical contributions of previous studies by contributing to the development of the context of reactions towards organizational change at the individual, collective, and leadership levels, and using many of the above-mentioned scales at each level, which helps in accurately determining the impact at each level towards organizational change. This study, through its multi-level approach, attempted to cover as much as possible the reasons that may promote positive or negative reactions towards organizational change smoothly, which have not been extensively examined in previous studies. The results of the study found that the reactions towards organizational change within the cognitive and behavioral response were affected differently at each of the levels. For example, at the individual level by influencing the emotional side of working individuals, which affects their perceptions and thus their cognitive response to change and their behavior in terms of dealing with it (Hatjidis and Parker, 2020; Borges & Quintas, 2020 ), as both negative perception and the stimulation of negative emotions have A clear effect on the resistance reactions to organizational change in general (Belschak et al., 2020 ). The micro level, based on the criteria for strategic change, the pandemic, social identity, and vocal behavior, showed the negative effects of resistance reactions to organizational change resulting in most cases from negative perceptions and negative emotions towards change (Li et al., 2021 ; Milton et al., 2020 ; Van et al., 2018). The macro level by reviewing the types of leadership and the way each of them affects the reactions towards organizational change, as transformational leadership and transactions, as well as the response of managers, showed a prominent positive role in reducing the standing towards organizational change, promoting it and participating in it (Faupel & Süß, 2019 ; Peng et al., 2020 ; Du et al., 2020 ). The macro levels depended on a set of important factors represented in education, human resources, explicit feedback, and self-evaluations. Organizational attitude is behind the disruption of positive and negative reactions based on individuals' perception of information in a positive or negative way, or rather in an optimistic or pessimistic manner (Roczniewska & Higgins, 2019 ). While the impact of human resources appears in the reactions towards organizational change, positively or negatively, depending on the system that has been adopted and the methods used to implement the change (Bin Mat Zin, 2009 ; Blom, 2018 ). The effect of explicit reactions appears depending on a rule from which individuals start in their behavior, which is the belief about change and a factor directing that behavior towards accepting change through the leader’s behavior as a role model to deal with change and clarifying the impact of change in the minds of individuals (Vakola et al., 2013 ). Finally, it seems that individuals' self-assessment about change is often based on the principle of maintaining the status quo and unwillingness to change, which shows resistance behavior (Rizzuto et al., 2014 ). Therefore, the study recommends in some variables for future research, which is the study of personality traits because there are some underlying factors of emotions and openness to change and other factors that may significantly affect reactions towards organizational change. It also recommends taking other types of leadership, for example, participatory leadership and knowing its impact in reactions.

The review also revealed research gaps to be addressed in future research. Regardless of the prevalence and value of reform initiatives in contemporary organizations, change initiatives often struggle to achieve desired goals. It has been argued employees are at the heart of the change initiative and major determinants of the degree to which any change will succeed. Despite many challenges, organizational change is relevant for firm survival and performance, which needs to be further investigated. Specific patterns can be drawn from different organization types where reactions towards organizational change have been studied. Further research gaps relate to the level of application, conceptual model, and sector. The literature made some recommendations to increase strategic performance as well as achieve marketing differentiation in addition to high customer satisfaction. This helps to reduce risks, respond to uncertainties and to achieve high flexibility under changing environmental conditions. These recommendations can address the challenges to organizational change and open more opportunities for future research. Because of the fierce competition, companies will continue to develop more sophisticated competitive advantages, and thus researchers must identify emerging trends and strategies of organizational change. Based on the research that is shown throughout this review, there is a wealth of work in different settings and at various levels of analysis that considers reactions to organizational change during the prior two decades.

The current study is not without some limitations like any other study. As the current study was limited to focusing on the leadership level on direct leadership instead of focusing on the leadership team, as the former appears as a representative of the interests of the organization and transfers its goals and defines tasks to working individuals, while the latter is concerned with clarifying the objectives and reasons behind the organizational change in a way that enhances acceptance of change and participation in it. by working individuals. In addition, when studying the variables that were adopted in the study and their impact on reactions to organizational change, that study did not control some of the variables that could have a very big role in explaining the nature of the results that were reached, which are individual differences and personal traits. Finally, the study neglects the cultural context, which often has a significant role in influencing the nature of the interrelationships between variables at the individual, collective, and leadership levels, and between the nature of reactions towards organizational change, which appears more clearly when the study sample is diverse in different countries able to reflect the nature of cultures change.

Data availability

The data of the paper, which support the analysis and results of this paper, are available with the corresponding author and the data can be obtained from the authors upon request.

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This work is funded by Universiti Sains Malaysia, Short Term Grant [Grant Number: 304/PMGT/6315513], for the Project entitled "The Efficiency of Variable Sampling Interval Scheme for the Multivariate Coefficient of Variation in Short Production Runs".

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Khaw, K.W., Alnoor, A., AL-Abrrow, H. et al. Reactions towards organizational change: a systematic literature review. Curr Psychol 42 , 19137–19160 (2023). https://doi.org/10.1007/s12144-022-03070-6

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An Agile Approach to Change Management

• Sarah Jensen Clayton

Six lessons on moving quickly under pressure.

In the wake of Covid-19, organizations are fundamentally rethinking their product and service portfolios, reinventing their supply chains, pursuing large-scale organizational restructuring and digital transformation, and rebuilding to correct systemic racism from the ground up. Traditional change management process won’t cut it. The author borrows from agile software development processes to reinvent the change management playbook.

The business world has arguably seen more disruption in the last nine months than in the last nine years, bringing new and urgent demand for change. Initiatives are being launched by the dozen, adoption can’t happen fast enough, and the stakes are higher than ever. In the midst of a Covid-induced recession, and with some industries on the brink of extinction, change isn’t about fine-tuning — it’s existential.

• Sarah Jensen Clayton is a senior partner with Korn Ferry. She works with leadership teams to define, align around, and activate enterprise and ecosystem change.

Partner Center

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

Published on 1.5.2024 in Vol 12 (2024)

Cross-Cutting mHealth Behavior Change Techniques to Support Treatment Adherence and Self-Management of Complex Medical Conditions: Systematic Review

Authors of this article:

• Cyd K Eaton 1 , PhD ; 
• Emma McWilliams 2 , BA ; 
• Dana Yablon 3 , BS ; 
• Irem Kesim 3 , BS ; 
• Renee Ge 3 , BS ; 
• Karissa Mirus 3 , MHSA ; 
• Takeera Sconiers 3 , BS ; 
• Alfred Donkoh 3 , BS ; 
• Melanie Lawrence 4 , BS ; 
• Cynthia George 5 , MSN ; 
• Mary Leigh Morrison 4 , MA ; 
• Emily Muther 6 , PhD ; 
• Gabriela R Oates 7 , PhD ; 
• Meghana Sathe 8 , MD ; 
• Gregory S Sawicki 2 , MD, MPH ; 
• Carolyn Snell 2 , PhD ; 
• Kristin Riekert 3 , PhD

1 Division of General Pediatrics, Department of Pediatrics, Johns Hopkins School of Medicine, , Baltimore, MD, , United States

2 Boston Children’s Hospital, Harvard Medical School, , Boston, MA, , United States

3 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, , Baltimore, MD, , United States

4 Success with Therapies Research Consortium CF Community Member Advisory Board, , Bethesda, MD, , United States

5 Cystic Fibrosis Foundation, , Bethesda, MD, , United States

6 Children’s Hospital Colorado, University of Colorado School of Medicine, , Aurora, CO, , United States

7 Division of Pediatric Pulmonary & Sleep Medicine, Preventive Medicine, University of Alabama at Birmingham, , Birmingham, AL, , United States

8 Children’s Health Dallas, University of Texas Southwestern Medical Center, , Dallas, TX, , United States

Corresponding Author:

Cyd K Eaton, PhD

Background: Mobile health (mHealth) interventions have immense potential to support disease self-management for people with complex medical conditions following treatment regimens that involve taking medicine and other self-management activities. However, there is no consensus on what discrete behavior change techniques (BCTs) should be used in an effective adherence and self-management–promoting mHealth solution for any chronic illness. Reviewing the extant literature to identify effective, cross-cutting BCTs in mHealth interventions for adherence and self-management promotion could help accelerate the development, evaluation, and dissemination of behavior change interventions with potential generalizability across complex medical conditions.

Objective: This study aimed to identify cross-cutting, mHealth-based BCTs to incorporate into effective mHealth adherence and self-management interventions for people with complex medical conditions, by systematically reviewing the literature across chronic medical conditions with similar adherence and self-management demands.

Methods: A registered systematic review was conducted to identify published evaluations of mHealth adherence and self-management interventions for chronic medical conditions with complex adherence and self-management demands. The methodological characteristics and BCTs in each study were extracted using a standard data collection form.

Results: A total of 122 studies were reviewed; the majority involved people with type 2 diabetes (28/122, 23%), asthma (27/122, 22%), and type 1 diabetes (19/122, 16%). mHealth interventions rated as having a positive outcome on adherence and self-management used more BCTs (mean 4.95, SD 2.56) than interventions with no impact on outcomes (mean 3.57, SD 1.95) or those that used >1 outcome measure or analytic approach (mean 3.90, SD 1.93; P =.02). The following BCTs were associated with positive outcomes: self-monitoring outcomes of behavior (39/59, 66%), feedback on outcomes of behavior (34/59, 58%), self-monitoring of behavior (34/59, 58%), feedback on behavior (29/59, 49%), credible source (24/59, 41%), and goal setting (behavior; 14/59, 24%). In adult-only samples, prompts and cues were associated with positive outcomes (34/45, 76%). In adolescent and young adult samples, information about health consequences (1/4, 25%), problem-solving (1/4, 25%), and material reward (behavior; 2/4, 50%) were associated with positive outcomes. In interventions explicitly targeting medicine taking, prompts and cues (25/33, 76%) and credible source (13/33, 39%) were associated with positive outcomes. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior (8/26, 31%), goal setting (behavior; 8/26, 31%), and action planning (5/26, 19%) were associated with positive outcomes.

Conclusions: To support adherence and self-management in people with complex medical conditions, mHealth tools should purposefully incorporate effective and developmentally appropriate BCTs. A cross-cutting approach to BCT selection could accelerate the development of much-needed mHealth interventions for target populations, although mHealth intervention developers should continue to consider the unique needs of the target population when designing these tools.

Trial Registration: PROSPERO CRD42021224407; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224407

Introduction

Ever-advancing mobile health (mHealth) technologies hold immense potential to deliver behavior change techniques (BCTs) to diverse audiences, including people with complex medical conditions that involve treatment adherence and other self-management activities. mHealth refers to “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants, and other wireless devices” [ 1 ]. Common examples include sending smartphone notifications as medication reminders or recording in an app when treatments are completed. Prior mHealth reviews have broadly summarized mHealth interventions as “reminders, education, or behavioral” [ 2 ], which included a wide range of study outcomes beyond adherence or self-management [ 3 ] or limited the outcome to medication taking [ 4 , 5 ]. Therefore, existing reviews have a limited impact on exactly how mHealth can most effectively support adherence and disease self-management or can be adapted and tailored for chronic illnesses with complex regimens beyond simply taking medicine.

The BCT Taxonomy [ 6 ] was created to define discrete, cross-cutting techniques (or approaches) to changing behavior to facilitate the design and evaluation of behavior change interventions, as well as the comparison of BCTs across interventions to identify which BCTs are the most efficacious. The BCT Taxonomy is disease agnostic such that BCTs found to effectively improve treatment adherence and self-management in one complex medical condition should, in theory, generalize to other complex medical conditions with similar adherence and self-management demands. Reviewing mHealth interventions of diseases with complex adherence and self-management demands using BCT Taxonomy could accelerate the design of mHealth solutions by identifying “essential elements” of effective mHealth interventions. Unfortunately, there is no consensus on what essential features should be included in an adherence or self-management mHealth solution for any chronic medical condition.

Our group’s interest in cross-cutting BCTs for adherence and self-management stems from our work with the cystic fibrosis (CF) community. CF is a rare, multisystemic medical condition affecting an estimated 162,428 people worldwide [ 7 ]. CF self-management is complex and typically involves a combination of daily oral medications, inhaled treatment, high calorie diet, chest physiotherapy, airway clearance, and exercise [ 8 ]. Not surprisingly, people with CF have demonstrated high rates of nonadherence across various aspects of the multicomponent treatment regimen, including low medication adherence (48%-68%) [ 9 , 10 ], nonadherence to caloric goals (24%-40%) [ 11 ], and low adherence to airway clearance therapy (28%) [ 12 ]. Effective behavioral interventions are needed to promote CF self-management and, in turn, support health outcomes and quality of life. However, rare diseases with complex regimens are rarely the target population for technology developers, and for almost a decade, people with CF have expressed interest in an app but noted that existing apps do not provide the necessary functionality to address their CF management needs [ 13 - 15 ]. A recent search of the Google Play Store (Android) and Apple App Store (iOS) for health-related apps found that only 29 (1.3%) out of 2272 apps address a rare disease population [ 16 ], including CF, with none having empirical evidence of their efficacy.

Recognizing that there is a dearth of empirical research on mHealth solutions for treatment adherence and self-management of CF and other rare diseases, we aimed to learn from the BCTs used in effective mHealth interventions for other chronic medical conditions with complex treatment adherence and self-management demands. We, therefore, purposefully designed our systematic review to include people with complex diseases and regimens with overlapping characteristics to CF. Our research questions were (1) Which BCTs have been used in mHealth interventions? and (2) Which BCTs have a positive impact on adherence and self-management behaviors? Differences in BCTs in adult-only studies compared to adolescent and young adult studies were examined, as well as interventions explicitly targeting medicine taking compared to studies targeting broader self-management and other areas of treatment adherence. A systematic review was used because heterogeneity in measuring adherence and self-management outcomes across studies precludes a meta-analysis [ 17 - 19 ] (in contrast to a systematic review, a meta-analysis involves statistically summarizing results across reviewed studies using effect sizes [ 20 ]). Our overarching goal was to identify the essential, cross-cutting BCTs delivered via mHealth to effectively facilitate long-term adherence and self-management for people with complex medical regimens, thereby accelerating intervention development, evaluation, and dissemination.

Standardized search strategies, eligibility evaluations, and data extraction procedures were used (detailed below and in Multimedia Appendix 1 ). This review was registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42021224407), in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines ( Checklist 1 ).

Ethical Considerations

As this was a systematic review, institutional review board approval was not required.

Search Strategy

A literature search in the PubMed, Scopus, Embase, CENTRAL, Web of Science, and PsycINFO databases identified potentially relevant articles published from 2015 through 2020, to enhance relevance to current technology. Given our group’s focus on CF, 2 categories of search terms were used: “CF-specific” and “other chronic conditions,” which included conditions identified by the study authors as having similar adherence and self-management characteristics to CF (eg, conditions with complex daily medical regimens and diseases often diagnosed in childhood, thus involving caregivers in self-management tasks).

Eligibility Criteria

Peer-reviewed, English language articles published between 2015 and 2020 reporting original empirical findings of mHealth interventions for selected medical conditions and targeting adherence and self-management were included. The mHealth interventions must be accessed on a mobile device (smartphones, cell phones, or tablets, including internet browser programs) and used by a person managing a medical condition or their caregiver.

Post Hoc Exclusions

After executing the search strategy, 3 post hoc exclusion criteria were added. People with chronic obstructive pulmonary disease or engaging in pulmonary rehabilitation were excluded, as it was decided that the former population was too different from people with CF and the latter included medical conditions. Reminder-only text messaging and exclusively synchronous telephone or web videoconferencing interventions were excluded, as our interest was in automated BCTs beyond simple reminders and interventions requiring real-time human interaction. Investigations conducted in low- to middle-income countries were excluded due to potential technology access limitations (unreliable internet or cellular service) that would likely affect the types of interventions tested.

Selection Process

Study records were compiled in a database; duplicates were removed based on DOI number or title. Reviewers (CKE, E McWilliams, DY, TS, and Brandi Blackshear) evaluated each study record (title and citation; blinded double review) for eligibility criteria. The reviewers screened studies for final inclusion and data abstraction using a REDCap (Research Electronic Data Capture; Vanderbilt University) [ 21 , 22 ] form developed for this study.

Data Collection

A reviewer independently abstracted the study data. A second reviewer read the article, reviewed the initial data abstraction, and identified items of disagreement. Discrepancies were discussed and resolved with all team members. Study characteristics were abstracted for each study in the final review (publication year, study location, study design, sample size, medical condition, age group, and theoretically derived intervention). Missing study details were noted.

Key Definitions

The adherence and self-management measurement method was abstracted. Reviewers categorized adherence and self-management measurement as (1) objective behavior (eg, electronic medication monitoring), (2) subjective behavior (eg, patient-reported medication adherence), (3) psychosocial outcome (eg, disease knowledge and adherence self-efficacy), (4) objective health outcome (eg, hemoglobin A 1c and viral load), or (5) subjective health outcome (eg, patient-reported asthma control level). Health outcomes were included if the authors conceptualized them as adherence and self-management indicators.

mHealth tools (eg, app and text messaging) and targets of intervention (eg, taking a specific medicine, airway clearance therapy, diabetes self-management activities, dietary recommendations, exercise and physical activity, managing disease activity and symptoms, etc) were abstracted. mHealth intervention results were categorized based on authors’ conclusion of the results as follows:

• Positive: intervention was associated with improved adherence and self-management.
• Negative: intervention was associated with worse adherence and self-management.
• No impact: intervention had no effect on adherence and self-management.
• Mixed: intervention had different effects (positive effect, negative effect, or no impact) on adherence and self-management due to multiple outcome measures and analytic approaches.

The abstracter used information in the manuscript and the BCT Taxonomy to assign discrete BCTs to each intervention component.

Risk of Bias

The Revised Cochrane Risk-of-Bias tool (RoB 2) [ 23 ] for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) [ 24 ] tool for nonrandomized studies (excluding qualitative studies) were used to assess risk of bias, certainty, and quality of evidence among the studies reviewed. Blinded double assessments were conducted by 2 independent reviewers (RG, IK, E McWilliams, DY, and AD). The RoB-2 assessed risk of bias due to the randomization process, deviations from intended interventions, missing outcome data, measurement of outcome, and selection of the reported result. The ROBINS-I assessed risk of bias due to confounding, deviations from intended interventions, missing data, bias in measurement of outcomes, and bias in selection of the reported result. Discrepancies in ratings were identified and resolved. If multiple outcomes were assessed, an average risk score was calculated to derive a single rating.

Statistical analyses were conducted in Stata 15 software (StataCorp LLC). Abstracted data were summarized using frequencies and percentages. Subgroup analyses examined differences in study characteristics, including BCTs used, age group (adult only [≥18 years and older] vs adolescent and young adult [11-25 years or sample characterized by authors as “adolescents and young adults”]), study design (RCT vs non-RCT), and whether the intervention was theoretically derived. We also conducted an exploratory subgroup analysis to examine which BCTs appeared the most often in interventions explicitly focusing on medicine taking compared to interventions focusing on self-management and other adherence targets. The results highlight BCTs (1) appearing in ≥5% of studies and (2) with a difference of >10% between positive effects versus no impact on adherence and self-management outcomes. This does not mean that rarely used BCTs are ineffective or that 10% is a verified benchmark of clinically meaningful difference. This pragmatic decision supported the interpretation of a large number of BCTs and comparisons. Statistically significant ( P <.05) differences in the number of BCTs based on the direction of results were tested using 1-way ANOVA. No effect measures, missing summary statistics or data conversions, or meta-regression were used for this systematic review.

Screening Process

Figure 1 presents this review’s PRISMA diagram. The initial search returned 14,889 articles. After removing duplicates and clinical trial registrations, 7400 titles were screened for initial eligibility, 303 articles were potentially eligible, and 122 manuscripts met the criteria for data extraction (see Table S1 in Multimedia Appendix 1 for all included studies and characteristics).

Study Characteristics

The most represented medical conditions were type 1 or 2 diabetes and asthma ( Table 1 ). Only 6 (4.9%) out of 122 studies involved people with CF. Most studies were published in 2020 (32/122, 26.2%), were conducted outside of the United States (64/122, 52.5%), and used an RCT design (75/122, 61.5%). Nonrandomized study designs were primarily observational pre-post (23/122, 18.9%), observational without pre-post measurement (6/122, 4.9%), or mixed methods (6/122, 4.9%) studies. Study sample sizes ranged from 10 to 14,085 (median 92, IQR 44-179) participants. Most studies involved adult-only (81/122, 66.4%) or adolescent and young adult–only samples (22/122, 18%), followed by child, adolescent, young adult (11/122, 9%); child, adolescent, young adult, and adult (6/122, 4.9%); and child-only (2/122, 1.6%) samples.

a Medical conditions are listed from most frequently to least frequently observed in the overall study sample.

Adherence and self-management outcomes were typically evaluated with objective health outcomes or subjective behavior measures (61/122, 50% for each; Table S2 in Multimedia Appendix 1 ). mHealth interventions were delivered via app (75/122, 61.5%), SMS text messaging (34/122, 27.9%), or website (30/122, 24.6%). Nearly all studies presented mHealth tools used by patients (118/122, 96.7%), but many included health care providers (48/122, 39.3%) or caregivers (21/122, 17.2%). Only 22 (18%) interventions were clearly informed by scientific theory. mHealth interventions most often targeted taking medication (68/122, 55.7%), diabetes self-management activities (46/122, 37.7%), dietary recommendations (32/122, 26.2%), exercise and physical activity (27/122, 22.1%), asthma self-management activities (13/122, 10.7%), managing disease activity and symptoms (11/122, 9%), and general “self-care” behaviors (5/122, 4.1%). One (0.8%) study targeted airway clearance therapy.

Study results were characterized as having a positive effect on the outcome or outcomes (59/122, 48.4%), followed by mixed results (40/122, 32.8%) or no impact (23/122, 18.9%). No studies were characterized as having negative effects ( Table 1 ). Comparing studies reporting positive effects to no impact, 34% (20/59) of the positive studies used objective behavior adherence measures compared to 13% (3/23) of no-impact studies (Table S2 in Multimedia Appendix 1 ).

Across all reviewed studies, 32 different BCTs were used (mean 4.30, SD 2.32). Table S3 in Multimedia Appendix 1 provides the frequencies, definitions, and examples of BCTs appearing in ≥5% of reviewed studies.

BCTs by Intervention Effect on Outcomes

Interventions with positive effects contained significantly more BCTs (mean 4.95, SD 2.56) than interventions with mixed effects (mean 3.90, SD 1.93) or no impact (mean 3.57, SD 1.95; P =.02). BCTs used in >10% of studies with positive results versus no impact ( Multimedia Appendix 2 ) were self-monitoring of behavior, self-monitoring of outcomes of behavior, feedback on outcomes of behavior, feedback on behavior, credible source, and goal setting (behavior).

Subgroup Analysis: Age

Table S3 in Multimedia Appendix 1 includes the 15 most common BCTs used in adult-only and adolescent and young adult–only studies. Among adult-only studies (n=81), interventions with positive effects contained significantly more BCTs (mean 5.02, SD 2.13) than studies with mixed effects (mean 4.28, SD 2.27) or no impact (mean 3.28, SD 1.96; P =.02). BCTs used in >10% of studies with positive results compared to no impact included prompts and cues, self-monitoring of outcomes of behavior, feedback on outcomes of behavior, self-monitoring of behavior, feedback on behavior, credible source, and goal setting (behavior; Multimedia Appendix 3 ).

In adolescent and young adult–only studies (n=22), interventions with positive effects contained significantly more BCTs (mean 7.75, SD 5.91) than studies with mixed effects (mean 3.50, SD 1.67) or no impact (mean 5.00, SD 1.41; P =.04). BCTs used in >10% of studies with positive results compared to no impact included self-monitoring of behavior, feedback on behavior, goal setting (behavior), information about health consequences, problem-solving, and material reward (behavior; Multimedia Appendix 4 ).

Subgroup Analysis: Study Design and Theory

Non-RCT studies tended to report positive results (33/59, 56%), whereas RCT designs more commonly reported no impact (21/23, 91%) or mixed results (28/40, 70%). Theory rarely guided intervention design; a small proportion (12/59, 20%) of theory-informed interventions were shown to have a positive effect ( Table 1 ).

Subgroup Analysis: Intervention Target

Table S4 in Multimedia Appendix 1 includes the 16 most common BCTs used in studies targeting medicine taking versus self-management and other adherence targets (appeared in >5% of studies). A total of 62% (42/68) of studies targeting medicine taking included people with diabetes (21/68, 31%) or asthma (21/68, 31%). A total of 80% (43/54) of studies targeting self-management and other adherence targets included people with diabetes (37/54, 69%) or asthma (6/54, 11%). There were no significant differences in the number of BCTs used in interventions targeting medicine taking (mean 4.07, SD 1.94) compared to interventions targeting self-management and other adherence targets (mean 4.69, SD 2.70; P =.16).

Within interventions explicitly targeting medicine taking (n=68), BCTs used in >10% of studies with positive results compared to no impact included prompts and cues, self-monitoring outcomes of behavior, self-monitoring of behavior, feedback on behavior, feedback on outcomes of behavior, and credible source ( Multimedia Appendix 5 ). There were no significant differences in the number of BCTs used based on the direction of results ( P =.06).

Within interventions focused on self-management and other adherence targets (n=54), BCTs used in >10% of studies with positive results compared to no impact included self-monitoring outcomes of behavior, feedback on outcomes of behavior, self-monitoring of behavior, feedback on behavior, instruction on how to perform the behavior, goal setting (behavior), and action planning ( Multimedia Appendix 6 ). There were no significant differences in the number of BCTs used based on the direction of results ( P =.21).

Table S1 in Multimedia Appendix 1 reports each study’s risk of bias rating. No study was excluded due to bias rating. For RCTs, 57% (43/75) received an overall risk of bias rating of “Some concerns,” 39% (29/75) had “High” concerns, and only 4% (3/75) had “Low” concerns. “High” concern ratings were generally due to deviations from the intended interventions (18/29, 62%), the randomization process (11/29, 38%), or missing outcome data (11/29, 38%). For nonrandomized studies, 82% (36/44) received an overall risk of bias rating of “Serious” concerns, 9% (4/44) had “Critical” concerns, and 2% (1/44) had “Moderate” concerns. No nonrandomized study had “Low” risk of bias. “Serious” or “Critical” ratings were generally due to confounding (38/40, 95%) or deviations from intended interventions (13/40, 33%).

Principal Findings

Our literature review of mHealth adherence and self-management interventions returned 122 studies, from which we identified discrete behavioral strategies using the BCT Taxonomy [ 6 ] with promise to promote adherence and self-management for people living with medical conditions requiring complex, daily self-management activities. The BCT Taxonomy provides, to date, the most rigorously tested, standardized method to identify cross-cutting BCTs with potential applicability across chronic medical conditions with overlapping adherence and self-management demands. The BCT Taxonomy also helps compare mHealth interventions and provides a shared language about BCTs for clinicians, researchers, mHealth innovators, and other key stakeholders such as patients and caregivers. As technological advances can quickly outdate mHealth, focusing on BCT principles, rather than the technology to deliver them, enhances the research’s relevance and potential generalizability to a range of complex medical conditions, including rare diseases (an area of focus for our group), which often have significant need for such tools in contrast to the finite resources available to conduct large-scale, multistep mHealth design and evaluation studies.

Consistent with prior research [ 25 , 26 ], using more BCTs was associated with improved adherence and self-management. However, 6 BCTs appear particularly promising: self-monitoring of behavior, self-monitoring of outcomes of behavior, feedback on behavior, feedback on outcomes of behavior, credible source, and goal setting. Self-monitoring of behavior and outcomes of behavior involve tracking health behavior engagement (eg, logging in an app when medicine is taken) or outcomes of behavior (eg, using a Bluetooth-enabled glucometer to monitor blood glucose levels), whereas feedback on behavior and outcomes of behavior involve providing users with a summarized interpretation of the tracked data (eg, providing in-app graphical representations of one’s daily step count over the past month). Consistent with our results, a prior meta-analysis showed that monitoring medication adherence and providing feedback improve medication adherence [ 27 ]. These strategies may build awareness for when the mHealth user engages in a health behavior, provide opportunity to reflect on successes and challenges, and ultimately help the user make informed behavior changes. Credible source involves providing expert-generated information about managing the user’s medical condition (eg, the app contains information about etiology, symptoms, and treatment), which presents users with knowledge to understand the condition and its management. Goal setting (behavior ) involves setting measurable and attainable goals for a target health behavior (eg, set a goal for number of days to exercise in a month), which can help the mHealth user focus on key health behavior and build self-efficacy as goals are met.

Developmental differences emerged between adult samples and adolescents and young adult samples. In adult-only studies, prompts and cues (reminders) were associated with positive outcomes, consistent with reviews showing that reminders are associated with a 2- to 3-fold increase in adherence [ 28 , 29 ], but they were less effective in adolescent and young adult studies. Indeed, a pre-post study of children and adolescents with CF found that adherence did not change after delivering reminders only (therefore excluded from this review) for 6 months [ 30 ]. Adolescents and young adults may benefit from improving knowledge ( information about health consequences ), improving skills ( problem-solving ), and building motivation ( material reward [ behavior ]). Given the small number of adolescent and young adult studies, these results and interpretations should be seen as hypothesis generating.

Differences emerged between interventions explicitly targeting medicine taking versus those focused on disease self-management and other adherence targets. In interventions targeting medicine taking, prompts and cues and credible source were associated with positive outcomes. Reminders and expert information may be the most effective when focused on discrete, clearly defined behaviors rather than complex, multicomponent self-management activities. In interventions focused on self-management and other adherence targets, instruction on how to perform the behavior, goal setting (behavior), and action planning were associated with positive outcomes. Over three-quarters (43/54, 80%) of studies focused on self-management and other adherence targets involved people with diabetes or asthma, which are relatively common yet complex medical conditions involving self-management behaviors that extend beyond simply taking medicine. Skills training, behavioral goals, and assistance with creating a detailed plan for managing a complex medical condition may be the most effective for multicomponent self-management activities that may involve monitoring and intervening upon changes in disease activity (eg, managing fluctuations in blood glucose levels for people with diabetes or managing asthma exacerbations) and self-managing lifestyle and environmental considerations (eg, diet in diabetes and environmental triggers in asthma). Careful consideration of the intervention target will likely help to further guide appropriate BCT selection from the BCTs found to be associated with improved adherence and self-management in our review.

This review has limitations. A meta-analysis was not conducted due to heterogeneous outcomes [ 17 - 19 ], thus we could not conclude which BCTs were statistically the most effective. Our risk-of-bias assessment highlighted methodological concerns across the studies reviewed. No-impact studies were more likely to be RCTs, and positive studies were more likely to be nonrandomized, raising concerns about publication bias toward positive results irrespective of study quality. We excluded reminder-only interventions; thus, most studies incorporated more than 1 BCT. Our reported average number of BCTs is likely higher than that of all adherence-promoting mHealth interventions. Although we identified some BCTs that may be effective, others may be as or more effective in supporting disease self-management but were rarely used in the reviewed studies. Moreover, no BCT was found to do harm. Thus, mHealth innovators should continue to integrate and evaluate how a wide variety of technology-delivered BCTs may support people living with chronic diseases, including rare diseases such as CF. An inherent limitation of conducting literature reviews is that a cutoff date must be selected, yet scientific literature is constantly being published; there may be utility in conducting an updated systematic review of this topic in the future. We only included studies that were published in peer-reviewed journals to focus on interventions with clear evidence of scientific evaluation; however, expanding our review to “gray literature” may have provided more insight into the most current interventions and reduced publication bias. Our review characterized mHealth BCTs generally. Other metrics including digital literacy and socioeconomic barriers to mHealth were not evaluated. Future researchers should evaluate these factors to support sustained mHealth use among diverse audiences. Additionally, BCTs were analyzed across the included chronic medical conditions given the disproportionate number of studies in diabetes and asthma compared to other medical conditions. Although the BCTs are disease agnostic, intervention developers and researchers should carefully consider the applicability of the BCT to the target patient population.

Future Directions

Our review identified discrete BCTs that may have broad cross-cutting applicability across chronic diseases with complex medical regimens, including people with CF, the community with which our group primarily works with. We consider our systematic review approach to be a model for gathering key findings from the extant scientific literature to inform the development of multicomponent behavioral mHealth interventions tailored for a patient population that may be smaller and with less existing research, yet has significant self-management needs warranting further research, such as CF [ 9 , 10 , 31 , 32 ]. Research involving people with chronic medical conditions following complex treatment regimens should prioritize the design and evaluation of mHealth interventions incorporating cross-cutting, evidence-based, and age-appropriate BCTs to promote adherence and self-management. Such an approach could help accelerate mHealth intervention design and evaluation to create effective products that may be efficiently disseminated to communities with significant need for such tools.

Accelerating mHealth design and evaluation by taking a cross-cutting approach to BCT selection would also help answer remaining “unknowns” about mHealth BCTs and strengthen mHealth intervention quality. For example, although interventions including more BCTs appear to have greater benefit, the optimal number, type, and combination of BCTs to include in mHealth interventions have not been determined. For BCTs demonstrating potential to promote adherence or self-management, the ideal delivery method must be determined (eg, should the BCT self-monitoring of behavior be delivered via manual data entry of treatment completion or using an electronic monitoring device to automatically track data?). An overrepresentation of certain BCTs (eg, prompts and cues and self-monitoring of outcomes of behavior ) and underuse of other, potentially more effective techniques (eg, feedback on behavior and goal setting [ behavior ]) highlight mHealth’s focus on simpler technologies at the expense of innovation and efficacy. Collaborations between behavioral scientists, care teams, patients, caregivers, and industry could answer these questions and produce mHealth solutions that are transformative and effective.

When incorporating BCTs that are expected to effectively and appropriately generalize to a range of complex medical conditions and associated regimens, mHealth intervention developers must still consider the unique needs of the target population. In CF, for example, highly effect CF transmembrane conductance regulator modulator therapies have the potential to simplify the regimen and reduce treatment burden [ 33 , 34 ]. The implementation of key BCTs may need to be adapted as new therapies roll out, although the core theory behind the BCT itself is not expected to change. It is critical to build the scientific evidence base for effective adherence and self-management mHealth interventions that maintain pace with rapidly advancing medical management across complex medical conditions.

Acknowledgments

We are thankful for the contributions of Brandi Blackshear, Angela Green, Kirsten Kulik, and Anne Bowen to this important investigation.

Conflicts of Interest

CKE, KR, CS, E McWilliams, MS, KM, E Muther, GRO, TS, and DY receive or received salary and/or grant support from the Cystic Fibrosis Foundation’s Success with Therapies Research Consortium. GSS and KR receive honoraria and/or speaker fees from Vertex Pharmaceuticals. CG is an employee of the Cystic Fibrosis Foundation, which funded this research through the Success with Therapies Research Consortium. GRO receives grants from the Kael Pediatric Research Institute, National Institutes of Health, Health Resources and Services Administration’s Children’s National Research Institute, and the Alabama Department of Public Health, in addition to grant support from the Cystic Fibrosis Foundation. She also receives consulting fees from International Biophysics Corporation. CS serves as an unpaid advisor and consultant to MMNTS, Inc in addition to receiving salary support from the Cystic Fibrosis Foundation’s Success with Therapies Research Consortium. MS receives grant support from Cystic Fibrosis Foundation and Anagram Therapeutics, Inc. AD, RG, IK, MLM, and ML declare no conflicts of interest.

Additional details on search and screening strategies, study characteristics, adherence measure types, behavior change technique definitions, and behavior change techniques by intervention target.

The most common BCTs (>5% of all abstracted studies) by the direction of results in the overall sample. BCTs with >10% difference in how often they appear in studies with positive results compared to no-impact results are highlighted in red boxes. BCT: behavior change technique.

The most common BCTs (>5% of all abstracted studies) by the direction of results in adult-only samples. BCTs with >10% difference in how often they appear in studies with positive results compared to no-impact results are highlighted in red boxes. BCT: behavior change technique.

The most common BCTs (>5% of all abstracted studies) by the direction of results in adolescent and young adult samples. BCTs with >10% difference in how often they appear in studies with positive results compared to no-impact results are highlighted in red boxes. BCT: behavior change technique.

The most common BCTs (>5% of all abstracted studies) by the direction of results in interventions explicitly targeting medicine taking. BCTs with >10% difference in how often they appear in studies with positive results compared to no-impact results are highlighted in red boxes. BCT: behavior change technique.

The most common BCTs (>5% of all abstracted studies) by the direction of results in interventions targeting self-management or other adherence targets. BCTs with >10% difference in how often they appear in studies with positive results compared to no-impact results are highlighted in red boxes. BCT: behavior change technique.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 checklist.

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Abbreviations

Edited by Lorraine Buis; submitted 26.05.23; peer-reviewed by Cara Bossley, Uday Kumar Chalwadi; final revised version received 26.01.24; accepted 26.02.24; published 01.05.24.

© Cyd K Eaton, Emma McWilliams, Dana Yablon, Irem Kesim, Renee Ge, Karissa Mirus, Takeera Sconiers, Alfred Donkoh, Melanie Lawrence, Cynthia George, Mary Leigh Morrison, Emily Muther, Gabriela R Oates, Meghana Sathe, Gregory S Sawicki, Carolyn Snell, Kristin Riekert. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 1.5.2024.

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

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Librarians and Academic Libraries’ Role in Promoting Open Access: What Needs to Change?

Shlomit Hadad and Noa Aharony *

Profound changes due to Open-Access (OA) publications lead to organizational changes in universities and libraries. This study examines Israeli librarians’ perceptions regarding their role and the academic library’s role in promoting OA-publications, including the barriers, challenges, needs, and requirements necessary to promote OA publishing. Lack of a budget for OA-agreements, no cooperation from university management, and researchers’ unfamiliarity with OA were among the most prominent barriers. Librarians see great importance in their role of advising researchers regarding OA. However, they insist on a regulated OA-policy at the national and institutional levels to strengthen their status as change-leaders of the OA-movement.

Introduction

Open Access (OA) is a term that is used to describe unrestricted online access to scientific articles as part of an effort to “open up” scientific output to the public. 1 The premise is that OA may improve the rigor, validity, replicability, and availability of research. 2 One of the major arguments against the subscription-based model of publishing is that while authors contribute their work to publishers without monetary gain, readers are required to pay a subscription fee to the journal. 3 At the same time, organizations and academic institutions have to pay publishers through mega-agreements, known as the “big deals,” to allow researchers and students access to those articles. 4

Following OA initiatives from the early 2000s, which formed the ideological and practical basis of the movement, countries, funders, and research institutions across the globe commenced to provide OA for their research output, while also attempting to develop a clear OA policy. 5 The evolving form of new business models of academic publishing and the entry of “new players” to this field are among the main reasons for the transformation of academic libraries. 6

However, open access has its own concerns. These include the costs associated with article processing charges (APCs) for OA journals, which affect the ability of academics from the social science and humanities (SSH) to publish in OA journals. Other problematic issues are implementing and maintaining an institutional repository and the fear of copyright infringement when depositing articles in open repositories. 7 In addition, there is the rise of predatory journals interested in only making quick money that pay little or no attention to peer review. 8 These predatory journals negatively influence researchers’ attitudes towards OA publishing. 9

Many previous studies have dealt with the new and emerging roles of librarians resulting from a new digital era and the change from the traditional publishing models to OA. 10 Scholars have explored librarians’ role changes and have suggested ways to improve and promote OA in their institutions. 11 However, only a few have explored ways to promote OA from the perspective of librarians, who are considered experts in their field. The present study aims to address this gap by exploring Israeli librarians’ perceptions of their role and the academic library’s role in promoting OA publication, as well as the barriers, challenges, needs, and requirements needed to promote OA publishing in their institutions and on a national level.

Literature Review

Librarians’ and libraries’ roles in the scientific communication system over time.

In the scholarly world, libraries and librarians have always played a central role in the creation, preservation, and dissemination of information. 12 Over the years, academic libraries have evolved alongside the development of higher education institutions, and have adapted to social, political, and technical changes. 13 Thus, the ever-changing research landscape and the relentless advances in technology have significantly influenced the responsibilities of academic librarians. 14

Traditional functions, such as reference work and collection management, are rapidly losing their status as primary responsibilities of librarians, while new functions related to research support, data management, bibliometrics, and digital initiatives, are increasingly becoming part of the academic librarian’s responsibilities. 15 These changes enable librarians to perform new and significant roles, redefine their roles, and provide libraries with the opportunity to remain relevant in the digital age. 16

Open-access Publication and its Impact on Librarians’ Roles

Digital developments are not the only factor that have influenced academic library service. Major changes in scientific communication such as the OA movement affected scientists and publishers and led to organizational changes in universities and libraries. 17

The OA movement was initiated in the 1990s, as access to the Internet became widely available and online publishing became the norm. It was intensified by three initiatives, known as the BBB declarations: the Budapest OA Initiative , the Bethesda Statement on OA Publishing in 2002, and the Berlin Declaration on OA in 2003. These initiatives represent the most highly regarded definitions of OA, and all agree on the essentials. As stated by Peter Suber, “an OA work is digital, online, free of charge, and free of most copyright and licensing restrictions” (para. 1). 18 The Budapest OA Initiative recommended two approaches to providing open access to the research literature: open access journals (known as the “gold” road) and institutional or individual self-archiving in digital repositories (known as the “green” road). 19 Heather Piwowar et al. prefer a less strict definition: “OA articles are free to read online, either on the publisher website or in an OA repository.” 20

Following the BBB declarations, major research institutions across the globe committed to providing OA for their research output. 21 More recently, grant conditions of many funding organizations, including Plan S, Europe PMC Funders’ Group, and Horizon Europe, began requiring peer-reviewed research output to be freely available. These aims can be achieved either by publishing in OA journals, archiving publications in an OA repository, or in some cases, both options are required. 22 Although there is an increased awareness regarding OA over the years, there is still confusion and misunderstanding concerning the various OA models. Moreover, following the rise of the gold OA model (OA journals), many predatory journals have emerged. 23 Hence, researchers’ suspicions towards OA journals are understandable. Researchers question the reliability of OA journals and now consider gold journals as providers of lower-quality articles. 24

Because of this, researchers need to recognize and distinguish between OA publication models and routes, as well as between legitimate and predatory journals. In addition, the increasing costs of toll-access subscriptions, particularly via so-called ‘‘Big Deals’’ from publishers, forced libraries and other institutions to initiate large-scale subscription cancellations. 25 As libraries make difficult budgetary decisions, the OA movement allows them to redefine their roles within this emerging publishing model. 26 Further, with the development of OA, there has been an expectation that academic libraries will take on additional responsibilities like managing research data and open access requirements. 27 As a result, OA promoters asked librarians to be the change leaders in their institutions, 28 adding suggestions on how to promote OA publication among researchers and management. 29 Studies have found that academic libraries promote OA in a variety of ways such as: including records for OA journals in their public catalogs and electronic journal lists, collaborating with their institutions to establish institutional repositories, participating in institutional initiatives to encourage faculties to deposit research outputs in the institution’s database and more. 30 However, some studies have argued that for experienced librarians as well as those new to the profession, there may be a lack of understanding about potential roles in a changing vision of scholarly communication that includes advocacy for openness. 31 Furthermore, some librarians may not believe that “open access” has relevance to their busy roles in the library and they need clear instructions on how to change their daily work in the library. 32

In addition, previous studies demonstrated that faculty staff did not perceive librarians as team members for policy development, funding, publishing, or rewards and recognition regarding OA. 33 Faculty members would like to have librarians’ assistance and support while keeping the traditional vision of the library as a useful warehouse of information and of librarians as selectors and minders of the inventory. 34 Thus, although academic libraries have the ability to provide services in accordance with OA requirements and information system management, they may encounter a lack of cooperation and support for their initiatives from the institution’s leaders and faculty. 35 Moreover, scholars question the ability of librarians to integrate the new requirements into the library’s administrative structure. 36 Therefore, the aim of this study was to examine Israeli librarians’ perceptions regarding their role and the academic library’s role in promoting OA publishing, including barriers, challenges, and difficulties. Further, it explored the factors and requirements needed to promote open access publishing in their libraries and nationally. The research questions that guided the study are:

• How do librarians perceive their role and the academic library’s role in promoting OA publishing?
• What are the barriers, challenges, and difficulties in implementing open-access?
• What are the factors and needs that are required to promote open access?

Participants

The study was conducted within the qualitative research paradigm. Qualitative interviews offer ecological validity, provide rich and insightful descriptions, and have the ability to aid in the understanding of complex organizational realities. 37 Monique Hennink et al. found that in order to reach code saturation, the point when no additional issues are identified and the codebook begins to stabilize, qualitative research needs 9 interviews. 38 In this study, the consideration in choosing the number of research participants was to allow one representative participant from each of the ten existing universities in Israel. The participants were 10 librarians and academic library administrators from ten universities in Israel. Regarding gender, 90% were female. Among them: five (50%) were administrators of the library system at their institution, three (30%) were directors of disciplinary libraries and two (20%) were directors of information systems at the libraries within their institution. In terms of seniority, six (60%) had been employed by their institution for over 10 years, and four (40%) had less than 10 years in their current positions.

Procedure and Instruments

An email was sent to Israeli academic librarians having positions of administrators or directors of disciplinary libraries or information systems in academic libraries of universities, with a request to participate in the study. Respondents were provided with full details about the research and were invited to an informal telephone discussion with the interviewer to discuss the research aims and procedures. The researcher then conducted semi-structured interviews via Zoom with the participants who agreed to take part in the project. All interviews were conducted between April to June 2020 and lasted between 30 and 90 minutes. The librarians’ interviews were based on items extracted from the “Librarians’ attitudes towards open access, principles and related behaviors survey,” 39 and included items that deal with changes in the practice of the academic library based on Perkins and Slowik’s (2013) study. 40 During the interviews, librarians were asked: 1) to report how they perceive their role and the role of academic libraries in promoting OA publishing; 2) to address the barriers, challenges and difficulties regarding promoting open access; and 3) to address the factors and needs required to promote open access publication.

The answers were analyzed from the “bottom-up.” Researchers categorized the answers using a thematic analysis technique. 41 This analysis allowed researchers to reach the main categories. Further, it enabled researchers to catalog and code the interviewees’ quotes and to identify common expressions and recurring themes. In addition, during the analysis process, researchers merged themes and categories and identified the overlap between themes. The richness of responses justified the number of participants, showing data collected are of sufficient depth to provide salient information in relation to the research purpose.

The thematic content analysis of the librarians’ narratives yielded 1,264 statements which were classified into three main and broad categories. Each main category included several sub-categories (see Table 1). The unit of analysis in this study was a statement presenting a content unit. The coding was not exclusive, as the same statements could be attributed to several categories. To ensure inter-rater reliability of the coding, 25% of the statements were analyzed by a second coder (a trained researcher knowledgeable in research methods and the relevant topic, in addition to the study researchers) and the agreement level between them had a Cohen’s Kappa of .86. Table 1 describes the final research categories and sub-categories.

To ensure reliability in the findings, rigor in interviews was based on “trustworthiness of data,” 42 by adhering to four principles: 1. Truth-value of data : Librarians were informed in advance that their perspectives and reports would be confidential. To preserve the privacy of the participants, researchers removed all names and places from data sheets; 2. Applicability of the data: was achieved by selecting librarians from different universities, genders, and seniority; 3. Consistency of the data was assured by verbatim transcriptions of the interviews and keeping records of data collection. However, there are no ages, genders, or names associated with the quotes; and 4. Neutrality of data was assured by recording all steps during data coding of the interviews and trying to present librarians’ perceptions concerning the phenomenon.

Role and Contribution of Librarians and the Library in Promoting Open Access

The first research question examined the contribution and role of librarians and the library in promoting open access. The librarians discussed six main aspects of their actual role in promoting OA publication in their institutions. Table 2 presents the sub-categories according to their frequency.

Analysis of the sub-categories and representative quotes are presented below:

1. The library as leader of the change, after setting OA policy.

Librarians expressed their feeling that they are leading the process of promoting open access in their institution. However, they claim that promoting OA is not their sole responsibility; it is the national government’s and university administration’s role to establish a regulated policy on the subject: “We try to promote OA in every possible way. But still, the library is not the regulator, it is the execution contractor. We can be the ones in the field who encourage policy, recommend, educate and implement the changes” (L10).

2. Guidance and advising researchers regarding issues in OA publishing.

Librarians advise and guide researchers: “We provide information; we have a special page on our library portal that really explains the different routes in OA, what to do not to do, questions and answers. We also conduct individual and group trainings” (L10). In addition, librarians reported that they help researchers obtain research funding for publishing in OA journals: “We have a small fund to support OA. The founder invests a relatively small amount in it, and set very strict criteria for which researchers. The whole process is managed through the library” (L5).

3. Involvement in agreements through MALMAD consortium.

Most librarians mentioned the connection with MALMAD as the body responsible for promoting OA in Israel. MALMAD is the “Inter-University Center for Digital Information Services” and is a consortium for acquiring, licensing, and managing digital information services to Israel’s universities and colleges. The director of MALMAD reported that there are significant conflicts with publishers to lower the price of those “big deals,” and transfer to models that would incorporate OA: “We are partners in the whole process and try to involve stakeholders in the university” (L4).

4. Contact with university management and the research authority.

Contact with management and the research authority is one of the important roles in promoting OA: “As part of the ongoing process, there are meetings with deans and the research authority, and in every meeting the issue of OA arises, and we are asked to explain why this issue is important and worthwhile to the university” (L7).

5. CRIS system operation.

Librarians referred to CRIS (Current Research Information System), a database that stores and manages data about research activities, as a system that will eventually promote OA: “After a struggle, now the CRIS returns to the library. Finally, the university managers understand that it’s the library’s role. Perhaps this will promote OA” (L1).

6. Promoting an institutional repository.

Librarians referred to promoting and establishing an institutional repository (IR) at their universities: “There is now a demand among many researchers, due to the funders’ requirements—to deposit not only the article but also the research data. We contacted the university administration, showed them researchers’ requests, and asked for a budget to promote the construction of IR” (L9).

Barriers, Challenges, and Difficulties

The second research question examined the barriers, challenges, and difficulties of OA as perceived by librarians. Librarians’ response to this topic yielded the largest category (541 statements, 43% of all statements). Table 3 presents the sub-categories according to their frequency.

Analysis of the sub-categories and representative quotes are given below.

1. Lack of budget and OA agreements with publishers.

Librarians expressed helplessness in the face of mega-agreements with publishers that leave them no budget for further agreements with OA journals: “Once these mega-agreements with publishers are signed, we have no ability to deal with it. We renew agreements from year-to-year and we need almost the entire operating budget for acquisition” (L4). Thus, there is no budget left to OA journals: “Researchers contact us to request a budget for OA publication, but unfortunately, we have nothing to offer them” (L10).

2. Lack of cooperation with management, the research authority, and the rector.

Lack of cooperation and disconnection is a frequently mentioned barrier by the librarians, as expressed in the following quote: “For many years there has been no contact with the research authority. They did not see or meet us unless they needed the help of the library. Thus, we cannot make such progress in promoting OA” (L9).

3. Researchers’ lack of awareness regarding OA publication and fear of predatory journals and copyright infringement.

Researchers, according to librarians, are unaware of OA in general, and in their field of research in particular: “Our feeling is that researchers are not aware of OA. They need someone to explain them both the OA ideology and information relevant to their discipline” (L1). Researchers are also afraid of predatory journals: “We expose researchers to the fact that there are many quality open journals. Many researchers think that all OA journals are predatory journals” (L7). Regarding self-archiving in repositories, according to the librarians, researchers are concerned about copyright infringement and scooping: “Researchers are afraid to deposit a post-print article in an open database because they fear violating the copyrights they have committed to with the publisher. In addition, they are also afraid to deposit a pre-print article, because of the fear of plagiarism” (L1).

4. Journal Impact Factor (IF).

Researchers are evaluated by publishing in high IF journals: “Researchers do not want to publish in an open journal or in an institutional repository that we as a library want to promote. They want to publish in a journal with a high IF, which will improve their CV (curriculum vitae) as their promotion depends on publications. Some OA journals have a high IF, but most have a relatively low IF for their field, so this is one of the main reasons why researchers refuse to publish in OA journals” (L5).

5. Fear of changes resulting from the transition to OA.

Librarians discussed their own concerns. They have difficulties adjusting to the transition to OA, which often reduces the need for library services: “The library is changing, and this world of OA will change the world of access to information. The librarians will still be needed, but everything will look different and that is a cause for concern” (L7). Librarians have also mentioned researchers’ concerns. Researchers are also afraid of changing the existing traditional model: “Researchers think; why do we have to change the existing publishing model? What’s wrong with what we do today? Why rock the boat?” (L3).

6. Lack of information regarding researchers’ publications venues and norms.

Another difficulty is the lack of information regarding researchers’ publications: “The information is not centralized, we actually make surveys and ask our researchers: Tell us where do you publish? How much money do you pay for publications? Otherwise, how do we know what to offer them?” (L1).

7. Difficulties “marketing” OA publishing and the fear of leading the change.

Librarians reported difficulties marketing OA to researchers and the institution’s management. They were worried about being responsible for failure: “Agreements that contain open components are expensive, and if in the end there are not enough publications to justify the investment, it will be our fault. That is why it is very difficult for us to explain, market, and promote OA” (L2). In addition, researchers are not aware of library’s activities regarding OA, and it leads to researchers’ lack of information: “One of the most difficult problems is that researchers are unaware of how much help they can get from the library, so they don’t use the library to publish in OA” (L3).

8. Lack of personnel, guidance, and training for librarians.

A number of statements addressed the lack of manpower and insufficient guidance regarding OA: “In addition to the manpower we lack, we lack professional training to learn about OA, so that we can be professional while conveying the information to researchers and management” (L8).

9. Opposition from stakeholders and researchers to OA promotion.

Librarians have reported opposition regarding OA, resulting in conflicts between researchers and the management at their institution: “Unfortunately, some of the researchers are employees of some of journals’ publishers, and they resist promoting open-access journals. This is a blatant intervention by stakeholders in academia” (L10).

Factors and Requirements Needed to Promote Open Access

The third research question examined what is needed to promote OA publication. This category includes 295 statements (23% of the total). The librarians gave six factors and requirements to promote OA.

Table 4 presents the sub-categories according to their frequency.

Analysis of the sub-categories and representative quotes are listed below.

1. The need to change policy at the national level and adopt an advanced OA policy.

The largest number of statements addressed the need to change policy: “Why would researchers consider publishing in OA? It should be a policy. The breakthrough of OA will come from a national policy, as exists in many other countries in Europe and United States. Currently, we are ‘ tilting at windmills’” (L1).

2. The need for cooperation between academic institutions to establish new agreements and an institutional repository.

Cooperation between all academic institutions in Israel would create a greater advantage to negotiate with the publishers: “It’s too big for each university individually. If all universities are together, they will consist one incorporated group that can negotiate with publishers” (L2). In addition, the librarians mentioned the establishment of a common IR: “If there was a common institutional repository for all institutions, it would give researchers an alternative to the publishers” (L10).

3. Collaboration between the University management, research authority, and the library for advancing OA.

Collaboration between university authorities will help promote OA open access: “The university management and the research authority must cooperate with us (the library) if we really want to promote OA” (L8).

4. The need for tutorials and training for library staff on OA publishing.

Librarians mentioned the need for professional development regarding OA: “The library staff must specialize in OA. We must be ready to guide and advise both researchers and management” (L4).

5. The need to guide researchers and reward them for open access publications.

Librarians argued that researchers need guidance concerning high IF OA journals, and their added value: “Researchers need guidance because they do not understand the value in publishing OA, they wonder why do they need it. And even if they do understand, it is not certain that they will publish on their own initiative” (L6). Therefore, librarians offer to provide funding for researchers: “The Higher Education Council should budget OA publications, and at the same time oblige researchers to self-archive pre-post version in open repository” (L3).

6. The need to establish the library as a central body for Open Access.

Librarians suggested that the library would take a major role and handle everything related to OA: “It would be correct if we as the library centralize the issue of OA publication and not the dean. If researchers need help, they should contact us because we work with publishers” (L9).

Academic libraries have the expertise and mindset to be early adopters of new technologies such as digital curation, digital preservation, digital archiving, and more. 43 This study examined Israeli librarians’ perceptions regarding their role and the academic library’s role in promoting OA publication, the barriers, challenges, needs, and requirements needed to promote OA publishing in their institutions as well as at the national level. Interpretation of the findings was presented in an integrative way.

It reveals that librarians perceive themselves as being at the forefront of promoting OA in their institutions. However, they emphasized that they are not the first or only persons to be responsible for promoting OA publishing. They assert that since there is not a definite policy towards OA in Israel, it is the national government’s and the university administration’s role to create a regulated policy towards OA. Once the policy is outlined, they will be the ones to guide, recommend, educate, and implement the changes. A number of studies evaluated the involvement of countries in the international OA movement, and in particular examined the distribution of the number of OA repositories, OA journals, institutional OA policies, and OA articles among selected countries. 44 Studies found a positive relationship between countries’ involvement in OA and the proportion of research outputs published in gold/green OA. 45

Librarians perceive the relationship with the university management as key to promoting OA. However, they emphasized that a lack of cooperation with management, the research authority, and the rector does not enable a substantial advancement in agreements with OA components or promotion of an institutional repository. Librarians also reported that sometimes, due to conflicts of interest, management actively opposes librarians’ initiatives. Therefore, and as found in past studies, 46 cooperation with the university administration is a necessary condition for promoting OA publishing and strengthening the library’s role in it.

The lack of budget for OA agreements with publishers is the greatest barrier according to librarians in this and previous studies. 47 Librarians feel frustrated by the mega-agreements with publishers that leave them no budget for further agreements with OA journals. Further, they added that they have no budget for researchers who approach them for help in funding APCs to publish in an OA journal. Therefore, to confront the budget barrier, they are involved in supporting activities carried out through the MALMAD consortium aimed at promoting OA, even without the support of university management. Librarians assume that their involvement in two major current projects will lead to OA awareness. The first is the CRIS database. Librarians assert that in order to recommend and advise researchers and university management regarding publishing in OA, they need information about all researchers’ publications. CRIS assists them in achieving this goal by centralizing publications and performing data analysis. 48 The second system is the institutional repository (IR), which was mentioned in other studies as contributing greatly to the OA movement. 49 Librarians note that researchers ask them to deposit their work in an institutional repository based on requests from funding agencies. Therefore, they suggest establishing a shared institutional repository for all academic institutions, which would emphasize cooperation between academic institutions. According to the librarians, the collaboration of all academic institutions in Israel will result in a consolidation of forces and a better position to negotiate with the publishers.

Librarians see great importance in their role of guiding and advising researchers regarding OA publishing. One of the biggest barriers in promoting OA is researchers’ lack of awareness concerning OA in general, and in their field of study. Further, researchers fail to distinguish between legitimate OA journals and predatory journals. Librarians mention the journal impact factor as one of the main barriers to OA promotion. The journal IF index has a broad and long-term impact on research institutions and researchers. In most academic disciplines, researchers have to publish in journals with a high IF in order to succeed, especially for those on a tenure track. In many cases, OA journals have a less established IF. 50

Thus, due to these considerations, junior academics have less experience with OA journals. 51 In addition, researchers, according to librarians, do not know the copyright terms of publishers and therefore avoid self-archiving. They are also concerned about depositing a pre-print version for fear of “scooping” (i.e., that someone will steal their research idea). Moreover, librarians add that researchers are afraid of changing the traditional publishing model and need guidance adjusted for their discipline. Therefore, and as found in other studies, librarians consider their role as facilitating and guiding proper publication in OA. 52

Open access is transforming scholarly communication. Various modes of OA include: gold, hybrid, delayed, bronze, institutional and subject-based repositories, and others, which reflect the complexity of OA. 53 Thus, new challenges emerge for academic library faculty that require investing in developing skills and continuous improvement. 54 With professional development, support and proper guidance, librarians will be able to be real promoters and leaders for OA in their institutions.

To summarize librarians’ findings and to outline what can be drawn from this study, Figure 1 shows the roles, barriers, and what is necessary to promote OA:

Librarians referred in this study to several stakeholders who can promote open access: at the state level, at the universities management level, and at researcher, and academic library level. Librarians see great importance in their role of advising researchers regarding issues in OA publishing. In order to provide the appropriate training, librarians acknowledge that they need professional development in the various aspects of OA. At the universities management level—the findings indicate the need for support in libraries’ activities in relation to OA, but also the need for collaboration between the academic institutions to promote the publication of OA. However, librarians insisted on a regulated OA-policy at the national and institutional levels, which would strengthen their status as change-leaders of the OA-movement. Finally, as Figure 1 indicates, academic libraries have the opportunity to contribute to the adoption of OA and change their traditional roles, provided they get the support they need.

Conclusions and Future Work

Over a decade ago, and 10 years after the BBB declarations, some scholars argued that the growth in OA publication is encouraging. Considering the indicators of progress made by the OA movement against the obstacles in the first decade, there is a reason for great optimism for the next decade. 55 Now, 20 years after the BBB declarations, the struggle continues and OA publishing is not yet the norm in some countries and academic institutions. According to the librarians, the university administration and researchers are not aware of the potential of open access publishing. To encourage the adoption of OA practices—publishing in OA journals, depositing in OA repositories—advocacy is important but insufficient. Librarians require a set of regulated and legal OA policies. Otherwise, they are “tilting at windmills.” Much is written in the literature about the difficulty of adapting to the change of roles with the transition to the digital world. 56 The librarians in the current study are willing to lead the change, guide researchers, and support the transition to the OA publishing model. Yet, they need the strengthening that comes from regulated policies at the national level, as well as public support from academic institutions’ management of their libraries.

The current study has some recommendations for future research. Future studies may expand the sample and crosscheck librarians’ perspectives with other quantitative methods. In addition, future studies should include and examine researchers’ and policymakers’ perspectives too.

Acknowledgements

The authors thank the academic libraries who volunteered to participate and assist in our study.

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* Shlomit Hadad is Lecturer in the Department of Digital Learning Technologies at The Israel Academic College in Ramat-Gan, email: [email protected] ; Noa Aharony is Full Professor at Bar-Ilan University, email: [email protected] . ©2024 Shlomit Hadad and Noa Aharony, Attribution-NonCommercial ( https://creativecommons.org/licenses/by-nc/4.0/ ) CC BY-NC.

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