how to find research articles on pubmed

PubMed: Find Research Articles

• Run a Search
• Find Full Text
• Refine Searches
• Find Research Articles
• MeSH/Advanced Search
• Export to Citation Managers
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Finding Comparative Effectiveness Research

Comparative effectiveness research is the conduct and synthesis of research comparing the benefits and harms of different interventions and strategies to prevent, diagnose, treat and monitor health conditions in "real world" settings.

Two specialized resources are available to inform comparative effectiveness research:

Comparative Effectiveness Research  on the PubMed Topic-Specific Queries page. Provides specialized PubMed searches of published research and research in progress to help inform investigations of comparative effectiveness.

• Medline Plus  is the world’s largest medical library, it brings you information about diseases, conditions, and wellness issues in language you can understand. MedlinePlus offers reliable, up-to-date health information, anytime, anywhere, for free.

3 Ways to Find Research Articles in PubMed

1. filter (limit) to article type.

Most citations in PubMed are for journal articles. However, you may limit your retrieval based on the type of material the article represents. Use the Filters on the Results page sidebar and look at the Article Types checklist which contains a list of frequently searched publication types.

For example, choose Randomized Controlled Trial or Clinical Trial or Meta-Analysis from the list.

2. PubMed Clinical Queries 

Enter your search terms and evidence-filtered citations will appear under Clinical Study Categories. Systematic Reviews or Medical Genetics. The Clinical Queries link is found on the PubMed home page or under the More Resources drop-down at the top of the Advanced Search page.

The resulting retrieval in PubMed Clinical Queries can be further refined using PubMed's Filters, e.g., English language, humans.

3. Limit to Articles with Structured Abstracts

Many abstracts that are added to PubMed include section labels such as BACKGROUND, OBJECTIVE, METHODS, RESULTS, and CONCLUSIONS. These 'structured' abstracts appear in many different article types such as review articles, original research, and practice guidelines and facilitate skimming of citations for relevance and specific information such as research design within the Methods section.  The presence of structured abstracts in citations are a searchable feature in PubMed.  To limit to citations containing structured abstracts, include the term hasstructuredabstract in the search box.

For example: valerian AND sleep AND hasstructuredabstract

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How to Search in Biomedical Databases

• Getting Started with your Search

PubMed Search Tips

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• Why Use PubMed?
• How to Access PubMed at NEOMED
• Before You Start Searching . . .
• Step 1: Identifying Key Search Concepts Using PICO
• Step 2: Locating Relevant MeSH Terms
• Step 3: Locating Relevant Keywords & Synonyms
• Step 4: Combining MeSH & Keywords Pt. 1
• Step 5: Combining MeSH & Keywords Pt. 2
• Step 6: Combining Search Elements Using AND
• Step 7: Applying Filters
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Contact Your Librarian for Help!

We encourage students, researchers, and faculty members throughout NEOMED's campus and at our clinical sites to use this overview of how to search in PubMed for their research and instruction needs.

Contents (click on items to jump ahead)

Overview: When should I use this database?

How to access PubMed at NEOMED

Before you start searching, keep in mind . . .

Keywords  

Automatic Term Mapping 

How to Find & Use Keywords

Controlled Vocabularies 

Medical Subject Headings (MeSH)

Explode vs. No Explode

Subheadings

Combining Searches Using Boolean Operators (OR, AND, NOT)

Applying Filters

How to Access Full Text

More Information

PubMed Tipsheet (pdf)

Overview: when should I use this database?

PubMed comprises more than 27 million citations for biomedical literature from MEDLINE, life science journals, and online books. The public database is maintained by the U.S. National Library of Medicine (NLM) and the National Center for Biotechnology Information, and this tip sheets applies to this public-facing version, not the version of Medline supported by Ovid. It offers a fairly broad overview of existing literature on a particular topic, but it should not be seen as a complete overview.

How to access PubMed at NEOMED

Please note that to access full text for articles located within PubMed, authentication with your NEOMED Library credentials  is required both  on- and  off-campus to  PubMed. The NEOMED instance of PubMed can be located from our landing page searchbox or via the following link:  PubMed . Do not simply google PubMed; it will not provide NEOMED full text links. Learn more about  how to Access Full Text  within a specific PubMed record.

Save your search in a document, citation management software (Endnote, Refworks, etc.), and/or the database

By saving your search, your strategy will be reproducible for another time and properly documented.

Explore options and instruction for citation management here , and find tips on how to export results.

To save searches in PubMed, create an NCBI account by clicking on the sign in to NCBI link in the upper-right corner of the screen (sign up for a My NCBI account by clicking here ). Once you complete a search, click on "Create an alert" underneath the search box. From here you can create a search alert or save your search strategy.

Automatic Term Mapping

PubMed uses Automatic Term Mapping (ATM) when you search with keywords. This means that the search terms you type into the search box are automatically mapped to controlled vocabulary (MeSH) terms. To see ATM in action, scroll to the "Search details" box on the left hand side of the results page. Warning: ATM is not always correct. For example, if you search for “cold AND zinc,” PubMed will include the controlled vocabulary for "cold temperatures" in the search.

Using quotes around a phrase or truncation turns off Automatic Term Mapping. The terms are instead searched as keywords.

Keywords — How to Find & Use

Keyword terms can be single words or phrases.

Use quotes around all phrases to ensure that the phrase is searched instead of each word individually. (e.g. “public health”)

For more possible search terms, visit the MeSH (Medical Subject Headings) database and look at the "entry terms" listed for each MeSH record . MeSH is NLM’s controlled vocabulary of biomedical terms used to describe the subject of each journal article in MEDLINE. The entry terms are synonyms, alternate forms, and other closely related terms generally used interchangeably with the preferred term.

Consult controlled vocabularies in other subject databases for additional help. For example, the Embase has a controlled vocabulary called Emtree . Emtree records contain synonym lists similar to the "entry terms" in a MeSH record.  The Emtree synonym list often contains European spellings/variations.

Controlled Vocabularies -- How to Find & Use

Locate controlled vocabulary (mesh).

MeSH (Medical Subject Headings) is NLM’s controlled vocabulary of biomedical terms used to describe the subject of each journal article in MEDLINE. These are a standardized set of terms that are used to bring consistency to the searching process. In total, there are approximately 26,000 terms, and they are updated annually to reflect changes in medicine and medical terminology. Using MeSH terms helps account for variations in language, acronyms, and British vs. American English.

MeSH can be searched from a NCBI interface: https://www.ncbi.nlm.nih.gov/mesh

Terms are arranged hierarchically by subject categories with more specific terms arranged beneath broader terms. MeSH terms in PubMed automatically include the more specific MeSH terms in a search.

To turn off this automatic explode feature, click on the button next to, "Do not include MeSH terms found below this term in the MeSH hierarchy" in the MeSH record or type [mh:noexp] next to the search term, e.g. neoplasms [mh:noexp]. See next page for additional information on no explode.

Once MeSH terms have been searched, terms will appear in a box labelled “Search details,” located beside the list of the results on the right side of the screen. This box will display how each term has been searched, and can be useful for editing your search. Corrections can be made directly within this box, and once corrections have been made, the search button beneath the box will re-run your search.

Difference between “Explode,” “No Explode,” and “Major Heading”

“Explode” will search with all subheadings beneath the main heading included and bring up all results listing any of these terms subject heading subheadings combinations. PubMed will default to explode any MeSH you search.

Choosing to focus (also referred to as “not exploding”) will only search for your chosen MeSH term. Terms are chosen by MeSH indexers to be the primary focus of an individual article. Command to search: [Mesh:noexp] will only find the term specified, not the terms beneath it (for example: “diarrhea”[Mesh:noexp] only finds records indexed with diarrhea, not acute diarrhea or bloody diarrhea, etc.)

Searching for “major headings” will narrow your search to only find MeSH terms listed as a major topic of an article. Command to search: [majr] (e.g. “diarrhea”[majr] will find articles with diarrhea as a major topic. Major topic MeSH terms will have an asterisks (e.g. Diarrhea*), while non-major topics will not have one.

MeSH can be made more specific by the addition of  subheadings such as "therapy" and "prevention and control"

When in the MeSH record, add subheadings by clicking on the boxes next to the desired subheadings. Then click "Add to Search Builder." Warning: Adding too many subheadings may lead to missing important articles.

MeSH/Subheading Combinations: You can manually add subheadings in the search box by using the format MeSH Term/Subheading, e.g. neoplasms/diet therapy. You can also use the two letter abbreviation for subheadings rather than typing out the full phrase, e.g. neoplasms/dh. Click here for the abbreviations of other MeSH subheadings. ( https://www.ncbi.nlm.nih.gov/books/NBK3827/table/pubmedhelp.T.mesh_subheadings/ )

For a MeSH/Subheading combination, only one Subheading at a time may be directly attached to a MeSH term. For example, a search of hypertension with the subheadings diagnosis or drug therapy will appear as hypertension/diagnosis or hypertension/drug therapy.

As with MeSH terms, PubMed search results, by default, include the more specific terms arranged beneath broader terms for the MeSH term and also includes the more specific terms arranged beneath broader  Subheadings .

Combining Searches Using Boolean Operators

A comprehensive and systematic search of PubMed includes both controlled vocabulary and keyword terms (i.e. free text, natural language, and synonyms).

Boolean operators are used to combine search terms. In PubMed, you can use the operators AND, OR, and NOT.

Go to the “Advanced Search” page to combine searches. This is where your search history is located during your search session.

Boolean operators MUST be used as upper case (AND, OR, NOT).

OR --use OR between similar keywords, like synonyms, acronyms, and variations in spelling within the same idea or concept

AND —use AND to link ideas and concepts where you want to see both ideas or concepts in your search results

NOT —used to exclude specific keywords from the search, however, you will want to use NOT with caution because you may end up missing something important.

You can use field tags to specify where the database looks for the search term. In PubMed, first type the search term and then the field tag in brackets. e.g. Cardiology [TIAB] looks for cardiology in the title and abstract.

[All Fields] or [ALL] – Untagged terms and terms tagged with [all fields] are processed using  Automatic Term Mapping . Terms enclosed in double quotes or truncated will be searched in all fields and not processed using automatic term mapping.

[Text Words] or [TW] – Includes all words and numbers in the title, abstract, other abstract, MeSH terms, MeSH Subheadings, Publication Types, Substance Names, Personal Name as Subject, Corporate Author, Secondary Source, Comment/Correction Notes, and Other Terms.

[Title/Abstract] or [TIAB] – Words and numbers included in the title, collection title, abstract, and other abstract of a citation. English language abstracts are taken directly from the published article. If an article does not have a published abstract, NLM does not create one.

NCBI explanation of Field Descriptions and Tags  

Applying Filters

On the left side of the results are options to filter your search by Article types, Publication dates, Language, Age, Gender, etc. To access the complete list of filters, click on the “Show additional filters” link.

Use the PubMed built-in limits cautiously. Limits other than date or language will limit your search to indexed records only. In most cases it is best to develop another concept to use as a limiter.

For example, if you would like to limit your results to "human studies," use the following search to exclude animal studies instead of using the "humans" limit from the search results page. Simply add this to the rest of your search strategy using the NOT Boolean operator

(animals[MeSH Terms] NOT humans[MeSH Terms])

• In PubMed you can use a * at the root of a word to find multiple endings.  For example:

arthroplast* will return arthroplasty, arthroplasties, arthroplastic, arthroplastics, etc.

mobili* will return mobility, mobilization, mobilisation, mobilize, etc.

• Note: In PubMed you cannot combine phrase searching with truncation. Either use quotes, e.g. " early childhood mobility ," or use truncation, e.g. early childhood mobili*

In PubMed, the “Northeast Ohio Medical University” icon (pictured above) will often appear within an item record. To access the full text, click the pictured icon to go to an external page listing available full-text options. If the full text is not available, you will see a heading that says, "ILLiad - Request this item through interlibrary loan." When prompted, enter your ILLiad login and password and then submit the request via the pre-filled in template. The article will be emailed to you free of charge (only available for NEOMED students, faculty, and staff).

General principles on searching in any database

PubMedTutorials

Additional tips on exploring journal table of contents, subject filters, and topic alerts

Detailed information about MeSH ( https://www.nlm.nih.gov/mesh/intro_retrieval.html )

This content was adapted from “PubMed Search Tips” by Simon Robins, which is licensed under  Creative Commons 4.0 License, CC BY , and content found on Welch Medical Library's  Nursing Resources Guide  which is licensed under  a  Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License   attributable to the Welch Medical Library

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Pubmed: searching tips & more: home, accessing pubmed.

Direct link to this guide: guides.lib.berkeley.edu/pubmed .

This PubMed exercise set (docx) will help get you started using PubMed's search features, including filters, field tags, MeSH, and more.

The PubMed FAQ and User Guide is your best bet for up-to-date PubMed help.

PubMed Searching: Top Tips; Details Below

• Combine terms with AND or OR ;
• Use Filters (eg, Ages, Article types, Languages, etc.);
• Search for your term as a word in the title or title or abstract (using Filters, Advanced Search, or Field Tags );
• Use MeSH (Medical Subject Headings), with subheadings ;
• Use the Similar articles link located by each citation;
• Always keep in mind the question you are trying to answer when creating a search strategy and when reviewing the articles you find .

Search Tips

Looking for a known article? In the Search box, simply type the article title, or a combination of article title words with author and/or journal name words, and click Search. PubMed's citation sensor will automatically analyze your query for citation information to return the correct citation. More information in the PubMed User Guide .

Subject Searching : For most literature reviews, it may be best to search narrowly: think of your topic in specific concepts: Who is your population ? Are you looking at a specific outcome or intervention ? Are you interested in a specific geography ? Do you only want studies that used a particular method ? Build your search using the concepts that describe what you want, then broaden or narrow the search as needed. Consult our Searching the Public Health Literature More Effectively Guide for more literature searching tips.

Search specific fields (author name or affiliation, word in title and/or abstract, journal name, etc.) : Two methods: Field Tags or Advanced Search

Field tags exist for every field in a PubMed record. For example, type cell[ta] to search for articles in the journal Cell. Affiliation (tag is [ad]) can include any field in an author's address. Type cell[ta] AND (berkeley[ad] OR 94720[ad]) to find articles in Cell by Berkeley authors. A complete list of field tags (there are several dozen) is in the PubMed User Guide .

Click Advanced under the search box to be taken to PubMed's Advanced Search page where you can use a drop-down menu to specify fields to be searched. Click Add to add the term to the search box. You may then use the drop-down menu to add another field to be searched; click AND (or change to OR or NOT), to add it to the Query box:

More information in the PubMed User Guide

Looking for a Plain Language Summary? In the Search box, type AND hasplainlanguagesummary after your search terms. Each citation your search finds will have a plain English summary of the article. Example: asthma inhalers AND hasplainlanguagesummary .

New! Proximity Searching: Search for multiple terms appearing in any order within a specified distance of one another in the [Title] or [Title/Abstract] fields. To create a proximity search in PubMed, enter terms using the following format:

"search terms"[field:~N]

• Search terms = Two or more words enclosed in double quotes.
• Field = The search field tag for the [Title] or [Title/Abstract] fields.
• N = The maximum number of words that may appear between your search terms.

For example, to search PubMed for citations where the terms "hip" and "pain" appear with no more than two words between them in the Title/Abstract search field, try the search:

"hip pain"[Title/Abstract:~2]

Search results may include hip pain, hip-related pain, hip joint pain, hip/groin pain, hip biomechanics and pain, pain after total hip arthroplasty, pain in right hip, and more.

See the PubMed User Guide and view the proximity searching tutorial for more examples and information about proximity searching in PubMed.

Search History

Click Advanced (under the Search box) and scroll down to see your search history . Click > in the Details column to see how PubMed translated your query. Click the number in the Results column to go back to the search results for that search. You can build new searches or revise past searches here; details in the PubMed User Guide . It is highly recommended that you download your search history by clicking the Download button. This will help you keep track of what and when you searched; this is especially important when doing a systematic review.

Exporting Citation to Reference Management Software

EndNote: Open your EndNote library. Select the PubMed citations to export by clicking in the checkbox to the left of each. Click Send to (just under the search box) and choose Citation manager , then click Create file . The first time you do this, make sure EndNote or Research Soft Direct Export is selected as the Open with program; navigate to the EndNote program on your computer if necessary. Click OK.

RefWorks (Note: UC Berkeley's access to RefWorks will end in 2024): Tools . Click Install Save to RefWorks , then drag the bookmarklet to your favorites toolbar.--> Note: Currently, RefWorks Save to RefWorks bookmarklet does not always work with PubMed. In PubMed, select the citations to export by clicking in the checkbox to the left of each. Click Save , and make sure Selection (number) is what you see on that drop-down menu. Choose PubMed in the Format menu, and then Create file . Save the file to somewhere you will remember. In RefWorks, select Add > Import references . Select a file from your computer or drag and drop it onto the import page, then click Import . You can select which RefWorks folder to import into.

Zotero: Note: Currently the Zotero Connector does not always work with PubMed. In PubMed, select the citations to export by clicking in the checkbox to the left of each. Click Save , and make sure Selection (number) is what you see on that drop-down menu. Choose PubMed in the Format menu, and then Create file . Save the file to somewhere you will remember. In Zotero, click File > Import... > A File, and navigate to the file you saved. Select it and click Open.

Mendeley: In PubMed, select the citations to export by clicking in the checkbox to the left of each. Click Save , and make sure Selection (number) is what you see on that drop-down menu. Choose PubMed in the Format menu, and then Create file . Save the file to somewhere you will remember. In Mendeley, select the folder you want to import into, and click Add Files . Select the search results file.

Others: Most citation managers will let you import a text file in RIS format . Save citations in the PubMed format , which is comparable to RIS format, then import into your citation manager.

More information in the PubMed User Guide .

PubMed's "Cite" feature: Another option: When you are viewing a record, click Cite on the right side, select the desired citation style, then click Copy . You may also click Download .nbib to download and add that single citation to your reference management software.

Using Search Filters

After running a search, use the filters on the left side to limit your search results. Click Additional filters to add filtering options such as article type, language, and age groups. Note that selected filters will "stick" for future searches until you de-select them. More information is in the PubMed User Guide .

Important note : Using filters will have the effect of limiting your search results to include only citations with MeSH terms applied; see below on what will be excluded by limiting your search to only include citations with MeSH terms.

Using MeSH (Medical Subject Headings)

Why MeSH? Using Medical Subject Headings, or MeSH , may help you retrieve more relevant search results. MeSH are the subject terms applied to nearly all PubMed citations. However, it is important to remember that some PubMed citations - including the very newest citations - do not have MeSH terms applied to them, and therefore will not appear in a search that exclusively uses MeSH terms.

Three ways to search using MeSH :

• Use the MeSH terms from a known, relevant article : Search for a known article, click to open the full record, then scroll down to see the MeSH terms applied to that article. Clicking on a MeSH term will allow you to either search PubMed using only that term, or add that term to the search box; you can then add additional terms and execute your search.
• Use the MeSH Database to find terms, then build a search using those terms : Step-by step instructions may be found in the PubMed User Guide (scroll down to "Launch PubMed searches from the MeSH database").
• Use Advanced Search to search using known MeSH terms : If you know the MeSH terms you want to use for your search, click Advanced under the Search box, then use the drop-down menu in Advanced Search. Instructions in the PubMed User Guide .

To see suggested MeSH terms based on a block of submitted text (ie, an abstract, article, etc.), use the MeSH on Demand tool . MeSH on Demand also lists similar PubMed articles relevant to your submitted text, thus MeSH on Demand can help you find articles similar to a known, relevant article.

MeSH Subheadings (or " Qualifiers ") help focus your search results more precisely. In the MeSH Database, select desired subheadings, then click Add to search builder , then click Search PubMed :

Help & Tutorials

The PubMed User Guide is updated frequently. It includes FAQs on most common search issues, as well as search tips and more. Examples:

• I retrieved too many citations. How can I focus my search?
• I retrieved too few citations. How can I expand my search?
• How do I find systematic reviews ?

PubMed's Online Training website includes numerous tutorials, guides, and handouts.

See also the UC Berkeley Library PubMed Quick Guide for more tips and examples.

Alternative PubMed Search Interfaces

The Medline subset of PubMed , which consists of articles assigned MeSH terms, and comprises the overwhelming majority of PubMed citations, is available for searching in both Ovid Medline and in Embase .

PubMed PubReMiner lets you enter a search, and the results will list terms in a frequency order : you will see lists of MeSH terms, title words, abstract words, authors, journals, etc., in the frequency order each of these appears in your search result. This can help you come up with additional terms to include in your search, as well as the top publishing authors and journals on your topic.

Use PubMed by Year to see a graph the number and rate per 100,000 citations of your search terms, and to compare to the frequency of various terms over time. PubMed by Year searches from the oldest citations in PubMed (1781) to the current year.  Data downloadable to csv or svg.

PubVenn enables you to explore PubMed using Venn diagrams. Enter any multi-term search to see the relative size of the citation set for each term as well as how those sets interact. The resulting diagrams are printable.

Once you have a PubMed search strategy, you can use the Polyglot Search tool to translate your PubMed search into the correct syntax for several other databases, including Embase, Scopus, Web of Science, and more.

My NCBI: Customizing PubMed & More

My NCBI allows you to save searches and citations, customize PubMed, and more. Click Log in (top right of PubMed home page); you will be presented with several options. Unless you already use an eRA or NIH logon, we strongly suggest you select more login options , then start typing berkeley and choose University of California, Berkeley . You can then log in using CalNet. Once logged in, click your user name (top right) then select Dashboard (My NCBI) . Here will be your:

• Saved Searches (which you can have re-run as an "alert" on a schedule);
• Collections (citations you have saved, which you can share if desired);
• Custom filters you have created;

and more. Detailed instructions may be found in My NCBI Help . If you already are a NCBI user, please note: As of June 2022, you will be required to login using a 3rd-party option .

• Last Updated: Apr 25, 2024 1:10 PM
• URL: https://guides.lib.berkeley.edu/pubmed

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Searching PubMed: Basic Searches

Created by health science librarians.

Topic Search

Author name search, journal search, single citation matcher, advanced search, adding truncation to your search, proximity search.

• Filters and Narrowing Searches
• Find Full-Text Articles
• Save Search Results
• Saving Searches & Creating Alerts
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• Literature Reviews

Finding a few good good articles on a particular topic can be very easy.

State your question as specifically as possible:

• Is acupuncture effective for the treatment of migraine headaches?

Identify the key words in your question:

• acupuncture

Type the key words into the search box:

• acupuncture AND migraine

PubMed searches for the keywords in the article title, abstract and subject headings. It does not search the full text of the article.

Results show up with the most relevant articles, as predicted by PubMed, first in summary format. Click on the title for more information about a single article, change your search by adding, editing, or deleting terms in the search box, or change the Display Settings to view the most recent articles first. 

Go to a PubMed search for:  acupuncture AND migraine

Enter the author's name in the following format:  Author's Last Name Initials. Example: Corbie-Smith G

• No periods or commas are necessary.
• Adding the second initial can help focus the search on a particular person, but may cause you to miss articles published by the author that do not include the middle name.
• Searching by the authors full first name will work sometimes but not always, so it's better to use their initial(s). 

Go to this author search in PubMed: Corbie-Smith G Notice that the last (oldest) article retrieved was published in May 1997.

You can also search for a specific journal in PubMed and set up an alert to see new articles in your favorite journals.

If that does not work, you can try searching for the journal by title on the main search bar without the journal field. We don't recommend that as a first strategy because you might get results from several journals with similar names. 

If you see results from your target journal, you can select one and click on the journal abbreviation to search for the journal by its abbreviation.

Contact a librarian if you would like support with your search strategy. 

To find a specific article when you know some of the publication information such as journal name, publication date, page numbers, author name, or title words, use the Single Citation Matcher form.

The link to Single Citation Matcher is on the PubMed homepage. It is the third item in the second-left section labeled Find, below the search box.

You only need to fill in a few data points. Author Name and First Page often bring up a single result.

Go to the PubMed Single Citation Matcher

To run a more advanced search in PubMed or see your search history, select Advanced below the search box.

On the PubMed Advanced Search page:

• You can add specific search terms using the Add Terms to Query Box option.
• To limit your search to articles published in one journal, select Journal from the drop-down box.
• Start typing the journal name in the Search box.
• Select the correct full journal name from the auto-complete list.
• With the correct full journal name inserted in the top search box, click Add and the journal will be added to your search. You can then click the search button or then add more terms to your search.
• To limit your search to English, select Language from the drop-down box, type "English", then click add.
• You can also see your Search History of the recent searches you've run, see the Details of how PubMed interpreted your search terms and Add your previous search back to the Search Design box to be edited or added to. 

Go to the PubMed Advanced Search page .

A truncation search feature provides the ability to search for variant words or spellings.

To search for all terms that begin with a word, enter the word followed by an asterisk (*): the wildcard character. 

To search for a phrase including a truncated term, use the following formats:

• Enclose the phrase in double quotes: "breast feed*"
• Use a search tag: breast feed*[tiab]
• Use a hyphen: breast-feed* 

At least four characters must be provided in the truncated term.

The truncated term must be the last word in the phrase.

Using the PubMed truncation feature also has some specific consequences:

• Automatic Term Mapping (ATM) is turned off;
• The truncation function looks for only the first 600 variations, so the search could be incomplete;
• Truncation can cause a search to time out if an excessive number of variants are generated.
• Truncation can cause lengthy and confusing error messages for My NCBI updates

For example, heart attack* will not map to the MeSH term Myocardial Infarction or include any of the more specific terms, e.g., Myocardial Stunning; Shock, Cardiogenic.

See the PubMed User Guide for more examples and information about advanced search features in PubMed.

How to Build a Proximity Search in PubMed

To create a proximity search in PubMed, enter terms using the following format:

"search terms"[field:~N]

• Search terms = Two or more words enclosed in double quotes.
• Field = The search field tag for the [Title] or [Title/Abstract] fields.
• N = The maximum number of words that may appear between your search terms.

For example, to search PubMed for citations where the terms "hip" and "pain" appear with no more than two words between them in the Title search field, or in the Title/Abstract search field, try the search:

"hip pain"[Title:~2] "hip pain"[Title/Abstract:~2]

Search results may include hip pain, hip-related pain, hip joint pain, hip/groin pain, hip biomechanics and pain, pain after total hip arthroplasty, pain in right hip, and more.

See the PubMed User Guide and view the proximity searching tutorial for more examples and information about proximity searching in PubMed.

Proximity Search Now Available in PubMed. NLM Tech Bull. 2022 Nov-Dec;(449):e4.

• << Previous: Quick Tips
• Next: Filters and Narrowing Searches >>
• Last Updated: May 14, 2024 12:50 PM
• URL: https://guides.lib.unc.edu/search-pubmed

PubMed Help Guide

Table of Contents

Database information: pubmed, searching pubmed.

• Accessing Full Text
• Exporting Results from PubMed

Saving Results/Personal Account in PubMed

Auto alerts in pubmed.

• Video Tutorials for PubMed

Go to  PubMed

What is PubMed?

• PubMed is the free web interface to the MEDLINE database. PubMed indexes the published journal literature in clinical medicine, nursing, dentistry, public health, veterinary health, allied health fields and some basic bioscience literature.
• PubMed contains more than 30 million citations and abstracts of peer-reviewed biomedical literature. It does not include full-text journal articles; however, links to the full text are often present when available from other sources, such as the publisher's website or PubMed Central (PMC) .   The citations come from more than 5,200 worldwide journals in about 40 languages.
• Coverage is from 1946-present

Searching PubMed  (PubMed User Guide )

• Identify the key concepts for your search. 
• Enter the terms (or key concepts) in the search box.
• Press the Enter key or click Search.

Combining search terms with Boolean operators (AND, OR, NOT)

PubMed applies an AND operator between concepts, e.g., “vitamin c common cold” is translated as vitamin c AND common cold. Enter Boolean operators in uppercase characters to combine or exclude search terms:

• AND retrieves results that include all the search terms.
• OR retrieves results that include at least one of the search terms.
• NOT excludes the retrieval of terms from your search.

PubMed processes searches in a left-to-right sequence. Use parentheses to “nest” concepts that should be processed as a unit and then incorporated into the overall search.  Boolean operators must be used when combining tagged search terms as follows: search term [tag] BOOLEAN OPERATOR search term [tag].

Searching for a phrase

PubMed does not perform adjacency searching. However, many phrases are recognized by the subject translation table used in PubMed' s Automatic Term Mapping (ATM). For example, if you enter fever of unknown origin, PubMed recognizes this phrase as a MeSH Term.

You can bypass ATM and search for a specific phrase using the following formats:

• If you use quotes and the phrase is not found in the phrase index, the quotes are ignored and the terms are processed using automatic term mapping.
• If you use a search tag and the phrase is not found in the phrase index, the phrase will be broken into separate terms, e.g., "psittacine flight" is not in the phrase index, so a search for psittacine flight[tw] is broken up and translated as: ((("psittaciformes"[MeSH Terms] OR "psittaciformes"[All Fields]) OR "psittacine"[All Fields]) OR "psittacines"[All Fields]) AND "flight"[Text Word]
• If you use a hyphen and the phrase is not found in the phrase index, the search will not return any results for that phrase.

Applying Filters/Limits

You can use filters to narrow your search results by article type, text availability, publication date, species, language, sex, subject, journal category, and age.

To apply a filter:

• Run a search in PubMed.
• Click the filter you would like to activate from the sidebar. A check mark will appear next to the activated filter(s). 
• Subsequent searches will be filtered until the selected filters are cleared, or until 8 hours of inactivity.

The most popular filters are included on the sidebar by default. To display additional filters on the sidebar:

• Click the “Additional filters” button.
• A pop-up menu will appear showing the available filters for each category: article type, species, language, sex, subject, journal, and age.
• Choose a category from the list of options on the left side of the menu: Article Type, Species, etc.
• Within each category, select the filters you would like to add to the sidebar.
• Click Apply. This will close the pop-up menu and display your selections on the sidebar with the other filters.
• If you would like to cancel your selections, click Cancel or click on the X in the upper right corner to close the pop-up and return to your search results.
• To apply the filter(s) to your search, click the filter(s) on the sidebar.

Advanced Search

• From the "All Fields" drop-down menu, select the field you would like to search.
• Add terms from the builder to the query box to construct your search. The default Boolean operator is AND; if desired, choose OR or NOT from the pull-down menu.
• Once you have finished adding terms to the query box, click Search (or Add to History) to run the search.

Your PubMed search history appears on the Advanced Search page under History.

Display, Sort, and Navigate your PubMed Results

• Click the gear icon in the upper right corner of the search results page
• Select the number of citations to display per page: 10, 20, 50, 100, or 200

Click "Show more" to display the next page of results, or click "Jump to page" to navigate directly to a specific page of results. 

• By default, PubMed search results are displayed in a summary format and include snippets from the citation abstract. Snippets and highlighted terms are selected based on relatedness to your query.
• To see the abstract for an individual citation, click the title of the citation to go to its abstract page or change the search results display to Abstract format using the gear icon in the upper right corner of the search results page.

Getting full text

When using Library resources, the FindIt link is your connection to accessing the full text of articles if a PDF link is not already visible.

This short video will show you how to get to the articles you need for your research paper or other University of Minnesota assignments. Never pay for articles! If we don't have it online, request it and we will get it for you. 

Exporting Results From PubMed

Export citations into citation management software

To export citations into a citation management software program such as EndNote, Mendeley, or Zotero, follow the instructions for saving citations as a text file and choose the format: RIS. Import this saved file into your citation management program.

Email citations

• Use the check boxes to select citations from your search results or Clipboard. You may move to other pages and continue your selections. You may also choose to email all citations shown on the page without making any selections.
• Click the Email button.
• Enter an email address, subject line, and any additional text you would like to include in the body of the email. Select which citations to send and the format.
• Click Send email. The system returns you to your results page and displays a confirmation e-mail sent message.

Print your search results

Use the print function of your web browser. To print citations from different searches, save the citations in PubMed’s Clipboard, and then print.

Managing Citations to Send to Printer/Email/Other Outputs

• Use the Save button to download citations to a text file and and choose a Selection and Format from the menus that appear.
• To email a list of citations, click the Email button.
• The Clipboard stores up to 500 PubMed citations from one or more searches for up to 8 hours 

The My Bibliography option sends citations into the My Bibliography section and the Collections option stores selected citations in named collections in the Collections section of My NCBI (you must have an My NCBI account to use this feature).  

To get the URL for an individual citation, copy the permalink for the citation under " Share. "  To get the URL for your search results, copy the URL from your web browser's address bar or bookmark the URL using your web browser's bookmark function.

My NCBI ( My NCBI help)

My NCBI saves searches and results from PubMed and features an option to automatically update and e-mail search results from your saved searches. My NCBI includes features that help you manage peer review article compliance with the NIH Public Access Policy ( My Bibliograph y )

Use the NCBI link to sign in to My NCBI . This link can be accessed from any NCBI database and it appears at the top right of the screen. The URL to the login page is https://www. ncbi .nlm.nih.gov/account/.

Registering with My NCBI

• Click on the Sign in to NCBI link in the upper right-hand corner of the page.
• Enter an alphanumeric username (3 or more letters or numbers) and a password (8 or more characters). Passwords are case-sensitive.
• Enter your e-mail address.
• Choose a security question and answer. This information will be used to reset your password.
• Below the Security Question, you will see an image with 5 characters. This step is to help us prevent automated programs from registering accounts.
• You will receive a confirmation e-mail from NCBI ; confirm your registration by clicking the link provided. After confirming your e-mail address, you can start setting up automatic e-mails for search alerts.

Create an email alert for a search

Click "Create alert" under the search bar to create an automatic email update for searches. You must sign in to My NCBI to use this feature.

PubMed Tutorials and Guides

PubMed User Guide  FAQs and How to Search PubMed (frequently updated)

PubMed Quick Videos

PubMed: Find articles on a topic A brief tutorial on how to find articles on a topic using PubMed.  (1 min(s)) MP4 Video / Quick Tour

PubMed: Find articles by author A brief tutorial on how to find articles by an author using PubMed. (2 min(s)) MP4 Video / Quick Tour

PubMed: Find articles from a citation A brief tutorial on how to find articles from citation information using PubMed. (2 min(s)) MP4 Video / Quick Tour

PubMed: Find articles by journal A brief tutorial on how to find articles from a journal using PubMed. (2 min(s))  MP4 Video / Quick Tour

PubMed: Find the latest treatments for a disease or disorder A brief tutorial on how to find the latest treatments for a disease or disorder using PubMed. (2 min(s))  MP4 Video / Quick Tour

PubMed: Get the full text for an article A brief tutorial on how to get the full text for an article cited in PubMed. (2 min(s)) MP4 Video / Quick Tour

PubMed: Save searches and set e-mail alerts A brief tutorial on how to get alerts for articles on a topic using PubMed. (2 min(s))                                                                                                                                                                         MP4 Video / Quick Tour

PubMed subject search: How it works A brief tutorial on how automatic term mapping and explosion enhance your PubMed search. (4 min(s)) MP4 Video/Quick Tour

PubMed: Using the Advanced Search Builder learn to use PubMed's Advanced Search features to refine your search with the example of a publication date range; and find journal and author names using the autocomplete feature. (3 min(s)) / MP4 Video

PubMed and MedlinePlus: Consumer health Help consumers find research in PubMed using MedlinePlus (3 min(s)) MP4 Video / Quick Tour

Self-Paced Online Training Course

Using PubMed in Evidence-Based Practice  created to help clinicians including nurses and allied health professionals develop a clinical question using the PICO framework and efficiently find relevant biomedical literature using PubMed. The tutorial was designed to be completed in less than 30 minutes.  Includes scenarios and try-it exercises.

Handouts/Guides

My NCBI Outside Tool: Connecting your My NCBI account to UMN Find It  

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

PubMed Central (PMC) Home Page

PubMed Central ® (PMC) is a free full-text archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM)

Discover a digital archive of scholarly articles, spanning centuries of scientific research.

Learn how to find and read articles of interest to you.

Collections

Browse the PMC Journal List or learn about some of PMC's unique collections.

For Authors

Navigate the PMC submission methods to comply with a funder mandate, expand access, and ensure preservation.

For Publishers

Learn about deposit options for journals and publishers and the PMC selection process.

For Developers

Find tools for bulk download, text mining, and other machine analysis.

9.9 MILLION articles are archived in PMC.

Content provided in part by:, full participation journals.

Journals deposit the complete contents of each issue or volume.

NIH Portfolio Journals

Journals deposit all NIH-funded articles as defined by the NIH Public Access Policy.

Selective Deposit Programs

Publisher deposits a subset of articles from a collection of journals.

March 21, 2024

Preview upcoming improvements to pmc.

We are pleased to announce the availability of a preview of improvements planned for the PMC website. These…

Dec. 15, 2023

Update on pubreader format.

The PubReader format was added to PMC in 2012 to make it easier to read full text articles on tablet, mobile, and oth…

We are pleased to announce the availability of a preview of improvements planned for the PMC website. These improvements will become the default in October 2024.

Literature Searching

In this guide.

• Introduction
• Steps for searching the literature in PubMed
• Step 1 - Formulate a search question
• Step 2- Identify primary concepts and gather synonyms
• Step 3 - Locate subject headings (MeSH)
• Step 4 - Combine concepts using Boolean operators
• Step 5 - Refine search terms and search in PubMed
• Step 6 - Apply limits

Steps for Searching the Literature

Searching is an iterative process and often requires re-evaluation and testing by adding or changing keywords and the ways they relate to each other. To guide your search development, you can follow the search steps below. For more information on each step, navigate to its matching tab on the right menu. 

1. Formulate a clear, well-defined, answerable search question

Generally, the basic literature search process begins with formulating a clear, well-defined research question. Asking the right research question is essential to creating an effective search. Your research question(s) must be well-defined and answerable. If the question is too broad, your search will yield more information than you can possibly look through.

2. Identify primary concepts and gather synonyms

Your research question will also help identify the primary search concepts. This will allow you to think about how you want the concepts to relate to each other. Since different authors use different terminology to refer to the same concept, you will need to gather synonyms and all the ways authors might express them. However, it is important to balance the terms so that the synonyms do not go beyond the scope of how you've defined them.

3. Locate subject headings (MeSH)

Subject databases like PubMed use 'controlled vocabularies' made up of subject headings that are preassigned to indexed articles that share a similar topic. These subject headings are organized hierarchically within a family tree of broader and narrower concepts. In PubMed and MEDLINE, the subject headings are called Medical Subject Headings (MeSH). By including MeSH terms in your search, you will not have to think about word variations, word endings, plural or singular forms, or synonyms. Some topics or concepts may even have more than one appropriate MeSH term. There are also times when a topic or concept may not have a MeSH term. 

4. Combine concepts using Boolean operators AND/OR

Once you have identified your search concepts, synonyms, and MeSH terms, you'll need to put them together using nesting and Boolean operators (e.g. AND, OR, NOT). Nesting uses parentheses to put search terms into groups. Boolean operators are used to combine similar and different concepts into one query. 

5. Refine search terms and search in PubMed

There are various database search tactics you can use, such as field tags to limit the search to certain fields, quotation marks for phrase searching, and proximity operators to search a number of spaces between terms to refine your search terms. The constructed search string is ready to be pasted into PubMed. 

6. Apply limits (optional)

If you're getting too many results, you can further refine your search results by using limits on the left box of the results page. Limits allow you to narrow your search by a number of facets such as year, journal name, article type, language, age, etc. 

Depending on the nature of the literature review, the complexity and comprehensiveness of the search strategies and the choice of databases can be different. Please contact the Lane Librarians if you have any questions. 

The type of information you gather is influenced by the type of information source or database you select to search. Bibliographic databases contain references to published literature, such as journal articles, conference abstracts, books, reports, government and legal publications, and patents. Literature reviews typically synthesis indexed, peer-reviewed articles (i.e. works that generally represent the latest original research and have undergone rigorous expert screening before publication), and gray literature (i.e. materials not formally published by commercial publishers or peer-reviewed journals). PubMed offers a breadth of health sciences literature and is a good starting point to locate journal articles.

What is PubMed?

PubMed is a free search engine accessing primarily the MEDLINE database of references and abstracts on life sciences and biomedical topics. Available to the public online since 1996, PubMed was developed and is maintained by the  National Center for Biotechnology Information (NCBI) , at the  U.S. National Library of Medicine (NLM) , located at the  National Institutes of Health (NIH) .

MEDLINE is the National Library of Medicine’s (NLM) premier bibliographic database that contains more than 27 million references to journal articles from more than 5,200 worldwide journals in life sciences with a concentration on biomedicine. The Literature Selection Technica Review Committee (LSTRC) reviews and selects journals for MEDLINE based on the research quality and impact of the journals. A distinctive feature of MEDLINE is that the records are indexed with NLM  Medical Subject Headings  (MeSH).

PubMed also contains citations for  PubMed Central (PMC)  articles. PMC is a full-text archive that includes articles from journals reviewed and selected by NLM for archiving (current and historical), as well as individual articles collected for archiving in compliance with funder policies.  PubMed allows users to search keywords in the bibliographic data, but not the full text of the PMC articles.

How to Access PubMed?

To access PubMed, go to the Lane Library homepage and click PubMed in "Top Resources" on the left. This PubMed link is coded with Find Fulltext @ Lane Library Stanford that links you to Lane's full-text articles online. 

• << Previous: Introduction
• Next: Step 1 - Formulate a search question >>
• Last Updated: Jan 9, 2024 10:30 AM
• URL: https://laneguides.stanford.edu/LitSearch

Finding Qualitative Research Articles

• General Strategies
• Grey Literature
• Other Resources

• Qualitative Research  [research that derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. Year introduced 2003]
• Interviews as Topic  [conversations with an individual or individuals held in order to obtain information about their background and other personal biographical data, their attitudes and opinions, etc. It includes school admission or job interviews. Year introduced: 2008 (1980)]
• Focus Groups  [a method of data collection and a qualitative research tool in which a small group of individuals are brought together and allowed to interact in a discussion of their opinions about topics, issues, or questions. Year introduced: 1993]
• Grounded Theory [The generation of theories from analysis of empirical data. Year introduced 2015]
• Nursing Methodology Research  [research carried out by nurses concerning techniques and methods to implement projects and to document information, including methods of interviewing patients, collecting data, and forming inferences. The concept includes exploration of methodological issues such as human subjectivity and human experience. Year introduced: 1991(1989)]
• Anecdotes as Topic  [brief accounts or narratives of an incident or event. Year introduced: 2008(1963)]
• Narration  [the act, process, or an instance of narrating, i.e., telling a story. In the context of MEDICINE or ETHICS, narration includes relating the particular and the personal in the life story of an individual. Year introduced: 2003]
• Video Recording  [the storing or preserving of video signals for television to be played back later via a transmitter or receiver. Recordings may be made on magnetic tape or discs (VIDEODISC RECORDING). Year introduced: 1984]
• Tape Recording  [recording of information on magnetic or punched paper tape. Year introduced: 1967(1964)]
• Personal Narratives as Topic [works about accounts of individual experience in relation to a particular field or of participation in related activities. Year introduced: 2013]
• Observational Study as Topic [A clinical study in which participants may receive diagnostic, therapeutic, or other types of interventions, but the investigator does not assign participants to specific interventions (as in an interventional study). Year introduced: 2014]

NOTE: Inconsistent indexing in PubMed. For example, grounded theory articles are not always indexed for qualitative research. Need to TextWord search for additional terms: “grounded theory”, “action research”, ethnograph* etc.

Additional MeSH terms that may be applicable to your topic include:  Attitude of Health Personnel ;  Attitude to Death ;  Attitude to Health ; or  Health Knowledge, Attitudes, Practice.

• Interview  [work consisting of a conversation with an individual regarding his or her background and other personal and professional details, opinions on specific subjects posed by the interviewer, etc. Year introduced: 2008(1993)]
• Diaries  [works consisting of records, usually private, of writers' experiences, observations, feelings, attitudes, etc. They may also be works marked in calendar order in which to note appointments and the like. (From Random House Unabridged Dictionary, 2d ed) Year introduced: 2008(1997)]
• Anecdotes  [works consisting of brief accounts or narratives of incidents or events. Year introduced: 2008(1999)]
• Personal Narratives [works consisting of accounts of individual experience in relation to a particular field or of participation in related activities. Year introduced: 2013]
• Observational Study [A clinical study in which participants may receive diagnostic, therapeutic, or other types of interventions, but the investigator does not assign participants to specific interventions (as in an interventional study).Year introduced: 2014]
• Use Text Words to find articles missed by MeSH terms (see Strategy 2)
• Select Topic - Specific Queries from the PubMed home page and then Health Services Research Queries.
• This page provides a filter for specialized PubMed searches on healthcare quality and costs.
• Enter your search topic and select Qualitative Research under Category
• 2.  Qualitative Research search filter example [copy and paste the following modified filter into PubMed and combine your subject terms with this search filter]

(((“semi-structured”[TIAB] OR semistructured[TIAB] OR unstructured[TIAB] OR informal[TIAB] OR “in-depth”[TIAB] OR indepth[TIAB] OR “face-to-face”[TIAB] OR structured[TIAB] OR guide[TIAB] OR guides[TIAB]) AND (interview*[TIAB] OR discussion*[TIAB] OR questionnaire*[TIAB])) OR (“focus group”[TIAB] OR “focus groups”[TIAB] OR qualitative[TIAB] OR ethnograph*[TIAB] OR fieldwork[TIAB] OR “field work”[TIAB] OR “key informant”[TIAB])) OR “interviews as topic”[Mesh] OR “focus groups”[Mesh] OR narration[Mesh] OR qualitative research[Mesh] OR "personal narratives as topic"[Mesh] OR (theme[TIAB] OR thematic[TIAB]) OR "ethnological research"[TIAB] OR phenomenol*[TIAB] OR "grounded theory" [TIAB] OR "grounded study" [TIAB] OR "grounded studies" [TIAB] OR "grounded research" [TIAB] OR "grounded analysis"[TIAB] OR "grounded analyses" [TIAB] OR "life story" [TIAB] OR "life stories"[TIAB] OR emic[TIAB] OR etic[TIAB] OR hermeneutics[TIAB] OR heuristic*[TIAB] OR semiotic[TIAB] OR "data saturation"[TIAB] OR "participant observation"[TIAB] OR "action research"[TIAB] OR "cooperative inquiry" [TIAB] OR "co-operative inquiry" [TIAB] OR "field study" [TIAB] OR "field studies"[TIAB] OR "field research"[TIAB] OR "theoretical sample"[TIAB] OR "theoretical samples" [TIAB] OR "theoretical sampling"[TIAB] OR "purposive sampling"[TIAB] OR  "purposive sample"[TIAB] OR "purposive samples"[TIAB]  OR "lived experience"[TIAB] OR "lived experiences"[TIAB] OR "purposive sampling"[TIAB]  OR "content analysis"[TIAB] OR discourse[TIAB] OR "narrative analysis"[TIAB] OR heidegger*[TIAB] OR colaizzi[TIAB] OR spiegelberg[TIAB] OR "van manen*"[TIAB] OR "van kaam"[TIAB] OR "merleau ponty"[TIAB] OR husserl*[TIAB] OR Foucault[TIAB] or Corbin[TIAB] OR Strauss[TIAB] OR Glaser[TIAB] 

Mixed Methods Research Design

PubMed does not have suitable MeSH terms for mixed methods research. Search your topic with the following suggested text words using the quotes and truncation symbol*:

• << Previous: CINAHL
• Next: PsycInfo >>
• Last Updated: Jan 12, 2024 4:31 PM
• URL: https://guides.lib.uw.edu/hsl/qualres

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© 2024 University of Washington | Seattle, WA

• Connelly Library

Qualitative and Quantitative Research

Locating articles in pubmed.

• What is "Empirical Research"?
• Locating Articles in Cinahl and PsycInfo
• Getting the Articles

Remember to use  PUBMED FROM CONNELLY  to take advantage of Connelly library links to journals, ILL etc. Read more about PubMed from Connelly here

When searching for Qualitative studies in PubMed you can use the controlled MeSH terms. Use the Advanced Search, change the field to MeSH terms and enter the phrase qualitative resesearch

Finding Quantitative studies is a bit different.  You must run your search and then apply limits by clicking on the Customize link under Article Types. There are many different types of quantitative studies.  You can choose as many as you want - or as few. They are listed below.  After you choose the types you want, click Show.  Then the types show up in the Article Type field and you can click on them to filter out the types you want

When you click Show the Article Types show up on the left hand side.  Click the ones you want to filter out the correct type of article

• << Previous: Locating Articles in Cinahl and PsycInfo
• Next: Getting the Articles >>

© Copyright La Salle University. All rights reserved.

More than 10,000 research papers were retracted in 2023 - a new record

• PMID: 38087103
• DOI: 10.1038/d41586-023-03974-8

Keywords: Publishing; Scientific community.

Publication types

• History, 21st Century
• Retraction of Publication as Topic*
• Scientific Misconduct / history
• Scientific Misconduct / statistics & numerical data

• Harvard Library
• Research Guides
• Faculty of Arts & Sciences Libraries
• Identifying Articles
• PubMed at Harvard
• Searching in PubMed
• My NCBI in PubMed
• Utilizing Search Results
• Scenarios in PubMed

Primary Research Article

Review article.

Identifying and creating an APA style citation for your bibliography: 

• Author initials are separated by a period
• Multiple authors are separated by commas and an ampersand (&)  
• Title format rules change depending on what is referenced
• Double check them for accuracy 

Identifying and creating an APA style in-text citation: 

• eg. (Smith, 2022) or (Smith & Stevens, 2022) 

The structure of this changes depending on whether a direct quote or parenthetical used:

Direct Quote: the citation must follow the quote directly and contain a page number after the date

eg. (Smith, 2022, p.21)

Parenthetical: the page number is not needed

For more information, take a look at Harvard Library's Citation Styles guide !

A primary research article typically contains the following section headings:

"Methods"/"Materials and Methods"/"Experimental Methods"(different journals title this section in different ways)

"Results"

"Discussion"

If you skim the article, you should find additional evidence that an experiment was conducted by the authors themselves.

Primary research articles provide a background on their subject by summarizing previously conducted research, this typically occurs only in the Introduction section of the article.

Review articles do not report new experiments. Rather, they attempt to provide a thorough review of a specific subject by assessing either all or the best available scholarly literature on that topic.

Ways to identify a review article: 

• Author(s) summarize and analyze previously published research 
• May focus on a specific research question, comparing and contrasting previously published research 
• Overview all of the research on a particular topic 
• Does not contain "methods" or "results" type sections
• << Previous: Scenarios in PubMed
• Last Updated: Oct 3, 2023 4:16 PM
• URL: https://guides.library.harvard.edu/PubMed

Harvard University Digital Accessibility Policy

• Open access
• Published: 09 May 2024

Psychological interventions to promote self-forgiveness: a systematic review

• A. Vismaya   ORCID: orcid.org/0000-0003-0428-4226 1 ,
• Aswathy Gopi   ORCID: orcid.org/0000-0002-5255-8984 1 ,
• John Romate   ORCID: orcid.org/0000-0003-0487-7849 1 &
• Eslavath Rajkumar   ORCID: orcid.org/0000-0002-3012-0391 2  

BMC Psychology volume  12 , Article number:  258 ( 2024 ) Cite this article

375 Accesses

Metrics details

Being able to forgive one’s own wrongdoings improves the health and well-being of a person. People find it difficult to forgive themselves due to different reasons. It is essential to enhance the ability to accept one’s deeds and thereby enhance self-forgiveness. The current systematic review’s objective is to comprehend the application and efficiency of numerous interventions that improve self-forgiveness.

The search was done on electronic databases such as PubMed, ERIC, Web of Science, PsycNet, Science Direct, and Google Scholar. The initial search yielded 399 articles. After the duplicate removal, 19 articles met the eligibility criteria. Two studies were identified through related references. Thus, 21 articles were finalized for review. The study adhered to the PRISMA recommendations for systematic reviews.

The 21 finalized articles varied in method, participants, research design, duration, measurement tools used, and observed outcomes. Thirteen of the 21 finalized articles followed interventions specifically designed to promote self-forgiveness. Interventions are seen to be applied at both individual and group levels.

The review categorizes the interventions into self-directed and group. The self-directed interventions, notably those based on Enright’s process model, demonstrate its efficiency in nurturing self-forgiveness. Self-forgiveness interventions are also found to be effective in promoting other positive psychological and clinical variables. Further implications and future research avenues are outlined.

Peer Review reports

Background of the study

Forgiveness as a core positive psychological and moral construct has gained recent research attention. It is defined as a “complex affective, cognitive, and behavioral phenomena in which negative affect and judgment toward one’s offender are reduced, not by denying one’s right to such affect but by viewing the offender with compassion, benevolence, and love” [ 1 ].Enright [ 2 ] described forgiveness in terms of a triad including forgiving others, obtaining forgiveness from others, and self-forgiveness. Self-forgiveness is a relatively recent and moderately explored psychological construct [ 3 ]. It has been considered within the broader framework of self-compassion as a higher-level overarching construct [ 4 ]. Despite this, it has historically and presently been regarded as one among several dimensions constituting the broader construct of forgiveness [ 4 ]. Self-forgiveness shares some similarities and differences with the forgiveness of others. Like interpersonal forgiveness, self-forgiveness can be unconditional, irrespective of the essence of the transgression [ 5 ]. Both entail the release of resentment, responding to specific events perceived as offensive to oneself or others [ 5 ]. On the other hand, self-forgiveness may rely less on the behavior of others, while forgiving others is enabled when the offender apologizes or shows regret [ 6 ]. An individual who experiences difficulties in forgiving oneself internalizes his/her negative emotions, while those who have difficulty forgiving others externalize their negative affect [ 7 ].

Various conceptualizations exist for the construct of self-forgiveness. For instance, considered as a moral virtue, it is defined as “people, on rationally determining that they have offended themselves by violating their sense of justice, self-forgive when they willfully abandon self-resentment and related responses (which begin as natural reactions when the violation of justice is acknowledged but can turn into toxic self-loathing) and endeavor to respond to themselves based on the moral principle of beneficence, which may include compassion, unconditional worth, generosity and moral love” [ 8 ]. Alternative definitions of self-forgiveness have been proposed by many scholars, such as “a set of motivational changes whereby one becomes decreasingly motivated to avoid stimuli associated with the offense, decreasingly motivated to retaliate against the self, and increasingly motivated to act benevolently towards the self” [ 9 ]. When the former defines self-forgiveness from a morality perspective, the latter describes it as a behavior or behavioral motivation. An alternative conceptualization pertains to the behavioral dimension in the process of self-forgiveness, which is “an emotion-focused coping strategy that involves reducing negative and increasing positive thoughts, emotions, motivations and behaviors regarding oneself” [ 10 ]. A comparatively broader definition recognizes self-forgiveness as “the act of generosity and kindness toward the self following self-perceived inappropriate action” [ 11 ]. The dual-process model of self-forgiveness defines “self-forgiveness as a moral repair strategy in which perpetrators (a) orient toward positive values by making a decision to accept responsibility for wrongdoing and align their behavior with positive values in the future as well as (b) restore esteem by replacing self-condemning emotions with self-affirming emotions” [ 12 , 13 ].

Even though there has been tremendous research on forgiveness, relatively little is known about forgiving one’s own mistakes. Existing evidence suggests that the practice of self-forgiveness can help a lot of condemnation due to various offenses [ 14 ]. Self-forgiveness improves psychological health, including life satisfaction [ 15 ], self-esteem [ 16 ], emotional stability [ 17 ], and perceived quality of life [ 18 ]. Recent research reveals that self-compassion and self-esteem significantly impact the nature and extent of self-forgiveness [ 19 ]. It is also evident that interpersonal forgiveness, self-esteem, and self-forgiveness are all significantly correlated with subjective well-being [ 20 ]. Additionally, individuals who are more self-forgiving also tend to engage in more fulfilling interpersonal interactions [ 21 ]. Lower life satisfaction and self-esteem, as well as higher neuroticism, depression, anxiety, and anger, are all correlated with a lack of self-forgiveness [ 10 ]. Authentically forgiving oneself is one of the best ways to overcome these negative thoughts and feelings [ 22 ].

The abstract nature of self-forgiveness hinders its promotion, making it hard to enhance or cultivate [ 2 ]. Besides, Holmgren [ 23 ] suggests that the development of self-forgiveness encompasses three major components. Firstly, there needs to be an acknowledged objective wrongdoing committed by the individual, along with a genuine recognition of it as wrongdoing that causes a guilty feeling. The second element involves the individual’s ability to let go of the grudge and guilt directed towards oneself, thereby initiating the process of self-forgiveness. Lastly, self-acceptance plays a significant role; the individual must fully accept oneself, acknowledge their imperfections, and demonstrate self-compassion to fully achieve self-forgiveness [ 23 ]. Moreover, based on human experiences, most people are harder on themselves than others, making it difficult to reconcile themselves [ 2 ]. Psychological defense mechanisms, such as rationalization and moral disengagements, are employed in response to threats to self-regard or moral integrity [ 24 , 25 ]. These mechanisms collectively form a psychological immune system, which shields individuals from the negative impact of transgressions by preserving optimistic self-perceptions [ 26 ]. Pseudo self-forgiveness is the process that involves offenders using these defenses to attain a positive self-regard following wrongdoing, essentially reconstructing the cognitive interpretation of their actions to mitigate emotional distress [ 9 , 16 , 27 , 28 ]. Unlike genuine self-forgiveness, pseudo self-forgiveness lacks true acknowledgment of wrongdoing [ 29 ]. The latter is characterized as a cognitive adaptation aimed at reducing emotional strain arising from moral transgressions [ 30 ].

However, practicing forgiveness towards oneself is comparatively more effortful than forgiving others [ 5 , 31 , 32 ]. The extent to which a transgressor forgives oneself may be influenced by the severity of the offense, particularly in relation to its consequences [ 9 ]. Likewise, in a therapeutic context, dealing with clients who require self-forgiveness is challenging since any mistake in decision-making can lead to self-hurt or self-harming behavior [ 33 ]. Moreover, unless the self-transgression in the client is not managed correctly, it may become severe and eventually lead to depression and suicide [ 33 ].

Despite these challenges, promoting self-forgiveness is essential in interpersonal and intrapersonal contexts. In an interpersonal context, the person commits an objective wrong to another person, which induces shame or guilt in the wrongdoer [ 34 ]. An intriguing aspect of self-forgiveness is its potential to enhance interpersonal relationships. The same study reported that in an intrapersonal context, the person does wrong to oneself, such as hurting oneself verbally or physically and then having a regretful negative feeling towards oneself [ 34 ].

Systematic reviews in the area of self-forgiveness are limited. A study that explores the nature and relationship between self-compassion, self-harm or suicidal ideation is the only systematic review that is been conducted in this area [ 35 ]. Just like the interventions in forgiveness of others, numerous interventions have been employed to enhance self-forgiveness. However, no systematic review has been conducted to analyze various interventions that enhance self-forgiveness. Although a related review of self-forgiveness exists [ 36 ], the present study attempts to bring an in-depth analysis of the characteristics of interventions and outcomes. Hence, the aim of the systematic review includes (a) a narrative or descriptive synthesis of existing self-forgiveness interventions based on their characteristics and effectiveness and (b) to comprehensively present various positive psychological, clinical, and physiological outcomes of the interventions that promote self-forgiveness.

The guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for the current systematic review [ 37 ].

Eligibility criteria

Quantitative and qualitative studies published in the English language with a focus on promoting self-forgiveness across diverse populations were included. No limits were placed on gender, age, ethnicity of the participants, and year of publication due to the limited number of studies in the area. Whereas, review papers, book chapters, conference proceedings, and abstracts were excluded.

Information sources and search strategy

Two authors independently searched PubMed, Web of Science, PsycNet, ScienceDirect, ERIC, and Google Scholar in January 2024. The broad keywords such as “self-forgiveness” OR “self forgiveness” were used due to limited number of studies in the area. These search terms were employed in each online database according to their search strategy. For instance, search strategy used in PubMed: (“self-forgiveness"[Title/Abstract]) OR (“self forgiveness"[Title/Abstract]), Web of Science: (TS=(“self-forgiveness”)) OR TS=(“self forgiveness”), PsycNet: Abstract: “self forgiveness” OR Abstract: “self forgiveness”, ScienceDirect: Title, abstract, keywords: “self-forgiveness” OR “self forgiveness”, ERIC: “self-forgiveness” OR “self forgiveness”.

Selection process

The relevant articles yielded from databases were exported to Zotero reference management software. After the removal of duplicates, the remaining studies were screened for title/ abstract by two reviewers. Studies that were found ineligible at this stage were removed. Full texts were retrieved for the studies that met eligibility criteria. Consequently, the same authors independently performed the full-text analysis. Any disagreements between the two reviewers during the selection process were resolved through consultation with the third reviewer.

Data collection process

After the full-text screening, significant information was extracted from eligible reports, including the name of the author(s) and year of publication, country, study design, characteristics of participants (sample and sample size), intervention promoting self-forgiveness, duration of intervention, and study outcomes.

Quality assessment and data synthesis

The risk of bias in the included studies was assessed by two reviewers using JBI critical appraisal tools for randomized controlled trials (RCTs) [ 36 ], quasi-experimental studies [ 38 ] and qualitative studies [ 39 ]. The total “Yes” score ranges from 0 to 13 for randomized controlled studies, 0 to 9 for quasi-experimental studies, and 0 to 10 for qualitative studies. For studies with randomized controlled trials, a score of 1–4 indicates low quality, 5–8 medium quality, and 9–13 high quality. For the quasi-experimental reports, a quality score of ≥ 6 was considered. Regarding qualitative studies, 0–3 indicates high risk, 4–7 indicates moderate risk, and 8–10 indicates low risk. The checklist for randomized controlled trials included proper randomization baseline similarity and concealment of treatment being provided to assigned groups. The criteria for quasi-experimental reports included the presence of a control group, baseline similarity, and reliability of the measures used. The checklist for qualitative studies assessed the philosophical perspectives, methodological approaches, and ethical considerations in the included studies. The extracted evidence from eligible studies was narratively synthesized and presented descriptively.

Study selection

The systematic searches across the databases returned 399 records, including 30 studies from APA PsycNet, 28 from ScienceDirect, 113 from PubMed, 199 from Web of Science, 25 from ERIC, and a manual search from Google Scholar yielded four reports (see Fig.  1 ). After removing the duplicates, 256 records were screened based on title and abstract. This phase removed titles/abstracts that did not meet the eligibility criteria (k = 159). Out of 97 studies sought for full-text, 18 were unavailable. Thus, a full-text analysis has been done for the remaining 79 studies. Subsequently, 60 reports were eliminated due to various reasons, such as review papers (k = 6), non-English studies (k = 3), and non-empirical studies (k = 51). After excluding ineligible reports, 19 studies remained within the purview of analysis. Further, two studies were identified through a related citation search. Thus, the final analysis included 21 studies focusing on psychological interventions that enhance self-forgiveness.

PRISMA flow diagram

Study characteristics

The included studies were conducted in the USA (k = 14), Korea (k = 1), Indonesia (k = 1), Istanbul (k = 1), Australia (k = 1), New Zealand (k = 1), UK (k = 1), and North America (k = 1) from 1997 to 2023. Among the 21 articles analyzed, 18 studies were in general populations. Two studies were in clinical populations, such as cancer patients [ 35 ] and participants with eating disorders [ 40 ], and the remaining one included people undergoing alcohol abuse treatment programs [ 41 ]. The finalized articles were heterogeneous regarding research design, forms of interventions, and outcomes. Hence, the data was synthesized narratively or descriptively. Details of the included studies are shown in Table  1 . Based on the review’s objectives, the data analysis is restricted to identifying interventions to facilitate self-forgiveness and summarizing their impact on clinical and positive psychological outcomes.

Risk of bias

As mentioned above, the risk of bias was assessed using the JBI critical appraisal tool. Fourteen studies were randomized controlled trials [ 15 , 29 , 58 , 43 , 45 , 47 , 51 , 52 , 53 , 54 , 57 , 59 , 44 ], five were quasi-experimental [ 45 , 48 , 53 , 54 , 58 ], and two were qualitative studies [ 40 , 52 ]. All fourteen RCTs were high quality according to the appraisal tool, and all five quasi-experimental studies and two qualitative studies were eligible since they were above the cut-off quality score.

Intervention program and procedure

This section concisely overviews the interventions and their effect on clinical and positive psychological variables across diverse populations. Depending upon the nature of the intervention, it is grouped into two broad categories: (1) self-directed interventions and (2) group interventions. Self-directed interventions are fully directed by self without any human contact or guidance, while group interventions are administered to groups of people rather than individuals.

Self-directed interventions.

In the present systematic review, 16 self-directed interventions were identified under five categories. Those are further categorized into five: (a) REACH model-based workbook interventions, (b) Enright’s process model-based interventions, (c) Therapeutic interventions, (d) Guided imagery interventions, and (e) Other interventions.

REACH model-based workbook interventions.

Worthington’s REACH model [ 59 ] was incorporated in four of the 16 self-directed interventions [ 13 , 41 , 43 , 51 ]. From the self-forgiveness point of view, REACH stands for Recalling the hurt, Empathise with oneself, Altruistically gifting oneself, Committed to the self-forgiveness process, and Hold on to the attained state [ 59 ]. Griffin et al. [ 13 ] followed a six-step theory of intervention, such as receiving divine self-forgiveness, repairing the social bond, restoring positive self-regard, rethinking the rumination, REACH model of self-forgiveness, rebuilding the self-acceptance and resolving to live with virtue. The study by Massengale and Michael [ 51 ] adopted the intervention procedure of Griffin et al. [ 13 ]. They incorporated terminology and methods tailored to address these issues, which involve educating individuals about self-appraisal issues and navigating the challenges associated with perfectionist tendencies using cognitive therapy techniques. Scherer et al. [ 41 ] introduced an additional layer to the intervention landscape by integrating motivational interviewing techniques designed to enhance motivation for change and mitigate resistance to participation, particularly within the framework of the REACH model. Their emphasis on self-discovery contrasts with direct educational methods, suggesting a nuanced approach to facilitating self-forgiveness. Further, the REACH model was found to be applied by Campana [ 43 ] in their study.

Among these four studies, the first two were conducted on college students [ 13 , 51 ], the third one on individuals undergoing alcohol treatment programs [ 41 ], and the fourth among women experiencing breakups [ 43 ]. The duration of intervention also varied such as six hours [ 13 ], two hours [ 51 ], and four hours within three weeks (30 to 90 min for each session) [ 41 ] and in the fourth study [ 43 ], the participants were free to finish the 15 sections of intervention at their own pace with two weeks. The first three studies described here effectively enhanced the self-forgiveness of the participants, whereas the study by Campana [ 43 ] showed no significant change in self-forgiveness. Positive psychological outcomes other than self-forgiveness included well-being [ 51 ], drinking refusal, self-efficacy [ 40 ], compassion, self-esteem, and trait forgiveness [ 43 ]. The clinical outcomes of different studies include reduced state guilt, state shame [ 13 , 41 , 43 ], and anger [ 43 ].

Enright’s process model-based interventions.

Four of the included studies [ 40 , 44 , 47 , 57 ] followed Enright’s process model, a psychoeducation intervention of self-forgiveness. The intervention module has four phases. The first phase is uncovering the emotions and defense mechanisms related to the hurt situation. Second is the decision phase, in which the participant commits to forgive. Third is the work phase, during which participants explore the past of the wrongdoer and build empathy and compassion. The fourth is the deepening phase, which focuses on finding new meaning in life. For each session, the participants were asked to go through a chapter in the book based on which upcoming session will be dealt with. The populations included grieving parents [ 57 ], ex-substance abusers [ 47 ], men hurt by the abortion decision of partner [ 44 ], and woman with eating disorder [ 40 ]. The duration of the study varied, as shown by 12 weekly one-hour sessions [ 57 ], 10 weekly 90-minute sessions [ 47 ], 12 weekly 90-minute sessions [ 44 ], and 24 weekly sessions [ 40 ]. All four studies effectively enhanced the self-forgiveness of the participants. Other positive psychological outcomes observed in the studies include forgiveness towards others, self-esteem, hope, meaning in life, post-traumatic growth [ 57 ] happiness, and well-being [ 47 ]. Similarly, a significant reduction in clinical variables was observed in three of the studies, such as anxiety [ 47 , 57 ], depression [ 44 , 57 ], anger, grief [ 44 , 57 ], and shame [ 47 ].

Therapeutic intervention.

There are different therapeutic interventions in the field of Psychology. The result of this review reveals two major self-directed therapeutic interventions that enhance the self-forgiveness of the participants. In their study, Cornish and Wade [ 14 ] tested the efficacy of emotion-focused counseling on self-forgiveness. They adapted the intervention developed by Worthington [ 60 ] with certain additions regarding self-forgiveness. The intervention incorporates Emotion-Focused Therapy (EFT) and the four Rs (Responsibility, Remorse, Restoration, and Renewal) of genuine self-forgiveness. The first task of the intervention is to make the participant accept responsibility for their action through discussions with the therapist. Maguen [ 50 ] evaluated the Impact of Killing (IOK) intervention grounded in cognitive behavior therapy and trauma-focused treatment. Initial sessions aimed to destigmatize veterans’ reactions, followed by assignments focusing on self-forgiveness and cognitive behavior therapy techniques. The interventions were implemented in healthy adults [ 14 ] and combat veterans [ 50 ]. The duration of the programs was 50-minute sessions over eight weeks [ 15 ] as well as six to eight sessions lasting 60 to 90 min [ 50 ] each. Cornish and Wade [ 14 ] observed an improvement in self-compassion in the study. Both interventions resulted in a significant reduction of clinical psychological variables such as self-condemnation and psychological distress [ 14 , 50 ] as well as post-traumatic stress disorder [ 50 ].

Guided imagery interventions.

The result reveals the use of an Internal Family System (IFS) based guided imagery intervention in two of the studies [ 45 , 53 ]. The guided imagery session comprised seven epochs, each lasting around five minutes and designed to evoke specific emotional states. Epochs included baseline, guided relaxation, second baseline, recalling the transgression, inner critique, authentic self-reflection, and concluding with the self-forgiving state. The guided meditation is implemented in university students [ 45 ] and medical education professionals [ 53 ]. The study by Eaton and Ferrari [ 45 ] enhanced dispositional self-forgiveness, state self-forgiveness, and parasympathetic responses. At the same time, the other study enhanced self-forgiveness, the forgiveness of others, and the situational forgiveness of medical education professionals [ 53 ].

Other interventions.

Certain studies examined self-forgiveness development through unique interventions [ 28 , 42 , 46 , 55 ]. Woodyat and Wenzel [ 28 ] used transgression-relevant value affirmation in their study. The participants were instructed to identify a personally significant value, articulate the reasons behind its importance, and discuss a past instance in which their behavior aligned with that value. Bell et al. [ 61 ] crafted a manual comprising three components to foster self-forgiveness: (1) promoting a prosocial and responsible attitude through solution-focused strategies and psychoeducation; (2) removing obstacles to self-forgiveness by fostering unconditioned self-acceptance and reducing shame; and (3) encouraging healthy thoughts and behaviors to facilitate planning and sustaining self-forgiveness. Exline et al. [ 46 ] conducted an experiment in which the participants were asked to list any obstacles to self-forgiveness. They were then urged to let go of any extra guilt or sentiments of self-punishment they might have had in the past. Peterson et al. [ 55 ] developed an individualized approach in which the experimental group responded to eight questions promoting self-forgiveness related to drinking-related transgression. All four studies were conducted on undergraduate students. Among the four studies, the duration of intervention was mentioned only for the study [ 61 ], a single-sitting program that lasted 70 min. Self-forgiveness was enhanced in the study by Woodyat and Wenzel [ 29 ]; self-forgiving feelings and actions were improved by the study of Bell et al. [ 61 ], but not self-forgiving beliefs. Two studies reported an increase in positive psychological variables, self-trust [ 28 ], acceptance of responsibility, and willingness to make reparations [ 61 ]. The study by Woodyat and Wenzel [ 28 ] had a clinical outcome: a reduction in the state shame of the participants. Both studies by Exline et al. [ 46 ] and Peterson et al. [ 55 ] did not result in a significant change in any of the observed outcome variables, including self-forgiveness.

Group interventions.

There are five articles [ 51 , 50 , 62 , 63 , 64 ] that incorporate interventions that are implemented via the group. All these five interventions are peculiar in nature, which include a reminiscence program, psychoeducation, meditation, psychodrama, and therapy.

Parlak and Gul [ 54 ] examined a “psychodrama-oriented forgiveness flexibility group program” featuring doubling, role reversal, mirroring, cognitive rework, and ceremonial support techniques. The participant-centered intervention comprised warm-up, play, and sharing stages, during which participants observed their self-forgiveness. Another group-based intervention study [ 52 ] identified in the present review focused on the effectiveness of compassion-focused therapy. It included psychoeducation regarding the evolutionary aspects of compassion, the neuroscience of the emotion regulation system, and common obstacles in developing compassion. Further, the intervention used Compassionate Mind Training (CMT), which helps in developing a calm mind and a compassionate identity [ 52 ].

Toussaint et al. [ 35 ] implemented a group-based intervention combining self-acceptance and self-improvement. The intervention utilized workbook activities supplemented by meditation, reflection, and expressive writing. Participants were introduced to the concept and goals of self-forgiveness, followed by discussions on self-acceptance and self-improvement. The intervention concluded with a focus on maintaining commitment and achieving growth. Kahija et al. [ 58 ] investigated the efficacy of a meditation intervention. The session consisted of an introduction, relaxation technique, meditation practice, and distribution of the training kits to the participants. It ended by creating a determination in the participants’ minds. Jo and An [ 48 ] investigated the efficacy of a group reminiscence program grounded in the life review theory to enhance older adults’ self-concept. The program encompassed themes covering self-introduction, attitudes towards family, marriage, hardships, aging, preparations for death, designing present and future, and summary of thoughts.

The group-based intervention studies were implemented in diverse populations such as university students [ 54 ], adults [ 52 ], cancer patients and their caregivers [ 35 ], and adults from nursing homes [ 48 ]. The duration of each study was different. The duration of group interventions varied by 16 weekly sessions, each nearly three hours [ 62 ], two hours [ 64 ], four sessions for two weeks (each 90–150 min) [ 42 ], and eight 50-minute sessions [ 48 ]. Duration of intervention was not mentioned in a study by Toussaint et al. [ 35 ]. The study by Parlak and Gul [ 54 ] and Maynard [ 52 ] significantly enhanced the self-forgiveness of the participants. On the other hand, the study by Toussaint et al. [ 35 ] could enhance the self-forgiveness feelings and actions but not self-forgiving beliefs. Contrary to the existing findings, the study by Jo and An [ 48 ] did not enhance self-forgiveness, while the study by Kahija et al. [ 58 ] could not bring a significant change in any of the observed outcome variables. There are certain positive psychological variables that are improved through different interventions in these studies, such as forgiveness towards others and situational forgiveness [ 62 ], self-compassion [ 64 ], self-acceptance, self-improvement [ 51 ], and life satisfaction [ 48 ]. Group interventions also resulted in the significant reduction of two clinical variables, such as pessimism [ 35 ] and death anxiety [ 48 ].

The present systematic review synthesizes evidence on available interventions in promoting self-forgiveness through evidence from 21 studies. As per the author’s knowledge, this is the first systematic review that narratively presents these interventions based on their characteristics and outcomes. The result of the systematic review shows a diversity in interventions that promote self-forgiveness within the method followed, duration, population, and outcomes observed. Among the 21 studies that examined the effectiveness of intervention in self-forgiveness, 13 are specifically designed to enhance self-forgiveness.

Studies are categorized as self-directed and group interventions based on the types of interventions. A superiority of self-directed interventions over group interventions is seen in the results. There is a possibility of different reasons for participants to prefer self-directed interventions over group interventions. One of the major reasons is the level of shame and distress associated with disclosing one’s wrongdoing [ 62 ]. Further, the research by Lundahl et al. [ 63 ] states that programs delivered individually are superior to those delivered in groups. The present findings further categorize self-directed interventions into five: REACH model-based workbook interventions, Enright’s process model-based interventions, therapeutic interventions, guided imagery interventions, and other interventions. The REACH model [ 64 ] and Enright’s Process model [ 2 ] are two process models of forgiveness as well as self-forgiveness. This is in line with Baskin and Enright [ 65 ] and Wade and Worthington [ 34 ], who provided evidence on the role of process models in forgiveness.

Even though the usage of REACH model-based workbook interventions and Enright’s process model interventions are found to be equal in number, the ineffectiveness of REACH model to enhance self-forgiveness in the study by Campana [ 43 ] might be an indication of Enright’s process model to be better than REACH model. The result is similar in the aspect of forgiving others. For instance, Lundahl et al. [ 63 ] and Aktar and Barlow [ 66 ] state in their study that Enright’s process model outperformed the REACH model. Psychoeducation interventions offer education and therapeutic strategies that improve the quality of life of the participants and decrease the possibility of relapse [ 67 ]. The length of the intervention could also be a criterion responsible for bringing a significant output. Interventions based on Enright’s process model are comparatively lengthier than the others. Therefore, further research in different populations and large sample sizes is required to clarify the effectiveness and factors behind these results.

Other than these two models mentioned above, therapeutic and guided imagery-based meditation interventions have also been found to be effective in enhancing self-forgiveness. Concerning the therapeutic intervention by Cornish and Wade [ 15 ], exploring conflicting emotions and views about themselves through emotion-focused therapy helped the intervention to be effective [ 68 ]. The therapeutic stages, such as recognition, responsibility, expression, and recreation developed by Jacinto and Edwards [81], are yet an underexplored therapeutic model of self-forgiveness. The therapeutic interventions are applied in two populations: healthy adults and combat veterans. Further, there will be different populations that require therapeutic assistance in forgiving oneself. The IFS approach is followed in the two guided imagery-based meditation interventions, which help the participants to release the burden of past life by acting on the emotional, developmental, and cognitive dimensions of a person [ 69 ].

Group interventions are found to be comparatively lesser in number than self-directed interventions in the area of self-forgiveness. Self-condemnations occur when we disrupt our own ethical standards just to meet societal demands; it can be resolved through self-forgiveness [ 70 ]. Hence, Self-forgiveness is not only a factor that depends on and affects an individual, but also the social expectations and value set that one person is surrounded with. Due to these reasons, further studies can focus on treatments delivered in groups. Among the five group interventions analyzed, two of them could not enhance the self-forgiveness of the participants. The duration of intervention was less in the study of Kahija et al. [ 58 ] which could be a possible reason for its ineffectiveness. Coping with important negative life events to establish ego integration and to offer a coping mechanism is one of the functions of reminiscence [ 71 ]. However, the participants who were elderly people were not willing to discuss negative events of their lives. This could be a factor for the failure of intervention to show a change in self-forgiveness in the study by Jo and An [ 48 ].

Most of these studies are tested in a variety of populations. There are only two studies that are conducted in clinical populations, such as cancer patients and people with eating disorders. However, there are many other clinical populations that demand treatment for self-forgiveness. Participants affected by HIV/AIDS report low self-forgiveness and life satisfaction [ 72 ]. Fibromyalgia patients also report lower self-forgiveness scores [ 73 ]. Similarly, there are several clinical and positive psychological outcomes that can be further tested. Literature reveals that parameters such as social exclusion, internet addiction [ 74 ], hypersexual behavior [88], and chronic unhealthy behavior [ 75 ] which are negatively correlated with self-forgiveness. At the same time, positive psychological variables such as humility [ 76 ]and flourishing [ 77 ] are positively associated with self-forgiveness. Interventions emphasizing these variables can be considered in future research.

Quality assessment using JBI checklists revealed a high quality for the included studies. However, most randomized controlled trials did not provide information regarding those allocating treatment blinded to treatment assignment. In the case of quasi-experimental studies, many did not mention the comparison group and the follow-up assessments. Among the two qualitative studies, one study [ 52 ] did not provide detailed evidence of the representation of participants in the conclusion. Whereas in the other [ 40 ] ethical considerations were not adequately reported. Thus, the quality assessment of the finalized articles suggests further research to overcome these methodological concerns.

Implications of findings

The current findings contribute to the extant literature on self-forgiveness by highlighting the predominance of self-directed interventions in promoting self-forgiveness. Also, the result emphasizes the applicability of Enright’s process model as a widely accepted approach to developing self-forgiveness. However, longitudinal studies are required to assess the long-term effects and sustainability of self-forgiveness interventions over time. Also, studies that compare the effectiveness of various intervention approaches (e.g., cognitive-behavioral therapy, psychodrama, mindfulness) to identify the most efficacious strategies to enhance self-forgiveness are critical. The findings also support clinical and non-clinical implications. Psychologists who work with individuals having self-condemnation issues due to different circumstances can apply self-forgiveness interventions. Besides, mental health professionals can integrate self-forgiveness interventions into therapeutic practices, particularly for clients struggling with guilt, shame, and self-blame associated with past transgressions or trauma. Moreover, self-forgiveness interventions are crucial in everyday life as they help to reduce negative intrapersonal and interpersonal behaviors and boost various positive aspects of psychological well-being. Encouraging self-forgiveness can facilitate personal growth and transformation, empowering individuals to move forward with renewed purpose and authenticity in their lives.

Limitations of the study

The articles in the systematic review were confined to studies in the English language. Hence, there is a possibility of selection bias. Self-forgiveness interventions can be applied to diverse populations with large sample sizes. Variables like self-condemnation, self-compassion, and self-forgiveness, which may be highly correlated, are not emphasized in the existing interventions that warrant further attention. Future research should focus on how self-forgiveness overlaps and differs from other variables. Research is needed to identify the barriers and facilitators in the therapeutic process of self-forgiveness. Further, the feasibility and effectiveness of delivering self-forgiveness interventions through technology-based platforms, such as smartphone apps or online programs, need to be explored to increase accessibility and reach a broader audience.

The systematic review provides valuable insights into interventions aimed at promoting self-forgiveness from the 21 studies. Characteristics of interventions, duration, population, and positive psychological and clinical outcomes are analyzed. Self-directed interventions, particularly those based on Enright’s process model, are efficient in fostering self-forgiveness. The findings not only enrich the existing literature on self-forgiveness but also offer practical implications for psychologists to use the interventions for the clients in need of it.

Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files].

Abbreviations

Randomized Controlled Trials

Emotion Focused Therapy

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Vismaya, A., Gopi, A., Romate, J. et al. Psychological interventions to promote self-forgiveness: a systematic review. BMC Psychol 12 , 258 (2024). https://doi.org/10.1186/s40359-024-01671-3

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What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review

• Olivia R. Phillips 1 , 2   na1 ,
• Cerian Harries 2 , 3   na1 ,
• Jo Leonardi-Bee 1 , 2 , 4   na1 ,
• Holly Knight 1 , 2 ,
• Lauren B. Sherar 2 , 3 ,
• Veronica Varela-Mato 2 , 3 &
• Joanne R. Morling 1 , 2 , 5  

Research Involvement and Engagement volume  10 , Article number:  48 ( 2024 ) Cite this article

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There is increasing interest in using patient and public involvement (PPI) in research to improve the quality of healthcare. Ordinarily, traditional methods have been used such as interviews or focus groups. However, these methods tend to engage a similar demographic of people. Thus, creative methods are being developed to involve patients for whom traditional methods are inaccessible or non-engaging.

To determine the strengths and limitations to using creative PPI methods in health and social care research.

Electronic searches were conducted over five databases on 14th April 2023 (Web of Science, PubMed, ASSIA, CINAHL, Cochrane Library). Studies that involved traditional, non-creative PPI methods were excluded. Creative PPI methods were used to engage with people as research advisors, rather than study participants. Only primary data published in English from 2009 were accepted. Title, abstract and full text screening was undertaken by two independent reviewers before inductive thematic analysis was used to generate themes.

Twelve papers met the inclusion criteria. The creative methods used included songs, poems, drawings, photograph elicitation, drama performance, visualisations, social media, photography, prototype development, cultural animation, card sorting and persona development. Analysis identified four limitations and five strengths to the creative approaches. Limitations included the time and resource intensive nature of creative PPI, the lack of generalisation to wider populations and ethical issues. External factors, such as the lack of infrastructure to support creative PPI, also affected their implementation. Strengths included the disruption of power hierarchies and the creation of a safe space for people to express mundane or “taboo” topics. Creative methods are also engaging, inclusive of people who struggle to participate in traditional PPI and can also be cost and time efficient.

‘Creative PPI’ is an umbrella term encapsulating many different methods of engagement and there are strengths and limitations to each. The choice of which should be determined by the aims and requirements of the research, as well as the characteristics of the PPI group and practical limitations. Creative PPI can be advantageous over more traditional methods, however a hybrid approach could be considered to reap the benefits of both. Creative PPI methods are not widely used; however, this could change over time as PPI becomes embedded even more into research.

Plain English Summary

It is important that patients and public are included in the research process from initial brainstorming, through design to delivery. This is known as public and patient involvement (PPI). Their input means that research closely aligns with their wants and needs. Traditionally to get this input, interviews and group discussions are held, but this can exclude people who find these activities non-engaging or inaccessible, for example those with language challenges, learning disabilities or memory issues. Creative methods of PPI can overcome this. This is a broad term describing different (non-traditional) ways of engaging patients and public in research, such as through the use or art, animation or performance. This review investigated the reasons why creative approaches to PPI could be difficult (limitations) or helpful (strengths) in health and social care research. After searching 5 online databases, 12 studies were included in the review. PPI groups included adults, children and people with language and memory impairments. Creative methods included songs, poems, drawings, the use of photos and drama, visualisations, Facebook, creating prototypes, personas and card sorting. Limitations included the time, cost and effort associated with creative methods, the lack of application to other populations, ethical issues and buy-in from the wider research community. Strengths included the feeling of equality between academics and the public, creation of a safe space for people to express themselves, inclusivity, and that creative PPI can be cost and time efficient. Overall, this review suggests that creative PPI is worthwhile, however each method has its own strengths and limitations and the choice of which will depend on the research project, PPI group characteristics and other practical limitations, such as time and financial constraints.

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Introduction

Patient and public involvement (PPI) is the term used to describe the partnership between patients (including caregivers, potential patients, healthcare users etc.) or the public (a community member with no known interest in the topic) with researchers. It describes research that is done “‘with’ or ‘by’ the public, rather than ‘to,’ ‘about’ or ‘for’ them” [ 1 ]. In 2009, it became a legislative requirement for certain health and social care organisations to include patients, families, carers and communities in not only the planning of health and social care services, but the commissioning, delivery and evaluation of them too [ 2 ]. For example, funding applications for the National Institute of Health and Care Research (NIHR), a UK funding body, mandates a demonstration of how researchers plan to include patients/service users, the public and carers at each stage of the project [ 3 ]. However, this should not simply be a tokenistic, tick-box exercise. PPI should help formulate initial ideas and should be an instrumental, continuous part of the research process. Input from PPI can provide unique insights not yet considered and can ensure that research and health services are closely aligned to the needs and requirements of service users PPI also generally makes research more relevant with clearer outcomes and impacts [ 4 ]. Although this review refers to both patients and the public using the umbrella term ‘PPI’, it is important to acknowledge that these are two different groups with different motivations, needs and interests when it comes to health research and service delivery [ 5 ].

Despite continuing recognition of the need of PPI to improve quality of healthcare, researchers have also recognised that there is no ‘one size fits all’ method for involving patients [ 4 ]. Traditionally, PPI methods invite people to take part in interviews or focus groups to facilitate discussion, or surveys and questionnaires. However, these can sometimes be inaccessible or non-engaging for certain populations. For example, someone with communication difficulties may find it difficult to engage in focus groups or interviews. If individuals lack the appropriate skills to interact in these types of scenarios, they cannot take advantage of the participation opportunities it can provide [ 6 ]. Creative methods, however, aim to resolve these issues. These are a relatively new concept whereby researchers use creative methods (e.g., artwork, animations, Lego), to make PPI more accessible and engaging for those whose voices would otherwise go unheard. They ensure that all populations can engage in research, regardless of their background or skills. Seminal work has previously been conducted in this area, which brought to light the use of creative methodologies in research. Leavy (2008) [ 7 ] discussed how traditional interviews had limits on what could be expressed due to their sterile, jargon-filled and formulaic structure, read by only a few specialised academics. It was this that called for more creative approaches, which included narrative enquiry, fiction-based research, poetry, music, dance, art, theatre, film and visual art. These practices, which can be used in any stage of the research cycle, supported greater empathy, self-reflection and longer-lasting learning experiences compared to interviews [ 7 ]. They also pushed traditional academic boundaries, which made the research accessible not only to researchers, but the public too. Leavy explains that there are similarities between arts-based approaches and scientific approaches: both attempts to investigate what it means to be human through exploration, and used together, these complimentary approaches can progress our understanding of the human experience [ 7 ]. Further, it is important to acknowledge the parallels and nuances between creative and inclusive methods of PPI. Although creative methods aim to be inclusive (this should underlie any PPI activity, whether creative or not), they do not incorporate all types of accessible, inclusive methodologies e.g., using sign language for people with hearing impairments or audio recordings for people who cannot read. Given that there was not enough scope to include an evaluation of all possible inclusive methodologies, this review will focus on creative methods of PPI only.

We aimed to conduct a qualitative systematic review to highlight the strengths of creative PPI in health and social care research, as well as the limitations, which might act as a barrier to their implementation. A qualitative systematic review “brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together” [ 8 ]. This review can then advise researchers of the best practices when designing PPI.

Public involvement

The PHIRST-LIGHT Public Advisory Group (PAG) consists of a team of experienced public contributors with a diverse range of characteristics from across the UK. The PAG was involved in the initial question setting and study design for this review.

Search strategy

For the purpose of this review, the JBI approach for conducting qualitative systematic reviews was followed [ 9 ]. The search terms were (“creativ*” OR “innovat*” OR “authentic” OR “original” OR “inclu*”) AND (“public and patient involvement” OR “patient and public involvement” OR “public and patient involvement and engagement” OR “patient and public involvement and engagement” OR “PPI” OR “PPIE” OR “co-produc*” OR “co-creat*” OR “co-design*” OR “cooperat*” OR “co-operat*”). This search string was modified according to the requirements of each database. Papers were filtered by title, abstract and keywords (see Additional file 1 for search strings). The databases searched included Web of Science (WoS), PubMed, ASSIA and CINAHL. The Cochrane Library was also searched to identify relevant reviews which could lead to the identification of primary research. The search was conducted on 14/04/23. As our aim was to report on the use of creative PPI in research, rather than more generic public engagement, we used electronic databases of scholarly peer-reviewed literature, which represent a wide range of recognised databases. These identified studies published in general international journals (WoS, PubMed), those in social sciences journals (ASSIA), those in nursing and allied health journals (CINAHL), and trials of interventions (Cochrane Library).

Inclusion criteria

Only full-text, English language, primary research papers from 2009 to 2023 were included. This was the chosen timeframe as in 2009 the Health and Social Reform Act made it mandatory for certain Health and Social Care organisations to involve the public and patients in planning, delivering, and evaluating services [ 2 ]. Only creative methods of PPI were accepted, rather than traditional methods, such as interviews or focus groups. For the purposes of this paper, creative PPI included creative art or arts-based approaches (e.g., e.g. stories, songs, drama, drawing, painting, poetry, photography) to enhance engagement. Titles were related to health and social care and the creative PPI was used to engage with people as research advisors, not as study participants. Meta-analyses, conference abstracts, book chapters, commentaries and reviews were excluded. There were no limits concerning study location or the demographic characteristics of the PPI groups. Only qualitative data were accepted.

Quality appraisal

Quality appraisal using the Critical Appraisal Skills Programme (CASP) checklist [ 10 ] was conducted by the primary authors (ORP and CH). This was done independently, and discrepancies were discussed and resolved. If a consensus could not be reached, a third independent reviewer was consulted (JRM). The full list of quality appraisal questions can be found in Additional file 2 .

Data extraction

ORP extracted the study characteristics and a subset of these were checked by CH. Discrepancies were discussed and amendments made. Extracted data included author, title, location, year of publication, year study was carried out, research question/aim, creative methods used, number of participants, mean age, gender, ethnicity of participants, setting, limitations and strengths of creative PPI and main findings.

Data analysis

The included studies were analysed using inductive thematic analysis [ 11 ], where themes were determined by the data. The familiarisation stage took place during full-text reading of the included articles. Anything identified as a strength or limitation to creative PPI methods was extracted verbatim as an initial code and inputted into the data extraction Excel sheet. Similar codes were sorted into broader themes, either under ‘strengths’ or ‘limitations’ and reviewed. Themes were then assigned a name according to the codes.

The search yielded 9978 titles across the 5 databases: Web of Science (1480 results), PubMed (94 results), ASSIA (2454 results), CINAHL (5948 results) and Cochrane Library (2 results), resulting in 8553 different studies after deduplication. ORP and CH independently screened their titles and abstracts, excluding those that did not meet the criteria. After assessment, 12 studies were included (see Fig.  1 ).

PRISMA flowchart of the study selection process

Study characteristics

The included studies were published between 2018 and 2022. Seven were conducted in the UK [ 12 , 14 , 15 , 17 , 18 , 19 , 23 ], two in Canada [ 21 , 22 ], one in Australia [ 13 ], one in Norway [ 16 ] and one in Ireland [ 20 ]. The PPI activities occurred across various settings, including a school [ 12 ], social club [ 12 ], hospital [ 17 ], university [ 22 ], theatre [ 19 ], hotel [ 20 ], or online [ 15 , 21 ], however this information was omitted in 5 studies [ 13 , 14 , 16 , 18 , 23 ]. The number of people attending the PPI sessions varied, ranging from 6 to 289, however the majority (ten studies) had less than 70 participants [ 13 , 14 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Seven studies did not provide information on the age or gender of the PPI groups. Of those that did, ages ranged from 8 to 76 and were mostly female. The ethnicities of the PPI group members were also rarely recorded (see Additional file 3 for data extraction table).

Types of creative methods

The type of creative methods used to engage the PPI groups were varied. These included songs, poems, drawings, photograph elicitation, drama performance, visualisations, Facebook, photography, prototype development, cultural animation, card sorting and creating personas (see Table  1 ). These were sometimes accompanied by traditional methods of PPI such as interviews and focus group discussions.

The 12 included studies were all deemed to be of good methodological quality, with scores ranging from 6/10 to 10/10 with the CASP critical appraisal tool [ 10 ] (Table  2 ).

Thematic analysis

Analysis identified four limitations and five strengths to creative PPI (see Fig.  2 ). Limitations included the time and resource intensity of creative PPI methods, its lack of generalisation, ethical issues and external factors. Strengths included the disruption of power hierarchies, the engaging and inclusive nature of the methods and their long-term cost and time efficiency. Creative PPI methods also allowed mundane and “taboo” topics to be discussed within a safe space.

Theme map of strengths and limitations

Limitations of creative PPI

Creative ppi methods are time and resource intensive.

The time and resource intensive nature of creative PPI methods is a limitation, most notably for the persona-scenario methodology. Valaitis et al. [ 22 ] used 14 persona-scenario workshops with 70 participants to co-design a healthcare intervention, which aimed to promote optimal aging in Canada. Using the persona method, pairs composed of patients, healthcare providers, community service providers and volunteers developed a fictional character which they believed represented an ‘end-user’ of the healthcare intervention. Due to the depth and richness of the data produced the authors reported that it was time consuming to analyse. Further, they commented that the amount of information was difficult to disseminate to scientific leads and present at team meetings. Additionally, to ensure the production of high-quality data, to probe for details and lead group discussion there was a need for highly skilled facilitators. The resource intensive nature of the creative co-production was also noted in a study using the persona scenario and creative worksheets to develop a prototype decision support tool for individuals with malignant pleural effusion [ 17 ]. With approximately 50 people, this was also likely to yield a high volume of data to consider.

To prepare materials for populations who cannot engage in traditional methods of PPI was also timely. Kearns et al. [ 18 ] developed a feedback questionnaire for people with aphasia to evaluate ICT-delivered rehabilitation. To ensure people could participate effectively, the resources used during the workshops, such as PowerPoints, online images and photographs, had to be aphasia-accessible, which was labour and time intensive. The author warned that this time commitment should not be underestimated.

There are further practical limitations to implementing creative PPI, such as the costs of materials for activities as well as hiring a space for workshops. For example, the included studies in this review utilised pens, paper, worksheets, laptops, arts and craft supplies and magazines and took place in venues such as universities, a social club, and a hotel. Further, although not limited to creative PPI methods exclusively but rather most studies involving the public, a financial incentive was often offered for participation, as well as food, parking, transport and accommodation [ 21 , 22 ].

Creative PPI lacks generalisation

Another barrier to the use of creative PPI methods in health and social care research was the individual nature of its output. Those who participate, usually small in number, produce unique creative outputs specific to their own experiences, opinions and location. Craven et al. [ 13 ], used arts-based visualisations to develop a toolbox for adults with mental health difficulties. They commented, “such an approach might still not be worthwhile”, as the visualisations were individualised and highly personal. This indicates that the output may fail to meet the needs of its end-users. Further, these creative PPI groups were based in certain geographical regions such as Stoke-on-Trent [ 19 ] Sheffield [ 23 ], South Wales [ 12 ] or Ireland [ 20 ], which limits the extent the findings can be applied to wider populations, even within the same area due to individual nuances. Further, the study by Galler et al. [ 16 ], is specific to the Norwegian context and even then, maybe only a sub-group of the Norwegian population as the sample used was of higher socioeconomic status.

However, Grindell et al. [ 17 ], who used persona scenarios, creative worksheets and prototype development, pointed out that the purpose of this type of research is to improve a certain place, rather than apply findings across other populations and locations. Individualised output may, therefore, only be a limitation to research wanting to conduct PPI on a large scale.

If, however, greater generalisation within PPI is deemed necessary, then social media may offer a resolution. Fedorowicz et al. [ 15 ], used Facebook to gain feedback from the public on the use of video-recording methodology for an upcoming project. This had the benefit of including a more diverse range of people (289 people joined the closed group), who were spread geographically around the UK, as well as seven people from overseas.

Creative PPI has ethical issues

As with other research, ethical issues must be taken into consideration. Due to the nature of creative approaches, as well as the personal effort put into them, people often want to be recognised for their work. However, this compromises principles so heavily instilled in research such as anonymity and confidentiality. With the aim of exploring issues related to health and well-being in a town in South Wales, Byrne et al. [ 12 ], asked year 4/5 and year 10 pupils to create poems, songs, drawings and photographs. Community members also created a performance, mainly of monologues, to explore how poverty and inequalities are dealt with. Byrne noted the risks of these arts-based approaches, that being the possibility of over-disclosure and consequent emotional distress, as well as people’s desire to be named for their work. On one hand, the anonymity reduces the sense of ownership of the output as it does not portray a particular individual’s lived experience anymore. On the other hand, however, it could promote a more honest account of lived experience. Supporting this, Webber et al. [ 23 ], who used the persona method to co-design a back pain educational resource prototype, claimed that the anonymity provided by this creative technique allowed individuals to externalise and anonymise their own personal experience, thus creating a more authentic and genuine resource for future users. This implies that anonymity can be both a limitation and strength here.

The use of creative PPI methods is impeded by external factors

Despite the above limitations influencing the implementation of creative PPI techniques, perhaps the most influential is that creative methodologies are simply not mainstream [ 19 ]. This could be linked to the issues above, like time and resource intensity, generalisation and ethical issues but it is also likely to involve more systemic factors within the research community. Micsinszki et al. [ 21 ], who co-designed a hub for the health and well-being of vulnerable populations, commented that there is insufficient infrastructure to conduct meaningful co-design as well as a dominant medical model. Through a more holistic lens, there are “sociopolitical environments that privilege individualism over collectivism, self-sufficiency over collaboration, and scientific expertise over other ways of knowing based on lived experience” [ 21 ]. This, it could be suggested, renders creative co-design methodologies, which are based on the foundations of collectivism, collaboration and imagination an invalid technique in the research field, which is heavily dominated by more scientific methods offering reproducibility, objectivity and reliability.

Although we acknowledge that creative PPI techniques are not always appropriate, it may be that their main limitation is the lack of awareness of these methods or lack of willingness to use them. Further, there is always the risk that PPI, despite being a mandatory part of research, is used in a tokenistic or tick-box fashion [ 20 ], without considering the contribution that meaningful PPI could make to enhancing the research. It may be that PPI, let alone creative PPI, is not at the forefront of researchers’ minds when planning research.

Strengths of creative PPI

Creative ppi disrupts power hierarchies.

One of the main strengths of creative PPI techniques, cited most frequently in the included literature, was that they disrupt traditional power hierarchies [ 12 , 13 , 17 , 19 , 23 ]. For example, the use of theatre performance blurred the lines between professional and lay roles between the community and policy makers [ 12 ]. Individuals created a monologue to portray how poverty and inequality impact daily life and presented this to representatives of the National Assembly of Wales, Welsh Government, the Local Authority, Arts Council and Westminster. Byrne et al. [ 12 ], states how this medium allowed the community to engage with the people who make decisions about their lives in an environment of respect and understanding, where the hierarchies are not as visible as in other settings, e.g., political surgeries. Creative PPI methods have also removed traditional power hierarchies between researchers and adolescents. Cook et al. [ 13 ], used arts-based approaches to explore adolescents’ ideas about the “perfect” condom. They utilised the “Life Happens” resource, where adolescents drew and then decorated a person with their thoughts about sexual relationships, not too dissimilar from the persona-scenario method. This was then combined with hypothetical scenarios about sexuality. A condom-mapping exercise was then implemented, where groups shared the characteristics that make a condom “perfect” on large pieces of paper. Cook et al. [ 13 ], noted that usually power imbalances make it difficult to elicit information from adolescents, however these power imbalances were reduced due to the use of creative co-design techniques.

The same reduction in power hierarchies was noted by Grindell et al. [ 17 ], who used the person-scenario method and creative worksheets with individuals with malignant pleural effusion. This was with the aim of developing a prototype of a decision support tool for patients to help with treatment options. Although this process involved a variety of stakeholders, such as patients, carers and healthcare professionals, creative co-design was cited as a mechanism that worked to reduce power imbalances – a limitation of more traditional methods of research. Creative co-design blurred boundaries between end-users and clinical staff and enabled the sharing of ideas from multiple, valuable perspectives, meaning the prototype was able to suit user needs whilst addressing clinical problems.

Similarly, a specific creative method named cultural animation was also cited to dissolve hierarchies and encourage equal contributions from participants. Within this arts-based approach, Keleman et al. [ 19 ], explored the concept of “good health” with individuals from Stoke-on Trent. Members of the group created art installations using ribbons, buttons, cardboard and straws to depict their idea of a “healthy community”, which was accompanied by a poem. They also created a 3D Facebook page and produced another poem or song addressing the government to communicate their version of a “picture of health”. Public participants said that they found the process empowering, honest, democratic, valuable and practical.

This dissolving of hierarchies and levelling of power is beneficial as it increases the sense of ownership experienced by the creators/producers of the output [ 12 , 17 , 23 ]. This is advantageous as it has been suggested to improve its quality [ 23 ].

Creative PPI allows the unsayable to be said

Creative PPI fosters a safe space for mundane or taboo topics to be shared, which may be difficult to communicate using traditional methods of PPI. For example, the hypothetical nature of condom mapping and persona-scenarios meant that adolescents could discuss a personal topic without fear of discrimination, judgement or personal disclosure [ 13 ]. The safe space allowed a greater volume of ideas to be generated amongst peers where they might not have otherwise. Similarly, Webber et al. [ 23 ], , who used the persona method to co-design the prototype back pain educational resource, also noted how this method creates anonymity whilst allowing people the opportunity to externalise personal experiences, thoughts and feelings. Other creative methods were also used, such as drawing, collaging, role play and creating mood boards. A cardboard cube (labelled a “magic box”) was used to symbolise a physical representation of their final prototype. These creative methods levelled the playing field and made personal experiences accessible in a safe, open environment that fostered trust, as well as understanding from the researchers.

It is not only sensitive subjects that were made easier to articulate through creative PPI. The communication of mundane everyday experiences were also facilitated, which were deemed typically ‘unsayable’. This was specifically given in the context of describing intangible aspects of everyday health and wellbeing [ 11 ]. Graphic designers can also be used to visually represent the outputs of creative PPI. These captured the movement and fluidity of people and well as the relationships between them - things that cannot be spoken but can be depicted [ 21 ].

Creative PPI methods are inclusive

Another strength of creative PPI was that it is inclusive and accessible [ 17 , 19 , 21 ]. The safe space it fosters, as well as the dismantling of hierarchies, welcomed people from a diverse range of backgrounds and provided equal opportunities [ 21 ], especially for those with communication and memory difficulties who might be otherwise excluded from PPI. Kelemen et al. [ 19 ], who used creative methods to explore health and well-being in Stoke-on-Trent, discussed how people from different backgrounds came together and connected, discussed and reached a consensus over a topic which evoked strong emotions, that they all have in common. Individuals said that the techniques used “sets people to open up as they are not overwhelmed by words”. Similarly, creative activities, such as the persona method, have been stated to allow people to express themselves in an inclusive environment using a common language. Kearns et al. [ 18 ], who used aphasia-accessible material to develop a questionnaire with aphasic individuals, described how they felt comfortable in contributing to workshops (although this material was time-consuming to make, see ‘Limitations of creative PPI’ ).

Despite the general inclusivity of creative PPI, it can also be exclusive, particularly if online mediums are used. Fedorowicz et al. [ 15 ], used Facebook to create a PPI group, and although this may rectify previous drawbacks about lack of generalisation of creative methods (as Facebook can reach a greater number of people, globally), it excluded those who are not digitally active or have limited internet access or knowledge of technology. Online methods have other issues too. Maintaining the online group was cited as challenging and the volume of responses required researchers to interact outside of their working hours. Despite this, online methods like Facebook are very accessible for people who are physically disabled.

Creative PPI methods are engaging

The process of creative PPI is typically more engaging and produces more colourful data than traditional methods [ 13 ]. Individuals are permitted and encouraged to explore a creative self [ 19 ], which can lead to the exploration of new ideas and an overall increased enjoyment of the process. This increased engagement is particularly beneficial for younger PPI groups. For example, to involve children in the development of health food products, Galler et al. [ 16 ] asked 9-12-year-olds to take photos of their food and present it to other children in a “show and tell” fashion. They then created a newspaper article describing a new healthy snack. In this creative focus group, children were given lab coats to further their identity as inventors. Galler et al. [ 16 ], notes that the methods were highly engaging and facilitated teamwork and group learning. This collaborative nature of problem-solving was also observed in adults who used personas and creative worksheets to develop the resource for lower back pain [ 23 ]. Dementia patients too have been reported to enjoy the creative and informal approach to idea generation [ 20 ].

The use of cultural animation allowed people to connect with each other in a way that traditional methods do not [ 19 , 21 ]. These connections were held in place by boundary objects, such as ribbons, buttons, fabric and picture frames, which symbolised a shared meaning between people and an exchange of knowledge and emotion. Asking groups to create an art installation using these objects further fostered teamwork and collaboration, both at an individual and collective level. The exploration of a creative self increased energy levels and encouraged productive discussions and problem-solving [ 19 ]. Objects also encouraged a solution-focused approach and permitted people to think beyond their usual everyday scope [ 17 ]. They also allowed facilitators to probe deeper about the greater meanings carried by the object, which acted as a metaphor [ 21 ].

From the researcher’s point of view, co-creative methods gave rise to ideas they might not have initially considered. Valaitis et al. [ 22 ], found that over 40% of the creative outputs were novel ideas brought to light by patients, healthcare providers/community care providers, community service providers and volunteers. One researcher commented, “It [the creative methods] took me on a journey, in a way that when we do other pieces of research it can feel disconnected” [ 23 ]. Another researcher also stated they could not return to the way they used to do research, as they have learnt so much about their own health and community and how they are perceived [ 19 ]. This demonstrates that creative processes not only benefit the project outcomes and the PPI group, but also facilitators and researchers. However, although engaging, creative methods have been criticised for not demonstrating academic rigour [ 17 ]. Moreover, creative PPI may also be exclusive to people who do not like or enjoy creative activities.

Creative PPI methods are cost and time efficient

Creative PPI workshops can often produce output that is visible and tangible. This can save time and money in the long run as the output is either ready to be implemented in a healthcare setting or a first iteration has already been developed. This may also offset the time and costs it takes to implement creative PPI. For example, the prototype of the decision support tool for people with malignant pleural effusion was developed using personas and creative worksheets. The end result was two tangible prototypes to drive the initial idea forward as something to be used in practice [ 17 ]. The use of creative co-design in this case saved clinician time as well as the time it would take to develop this product without the help of its end-users. In the development of this particular prototype, analysis was iterative and informed the next stage of development, which again saved time. The same applies for the feedback questionnaire for the assessment of ICT delivered aphasia rehabilitation. The co-created questionnaire, designed with people with aphasia, was ready to be used in practice [ 18 ]. This suggests that to overcome time and resource barriers to creative PPI, researchers should aim for it to be engaging whilst also producing output.

That useable products are generated during creative workshops signals to participating patients and public members that they have been listened to and their thoughts and opinions acted upon [ 23 ]. For example, the development of the back pain resource based on patient experiences implies that their suggestions were valid and valuable. Further, those who participated in the cultural animation workshop reported that the process visualises change, and that it already feels as though the process of change has started [ 19 ].

The most cost and time efficient method of creative PPI in this review is most likely the use of Facebook to gather feedback on project methodology [ 15 ]. Although there were drawbacks to this, researchers could involve more people from a range of geographical areas at little to no cost. Feedback was instantaneous and no training was required. From the perspective of the PPI group, they could interact however much or little they wish with no time commitment.

This systematic review identified four limitations and five strengths to the use of creative PPI in health and social care research. Creative PPI is time and resource intensive, can raise ethical issues and lacks generalisability. It is also not accepted by the mainstream. These factors may act as barriers to the implementation of creative PPI. However, creative PPI disrupts traditional power hierarchies and creates a safe space for taboo or mundane topics. It is also engaging, inclusive and can be time and cost efficient in the long term.

Something that became apparent during data analysis was that these are not blanket strengths and limitations of creative PPI as a whole. The umbrella term ‘creative PPI’ is broad and encapsulates a wide range of activities, ranging from music and poems to prototype development and persona-scenarios, to more simplistic things like the use of sticky notes and ordering cards. Many different activities can be deemed ‘creative’ and the strengths and limitations of one does not necessarily apply to another. For example, cultural animation takes greater effort to prepare than the use of sticky notes and sorting cards, and the use of Facebook is cheaper and wider reaching than persona development. Researchers should use their discretion and weigh up the benefits and drawbacks of each method to decide on a technique which suits the project. What might be a limitation to creative PPI in one project may not be in another. In some cases, creative PPI may not be suitable at all.

Furthermore, the choice of creative PPI method also depends on the needs and characteristics of the PPI group. Children, adults and people living with dementia or language difficulties all have different engagement needs and capabilities. This indicates that creative PPI is not one size fits all and that the most appropriate method will change depending on the composition of the group. The choice of method will also be determined by the constraints of the research project, namely time, money and the research aim. For example, if there are time constraints, then a method which yields a lot of data and requires a lot of preparation may not be appropriate. If generalisation is important, then an online method is more suitable. Together this indicates that the choice of creative PPI method is highly individualised and dependent on multiple factors.

Although the limitations discussed in this review apply to creative PPI, they are not exclusive to creative PPI. Ethical issues are a consideration within general PPI research, especially when working with more vulnerable populations, such as children or adults living with a disability. It can also be the case that traditional PPI methods lack generalisability, as people who volunteer to be part of such a group are more likely be older, middle class and retired [ 24 ]. Most research is vulnerable to this type of bias, however, it is worth noting that generalisation is not always a goal and research remains valid and meaningful in its absence. Although online methods may somewhat combat issues related to generalisability, these methods still exclude people who do not have access to the internet/technology or who choose not to use it, implying that online PPI methods may not be wholly representative of the general population. Saying this, however, the accessibility of creative PPI techniques differs from person to person, and for some, online mediums may be more accessible (for example for those with a physical disability), and for others, this might be face-to-face. To combat this, a range of methods should be implemented. Planning multiple focus group and interviews for traditional PPI is also time and resource intensive, however the extra resources required to make this creative may be even greater. Although, the rich data provided may be worth the preparation and analysis time, which is also likely to depend on the number of participants and workshop sessions required. PPI, not just creative PPI, often requires the provision of a financial incentive, refreshments, parking and accommodation, which increase costs. These, however, are imperative and non-negotiable, as they increase the accessibility of research, especially to minority and lower-income groups less likely to participate. Adequate funding is also important for co-design studies where repeated engagement is required. One barrier to implementation, which appears to be exclusive to creative methods, however, is that creative methods are not mainstream. This cannot be said for traditional PPI as this is often a mandatory part of research applications.

Regarding the strengths of creative PPI, it could be argued that most appear to be exclusive to creative methodologies. These are inclusive by nature as multiple approaches can be taken to evoke ideas from different populations - approaches that do not necessarily rely on verbal or written communication like interviews and focus groups do. Given the anonymity provided by some creative methods, such as personas, people may be more likely to discuss their personal experiences under the guise of a general end-user, which might be more difficult to maintain when an interviewer is asking an individual questions directly. Additionally, creative methods are by nature more engaging and interactive than traditional methods, although this is a blanket statement and there may be people who find the question-and-answer/group discussion format more engaging. Creative methods have also been cited to eliminate power imbalances which exist in traditional research [ 12 , 13 , 17 , 19 , 23 ]. These imbalances exist between researchers and policy makers and adolescents, adults and the community. Lastly, although this may occur to a greater extent in creative methods like prototype development, it could be suggested that PPI in general – regardless of whether it is creative - is more time and cost efficient in the long-term than not using any PPI to guide or refine the research process. It must be noted that these are observations based on the literature. To be certain these differences exist between creative and traditional methods of PPI, direct empirical evaluation of both should be conducted.

To the best of our knowledge, this is the first review to identify the strengths and limitations to creative PPI, however, similar literature has identified barriers and facilitators to PPI in general. In the context of clinical trials, recruitment difficulties were cited as a barrier, as well as finding public contributors who were free during work/school hours. Trial managers reported finding group dynamics difficult to manage and the academic environment also made some public contributors feel nervous and lacking confidence to speak. Facilitators, however, included the shared ownership of the research – something that has been identified in the current review too. In addition, planning and the provision of knowledge, information and communication were also identified as facilitators [ 25 ]. Other research on the barriers to meaningful PPI in trial oversight committees included trialist confusion or scepticism over the PPI role and the difficulties in finding PPI members who had a basic understanding of research [ 26 ]. However, it could be argued that this is not representative of the average patient or public member. The formality of oversight meetings and the technical language used also acted as a barrier, which may imply that the informal nature of creative methods and its lack of dependency on literacy skills could overcome this. Further, a review of 42 reviews on PPI in health and social care identified financial compensation, resources, training and general support as necessary to conduct PPI, much like in the current review where the resource intensiveness of creative PPI was identified as a limitation. However, others were identified too, such as recruitment and representativeness of public contributors [ 27 ]. Like in the current review, power imbalances were also noted, however this was included as both a barrier and facilitator. Collaboration seemed to diminish hierarchies but not always, as sometimes these imbalances remained between public contributors and healthcare staff, described as a ‘them and us’ culture [ 27 ]. Although these studies compliment the findings of the current review, a direct comparison cannot be made as they do not concern creative methods. However, it does suggest that some strengths and weaknesses are shared between creative and traditional methods of PPI.

Strengths and limitations of this review

Although a general definition of creative PPI exists, it was up to our discretion to decide exactly which activities were deemed as such for this review. For example, we included sorting cards, the use of interactive whiteboards and sticky notes. Other researchers may have a more or less stringent criteria. However, two reviewers were involved in this decision which aids the reliability of the included articles. Further, it may be that some of the strengths and limitations cannot fully be attributed to the creative nature of the PPI process, but rather their co-created nature, however this is hard to disentangle as the included papers involved both these aspects.

During screening, it was difficult to decide whether the article was utilising creative qualitative methodology or creative PPI , as it was often not explicitly labelled as such. Regardless, both approaches involved the public/patients refining a healthcare product/service. This implies that if this review were to be replicated, others may do it differently. This may call for greater standardisation in the reporting of the public’s involvement in research. For example, the NIHR outlines different approaches to PPI, namely “consultation”, “collaboration”, “co-production” and “user-controlled”, which each signify an increased level of public power and influence [ 28 ]. Papers with elements of PPI could use these labels to clarify the extent of public involvement, or even explicitly state that there was no PPI. Further, given our decision to include only scholarly peer-reviewed literature, it is possible that data were missed within the grey literature. Similarly, the literature search will not have identified all papers relating to different types of accessible inclusion. However, the intent of the review was to focus solely on those within the definition of creative.

This review fills a gap in the literature and helps circulate and promote the concept of creative PPI. Each stage of this review, namely screening and quality appraisal, was conducted by two independent reviewers. However, four full texts could not be accessed during the full text reading stage, meaning there are missing data that could have altered or contributed to the findings of this review.

Research recommendations

Given that creative PPI can require effort to prepare, perform and analyse, sufficient time and funding should be allocated in the research protocol to enable meaningful and continuous PPI. This is worthwhile as PPI can significantly change the research output so that it aligns closely with the needs of the group it is to benefit. Researchers should also consider prototype development as a creative PPI activity as this might reduce future time/resource constraints. Shifting from a top-down approach within research to a bottom-up can be advantageous to all stakeholders and can help move creative PPI towards the mainstream. This, however, is the collective responsibility of funding bodies, universities and researchers, as well as committees who approve research bids.

A few of the included studies used creative techniques alongside traditional methods, such as interviews, which could also be used as a hybrid method of PPI, perhaps by researchers who are unfamiliar with creative techniques or to those who wish to reap the benefits of both. Often the characteristics of the PPI group were not included, including age, gender and ethnicity. It would be useful to include such information to assess how representative the PPI group is of the population of interest.

Creative PPI is a relatively novel approach of engaging the public and patients in research and it has both advantages and disadvantages compared to more traditional methods. There are many approaches to implementing creative PPI and the choice of technique will be unique to each piece of research and is reliant on several factors. These include the age and ability of the PPI group as well as the resource limitations of the project. Each method has benefits and drawbacks, which should be considered at the protocol-writing stage. However, given adequate funding, time and planning, creative PPI is a worthwhile and engaging method of generating ideas with end-users of research – ideas which may not be otherwise generated using traditional methods.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

Critical Appraisal Skills Programme

The Joanna Briggs Institute

National Institute of Health and Care Research

Public Advisory Group

Public and Patient Involvement

Web of Science

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Acknowledgements

With thanks to the PHIRST-LIGHT public advisory group and consortium for their thoughts and contributions to the design of this work.

The research team is supported by a National Institute for Health and Care Research grant (PHIRST-LIGHT Reference NIHR 135190).

Author information

Olivia R. Phillips and Cerian Harries share joint first authorship.

Authors and Affiliations

Nottingham Centre for Public Health and Epidemiology, Lifespan and Population Health, School of Medicine, University of Nottingham, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK

Olivia R. Phillips, Jo Leonardi-Bee, Holly Knight & Joanne R. Morling

National Institute for Health and Care Research (NIHR) PHIRST-LIGHT, Nottingham, UK

Olivia R. Phillips, Cerian Harries, Jo Leonardi-Bee, Holly Knight, Lauren B. Sherar, Veronica Varela-Mato & Joanne R. Morling

School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU, UK

Cerian Harries, Lauren B. Sherar & Veronica Varela-Mato

Nottingham Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK

Jo Leonardi-Bee

NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, NG7 2UH, UK

Joanne R. Morling

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Contributions

Author contributions: study design: ORP, CH, JRM, JLB, HK, LBS, VVM, literature searching and screening: ORP, CH, JRM, data curation: ORP, CH, analysis: ORP, CH, JRM, manuscript draft: ORP, CH, JRM, Plain English Summary: ORP, manuscript critical review and editing: ORP, CH, JRM, JLB, HK, LBS, VVM.

Corresponding author

Correspondence to Olivia R. Phillips .

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Additional file 1: Search strings: Description of data: the search strings and filters used in each of the 5 databases in this review

Additional file 2: Quality appraisal questions: Description of data: CASP quality appraisal questions

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Additional file 3: Table 1: Description of data: elements of the data extraction table that are not in the main manuscript

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Phillips, O.R., Harries, C., Leonardi-Bee, J. et al. What are the strengths and limitations to utilising creative methods in public and patient involvement in health and social care research? A qualitative systematic review. Res Involv Engagem 10 , 48 (2024). https://doi.org/10.1186/s40900-024-00580-4

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Received : 28 November 2023

Accepted : 25 April 2024

Published : 13 May 2024

DOI : https://doi.org/10.1186/s40900-024-00580-4

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