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

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

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

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

There are five key steps to writing a literature review:

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

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

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Table of contents

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

• Quick Run-through
• Step 1 & 2

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

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

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

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

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

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

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

Download Word doc Download Google doc

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

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

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

Make a list of keywords

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

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

Search for relevant sources

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

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

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

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

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

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

For each publication, ask yourself:

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

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

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

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

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

Take notes and cite your sources

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

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

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

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

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

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

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

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

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

Chronological

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

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

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

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

Methodological

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

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

Theoretical

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

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

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

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

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

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

As you write, make sure to follow these tips:

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

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

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

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

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

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

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

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

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

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Research Methods

• Getting Started
• Literature Review Research
• Research Design
• Research Design By Discipline
• SAGE Research Methods
• Teaching with SAGE Research Methods

Literature Review

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

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

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

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

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

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

A literature review is important because it:

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

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

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

Not an essay 

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

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

A literature review serves several purposes. For example, it

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

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

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

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

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

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

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

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

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

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

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

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

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

Systematic review or meta-analysis?

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

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

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

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

Not all systematic reviews contain meta-analysis. 

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

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

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

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

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• Last Updated: Aug 21, 2023 4:07 PM
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Systematic Reviews

• Types of Literature Reviews

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

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

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

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

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

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

The Differences in the Review Types

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

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

Literature Reviews

Literature Review: it is a product and a process.

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

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

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

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

Scoping Reviews

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

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

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

• Scoping review timeframe and limitations (Touro College of Pharmacy

Systematic Reviews

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

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

• Better evidence for a better world Browsable collection of systematic reviews
• Systematic Reviews in the Health Sciences by Molly Maloney Last Updated May 7, 2024 573 views this year
• Next: Framework, Protocol, and Writing Steps >>

Types of Literature Review

There are many types of literature review. The choice of a specific type depends on your research approach and design. The following types of literature review are the most popular in business studies:

Narrative literature review , also referred to as traditional literature review, critiques literature and summarizes the body of a literature. Narrative review also draws conclusions about the topic and identifies gaps or inconsistencies in a body of knowledge. You need to have a sufficiently focused research question to conduct a narrative literature review

Systematic literature review requires more rigorous and well-defined approach compared to most other types of literature review. Systematic literature review is comprehensive and details the timeframe within which the literature was selected. Systematic literature review can be divided into two categories: meta-analysis and meta-synthesis.

When you conduct meta-analysis you take findings from several studies on the same subject and analyze these using standardized statistical procedures. In meta-analysis patterns and relationships are detected and conclusions are drawn. Meta-analysis is associated with deductive research approach.

Meta-synthesis, on the other hand, is based on non-statistical techniques. This technique integrates, evaluates and interprets findings of multiple qualitative research studies. Meta-synthesis literature review is conducted usually when following inductive research approach.

Scoping literature review , as implied by its name is used to identify the scope or coverage of a body of literature on a given topic. It has been noted that “scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed and valuably addressed by a more precise systematic review.” [1] The main difference between systematic and scoping types of literature review is that, systematic literature review is conducted to find answer to more specific research questions, whereas scoping literature review is conducted to explore more general research question.

Argumentative literature review , as the name implies, examines literature selectively in order to support or refute an argument, deeply imbedded assumption, or philosophical problem already established in the literature. It should be noted that a potential for bias is a major shortcoming associated with argumentative literature review.

Integrative literature review reviews , critiques, and synthesizes secondary data about research topic in an integrated way such that new frameworks and perspectives on the topic are generated. If your research does not involve primary data collection and data analysis, then using integrative literature review will be your only option.

Theoretical literature review focuses on a pool of theory that has accumulated in regard to an issue, concept, theory, phenomena. Theoretical literature reviews play an instrumental role in establishing what theories already exist, the relationships between them, to what degree existing theories have been investigated, and to develop new hypotheses to be tested.

At the earlier parts of the literature review chapter, you need to specify the type of your literature review your chose and justify your choice. Your choice of a specific type of literature review should be based upon your research area, research problem and research methods.  Also, you can briefly discuss other most popular types of literature review mentioned above, to illustrate your awareness of them.

[1] Munn, A. et. al. (2018) “Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach” BMC Medical Research Methodology

  John Dudovskiy

• Open access
• Published: 08 October 2021

Scoping reviews: reinforcing and advancing the methodology and application

• Micah D. J. Peters 1 , 2 , 3 ,
• Casey Marnie 1 ,
• Heather Colquhoun 4 , 5 ,
• Chantelle M. Garritty 6 ,
• Susanne Hempel 7 ,
• Tanya Horsley 8 ,
• Etienne V. Langlois 9 ,
• Erin Lillie 10 ,
• Kelly K. O’Brien 5 , 11 , 12 ,
• Ӧzge Tunçalp 13 ,
• Michael G. Wilson 14 , 15 , 16 ,
• Wasifa Zarin 17 &
• Andrea C. Tricco   ORCID: orcid.org/0000-0002-4114-8971 17 , 18 , 19  

Systematic Reviews volume  10 , Article number:  263 ( 2021 ) Cite this article

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Scoping reviews are an increasingly common approach to evidence synthesis with a growing suite of methodological guidance and resources to assist review authors with their planning, conduct and reporting. The latest guidance for scoping reviews includes the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews. This paper provides readers with a brief update regarding ongoing work to enhance and improve the conduct and reporting of scoping reviews as well as information regarding the future steps in scoping review methods development. The purpose of this paper is to provide readers with a concise source of information regarding the difference between scoping reviews and other review types, the reasons for undertaking scoping reviews, and an update on methodological guidance for the conduct and reporting of scoping reviews.

Despite available guidance, some publications use the term ‘scoping review’ without clear consideration of available reporting and methodological tools. Selection of the most appropriate review type for the stated research objectives or questions, standardised use of methodological approaches and terminology in scoping reviews, clarity and consistency of reporting and ensuring that the reporting and presentation of the results clearly addresses the review’s objective(s) and question(s) are critical components for improving the rigour of scoping reviews.

Rigourous, high-quality scoping reviews should clearly follow up to date methodological guidance and reporting criteria. Stakeholder engagement is one area where further work could occur to enhance integration of consultation with the results of evidence syntheses and to support effective knowledge translation. Scoping review methodology is evolving as a policy and decision-making tool. Ensuring the integrity of scoping reviews by adherence to up-to-date reporting standards is integral to supporting well-informed decision-making.

Peer Review reports

Introduction

Given the readily increasing access to evidence and data, methods of identifying, charting and reporting on information must be driven by new, user-friendly approaches. Since 2005, when the first framework for scoping reviews was published, several more detailed approaches (both methodological guidance and a reporting guideline) have been developed. Scoping reviews are an increasingly common approach to evidence synthesis which is very popular amongst end users [ 1 ]. Indeed, one scoping review of scoping reviews found that 53% (262/494) of scoping reviews had government authorities and policymakers as their target end-user audience [ 2 ]. Scoping reviews can provide end users with important insights into the characteristics of a body of evidence, the ways, concepts or terms have been used, and how a topic has been reported upon. Scoping reviews can provide overviews of either broad or specific research and policy fields, underpin research and policy agendas, highlight knowledge gaps and identify areas for subsequent evidence syntheses [ 3 ].

Despite or even potentially because of the range of different approaches to conducting and reporting scoping reviews that have emerged since Arksey and O’Malley’s first framework in 2005, it appears that lack of consistency in use of terminology, conduct and reporting persist [ 2 , 4 ]. There are many examples where manuscripts are titled ‘a scoping review’ without citing or appearing to follow any particular approach [ 5 , 6 , 7 , 8 , 9 ]. This is similar to how many reviews appear to misleadingly include ‘systematic’ in the title or purport to have adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement without doing so. Despite the publication of the PRISMA Extension for Scoping Reviews (PRISMA-ScR) and other recent guidance [ 4 , 10 , 11 , 12 , 13 , 14 ], many scoping reviews continue to be conducted and published without apparent (i.e. cited) consideration of these tools or only cursory reference to Arksey and O’Malley’s original framework. We can only speculate at this stage why many authors appear to be either unaware of or unwilling to adopt more recent methodological guidance and reporting items in their work. It could be that some authors are more familiar and comfortable with the older, less prescriptive framework and see no reason to change. It could be that more recent methodologies such as JBI’s guidance and the PRISMA-ScR appear more complicated and onerous to comply with and so may possibly be unfit for purpose from the perspective of some authors. In their 2005 publication, Arksey and O’Malley themselves called for scoping review (then scoping study) methodology to continue to be advanced and built upon by subsequent authors, so it is interesting to note a persistent resistance or lack of awareness from some authors. Whatever the reason or reasons, we contend that transparency and reproducibility are key markers of high-quality reporting of scoping reviews and that reporting a review’s conduct and results clearly and consistently in line with a recognised methodology or checklist is more likely than not to enhance rigour and utility. Scoping reviews should not be used as a synonym for an exploratory search or general review of the literature. Instead, it is critical that potential authors recognise the purpose and methodology of scoping reviews. In this editorial, we discuss the definition of scoping reviews, introduce contemporary methodological guidance and address the circumstances where scoping reviews may be conducted. Finally, we briefly consider where ongoing advances in the methodology are occurring.

What is a scoping review and how is it different from other evidence syntheses?

A scoping review is a type of evidence synthesis that has the objective of identifying and mapping relevant evidence that meets pre-determined inclusion criteria regarding the topic, field, context, concept or issue under review. The review question guiding a scoping review is typically broader than that of a traditional systematic review. Scoping reviews may include multiple types of evidence (i.e. different research methodologies, primary research, reviews, non-empirical evidence). Because scoping reviews seek to develop a comprehensive overview of the evidence rather than a quantitative or qualitative synthesis of data, it is not usually necessary to undertake methodological appraisal/risk of bias assessment of the sources included in a scoping review. Scoping reviews systematically identify and chart relevant literature that meet predetermined inclusion criteria available on a given topic to address specified objective(s) and review question(s) in relation to key concepts, theories, data and evidence gaps. Scoping reviews are unlike ‘evidence maps’ which can be defined as the figural or graphical presentation of the results of a broad and systematic search to identify gaps in knowledge and/or future research needs often using a searchable database [ 15 ]. Evidence maps can be underpinned by a scoping review or be used to present the results of a scoping review. Scoping reviews are similar to but distinct from other well-known forms of evidence synthesis of which there are many [ 16 ]. Whilst this paper’s purpose is not to go into depth regarding the similarities and differences between scoping reviews and the diverse range of other evidence synthesis approaches, Munn and colleagues recently discussed the key differences between scoping reviews and other common review types [ 3 ]. Like integrative reviews and narrative literature reviews, scoping reviews can include both research (i.e. empirical) and non-research evidence (grey literature) such as policy documents and online media [ 17 , 18 ]. Scoping reviews also address broader questions beyond the effectiveness of a given intervention typical of ‘traditional’ (i.e. Cochrane) systematic reviews or peoples’ experience of a particular phenomenon of interest (i.e. JBI systematic review of qualitative evidence). Scoping reviews typically identify, present and describe relevant characteristics of included sources of evidence rather than seeking to combine statistical or qualitative data from different sources to develop synthesised results.

Similar to systematic reviews, the conduct of scoping reviews should be based on well-defined methodological guidance and reporting standards that include an a priori protocol, eligibility criteria and comprehensive search strategy [ 11 , 12 ]. Unlike systematic reviews, however, scoping reviews may be iterative and flexible and whilst any deviations from the protocol should be transparently reported, adjustments to the questions, inclusion/exclusion criteria and search may be made during the conduct of the review [ 4 , 14 ]. Unlike systematic reviews where implications or recommendations for practice are a key feature, scoping reviews are not designed to underpin clinical practice decisions; hence, assessment of methodological quality or risk of bias of included studies (which is critical when reporting effect size estimates) is not a mandatory step and often does not occur [ 10 , 12 ]. Rapid reviews are another popular review type, but as yet have no consistent, best practice methodology [ 19 ]. Rapid reviews can be understood to be streamlined forms of other review types (i.e. systematic, integrative and scoping reviews) [ 20 ].

Guidance to improve the quality of reporting of scoping reviews

Since the first 2005 framework for scoping reviews (then termed ‘scoping studies’) [ 13 ], the popularity of this approach has grown, with numbers doubling between 2014 and 2017 [ 2 ]. The PRISMA-ScR is the most up-to-date and advanced approach for reporting scoping reviews which is largely based on the popular PRISMA statement and checklist, the JBI methodological guidance and other approaches for undertaking scoping reviews [ 11 ]. Experts in evidence synthesis including authors of earlier guidance for scoping reviews developed the PRISMA-ScR checklist and explanation using a robust and comprehensive approach. Enhancing transparency and uniformity of reporting scoping reviews using the PRISMA-ScR can help to improve the quality and value of a scoping review to readers and end users [ 21 ]. The PRISMA-ScR is not a methodological guideline for review conduct, but rather a complementary checklist to support comprehensive reporting of methods and findings that can be used alongside other methodological guidance [ 10 , 12 , 13 , 14 ]. For this reason, authors who are more familiar with or prefer Arksey and O’Malley’s framework; Levac, Colquhoun and O’Brien’s extension of that framework or JBI’s methodological guidance could each select their preferred methodological approach and report in accordance with the PRISMA-ScR checklist.

Reasons for conducting a scoping review

Whilst systematic reviews sit at the top of the evidence hierarchy, the types of research questions they address are not suitable for every application [ 3 ]. Many indications more appropriately require a scoping review. For example, to explore the extent and nature of a body of literature, the development of evidence maps and summaries; to inform future research and reviews and to identify evidence gaps [ 2 ]. Scoping reviews are particularly useful where evidence is extensive and widely dispersed (i.e. many different types of evidence), or emerging and not yet amenable to questions of effectiveness [ 22 ]. Because scoping reviews are agnostic in terms of the types of evidence they can draw upon, they can be used to bring together and report upon heterogeneous literature—including both empirical and non-empirical evidence—across disciplines within and beyond health [ 23 , 24 , 25 ].

When deciding between whether to conduct a systematic review or a scoping review, authors should have a strong understanding of their differences and be able to clearly identify their review’s precise research objective(s) and/or question(s). Munn and colleagues noted that a systematic review is likely the most suitable approach if reviewers intend to address questions regarding the feasibility, appropriateness, meaningfulness or effectiveness of a specified intervention [ 3 ]. There are also online resources for prospective authors [ 26 ]. A scoping review is probably best when research objectives or review questions involve exploring, identifying, mapping, reporting or discussing characteristics or concepts across a breadth of evidence sources.

Scoping reviews are increasingly used to respond to complex questions where comparing interventions may be neither relevant nor possible [ 27 ]. Often, cost, time, and resources are factors in decisions regarding review type. Whilst many scoping reviews can be quite large with numerous sources to screen and/or include, there is no expectation or possibility of statistical pooling, formal risk of bias rating, and quality of evidence assessment [ 28 , 29 ]. Topics where scoping reviews are necessary abound—for example, government organisations are often interested in the availability and applicability of tools to support health interventions, such as shared decision aids for pregnancy care [ 30 ]. Scoping reviews can also be applied to better understand complex issues related to the health workforce, such as how shift work impacts employee performance across diverse occupational sectors, which involves a diversity of evidence types as well as attention to knowledge gaps [ 31 ]. Another example is where more conceptual knowledge is required, for example, identifying and mapping existing tools [ 32 ]. Here, it is important to understand that scoping reviews are not the same as ‘realist reviews’ which can also be used to examine how interventions or programmes work. Realist reviews are typically designed to ellucide the theories that underpin a programme, examine evidence to reveal if and how those theories are relevant and explain how the given programme works (or not) [ 33 ].

Increased demand for scoping reviews to underpin high-quality knowledge translation across many disciplines within and beyond healthcare in turn fuels the need for consistency, clarity and rigour in reporting; hence, following recognised reporting guidelines is a streamlined and effective way of introducing these elements [ 34 ]. Standardisation and clarity of reporting (such as by using a published methodology and a reporting checklist—the PRISMA-ScR) can facilitate better understanding and uptake of the results of scoping reviews by end users who are able to more clearly understand the differences between systematic reviews, scoping reviews and literature reviews and how their findings can be applied to research, practice and policy.

Future directions in scoping reviews

The field of evidence synthesis is dynamic. Scoping review methodology continues to evolve to account for the changing needs and priorities of end users and the requirements of review authors for additional guidance regarding terminology, elements and steps of scoping reviews. Areas where ongoing research and development of scoping review guidance are occurring include inclusion of consultation with stakeholder groups such as end users and consumer representatives [ 35 ], clarity on when scoping reviews are the appropriate method over other synthesis approaches [ 3 ], approaches for mapping and presenting results in ways that clearly address the review’s research objective(s) and question(s) [ 29 ] and the assessment of the methodological quality of scoping reviews themselves [ 21 , 36 ]. The JBI Scoping Review Methodology group is currently working on this research agenda.

Consulting with end users, experts, or stakeholders has been a suggested but optional component of scoping reviews since 2005. Many of the subsequent approaches contained some reference to this useful activity. Stakeholder engagement is however often lost to the term ‘review’ in scoping reviews. Stakeholder engagement is important across all knowledge synthesis approaches to ensure relevance, contextualisation and uptake of research findings. In fact, it underlines the concept of integrated knowledge translation [ 37 , 38 ]. By including stakeholder consultation in the scoping review process, the utility and uptake of results may be enhanced making reviews more meaningful to end users. Stakeholder consultation can also support integrating knowledge translation efforts, facilitate identifying emerging priorities in the field not otherwise captured in the literature and may help build partnerships amongst stakeholder groups including consumers, researchers, funders and end users. Development in the field of evidence synthesis overall could be inspired by the incorporation of stakeholder consultation in scoping reviews and lead to better integration of consultation and engagement within projects utilising other synthesis methodologies. This highlights how further work could be conducted into establishing how and the extent to which scoping reviews have contributed to synthesising evidence and advancing scientific knowledge and understandings in a more general sense.

Currently, many methodological papers for scoping reviews are published in healthcare focussed journals and associated disciplines [ 6 , 39 , 40 , 41 , 42 , 43 ]. Another area where further work could also occur is to gain greater understanding on how scoping reviews and scoping review methodology is being used across disciplines beyond healthcare including how authors, reviewers and editors understand, recommend or utilise existing guidance for undertaking and reporting scoping reviews.

Whilst available guidance for the conduct and reporting of scoping review has evolved over recent years, opportunities remain to further enhance and progress the methodology, uptake and application. Despite existing guidance, some publications using the term ‘scoping review’ continue to be conducted without apparent consideration of available reporting and methodological tools. Because consistent and transparent reporting is widely recongised as important for supporting rigour, reproducibility and quality in research, we advocate for authors to use a stated scoping review methodology and to transparently report their conduct by using the PRISMA-ScR. Selection of the most appropriate review type for the stated research objectives or questions, standardising the use of methodological approaches and terminology in scoping reviews, clarity and consistency of reporting and ensuring that the reporting and presentation of the results clearly addresses the authors’ objective(s) and question(s) are also critical components for improving the rigour of scoping reviews. We contend that whilst the field of evidence synthesis and scoping reviews continues to evolve, use of the PRISMA-ScR is a valuable and practical tool for enhancing the quality of scoping reviews, particularly in combination with other methodological guidance [ 10 , 12 , 44 ]. Scoping review methodology is developing as a policy and decision-making tool, and so ensuring the integrity of these reviews by adhering to the most up-to-date reporting standards is integral to supporting well informed decision-making. As scoping review methodology continues to evolve alongside understandings regarding why authors do or do not use particular methodologies, we hope that future incarnations of scoping review methodology continues to provide useful, high-quality evidence to end users.

Availability of data and materials

All data and materials are available upon request.

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Acknowledgements

The authors would like to acknowledge the other members of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) working group as well as Shazia Siddiqui, a research assistant in the Knowledge Synthesis Team in the Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto.

The authors declare that no specific funding was received for this work. Author ACT declares that she is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. KKO is supported by a Canada Research Chair in Episodic Disability and Rehabilitation with the Canada Research Chairs Program.

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MDJP, CM, HC, CMG, SH, TH, EVL, EL, KKO, OT, MGW, WZ and AT all made substantial contributions to the conception, design and drafting of the work. MDJP and CM prepared the final version of the manuscript. All authors reviewed and approved the final version of the manuscript.

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Peters, M.D.J., Marnie, C., Colquhoun, H. et al. Scoping reviews: reinforcing and advancing the methodology and application. Syst Rev 10 , 263 (2021). https://doi.org/10.1186/s13643-021-01821-3

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Systematic Reviews

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Literature Review: Types of literature reviews

• Traditional or narrative literature reviews
• Scoping Reviews
• Systematic literature reviews
• Annotated bibliography
• Keeping up to date with literature
• Finding a thesis
• Evaluating sources and critical appraisal of literature
• Managing and analysing your literature
• Further reading and resources

Types of literature reviews

The type of literature review you write will depend on your discipline and whether you are a researcher writing your PhD, publishing a study in a journal or completing an assessment task in your undergraduate study.

A literature review for a subject in an undergraduate degree will not be as comprehensive as the literature review required for a PhD thesis.

An undergraduate literature review may be in the form of an annotated bibliography or a narrative review of a small selection of literature, for example ten relevant articles. If you are asked to write a literature review, and you are an undergraduate student, be guided by your subject coordinator or lecturer.

The common types of literature reviews will be explained in the pages of this section.

• Narrative or traditional literature reviews
• Critically Appraised Topic (CAT)
• Scoping reviews
• Annotated bibliographies

These are not the only types of reviews of literature that can be conducted. Often the term "review" and "literature" can be confusing and used in the wrong context. Grant and Booth (2009) attempt to clear up this confusion by discussing 14 review types and the associated methodology, and advantages and disadvantages associated with each review.

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

What's the difference between reviews?

Researchers, academics, and librarians all use various terms to describe different types of literature reviews, and there is often inconsistency in the ways the types are discussed. Here are a couple of simple explanations.

• The image below describes common review types in terms of speed, detail, risk of bias, and comprehensiveness:

"Schematic of the main differences between the types of literature review" by Brennan, M. L., Arlt, S. P., Belshaw, Z., Buckley, L., Corah, L., Doit, H., Fajt, V. R., Grindlay, D., Moberly, H. K., Morrow, L. D., Stavisky, J., & White, C. (2020). Critically Appraised Topics (CATs) in veterinary medicine: Applying evidence in clinical practice. Frontiers in Veterinary Science, 7 , 314. https://doi.org/10.3389/fvets.2020.00314 is licensed under CC BY 3.0

• The table below lists four of the most common types of review , as adapted from a widely used typology of fourteen types of reviews (Grant & Booth, 2009).  

Grant, M.J. & Booth, A. (2009).  A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26 (2), 91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x

See also the Library's  Literature Review guide.

Critical Appraised Topic (CAT)

For information on conducting a Critically Appraised Topic or CAT

Callander, J., Anstey, A. V., Ingram, J. R., Limpens, J., Flohr, C., & Spuls, P. I. (2017).  How to write a Critically Appraised Topic: evidence to underpin routine clinical practice.  British Journal of Dermatology (1951), 177(4), 1007-1013. https://doi.org/10.1111/bjd.15873 

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How do I Write a Literature Review?: #5 Writing the Review

• Step #1: Choosing a Topic
• Step #2: Finding Information
• Step #3: Evaluating Content
• Step #4: Synthesizing Content
• #5 Writing the Review
• Citing Your Sources

WRITING THE REVIEW 

You've done the research and now you're ready to put your findings down on paper. When preparing to write your review, first consider how will you organize your review.

The actual review generally has 5 components:

Abstract  -  An abstract is a summary of your literature review. It is made up of the following parts:

• A contextual sentence about your motivation behind your research topic
• Your thesis statement
• A descriptive statement about the types of literature used in the review
• Summarize your findings
• Conclusion(s) based upon your findings

Introduction :   Like a typical research paper introduction, provide the reader with a quick idea of the topic of the literature review:

• Define or identify the general topic, issue, or area of concern. This provides the reader with context for reviewing the literature.
• Identify related trends in what has already been published about the topic; or conflicts in theory, methodology, evidence, and conclusions; or gaps in research and scholarship; or a single problem or new perspective of immediate interest.
• Establish your reason (point of view) for reviewing the literature; explain the criteria to be used in analyzing and comparing literature and the organization of the review (sequence); and, when necessary, state why certain literature is or is not included (scope)  - 

Body :  The body of a literature review contains your discussion of sources and can be organized in 3 ways-

• Chronological -  by publication or by trend
• Thematic -  organized around a topic or issue, rather than the progression of time
• Methodical -  the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the "methods" of the literature's researcher or writer that you are reviewing

You may also want to include a section on "questions for further research" and discuss what questions the review has sparked about the topic/field or offer suggestions for future studies/examinations that build on your current findings.

Conclusion :  In the conclusion, you should:

Conclude your paper by providing your reader with some perspective on the relationship between your literature review's specific topic and how it's related to it's parent discipline, scientific endeavor, or profession.

Bibliography :   Since a literature review is composed of pieces of research, it is very important that your correctly cite the literature you are reviewing, both in the reviews body as well as in a bibliography/works cited. To learn more about different citation styles, visit the " Citing Your Sources " tab.

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Literature Review vs Systematic Review

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Definitions

It’s common to confuse systematic and literature reviews because both are used to provide a summary of the existent literature or research on a specific topic. Regardless of this commonality, both types of review vary significantly. The following table provides a detailed explanation as well as the differences between systematic and literature reviews. 

Kysh, Lynn (2013): Difference between a systematic review and a literature review. [figshare]. Available at:  http://dx.doi.org/10.6084/m9.figshare.766364

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Rapid literature review: definition and methodology

Beata smela.

a Assignity, Cracow, Poland

Mondher Toumi

b Public Health Department, Aix-Marseille University, Marseille, France

Karolina Świerk

Clement francois, małgorzata biernikiewicz.

c Studio Slowa, Wroclaw, Poland

Emilie Clay

d Clever-Access, Paris, France

Laurent Boyer

Introduction: A rapid literature review (RLR) is an alternative to systematic literature review (SLR) that can speed up the analysis of newly published data. The objective was to identify and summarize available information regarding different approaches to defining RLR and the methodology applied to the conduct of such reviews.

Methods: The Medline and EMBASE databases, as well as the grey literature, were searched using the set of keywords and their combination related to the targeted and rapid review, as well as design, approach, and methodology. Of the 3,898 records retrieved, 12 articles were included.

Results: Specific definition of RLRs has only been developed in 2021. In terms of methodology, the RLR should be completed within shorter timeframes using simplified procedures in comparison to SLRs, while maintaining a similar level of transparency and minimizing bias. Inherent components of the RLR process should be a clear research question, search protocol, simplified process of study selection, data extraction, and quality assurance.

Conclusions: There is a lack of consensus on the formal definition of the RLR and the best approaches to perform it. The evidence-based supporting methods are evolving, and more work is needed to define the most robust approaches.

Introduction

A systematic literature review (SLR) summarizes the results of all available studies on a specific topic and provides a high level of evidence. Authors of the SLR have to follow an advanced plan that covers defining a priori information regarding the research question, sources they are going to search, inclusion criteria applied to choose studies answering the research question, and information regarding how they are going to summarize findings [ 1 ].

The rigor and transparency of SLRs make them the most reliable form of literature review [ 2 ], providing a comprehensive, objective summary of the evidence for a given topic [ 3 , 4 ]. On the other hand, the SLR process is usually very time-consuming and requires a lot of human resources. Taking into account a high increase of newly published data and a growing need to analyze information in the fastest possible way, rapid literature reviews (RLRs) often replace standard SLRs.

There are several guidelines on the methodology of RLRs [ 5–11 ]; however, only recently, one publication from 2021 attempted to construct a unified definition [ 11 ]. Generally, by RLRs, researchers understand evidence synthesis during which some of the components of the systematic approach are being used to facilitate answering a focused research question; however, scope restrictions and a narrower search strategy help to make the project manageable in a shorter time and to get the key conclusions faster [ 4 ].

The objective of this research was to collect and summarize available information on different approaches to the definition and methodology of RLRs. An RLR has been run to capture publications providing data that fit the project objective.

To find publications reporting information on the methodology of RLRs, searches were run in the Medline and EMBASE databases in November 2022. The following keywords were searched for in titles and abstracts: ‘targeted adj2 review’ OR ‘focused adj2 review’ OR ‘rapid adj2 review’, and ‘methodology’ OR ‘design’ OR ‘scheme’ OR ‘approach’. The grey literature was identified using Google Scholar with keywords including ‘targeted review methodology’ OR ‘focused review methodology’ OR ‘rapid review methodology’. Only publications in English were included, and the date of publication was restricted to year 2016 onward in order to identify the most up-to-date literature. The reference lists of each included article were searched manually to obtain the potentially eligible articles. Titles and abstracts of the retrieved records were first screened to exclude articles that were evidently irrelevant. The full texts of potentially relevant papers were further reviewed to examine their eligibility.

A pre-defined Excel grid was developed to extract the following information related to the methodology of RLR from guidelines:

• Definition,
• Research question and searches,
• Studies selection,
• Data extraction and quality assessment,
• Additional information.

There was no restriction on the study types to be analyzed; any study reporting on the methodology of RLRs could be included: reviews, practice guidelines, commentaries, and expert opinions on RLR relevant to healthcare policymakers or practitioners. The data extraction and evidence summary were conducted by one analyst and further examined by a senior analyst to ensure that relevant information was not omitted. Disagreements were resolved by discussion and consensus.

Studies selection

A total of 3,898 records (3,864 articles from a database search and 34 grey literature from Google Scholar) were retrieved. After removing duplicates, titles and abstracts of 3,813 articles were uploaded and screened. The full texts of 43 articles were analyzed resulting in 12 articles selected for this review, including 7 guidelines [ 5–11 ] on the methodology of RLRs, together with 2 papers summarizing the results of the Delphi consensus on the topic [ 12 , 13 ], and 3 publications analyzing and assessing different approaches to RLRs [ 4 , 14 , 15 ].

Overall, seven guidelines were identified: from the World Health Organization (WHO) [ 5 ], National Collaborating Centre for Methods and Tools (NCCMT) [ 7 ], the UK government [ 8 ], the Oxford Centre for Evidence Based Medicine [ 9 ], the Cochrane group [ 6 , 11 ], and one multi-national review [ 10 ]. Among the papers that did not describe the guidelines, Gordon et al. [ 4 ] proposed 12 tips for conducting a rapid review in the right settings and discussed why these reviews may be more beneficial in some circumstances. The objective of work conducted by Tricco et al. [ 13 ] and Pandor et al. [ 12 ] was to collect and compare perceptions of rapid reviews from stakeholders, including researchers, policymakers, industry, journal editors, and healthcare providers, and to reach a consensus outlining the domains to consider when deciding on approaches for RLRs. Haby et al. [ 14 ] run a rapid review of systematic reviews and primary studies to find out the best way to conduct an RLR in health policy and practice. In Tricco et al. (2022) [ 15 ], JBI position statement for RLRs is presented.

From all the seven identified guidelines information regarding definitions the authors used for RLRs, approach to the PICOS criteria and search strategy development, studies selection, data extractions, quality assessment, and reporting were extracted.

Cochrane Rapid Reviews Methods Group developed methods guidance based on scoping review of the underlying evidence, primary methods studies conducted, as well as surveys sent to Cochrane representative and discussion among those with expertise [ 11 ]. They analyzed over 300 RLRs or RLR method papers and based on the methodology of those studies, constructed a broad definition RLR, one that meets a minimum set of requirements identified in the thematic analysis: ‘ A rapid review is a form of knowledge synthesis that accelerates the process of conducting a traditional systematic review through streamlining or omitting a variety of methods to produce evidence in a resource-efficient manner .’ This interpretation aligns with more than 50% of RLRs identified in this study. The authors additionally provided several other definitions, depending on specific situations or requirements (e.g., when RLR is produced on stakeholder’s request). It was additionally underlined that RLRs should be driven by the need of timely evidence for decision-making purposes [ 11 ].

Rapid reviews vary in their objective, format, and methods used for evidence synthesis. This is a quite new area, and still no agreement on optimal methods can be found [ 5 ]. All of the definitions are highlighting that RLRs are completed within shorter timeframes than SLRs, and also lack of time is one of the main reasons they are conducted. It has been suggested that most rapid reviews are conducted within 12 weeks; however, some of the resources suggest time between a few weeks to no more than 6 months [ 5 , 6 ]. Some of the definitions are highlighting that RLRs follow the SLR process, but certain phases of the process are simplified or omitted to retrieve information in a time-saving way [ 6 , 7 ]. Different mechanisms are used to enhance the timeliness of reviews. They can be used independently or concurrently: increasing the intensity of work by intensifying the efforts of multiple analysts by parallelization of tasks, using review shortcuts whereby one or more systematic review steps may be reduced, automatizing review steps by using new technologies [ 5 ]. The UK government report [ 8 ] referred to two different RLRs: in the form of quick scoping reviews (QSR) or rapid evidence assessments (REA). While being less resource and time-consuming compared to standard SLRs, QSRs and REAs are designed to be similarly transparent and to minimize bias. QSRs can be applied to rather open-ended questions, e.g., ‘what do we know about something’ but both, QSRs and REAs, provide an understanding of the volume and characteristics of evidence on a specific topic, allowing answering questions by maximizing the use of existing data, and providing a clear picture of the adequacy of existing evidence [ 8 ].

Research questions and searches

The guidelines suggest creating a clear research question and search protocol at the beginning of the project. Additionally, to not duplicate RLRs, the Cochrane Rapid Reviews Methods Group encourages all people working on RLRs to consider registering their search protocol with PROSPERO, the international prospective register of reviews; however, so far they are not formally registered in most cases [ 5 , 6 ]. They also recommend involving key stakeholders (review users) to set and refine the review question, criteria, and outcomes, as well as consulting them through the entire process [ 11 ].

Regarding research questions, it is better to structure them in a neutral way rather than focus on a specific direction for the outcome. By doing so, the researcher is in a better position to identify all the relevant evidence [ 7 ]. Authors can add a second, supportive research question when needed [ 8 ]. It is encouraged to limit the number of interventions, comparators and outcomes, to focus on the ones that are most important for decision-making [ 11 ]. Useful could be also reviewing additional materials, e.g., SLRs on the topic, as well as conducting a quick literature search to better understand the topic before starting with RLRs [ 7 ]. In SLRs researchers usually do not need to care a lot about time spent on creating PICOS, they need to make sure that the scope is broad enough, and they cannot use many restrictions. When working on RLRs, a reviewer may spend more or less time defining each of the components of the study question, and the main step is making sure that PICOS addresses the needs of those who requested the rapid review, and at the same time, it is feasible within the required time frame [ 7 ]. Search protocol should contain an outline of how the following review steps are to be carried out, including selected search keywords and a full strategy, a list of data sources, precise inclusion and exclusion criteria, a strategy for data extraction and critical appraisal, and a plan of how the information will be synthesized [ 8 ].

In terms of searches running, in most cases, an exhaustive process will not be feasible. Researchers should make sure that the search is effective and efficient to produce results in a timely manner. Cochrane Rapid Reviews Methods Group recommends involving an information specialist and conducting peer review of at least one search strategy [ 11 ]. According to the rapid review guidebook by McMaster University [ 7 ], it is important that RLRs, especially those that support policy and program decisions, are being fed by the results of a body of literature, rather than single studies, when possible. It would result in more generalizable findings applied at the level of a population and serve more realistic findings for program decisions [ 7 ]. It is important to document the search strategy, together with a record of the date and any date limits of the search, so that it can easily be run again, modified, or updated. Furthermore, the information on the individual databases included in platform services should always be reported, as this depends on organizations’ subscriptions and must be included for transparency and repeatability [ 7 , 8 ]. Good solution for RLRs is narrowing the scope or searching a limited number of databases and other sources [ 7 ]. Often, the authors use the PubMed/MEDLINE, Cochrane Library, and Embase databases. In most reviews, two or more databases are searched, and common limits are language (usually restricted to English), date, study design, and geographical area. Some RLRs include searching of grey literature; however, contact with authors is rather uncommon [ 5 , 8 ]. According to the flexible framework for restricted systematic review published by the University of Oxford, the search should be run in at least one major scientific database such as PubMed, and one other source, e.g., Google Scholar [ 9 ]. Grey literature and unpublished evidence may be particularly needed and important for intervention questions. It is related to the fact that studies that do not report the effects of interventions are less likely to be published [ 8 ]. If there is any type of evidence that will not be considered by the RLRs, e.g., reviews or theoretical and conceptual studies, it should also be stated in the protocol together with justification [ 8 ]. Additionally, authors of a practical guide published by WHO suggest using a staged search to identify existing SLRs at the beginning, and then focusing on studies with other designs [ 5 ]. If a low number of citations have been retrieved, it is acceptable to expand searches, remove some of the limits, and add additional databases and sources [ 7 ].

Searching for RLRs is an iterative process, and revising the approach is usually needed [ 7 ]. Changes should be confirmed with stakeholders and should be tracked and reflected in the final report [ 5 ].

The next step in the rapid review is the selection of studies consisting of two phases: screening of titles and abstracts, and analysis of full texts. Prior to screening initiation, it is recommended to conduct a pilot exercise using the same 30–50 abstracts and 5–10 full-texts for the entire screening team in order to calibrate and test the review form [ 11 ]. In contrast to SLRs, it can be done by one reviewer with or without verification by a second one. If verification is performed, usually the second reviewer checks only a subset of records and compares them. Cochrane Group, in contrast, recommends a stricter approach: at least 20% of references should be double-screened at titles and abstracts stage, and while the rest of the references may be screened by one reviewer, the excluded items need to be re-examined by second reviewer; similar approach is used in full-text screening [ 11 ]. This helps to ensure that bias was reduced and that the PICOS criteria are applied in a relevant way [ 5 , 8 , 9 , 11 ]. During the analysis of titles and abstracts, there is no need to report reasons for exclusion; however, they should be tracked for all excluded full texts [ 7 ].

Data extraction and quality assessment

According to the WHO guide, the most common method for data extraction in RLRs is extraction done by a single reviewer with or without partial verification. The authors point out that a reasonable approach is to use a second reviewer to check a random sample of at least 10% of the extractions for accuracy. Dual performance is more necessary for the extraction of quantitative results than for descriptive study information. In contrast, Cochrane group recommends that second reviewer should check the correctness and completeness of all data [ 11 ]. When possible, extractions should be limited to key characteristics and outcomes of the study. The same approach to data extraction is also suggested for a quality assessment process within rapid reviews [ 5 , 9 , 11 ]. Authors of the guidebook from McMaster University highlight that data extraction should be done ideally by two reviewers independently and consensus on the discrepancies should always be reached [ 7 ]. The final decision on the approach to this important step of review should depend on the available time and should also reflect the complexity of the research question [ 9 ].

For screening, analysis of full texts, extractions, and quality assessments, researchers can use information technologies to support them by making these review steps more efficient [ 5 ].

Before data reporting, a reviewer should prepare a document with key message headings, executive summary, background related to the topic and status of the current knowledge, project question, synthesis of findings, conclusions, and recommendations. According to the McMaster University guidebook, a report should be structured in a 1:2:20 format, that is, one page for key messages, two pages for an executive summary, and a full report of up to 20 pages [ 7 ]. All the limitations of the RLRs should be analyzed, and conclusions should be drawn with caution [ 5 ]. The quality of the accumulated evidence and the strength of recommendations can be assessed using, e.g., the GRADE system [ 5 ]. When working on references quoting, researchers should remember to use a primary source, not secondary references [ 7 ]. It would be worth considering the support of some software tools to automate reporting steps. Additionally, any standardization of the process and the usage of templates can support report development and enhance the transparency of the review [ 5 ].

Ideally, all the review steps should be completed during RLRs; however, often some steps may need skipping or will not be completed as thoroughly as should because of time constraints. It is always crucial to decide which steps may be skipped, and which are the key ones, depending on the project [ 7 ]. Guidelines suggest that it may be helpful to invite researchers with experience in the operations of SLRs to participate in the rapid review development [ 5 , 9 ]. As some of the steps will be completed by one reviewer only, it is important to provide them with relevant training at the beginning of the process, as well as during the review, to minimize the risk of mistakes [ 5 ].

Additional information

Depending on the policy goal and available resources and deadlines, methodology of the RLRs may be modified. Wilson et al. [ 10 ] provided extensive guidelines for performing RLR within days (e.g., to inform urgent internal policy discussions and/or management decisions), weeks (e.g., to inform public debates), or months (e.g., to inform policy development cycles that have a longer timeline, but that cannot wait for a traditional full systematic review). These approaches vary in terms of data synthesis, types of considered evidence and project management considerations.

In shortest timeframes, focused questions and subquestions should be formulated, typically to conduct a policy analysis; the report should consist of tables along with a brief narrative summary. Evidence from SLRs is often considered, as well as key informant interviews may be conducted to identify additional literature and insights about the topic, while primary studies and other types of evidence are not typically feasible due to time restrictions. The review would be best conducted with 1–2 reviewers sharing the work, enabling rapid iterations of the review. As for RLRs with longer timeline (weeks), these may use a mix of policy, systems and political analysis. Structure of the review would be similar to shorter RLRs – tabular with short narrative summary, as the timeline does not allow for comprehensive synthesis of data. Besides SLRs, primary studies and other evidence may be feasible in this timeframe, if obtained using the targeted searches in the most relevant databases. The review team should be larger, and standardized procedures for reviewing of the results and data extraction should be applied. In contrast to previous timeframe, merit review process may be feasible. For both timeframes, brief consultations with small transdisciplinary team should be conducted at the beginning and in the final stage of the review to discuss important matters.

For RLRs spanning several months, more comprehensive methodology may be adapted in terms of data synthesis and types of evidence. However, authors advise that review may be best conducted with a small review team in order to allow for more in-depth interpretation and iteration.

Studies analyzing methodology

There have been two interesting publications summarizing the results of Delphi consensus on the RLR methodology identified and included in this review [ 12 , 13 ].

Tricco et al. [ 13 ] first conducted an international survey and scoping review to collect information on the possible approaches to the running of rapid reviews, based on which, they employed a modified Delphi method that included inputs from 113 stakeholders to explore the most optimized approach. Among the six most frequent rapid review approaches (not all detailed here) being evaluated, the approach that combines inclusion of published literature only, a search of more than one database and limitations by date and language, study selection by one analyst, data extraction, and quality assessment by one analyst and one verifier, was perceived as the most feasible approach (72%, 81/113 responses) with the potentially lowest risk of bias (12%, 12/103). The approach ranked as the first one when considering timelines assumes updating of the search from a previously published review, no additional limits on search, studies selection and data extraction done by one reviewer, and no quality assessment. Finally, based on the publication, the most comprehensive RLRs can be made by moving on with the following rules: searching more than one database and grey literature and using date restriction, and assigning one reviewer working on screening, data extraction, and risk of bias assessment ( Table 1 ). Pandor et al. [ 12 ] introduced a decision tool for SelecTing Approaches for Rapid Reviews (STARR) that were produced through the Delphi consensus of international experts through an iterative and rigorous process. Participants were asked to assess the importance of predefined items in four domains related to the rapid review process: interaction with commissioners, understanding the evidence base, data extraction and synthesis methods, and reporting of rapid review methods. All items assigned to four domains achieved > 70% of consensus, and in that way, the first consensus-driven tool has been created that supports authors of RLRs in planning and deciding on approaches.

Six most frequent approaches to RLRs (adapted from Tricco et al. [ 13 ]).

Haby et al. [ 14 ] run searches of 11 databases and two websites and developed a comprehensive overview of the methodology of RLRs. With five SLRs and one RCT being finally included, they identified the following approaches used in RLRs to make them faster than full SLRs: limiting the number and scope of questions, searching fewer databases, limited searching of grey literature, restrictions on language and date (e.g., English only, most recent publications), updating the existing SLRs, eliminating or limiting hand searches of reference lists, noniterative search strategies, eliminating consultation with experts, limiting dual study selection, data extraction and quality assessment, minimal data synthesis with short concise conclusions or recommendations. All the SLRs included in this review were consistent in stating that no agreed definition of rapid reviews is available, and there is still no final agreement on the best methodological rules to be followed.

Gordon et al. [ 4 ] explained the advantages of performing a focused review and provided 12 tips for its conduction. They define focused reviews as ‘a form of knowledge synthesis in which the components of the systematic process are applied to facilitate the analysis of a focused research question’. The first tip presented by the authors is related to deciding if a focused review is a right solution for the considered project. RLRs will suit emerging topics, approaches, or assessments where early synthesis can support doctors, policymakers, etc., but also can direct future research. The second, third, and fourth tips highlight the importance of running preliminary searches and considering narrowing the results by using reasonable constraints taking into account the local context, problems, efficiency perspectives, and available time. Further tips include creating a team of experienced reviewers working on the RLRs, thinking about the target journal from the beginning of work on the rapid review, registering the search protocol on the PROSPERO registry, and the need for contacting authors of papers when data available in publications are missing or incongruent. The last three tips are related to the choice of evidence synthesis method, using the visual presentation of data, and considering and describing all the limitations of the focused review.

Finally, a new publication by Tricco et al. from 2022, describing JBI position statement [ 15 ] underlined that for the time being, there is no specific tool for critical appraisal of the RLR’s methodological quality. Instead, reviewers may use available tools to assess the risk of bias or quality of SLRs, like ROBIS, the JBI critical appraisal tools, or the assessment of multiple systematic reviews (AMSTAR).

Inconsistency in the definitions and methodologies of RLR

Although RLR was broadly perceived as an approach to quicken the conduct of conventional SLR, there is a lack of consensus on the formal definition of the RLR, so as to the best approaches to perform it. Only in 2021, a study proposing unified definition was published; however, it is important to note that the most accurate definition was only matching slightly over 50% of papers analysed by the authors, which underlines the lack of homogeneity in the field [ 11 ]. The evidence-based supporting methods are evolving, and more evidence is needed to define the most robust approaches [ 5 ].

Diverse terms are used to describe the RLR, including ‘rapid review’, focused systematic review’, ‘quick scoping reviews’, and ‘rapid evidence assessments’. Although the general principles of conducting RLR are to accelerate the whole process, complexity was seen in the methodologies used for RLRs, as reflected in this study. Also, inconsistencies related to the scope of the questions, search strategies, inclusion criteria, study screening, full-text review, quality assessment, and evidence presentation were implied. All these factors may hamper decision-making about optimal methodologies for conducting rapid reviews, and as a result, the efficiency of RLR might be decreased. Additionally, researchers may tend to report the methodology of their reviews without a sufficient level of detail, making it difficult to appraise the quality and robustness of their work.

Advantages and weaknesses of RLR

Although RLR used simplified approaches for evidence synthesis compared with SLR, the methodologies for RLR should be replicable, rigorous, and transparent to the greatest extent [ 16 ]. When time and resources are limited, RLR could be a practical and efficient tool to provide the summary of evidence that is critical for making rapid clinical or policy-related decisions [ 5 ]. Focusing on specific questions that are of controversy or special interest could be powerful in reaffirming whether the existing recommendation statements are still appropriate [ 17 ].

The weakness of RLR should also be borne in mind, and the trade-off of using RLR should be carefully considered regarding the thoroughness of the search, breadth of a research question, and depth of analysis [ 18 ]. If allowed, SLR is preferred over RLR considering that some relevant studies might be omitted with narrowed search strategies and simplified screening process [ 14 ]. Additionally, omitting the quality assessment of included studies could result in an increased risk of bias, making the comprehensiveness of RLR compromised [ 13 ]. Furthermore, in situations that require high accuracy, for example, where a small relative difference in an intervention has great impacts, for the purpose of drafting clinical guidelines, or making licensing decisions, a comprehensive SLR may remain the priority [ 19 ]. Therefore, clear communications with policymakers are recommended to reach an agreement on whether an RLR is justified and whether the methodologies of RLR are acceptable to address the unanswered questions [ 18 ].

Disclosure statement

No potential conflict of interest was reported by the author(s).

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Review Typologies

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

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

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

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

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HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019

• Sarah Ajrouche 1 ,
• Lisa Louis 1 ,
• Maxime Esvan 2 ,
• Anthony Chapron 1 , 2 ,
• Ronan Garlantezec 3 &
• Emmanuel Allory 1 , 2 , 4  

BMC Endocrine Disorders volume  24 , Article number:  72 ( 2024 ) Cite this article

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Diabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme.

The historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 ( n  = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner’s practice ( n  = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation.

HbA1c was significantly improved in the exposed group after the programme ( p  < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation.

Conclusions

These results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation).

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Introduction

Diabetes is a chronic disease that has doubled in prevalence in the last three decades [ 1 ] and is now one of the ten first causes of death worldwide [ 2 ]. Currently, 463 million people have diabetes worldwide (4.5 million in France) and this number could rise to 700 million by 2045 [ 3 ]. Diabetes incidence has increased dramatically, particularly that of type 2 diabetes mellitus that accounts for 90% of all cases [ 4 ]. Diabetes is associated with high morbidity index and altered quality of life [ 5 , 6 , 7 ]. Its prevalence has particularly increased in low-income and disadvantaged socio-economic groups [ 8 , 9 , 10 ], and even more in developed countries [ 11 ]. Its prevalence was twice as high in people receiving universal health coverage (UHC) [ 8 ] in whom it was also associated with worse glycaemic control [ 12 ] and more complications [ 13 , 14 , 15 ]. Higher diabetes prevalence was also found in some immigrant populations. For example, in metropolitan France, the risk of diabetes is 2.5 times higher in women who came from a North African country than in non-immigrant women [ 9 ]. Therefore, the population’s contextual and cultural characteristics need to be considered when developing preventive actions, such as Diabetes Self-Management (DSM) programmes [ 16 , 17 ].

DSM education brings together the knowledge and skills that make people more aware about their health and their health choices by offering specific training, support and coaching [ 18 ]. DSM education enables people with diabetes to acquire and maintain skills to manage diabetes, resulting in quality of life improvement, increasing active role with the healthcare providers (HCP), and better adherence to treatment/follow-up and prevention of complications [ 19 , 20 ]. The objective of DSM education is to make patients more autonomous and to produce a complementary effect to the usual pharmacological interventions [ 19 ]. It is an ongoing process, adapted to the disease course and the patient's lifestyle [ 21 ]. Although their effectiveness is acknowledged, particularly for type 2 diabetes mellitus [ 22 , 23 , 24 ], participation in DSM programmes in group settings is still limited among people with diabetes [ 25 ], especially in deprived populations. This difficult access is partly explained by their living conditions and socio-cultural background that complicate access to programmes and the will to change lifestyle habits [ 26 ]. Another explanation is that the current DSM programmes were not developed by taking into account the social and cultural background of the targeted populations [ 27 ].

The accessibility issues to DSM programmes and the obstacles to DSM practice are a major research topic [ 28 , 29 ]. Furthermore, the fact that DSM education is mostly organised in hospitals [ 30 , 31 ] may constitute an additional obstacle [ 32 ]. In 2014, in France, only 3.9% of self-management programmes were run in primary care settings, compared with 82% in a hospital structure [ 18 ]. Primary care now appears to be the preferred place for promoting access to care and reducing social inequalities in health [ 27 ]. Multi-professional Primary Care Practices (MPCP) bring together medical/paramedical professionals and social services around a common health project to improve inter-professional collaboration and access to care for the population [ 33 ]. Therefore, they seem suitable places for developing prevention programmes due to their accessibility based on their geographical position, relational proximity with the habitants, better cultural knowledge by the HCP and capacity to break down social isolation [ 34 ]. MPCPs are an opportunity to integrate DSM education in primary care and they could become reference structures in this field [ 35 , 36 ].

In Rennes, the Villejean district is one of the five socio-economically deprived areas of the city. The median income is estimated at 670 euros (vs 1628 euros in the whole city), 38.3% of the population is unemployed, and 51% of < 20-year-old people receive UHC [ 37 ]. In 2015, 71 HCPs of this district decided to create the "Rennes Nord-Ouest" MPCP and developed a collective DSM programme for their patients with diabetes (supplementary files 1 and 2). In accordance with the recommendations, DSM programmes must be evaluated [ 18 ]. The value of this programme was initially demonstrated from the users’ point of view [ 34 ]. This qualitative study in 2020 also showed that in the first year of the DSM programme, participants were from nine different countries and 80% were considered as socio-economically deprived. This assessment must be continued by including quantitative biomedical parameters, as described in the international literature [ 38 ]. In Europe, several randomised controlled trials have demonstrated the benefit of group DSM for improving glycaemic control in non-deprived populations, such as the X-PERT study [ 39 ] and the DESMOND study [ 40 ]. In the United States, two randomised control trials carried out by community health workers in clinics found a significative effect of DSM programmes among socially deprived immigrant people with diabetes [ 41 , 42 ]. However, we did not find any study on similar interventions for deprived people carried out in MPCPs.

The main objective of this study in a socio-economically deprived area was to compare diabetes control in a group that participated in a DSM programme run by an MPCP and in a group that did not receive this intervention.

Study design

This was an historical exposed/non-exposed cohort study to assess the effect of a DSM intervention in primary care, carried out by a MPCP located in a socio-economically deprived area of Rennes, France.

Description of the intervention

The programme targeted ≥ 18-year-old people with diabetes to improve or develop self-care skills and change their eating habits. The DSM programme was designed and implemented by the "Rennes Nord-Ouest" MPCP, in the Villejean district, Rennes, France, in 2017. Patients were included in the programme upon suggestion by one of the MPCP HCPs involved in their care (e.g. general practitioner (GP), nurse, pharmacist, chiropodist), even if their own GP was not working at the MPCP. HCP of the MPCP recruited participants during their usual consultations. Refusal to participate was not recorded. Only interested patients had a BEPI (Bilan educatif partagé initial, patient-centred educational assessment) (supplementary file 3) with a HCP of the team before the DSM programme start to fix personal objectives that were used to prepare a personalized attendance programme to the different workshops.The programme consisted of seven to nine workshops that lasted 1–2 h and were held on weekdays between 9am and 5pm over a period of 1–2 months. The MPCP received annual funding from the local health authority (Agence régionale de santé) to cover the intervention running costs, and the training and remuneration of the involved HCPs.

Exposed and non-exposed groups

The exposed group (receiving the intervention) included ≥ 18-year-old patients with type 1 or type 2 diabetes who were followed by at least one HCP in the MPCP and who participated in the DSM programme between 2017 and 2020. All the 75 patients who participated in the programme (at least BEPI completion) were eligible. If some had participated in more than one annual session, only their first participation was considered.

The non-exposed group included all the patients selected from the SOPHIA database of the GPs whose patients were in the exposed group. SOPHIA is a free diabetes support service set up by the French public health insurance in 2008 to offer remote coaching (emails, personal online space, and telephone follow-up with a nurse) adapted to the needs of people with diabetes in order to help them live better with their disease. This service was offered to all patients at the MPCP (i.e. people in the exposed and non-exposed groups). The SOPHIA database includes ≥ 18-year-old patients with type 1 and 2 diabetes who are registered with a GP, have long duration disease (LDD) status for diabetes, are affiliated to the public health insurance, and had at least three prescriptions for anti-diabetic drugs in the year of the intervention.

Each patient in the exposed group was randomly matched to two control patients based on sex (male or female), diabetes type (type 1 or type 2), year of birth (before 1960 or after; median calculated in the exposed group) and whether their GP was a MPCP member. The intervention date was the BEPI date.

The exclusion criteria for the exposed and non-exposed groups were: GP’s or patient’s refusal to participate in the study, patients unable to read and write in French, lack of follow-up during the study period (patient arrived at the practice after the intervention date, or left before), haemoglobinopathy that does not allow HbA1c monitoring, gestational diabetes, and drug-induced diabetes.

Study endpoints

The primary outcome was glycated haemoglobin change (HbA1c in %) between 12 months before and 12 months after the intervention start date (i.e. the BEPI date).

Secondary outcomes were modifications in diabetes treatment, body mass index (BMI; in kg/m2), systolic and diastolic blood pressure (in mmHg), lipid profile (low density lipoprotein C, LDLc, in mmol/L), microalbuminuria, and screening for diabetic retinopathy between before and after the intervention.

Data collection

Data were collected by two residents in general practice in 11 practices (21 GPs who followed the participants) after the intervention, between March and December 2021. Data were extracted from computerised medical records (consultations with clinical examination, laboratory work-up results, and specialist letters) from the practice professional software. Data were collected for the years 2017 to 2020, and as close as possible to the target dates (12 months before and 12 months after the intervention) to obtain at least two distinct values, particularly in terms of kidney function, lipid levels and microalbuminuria.

To characterise the two groups, each patient’s socio-demographic data (year of birth, sex, profession, education level, and socio-professional categories) and medical history (diabetes type and duration, other associated LDD) were collected. Concerning chronic treatment, prescriptions close to the target dates were identified to determine the diabetes treatments (metformin, other oral drugs, GLP-1 analogues, or insulin). Prescriptions for statins, angiotensin converting enzyme inhibitors, or related drugs were also retained.

Lastly, mentions of ophthalmological consultations (specialist’s letters or key words) were searched in the different consultations within the study interval.

Statistical analysis

Patient characteristics were expressed as n (%) for categorical variables and mean ± standard deviation (SD) for continuous variables. For univariate comparison between (exposed and non-exposed) groups, the Student’s t or Mann–Whitney-Wilcoxon’s test was used for continuous variables and the χ2 or Fisher’s exact test for categorical variables.

Outcome changes over time were analysed using generalised linear mixed models. A sensitivity analysis was performed for the primary outcome using a model adjusted for sex, age, BMI, and education level. Multiple imputation was used to account for missing values. Fifty imputed datasets were created and combined using standard between/within-variance techniques. Statistical analyses were computed at the two-sided α level of 5% with SAS version 9.4 (SAS Institute, Cary, North Carolina, USA).

Ethical aspects and legislation

This study was approved by the Rennes University Hospital ethics committee on 14 June 2021 (Number 21.77–2, supplementary file 5). It complied with the reference methodology MR-004 defined by the French committee on personal data protection (Commission Nationale Informatique et Libertés; CNIL) and with the European General Data Protection Regulation (GDPR).

Among the 75 patients who completed a BEPI between 2017 and 2019, 24 GP’s were identified. Three GP’s refused to participate; each of them had one patient who had the BEPI. As three other patients with a BEPI refused to participate to the study, the exposed group was composed of 69 patients (Fig.  1 ). In the SOPHIA database, 488/560 patients followed by the GPs of the patients in the exposed group did not participate in the intervention. Therefore, a participation rate of 13% to the DSM programme could be estimated. Among them, 149 were selected by random 2:1 matching. After excluding 11 patients, 138 patients were included in the non-exposed group. With the 69 patients of the exposed group, 207 patients were included in the study.

Description of the study population (Table  1 )

The analysis did not find any significant difference between groups concerning socio-demographic characteristics, age at diabetes diagnosis [49 (± 12) years for the exposed group and 49 (± 13) years for the non-exposed group], and percentage of patients with diabetes discovered < 1 year before the intervention date [ n  = 13 (19.1%) for the exposed group and n  = 22 (17.3%) for the non-exposed group]. Education level and percentage of retired patients [ n  = 29 (42%) for the exposed group and n  = 43 (37.7%) for the non-exposed group] were comparable between groups. Presence of another known LDD [ n  = 29 (42%) in the exposed group and n  = 57 (41.3%) in the non-exposed group], mean number of LDDs per patient and their nature, and comorbidities (hypertension, dyslipidaemia, known diabetic nephropathy, known diabetic retinopathy or obesity) were not significantly different between groups.

Pre-intervention data (Table  2 )

Pre-intervention weight, BMI and blood pressure were not significantly different between groups. Among treatments, only prescription of GLP-1 analogues was higher in the exposed group than non-exposed group [ n  = 12 (17.6%) vs n  = 6 (4.3%); p  = 0.01]. Among laboratory data, the mean HbA1c level was significantly higher in the exposed than non-exposed group [8.3% ± 2.2 vs 7.1% ± 1.2; p  < 0.01], and more patients had nephropathy with microalbuminuria in the exposed than non-exposed group [ n  = 19 (33.9%) vs n  = 17 (17.9%); p  = 0.02]. Adherence to the annual ophthalmological follow-up was higher in the exposed than non-exposed group [ n  = 39 (72.2%) vs n  = 48 (44.4%); p  < 0.01].

Post-intervention changes (Table  3 , Fig.  2 )

HbA1c (%) change over time (24 months) in the exposed and non-exposed groups

After the intervention, the mean HbA1c decreased by 0.73% [-1.13; -0.33] in the exposed group and increased by 0.35% [0.07; 0.63] in the non-exposed group ( p  < 0.01) (primary endpoint). All the secondary endpoints were similar between groups (supplementary file 6). In the secondary analyses, HbA1c change difference in the two groups after exclusion of patients with type 1 diabetes was still significant ( p  < 0.01) and remained also after the sensitivity analysis adjusted for sex, age, BMI and education level ( p  < 0.01).

The main result of our study is the significant difference in HbA1c change ( p  < 0.01) between the exposed group and the non-exposed group at 12 months post-intervention (i.e. DSM programme). This result is consistent with the literature. The systematic review by Odgers-Jewell et al. found that DSM education in groups efficiently reduced HbA1c by 0.3% at 12 months and up to 36 months [ 38 ]. Like in our study, there was no significant difference in BMI, blood pressure and LDLc change between exposed and non-exposed groups during the same period. The TIME randomised controlled trial on the long-term effectiveness of a programme for low-income populations in Houston community clinics found improvements in HbA1c at 12, 18 and even 24 months post-intervention [ 43 ]. Compared with the exposed group, HbA1c level in the non-exposed group (conventional medical follow-up) worsened. Similarly, the randomised controlled trial by Trento et al. [ 44 ] showed a progressive increase over 5 years in the HbA1c of controls compared with individuals receiving group DSM education in a hospital. In our study, the pre-intervention HbA1c and microalbuminuria were significantly higher in the intervention group, suggesting that patients who participated in the programme had more unbalanced and complicated diabetes. Hadjiconstantinou et al. found that patients with higher HbA1c (> 7%) benefit more from DSM programmes, as observed for our participants [ 29 ]. In this perspective article, the authors stressed that better outcomes were observed in groups that included participants with higher baseline HbA1c, younger age (< 65 years), and a higher proportion of ethnic minorities, like in our population. The lack of significant between-group difference in HbA1c and microalbuminuria after the intervention (supplementary file 6), combined with the analysis of variance for HbA1c, may indicate that the DSM intervention has a catch-up effect between groups, bringing both populations to same level. Indeed, while HbA1c decreased by 0.73% [-1.13; -0.33] in the exposed group, it increased by 0.35% [0.07; 0.63] in the non-exposed group ( p  < 0.01). Insulin prescription alone cannot explain this result because changes in insulin prescription were similar between groups ( p  = 0.54) and the HbA1c change difference remained also after the subgroup analysis adjusted for insulin prescription ( p  < 0.01). One hypothesis to be considered is that HCPs might have preferentially proposed the DSM programme to patients with badly controlled diabetes, although this was not an objective of the programme. In an interdisciplinary literature review, Carey et al. suggested the concept of " proportionate universalism " according to which health actions should be universal, but with a scale and intensity proportionate to the patients’ disadvantage level [ 45 ]. " Proportionate universalism " would be a way to move towards more equity in health by rebalancing situations without stigmatising population groups. Continuity of care in general practice allows practitioners to reduce social inequalities in health. Gray et al., in a systematic review of observational studies between 1996 and 2017, highlighted that increased continuity of care by doctors is associated with lower mortality rate in their patients [ 46 ]. Similarly, Sandvik et al. described the GP’s contribution to the life expectancy of their patients through the implementation of informal (access to all the patient's information), longitudinal (transcending the various disease episodes), and interpersonal (the relationship of trust established between patient and GP) continuity [ 47 ].

Another important finding in our study was the significant higher adherence to the ophthalmological follow-up in the exposed group than in the non-exposed group (72.2% versus 44% before the intervention and 72% versus 38.1% after the intervention). This may be explained by a closer follow-up of patients in the exposed group by their GP/other HCPs. However, this does not seem to have had an effect on baseline HbA1c that was higher in the exposed group. Additionally, our exposed group may have had a lower level of health literacy (i.e. the set of individual and environmental conditions for a patient to understand and process health information) [ 48 ]. This could explain why the GP better followed these patients and, for instance, might have been more likely to ask the secretary of the practice to organise an appointment with the specialist rather than delegating this task directly to the patient. According to the French national health council (Haut Conseil de la Santé Publique; HCSP), " people with low literacy level are 1.5 to 3 times more likely to be in unfavourable health conditions than people with higher literacy level " [ 27 ]. This could explain the initial difference in HbA1c level between groups. A qualitative study on the health literacy level of participants in a DSM programme in a socio-economically deprived area of Montpellier (south of France) highlighted the diversity of health literacy profiles that coexisted in that area [ 49 ]. Moreover, low health literacy is more likely to be observed among people with low income, belonging to ethnic minorities, or migrant populations [ 27 ]. Our exposed group included mainly patients from a practice in an area with elevated socio-economic difficulties and consequently people with more precarious profiles.

Strengths and limitations

To our knowledge, this is the first French study that evaluated the effect on HbA1c of a DSM intervention carried out by an MPCP in a socio-economically deprived area. Another of its strengths is that patients were from different general practices in this deprived area and their medical records were fully accessible. Moreover, our exclusion criteria included absence of follow-up during the study period or the presence of a pathology that did not allow HbA1c monitoring. The aim was to optimise data collection, especially for the primary outcome (HbA1c changes). Our study also has several limitations including missing data, potential residual cofounding, and potential selection bias. First, data were missing for some variables, especially education level and participation rate. Education level is not routinely collected in medical records. We assumed that this variable was missing at random and consequently we used the multiple imputation method to deal with this issue. The obtained results were in accordance with the main analysis. Second, other information (e.g. private health insurance status, marital and family situation, country of birth, understanding of written French, financial situation) was not present in the medical records. These missing data would have allowed matching the two groups also for these socio-economic variables. In our opinion, to develop research in primary care in France, the healthcare organisation needs to think how the patients’ socio-economic data could be collected using the GP’s professional software tools. Moreover, the study retrospective nature did not allow collecting other potential cofounding variables, for instance participation in other DSM programmes or individual data about deprivation for both groups. In addition, we used a logistic regression to take into account potential confounding factors collected in our study. Alternatively, we could have used a propensity score to take into account the non-random allocation of the intervention in our study. However, the performance of these two methods is similar in observational studies [ 50 , 51 , 52 ]. Lastly, we did not know why some patients with diabetes followed at this MPCP did not participate in the DSM programme (refusal rate and reasons for this choice). Therefore, we could not exclude, in addition to a possible reversion to the mean, a selection bias because our exposed group may constitute a subgroup of the population with diabetes more committed to better control their HbA1c.

Our findings suggest that HbA1c improved after participation in a DSM programme led by an MPCP in a socio-economically deprived area. This needs to be confirmed by a prospective study, but it should already encourage the development of DSM targeted to deprived populations in primary care.

Availability of data and materials

The datasets used and analysed in the current study are available from the corresponding author on reasonable request.

Abbreviations

Angiotensin Converting Enzyme Inhibitor

Angiotensin II Receptor Antagonist

Agence Régionale de Santé (Local Health Authority)

Bilan Educatif Partagé Initial (Initial patient-centred educational assessment)

Body Mass Index

Chronic Kidney Disease Epidemiology

Commission Nationale de l’Informatique et des Libertés (French Committee on Data Protection)

Complémentaire Santé Solidaire

Diastolic Blood Pressure

Diabetes Self-Management

General Data Protection Regulation

Glomerular Filtration Rate

Glucagon-Like Peptide-1

General Practitioner

Haute Autorité de Santé (French Health Authority)

Glycated Haemoglobin fraction A1c

HealthCare Provider

Haut Conseil de la Santé Publique (National Health Council)

Institut National de la Statistique et des Etudes Economiques (National institute of statistic and economic studies)

Long Duration Disease

Low Density Lipoprotein C

Multi-professional Primary Care Practice

Type two Diabetes Mellitus

Randomised Controlled Trial

Règlement Général sur la Protection des Données (General data protection framework)

Systolic Blood Pressure

Universal Health Coverage

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Acknowledgements

We thank the Rennes Nord-Ouest primary care practice (managed by the association “Avenir Santé Villejean Beauregard”). We thank all the study participants and their GPs who gave their consent to the use of their health data. We thank the French network of University Hospitals HUGO (‘Hôpitaux Universitaires du Grand Ouest’) that supported this article.

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SA, LL, ME, EA: Substantial contributions to the conception and design of the work SA, LL: data acquisition SA, LL, ME, EA: data analysis SA, LL, ME, RG, EA: data interpretation SA, LL, ME, RG, EA: drafted the manuscript SA, LL, ME, AC, RG, EA: substantively revised it.

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Ajrouche, S., Louis, L., Esvan, M. et al. HbA1c changes in a deprived population who followed or not a diabetes self-management programme, organised in a multi-professional primary care practice: a historical cohort study on 207 patients between 2017 and 2019. BMC Endocr Disord 24 , 72 (2024). https://doi.org/10.1186/s12902-024-01601-9

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Cultural nuances in preschool education: a comparative analysis of classroom rules perception in China and Thailand

• Published: 24 May 2024

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• Li Tian 1 ,
• Huixuan Chang 2 ,
• Tianyu Wang 2 ,
• Ying Dao 2 &
• Sanikun Khampheera 3  

This study explores the differences in preschool teachers’ perceptions of classroom rules in a cross-cultural context, to help preschool teachers cope with cultural differences and construct appropriate classroom rules. The study conducted semi-structured interviews with 26 in-service preschool teachers from China and Thailand. The findings indicated that teachers’ perceptions of the functional significance of classroom rules were generally consistent between the two countries, and that differences existed in the perceptions of the sources, settings, and implementation of rules, and that teachers’ perceptions were closely related to their practice experiences and developmental levels. This study provides a novel contribution by investigating how cultural nuances shape preschool teachers’ perspectives on classroom rules in China and Thailand, it unveils distinct insights into educational practices, contributing to cross-cultural understanding and offering practical implications for effective teaching strategies in diverse contexts. Teachers’ perceptions of classroom rule violations in the face of young children had both similarities and differences, as well as different ways of dealing with them. It has been shown that despite the increasing prevalence of intercultural learning among younger learners, teachers’ perceptions and implementation of intercultural teaching and learning are not adequate. By analyzing preschool teachers’ perceptions of classroom rules in China and Thailand, we argue that understanding the cultural differences between the two countries and focusing on the educational culture of the target country can effectively help teachers establish and implement rules while helping young children understand them.

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Tian, L., Chang, H., Wang, T. et al. Cultural nuances in preschool education: a comparative analysis of classroom rules perception in China and Thailand. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06055-9

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DOI : https://doi.org/10.1007/s12144-024-06055-9

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