how to identify a research gap pdf

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Methods for Identifying Health Research Gaps, Needs, and Priorities: a Scoping Review

Eunice c. wong.

1 RAND Corporation, Santa Monica, CA USA

Alicia R. Maher

Aneesa motala.

2 Department of Population and Public Health Sciences, University of Southern California Gehr Family Center for Health Systems Science & Innovation, Los Angeles, USA

Rachel Ross

Olamigoke akinniranye, jody larkin, susanne hempel, associated data.

Well-defined, systematic, and transparent processes to identify health research gaps, needs, and priorities are vital to ensuring that available funds target areas with the greatest potential for impact.

The purpose of this review is to characterize methods conducted or supported by research funding organizations to identify health research gaps, needs, or priorities.

We searched MEDLINE, PsycINFO, and the Web of Science up to September 2019. Eligible studies reported on methods to identify health research gaps, needs, and priorities that had been conducted or supported by research funding organizations. Using a published protocol, we extracted data on the method, criteria, involvement of stakeholders, evaluations, and whether the method had been replicated (i.e., used in other studies).

Among 10,832 citations, 167 studies were eligible for full data extraction. More than half of the studies employed methods to identify both needs and priorities, whereas about a quarter of studies focused singularly on identifying gaps (7%), needs (6%), or priorities (14%) only. The most frequently used methods were the convening of workshops or meetings (37%), quantitative methods (32%), and the James Lind Alliance approach, a multi-stakeholder research needs and priority setting process (28%). The most widely applied criteria were importance to stakeholders (72%), potential value (29%), and feasibility (18%). Stakeholder involvement was most prominent among clinicians (69%), researchers (66%), and patients and the public (59%). Stakeholders were identified through stakeholder organizations (51%) and purposive (26%) and convenience sampling (11%). Only 4% of studies evaluated the effectiveness of the methods and 37% employed methods that were reproducible and used in other studies.

To ensure optimal targeting of funds to meet the greatest areas of need and maximize outcomes, a much more robust evidence base is needed to ascertain the effectiveness of methods used to identify research gaps, needs, and priorities.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11606-021-07064-1.

Well-defined, systematic, and transparent methods to identify health research gaps, needs, and priorities are vital to ensuring that available funds target areas with the greatest potential for impact. 1 , 2 As defined in the literature, 3 , 4 research gaps are defined as areas or topics in which the ability to draw a conclusion for a given question is prevented by insufficient evidence. Research gaps are not necessarily synonymous with research needs , which are those knowledge gaps that significantly inhibit the decision-making ability of key stakeholders, who are end users of research, such as patients, clinicians, and policy makers. The selection of research priorities is often necessary when all identified research gaps or needs cannot be pursued because of resource constraints. Methods to identify health research gaps, needs, and priorities (from herein referred to as gaps, needs, priorities) can be multi-varied and there does not appear to be general consensus on best practices. 3 , 5

Several published reviews highlight the diverse methods that have been used to identify gaps and priorities. In a review of methods used to identify gaps from systematic reviews, Robinson et al. noted the wide range of organizing principles that were employed in published literature between 2001 and 2009 (e.g., care pathway, decision tree, and patient, intervention, comparison, outcome framework,). 6 In a more recent review spanning 2007 to 2017, Nyanchoka et al. found that the vast majority of studies with a primary focus on the identification of gaps (83%) relied solely on knowledge synthesis methods (e.g., systematic review, scoping review, evidence mapping, literature review). A much smaller proportion (9%) relied exclusively on primary research methods (i.e., quantitative survey, qualitative study). 7

With respect to research priorities, in a review limited to a PubMed database search covering the period from 2001 to 2014, Yoshida documented a wide range of methods to identify priorities including the use of not only knowledge synthesis (i.e., literature reviews) and primary research methods (i.e., surveys) but also multi-stage, structured methods such as Delphi, Child Health and Nutrition Research Initiative (CHNRI), James Lind Alliance Priority Setting Partnership (JLA PSP), and Essential National Health Research (ENHR). 2 The CHNRI method, originally developed for the purpose of setting global child health research priorities, typically employs researchers and experts to specify a long list of research questions, the criteria that will be used to prioritize research questions, and the technical scoring of research questions using the defined criteria. 8 During the latter stages, non-expert stakeholders’ input are incorporated by using their ratings of the importance of selected criteria to weight the technical scores. The ENHR method, initially designed for health research priority setting at the national level, involves researchers, decision-makers, health service providers, and communities throughout the entire process of identifying and prioritizing research topics. 9 The JLA PSP method convenes patients, carers, and clinicians to equally and jointly identify questions about healthcare that cannot be answered by existing evidence that are important to all groups (i.e., research needs). 10 The identified research needs are then prioritized by the groups resulting in a final list (often a top 10) of research priorities. Non-clinical researchers are excluded from voting on research needs or priorities but can be involved in other processes (e.g., knowledge synthesis). CHNRI, ENHR, and JLA PSP usually employ a mix of knowledge synthesis and primary research methods to first identify a set of gaps or needs that are then prioritized. Thus, even though CHNRI, ENHR, and JLA PSP have been referred to as priority setting methods, they actually consist of a gaps or needs identification stage that feeds into a research prioritization stage.

Nyanchoka et al.’s review found that the majority of studies focused on the identification of gaps alone (65%), whereas the remaining studies focused either on research priorities alone (17%) or on both gaps and priorities (19%). 7 In an update to Robinson et al.’s review, 6 Carey et al. reviewed the literature between 2010 and 2011 and observed that the studies conducted during this latter period of time focused more on research priorities than gaps and had increased stakeholder involvement, and that none had evaluated the reproducibility of the methods. 11

The increasing development and diversity of formal processes and methods to identify gaps and priorities are indicative of a developing field. 2 , 12 To facilitate more standardized and systematic processes, other important areas warrant further investigation. Prior reviews did not distinguish between the identification of gaps versus research needs. The Agency for Healthcare Research and Quality Evidence-based Practice Center (AHRQ EPC) Program issued a series of method papers related to establishing research needs as part of comparative effectiveness research. 13 – 15 The AHRQ EPC Program defined research needs as “evidence gaps” identified within systematic reviews that are prioritized by stakeholders according to their potential impact on practice or care. 16 Furthermore, Nyanchoka et al. relied on author designations to classify studies as focusing on gaps versus research priorities and noted that definitions of gaps varied across studies, highlighting the need to apply consistent taxonomy when categorizing studies in reviews. 7 Given the rise in the use of stakeholders in both gaps and prioritization exercises, a greater understanding of the range of practices involving stakeholders is also needed. This includes the roles and responsibilities of stakeholders (e.g., consultants versus final decision-makers), the composition of stakeholders (e.g., non-research clinicians, patients, caregivers, policymakers), and the methods used to recruit stakeholders. The lack of consensus of best practices also highlights the importance of learning the extent to which evaluations to determine the effectiveness of gaps, needs, and prioritization exercises have been conducted, and if so, what were the resultant outcomes.

To better inform efforts and organizations that fund health research, we conducted a scoping review of methods used to identify gaps, needs, and priorities that were linked to potential or actual health research funding decision-making. Hence, this scoping review was limited to studies in which the identification of health research gaps, needs, or priorities was supported or conducted by funding organizations to address the following questions 1 : What are the characteristics of methods to identify health research gaps, needs, and priorities? and 2 To what extent have evaluations of the impact of these methods been conducted? Given that scoping reviews may be executed to characterize the ways an area of research has been conducted, 17 , 18 this approach is appropriate for the broad nature of this study’s aims.

Protocol and Registration

We employed methods that conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. 19 See Appendix A in the Supplementary Information. The scoping review protocol is registered with the Open Science Framework ( https://osf.io/5zjqx/ ).

Eligibility Criteria

Studies published in English that described methods to identify health research gaps, needs, or priorities that were supported or conducted by funding organizations were eligible for inclusion. We excluded studies that reported only the results of the exercise (e.g., list of priorities) absent of information on the methods used. We also excluded studies involving evidence synthesis (e.g., literature or systematic reviews) that were solely descriptive and did not employ an explicit method to identify research gaps, needs, or priorities.

Information Sources and Search Strategy

We searched the following electronic databases: MEDLINE, PsycINFO, and Web of Science. Our database search also included an update of the Nyanchoka et al. scoping review, which entailed executing their database searches for the time period following 2017 (the study’s search end date). 7 Nyanchoka et al. did not include database searches for research needs. The electronic database search and scoping review update were completed in August and September 2019, respectively . The search strategy employed for each of the databases is presented in Appendix B in the Supplementary Information.

Selection of Sources of Evidence and Data Charting Process

Two reviewers screened titles and abstracts and full-text publications. Citations that one or both reviewers considered potentially eligible were retrieved for full-text review. Relevant background articles and scoping and systematic reviews were reference mined to screen for eligible studies. Full-text publications were screened against detailed inclusion and exclusion criteria. Data was extracted by one reviewer and checked by a second reviewer. Discrepancies were resolved through discussion by the review team.

Information on study characteristics were extracted from each article including the aims of the exercise (i.e., gaps, needs, priorities, or a combination) and health condition (i.e., physical or psychological). Based on definitions in the literature, 3 – 5 the aims of the exercise were coded according to the activities that were conducted, which may not have always corresponded with the study authors’ labeling of the exercises. For instance, the JLA PSP method is often described as a priority exercise but we categorized it as a needs and priority exercise. Priority exercises can be preceded by exercises to identify gaps or needs, which then feed into the priority exercise such as in JLA PSP; however, standalone priority exercises can also be conducted (e.g., stakeholders prioritize an existing list of emerging diseases).

For each type of exercise, information on the methods were recorded. An initial list of methods was created based on previous reviews. 9 , 12 , 20 During the data extraction process, any methods not included in the initial list were subsequently added. If more than one exercise was reported within an article (e.g., gaps and priorities), information was extracted for each exercise separately. Reviewers extracted the following information: methods employed (e.g., qualitative, quantitative), criteria used (e.g., disease burden, importance to stakeholders), stakeholder involvement (e.g., stakeholder composition, method for identifying stakeholders), and whether an evaluation was conducted on the effectiveness of the exercise (see Appendix C in the Supplementary Information for full data extraction form).

Synthesis of results entailed quantitative descriptives of study characteristics (e.g., proportion of studies by aims of exercise) and characteristics of methods employed across all studies and by each type of study (e.g., gaps, needs, priorities).

The electronic database search yielded a total of 10,548 titles. Another 284 articles were identified after searching the reference lists of full-text publications, including three systematic reviews 21 – 23 and one scoping review 24 that had met eligibility criteria. Moreover, a total of 99 publications designated as relevant background articles were also reference mined to screen for eligible studies. We conducted full-text screening for 2524 articles, which resulted in 2344 exclusions (440 studies were designated as background articles). A total of 167 exercises related to the identification of gaps, needs, or priorities that were supported or conducted by a research funding organization were described across 180 publications and underwent full data extraction. See Figure ​ Figure1 1 for the flow diagram of our search strategy and reasons for exclusion.

Literature flow

Characteristics of Sources of Evidence

Among the published exercises, the majority of studies (152/167) conducted gaps, need, or prioritization exercises related to physical health, whereas only a small fraction of studies focused on psychological health (12/167) (see Appendix D in the Supplementary Information).

Methods for Identifying Gaps, Needs, and Priorities

As seen in Table ​ Table1, 1 , only about a quarter of studies involved a singular type of exercise with 7% focused on the identification of gaps only (i.e., areas with insufficient information to draw a conclusion for a given question), 6% on needs only (i.e., knowledge gaps that inhibit the decision-making of key stakeholders), and 14% priorities only (i.e., ranked gaps or needs often because of resource constraints). Studies more commonly conducted a combination of multiple types of exercises with more than half focused on the identification of both research needs and priorities, 14% on gaps and priorities, 3% gaps, needs, and priorities, and 3% gaps and needs.

Methods for Identifying Health Research Gaps, Needs, and Priorities

JLA PSP , James Lind Alliance Priority Setting Partnerships; ENHR , Essential National Health Research; CHNRI , Child Health and Nutrition Research Initiative. Numbers in columns may add up to more than the total N or 100% since some studies employed more than one method

Across the 167 studies, the three most frequently used methods were the convening of workshops/meetings/conferences (37%), quantitative methods (32%), and the JLA PSP approach (28%). This was followed by methods involving literature reviews (17%), qualitative methods (17%), consensus methods (13%), and reviews of source materials (15%). Other methods included the CHNRI process (7%), reviews of in-progress data (7%), consultation with (non-researcher) stakeholders (4%), applying a framework tool (4%), ENHR (1%), systematic reviews (1%), and evidence mapping (1%).

The criterion most widely applied across the 167 studies was the importance to stakeholders (72%) (see Table ​ Table2). 2 ). Almost one-third (29%) considered the potential value and 18% feasibility as criteria. Burden of disease (9%), addressing inequities (8%), costs (6%), alignment with organization’s mission (3%), and patient centeredness (2%) were adopted as criteria to a lesser extent.

Criteria for Identifying Health Research Gaps, Needs, and Priorities

Numbers in columns may add up to more than the total N or 100% since some studies employed more than one criterion

About two-thirds of the studies included researchers (66%) and clinicians (69%) as stakeholders (see Appendix E in the Supplementary Information). Patients and the public were involved in 59% of the studies. A smaller proportion included policy makers (20%), funders (13%), product makers (8%), payers (5%), and purchasers (2%) as stakeholders. Nearly half of the studies (51%) relied on stakeholder organizations to identify stakeholders (see Appendix F in the Supplementary Information). A quarter of studies (26%) used purposive sampling and some convenience sampling (11%). Few (9%) used snowball sampling to identify stakeholders. Only a minor fraction of studies, seven of the 167 (4%), reported some type of effectiveness evaluation. 25 – 31

Our scoping review revealed that approaches to identifying gaps, needs, and priorities are less likely to occur as discrete processes and more often involve a combination of exercises. Approaches encompassing multiple exercises (e.g., gaps and needs) were far more prevalent than singular standalone exercises (e.g., gaps only) (73% vs. 27%). Findings underscore the varying importance placed on gaps, needs, and priorities, which reflect key principles of the Value of Information approach (i.e., not all gaps are important, addressing gaps do not necessarily address needs nor does addressing needs necessarily address priorities). 32

Findings differ from Nyanchoka et al.’s review in which studies involving the identification of gaps only outnumbered studies involving both gaps and priorities. 7 However, Nyanchoka et al. relied on author definitions to categorize exercises, whereas our study made designations based on our review of the activities described in the article and applied definitions drawn from the literature. 3 , 4 Lack of consensus on definitions of gaps and priority setting has been noted in the literature. 33 , 34 To the authors’ knowledge, no prior scoping review has focused on methods related to the identification of “research needs.” Findings underscore the need to develop and apply more consistent taxonomy to this growing field of research.

More than 40% of studies employed methods with a structured protocol including JLA PSP, ENHR, CHRNI, World Café, and the Dialogue model. 10 , 35 – 40 The World Café and Dialogue models particularly value the experiential perspectives of stakeholders. The World Café centers on creating a special environment, often modeled after a café, in which rounds of multi-stakeholder, small group, conversations are facilitated and prefaced with questions designed for the specific purpose of the session. Insights and results are reported and shared back to the entire group with no expectation to achieve consensus, but rather diverse perspectives are encouraged. 36 The Dialogue model is a multi-stakeholder, participatory, priority setting method involving the following phases: exploratory (informal discussions), consultation (separate stakeholder consultations), prioritization (stakeholder ratings), and integration (dialog between stakeholders). 39 Findings may indicate a trend away from non-replicable methods to approaches that afford greater transparency and reproducibility. 41 For instance, of the 17 studies published between 2000 and 2009, none had employed CHNRI and 6% used JLA PSP compared to the 141 studies between 2010 and 2019 in which 8% applied CHNRI and 32% JLA PSP. However, notable variations in implementing CHNRI and JLA PSP have been observed. 41 – 43 Though these protocols help to ensure a more standardized process, which is essential when testing the effectiveness of methods, such evaluations are infrequent but necessary to establish the usefulness of replicable methods.

Convening workshops, meetings, or conferences was the method used by the greatest proportion of studies (37%). The operationalization of even this singular method varied widely in duration (e.g., single vs. multi-day conferences), format (e.g., expert panel presentations, breakout discussion groups), processes (e.g., use of formal/informal consensus methods), and composition of stakeholders. The operationalization of other methods (e.g., quantitative, qualitative) also exhibited great diversity.

The use of explicit criteria to determine gaps, needs, or priorities is a key component of certain structured protocols 40 , 44 and frameworks. 9 , 45 In our scoping review, the criterion applied most frequently across studies (71%) was “importance to stakeholders” followed by potential value (31%) and feasibility (18%). Stakeholder values are being incorporated into the identification of gaps, needs, and exercises across a significant proportion of studies, but how this is operationalized varies widely across studies. For instance, the CHNRI typically employs multiple criteria that are scored by technical experts and these scores are then weighted based on stakeholder ratings of their relative importance. Other studies totaled scores across multiple criteria, whereas JLA PSP asks multiple stakeholders to rank the top ten priorities. The importance of involving stakeholders, especially patients and the public, in priority setting is increasingly viewed as vital to ensuring the needs of end users are met, 46 , 47 particularly in light of evidence demonstrating mismatches between the research interests of patients and researchers and clinicians. 48 – 50 In our review, clinicians (69%) and researchers (66%) were the most widely represented stakeholder groups across studies. Patients and the public (e.g., caregivers) were included as stakeholders in 59% of the studies. Only a small fraction of studies involved exercises in which stakeholders were limited to researchers only. Patients and the public were involved as stakeholders in 12% of studies published between 2000 and 2009 compared to 60% of studies between 2010 and 2019. Findings may reflect a trend away from researchers traditionally serving as one of the sole drivers of determining which research topics should be pursued.

More than half of the studies reported relying on stakeholder organizations to identify participants. Partnering with stakeholder organizations has been noted as one of the primary methods for identifying stakeholders for priority setting exercises. 34 Purposive sampling was the next most frequently used stakeholder identification method. In contrast, convenience sampling (e.g., recommendations by study team) and snowball sampling (e.g., identified stakeholders refer other stakeholders who then refer additional stakeholders) were not as frequently employed, but were documented as common methods in a prior review conducted almost a decade ago. 14 The greater use of stakeholder organizations than convenience or snowball sampling may be partly due to the more recent proliferation of published studies using structured protocols like JLA PSP, which rely heavily on partnerships with stakeholder organizations. Though methods such as snowball sampling may introduce more bias than random sampling, 14 there are no established best practices for stakeholder identification methods. 51 Nearly a quarter of studies provided either unclear or no information on stakeholder identification methods, which has been documented as a barrier to comparing across studies and assessing the validity of research priorities. 34

Determining the effectiveness of gaps, needs, and priority exercises is challenging given that outcome evaluations are rarely conducted. Only seven studies reported conducting an evaluation. 25 – 31 Evaluations varied with respect to their focus on process- (e.g., balanced stakeholder representation, stakeholder satisfaction) versus outcome-related impact (e.g., prioritized topics funded, knowledge production, benefits to health). There is no consensus on what constitutes optimal outcomes, which has been found to vary by discipline. 52

More than 90% of studies involved exercises related to physical health in contrast to a minor portfolio of work being dedicated to psychological health, which may be an indication of the low priority placed on psychological health policy research. Understanding whether funding decisions for physical versus psychological health research are similarly or differentially governed by more systematic, formal processes may be important to the extent that this affects the effective targeting of funds.

Limitations

By limiting studies to those supported or conducted by funding organizations, we may have excluded global, national, or local priority setting exercises. In addition, our scoping review categorized approaches according to the actual exercises conducted and definitions provided in the scientific literature rather than relying on the terminology employed by studies. This resulted in instances in which the category assigned to an exercise within our scoping review could diverge from the category employed by the study authors. Lastly, this study’s findings are subject to limitations often characteristic of scoping reviews such as publication bias, language bias, lack of quality assessment, and search, inclusion, and extraction biases. 53

Conclusions

The diversity and growing establishment of formal processes and methods to identify health research gaps, needs, and priorities are characteristic of a developing field. Even with the emergence of more structured and systematic approaches, the inconsistent categorization and definition of gaps, needs, and priorities inhibit efforts to evaluate the effectiveness of varied methods and processes, such efforts are rare and sorely needed to build an evidence base to guide best practices. The immense variation occurring within structured protocols, across different combinations of disparate methods, and even within singular methods, further emphasizes the importance of using clearly defined approaches, which are essential to conducting investigations of the effectiveness of these varied approaches. The recent development of reporting guidelines for priority setting for health research may facilitate more consistent and clear documentation of processes and methods, which includes the many facets of involving stakeholders. 34 To ensure optimal targeting of funds to meet the greatest areas of need and maximize outcomes, a much more robust evidence base is needed to ascertain the effectiveness of methods used to identify research gaps, needs, and priorities.

(PDF 1205 kb)

Acknowledgements

This scoping review is part of research that was sponsored by Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (now Psychological Health Center of Excellence).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The Research Gap (Literature Gap)

Everything you need to know to find a quality research gap

By: Ethar Al-Saraf (PhD) | Expert Reviewed By: Eunice Rautenbach (DTech) | November 2022

If you’re just starting out in research, chances are you’ve heard about the elusive research gap (also called a literature gap). In this post, we’ll explore the tricky topic of research gaps. We’ll explain what a research gap is, look at the four most common types of research gaps, and unpack how you can go about finding a suitable research gap for your dissertation, thesis or research project.

Overview: Research Gap 101

• What is a research gap
• Four common types of research gaps
• Practical examples
• How to find research gaps
• Recap & key takeaways

What (exactly) is a research gap?

Well, at the simplest level, a research gap is essentially an unanswered question or unresolved problem in a field, which reflects a lack of existing research in that space. Alternatively, a research gap can also exist when there’s already a fair deal of existing research, but where the findings of the studies pull in different directions , making it difficult to draw firm conclusions.

For example, let’s say your research aims to identify the cause (or causes) of a particular disease. Upon reviewing the literature, you may find that there’s a body of research that points toward cigarette smoking as a key factor – but at the same time, a large body of research that finds no link between smoking and the disease. In that case, you may have something of a research gap that warrants further investigation.

Now that we’ve defined what a research gap is – an unanswered question or unresolved problem – let’s look at a few different types of research gaps.

Types of research gaps

While there are many different types of research gaps, the four most common ones we encounter when helping students at Grad Coach are as follows:

• The classic literature gap
• The disagreement gap
• The contextual gap, and
• The methodological gap

Need a helping hand?

1. The Classic Literature Gap

First up is the classic literature gap. This type of research gap emerges when there’s a new concept or phenomenon that hasn’t been studied much, or at all. For example, when a social media platform is launched, there’s an opportunity to explore its impacts on users, how it could be leveraged for marketing, its impact on society, and so on. The same applies for new technologies, new modes of communication, transportation, etc.

Classic literature gaps can present exciting research opportunities , but a drawback you need to be aware of is that with this type of research gap, you’ll be exploring completely new territory . This means you’ll have to draw on adjacent literature (that is, research in adjacent fields) to build your literature review, as there naturally won’t be very many existing studies that directly relate to the topic. While this is manageable, it can be challenging for first-time researchers, so be careful not to bite off more than you can chew.

2. The Disagreement Gap

As the name suggests, the disagreement gap emerges when there are contrasting or contradictory findings in the existing research regarding a specific research question (or set of questions). The hypothetical example we looked at earlier regarding the causes of a disease reflects a disagreement gap.

Importantly, for this type of research gap, there needs to be a relatively balanced set of opposing findings . In other words, a situation where 95% of studies find one result and 5% find the opposite result wouldn’t quite constitute a disagreement in the literature. Of course, it’s hard to quantify exactly how much weight to give to each study, but you’ll need to at least show that the opposing findings aren’t simply a corner-case anomaly .

3. The Contextual Gap

The third type of research gap is the contextual gap. Simply put, a contextual gap exists when there’s already a decent body of existing research on a particular topic, but an absence of research in specific contexts .

For example, there could be a lack of research on:

• A specific population – perhaps a certain age group, gender or ethnicity
• A geographic area – for example, a city, country or region
• A certain time period – perhaps the bulk of the studies took place many years or even decades ago and the landscape has changed.

The contextual gap is a popular option for dissertations and theses, especially for first-time researchers, as it allows you to develop your research on a solid foundation of existing literature and potentially even use existing survey measures.

Importantly, if you’re gonna go this route, you need to ensure that there’s a plausible reason why you’d expect potential differences in the specific context you choose. If there’s no reason to expect different results between existing and new contexts, the research gap wouldn’t be well justified. So, make sure that you can clearly articulate why your chosen context is “different” from existing studies and why that might reasonably result in different findings.

4. The Methodological Gap

Last but not least, we have the methodological gap. As the name suggests, this type of research gap emerges as a result of the research methodology or design of existing studies. With this approach, you’d argue that the methodology of existing studies is lacking in some way , or that they’re missing a certain perspective.

For example, you might argue that the bulk of the existing research has taken a quantitative approach, and therefore there is a lack of rich insight and texture that a qualitative study could provide. Similarly, you might argue that existing studies have primarily taken a cross-sectional approach , and as a result, have only provided a snapshot view of the situation – whereas a longitudinal approach could help uncover how constructs or variables have evolved over time.

Practical Examples

Let’s take a look at some practical examples so that you can see how research gaps are typically expressed in written form. Keep in mind that these are just examples – not actual current gaps (we’ll show you how to find these a little later!).

Context: Healthcare

Despite extensive research on diabetes management, there’s a research gap in terms of understanding the effectiveness of digital health interventions in rural populations (compared to urban ones) within Eastern Europe.

Context: Environmental Science

While a wealth of research exists regarding plastic pollution in oceans, there is significantly less understanding of microplastic accumulation in freshwater ecosystems like rivers and lakes, particularly within Southern Africa.

Context: Education

While empirical research surrounding online learning has grown over the past five years, there remains a lack of comprehensive studies regarding the effectiveness of online learning for students with special educational needs.

As you can see in each of these examples, the author begins by clearly acknowledging the existing research and then proceeds to explain where the current area of lack (i.e., the research gap) exists.

How To Find A Research Gap

Now that you’ve got a clearer picture of the different types of research gaps, the next question is of course, “how do you find these research gaps?” .

Well, we cover the process of how to find original, high-value research gaps in a separate post . But, for now, I’ll share a basic two-step strategy here to help you find potential research gaps.

As a starting point, you should find as many literature reviews, systematic reviews and meta-analyses as you can, covering your area of interest. Additionally, you should dig into the most recent journal articles to wrap your head around the current state of knowledge. It’s also a good idea to look at recent dissertations and theses (especially doctoral-level ones). Dissertation databases such as ProQuest, EBSCO and Open Access are a goldmine for this sort of thing. Importantly, make sure that you’re looking at recent resources (ideally those published in the last year or two), or the gaps you find might have already been plugged by other researchers.

Once you’ve gathered a meaty collection of resources, the section that you really want to focus on is the one titled “ further research opportunities ” or “further research is needed”. In this section, the researchers will explicitly state where more studies are required – in other words, where potential research gaps may exist. You can also look at the “ limitations ” section of the studies, as this will often spur ideas for methodology-based research gaps.

By following this process, you’ll orient yourself with the current state of research , which will lay the foundation for you to identify potential research gaps. You can then start drawing up a shortlist of ideas and evaluating them as candidate topics . But remember, make sure you’re looking at recent articles – there’s no use going down a rabbit hole only to find that someone’s already filled the gap 🙂

Let’s Recap

We’ve covered a lot of ground in this post. Here are the key takeaways:

• A research gap is an unanswered question or unresolved problem in a field, which reflects a lack of existing research in that space.
• The four most common types of research gaps are the classic literature gap, the disagreement gap, the contextual gap and the methodological gap. 
• To find potential research gaps, start by reviewing recent journal articles in your area of interest, paying particular attention to the FRIN section .

If you’re keen to learn more about research gaps and research topic ideation in general, be sure to check out the rest of the Grad Coach Blog . Alternatively, if you’re looking for 1-on-1 support with your dissertation, thesis or research project, be sure to check out our private coaching service .

Psst... there’s more!

This post was based on one of our popular Research Bootcamps . If you're working on a research project, you'll definitely want to check this out ...

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32 Comments

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• 34 Methods for identifying and displaying research gaps
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• Linda Nyanchoka 1 ,
• Catrin Tudur-Smith 2 ,
• Van Thu Nguyen 1 ,
• Raphaël Porcher Porcher 1
• 1 Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153) Inserm/Université Paris Descartes, Paris, France
• 2 University of Liverpool, Institute of Translational Medicine, Liverpool, UK

Objectives The current body of research is growing, with over 1 million clinical research papers published from clinical trials alone. This volume of health research demonstrates the importance of conducting knowledge syntheses in providing the evidence base and identifying gaps, which can inform further research, policy-making, and practice. This study aims to describe methods for identifying and displaying research gaps.

Method A scoping review using the Arksey and O’Malley methodological framework was conducted. We searched Medline, Pub Med, EMBASE, Cochrane Library, Scopus, Web of Science, PROSPERO register, TRIP, Google Scholar and Google. The following combination of terms were used: ‘identifying gaps in research’, ‘research gaps’,’evidence gaps’, ‘research uncertainties’, ‘research gaps identification’,’research gaps prioritisation’ and ‘methods’. The searches were limited to English, conducted in humans and published in the last 10 years for databases searches and unrestricted for hand and expert suggestion articles.

Results The literature search retrieved 1938 references, of which 139 were included for data synthesis. Of the 139 studies, 91 (65%) aimed to identify gaps, 22 (16%) determine research priorities and 26 (19%) on both identifying gaps and determining research priorities. A total of 13 different definitions of research gaps were identified. The methods for identifying gaps included different study designs, examples included primary research methods (quantitative surveys, interview, and focus groups), secondary research methods (systematic reviews, overview of reviews, scoping reviews, evidence mapping and bibliometric analysis), primary and secondary research methods (James Lind Alliance Priority Setting Partnerships (JLA PSP) and Global Evidence Mapping (GEM). Some of the examples of methods to determine research priorities included delphi survey, needs assessment, consensus meeting and Interviews.The methods for displaying gaps and determine research priorities mainly varied according to the number of variables being presented.

Conclusions This study provides an overview of different methods used to and/or reported on identifying gaps, determining research priorities and displaying both gaps and research priorities. These study findings can be adapted to inform the development of methodological guidance on ways to advance methods to identify, prioritise and display gaps to inform research and evidence-based decision-making.

https://doi.org/10.1136/bmjebm-2018-111024.34

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Home » Research Gap – Types, Examples and How to Identify

Research Gap – Types, Examples and How to Identify

Table of Contents

Research Gap

Definition:

Research gap refers to an area or topic within a field of study that has not yet been extensively researched or is yet to be explored. It is a question, problem or issue that has not been addressed or resolved by previous research.

How to Identify Research Gap

Identifying a research gap is an essential step in conducting research that adds value and contributes to the existing body of knowledge. Research gap requires critical thinking, creativity, and a thorough understanding of the existing literature . It is an iterative process that may require revisiting and refining your research questions and ideas multiple times.

Here are some steps that can help you identify a research gap:

• Review existing literature: Conduct a thorough review of the existing literature in your research area. This will help you identify what has already been studied and what gaps still exist.
• Identify a research problem: Identify a specific research problem or question that you want to address.
• Analyze existing research: Analyze the existing research related to your research problem. This will help you identify areas that have not been studied, inconsistencies in the findings, or limitations of the previous research.
• Brainstorm potential research ideas : Based on your analysis, brainstorm potential research ideas that address the identified gaps.
• Consult with experts: Consult with experts in your research area to get their opinions on potential research ideas and to identify any additional gaps that you may have missed.
• Refine research questions: Refine your research questions and hypotheses based on the identified gaps and potential research ideas.
• Develop a research proposal: Develop a research proposal that outlines your research questions, objectives, and methods to address the identified research gap.

Types of Research Gap

There are different types of research gaps that can be identified, and each type is associated with a specific situation or problem. Here are the main types of research gaps and their explanations:

Theoretical Gap

This type of research gap refers to a lack of theoretical understanding or knowledge in a particular area. It can occur when there is a discrepancy between existing theories and empirical evidence or when there is no theory that can explain a particular phenomenon. Identifying theoretical gaps can lead to the development of new theories or the refinement of existing ones.

Empirical Gap

An empirical gap occurs when there is a lack of empirical evidence or data in a particular area. It can happen when there is a lack of research on a specific topic or when existing research is inadequate or inconclusive. Identifying empirical gaps can lead to the development of new research studies to collect data or the refinement of existing research methods to improve the quality of data collected.

Methodological Gap

This type of research gap refers to a lack of appropriate research methods or techniques to answer a research question. It can occur when existing methods are inadequate, outdated, or inappropriate for the research question. Identifying methodological gaps can lead to the development of new research methods or the modification of existing ones to better address the research question.

Practical Gap

A practical gap occurs when there is a lack of practical applications or implementation of research findings. It can occur when research findings are not implemented due to financial, political, or social constraints. Identifying practical gaps can lead to the development of strategies for the effective implementation of research findings in practice.

Knowledge Gap

This type of research gap occurs when there is a lack of knowledge or information on a particular topic. It can happen when a new area of research is emerging, or when research is conducted in a different context or population. Identifying knowledge gaps can lead to the development of new research studies or the extension of existing research to fill the gap.

Examples of Research Gap

Here are some examples of research gaps that researchers might identify:

• Theoretical Gap Example : In the field of psychology, there might be a theoretical gap related to the lack of understanding of the relationship between social media use and mental health. Although there is existing research on the topic, there might be a lack of consensus on the mechanisms that link social media use to mental health outcomes.
• Empirical Gap Example : In the field of environmental science, there might be an empirical gap related to the lack of data on the long-term effects of climate change on biodiversity in specific regions. Although there might be some studies on the topic, there might be a lack of data on the long-term effects of climate change on specific species or ecosystems.
• Methodological Gap Example : In the field of education, there might be a methodological gap related to the lack of appropriate research methods to assess the impact of online learning on student outcomes. Although there might be some studies on the topic, existing research methods might not be appropriate to assess the complex relationships between online learning and student outcomes.
• Practical Gap Example: In the field of healthcare, there might be a practical gap related to the lack of effective strategies to implement evidence-based practices in clinical settings. Although there might be existing research on the effectiveness of certain practices, they might not be implemented in practice due to various barriers, such as financial constraints or lack of resources.
• Knowledge Gap Example: In the field of anthropology, there might be a knowledge gap related to the lack of understanding of the cultural practices of indigenous communities in certain regions. Although there might be some research on the topic, there might be a lack of knowledge about specific cultural practices or beliefs that are unique to those communities.

Examples of Research Gap In Literature Review, Thesis, and Research Paper might be:

• Literature review : A literature review on the topic of machine learning and healthcare might identify a research gap in the lack of studies that investigate the use of machine learning for early detection of rare diseases.
• Thesis : A thesis on the topic of cybersecurity might identify a research gap in the lack of studies that investigate the effectiveness of artificial intelligence in detecting and preventing cyber attacks.
• Research paper : A research paper on the topic of natural language processing might identify a research gap in the lack of studies that investigate the use of natural language processing techniques for sentiment analysis in non-English languages.

How to Write Research Gap

By following these steps, you can effectively write about research gaps in your paper and clearly articulate the contribution that your study will make to the existing body of knowledge.

Here are some steps to follow when writing about research gaps in your paper:

• Identify the research question : Before writing about research gaps, you need to identify your research question or problem. This will help you to understand the scope of your research and identify areas where additional research is needed.
• Review the literature: Conduct a thorough review of the literature related to your research question. This will help you to identify the current state of knowledge in the field and the gaps that exist.
• Identify the research gap: Based on your review of the literature, identify the specific research gap that your study will address. This could be a theoretical, empirical, methodological, practical, or knowledge gap.
• Provide evidence: Provide evidence to support your claim that the research gap exists. This could include a summary of the existing literature, a discussion of the limitations of previous studies, or an analysis of the current state of knowledge in the field.
• Explain the importance: Explain why it is important to fill the research gap. This could include a discussion of the potential implications of filling the gap, the significance of the research for the field, or the potential benefits to society.
• State your research objectives: State your research objectives, which should be aligned with the research gap you have identified. This will help you to clearly articulate the purpose of your study and how it will address the research gap.

Importance of Research Gap

The importance of research gaps can be summarized as follows:

• Advancing knowledge: Identifying research gaps is crucial for advancing knowledge in a particular field. By identifying areas where additional research is needed, researchers can fill gaps in the existing body of knowledge and contribute to the development of new theories and practices.
• Guiding research: Research gaps can guide researchers in designing studies that fill those gaps. By identifying research gaps, researchers can develop research questions and objectives that are aligned with the needs of the field and contribute to the development of new knowledge.
• Enhancing research quality: By identifying research gaps, researchers can avoid duplicating previous research and instead focus on developing innovative research that fills gaps in the existing body of knowledge. This can lead to more impactful research and higher-quality research outputs.
• Informing policy and practice: Research gaps can inform policy and practice by highlighting areas where additional research is needed to inform decision-making. By filling research gaps, researchers can provide evidence-based recommendations that have the potential to improve policy and practice in a particular field.

Applications of Research Gap

Here are some potential applications of research gap:

• Informing research priorities: Research gaps can help guide research funding agencies and researchers to prioritize research areas that require more attention and resources.
• Identifying practical implications: Identifying gaps in knowledge can help identify practical applications of research that are still unexplored or underdeveloped.
• Stimulating innovation: Research gaps can encourage innovation and the development of new approaches or methodologies to address unexplored areas.
• Improving policy-making: Research gaps can inform policy-making decisions by highlighting areas where more research is needed to make informed policy decisions.
• Enhancing academic discourse: Research gaps can lead to new and constructive debates and discussions within academic communities, leading to more robust and comprehensive research.

Advantages of Research Gap

Here are some of the advantages of research gap:

• Identifies new research opportunities: Identifying research gaps can help researchers identify areas that require further exploration, which can lead to new research opportunities.
• Improves the quality of research: By identifying gaps in current research, researchers can focus their efforts on addressing unanswered questions, which can improve the overall quality of research.
• Enhances the relevance of research: Research that addresses existing gaps can have significant implications for the development of theories, policies, and practices, and can therefore increase the relevance and impact of research.
• Helps avoid duplication of effort: Identifying existing research can help researchers avoid duplicating efforts, saving time and resources.
• Helps to refine research questions: Research gaps can help researchers refine their research questions, making them more focused and relevant to the needs of the field.
• Promotes collaboration: By identifying areas of research that require further investigation, researchers can collaborate with others to conduct research that addresses these gaps, which can lead to more comprehensive and impactful research outcomes.

Disadvantages of Research Gap

While research gaps can be advantageous, there are also some potential disadvantages that should be considered:

• Difficulty in identifying gaps: Identifying gaps in existing research can be challenging, particularly in fields where there is a large volume of research or where research findings are scattered across different disciplines.
• Lack of funding: Addressing research gaps may require significant resources, and researchers may struggle to secure funding for their work if it is perceived as too risky or uncertain.
• Time-consuming: Conducting research to address gaps can be time-consuming, particularly if the research involves collecting new data or developing new methods.
• Risk of oversimplification: Addressing research gaps may require researchers to simplify complex problems, which can lead to oversimplification and a failure to capture the complexity of the issues.
• Bias : Identifying research gaps can be influenced by researchers’ personal biases or perspectives, which can lead to a skewed understanding of the field.
• Potential for disagreement: Identifying research gaps can be subjective, and different researchers may have different views on what constitutes a gap in the field, leading to disagreements and debate.

About the author

Muhammad Hassan

Researcher, Academic Writer, Web developer

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ARTICLE/RESEARCH: A Taxonomy of Research Gaps: Identifying and Defining the Seven Research Gaps

2017, Journal of Research Methods and Strategies

One of the most prevailing issues in the craft of research is to develop a research agenda and build the research on the development of the research gap. Most research of any endeavor is attributed to the development of the research gap, which is a primary basis in the investigation of any problem, phenomenon or scientific question. Given this accepted tenet of engagement in research, surprising in the research fraternity, we do not train researchers on how to systematically identify research gaps as basis for the investigation. This is has continued to be a common problem with novice researchers. Unfailingly, very little theory and research has been developed on identifying research gaps as a basis for a line in inquiry. The purpose of this research is threefold. First, the proposed theoretical framework builds on the five-point theoretical model of Robinson, Saldanhea, and McKoy (2011) on research gaps. Second, this study builds on the six-point theoretical model of Müller-Bloch and Franz (2014) on research gaps. Lastly, the purpose of this research is to develop and propose a theoretical model that is an amalgamation of the two preceding models and re-conceptualizes the research gap concepts and their characteristics. Thus, this researcher proposes a seven-point theoretical model. This article discusses the characteristics of each research and the situation in which its application is warranted in the literature review The significance of this article is twofold. First, this research provides theoretical significance by developing a theoretical model on research gaps. Second, this research attempts to build a solid taxonomy on the different characteristics of research gaps and establish a foundation. The implication for researchers is that research gaps should be structured and characterized based on their functionality. Thus, this provides researchers with a basic framework for identifying them in the literature investigation.

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ISSAH BAAKO

Various researchers have established the need for researchers to position their research problem in the research gap of the study area. This does not only indicate the relevance of the study but it demonstrates the significant contribution it would make in the field of study. The purpose of this paper is to conduct a systematic literature review on the concept of research gaps and provoke a discussion on the contemporary literature on types of research gaps. The paper discusses the various approaches for researchers to identify, align and position research problems, research design, and methodology in the research gaps to achieve relevance in their findings and study. A systematic review of the current literature on research gaps might assist beginning researchers in the justification of research problems. Given the acceptable tenet of developing a research agenda, design, and development on a research gap, many early career researchers especially (post)graduate students have difficulties in systematically identifying research gaps as a basis for conducting research work. The significance of this paper is twofold. First, it provides a systematic review of literature on the identification of research gaps to undertake research that would challenge assumptions and underlying existing theories in a significant way. Second, it provides a theoretical discussion on the importance of developing research problems on research gaps to structure their study.

Kayode Oyediran

Problem in a research as well as human body calls for perfect diagnosis of illness. This is important to avoid treating the symptoms instead of the actual disease. A research problem could be identified through professional or/and academic efforts. This poses a lot of problems to students, both at the undergraduate and postgraduate levels, as this determines the title of their articles or research works. Many of them have to submit many topics to their supervisors before one could be reframed and approved. At times, students appealed to their supervisors to provide them with researchable topics. This to the supervisor(s) almost writing the dissertations/theses for them. The argument of this paper is to let students understand "problem identification" using an analogy from the Holy Bible. The study employed a conversation analysis methodology, which is empirically grounded, exploratory in process and inferential. This involves using every conversation between two or more parties to explore facts/lesson. It was recommended that seasoned lecturers should explain to students how to identify research problems using what are familiar to them to make them understand this important aspect of research.

Sid Ahmed KHETTAB

A research gap is generally any problem a scientific article, an academic book or a thesis may contain. In the previous article [https://discourse.clevious.com/2019/12/how-to-come-up-with-research-idea.html], based on Dr. Anthony Miles' article on research gaps, I summarized the 7 research gaps into three main categories: theoretical problems, reasoning problems, and empirical problems.

Research to Action: The Global Guide to Research Impact

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The basics of research are seemingly clear. Read a lot of articles, see what’s missing, and conduct research to fill the gap in the literature. Wait a minute. What is that? “See what’s missing?” How can we see something that is not there? In this post, we will show you how to “see the invisible;” How to identify the missing pieces in any study, literature review, or program analysis. With these straight-forward techniques, you will be able to better target your research in a more cost-effective way to fill those knowledge gaps to develop more effective theories, plans, and evaluations.

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Azeez T Fatimo

Researchers and academia often have difficulties identifying the research gap in literature in various fields of study. Hence, exploring research gap is one of the most arduous tasks for researchers especially those at the preliminary stage. The explicit identification of research gap is an inevitable step in developing a research agenda including decision about funding and the design of informative studies. Thus, to identify the research gap, the researcher needs to prune down his area of interest as identifying research gaps requires a lot of reading and analyzing of materials from various literatures. Hence, this study explores literatures regarding the method of identifying research gaps in management sciences. This was done by extensively examining various literatures on the method of identifying research gaps from previous researchers. However, the study made use of content analysis to identify research gaps in some articles. This study revealed that researchers are focused on a single type of research gap, leaving other research gaps unexplored. Also, there are some methods of research identification that has remained understandable by researchers as there are little or no knowledge about them. Hence, the study recommended among others that the various research identification methods be explored by researchers who intend to engage in studies in this field of management sciences.

Omini Akpang

This section contains the four Thematic Gap Analyses and the Cross-Cutting Gap Analysis. Each of the chapters has a lead author (s) as noted on the front page of the chapter. This follows the way that the team has divided-up the responsibilities for each Thematic Area, with a disciplinary specialist (s) taking the lead on each area. The chapters have, however, been reviewed and commented by others in the project team so the analysis and suggested actions and conclusions have the general support of the full project team.

In this second part of The Reason to Replicate Research, I develop with more details and explanations the Reasoning Gaps idea I briefly discussed in the article “How to Come Up with Research Question Easily Like a Pro”. (https://discourse.clevious.com/2019/12/how-to-come-up-with-research-idea.html) And just like in Part I (https://discourse.clevious.com/2020/01/the-empirical-gap-to-replicate-research.html), I will try to pivot the explanation around an example and show why they are important to fill.

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• Published: 21 May 2024

Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence

• Desmond Kuupiel 1 , 2 ,
• Monsurat A. Lateef 1 ,
• Patience Adzordor 3 , 4 ,
• Gugu G. Mchunu 1 &
• Julian D. Pillay 1  

Archives of Public Health volume  82 , Article number:  78 ( 2024 ) Cite this article

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Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This scoping review aimed to explore the range of research evidence on injuries and trauma resulting from SGBV among survivors in SSA and identify research gaps.

The review employed the Arksey and O’Malley methodological framework, conducting extensive literature searches across multiple electronic databases using keywords, Boolean operators, medical subject heading terms and manual searches of reference lists. It included studies focusing on injuries and trauma from SGBV, regardless of gender or age, published between 2012 and 2023, and involved an SSA countries. Two authors independently screened articles, performed data extraction and quality appraisal, with discrepancies resolved through discussions or a third author. Descriptive analysis and narrative synthesis were used to report the findings.

After screening 569 potentially eligible articles, 20 studies were included for data extraction and analysis. Of the 20 included studies, most were cross-sectional studies ( n  = 15; 75%) from South Africa ( n  = 11; 55%), and involved women ( n  = 15; 75%). The included studies reported significant burden of injuries and trauma resulting from SGBV, affecting various populations, including sexually abused children, married women, visually impaired women, refugees, and female students. Factors associated with injuries and trauma included the duration of abuse, severity of injuries sustained, marital status, family dynamics, and timing of incidents. SGBV had a significant impact on mental health, leading to post-traumatic stress disorder, depression, anxiety, suicidal ideations, and psychological trauma. Survivors faced challenges in accessing healthcare and support services, particularly in rural areas, with traditional healers sometimes providing the only mental health care available. Disparities were observed between urban and rural areas in the prevalence and patterns of SGBV, with rural women experiencing more repeated sexual assaults and non-genital injuries.

This scoping review highlights the need for targeted interventions to address SGBV and its consequences, improve access to healthcare and support services, and enhance mental health support for survivors. Further research is required to fill existing gaps and develop evidence-based strategies to mitigate the impact of SGBV on survivors in SSA.

Peer Review reports

The World Health Organization (WHO) reports that injuries are a growing global public health problem [ 1 ]. In 2021, unintentional and violence-related injuries were estimated to cause over 4 million deaths worldwide, accounting for nearly 8% of all deaths [ 1 ]. Additionally, injuries are responsible for approximately 10% of all years lived with disability each year [ 1 ]. While injuries can result from various causes such as road traffic accidents, falls, drowning, burns, poisoning, and acts of violence, including sexual and gender-based violence (SGBV) [ 1 , 2 ], SGBV remains a neglected cause of injuries that silently affects the lives of many, especially women [ 3 , 4 ]. Injuries due to SGBV refer to physical harm or trauma resulting from acts of violence perpetrated based on an individual’s sex or gender. These injuries can encompass a range of physical harm, including but not limited to bruises, cuts, fractures, internal injuries, and sexual trauma (psychological or emotional) [ 5 ].

Sexual and gender-based violence is a pervasive issue [ 6 , 7 , 8 , 9 , 10 ] with alarming rates globally, particularly in the WHO Africa and South-East Asia regions with 33% each compared to 20% in the Western Pacific, 22% in high-income countries and Europe, and 31% in the WHO Eastern Mediterranean region [ 8 ]. However, this statistic includes only physical and/or sexual violence by an intimate partner alone and does not include other forms of violence [ 8 ]. Sexual and gender-based violence encompasses various acts such as sexual assault, rape, intimate partner violence, and harmful traditional practices, all of which have severe physical and psychological consequences for women [ 9 , 11 , 12 ]. The sub-Saharan Africa region has witnessed numerous cases of SGBV perpetrated against vulnerable populations, such as women, children, refugees, and individuals with disabilities, with devastating impacts on their well-being and overall quality of life [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].

Understanding the extent and nature of injuries and trauma resulting from SGBV among survivors is crucial in formulating effective interventions, policies, and support systems. Research evidence plays a fundamental role in shaping responses to this pressing public health concern, guiding the development of targeted interventions and preventive measures. However, the available research on injuries and trauma related to SGBV in sub-Saharan Africa remains scattered and diverse, necessitating a comprehensive and systematic review to consolidate and analyse existing knowledge.

A scoping review study would support a valuable research approach to systematically map and describe the existing evidence on injuries and trauma related to SGBV against women in sub-Saharan Africa. In so doing, the scoping review would provide a broader overview of the literature to identify knowledge gaps, key concepts, and various study designs employed in the field, and inform more specific research questions that can be unpacked by way of a systematic review and /or meta-analysis quantitative studies or meta-synthesis of qualitative studies [ 33 , 34 ]. To our knowledge, current literature shows no evidence of any previous scoping review that has focused on injuries and trauma due SGBV. This study, therefore, conducted a systematic scoping review to explore the scope of research evidence regarding injuries and trauma stemming from SGBV among survivors in sub-Saharan Africa. This research sheds light on the prevalence, patterns, and factors associated with injuries and trauma resulting from SGBV in the region and their impact on survivors.

To achieve the objective of this scoping review, we utilised the Arksey and O’Malley methodological framework [ 35 ] as a guiding framework for mapping and examining the literature on injuries and trauma associated with SGBV in the context of sub-Saharan Africa. This framework comprises several key steps, including identifying the research question, identifying relevant studies, study selection, data charting and collation, and summarizing and reporting the results [ 33 , 34 ].

Identifying the research question

The primary research question guiding this scoping review is as follows: What is the scope of research evidence regarding injuries and trauma resulting from sexual and gender-based violence among survivors in sub-Saharan Africa in the last decade? To ensure the appropriateness and relevance of this question, we employed the Population, Concept, and Context (PCC) framework [ 36 ] as part of the study eligibility criteria, which is detailed in Table  1 . To comprehensively address the research objective, the scoping review explored the following sub-questions:

Literature searches

The purpose of our search was to identify relevant peer-reviewed papers that address the review questions. To accomplish this, a comprehensive search was conducted across several electronic databases, including PubMed, EBSCOhost (CINAHL, PsycInfo, and Health Source: Nursing/Academic Edition), SCOPUS, and Web of Science for original articles published within between 2012 and 2023. Additionally, a search using the Google Scholar search engine was performed to identify additional literature of relevance. For the database searches, we developed a search strategy in collaboration with an information scientist, ensuring the inclusion of relevant keywords such as “survivor,” “gender-based violence,” “sexual violence,” “injuries,” and “trauma.” We employed Boolean operators (AND/OR) and Medical Subject Heading (MeSH) terms to refine the search string (Please refer to Supplementary File 1 for the detailed search strategy). Adjustments were made to the syntax based on the specific requirements of each database. The information scientist also played a role in conducting website searches. In addition to electronic searches, we manually explored the reference lists of included sources to identify any additional relevant literature. At this stage, no search filters based on language or publication type were applied, however, the search results will be limited to publications from 2012 to 2023. This date limitation was to enable as captured recent and relevant studies to understand the current trend. All search results were imported into an EndNote Library X20 for efficient citation management.

Articles selection process

A study selection tool was developed using Google Forms based on the items outlined in the inclusion criteria (Table  1 ) and was subsequently pilot tested. The EndNote library was then examined for duplicates using the “Find Duplicate” function. Two authors (DK and ML) independently utilised the study screening tool to categorise titles and abstracts into two groups: “include” and “exclude.” Any discrepancies in their responses during this phase were resolved through discussion and consensus. The full-text articles of all titles and abstracts that met the inclusion criteria during the initial screening phase were obtained from using the Durban University of Technology Library Services, and independently screened by DK and ML following the eligibility criteria as a guide. In cases where there was a lack of consensus between DK and ML, a third author (PA) was consulted to resolve any discrepancies. The PRISMA flow diagram was utilised to document the article selection process, ensuring transparency and accountability.

Quality appraisal

The Mixed Method Quality Appraisal Tool (MMAT) Version 2018 [ 37 ] was utilised to assess the methodological quality and potential risk of bias in the included studies. This tool was employed to evaluate the appropriateness of the study’s objective, the suitability of the study design, participant recruitment methods, data collection procedures, data analysis techniques, and the presentation of results/findings. To determine the quality of the studies, a quality score based on established criteria was applied, where a score of 50% indicated low quality, 51–75% indicated average quality, and 76–100% indicated high quality. The total percentage score was calculated by adding all the items rated, divided by seven, and multiply by a hundred. This rigorous assessment is crucial for identifying any research gaps. Two authors (DK and ML) independently conducted the quality appraisal, and any disagreements were resolved by involving a third author (PA).

Data charting

Data extraction was conducted using a spreadsheet, which underwent a pilot test with 15% (3) of the included evidence sources to ensure its efficacy in capturing all relevant data for addressing the review question. Feedback from the pilot test was carefully considered, and necessary adjustments were made to the form. Upon a comprehensive examination of the full texts, two independent reviewers (DK and ML) extracted all pertinent data from the included studies. The data extraction process employed a hybrid approach, incorporating both inductive and deductive reasoning [ 38 ]. The process involved a thorough analysis of the extracted information to identify patterns, themes, and trends in the existing research evidence regarding injuries and trauma resulting from SGBV among survivors in sub-Saharan Africa. Key study characteristics, including author(s), publication year, study title, aim/objective, geographical location (country), study design and study population, were extracted. Additionally, the study findings pertaining to injuries and/or trauma resulting from SGBV were recorded.

Collating, summarising, and reporting the results

The results of the data extraction were collated and summarised in a narrative format. Descriptive analysis and narrative synthesis were utilised to present the findings in a comprehensive manner. The study outcomes included a comprehensive overview of the scope of research evidence on injuries and trauma due to SGBV among survivors in the region. This study was be reported in keeping with the Preferred Reporting Items for Systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist [ 39 ].

Study selection

A total of 569 potentially eligible titles and abstracts across databases were screened and after excluding duplicates and those that did not meet this eligibility criteria, included 20 [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] studies for data extraction and analysis (Fig.  1 ).

PRISMA 2020 flow diagram

Characteristics and quality appraisal of the included studies

Of the 20 included studies, the majority ( n  = 4; 20%) were from South Africa, and mostly ( n  = 11; 55%) published between 2012 and 2022. The majority ( n  = 9, 45%) were cross-sectional studies, and mostly ( n  = 15; 75%) involved women. The mean quality score ± SD of the 20 included studies was 87% ± 13. All details on the characteristics and quality appraisal of the included studies are provided in Table  2 .

Study findings

Theme 1: physical injuries/trauma due to sgbv occurrence/prevalence, pattern, and associated factors.

Several studies have explored the prevalence and factors associated with injuries/trauma due to SGBV (Table  3 ). Ssewanyana et al. highlighted the occurrence of genital trauma among adolescent girls resulting from sexual assault [ 14 ]. Apatinga et al. demonstrated that sexual violence was accompanied by physical abuse, leading to physical injuries among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of injuries including genital injuries [ 16 ]. Amashnee et al. identified specific patterns in the occurrence of sexual assault injuries, with higher prevalence on Mondays (28%) and Fridays (27.3%), during specific months, and predominantly during working hours [ 17 ]. Abubeker et al. examined the impact of physical violence on female students, with findings indicating various injuries such as bruising, cuts, scratches, and fractures, leading to missed classes and fear of walking alone [ 19 ]. Biribawa et al. investigated the burden of GBV-related injuries and found a significant number of hospital visits in Uganda, with slightly declining injury rates (from 13.6 to 13.5 per 10,000 population) from 2012 to 2016 [ 18 ]. Umana et al. documented that 6.6% of undergraduate and postgraduate female students experienced sexual intimate partner violence, leading to injuries such as cuts, bruises, and sprains [ 20 ]. Mukanangana et al. reported the prevalence of virginal bleeding, genital irritation and urinary tract infection among women in reproductive age in Zimbabwe [ 21 ]. These findings collectively underscore the occurrence/prevalence physical injuries/trauma, pattern and specific associated factors associated resulting from SGBV.

Theme 2: consequences and impact on mental health

Several studies highlighted the significant consequences and impact of SGBV on mental health (Table  4 ). Ombok et al. found that sexually abused children had a high prevalence (49%) of post-traumatic stress disorder (PTSD), which was associated with the duration of abuse, severity of injuries sustained, parents’ marital status, and family dynamics [ 13 ]. Apatinga et al. demonstrated that sexual violence was accompanied by emotional abuse, leading to psychological problems, sexual and reproductive health issues, and suicidal ideations among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of suicide attempts, and marital breakdown [ 16 ]. Liebling et al. found that women and girls who experienced SGBV frequently became pregnant and suffered from injuries, disability, and psychological trauma [ 22 ]. Morof et al. highlighted the high prevalence of violence and its association with PTSD symptoms and depression among women [ 23 ]. Nguyen et al. demonstrated that exposure to various forms of gender-based violence, including intimate partner violence and sexual harassment, was significantly associated with hypertension, mediated by depression, post-traumatic stress symptoms, and alcohol binge-drinking [ 24 ]. Abrahams et al. reported that women raped by intimate partners had higher levels of depressive symptoms compared to those raped by strangers [ 25 ]. Pitpitan et al. found a significant association between gender-based violence and increased alcohol use, as well as heightened levels of depressive symptoms and PTSD symptoms [ 26 ]. Okunola et al. revealed the complications experienced by survivors of sexual assault, including sexually transmitted infections, depression, and post-traumatic stress disorder [ 27 ]. Umana et al. identified the negative impact of violence on academic performance, with victims experiencing loss of concentration, self-confidence, and school absenteeism [ 20 ]. Roberts et al. highlighted the association between severe GBV and higher depressive symptoms, PTSD symptoms, disordered alcohol use, and more sex partners [ 29 ]. Tantu et al. emphasized the wide range of social, health-related, and psychological consequences resulting from gender-based violence [ 28 ]. Finally, Mukanangana et al. revealed that the majority of respondents who experienced rape suffered from psychological trauma, exposure to sexually transmitted infections, unwanted pregnancies, loss of libido, and illegal abortions [ 21 ]. These findings collectively demonstrate the significant impact of SGBV on mental health, including psychological trauma, depression, PTSD symptoms, and various adverse outcomes.

Theme 3: healthcare access and support services

The findings from the studies conducted in the Democratic Republic of the Congo and Togo highlight significant barriers and challenges faced by survivors of SGBV in accessing healthcare and receiving proper psychological care. In the Democratic Republic of the Congo, Scott et al. reported that SGBV survivors faced barriers to accessing healthcare, such as availability and affordability, in their study to evaluate community attitudes of SGBV and health facility capacity to address SGBV in the eastern part of the country [ 30 ]. Access to mental health care was difficult [ 30 ]. Witch doctors and other traditional healers provided mental health services to some survivors [ 30 ]. Burgos-Soto et al.‘s study in Togo, which sought to estimate the prevalence and contributing factors of intimate partner physical and sexual violence among HIV-infected and -uninfected women, found that lifetime prevalence rates of physical and sexual violence were significantly higher among HIV-infected women compared to uninfected women [ 31 ]. 42% of the women admitted to ever suffering physical harm as a result of intimate partner abuse [ 31 ]. Only one-third of the injured women had ever told the medical professionals the true nature of their injuries, and none had been directed to neighbourhood organizations for the proper psychological care [ 31 ].

Theme 4: rural vs. urban disparities

According to a study conducted in Nigeria by Na et al. to identify the trends in sexual assault against women in urban and rural areas of Osun State, completed rapes occurred 10.0% of the time in urban areas and 9.2% of the time in rural areas, while attempted rapes occurred 31.4% of the time in urban areas and 20.0% of the time in rural areas [ 32 ]. Rural women were more likely than urban women to endure repeated sexual assault and non-genital injuries [ 32 ]. This study findings suggest that sexual assault against women occurs in both urban and rural areas, with notable differences in the patterns and outcomes.

This scoping review study on injuries and trauma resulting from sexual and SGBV) in sub-Saharan Africa revealed key findings that shed light on this critical issue. The majority (15%) of the included studies were conducted in South Africa. Most (75%) of these studies adopted a cross-sectional design and focused on women as the population of interest. The overall mean quality score of the included studies was high, indicating robustness and reliability in the research.

The findings from the included studies collectively highlighted the prevalence of physical injuries and trauma resulting from SGBV in sub-Saharan Africa such as genital injuries, cuts, bites, scratches, abrasions, bruises, sprains, dislocations, fractures, vaginal bleeding, and genital trauma. The included studies provided insights into the consequences and specific factors associated with such violence, emphasising the urgent need for effective interventions and support services. Notably, the impact of SGBV on mental health was a recurring theme in the literature, with evidence pointing to psychological trauma, depression, PTSD symptoms, and other adverse outcomes experienced by survivors.

While the review identified limited research on healthcare access and support services for SGBV survivors, the available studies underscored significant barriers in accessing healthcare and receiving proper psychological care [ 30 , 31 ]. Challenges included limited availability and affordability of services, as well as survivors’ hesitancy to disclose abuse to medical professionals. These findings highlight importance healthcare gaps requiring interventions to ensure comprehensive support for survivors in sub-Saharan Africa.

Policymakers in sub-Saharan Africa should prioritise the implementation of comprehensive and evidence-based interventions to address injuries and trauma resulting from SGBV. The concentration of included studies from South Africa indicates the need to expand research efforts to include other countries in the region, ensuring that policies are tailored to meet the diverse needs and contexts of different nations. The limited research on healthcare access and support services for SGBV survivors underscores the urgency of improving healthcare systems and strengthening support services for survivors. Policymakers should consider investing in accessible and affordable healthcare services that provide specialised care for SGBV survivors, including mental health support. Additionally, addressing publication language bias by promoting research in multiple languages (e.g., French and Portuguese) can ensure that relevant findings reach policymakers across the sub-Saharan African region. Furthermore, this scoping review’s potentially can inform the development of targeted policies that address the specific risk factors, consequences, and contributing factors associated with injuries and trauma resulting from SGBV.

The scoping review findings highlight several avenues for future research on injuries and trauma as a result of SGBV in sub-Saharan Africa. Researchers should focus on conducting studies in countries with limited representation in the current literature to enhance the breadth and diversity of evidence available. Investigating the barriers and challenges faced by survivors in accessing healthcare and support services should be a priority to identify gaps and improve service delivery. Moreover, longitudinal studies could provide valuable insights into the long-term consequences of SGBV on survivors’ mental health and well-being. Researchers should also explore the effectiveness of various interventions, including those involving community-based support systems, to address SGBV-related injuries and trauma. Furthermore, incorporating qualitative research approaches could deepen the understanding of survivors’ experiences and help in tailoring interventions to their specific needs. Future research should also consider the perspectives of various stakeholders, including healthcare providers, community leaders, and policymakers, to develop comprehensive and context-specific strategies to prevent and respond to SGBV and its consequences. Overall, conducting rigorous research that spans diverse contexts and populations will contribute to a more comprehensive understanding of the multifaceted challenges posed by SGBV and inform evidence-based interventions that promote survivor support and well-being.

The scoping review’s strength lies in its comprehensive approach, encompassing a wide range of literature on injuries and trauma resulting from SGBV in sub-Saharan Africa. By considering various study designs and sources of evidence, the review offers a holistic view of the topic. Additionally, the study effectively identifies key themes and trends in the literature, leading to a deeper understanding of the prevalence, consequences, and specific factors associated with injuries and trauma resulting from SGBV in the region. The mapping of research evidence within the review proves to be a valuable resource for researchers, policymakers, and practitioners working in the field of SGBV. Furthermore, the review’s emphasis on studies with an overall high mean quality score (87% ± 13%) enhances the credibility and reliability of the findings, ensuring that the evidence presented is robust and trustworthy.

Despite these strengths, this scoping review has several limitations. The concentration of included studies from South Africa introduces a geographic bias, potentially limiting the generalizability of findings to other countries within sub-Saharan Africa. To enhance the review’s applicability, a more diverse representation of research from different regions in the area would be beneficial. Additionally, the paucity of studies investigating healthcare access and support services for SGBV survivors may restrict the review’s ability to provide comprehensive insights into this critical aspect of the topic. Despite these limitations, this scoping review provides a valuable overview of the available research evidence on injuries and trauma related to SGBV in sub-Saharan Africa, paving the way for further research and targeted interventions to address this critical issue. Researchers should acknowledge and consider these limitations when interpreting and applying the review’s findings.

In conclusion, this scoping review provides a comprehensive overview of the research evidence on injuries/trauma resulting from SGBV in the sub-Saharan African region. It underscores the urgent need for further research and targeted interventions to address this pervasive issue and support the well-being of survivors.

Data availability

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Kuupiel, D., Lateef, M.A., Adzordor, P. et al. Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence. Arch Public Health 82 , 78 (2024). https://doi.org/10.1186/s13690-024-01307-3

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Competency gap among graduating nursing students: what they have achieved and what is expected of them

• Majid Purabdollah 1 , 2 ,
• Vahid Zamanzadeh 2 , 3 ,
• Akram Ghahramanian 2 , 4 ,
• Leila Valizadeh 2 , 5 ,
• Saeid Mousavi 2 , 6 &
• Mostafa Ghasempour 2 , 4  

BMC Medical Education volume  24 , Article number:  546 ( 2024 ) Cite this article

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Nurses’ professional competencies play a significant role in providing safe care to patients. Identifying the acquired and expected competencies in nursing education and the gaps between them can be a good guide for nursing education institutions to improve their educational practices.

In a descriptive-comparative study, students’ perception of acquired competencies and expected competencies from the perspective of the Iranian nursing faculties were collected with two equivalent questionnaires consisting of 85 items covering 17 competencies across 5 domains. A cluster sampling technique was employed on 721 final-year nursing students and 365 Iranian nursing faculties. The data were analyzed using descriptive statistics and independent t-tests.

The results of the study showed that the highest scores for students’ acquired competencies and nursing faculties’ expected competencies were work readiness and professional development, with mean of 3.54 (SD = 0.39) and 4.30 (SD = 0.45), respectively. Also, the lowest score for both groups was evidence-based nursing care with mean of 2.74 (SD = 0.55) and 3.74 (SD = 0.57), respectively. The comparison of competencies, as viewed by both groups of the students and the faculties, showed that the difference between the two groups’ mean scores was significant in all 5 core-competencies and 17 sub-core competencies ( P  < .001). Evidence-based nursing care was the highest mean difference (mean diff = 1) and the professional nursing process with the lowest mean difference (mean diff = 0.70).

The results of the study highlight concerns about the gap between expected and achieved competencies in Iran. Further research is recommended to identify the reasons for the gap between the two and to plan how to reduce it. This will require greater collaboration between healthcare institutions and nursing schools.

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Introduction| Background

Nursing competence refers to a set of knowledge, skills, and behaviors that are necessary to successfully perform roles or responsibilities [ 1 ]. It is crucial for ensuring the safe and high-quality care of patients [ 2 , 3 , 4 , 5 ]. However, evaluating nursing competence is challenging due to the complex, dynamic, and multi factorial nature of the clinical environment [ 3 ]. The introduction of nursing competencies and their assessment as a standard measure of clinical performance at the professional level has been highlighted by the Association of American Colleges of Nursing [ 6 , 7 ]. As a result, AACN (2020) introduces competence assessment as an emerging concept in nursing education [ 7 ].

On the other hand, the main responsibility of nursing education is to prepare graduates who have the necessary competencies to provide safe and quality care [ 3 ]. Although it is believed that it is impossible to teach everything to students, acquiring some competencies requires entering a real clinical setting and gaining work experience [ 8 ]. However, nursing students are expected to be competent to ensure patient safety and quality of care after graduation [ 9 ]. To the extent that the World Health Organization (WHO), while expressing concern about the low quality of nursing education worldwide, has recommended investing in nursing education and considers that the future to require nurses who are theoretically and clinically competent [ 5 ]. Despite efforts, the inadequate preparation of newly graduated nursing students and doubts about the competencies acquired in line with expectations to provide safe care for entering the nursing setting have become a global concern [ 10 , 11 , 12 , 13 ]. The results of studies in this field are different. The results of Amsalu et al. showed that the competence of newly graduated nursing students to provide quality and safe care was not satisfactory [ 14 ]. Some studies have also highlighted shortcomings in students’ “soft” skills, such as technical competency, critical thinking, communication, teamwork, helping roles, and professionalism [ 15 ]. Additionally, prior research has indicated that several nursing students have an unrealistic perception of their acquired competencies before entering the clinical setting and they report a high level of competence [ 2 ]. In other study, Hickerson et al. showed that the lack of preparation of nursing students is associated with an increase in patient errors and poor patient outcomes [ 16 ]. Some studies also discussed nursing competencies separately; Such as patient safety [ 17 ], clinical reasoning [ 18 ], interpersonal communication [ 19 ], and evidence-based care competence [ 20 ].

On the other hand, the growing need for safe nursing care and the advent of new educational technologies, the emergence of infectious diseases has increased the necessity of nursing competence. As a result, the nursing profession must be educated to excellence more than ever before [ 5 , 21 , 22 ]. Therefore, the self-assessment of students’ competence levels as well as the evaluation of nursing managers about the competencies expected from them is an essential criterion for all healthcare stakeholders, educators, and nursing policymakers to ensure the delivery of safe, and effective nursing care [ 9 , 23 , 24 ].

However, studies of nurse managers’ perceptions of the competence of newly graduated nursing students are limited and mostly conducted at the national level. Hence, further investigation is needed in this field [ 25 , 26 ]. Some other studies have been carried out according to the context and the needs of societies [ 3 , 26 , 27 , 28 ]. The results of some other studies in the field of students’ self-assessment of perceived competencies and managers’ and academic staff’s assessment of expected competency levels are different and sometimes contradictory, and there is the “academic-clinical gap” between expected and achieved competencies [ 25 , 29 , 30 ]. A review of the literature showed that this gap has existed for four decades, and the current literature shows that it has not changed much over time. The academe and practice settings have also been criticized for training nurses who are not sufficiently prepared to fully engage in patient care [ 1 ]. Hence, nursing managers must understand the expected competencies of newly graduated students, because they have a more complete insight into the healthcare system and the challenges facing the nursing profession. Exploration of these gaps can reveal necessities regarding the work readiness of nursing graduates and help them develop their competencies to enter the clinical setting [ 1 , 25 ].

Although research has been carried out on this topic in other countries, the educational system in those countries varies from that of Iran’s nursing education [ 31 , 32 ]. Iran’s nursing curriculum has tried to prepare nurses who have the necessary competencies to meet the care needs of society. Despite the importance of proficiency in nursing education, many nursing graduates often report feeling unprepared to fulfill expected competencies and they have deficiencies in applying their knowledge and experience in practice [ 33 ]. Firstly, the failure to define and identify the expected competencies in the nursing curriculum of Iran led to the absence of precise and efficient educational objectives. Therefore, it is acknowledged that the traditional nursing curriculum of Iran focuses more on lessons organization than competencies [ 34 ]. Secondly, insufficient attention has been given to the scheduling, location, and level of competencies in the nursing curriculum across different semesters [ 35 ]. Thirdly, the large volume of content instead of focusing on expected competencies caused nursing graduates challenged to manage complex situations [ 36 ]. Therefore, we should not expect competencies such as critical thinking, clinical judgment, problem-solving, decision-making, management, and leadership from nursing students and graduates in Iran [ 37 ]. Limited research has been conducted in this field in Iran. Studies have explored the cultural competence of nursing students [ 38 ] and psychiatric nurses [ 39 ]. Additionally, the competence priorities of nurses in acute care have been investigated [ 40 ], as well as the competency dimensions of nurses [ 41 ].

In Iran, after receiving the diploma, the students participate in a national exam called Konkur. Based on the results of this exam, they enter the field of nursing without conducting an aptitude test interview and evaluating individual and social characteristics. The 4-year nursing curriculum in Iran has 130 units including 22 general, 54 specific, 15 basic sciences, and 39 internship units. In each semester, several workshops are held according to the syllabus [ 42 ]. Instead of the expected competencies, a list of general competencies is specified as learning outcomes in the program. Accepted students based on their rank in the exam and their choice in public and Islamic Azad Universities (non-profit), are trained with a common curriculum. Islamic Azad Universities are not supported by government funding and are managed autonomously, this problem limits the access to specialized human resources and sufficient educational fields, and the lower salaries of faculty members in Azad Universities compared to the government system, students face serious challenges. Islamic Azad Universities must pay exorbitant fees to medical universities for training students in clinical departments and medical training centers, doubling these Universities’ financial problems. In some smaller cities, these financial constraints cause students to train in more limited fields of clinical training and not experience much of what they have learned in the classroom in practice and the real world of nursing. The evaluation of learners in the courses according to the curriculum is based on formative and summative evaluation with teacher-made tests, checklists, clinical assignments, conferences, and logbooks. The accreditation process of nursing schools includes two stages internal evaluation, which is done by surveying students, professors and managers of educational groups, and external accreditation is done by the nursing board. After completing all their courses, to graduate, students must participate in an exam called “Final”, which is held by each faculty without the supervision of an accreditation institution, the country’s assessment organization or the Ministry of Health, and obtain at least a score of 10 out of 20 to graduate.

Therefore, we conducted this comprehensive study as the first study in Iran to investigate the difference between the expected and perceived competence levels of final year nursing students. The study’s theoretical framework is based on Patricia Benner’s “From Novice to Expert” model [ 43 ].

Materials and methods

The present study had the following three objectives:

Determining self-perceived competency levels from the perspective of final year nursing students in Iran.

Determining expected levels of competency from the perspective of nursing faculties in Iran.

To determine the difference between the expected competencies from the perspective of nursing faculties and the achieved competencies from the perspective of final-year nursing students.

This study is a descriptive-comparative study.

First, we obtained a list of all nursing schools in the provinces of Iran from the Ministry of Health ( n  = 31). From 208 Universities, 72 nursing schools were randomly selected using two-stage cluster sampling. Among the selected faculties, we chose 721 final-year nursing students and 365 nursing faculties who met the eligibility criteria for the study. Final-year nursing students who consented to participate in the study were selected. Full-time faculty members with at least 2 years of clinical experience and nurse managers with at least 5 years of clinical education experience were also included. In this study, nursing managers, in addition to their educational roles in colleges, also have managerial roles in the field of nursing. Some of these roles include nursing faculty management, nursing board member, curriculum development and review, planning and supervision of nursing education, evaluation, and continuous improvement of nursing education. The selection criteria were based on the significant role that managers play in nursing education and curriculum development [ 44 ]. Non-full-time faculty members and managers without clinical education experience were excluded from the study.

The instrument used in this study is a questionnaire developed and psychometrically tested in a doctoral nursing dissertation [ 45 ]. To design the tool, the competencies expected of undergraduate nursing students in Iran and worldwide were first identified through a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI) and supported by the PAGER framework. Summative content analysis by Hsieh and Shannon (2005) was used for analysis, which included: counting and comparing keywords and content, followed by interpretation of textual meaning. In the second step, the results of the first step were used to create tool statements. Then the validity of the instrument was checked by face validity, content validity (determination of the ratio and index of content validity), and validity of known groups. Its reliability was also checked by internal consistency using Cronbach’s alpha method and stability using the test-retest method. The competency questionnaire comprises 85 items covering 17 competencies across 5 domains: “individualized care” (4 competencies with 21 items), “evidence-based nursing care” (2 competencies with 10 items), “professional nursing process” (3 competencies with 13 items), “nursing management” (2 competencies with 16 items), and “work readiness and professional development” (6 competencies with 25 items) [ 45 ]. “The Bondy Rating Scale was utilized to assess the competency items, with ratings ranging from 1 (Dependent) to 5 (Independent) on a 5-point Likert scale [ 46 ]. The first group (nursing students) was asked to indicate the extent to which they had acquired each competency. The second group (nursing faculties) was asked to specify the level to which they expected nursing students to achieve each competency.

Data collection

First, the researcher contacted the deans and managers of the selected nursing schools by email to obtain permission. After explaining the aims of the study and the sampling method, we obtained the telephone number of the representative of the group of final year nursing students and also the email of the faculty members. The representative of the student group was then asked to forward the link to the questionnaire to 10 students who were willing to participate in the research. Informed consent for students to participate in the online research was provided through the questionnaires, while nursing faculty members who met the eligibility criteria for the study received an informed consent form attached to the email questionnaire. The informed consent process clarified the study objectives and ensured anonymity of respondent participation in the research, voluntary agreement to participate and the right to revoke consent at any time. An electronic questionnaire was then sent to 900 final year nursing students and 664 nursing faculties (from 4 March 2023 to 11 July 2023). Reminder emails were sent to nursing faculty members three times at two-week intervals. The attrition rate in the student group was reported to be 0 (no incomplete questionnaires). However, four questionnaires from nursing faculty members were discarded because of incomplete responses. Of the 900 questionnaires sent to students and 664 sent to nursing faculties, 721 students and 365 nursing faculty members completed the questionnaire. The response rates were 79% and 66% respectively.

Data were analyzed using SPSS version 22. Frequencies and percentages were used to report categorical variables and mean and standard deviations were used for quantitative variables. The normality of the quantitative data was confirmed using the Shapiro-Wilk and Skewness tests. An independent t-test was used for differences between the two groups.

Data analysis revealed that out of 721 students, 441 (61.20%) was female. The mean and deviation of the students’ age was 22.50 (SD = 1.21). Most of the students 577 (80%) were in their final semester. Also, of the total 365 faculties, the majority were female 253 (69.31%) with a mean of age 44.06 (SD = 7.46) and an age range of 22–65. The academic rank of most nursing faculty members 156 (21.60%) was assistant professor (Table  1 ).

The results of the study showed that in both groups the highest scores achieved by the students and expected by the nursing faculty members were work readiness and professional development with a mean and standard deviation of 3.54 (0.39) and 4.30 (0.45) respectively. The lowest score for both groups was also evidence-based nursing care with a mean and standard deviation of 2.74 (0.55) for students and 3.74 (0.57) for nursing faculty members (Table  2 ).

Also, the result of the study showed that the highest expected competency score from the nursing faculty members’ point of view was the safety subscale. In other words, faculty members expected nursing students to acquire safety competencies at the highest level and to be able to provide safe care independently according to the rating scale (Mean = 4.51, SD = 0.45). The mean score of the competencies achieved by the students was not above 3.77 in any of the subscales and the highest level of competency achievement according to self-report of students was related to safety competencies (mean = 3.77, SD = 0.51), preventive health services (mean = 3.69, SD = 0.79), values and ethical codes (mean = 3.67, SD = 0.77), and procedural/clinical skills (mean = 3.67, SD = 0.71). The other competency subscales from the perspective of the two groups are presented in Table  3 , from highest to lowest score.

The analysis of core competencies achieved and expected from both students’ and nursing faculty members’ perspectives revealed that, firstly, there was a significant difference between the mean scores of the two groups in all five core competencies ( P  < .001) and that the highest mean difference was related to evidence-based care with mean diff = 1 and the lowest mean difference was related to professional care process with mean diff = 0.70 (Table  4 ).

Table  5 indicates that there was a significant difference between the mean scores achieved by students and nursing faculty members in all 5 core competencies and 17 sub-core Competencies ( p  < .001).

The study aimed to determine the difference between nursing students’ self-perceived level of competence and the level of competence expected of them by their nursing faculty members. The study results indicate that students scored highest in work readiness and professional development. However, they were not independent in this competency and required support. The National League for Nursing (NLN) recognizes nursing professional development as the goal of nursing education programs [ 47 ] However, Aguayo-Gonzalez [ 48 ] believes that the appropriate time for professional development is after entering a clinical setting. This theme includes personal characteristics, legality, clinical/ procedural skills, patient safety, preventive health services, and mentoring competence. Personality traits of nursing students are strong predictors of coping with nursing stress, as suggested by Imus [ 49 ]. These outcomes reflect changes in students’ individual characteristics during their nursing education. Personality changes, such as the need for patience and persistence in nursing care and understanding the nurse identity prepare students for the nursing profession, which is consistent with the studies of Neishabouri et al. [ 50 ]. Although the students demonstrated a higher level of competence in this theme, an examination of the items indicates that they can still not adapt to the challenges of bedside nursing and to use coping techniques. This presents a concerning issue that requires attention and resolution. Previous studies have shown that nursing education can be a very stressful experience [ 51 , 52 , 53 ].

Of course, there is no consensus on the definition of professionalism and the results of studies in this field are different. For example, Akhtar et al. (2013) identified common viewpoints about professionalism held by nursing faculty and students, and four viewpoints emerged humanists, portrayers, facilitators, and regulators [ 54 ]. The findings of another study showed that nursing students perceived vulnerability, symbolic representation, role modeling, discontent, and professional development are elements that show their professionalism [ 55 ]. The differences indicate that there may be numerous contextual variables that affect individuals’ perceptions of professionalism.

The legal aspects of nursing were the next item in this theme that students needed help with. The findings of studies regarding the legal competence of newly graduated nursing students are contradictory reported that only one-third of nurse managers were satisfied with the legal competence of newly graduated nursing students [ 56 , 57 ]. Whereas the other studies showed that legality was the highest acquired competence for newly graduated nursing students [ 58 , 59 ]. However, the results of this study indicated that legality may be a challenge for newly graduated nursing students. Benner [ 43 ] highlighted the significant change for new graduates in that they now have full legal and professional responsibility for the patient. Tong and Epeneter [ 60 ] also reported that facing an ethical dilemma is one of the most stressful factors for new graduates. Therefore, the inexperience of new graduates cannot reduce the standard of care that patients expect from them [ 60 ]. Legal disputes regarding the duties and responsibilities of nurses have increased with the expansion of their roles. This is also the case in Iran. Nurses are now held accountable by law for their actions and must be aware of their legal obligations. To provide safe healthcare services, it is essential to know of professional, ethical, and criminal laws related to nursing practice. The nursing profession is accountable for the quality of services delivered to patients from both professional and legal perspectives. Therefore, it is a valuable finding that nurse managers should support new graduates to better deal with ethical dilemmas. Strengthening ethical education in nursing schools necessitates integrating real cases and ethical dilemmas into the curriculum. Especially, Nursing laws are missing from Iran’s undergraduate nursing curriculum. By incorporating authentic case studies drawn from clinical practice, nursing schools provide students with opportunities to engage in critical reflection, ethical analysis, and moral deliberation. These real cases challenge students to apply ethical principles to complex and ambiguous situations, fostering the development of ethical competence and moral sensitivity. Furthermore, ethical reflection and debriefing sessions during clinical experiences enable students to discuss and process ethical challenges encountered in practice, promoting self-awareness, empathy, and professional growth. Overall, by combining theoretical instruction with practical application and the use of real cases, nursing schools can effectively prepare future nurses to navigate ethical dilemmas with integrity and compassion.

However, the theme of evidence-based nursing care was the lowest scoring, indicating that students need help with this theme. The findings from studies conducted in this field are varied. A limited number of studies reported that nursing students were competent to implement evidence-based care [ 61 ], while other researchers reported that nursing students’ attitudes toward evidence-based care to guide clinical decisions were largely negative [ 20 , 62 ]. The principal barriers to implementing evidence-based care are lack of authority to change patient care policy, slow dissemination of evidence and lack of time at the bedside to implement evidence [ 10 ], and lack of knowledge and awareness of the process of searching databases and evaluating research [ 63 ]. While the European Higher Education Area (EHEA) framework and the International Council of Nurses Code of Ethics introduce the ability to identify, critically appraise, and apply scientific information as expected learning outcomes for nursing students [ 64 , 65 ], the variation in findings highlights the complexity of the concept of competence and its assessment [ 23 ]. Evidence-Based Nursing (EBN) education for nursing students is most beneficial when it incorporates a multifaceted approach. Interactive workshops play a crucial role, providing students with opportunities to critically appraise research articles, identify evidence-based practices, and apply them to clinical scenarios. Simulation-based learning further enhances students’ skills by offering realistic clinical experiences in a safe environment. Additionally, clinical rotations offer invaluable opportunities for students to observe and participate in evidence-based practices under the guidance of experienced preceptors. Journal clubs foster a culture of critical thinking and ongoing learning, where students regularly review and discuss current research articles. Access to online resources such as databases and evidence-based practice guidelines allows students to stay updated on the latest evidence and best practices. To bridge the gap between clinical practice and academic theory, collaboration between nursing schools and healthcare institutions is essential. This collaboration can involve partnerships to create clinical learning environments that prioritize evidence-based practice, inter professional education activities to promote collaboration across disciplines, training and support for clinical preceptors, and continuing education opportunities for practicing nurses to strengthen their understanding and application of EBN [ 66 ]. By implementing these strategies, nursing education programs can effectively prepare students to become competent practitioners who integrate evidence-based principles into their clinical practice, ultimately improving patient outcomes.

The study’s findings regarding the second objective showed that nursing faculty members expected students to achieve the highest level of competence in work readiness and professional development, and the lowest in evidence-based nursing care competence. The results of the studies in this area revealed that there is a lack of clarity about the level of competence of newly graduated nursing students and that confusion about the competencies expected of them has become a major challenge [ 13 , 67 ]. Evidence of nurse managers’ perceptions of newly graduated nursing student’s competence is limited and rather fragmented. There is a clear need for rigorous empirical studies with comprehensive views of managers, highlighting the key role of managers in the evaluation of nurse competence [ 1 , 9 ]. Some findings also reported that nursing students lacked competence in primary and specialized care after entering a real clinical setting [ 68 ] and that nursing managers were dissatisfied with the competence of students [ 30 ].

The results of the present study on the third objective confirmed the gap between expected and achieved competence requirements. The highest average difference was related to evidence-based nursing care, and the lowest mean difference was related to the professional nursing process. The findings from studies in this field vary. For instance, Brown and Crookes [ 13 ] reported that newly graduated nursing students were not independent in at least 26 out of 30 competency domains. Similar studies have also indicated that nursing students need a structured program after graduation to be ready to enter clinical work [ 30 ]. It can be stated that the nursing profession does not have clear expectations of the competencies of newly graduated nursing students, and preparing them for entry into clinical practice is a major challenge for administrators [ 13 ]. These findings can be explained by the Duchscher transition shock [ 69 ]. It is necessary to support newly graduated nursing students to develop their competence and increase their self-confidence.

The interesting but worrying finding was the low expectations of faculty members and the low scores of students in the theme of evidence-based care. However, nursing students need to keep their competencies up to date to provide safe and high-quality care. The WHO also considers the core competencies of nurse educators to be the preparation of effective, efficient, and skilled nurses who can teach the evidence-based learning process and help students apply it clinically [ 44 ]. The teaching of evidence-based nursing care appears to vary across universities, and some clinical Faculties do not have sufficient knowledge to support students. In general, it can be stated that the results of the present study are in line with the context of Iran. Some of the problems identified include a lack of attention to students’ academic talent, a lack of a competency-based curriculum, a gap between theory and clinical practice, and challenges in teaching and evaluating the achieved competencies [ 42 ].

Strengths and limitations

The study was conducted on a national level with a sizable sample. It is one of the first studies in Iran to address the gap between students’ self-perceived competence levels and nursing faculty members’ expected competency levels. Nevertheless, one of the limitations of the study is the self-report nature of the questionnaire, which may lead to social desirability bias. In addition, the COVID-19 pandemic coinciding with the student’s first and second years could potentially impact their educational quality and competencies. The limitations established during the outbreak negatively affected the nursing education of students worldwide.

Acquiring nursing competencies is the final product of nursing education. The current study’s findings suggest the existence of an academic-practice gap, highlighting the need for educators, faculty members, and nursing managers to collaborate in bridging the potential gap between theory and practice. While nursing students were able to meet some expectations, such as value and ethical codes, there is still a distance between expectations and reality. Especially, evidence-based care was identified as one of the weaknesses of nursing students. It is recommended that future research investigates the best teaching strategies and more objective assessments of competencies. The findings of this study can be used as a guide for the revision of undergraduate nursing education curricula, as well as a guide for curriculum development based on the development of competencies expected of nursing students. Nursing managers can identify existing gaps and plan to fill them and use them for the professionalization of students. This requires the design of educational content and objective assessment tools to address these competencies at different levels throughout the academic semester. This significant issue necessitates enhanced cooperation between healthcare institutions and nursing schools. Enhancing nursing education requires the implementation of concrete pedagogical strategies to bridge the gap between theoretical knowledge and practical skills. Simulation-based learning emerges as a pivotal approach, offering students immersive experiences in realistic clinical scenarios using high-fidelity simulators [ 70 ]. Interprofessional education (IPE) is also instrumental, in fostering collaboration among healthcare professionals and promoting holistic patient care. Strengthening clinical preceptorship programs is essential, with a focus on providing preceptors with formal training and ongoing support to facilitate students’ clinical experiences and transition to professional practice [ 71 ]. Integrating evidence-based practice (EBP) principles throughout the curriculum cultivates critical thinking and inquiry skills among students, while technology-enhanced learning platforms offer innovative ways to engage students and support self-directed learning [ 72 ]. Diverse and comprehensive clinical experiences across various healthcare settings ensure students are prepared for the complexities of modern healthcare delivery. By implementing these practical suggestions, nursing education programs can effectively prepare students to become competent and compassionate healthcare professionals.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors extend their gratitude to all the nursing students and faculties who took part in this study.

This article is part of research approved with the financial support of the deputy of research and technology of Tabriz University of Medical Sciences.

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Contributions

M P: conceptualized the study, data collection, analysis and interpretation, drafting of manuscript; V Z: conceptualized the study, analysis and interpretation, drafting of manuscript; LV: conceptualized the study, data collection and analysis, manuscript revision; A Gh: conceptualized the study, data collection, analysis, and drafting of manuscript; S M: conceptualized the study, analysis, and drafting of manuscript; M Gh: data collection, analysis, and interpretation, drafting of manuscript; All authors read and approved the final manuscript.

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Purabdollah, M., Zamanzadeh, V., Ghahramanian, A. et al. Competency gap among graduating nursing students: what they have achieved and what is expected of them. BMC Med Educ 24 , 546 (2024). https://doi.org/10.1186/s12909-024-05532-w

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Received : 23 November 2023

Accepted : 07 May 2024

Published : 16 May 2024

DOI : https://doi.org/10.1186/s12909-024-05532-w

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