the importance of literature review in research methodology

Methodological Approaches to Literature Review

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• First Online: 09 May 2023
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• Dennis Thomas 2 ,
• Elida Zairina 3 &
• Johnson George 4  

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The literature review can serve various functions in the contexts of education and research. It aids in identifying knowledge gaps, informing research methodology, and developing a theoretical framework during the planning stages of a research study or project, as well as reporting of review findings in the context of the existing literature. This chapter discusses the methodological approaches to conducting a literature review and offers an overview of different types of reviews. There are various types of reviews, including narrative reviews, scoping reviews, and systematic reviews with reporting strategies such as meta-analysis and meta-synthesis. Review authors should consider the scope of the literature review when selecting a type and method. Being focused is essential for a successful review; however, this must be balanced against the relevance of the review to a broad audience.

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Systematic Reviews in Educational Research: Methodology, Perspectives and Application

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Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Programme, Newcastle, NSW, Australia

Dennis Thomas

Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia

Elida Zairina

Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia

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Thomas, D., Zairina, E., George, J. (2023). Methodological Approaches to Literature Review. In: Encyclopedia of Evidence in Pharmaceutical Public Health and Health Services Research in Pharmacy. Springer, Cham. https://doi.org/10.1007/978-3-030-50247-8_57-1

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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

For each publication, ask yourself:

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

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

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

Take notes and cite your sources

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

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

Prevent plagiarism. Run a free check.

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

As you write, you can follow these tips:

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

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

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

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

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

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

 Statistics

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

Research bias

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

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

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

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

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

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

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

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

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

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Literature reviews, what is a literature review, learning more about how to do a literature review.

• Planning the Review
• The Research Question
• Choosing Where to Search
• Organizing the Review
• Writing the Review

A literature review is a review and synthesis of existing research on a topic or research question. A literature review is meant to analyze the scholarly literature, make connections across writings and identify strengths, weaknesses, trends, and missing conversations. A literature review should address different aspects of a topic as it relates to your research question. A literature review goes beyond a description or summary of the literature you have read. 

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Literature Review - what is a Literature Review, why it is important and how it is done

What are literature reviews, goals of literature reviews, types of literature reviews, about this guide/licence.

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 What is a literature review? "A literature review is an account of what has been published on a topic by accredited scholars and researchers. In writing the literature review, your purpose is to convey to your reader what knowledge and ideas have been established on a topic, and what their strengths and weaknesses are. As a piece of writing, the literature review must be defined by a guiding concept (e.g., your research objective, the problem or issue you are discussing, or your argumentative thesis). It is not just a descriptive list of the material available, or a set of summaries. " - Quote from Taylor, D. (n.d) "The literature review: A few tips on conducting it"

Source NC State University Libraries. This video is published under a Creative Commons 3.0 BY-NC-SA US license.

What are the goals of creating a Literature Review?

• To develop a theory or evaluate an existing theory
• To summarize the historical or existing state of a research topic
• Identify a problem in a field of research 

- Baumeister, R.F. & Leary, M.R. (1997). "Writing narrative literature reviews," Review of General Psychology , 1(3), 311-320.

When do you need to write a Literature Review?

• When writing a prospectus or a thesis/dissertation
• When writing a research paper
• When writing a grant proposal

In all these cases you need to dedicate a chapter in these works to showcase what have been written about your research topic and to point out how your own research will shed a new light into these body of scholarship.

Literature reviews are also written as standalone articles as a way to survey a particular research topic in-depth. This type of literature reviews look at a topic from a historical perspective to see how the understanding of the topic have change through time.

What kinds of literature reviews are written?

• Narrative Review: The purpose of this type of review is to describe the current state of the research on a specific topic/research and to offer a critical analysis of the literature reviewed. Studies are grouped by research/theoretical categories, and themes and trends, strengths and weakness, and gaps are identified. The review ends with a conclusion section which summarizes the findings regarding the state of the research of the specific study, the gaps identify and if applicable, explains how the author's research will address gaps identify in the review and expand the knowledge on the topic reviewed.
• Book review essays/ Historiographical review essays : This is a type of review that focus on a small set of research books on a particular topic " to locate these books within current scholarship, critical methodologies, and approaches" in the field. - LARR
• Systematic review : "The authors of a systematic review use a specific procedure to search the research literature, select the studies to include in their review, and critically evaluate the studies they find." (p. 139). Nelson, L.K. (2013). Research in Communication Sciences and Disorders . San Diego, CA: Plural Publishing.
• Meta-analysis : "Meta-analysis is a method of reviewing research findings in a quantitative fashion by transforming the data from individual studies into what is called an effect size and then pooling and analyzing this information. The basic goal in meta-analysis is to explain why different outcomes have occurred in different studies." (p. 197). Roberts, M.C. & Ilardi, S.S. (2003). Handbook of Research Methods in Clinical Psychology . Malden, MA: Blackwell Pub.
• Meta-synthesis : "Qualitative meta-synthesis is a type of qualitative study that uses as data the findings from other qualitative studies linked by the same or related topic." (p.312). Zimmer, L. (2006). "Qualitative meta-synthesis: A question of dialoguing with texts," Journal of Advanced Nursing , 53(3), 311-318.

Guide adapted from "Literature Review" , a guide developed by Marisol Ramos used under CC BY 4.0 /modified from original.

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Literature Review

• What is a Literature Review?
• What is NOT a Literature Review?
• Purposes of a Literature Review
• Types of Literature Reviews
• Literature Reviews vs. Systematic Reviews
• Systematic vs. Meta-Analysis

Literature Review  is a comprehensive survey of the works published in a particular field of study or line of research, usually over a specific period of time, in the form of an in-depth, critical bibliographic essay or annotated list in which attention is drawn to the most significant works.

Also, we can define a literature review as the collected body of scholarly works related to a topic:

• Summarizes and analyzes previous research relevant to a topic
• Includes scholarly books and articles published in academic journals
• Can be an specific scholarly paper or a section in a research paper

The objective of a Literature Review is to find previous published scholarly works relevant to an specific topic

• Help gather ideas or information
• Keep up to date in current trends and findings
• Help develop new questions

A literature review is important because it:

• Explains the background of research on a topic.
• Demonstrates why a topic is significant to a subject area.
• Helps focus your own research questions or problems
• Discovers relationships between research studies/ideas.
• Suggests unexplored ideas or populations
• Identifies major themes, concepts, and researchers on a topic.
• Tests assumptions; may help counter preconceived ideas and remove unconscious bias.
• Identifies critical gaps, points of disagreement, or potentially flawed methodology or theoretical approaches.
• Indicates potential directions for future research.

All content in this section is from Literature Review Research from Old Dominion University 

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

Not an essay 

Not an annotated bibliography  in which you summarize each article that you have reviewed.  A literature review goes beyond basic summarizing to focus on the critical analysis of the reviewed works and their relationship to your research question.

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

A literature review serves several purposes. For example, it

• provides thorough knowledge of previous studies; introduces seminal works.
• helps focus one’s own research topic.
• identifies a conceptual framework for one’s own research questions or problems; indicates potential directions for future research.
• suggests previously unused or underused methodologies, designs, quantitative and qualitative strategies.
• identifies gaps in previous studies; identifies flawed methodologies and/or theoretical approaches; avoids replication of mistakes.
• helps the researcher avoid repetition of earlier research.
• suggests unexplored populations.
• determines whether past studies agree or disagree; identifies controversy in the literature.
• tests assumptions; may help counter preconceived ideas and remove unconscious bias.

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

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

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

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

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

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

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

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

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

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

Robinson, P. and Lowe, J. (2015),  Literature reviews vs systematic reviews.  Australian and New Zealand Journal of Public Health, 39: 103-103. doi: 10.1111/1753-6405.12393

What's in the name? The difference between a Systematic Review and a Literature Review, and why it matters . By Lynn Kysh from University of Southern California

Systematic review or meta-analysis?

A  systematic review  answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria.

A  meta-analysis  is the use of statistical methods to summarize the results of these studies.

Systematic reviews, just like other research articles, can be of varying quality. They are a significant piece of work (the Centre for Reviews and Dissemination at York estimates that a team will take 9-24 months), and to be useful to other researchers and practitioners they should have:

• clearly stated objectives with pre-defined eligibility criteria for studies
• explicit, reproducible methodology
• a systematic search that attempts to identify all studies
• assessment of the validity of the findings of the included studies (e.g. risk of bias)
• systematic presentation, and synthesis, of the characteristics and findings of the included studies

Not all systematic reviews contain meta-analysis. 

Meta-analysis is the use of statistical methods to summarize the results of independent studies. By combining information from all relevant studies, meta-analysis can provide more precise estimates of the effects of health care than those derived from the individual studies included within a review.  More information on meta-analyses can be found in  Cochrane Handbook, Chapter 9 .

A meta-analysis goes beyond critique and integration and conducts secondary statistical analysis on the outcomes of similar studies.  It is a systematic review that uses quantitative methods to synthesize and summarize the results.

An advantage of a meta-analysis is the ability to be completely objective in evaluating research findings.  Not all topics, however, have sufficient research evidence to allow a meta-analysis to be conducted.  In that case, an integrative review is an appropriate strategy. 

Some of the content in this section is from Systematic reviews and meta-analyses: step by step guide created by Kate McAllister.

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Why is it important to do a literature review in research?

The importance of scientific communication in the healthcare industry

The Importance and Role of Biostatistics in Clinical Research

 “A substantive, thorough, sophisticated literature review is a precondition for doing substantive, thorough, sophisticated research”. Boote and Baile 2005

Authors of manuscripts treat writing a literature review as a routine work or a mere formality. But a seasoned one knows the purpose and importance of a well-written literature review.  Since it is one of the basic needs for researches at any level, they have to be done vigilantly. Only then the reader will know that the basics of research have not been neglected.

The aim of any literature review is to summarize and synthesize the arguments and ideas of existing knowledge in a particular field without adding any new contributions.   Being built on existing knowledge they help the researcher to even turn the wheels of the topic of research.  It is possible only with profound knowledge of what is wrong in the existing findings in detail to overpower them.  For other researches, the literature review gives the direction to be headed for its success. 

The common perception of literature review and reality:

As per the common belief, literature reviews are only a summary of the sources related to the research. And many authors of scientific manuscripts believe that they are only surveys of what are the researches are done on the chosen topic.  But on the contrary, it uses published information from pertinent and relevant sources like

• Scholarly books
• Scientific papers
• Latest studies in the field
• Established school of thoughts
• Relevant articles from renowned scientific journals

and many more for a field of study or theory or a particular problem to do the following:

• Summarize into a brief account of all information
• Synthesize the information by restructuring and reorganizing
• Critical evaluation of a concept or a school of thought or ideas
• Familiarize the authors to the extent of knowledge in the particular field
• Encapsulate
• Compare & contrast

By doing the above on the relevant information, it provides the reader of the scientific manuscript with the following for a better understanding of it:

• It establishes the authors’  in-depth understanding and knowledge of their field subject
• It gives the background of the research
• Portrays the scientific manuscript plan of examining the research result
• Illuminates on how the knowledge has changed within the field
• Highlights what has already been done in a particular field
• Information of the generally accepted facts, emerging and current state of the topic of research
• Identifies the research gap that is still unexplored or under-researched fields
• Demonstrates how the research fits within a larger field of study
• Provides an overview of the sources explored during the research of a particular topic

Importance of literature review in research:

The importance of literature review in scientific manuscripts can be condensed into an analytical feature to enable the multifold reach of its significance.  It adds value to the legitimacy of the research in many ways:

• Provides the interpretation of existing literature in light of updated developments in the field to help in establishing the consistency in knowledge and relevancy of existing materials
• It helps in calculating the impact of the latest information in the field by mapping their progress of knowledge.
• It brings out the dialects of contradictions between various thoughts within the field to establish facts
• The research gaps scrutinized initially are further explored to establish the latest facts of theories to add value to the field
• Indicates the current research place in the schema of a particular field
• Provides information for relevancy and coherency to check the research
• Apart from elucidating the continuance of knowledge, it also points out areas that require further investigation and thus aid as a starting point of any future research
• Justifies the research and sets up the research question
• Sets up a theoretical framework comprising the concepts and theories of the research upon which its success can be judged
• Helps to adopt a more appropriate methodology for the research by examining the strengths and weaknesses of existing research in the same field
• Increases the significance of the results by comparing it with the existing literature
• Provides a point of reference by writing the findings in the scientific manuscript
• Helps to get the due credit from the audience for having done the fact-finding and fact-checking mission in the scientific manuscripts
• The more the reference of relevant sources of it could increase more of its trustworthiness with the readers
• Helps to prevent plagiarism by tailoring and uniquely tweaking the scientific manuscript not to repeat other’s original idea
• By preventing plagiarism , it saves the scientific manuscript from rejection and thus also saves a lot of time and money
• Helps to evaluate, condense and synthesize gist in the author’s own words to sharpen the research focus
• Helps to compare and contrast to  show the originality and uniqueness of the research than that of the existing other researches
• Rationalizes the need for conducting the particular research in a specified field
• Helps to collect data accurately for allowing any new methodology of research than the existing ones
• Enables the readers of the manuscript to answer the following questions of its readers for its better chances for publication
• What do the researchers know?
• What do they not know?
• Is the scientific manuscript reliable and trustworthy?
• What are the knowledge gaps of the researcher?

22. It helps the readers to identify the following for further reading of the scientific manuscript:

• What has been already established, discredited and accepted in the particular field of research
• Areas of controversy and conflicts among different schools of thought
• Unsolved problems and issues in the connected field of research
• The emerging trends and approaches
• How the research extends, builds upon and leaves behind from the previous research

A profound literature review with many relevant sources of reference will enhance the chances of the scientific manuscript publication in renowned and reputed scientific journals .

References:

http://www.math.montana.edu/jobo/phdprep/phd6.pdf

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What is a literature review?

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

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

Why is it important?

A literature review is important because it:

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

APA7 Style resources

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1. Choose a topic. Define your research question.

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

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

2. Decide on the scope of your review

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

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

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

Make a list of the databases you will search. 

Where to find databases:

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

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

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

Review the literature

Some questions to help you analyze the research:

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

Tips: 

• Review the abstracts carefully.  
• Keep careful notes so that you may track your thought processes during the research process.
• Create a matrix of the studies for easy analysis, and synthesis, across all of the studies.
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Research Methods: Literature Reviews

• Annotated Bibliographies
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A literature review involves researching, reading, analyzing, evaluating, and summarizing scholarly literature (typically journals and articles) about a specific topic. The results of a literature review may be an entire report or article OR may be part of a article, thesis, dissertation, or grant proposal. A literature review helps the author learn about the history and nature of their topic, and identify research gaps and problems.

Steps & Elements

Problem formulation

• Determine your topic and its components by asking a question
• Research: locate literature related to your topic to identify the gap(s) that can be addressed
• Read: read the articles or other sources of information
• Analyze: assess the findings for relevancy
• Evaluating: determine how the article are relevant to your research and what are the key findings
• Synthesis: write about the key findings and how it is relevant to your research

Elements of a Literature Review

• Summarize subject, issue or theory under consideration, along with objectives of the review
• Divide works under review into categories (e.g. those in support of a particular position, those against, those offering alternative theories entirely)
• Explain how each work is similar to and how it varies from the others
• Conclude which pieces are best considered in their argument, are most convincing of their opinions, and make the greatest contribution to the understanding and development of an area of research

Writing a Literature Review Resources

• How to Write a Literature Review From the Wesleyan University Library
• Write a Literature Review From the University of California Santa Cruz Library. A Brief overview of a literature review, includes a list of stages for writing a lit review.
• Literature Reviews From the University of North Carolina Writing Center. Detailed information about writing a literature review.
• Undertaking a literature review: a step-by-step approach Cronin, P., Ryan, F., & Coughan, M. (2008). Undertaking a literature review: A step-by-step approach. British Journal of Nursing, 17(1), p.38-43

Literature Review Tutorial

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Systematic reviews of the literature: an introduction to current methods

Affiliation.

• 1 Department of Health Research Methods, Evidence, and Impact; McMaster University.
• PMID: 39038802
• DOI: 10.1093/aje/kwae232

Systematic reviews are a type of evidence synthesis in which authors develop explicit eligibility criteria, collect all the available studies that meet these criteria, and summarize results using reproducible methods that minimize biases and errors. Systematic reviews serve different purposes and use a different methodology than other types of evidence synthesis that include narrative reviews, scoping reviews, and overviews of reviews. Systematic reviews can address questions regarding effects of interventions or exposures, diagnostic properties of tests, and prevalence or prognosis of diseases. All rigorous systematic reviews have common processes that include: 1) determining the question and eligibility criteria, including a priori specification of subgroup hypotheses 2) searching for evidence and selecting studies, 3) abstracting data and assessing risk of bias of the included studies, 4) summarizing the data for each outcome of interest, whenever possible using meta-analyses, and 5) assessing the certainty of the evidence and drawing conclusions. There are several tools that can guide and facilitate the systematic review process, but methodological and content expertise are always necessary.

Keywords: Evidence synthesis; Systematic Reviews.

© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

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Chapter 2: The Importance of Theory and Literature

There is nothing more practical than a good theory.

— Kurt Lewin, 1951, p. 169

Learning Objectives

After reading this chapter, students should be able to do the following:

• Outline the main assumptions of positivist, interpretive, critical, and pragmatic paradigms.
• Explain why decolonization is necessary for learning about Indigenous knowledges.
• Define and differentiate between theoretical frameworks and theories.
• Distinguish between deductive and inductive reasoning and explain how the role of theory differs in qualitative and quantitative research.
• Formulate social research questions.
• Explain the importance of a literature review.
• Locate appropriate literature and evaluate sources of information found on the internet.

INTRODUCTION

In chapter 1, you were introduced to scientific reasoning as a desirable alternative to learning about the social world through tradition, common sense, authority, and personal experience. In addition, you learned to distinguish between basic and applied research and that research methods are used to collect data for a variety of purposes (e.g., to explore, describe, explain, or evaluate some phenomenon). In this chapter, you will learn about paradigms that shape our views of social research and alternative worldviews in the form of Indigenous knowledges. You will learn about theoretical frameworks and the importance of theory and prior research for informing the development of new research. Finally, this chapter helps you locate and evaluate sources of information you find in the library and on the internet.

INQUIRY PARADIGMS IN THE SOCIAL SCIENCES

At the most general level, a paradigm is a set of “basic beliefs” or a “worldview” that helps us make sense of the world, including our own place in it (Guba & Lincoln, 1994). Earl Babbie and Jason Edgerton (2024) define a paradigm as “a theoretical perspective including a set of assumptions about reality that guide research questions” (Some Social Science Paradigms section). As a broad framework, a paradigm includes assumptions about the nature of knowledge (a branch of philosophy called epistemology), assumptions about the nature of reality or the way things are (a branch of philosophy called ontology), and assumptions about how we go about solving problems and gathering information (a system of principles or practices collectively known as methodology). The assumptions are interrelated in the sense that how one views the nature of reality (an ontological stance) influences beliefs about one’s relationship to that reality (an epistemological stance) and how one would go about examining that reality (a methodological stance) (Guba & Lincoln, 1994). This will become clearer as we compare the assumptions of four distinct and competing inquiry paradigms.

Positivist Paradigm

French philosopher Auguste Comte (1798–1857) first used the term social physics (later called sociology ) to describe a positivist science of society that could teach us about the social world through research and theorizing (Ritzer & Stepnisky, 2021) . The positivist paradigm is a belief system aimed at discovering universal laws based on the assumption that a singular reality exists independent of individuals and their role in it. Positivism rests on a worldview like that of the natural sciences, which stresses objectivity and truth as discovered through direct empirical methods. In its most extreme form, positivism will accept as knowledge-only events that can verified through sensory experience (Bell et al., 2022). The goal of positivism is to explain events and relationships via a search for antecedent causes that produce outcomes. Within a positivist paradigm, the search for empirical truth begins with what is already known about an area. From that starting point, probable causes are “deduced” using logical reasoning, and then theories are tested for accuracy. Systematic observation and experimental methods are commonly employed modes of inquiry and the data obtained is quantifiable.

Interpretive Paradigm

The interpretive paradigm (also called constructivism) arose in part as a critique of positivism for its failure to recognize the importance of subjectivity in human-centred approaches. The interpretive paradigm worldview rests on the assumption that reality is socially constructed in the form of mental representations created and recreated by people through their experiences and interactions in social contexts (Lincoln et al., 2024). As such, “multiple realities exist” for any given individual (Guba, 1996), and these individual realities are largely “self-created” (Guba & Lincoln, 1994). The focus of the interpretive paradigm is on understanding individuals’ perceptions of reality, including how events and interactions come to have meaning for them, rather than identifying objective phenomena or social facts that exist outside of individuals and relationships. This generally necessitates a qualitative research strategy, such as ethnography, which brings the researcher into close contact with those being studied for prolonged periods of time; as a result, relationships develop and insight is gained from within those relationships. As Palys and Atchison (2014) put it, “good theory is not imposed; rather, it emerges from direct observation and contact with people in context” (p. 23).

Critical Paradigm

Another worldview that emphasizes interpretation and understanding is the critical paradigm . The critical paradigm rests on an assumption that “human nature operates in a world that is based on a struggle for power” (Lincoln et al., 2024, p. 81). The critical paradigm focuses specifically on determining the role power plays in the creation of knowledge, frequently using qualitative strategies. The critical approach is more of a critique concerning how and why particular views become the dominant ones and how privilege and oppression interact, often as the result of defining characteristics such as gender, race and ethnicity, and social class (Lincoln et al., 2024). Beyond examining inequality, there is also an emphasis on “praxis,” whereby scholars provide knowledge that can help to end powerlessness (Symbaluk & Bereska, 2022). To the extent that research can identify ways in which groups are disadvantaged and identify the causes of subordination, it can also be used to help resolve the inequities. Various theoretical perspectives and theories stem from a critical-interpretative stance including feminist inquiry, critical race theory, critical disabilities studies, and queer theory. [1]

Pragmatic Paradigm

Finally, in contrast to the dichotomy between the objectivity of positivism and the subjectivity of interpretive approaches, an impartial outlook is offered by a more recent paradigm called the pragmatic paradigm . The pragmatic view “arises out of actions, situations, and consequences rather than antecedent conditions” and is concerned with “applications—what works—and solutions to problems” (Creswell & Creswell, 2023, p. 11). This problem-centred worldview is not based in any philosophy, nor does it necessitate the use of a certain form of reasoning or research technique. It does, however, emphasize the importance of methodology for solving problems and advocates for the use of combined qualitative and quantitative approaches for a more complete understanding. Historically, combining qualitative and quantitative approaches has proven problematic given the opposing assumptions upon which each approach is based. The pragmatic paradigm offers a solution to the dichotomy. As John W. Creswell and J. David Creswell (2023) note, “pragmatists do not see the world as an absolute unity. In a similar way, mixed methods researchers look to many approaches for collecting and analyzing data rather than subscribing to any one way (e.g., quantitative or qualitative)” (p. 12). Thus, the starting point is the issue or research problem, which itself suggests the most applicable means for further research exploration. Mixed method approaches to research that are grounded in a pragmatic paradigm are discussed in more detail in chapter 11.

Test Yourself

• Which paradigm seeks to discover universal laws?
• Which paradigm is most concerned with objective reality?
• Which paradigm is problem-centred?
• Which paradigm rests on the assumption that reality is socially constructed?

INDIGENOUS KNOWLEDGES AND RESEARCH PARADIGMS

It is important to note that the paradigms discussed thus far have philosophical and research underpinnings based on dominant Euro-Western modes of thought. Indigenous scholars highlight the value of reclaiming alternative worldviews stemming from the silenced cultural perspectives of groups that are marginalized, underprivileged, and/or have suffered European colonization (e.g., see Battiste, 2000; Belanger & Hanrahan, 2022; Quinless, 2022; Smith, 2021; Warrior, 1995). “ Indigenous knowledges are diverse learning processes that come from living intimately with the land, working with the resources surrounding the land base, and the relationships that it has fostered over time and place. These are physical, social, and spiritual relationships that continue to be the foundations of its world views and ways of knowing that define their relationships with each other and others” (Battiste, 2013, p. 33). These Indigenous, sometimes called “traditional,” knowledges contain a wealth of pragmatic lessons in diverse areas from environmental conservation to cultural protocols and familial relationships.

The loss of language stemming from forced assimilation via structural mechanisms such as residential schools and Eurocentric educational systems poses challenges for the maintenance of Indigenous knowledges, though elders continue to play a vital role in the verification and transmission of Indigenous cultures. Note that researchers and their methods used to research Indigenous knowledges have historically been mainly non-Indigenous, and hence even the discourse of the colonized is shaped “through imperial eyes” (Smith, 2021). By employing decolonized methods, involving Indigenous researchers, including Indigenous peoples as active participants in research processes, listening to the teachings of elders, and recognizing the role that non-Indigenous researchers and Western methodologies have played in shaping the discourse on colonized Others, we can begin to remove the Eurocentric lens. The term colonized Other is used here to refer to Indigenous peoples in Canada who have experienced European colonization, but it can also be used more collectively to include those who are “disenfranchised” and “dispossessed” elsewhere in the world (e.g., those living in marginalized communities in underdeveloped countries) as described by Chilisa (2020, p. 9).

Decolonization is not one type of methodology but rather is “a process of conducting research in such a way that the worldviews of those who have suffered a long history of oppression and marginalization are given space to communicate from their frames of reference” (Chilisa, 2020, p. 11). For example, instead of asking volunteers to complete a questionnaire worded by the researcher to learn about participants’ views and experiences as prescribed by traditional social science methods, a former student of one of the authors named Reith Charlesworth (2016) spent several months developing relationships and establishing trust with program attendees before participating in a sharing circle she co-facilitated with an Indigenous social worker. The sharing circle included a feast and provided the opportunity for women to tell stories that ultimately helped Reith better understand social and structural barriers experienced by young Indigenous mothers in a parenting program at iHuman Youth Society in Edmonton, Alberta. [2]

Since Indigenous knowledge structures encompass a dynamic array of beliefs and lived experiences held by various individuals identifying with vastly different tribal groups in many different locations, it is difficult to identify common features. The United Nations Educational, Scientific, and Cultural Organization defines local and Indigenous knowledge as the

understandings, skills and philosophies developed by societies with long histories of interaction with their natural surroundings. For rural and Indigenous Peoples, local knowledge informs decision-making about fundamental aspects of day-to-day life. This knowledge is integral to a cultural complex that also encompasses language, systems of classification, resource use practices, social interactions, ritual and spirituality.” (UNESCO, 2024)

In her book on Indigenous methodologies, Margaret Kovach (2021) explains:

The scope and basis of an Indigenous epistemology encompasses: multiple sources of knowledge, more commonly recognized as holism (scope); a tangible and intangible animate world that is process oriented and cyclical, such as that expressed in verb-oriented language (e.g., with ing endings), which comprise many Indigenous languages (basis); and a web of interdependent, contextual, relationships over time, such as with place, family and community (basis)(p. 68).

Whereas the aim of a positivist paradigm is to discover universal laws, an Indigenous research paradigm seeks to challenge colonized ways of thinking and to employ decolonized research methods that enable a respectful reclaiming of Indigenous cultures and knowledges. Because Indigenous knowledges are largely maintained through oral transmission and cultural practices, Indigenous methodologies also include ceremonies and formal protocols, and they are amenable to narrative inquiry as in the case of sharing circles and storytelling (Kovach, 2021). When it comes to employing Indigenous research methods, the fundamental point to remember is that the research process and the resulting data and knowledge stemming from it are integrally based on “relational actions”—that is, the personal relationships and connections that are formed with Indigenous communities based on trust (Kovach, 2021).

• What are Indigenous knowledges?
• In research, what does decolonization mean?

Activity: Understanding Research Paradigms

Theoretical frameworks and theories.

Positivist, interpretive, critical, and pragmatic paradigms all offer a broad worldview from which theoretical frameworks emerge. Theoretical frameworks are perspectives based on core assumptions that provide a foundation for examining the social world at different levels. Theoretical frameworks that operate at the macro level tend to focus on “larger social forces,” while those dealing with the micro level are aimed at understanding “individual experiences” (Symbaluk & Bereska, 2022, p. 4).

Within the discipline of sociology, the functionalist, conflict, interactionist, feminist, and postmodern frameworks provide different lenses from which we can view society. The functionalist framework is a macro-level perspective that views society as being made up of certain structures—such as the family, education, and religion—that are essential for maintaining social order and stability. For example, a primary function of the family is to provide for the social, emotional, and economic well-being of its members and to serve as a key agent of socialization. The functionalist framework is rooted in positivism in its focus on observables in the form of social facts and universal truths. The conflict framework is also a macro-level perspective, but it is rooted in the critical paradigm in its examination of power and its emphasis on the prevalence of inequality in society as groups compete for scarce resources. Karl Marx (1818–1883), considered a key founder of this perspective, emphasized the central role of the economy in the creation of conflict and explained how workers in society are exploited and alienated under systems of capitalism (Ritzer & Stepnisky, 2021).

The symbolic interactionist framework is a micro-level perspective attributed to the early work of sociologists George Herbert Mead (1863–1931) and Herbert Blumer (1900–1987). The symbolic interactionist framework depicts society as consisting of individuals engaged in a variety of communications based on shared understandings (Symbaluk & Bereska, 2022). The emphasis here is on how individuals create meaning using symbols and language. Note how this framework emerges from interpretivism, with its emphasis on the importance of subjective meaning for individuals that is constructed and interpreted within interactions. For example, although two siblings in a familial union understand and relate to each other based on common features, such as a shared language and upbringing, they also each experience and recall events somewhat differently, based on their unique perspectives and relations toward one another. The symbolic interactionist perspective often guides qualitative researchers as they design strategies for uncovering meaning in groups and contexts.

With roots in the critical paradigm, the feminist framework [3]   rests on the premise that men and women should be treated equal in all facets of social life (e.g., family, employment, law, and policy). The feminist framework includes a diverse range of perspectives (e.g., radical, socialist, post-colonial), operates at both the micro and macro levels, and is especially helpful in demonstrating ways in which society is structured by gender and how gender roles differentially impact males and females. For example, feminist scholars are quick to point out that women in relationships with men continue to adhere to traditional gender role expectations, doing more than their share of housework and experiencing less free time compared to their partners (e.g., Bianchi, 2011; Guppy & Luongo, 2015). Even in egalitarian relationships (based on equality in principle) where both partners are Canadian academics working outside of the home, women assume more of the caregiving and household obligations at the expense of work-life balance (Wilton & Ross, 2017). COVID-19 exacerbated  gender inequalities with Canadian women spending close to 50 hours per week more than men on childcare during the pandemic (Johnston et al., 2020).

Finally, emerging post-World War II, the postmodern framework emphasizes the ways in which society has changed dramatically, particularly in relation to technological advances. The postmodern framework speaks out against singular monolithic structures and forces. It traces the intersectional features of inequality, including race, class, and gender, and focuses specifically on the effects of the digital age. This framework complicates dualistic boundaries between the micro and macro (arguing that they are one and the same) and calls into question the singular truths of earlier frameworks such as Marxism and functionalism. Postmodern perspectives are especially helping in guiding research in areas of media literacy, globalization, and environmental studies.

Drilling down another layer, within broader theoretical perspectives, we can locate particular theories . Within the functionalist framework, for example, we find Robert Merton’s (1938) strain theory of deviance, which explains how people adapt when there is a discrepancy between societal goals (what we are supposed to aspire to) and the legitimate means for obtaining them. Or, within the symbolic interactionist perspective, we can locate Edwin Lemert’s (1951) labelling theory of deviance, which explains a process whereby people may come to view themselves as lifelong deviants. Theories are discussed in more detail in the next section.

THE ROLE OF THEORY IN RESEARCH

A theory “is a set of propositions intended to explain a fact or a phenomenon” (Symbaluk & Bereska, 2022, p. 9). The propositions are usually expressed as statements that reflect the main assumptions of the theory. For example, Edwin Sutherland’s (1947) differential association theory is a theory about crime, and it is explained in nine propositions. To give you a sense of the theory, the first proposition is that “criminal behaviour is learned”; the second is that “criminal behaviour is learned in interactions with other persons in a process of communication” (p. 6). Taken together, the propositions in differential association theory explain how crime is learned through interactions with others in much the same way as non-criminal behaviour is learned. That is, members of small groups with whom we spend time and who we feel are important may teach us the techniques and motives needed to develop criminal tendencies.

Deductive Forms of Reasoning

Theory doesn’t happen in isolation from research; it can both inform the research process and develop from it. Theory that informs the research process is known as deductive reasoning. Deductive reasoning is a “theory-driven approach that typically concludes with [empirical] generalizations based on research findings” (Symbaluk & Bereska, 2022, p. 26). A deductive approach to social research is often a “top-down” linear one that begins with a research idea that is grounded in theory. A hypothesis or “testable research statement that includes at least two variables” is derived from the theory and this sets the stage for data collection (Symbaluk & Bereska, 2022, p. 29). A variable is a “categorical concept for properties of people or entities that can differ and change” (Symbaluk & Bereska, 2022, pp. 25–26; as discussed in more detail in chapter 4). In a study on crime, criminal behaviour (e.g., the presence or absence of it) or a certain type of crime is likely to be a main variable of interest, along with another variable regularly associated with crime, such as age, sex, or race. For example, based on a theory of aggression, a hypothesis could be that men are more likely than women to commit physical assaults.

Activity: Deductive Research Process

Testing hypotheses derived from theories.

Based on the tenets of Sutherland’s (1947) differential association theory, Reiss and Rhodes (1964) “deduced” that delinquent boys are likely to engage in the same acts of deviance as their closest friends, since these are the people from whom they learn the techniques, motives, and definitions favourable to committing crimes. Specifically, they tested a hypothesis that the probability of an individual committing a delinquent act (e.g., auto theft, an assault, and vandalism) would be dependent upon his two closest friends also committing that act. The researchers looked at six different delinquent acts among 299 triads (i.e., groups of three), wherein each boy reported on his delinquency and indicated whether he committed the act alone or in the presence of others. In support of the theory, Reiss and Rhodes (1964) found that boys who committed delinquent acts were more likely to have close friends that committed the same acts. Figure 2.2 summarizes the logic of a typical research process based on deductive reasoning.

Inductive Forms of Reasoning

An inductive reasoning approach is more “bottom-up,” beginning with observations and ending with the discovery of patterns and themes that are usually informed by theory or help establish and thereby “induce” new theory (see figure 2.3).

For example, Lowe and McClement (2011) examined the experience of spousal bereavement through interviews with young Canadian women whose husbands passed away. Over the course of data collection, the researchers identified various common themes including “elements of losses” such as the loss of companionship and the loss of hopes and dreams for the future. They also identified a notion of “who am I?” as the widows relayed their attempts to redefine themselves as single, in relation to other men, with their friends, and as single parents. Although the lived experience of young Canadian widows as a specific group of interest had not been previously explored, the researchers interpreted their findings within the context of previous studies and theoretical frameworks, such as Bowman’s (1997) earlier research on facing the loss of dreams and Shaffer’s (1993) dissertation research on rebuilding identity following the loss of a spouse. Lowe and McClement (2011) also identified the importance of making connections through memories as a means of adapting, suggesting a direction for additional research and the potential for an eventual theory on the development of relationships following the loss of a spouse.

The Role of Theory in Quantitative and Qualitative Research

Note that the role and use of theory differs depending on whether the study is quantitative (i.e., based on deductive reasoning) or qualitative (i.e., based on inductive reasoning). Recall from chapter 1 that qualitative research often seeks to provide an in-depth understanding of a research issue from the perspective of those who are affected first-hand. The research process begins with an interest in an area such as cannabis use and a research question (e.g., What do parents perceive their role to be in the education of cannabis use?). Data collection is often undertaken through a technique such as qualitative interviews, where researchers ask open-ended questions to learn as much as possible from interviewees. For example, Haines-Saah et al. (2018) asked parents of adolescent drug users what their experiences were like talking to their children about drug use. Theory is usually brought into an analysis to help make sense of the responses collected. In some cases, new theory develops out of the research findings. The “discovery of theory from data systematically obtained from social research” is better known as grounded theory (Glaser & Strauss, 2007, p. 2) since it is intricately linked to the data and context within which it developed. In most instances of qualitative research, theory plays a central role at various stages (e.g., in the formulation of the research question, in the initial stages of data coding, and especially toward the end of the data-analysis process). Findings from the cannabis study were interpreted in theoretical frameworks of risk and responsibility, as parents discussed cannabis use largely from a health narrative of drugs negatively impacting a developing brain or a blame narrative where parents viewed themselves as the primary agents of prevention (Haines-Saah et al., 2018).

In contrast, theory is the starting point for most quantitative studies. On one hand, a theory provides a set of interrelated ideas that organize the existing knowledge in a meaningful way and help to explain it (Cozby et al., 2020). For example, demographic transition theory helps to identify universal stages of population change as countries progress from pre-industrial societies through to post-industrial economies (Landry, 1934; Notestein, 1945). In countries characterized by the more advanced industrial stage of development, birth rates are low, corresponding to people having fewer children due to various considerations (e.g., birth control, female participation in the workforce, reliance on exported manufactured goods, greater emphasis on higher educational attainment). Despite the specificity of economic and social issues that vary from one country to the next, we can still identify broader commonalities such a declining birth rate coupled with an already low death rate in all countries that have reached the industrial stage of development, including Canada. Hence, this early theory is still useful today for explaining differences between countries in early industrial, industrial, and post-industrial stages of development.

In addition, a theory provides a focal point that draws our attention to issues and events in a manner that helps to generate new interest and knowledge (Cozby et al., 2020). For example, conflict theorists showed us how capitalism and its focus on economic productivity is linked to major environmental issues, including the high extraction of natural resources and the high accumulation of waste (Schnaiberg, 1980). Schnaiberg’s early framing of capitalism as a “treadmill of production” spawned additional interest in the study of modern industry, highlighting ways in which environmental issues are constructed as “proeconomic” measures in part because of alliances formed between capitalists, workers, and the state (Gould et al., 2008). Conflict theorists also direct our attention to the capitalist “treadmill of accumulation,” which, in its reliance on ever-increasing amounts of expansion and exploitation, renders attempts at sustainable capitalism largely unattainable from an environmental standpoint (Foster et al., 2010). With ongoing concerns about carbon emissions, conflict theorists are now asking the question: How much is enough? suggesting we need to aim for carbon minimalism through efforts at simplicity and sufficiency if we hope to tackle the climate crisis (Alter, 2024).

On the other hand, using theory as a starting point necessitates the development of specific propositions and the prior classifications of key concepts and assumptions before data collection begins. As Mathew David and Carole D. Sutton (2011) explain,

there are advantages and disadvantages here. Those who seek to classify their qualities prior to data collection can be accused of imposing their own priorities, while those who seek to allow classifications to emerge during the research process are thereby unable to use the data collection period to test their subsequent theories. They too can then be accused of imposing their own priorities because it is hard to confirm or disprove their interpretations as no ‘testing’ has been done. (p. 92)

You will learn more about the criteria used to evaluate research in chapter 4. For now, consider that both approaches, while different, have equal merit and drawbacks. Inductive and deductive approaches are probably best viewed as different components of the same research cycle, with some researchers beginning with theories and ending with observations, and others doing the reverse (Wallace, 1971).

Research on the Net

Classical Social  Theory Course

Classical social theory remains highly relevant today, guiding and informing the research of social scientists around the world. Professors at the University of Amsterdam have developed a free online course on Classical Social Theory for anyone interested in learning more about the works of influential social science theorists from the 18th, 19th, and 20th centuries, including Karl Marx, Max Weber, and Emile Durkheim.

• What is theory?
• What does a hypothesis contain?
• In what ways is a research process based on deductive reasoning different from one based on inductive reasoning?
• How do the role and use of theory differ in a qualitative versus quantitative study?
• What is grounded theory?

FORMULATING RESEARCH QUESTIONS

Although most of this chapter has focused on the role of theory for guiding the development of research and helping to inform research outcomes, research begins even before this, with a general area of interest. Every research study begins with a topic of interest. As a general worldview can be narrowed into a specific theory, a general area of interest can be shaped into a specific research question. Think about the last time you were asked to write an essay on a topic of interest or if you are considering continuing your studies into graduate school, what a general area of interest might entail. For a student in sociology, a broad area of interest could be the family, gender and sexualities, deviance, globalization, or social inequality. A student in psychology is more likely to consider the areas of developmental psychology, cognition, neuropsychology, or clinical testing, to name a few. Someone in anthropology may have a starting interest that lends itself more to archaeology, physical anthropology, cultural anthropology, or linguistics.

Locating a Topic of Interest

Within a broad area of interest, there are topics or issues that are focus points for research. For example, a sociologist specializing in social inequality might wish to learn more about the distribution of poverty in Canada or the barriers to housing experienced by those who are homeless. A developmental psychologist may be studying the intellectual, emotional, or perceptual development of children. Someone in anthropological linguistics might be interested in the evolution of language dialects or the loss of a mother tongue over time. Regardless of the topic you choose, your research interest is likely to centre on social groups (e.g., homeless people, children with developmental delays, Indigenous peoples who speak an endangered language) or social structures, policies, and processes that affect groups (e.g., barriers to housing, definitions of poverty, cannabis legislation, health benefit coverage).

Framing an Interest into a Social Research Question

Recall from chapter 1 that a social research question is designed to explore, describe, explain, or critically evaluate a topic of interest. This means as you develop your topic of interest, you need to consider how the wording of the question suggests the most appropriate course of action for answering it. A social research question is “a question about the social world that one seeks to answer through the collection and analysis of firsthand, verifiable, empirical data” (Schutt, 2022, p. 33). A question beginning with “What is it like to …” often implies an exploratory purpose, inductive reasoning, and a qualitative research method. A question beginning with “Why” may presuppose a search for causes, and this is generally undertaken for an explanatory purpose based on deductive reasoning and a quantitative method, such as an experiment. Alternatively, “Why” might also imply inductive reasoning that is designed to get the essence of a first-hand experience using a qualitative approach. Research questions that are designed to evaluate a program or service are likely to be formulated along the lines of “Is this working?” Program evaluations are often based on qualitative methods, but the approaches and methods vary considerably and may include mixed methods, depending on the nature of the program or policy. Descriptive studies, often resting on a research question such as “What are its main features?” tend to be heavily represented in the quantitative realm (especially when the data are gathered through surveys). However, like evaluation research, descriptive studies are amenable to qualitative methods, especially in the case of field observation, which can produce highly descriptive forms of data.

Framing an interest is not a process that occurs instantly; rather it is one that you develop over time, eventually shaping your interest into a manageable research question that will direct a study that contributes to the existing body of knowledge. You will need to start with a general area, select a topic, issue, or focus within that area, and then look at the literature before refining your topic into a central social research question. Figure 2.4 provides two examples of the progression from a general area to a more specific question.

• What does a research study begin with?
• What is a social research question?

THE IMPORTANCE OF A LITERATURE REVIEW

If you plan to conduct research, you will need to be familiar with what is already known about your research interest before you finalize your research question. It is important that you at least examine the literature relevant to your topic of interest before you commit to a specific research question. You are likely to modify your research question once you learn more about the topic from a literature review.

A literature review is essential for these reasons:

• First, a literature review tells you how much has already been done in this area. For example, if you are interested in carrying out a study on the portrayal of gender stereotypes in the media, it is important for you to know that you are going to be delving into an area that has been heavily researched for decades. There are literally millions of previous studies on the gender stereotypes in movies, on television, in magazines, and on the internet. In this case, your research question would not be exploratory in nature. One of your next steps with this topic would be to narrow your focus (e.g., perhaps you are more interested in male stereotypes portrayed in magazine advertisements).
• Second, a literature review helps familiarize you with what is already known in the area. Continuing with an interest in stereotyped depictions of males, the literature can help you learn more about the construction of masculinity and how the male body is depicted in advertising. For example, Mishkind, Rodin, Silberstein, & Striegel-Moore (1986) note that advertising has increasingly come to celebrate a young, lean, and highly muscular body. This helps you choose an area that most interests you and that you can build upon with your own research (or that you can identify for an area of future research).
• Third, a literature review helps you understand the debates and main points of interest within an area of study. Existing literature can inform you about how the portrayal of gender stereotypes in the media can lead people to become dissatisfied with their body image or engage in extreme practices and measures designed to obtain an ideal body image (e.g., dieting, fitness, cosmetic surgery). The literature can also help you understand similarities and differences in the ways in which men and women are portrayed, or how depictions of men have changed over time. These considerations may further shape the direction you elect to take with a current or future research project.
• Fourth, a literature review highlights what still needs to be done in an area of interest. By examining previous research, you can find out researchers’ suggestions for additional studies, where replications would be helpful, or areas that still need to be addressed. The discussion section at the end of most academic articles typically includes a few sentences that explicitly address how the current study could have been improved upon and/or point out a direction for future research. This is where you will obtain a sense of how you could design a study that builds on the existing literature but also contributes something new.
• Lastly, a literature review can help you define important theories and concepts as well as establish guidelines for how you will need to carry out your own study . For example, if you wish to clarify how male bodies are shown in magazine advertisements, it would be practical to locate examples by other researchers that have already established standard ways to describe and code the body of a central character in an advertisement appearing in magazines.

Research is a conversation

As the following video illustrates, when you are tasked with coming up with a research question, it is important to remember that you are entering into a discussion with other academics who have come before you.

Research is a Conversation by UNLV University Libraries is licensed under CC BY-NC . [Video transcript –  See Appendix D 2.1 ]

In what ways is a literature review essential in the development of a research question?

LOCATING RELEVANT LITERATURE

Resist the temptation to simply search the public internet with your preferred browser for any available resources you can find on your topic of interest. Search engines like Google prioritize links that are from paid sponsors, so the resources that appear first are likely not the most relevant or even appropriate references for your area of interest. Meanwhile, many of the research articles you find using a search engine like Google are behind a paywall requiring that you pay to read more relevant content published by academic publishers. In addition to commercial interests, the public internet also suffers from a lack of quality control; the information you glean from web pages you find on the internet can be obsolete, and worse, fraught with errors.

The best sources of information for a literature review include periodicals, books, and book chapters located in or accessed through a library in a post-secondary institution. You can probably browse an online catalogue system for your post-secondary institution’s library from any computer, if you can access the internet and you are officially registered as a student.

Searching for Books

Books are especially useful when researching specific theories, research methodologies, and the historic context of a topic. Sometimes edited volumes of books contain short research papers written by different authors, which can also be useful when conducting academic research. The search engine on your library’s home page is where you can find books (including eBooks). If you know the title of the book you are looking for, simply type the title into the search box. Putting the title in quotes (e.g., “The Sociology of Childhood and Youth in Canada”) will locate that exact title in the results if it is available. If you instead want to explore what is out there on your topic, enter some relevant keywords. In library databases you will want to put an AND  between each different keyword that you search for. For example, if you try searching for a book using the combined keywords male AND stereotypes , you will probably locate a list of starting resources. If there are more than 50 books on this topic, you might try male AND stereotypes AND media to narrow your search a bit further. You can also search for words with similar meanings by putting an OR  between the terms that you use in brackets, for instance, (male OR masculine OR masculinity) AND stereotypes AND media . After doing a search, most library catalogues will give you options to the left of your results to limit to just books or eBooks, as well as limiting by publication date and to books on general subject areas.

Searching for Periodicals

Periodicals (including magazines, newspapers, and scholarly journals) are publications that contain articles written by different authors. Periodicals are released  periodically at regular intervals such as daily, weekly, monthly, semi-annually, or annually. Popular press periodicals (e.g., Maclean’s, Reader’s Digest , newspapers, and news websites) contain articles that are less scientific and more general-interest focused than scholarly articles published in peer-reviewed periodicals. Scholarly journals published by academic and professional organizations (e.g., universities) are the form of periodical most often cited by your instructors as credible sources for you to use in writing essays and research reports. Scholarly journals contain articles on basic research authored by academics and researchers with expertise in their respective areas. Articles found in scholarly journals have undergone considerable scrutiny in a competitive selection process that rests on peer review and evaluation prior to publication. This helps to ensure that only up-to-date, high-quality research based on sound practices makes it to the publication stage. Examples of Canadian sociological periodicals include the Canadian Journal of Sociology and the Canadian Review of Sociology and Anthropology . Note that there are hundreds of periodicals spanning a range of related disciplines (e.g., Canadian Journal of Criminology , Canadian Journal of Economics , Canadian Journal of Political Science , and Canadian Psychology ) and more specialized topics (e.g., Sex Roles , Child Abuse and Neglect , Contemporary Drug Problems , Educational Gerontology ).

Similar to books, in many cases, you can access journals online using the search box on a university library’s homepage or through a database available on a library’s website. If an article is available in “full text,” you can usually download the entire article onto a storage device, so you can later retrieve it for further reading. Comprehensive databases for locating articles on research in the social sciences include Social Sciences Citation Index (part of Web of Science), Academic Search Complete, PsychINFO, SocINDEX, Sociological Abstracts, Criminal Justice Abstracts, and Anthropology Plus. For example, Academic Search Complete is dubbed one of the most comprehensive multidiscipline full-text databases, containing 5,812 full-text journals and magazines on a range of subjects, including psychology, religion, and philosophy (EBSCO Information Services, 2024).

Searching for Government Information

Depending on your research topic, you may find it helpful to reference research findings and statistics provided by governments. Governments at all levels hire researchers to conduct research on a range of topics to help inform public policy and address societal issues. This is one case where you will have to search for information that is available publicly on the internet. Websites like Statistics Canada and Government of Canada Publications contain a lot of content, however, and can be difficult to search. One strategy that can help with this is to perform a site search using Google. Simply enter site:  into Google followed by the domain of the website you would like to search along with relevant keywords to locate information on that site containing those words. For instance, site:statcan.gc.ca affordable housing  will locate statistics and analysis on housing needs available through Statistics Canada.

Research in Action

Fact Checking and Source Evaluation 

It is not enough to simply locate sources of information on an area of interest and assume that you have appropriate materials for learning about the area of interest. While academic journals undergo a peer-review process that helps to provide a check on the quality, accuracy, and currency of the published materials, the internet has little or no quality control. If you use the internet to find sources of information, such as webpages with links to various articles and other resources, it is important to evaluate that information before using it to inform your research.

SIFT & PICK 

Librarians at MacEwan University Library (2023) suggest you assess the quality of information you find through this SIFT and PICK strategy:

Review the Library’s SIFT and PICK handout [PDF] to learn more.

AFP Fact Check is a department within a larger news agency called Agence France-Press (AFP) dedicated to verifying and providing accurate news coverage. Here, you can find trending stories and search for topics such as “vaccination” to locate the most recent forms of misinformation about the Covid-19 vaccine reported as news.  Visit AFP Canada for exclusively Canadian coverage.

• What are the best sources of information for a literature review?

CHAPTER SUMMARY

• Outline the main assumptions of positivist, interpretative, critical, and pragmatic paradigms. The positivist paradigm emphasizes objectivity and the importance of discovering truth using empirical methods. The interpretive paradigm stresses the importance of subjective understanding and discovering meaning as it exists for the people experiencing it. The critical paradigm focuses on the role of power in the creation of knowledge. The pragmatic paradigm begins with a research problem and determines a course of action for studying it based on what seems most appropriate given that research problem.
• Explain why decolonization is necessary for learning about Indigenous knowledges. For Indigenous knowledges to be derived from Indigenous sources in an authentic and respectful manner, those who have suffered colonization need to be given the space to communicate on their own terms from their frames of reference, as opposed to trying to obtain information via research methods that are based on Euro-Western influences.
• Define and differentiate between theoretical frameworks and theories. Theoretical frameworks are perspectives based on core assumptions that provide a foundation for examining the social world at different levels. For example, theoretical frameworks at the macro level tend to focus on broader social forces, while those at the micro level emphasize individual experiences. Theories develop from theoretical perspectives, and they include propositions that are intended to explain a fact or phenomenon of interest.
• Distinguish between deductive and inductive reasoning and explain how the role of theory differs in qualitative and quantitative research. Deductive reasoning is a top-down, theory-driven approach that concludes with generalizations based on research findings. Inductive reasoning is a bottom-up approach that begins with observations and typically ends with theory construction. Inductive approaches to reasoning guide qualitative research processes, while deductive approaches guide the stages of quantitative research. Theory tends to be the starting point for quantitative research, while it is interspersed throughout and emphasized more in the later stages of qualitative research.
• Formulate social research questions. Based on a broad area of interest and a careful literature review, a researcher eventually shapes a research interest into a social research question, which is a question about the social world that is answered through the collection and analysis of data. For example, a researcher might begin with an interest in gender that develops into an examination of the effects of body size on income for male and female workers, as demonstrated earlier in the chapter.
• Explain the importance of a literature review. A literature review is the starting point for formulating social research questions. A literature review helps to identify what is already known about and still needs to be done in an area of interest. A literature review also points out debates and issues in an area of interest, along with the most relevant concepts and means for going about studying the issue in more depth.
• Locate appropriate literature and evaluate sources of information found on the internet. Appropriate literature sources include periodicals, books, and government documents, most of which can be accessed online through the library at post-secondary institutions. You should evaluate the quality of information gleaned from websites prior to using that information as a primary source in a literature review. Evaluating information on the internet generally takes the form of asking questions that centre on the source, timeliness, accuracy, and relevance of the site. For example, in assessing accuracy, you can ask “Is the information free of spelling, grammatical, and technical errors?” and “Where did the information come from?”

RESEARCH REFLECTION

• Read Margaret Kovach’s (2018) chapter titled Doing Indigenous methodologies: A letter to a research class in N. K. Denzin & Y. S. Lincoln (Eds.), The Sage handbook of qualitative research (5th ed., pp. 108–150). Sage. Based on your reading, explain why the author claims it is not possible to do Indigenous methodologies. Also note the ways in which Indigenous methodologies are relational in nature.
• Identify a general area of interest to you. Within that area of interest, develop two social research questions—one that implies an exploratory purpose and one that implies an explanatory purpose. Which paradigm introduced at the beginning of the chapter do you think best represents the research questions you developed? Explain why this is the case.
• In what ways is an article found in a scholarly journal likely to be more appropriate as a reference source for a research topic than one located using a search engine such as Bing or Google?

LEARNING THROUGH PRACTICE

Objective: To assess information on the internet

Directions:

• Use Google to locate a website that contains relevant information on a topic of interest.
• Who created the site and what are their credentials?
• What are the qualifications of authors associated with the site?
• Is it possible to verify the accuracy of any of the claims made on this site?
• Is an educational purpose for this site evident?
• Is the site objective (or free from bias)?
• Is the site free of advertisements?
• Can you tell when the site was created?
• Was the site updated recently?
• Are there properly cited references on the site?
• Are there any errors on site (e.g., spelling, grammatical)?
• What rating would you give this site out of 100, if 100 percent is “perfect” and 0 stands for “without any merit.” Explain why you think the site deserves this rating based on the questions listed above.

RESEARCH RESOURCES

• To learn more about social theorists and the underpinnings of social theory, refer to Ritzer, G., and Stepnisky, J. (2021). S ociological theory (11th ed.). Sage.
• For an introduction to Indigenous ways of knowing, as well as historical and contemporary issues involving Canada’s First Peoples, refer to Belanger, Y. D. and Hanrahan, M. (2022). Ways of knowing: An introduction to Indigenous studies in Canada (4th ed.). Top Hat.
• To learn about decolonizing strategies and the potential for Indigenizing education, read Cote-Meek, S., and Moeke-Pickering, T. (2020). Decolonizing and Indigenizing education in Canada . Canadian Scholars Press.
• To learn how Indigenous knowledge structures inform research conducted by Indigenous scholars, see Kovach, M. (2021). Indigenous methodologies: Characteristics, conversations and contexts . University of Toronto Press.
• For more information on feminist inquiry, critical race theory, critical disabilities studies, and queer theory , refer to The Sage handbook of qualitative research (6th ed.) (2024), edited by Norman K. Denzin, Yvonna S. Lincoln, Michael D. Giardina, and Gaile S. Cannella. ↵
• The sharing circle was part of a larger community-based project carried out by Reith Charlesworth during the winter of 2016, under the supervision of Brianna Olson, an Anishnaabe (First Nations) Métis woman/social worker who was iHuman’s program manager, and Dr. Alissa Overend, Reith’s research mentor at MacEwan University. Dr. Diane Symbaluk taught the foundational research methods course for this project in the fall of 2015 and set up/oversaw student placements as the faculty coordinator for the 2015–2016 calendar year. ↵
• An in-depth discussion of feminist perspectives is beyond the scope of this book. To learn about feminist standpoints and their relationships to research methodology, I recommend The handbook of feminist research: Theory and praxis (2nd ed.), edited by Sharlene Nagy Hesse-Biber (2012). For insight into conceptions of power, refer to The Power of Feminist Theory: Domination, Resistance, Solidarity , by Amy Allen (1999). ↵

A theoretical perspective including a set of assumptions about reality that guide research questions.

A worldview that upholds the importance of discovering truth through direct experience using empirical methods.

A worldview that rests on the assumption that reality is socially constructed and must be understood from the perspective of those experiencing it.

A worldview that is critical of paradigms that fail to acknowledge the role of power in the creation of knowledge and that is aimed at bringing about empowering change.

A worldview that rests on the assumption that reality is best understood in terms of the practical consequences of actions undertaken to solve problems.

Diverse learning processes that come from living intimately with the land and working with the resources surrounding the land base and the relationships that it has fostered over time and place.

A process of conducting research in such a way that the worldview of those who have suffered a long history of oppression and marginalization are given space to communicate from their frames of reference.

A perspective based on core assumptions.

The level of broader social forces.

The level of individual experiences and choices.

A set of propositions intended to explain a fact or phenomenon.

A theory-driven approach that typically concludes with empirical generalizations based on research findings.

A testable statement that contains at least two variables.

A categorical concept for properties of people or events that can differ and change.

A bottom-up approach beginning with observations and ending with the discovery of patterns and themes informed by theory.

Theory discovered from the systematic observation and analysis of data.

A question about the social world that is answered through the collection and analysis of first-hand, verifiable, empirical data.

Publications that contain articles written by different authors and are released at regular intervals.

Research Methods: Exploring the Social World in Canadian Context Copyright © 2024 by Diane Symbaluk & Robyn Hall is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Literature Reviews

• Searching for Literature
• Organizing Literature and Taking Notes
• Writing and Editing the Paper
• Help and Resources

Organizing Your Paper

Before you begin writing your paper, you will need to decide upon a way to organize your information. You can organize your paper using a number of different strategies, such as the following:

• Topics and subtopics : Discussing your sources in relation to different topics and subtopics; probably the most common approach
• Chronologically : Discussing your sources from oldest to newest in order to show trends or changes in the approach to a topic over time
• Methods : Discussing your sources by different methods that are used to approach the topic

When literature reviews are incorporated into a research paper, they are often structured using the  funnel method , which begins with a broad overview of a topic and then narrows down to more specific themes before focusing in on the specific research question that the paper will address.

A literature review paper often follows this basic organization:

Introduction

• Describes the importance of the topic
• Defines key terms
• Describes the goals of the review
• Provides an overview of the literature to be discussed (e.g., methods, trends, etc.) (optional)
• Describes parameters of the review and particular search methods used (optional)
• Discusses findings of sources, as well as strengths, weaknesses, similarities, differences, contradictions, and gaps
• Divides content into sections (for longer reviews), uses headings and subheadings to indicate section divisions, and provides brief summaries at the end of each section
• Summarizes what is known about the topic
• Discusses implications for practice
• Discusses areas for further research

Synthesizing Sources

A literature review paper not only describes and evaluates the scholarly research literature related to a particular topic, but it also synthesizes that information. Synthesis  is the process of weaving together information from sources to arrive at new analyses and insights.

To help you prepare to synthesize sources in your paper, you can take the topic matrix that you prepared as you were organizing your sources, and flesh it out into a  synthesis matrix  that contains detailed notes from each source as they relate to different topics and subtopics of your literature review. Once you've completed your synthesis matrix, you can more easily identify ways that sources relate to each other in terms of their similarities and differences, methodological strengths and weakness, and contradictions and gaps. The video below shows how to create a synthesis matrix.

Video:  Synthesis Matrix Tutorial  by  Andrew Davis .

Writing Your Paper

A literature review paper should flow logically from one topic to the next. As you write your paper, consider these tips:

• Write in a formal voice and with an impartial tone.
• Define critical terms and describe key theories.
• Use topic sentences to clearly indicate what each paragraph is about.
• Use transitions to make links between sections.
• Introduce acronyms upon first using them.
• Call attention to seminal (i.e., highly influential; groundbreaking) studies.
• Clearly distinguish between your ideas and those of the authors you cite.
• Cite multiple sources for a single idea, if appropriate.
• Create a list of references that follows appropriate style guidelines.
• Give your paper a title that conveys what the literature review is about.
• Once you have written your paper, carefully proofread it for errors.
• << Previous: Organizing Literature and Taking Notes
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• Open access
• Published: 22 July 2024

Symptom impact and health-related quality of life (HRQoL) assessment by cancer stage: a narrative literature review

• Karen C. Chung 1 ,
• Anushini Muthutantri 2 ,
• Grace G. Goldsmith 2 ,
• Megan R. Watts 2 ,
• Audrey E. Brown 2 &
• Donald L. Patrick 3  

BMC Cancer volume  24 , Article number:  884 ( 2024 ) Cite this article

122 Accesses

Metrics details

Cancer stage at diagnosis is an important prognostic indicator for patient outcomes, with detection at later stages associated with increased mortality and morbidity. The impact of cancer stage on patient-reported outcomes is poorly understood. This research aimed to understand symptom burden and health related quality of life (HRQoL) impact by cancer stage for ten cancer types: 1) ovarian, 2) lung, 3) pancreatic, 4) esophageal, 5) stomach, 6) head and neck, 7) colorectal, 8) anal, 9) cervical, and 10) liver and bile duct.

Ten narrative literature reviews were performed to identify and collate published literature on patient burden at different stages of disease progression. Literature searches were conducted using an AI-assisted platform to identify relevant articles published in the last five (2017–2022) or ten years (2012–2022) where articles were limited. Conference abstracts were searched for the last two years (2020–2022). The geographic scope was limited to the United States, Canada, Europe, and global studies, and only journal articles written in English were included.

A total of 26 studies with results stratified by cancer stage at diagnosis (and before treatment) were selected for the cancer types of lung, pancreatic, esophageal, stomach, head and neck, colorectal, anal, and cervical cancers. Two cancer types, ovarian cancer, and liver and bile duct cancer did not return any search results with outcomes stratified by disease stage. A general trend was observed for worse patient-reported outcomes in patients with cancer diagnosed at an advanced stage of disease compared with diagnosis at an earlier stage. Advanced disease stage was associated with greater symptom impact including general physical impairments such as pain, fatigue, and interference with functioning, as well as disease/region-specific symptom burden. Poorer HRQoL was also associated with advanced disease with commonly reported symptoms including anxiety and depression.

Conclusions

Overall, the general trend for greater symptom burden and poorer HRQoL seen in late stage versus early-stage disease across the included cancer types supports the importance for early diagnosis and treatment to improve patient survival and decrease negative impacts on disease burden and HRQoL.

Peer Review reports

Introduction

Cancer stage at diagnosis is an important prognostic indicator for patient outcomes, with detection at later stages associated with increased mortality and morbidity. An estimated 2,001,140 new cancer cases will occur in the United States in 2024 along with 611,720 cancer deaths [ 1 ]. Many cancers are diagnosed during late (distant) stage including 55% of ovarian cancer cases, 53% of lung cancer cases, 51% of pancreatic cancer cases, 38% of esophageal cancer cases, and 36% of stomach cancer cases [ 2 ]. Stage at diagnosis is an important predictor both for treatment efficacy and survival, but diagnosis times vary by cancer type [ 2 ].

The World Health Organization identified two strategies which allow for more effective cancer treatment: 1) diagnosing symptomatic cancer as early as possible, and 2) screening for asymptomatic cancer or pre-cancerous lesions in non-symptomatic target populations [ 3 ]. The US Preventive Services Task Force (USPSTF) recommends single cancer screening based on age and sex for lung (also risk-based), colon, and cervical cancers, among others [ 4 , 5 , 6 , 7 , 8 ]. For cancers with screening paradigms such as cervical cancer, most cases (43%) are diagnosed in early stage where 5-year survival rates are high (91.2%). However, for cancers without screening paradigms, such as pancreatic cancer, most cases (51%) are diagnosed in late stage, where 5-year survival rates are very low (3.2%) [ 2 ].

Currently, the level of invasiveness of cancer screening varies by cancer type and location, ranging from more invasive procedures such as colonoscopy for colorectal cancer and Papanicolaou test (pap smear) for cervical cancer, to less invasive procedures such as blood-based tests or imaging tests such as mammography or low-dose computed tomography. A key focus of current research for cancer screening is less invasive multi-cancer screening technologies, such as blood-based multi-cancer detection screening assays [ 9 ]. This multi-cancer early detection (MCED) approach has the potential to improve treatment outcomes through earlier diagnosis of a wide range of cancer types, in addition to improving health-related quality of life (HRQoL) for patients with a positive diagnosis.

Cancer type and cancer stage may be associated with specific symptomatology, with overall symptoms and symptom impact being greater in advanced disease stages [ 10 ]. Advanced cancer stage and increased symptoms are associated with worse HRQoL, which may be evaluated through patient reported outcome measures (PROMs). PROMs are self-reported questionnaires which provide a qualitative/quantitative measurement of various aspects of a patient’s health, including HRQoL, functional status, and symptoms and symptom burden, directly by the patient without clinician interpretation [ 11 ]. Inclusion of PROMs in clinical practice in oncology can be associated with benefits including improvements in care, prognosis, communication, patient safety, and risk identification such as symptom control and identification [ 12 ].

The purpose of this narrative review was to identify and collate published literature on symptom impact at different stages of disease progression for a range of 10 cancer types: 1) ovarian, 2) lung, 3) pancreatic, 4) esophageal, 5) stomach, 6) head and neck, 7) colorectal, 8) anal, 9) cervical, and 10) liver and bile duct. This will provide valuable information on symptom impact and HRQoL by cancer type and stage at diagnosis. In contrast to a systematic review, this narrative review was not intended to identify and report all the literature available for symptom impact but rather focused on the information most relevant to healthcare providers who are interested in understanding the burden of disease on patients with specific types of cancer.

Search strategy

Ten narrative literature reviews were performed to identify and collate published literature on patient burden at different stages of disease progression for the following cancer types: 1) ovarian, 2) lung, 3) pancreatic, 4) esophageal, 5) stomach, 6) head and neck, 7) colorectal, 8) anal, 9) cervical, and 10) liver and bile duct. Disease terms for each cancer type were run in an artificial intelligence (AI)-assisted platform (EVID PRO) [ 13 ] to identify relevant articles published within the last 5 years (January 2017—December 2022). Where the number of articles identified for a specific cancer type were limited to less than 10 articles, in the case of ovarian, esophageal, stomach, anal, cervical, and liver and bile duct cancers, this was extended to 10 years (January 2012—December 2022). The geographic scope was limited to the United States (U.S.), Canada, Europe and global studies, and only journal articles written in English were included. The EVID PRO tool automatically scans and pulls articles with any specific acronyms, scales, and/or PRO instruments. Electronic searches were supplemented with grey literature searches of relevant conference meeting abstracts restricted to the last 2 years (2020–2022). Congresses included: American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), and Professional Society for Health Economics and Outcomes Research (ISPOR) (for all indications), Digestive Disease Week (DDW) (GI cancers only), European Respiratory Society (ERS) (lung cancer), and American Head and Neck Society (AHNS) (head and neck).

Study selection

For each literature review, an initial screening was performed on the title and abstract of the identified articles followed by a full-text review of articles considered relevant. The PICOS (Population, Intervention, Comparison, Outcomes, Study Design) criteria are shown in Table 1 . Studies were considered for inclusion if patient staging information was reported; outcomes included impact of cancer-related symptoms by cancer type (by stage of disease preferred), as assessed by standardized/ validated instruments (e.g., EORTC QLQ-C30, MDASI); and met the geographic and language limits described above. Studies were excluded if the study population was pretreated (treatment may affect HRQoL/PRO and thus not reflect cancer specific symptoms/impact), if studies were conducted outside US/Europe (unless global), if outcomes reported were related to treatment or were only reported post intervention (no baseline scores), and if only instruments not previously validated were implemented.

Data extraction

Following selection of relevant literature from screening and full text review, data from publications meeting the PICOS elements were extracted into standardized extraction tables in an Excel workbook by one reviewer. A second author reviewed all data extractions for completeness and accuracy. Any discrepancies encountered were discussed and resolved by a third independent reviewer.

Across all cancer types, 150 articles reporting PRO data that included information on disease staging were selected. In most of these studies PRO data were not reported with results stratified by disease stage, and instead reported outcomes with patients of varying disease stages grouped together ( n  = 54) or included patients within a particular disease stage ( n  = 70). After excluding these studies, 26 studies across 8 cancer types reporting PRO results stratified by disease stage were selected for inclusion. Two cancer types, liver and bile duct, and ovarian did not return any search results with outcomes stratified by disease stage.

Descriptions of the PRO instruments used in the 26 included studies are provided in Table  2 [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. For each study across the 8 cancer types with results stratified by disease stage, a description including study design, PRO instruments and results, and any statistical analyses performed is presented in Table  3 . The results for these 8 cancer types are organized by the primary stage at which each cancer type is most often diagnosed according to the National Cancer Institute SEER statistics: 1) late stage/distant, 2) regional stage, and 3) early stage/localized [ 34 ]. SEER statistics for the 10 cancer types included in the original scope of this review are presented in Table  4 .

Disease staging varied throughout the 26 included studies and is reported as described in each study. Disease staging may have been described descriptively (ex. early-stage vs advanced stage) or according to a staging system such as the TNM Classification of Malignant Tumors (TNM) developed by the Union for International Cancer Control (UICC). The TNM is used for describing cancer based on: 1) tumor size and tissue location (T0 indicating no evidence of a tumor and T1-T4 describing the progressive size and invasiveness), 2) spread to lymph nodes (N0 indicating no regional nodal spread and N1-N3 indicating progressively distal nodal spread), and 3) presence of metastases (M0 indicating no metastases and M1 indicating presence of metastases) [ 58 ]. The combination of these 3 factors from the TNM system can then be used for simplified cancer staging (Stages I, II, III, and IV) [ 58 ]. While categorization as early or advanced disease based on staging varies between cancer types, generally Stage I indicates localized cancer (T1-T2, N0, M0), stage II indicates early-stage locally advanced cancer (T2-T4, N0, M0), stage III indicates late-stage locally advanced cancer (T1-T4, N1-N3, M0), and stage IV indicates metastatic cancer (T1-T4, N1-N3, M1) [ 58 ].

Cancers predominantly diagnosed at distant stage

Lung cancer.

The primary stage of diagnosis for lung cancer is at a distant stage, accounting for 53% of diagnoses [ 34 ]. For lung cancer, HRQoL and symptom burden by disease stage was reported using PRO instruments including Patient-Reported Outcomes Measurement Information System (PROMIS) [ 35 ], Short-Form Survey-8 (SF-8) [ 36 ], 12-item anorexia/cachexia scale (A/CS-12) [ 37 ], Short-Form Survey-12 (SF-12) [ 38 ], Revised Psychosocial Screen for Cancer (PSSCAN-R) [ 39 ], MD Anderson Symptom Inventory (MDASI) [ 40 ], and quality of life (QoL) single item scales [ 40 ]. Overall, findings suggested that both physical and mental HRQoL were impaired in advanced stages compared with early-stage disease.

Patients with stage III or IV disease reported significantly poorer physical and mental HRQoL versus patients with stage I disease [ 38 ]. Physical HRQoL scores were 41.16 and 37.74 in patients with stage III or IV disease and 43.9 in patients with stage I disease (SF-12, P for trend < 0.001). Mental HRQoL scores were 46.26 and 45.22 in patients with stage III or IV disease and 49.28 in patients with stage I disease (SF-12, p for trend < 0.001). Additionally, between patients with advanced versus early stage disease, poorer HRQoL measured using single-item QoL scales was reported for emotional well-being (6.5 vs 7.1, P  < 0.03), physical well-being (5.7 vs 6.6, P  < 0.002), and overall QoL (6.3 vs 7.2, P  < 0.001) [ 40 ].

A correlation between advanced disease stage and poorer mental health was also reported in studies using other PRO instruments. Advanced disease stage was significantly associated with an increased prevalence of emotional problems (SF-8, P  < 0.001) [ 36 ]. Additionally, anxiety was more prevalent in patients with metastases versus those without metastases (PSSCAN-R, Odds Ratio (OR): 1.46, P  < 0.001), although this association was not found for depression (Odds Ratio (OR): 1.10, P  = 0.196) [ 39 ].

Greater symptom prevalence and impact were also associated with patients with advanced disease. Patients with stage III/IV disease reported worse fatigue versus patients with stage I/II disease (PROMIS, 54.6 vs 58.2) based on a clinically meaningful difference of 3 points (as defined by the study authors for the PROMIS instrument) [ 35 ]. Social function was also worse in patients with stage III/IV disease (47.2 vs 43.7), indicating that the higher symptom burden reported by patients with advanced disease also has a broader impact on patient functioning [ 35 ]. These results are supported by a second study that reported a greater prevalence of both physical and emotional symptoms (measured using the MDASI) in patients with advanced disease compared with patients with early-stage disease [ 40 ]. Symptoms significantly associated with advanced disease included sleep problems (3.5 vs 2.5, P  < 0.001), drowsiness (2.6 vs 1.6, P  < 0.001), fatigue (3.9 vs 2.2, P  < 0.001), sadness (2.9 vs 1.9, P  < 0.002), pain (3.5 vs 2.1, P  < 0.001), shortness of breath (3.2 vs 2.2, P  < 0.001), lack of appetite (2.1 vs 1.3, P  < 0.001), and dry mouth (1.9 vs 1.2, P  < 0.008). Advanced disease was also associated with increased symptom interference for the domains of work (4.4 vs 2.3, P  < 0.001), enjoying life (3.8 vs 2.3, P  < 0.001), general activity (3.9 vs 2.0, P  < 0.001), mood (3.4 vs 2.3, P  < 0.001), walking (3.4 vs 1.8, P  < 0.001), and relationships with others (2.2 vs 1.2, P  < 0.001). Risk for anorexia/cachexia was not significantly associated with disease stage (A/CS-12, P  = 0.09) [ 37 ].

Pancreatic cancer

The primary stage of diagnosis for pancreatic cancer is at distant stage, accounting for 51% of diagnoses [ 34 ]. HRQoL and symptom outcomes in patients with pancreatic cancer were evaluated using the SF-12 [ 41 ] and MDASI [ 42 ]. Worse physical HRQoL was associated with advanced tumor stage (I-IV) (SF-12, P for trend < 0.001), although this association was not significant for mental HRQoL (SF-12, P for trend 0.16) [ 41 ]. Additionally, patients in stage III/IV had higher symptom scores compared with patients in stage II/III (MDASI, 51.8 vs 47.3), indicating worse symptom severity, although no statistical tests or P values were reported [ 42 ].

Esophageal cancer

The primary stage of diagnosis for esophageal cancer is at distant stage, accounting for 38% of diagnoses [ 34 ]. For esophageal cancer, results stratified by disease stage were reported for the instruments Functional Assessment of Cancer Therapy-General (FACT-G) [ 43 ], FACT-Esophageal (FACT-E) [ 43 , 44 ], FACT-Esophageal Cancer Subscale (FACT-ECS) [ 43 , 44 ], and European Quality of Life Five Dimension questionnaire (EQ-5D-3L) [ 43 ].

Better HRQoL was reported in patients with stage II/III disease versus patients in stage IV [ 43 ]. Patients with stage II/ III disease reported a mean (SD) EQ-5D baseline utility score of 0.82 (0.13) compared with a score of 0.72 (0.18) in patients with stage IV or recurrent disease. Given a minimally important difference in EQ-5D Health Utility Score (HUS) of 0.07, this indicates that patients with stage IV or recurrent disease have clinically meaningful impaired HRQoL compared with patients with early-stage disease [ 43 ]. Poorer HRQoL with advanced disease stage was also reported using disease specific instruments. Patients in stage IV showed directionally poorer scores versus patients in stage II/III for symptoms associated with esophageal cancer (FACT-ECS, 40.2 vs 46.0) and HRQoL subscales such as emotional well-being (FACT-E, 13.6 vs 17.0). However, p values were not reported for these comparisons [ 43 ]. A statistically significant trend between higher T-stage and worse HRQoL was reported between patients with T4 disease versus T1 (FACT-ECS, 44.5 vs 58.7, P  < 0.002), however this trend was not significant for all instruments (FACT-E, P  = 0.65) [ 44 ].

Stomach cancer

The primary stage of diagnosis for stomach cancer is at distant stage, accounting for 36% of diagnoses [ 34 ]. A significantly greater prevalence of reported cancer symptoms was associated with advanced disease stage, with results stratified by both T stage (1–4) and UICC stage (I-IV) [ 45 ]. A higher prevalence of alarm symptoms (dysphagia, weight loss, bleeding, vomiting) was reported by patients with T-stage 3/4 versus T-stage 1/2 (OR: 2.54, P  < 0.0001), and for patients with UICC stage III/IV versus UICC stage I/II (OR: 3.02, P  < 0.0001).

Cancers predominately diagnosed at regional stage

Head and neck cancer.

The primary stage of diagnosis for head and neck cancer is at regional stage, accounting for 51% of diagnoses [ 34 ]. For head and neck cancer, results stratified by disease stage were reported for the PRO instruments National Comprehensive Cancer Network Distress Thermometer (NCCN DT) [ 47 ], Pittsburgh Sleep Quality Index (PSQI) [ 49 ], Apnea/Hypopnea Index (AHI) [ 48 ], and Eating Assessment Tool-10 (EAT-10) [ 46 ]. There was a significant correlation between advanced disease (higher T stage) and problems with swallowing (i.e., increased severity of swallowing impairment; EAT-10, P  < 0.02) [ 46 ]. No statistically significant differences based on disease stage were reported for distress (NCCN DT) [ 47 ], sleep quality [ 49 ], or apnea and hypoxia [ 48 ].

Colorectal cancer

The primary stage of diagnosis for colorectal cancer is at regional stage, accounting for 36% of diagnoses [ 34 ]. In colorectal cancer, HRQoL and symptom burden by disease stage was reported using a range of PRO assessments including SF-12 [ 50 , 51 ], PROMIS [ 35 ], FACT-Colorectal (FACT-C) and NSABP Symptom Checklist (SCL-17) [ 52 ], PERFORM fatigue questionnaire [ 53 ], and Hospital Anxiety and Depression Scale (HADS) [ 54 ]. Across all PRO assessments, advanced stage disease was generally associated with poorer HRQoL and increased symptomology and burden.

Significantly poorer physical and mental HRQoL was reported for patients with late-stage versus early-stage disease [ 50 ]. Comparing between patients in stage IV versus stage I, advanced disease was associated with significantly lower scores (poorer HRQoL) for both physical HRQoL (SF-12 PCS, 40.8 vs 46.9, P  < 0.001) and mental HRQoL (SF-12, 46.0 vs 50.1, P  < 0.001). Additionally, another study also evaluated ethnicity (white, black, or Hispanic) as a factor in HRQoL outcomes [ 51 ]. While advanced disease stage in all ethnicities was significantly associated with poorer physical HRQoL (SF-12 PCS, P  < 0.05, for all), worse mental HRQoL with advanced disease was not observed, regardless of ethnicity. In comparing HRQoL in patients with stage II vs stage III cancer, significantly poorer HRQoL was reported in patients with stage III cancer (FACT-C TOI, 66.1 vs 64.0, P  < 0.004) [ 52 ].

An increase in symptoms and the impact of symptoms on functioning were also associated with advanced stage disease. Clinically meaningful differences (defined by the study authors as a difference of 3 points for the PROMIS instrument) were reported in patients with stage IV and stage III cancer versus stage I/II across a range of functions and symptoms. Poorer functioning was reported in patients with stage III and IV disease versus patients with stage I/II for physical (41.8 and 43.4 vs 46.5), social (45.4 and 48.0 vs 51.2), and cognitive function (49.1 and 49.7 vs 52.9) [ 35 ]. Symptoms of pain (56.5 vs 52.1, stage IV vs stage I/II) and fatigue (56.5 vs 50.8, stage IV vs stage I/II) were also clinically worse in patients with advanced disease [ 35 ]. However, other studies reported no significant difference in fatigue between early and advanced-stage disease using other PRO instruments (SF-36 vitality subscale [ 52 ] and PERFORM 12-item scale [ 53 ]). Symptom impact was also significantly associated with advanced disease stage. Patients with stage III reported greater symptom impact (pain, vision and hearing problems, and GI problems) compared with patients with stage II cancer (SCL-17, 8.5 vs 7.2, P  < 0.001) [ 52 ]. Additionally, depression was significantly more prevalent in patients with metastatic disease versus those without (HADS, 31% vs 23%, P  < 0.015), although this association was not statistically significant when comparing patients based on T stage or N stage [ 54 ].

Cancers predominately diagnosed at localized stage

Anal cancer.

The primary stage of diagnosis for anal cancer is at localized stage, accounting for 43% of diagnoses [ 34 ]. For anal cancer, symptom burden was described stratified by T-stage (T 1–4) [ 55 ]. Overall, the most common symptoms reported by patients with anal cancer were anal bleeding (78%), anal/perianal pain (29% and 24%, respectively), weight loss (31%), tumor on self-examination (26%), and foreign body sensation (22%). Patients with locally advanced cancer (T3/T4) reported significantly greater prevalence of constipation and abdominal pain ( P  < 0.02), and perianal pain and weight loss ( P  < 0.01). Meanwhile, pruritus was significantly more frequent in patients with early T stages ( P  < 0.01). Patients with more advanced disease reported significantly more symptoms than those with less advanced tumors (average total number of symptoms for T1 vs T4, 2.1 vs 4.4, P  < 0.01) indicating overall poorer HRQoL.

Cervical cancer

The primary stage of diagnosis for cervical cancer is at localized stage, accounting for 43% of diagnoses [ 34 ]. For cervical cancer, results stratified by disease stage were reported for the PRO instruments European Organization For Research And Treatment Of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) and EORTC cervical cancer questionnaire (EORTC QLQ-CX24) [ 56 ], PROMIS [ 35 ], and HADS [ 56 , 57 ]. In terms of global HRQoL (measured using EORTC QLQ-C30), there was no statistically significant association between cancer stage, early vs locally advanced, and global score (72.9 vs 76.1, P  = 0.264). Symptom burden was assessed through the PRO instruments, PROMIS, and HADS, and the disease-specific EORTC QLQ-CX24 instrument. Patients with locally advanced cancer reported significant impairments versus patients with early stage for sexual activity (EORTC QLQ-CX24, 9.1 vs 17.1, P  < 0.004) and sexual enjoyment (EORTC QLQ-CX24, 22.9 vs 52.1, P  < 0.006) [ 56 ]. Poorer mental and physical HRQoL was reported between patients with stage I cancer versus stage II/III/IV cancer for the PROMIS domains of pain interference (51.1 vs 56.1), fatigue (51.8 vs 56.6), anxiety (51.5 vs 54.9), depression (50.0 vs 53.6), physical function (48.4 vs 41.2), social function (52.6 vs 46.9), and cognitive function (51.7 vs 47.9) [ 35 ]. Depression and anxiety were evaluated based on FIGO staging in two studies [ 56 , 57 ]. No significant differences were reported for either anxiety or depression, although one study noted a directional trend of more patients with locally advanced disease reporting anxiety compared with patients with early-stage disease (HADS, 63% vs 53%) [ 56 ].

In this narrative literature review of patient reported outcomes assessing symptom impact and health-related quality of life across 10 different cancer types, a general trend was observed for worse PRO results in patients with cancer diagnosed at an advanced stage of disease versus patients diagnosed at an earlier stage. Advanced disease stage was associated with greater prevalence of symptoms and increased symptom impact including general physical impairments such as pain, fatigue, and interference with functioning, as well as disease/region-specific symptom burden. Poorer HRQoL was also associated with advanced disease with commonly reported symptoms including anxiety and depression.

HRQoL, measured using generic PRO instruments, was worse in patients with advanced stage disease compared with patients with early-stage disease across cancer types. A range of generic instruments were used to measure HRQoL including the SF-12, reported in 4 studies [ 36 , 39 , 46 , 48 ]. Clinically meaningful differences in HRQoL and symptoms were also reported for other PRO instruments such as PROMIS, with patients with advanced stage disease reporting worse HRQoL and more symptoms than patients with early stage disease [ 35 ]. Increased prevalence and/or interference of pain was correlated with advanced disease stage for colorectal cancer [ 35 ], lung cancer [ 35 , 40 ], cervical cancer [ 35 ], and anal cancer [ 55 ]. This included both general pain [ 35 , 40 ], and cancer type/site-specific pain such as perianal and abdominal pain in anal cancer [ 55 ]. Other general symptoms correlated with advanced disease included fatigue and sleep disturbances in lung, colorectal, and cervical cancers [ 35 , 40 ], impairments in physical and cognitive function in colorectal and cervical cancer [ 35 ], nausea, lack of appetite, or anorexia and cachexia for lung cancer [ 37 ] and anal cancer [ 55 ].

The results of this review also highlight the increased burden of disease-specific symptoms in patients with advanced stage disease. Results from cancer-type specific PRO instruments were reported for the cancer types of colorectal (FACT-C TOI), cervical (EORTC QLQ-CX24), and esophageal (FACT-ECS) cancers. For both colorectal and esophageal cancer, a statistically significant association was reported between advanced cancer stage and worse HRQoL scores, as measured by the relevant disease-specific PRO instrument [ 44 , 52 ]. For cervical cancer, advanced cancer stage was associated with statistically significant impairments in sexual activity and enjoyment [ 56 ]. In addition, disease-specific symptoms that correlated with advanced stage disease were seen in stomach cancer for alarm symptoms (dysphagia, weight loss, bleeding, vomiting) [ 45 ], and in head and neck cancer with trouble swallowing [ 46 ]. Together, these findings highlight the importance of using disease-specific PRO instruments to assess HRQoL and support the previously published observation that disease specific instruments are likely more sensitive to detect differences both between therapies [ 59 , 60 ], but also, in the case of this review, when comparing between patients in different disease stages [ 59 , 60 ].

Increased symptom burden can also impact a patient’s functional status, such as physical, emotional, or social functioning. Findings from this review show that advanced disease was associated with increased symptom interference in multiple areas including ability to work, walk, and general activity in lung cancer [ 40 ], and greater overall symptom burden in colorectal cancer [ 52 ] and anal cancer [ 55 ]. Increased prevalence or severity of emotional problems with more advanced disease was reported for multiple cancer types. Increased prevalence of emotional problems was correlated with advanced cancer stage for colorectal cancer [ 35 , 50 , 54 ], lung cancer [ 36 , 38 , 39 , 40 ], and cervical cancer [ 35 ]. Statistically significant trends for worse mental HRQoL with advanced disease stage were also reported for colorectal cancer [ 46 ] and lung cancer [ 36 ]. Additionally, there was a statistically significant association between metastatic disease in colorectal cancer and prevalence of depression, although results were non-significant when stratified by T-stage or N-stage [ 52 ]. However, in cervical cancer, a statistically significant association was not found between advanced disease stage and prevalence of anxiety or depression [ 54 , 55 ].

Across the 10 cancer types assessed in this review, 8 cancer types reported PRO results stratified by disease stage, while no studies were identified for the cancer types of liver and bile duct, or ovarian cancer. The number of studies found with results stratified by disease stage varied between cancer types and this is likely impacted by multiple variables including cancer prevalence and incidence, screening availability, distribution of cancer stage at diagnosis, treatment options, and efficacy and survival rates. The greatest number of studies found were for lung and colorectal cancer, returning 6 results each. Perhaps unsurprisingly, these cancers are the most prevalent of the 10 cancers included in the scope of this review: 1,388,422 for colorectal cancer, and 603,989 for lung cancer (Table  4 ) [ 34 ]. In contrast, no studies with results stratified by disease stage were found for the cancer types liver and bile duct, and ovarian, despite relatively high U.S. prevalence rates, 105,765 and 236,511, respectively (Table  4 ) [ 34 ]. The lack of results for these two cancers may be due to the lack of screening paradigms available for these cancers, thus resulting in the majority of cases being detected in later stages. Among the 10 cancers included in the scope of this narrative literature review, the stage at which each cancer type is primarily diagnosed varies. While stage distribution at diagnosis for colorectal cancer is more evenly distributed between early/localized stage (35% of cases), regional stage (36% of cases), and late/distant stage (23% of cases), other cancers are more highly skewed towards diagnosis at the advanced (distant) stage, including lung (53% of cases), pancreatic (51% of cases), esophageal (38% of cases), stomach (36% of cases), and ovarian (55% of cases) (Table  4 ) [ 34 ]. In general, 5-year survival rates are greater for those cancers that are more often diagnosed in earlier stages, although exceptions apply (e.g., liver and bile duct) [ 2 ]. Overall, data support the importance of early diagnosis and treatment to improve survival rates and reduce the negative impact of late diagnosis on patient symptom burden and HRQoL.

A few key limitations are present in this narrative literature review. First, while database searches were conducted in a systematic manner, this work was not intended to be a systematic review. Therefore, the studies selected are considered to be of most relevance to the question being addressed but may not include all relevant references. While the primary objective of this narrative literature review was to identify and collate published literature on patient burden at different stages of disease progression for the ten selected cancers, the secondary objective was to evaluate HRQoL based on cancer type and stage, within and between different cancer types. However, selected literature was heterogenous in terms of patient populations and study design. This review included both prospective and retrospective studies, the latter of which carries additional limitations including the potential for bias due to missing or misreported data. Also, while this review was focused on identifying patients with PRO assessments at the time of diagnosis and prior to treatment, the nature of retrospective claims analyses means that it is sometimes difficult to determine if patients may have previously received treatment. Additionally, studies may not have been powered for PRO endpoints. Statistical comparisons were not reported in all studies and few studies reported minimally important differences. Taken together, these factors limited the ability to draw strong conclusions.

The findings of this narrative literature review support the search for improvements in cancer screening and earlier detection and treatment. Studies with results stratified by disease stage were limited, likely due to some cancers primarily being detected at advanced stages. Although the HRQoL data lacked consistent stratification by cancer stage, advanced stage cancer at diagnosis and prior to treatment was generally associated with worse HRQoL. This observation was expected due to stage or spread of disease likely playing a significant role in symptom impact burden. Overall, this supports the importance of detecting and treating cancer at earlier stages when patients may be asymptomatic or have lower symptom burden to minimize the increased negative impact on HRQoL and functional status observed in cancers diagnosed in advanced stage.

Availability of data and materials

No datasets were generated or analysed during the current study.

Abbreviations

12-Item anorexia/cachexia scale

Apnea/Hypopnea Index

American Head and Neck Society

American Society of Clinical Oncology

Digestive Disease Week

Eating Assessment Tool-10

European Organization For Research And Treatment Of Cancer Core Quality of Life questionnaire

EORTC cervical cancer questionnaire

European Quality of Life Five Dimension questionnaire

European Respiratory Society

European Society for Medical Oncology

Functional Assessment of Cancer Therapy-Colorectal

Functional Assessment of Cancer Therapy-Esophageal

Functional Assessment of Cancer Therapy-Esophageal Cancer Subscale

Functional Assessment of Cancer Therapy-General

International Federation of Gynecology and Obstetrics

Hospital Anxiety and Depression Scale

Health-related quality of life

Health Utility Score

Professional Society for Health Economics and Outcomes Research

Multi-cancer early detection

Mental Component Summary

MD Anderson Symptom Inventory

National Comprehensive Cancer Network Distress Thermometer

Physical Component Summary

Population, Intervention, Comparison, Outcomes, Study Design

Patient-Reported Outcomes Measurement Information System

Patient reported outcome measures

Pittsburgh Sleep Quality Index

Revised Psychosocial Screen for Cancer

National Surgical Adjuvant Breast and Bowel Project (NSABP) Symptom Checklist

Short-Form Survey-12

Short-Form Survey-36

Short-Form Survey-8

Trial Outcome Index

Union for International Cancer Control

US Preventive Services Task Force

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K.C.C., A.M., G.G.G., M.R.W., and A.E.B. contributed to research design, synthesis and interpretation of findings. G.G.G. and M.R.W. contributed to acquisition, analysis, and interpretation of review data. K.C.C., G.G.G., A.E.B. and D.L.P. contributed to synthesis and interpretation of findings and critically reviewed draft manuscripts. All authors have read and approved the final manuscript.

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Chung, K.C., Muthutantri, A., Goldsmith, G.G. et al. Symptom impact and health-related quality of life (HRQoL) assessment by cancer stage: a narrative literature review. BMC Cancer 24 , 884 (2024). https://doi.org/10.1186/s12885-024-12612-z

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

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

Chapter 9 methods for literature reviews.

Guy Paré and Spyros Kitsiou .

9.1. Introduction

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

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

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

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

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

9.2. Overview of the Literature Review Process and Steps

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

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

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

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

9.3. Types of Review Articles and Brief Illustrations

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

9.3.1. Narrative Reviews

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

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

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

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

9.3.2. Descriptive or Mapping Reviews

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

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

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

9.3.3. Scoping Reviews

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

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

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

9.3.4. Forms of Aggregative Reviews

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

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

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

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

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

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

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

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

9.3.5. Realist Reviews

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

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

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

9.3.6. Critical Reviews

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

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

9.4. Summary

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

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

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

9.5. Concluding Remarks

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

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

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

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• Cite this Page Paré G, Kitsiou S. Chapter 9 Methods for Literature Reviews. In: Lau F, Kuziemsky C, editors. Handbook of eHealth Evaluation: An Evidence-based Approach [Internet]. Victoria (BC): University of Victoria; 2017 Feb 27.
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Relationships between self-efficacy and teachers’ well-being in middle school english teachers: the mediating role of teaching satisfaction and resilience.

1. Introduction

2. literature review, 2.1. teachers’ self-efficacy, 2.2. teaching satisfaction, 2.3. teacher resilience, 2.4. subjective well-being theory as the framework, 3. methodology, 3.1. participants, 3.2. instruments, 3.2.1. the self-efficacy scale, 3.2.2. the resilience scale, 3.2.3. the teaching satisfaction scale, 3.2.4. the well-being scale, 3.2.5. semi-structured interview, 3.3. data collection, 3.4. data analysis, 4.1. descriptive analysis, 4.2. reliability and validity checks and the measurement model, 4.3. the structural model and hypotheses testing, 4.4. the role of teaching satisfaction and resilience, 4.4.1. the role of teaching satisfaction, 4.4.2. the role of resilience, 5. discussion, 5.1. teaching satisfaction and resilience: keys to teachers’ well-being, 5.2. resilience and self-efficacy: pillars of teacher well-being, 5.3. theoretical and practical implications, 6. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Wang, X.; Gao, Y.; Wang, Q.; Zhang, P. Relationships between Self-Efficacy and Teachers’ Well-Being in Middle School English Teachers: The Mediating Role of Teaching Satisfaction and Resilience. Behav. Sci. 2024 , 14 , 629. https://doi.org/10.3390/bs14080629

Wang X, Gao Y, Wang Q, Zhang P. Relationships between Self-Efficacy and Teachers’ Well-Being in Middle School English Teachers: The Mediating Role of Teaching Satisfaction and Resilience. Behavioral Sciences . 2024; 14(8):629. https://doi.org/10.3390/bs14080629

Wang, Xiaochen, Yang Gao, Qikai Wang, and Panpan Zhang. 2024. "Relationships between Self-Efficacy and Teachers’ Well-Being in Middle School English Teachers: The Mediating Role of Teaching Satisfaction and Resilience" Behavioral Sciences 14, no. 8: 629. https://doi.org/10.3390/bs14080629

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